Health Care: Cruz vs. Sanders Debate

[Chou Toshio]

So yesterday CNN hosted a debate on the fate of Obama care between Bernie Sanders and Ted Cruz:

http://digg.com/2017/sanders-cruz-obamacare-debate-cnn-full-video

An oasis of intelligence and candor, a reprieve from the shit fest of idiocy that otherwise is the news. You couldn't help but think-- wow, what could have been.

Now, I'm no fan of Cruz... I think his arguments are either disingenuous or misguided (probably the former), either way fundamentally wrong about how to fix health care-- but that said, the level of candor and honest discussion of this debate makes it a far better one in my book than any even Obama and Romney had four years ago.

Sure, it's easy to chock it up to Cruz and Sanders being off the campaign trail, not fighting over an immediately relevant election, and the depth of discussion was obviously enhanced in terms of substance by staying on just 1 topic, and not the whole of everything like a typical presidential debate would-- either way, it was not only watchable (depressingly so compared to Trump vs. Hillary), but engaging and thought provoking. I actually gained a bit of respect for Cruz, but because of his sharpness and input, Bernie burned brighter than any speech or debate on the campaign trail, and the brilliance and urgency of his message was underscored to greater affect. Please, please, PLEASE CNN have the follow-up you promised off-handedly here to have them back to debate tax reform.

Anyway, free market is the best model for development and distribution of goods and services in most industries, but any economist will admit that there is a limited number of markets where public/semi-public models do it better. This usually has to do with the nature of the good/service-- and healthcare is one of those things. The Republican stance ignores not only the global reality of healthcare, but the fundamental economics surrounding it.

The key economic piece here is that a) Health care itself has a very inelastic demand b) The repercussions for "not servicing" individuals is extremely heavy-- they will literally die. Inelastic demand means demand changes little despite changes to price-- a sick person has to pay anything for treatment, or suffer/die. When you have inelastic demand, the balancing price point for a "free market" model sets very high prices-- which is where b) kicks in because high prices mean that some in the market will go without service, but in this case the repercussion for that is extremely heavy (letting many people die). While there are plenty of people (especially under Obama care) who are willing to not buy insurance, an effective model of insurance where everyone invests into the system is needed to provide widespread distribution of health care, where of its nature as a necessity would naturally set very high prices in a government vacuum.

The global reality of health care is that other systems simply do it better-- in that the universal models in other developed countries deliver better health statistics by any measure; from life expectancy, infant mortality, etc. Countries like Japan and Taiwan actually do it with shorter wait times than the United States, and most Republican voters would be surprised to find that even the UK, which has created a competitive model that shuts down under-performing hospitals, has driven down its waiting times and improved its service quality to be quite reasonable. Now, many of these countries (notably Japan) constantly struggle with a health sector that under-performs financially, with much lower average salaries in all areas of the industry, and many hospitals constantly in the red-- but from the perspective of the average consumer, the system is delivering much better support at a fraction of the cost to consumer.

While the ACA is a really terrible model-- it's hobbled by design, because Republicans and the insurance industry fought to prevent competition from a government run option. Cruz fought really hard in this debate to skate around the fact that collective bargaining power of a highly bought into, state-run insurance plan would also succeed (and succeed to a much greater degree than a state-blind market) in reducing prices for many goods and services. The nonexistence of that bargaining power in both Obama care plans and the Medicare is part of what makes both of them obsolete compared to foreign models, and is the primary cause of ACA's high prices.

Anyway, there was a lot of substance to this debate-- I have a lot of other thoughts on the smaller points-- the places where the two agreed and about some of Cruz's ideas that come off as being liberal philosophy in disguise... but these are my thought on the core piece of the debate. I hope it gets a watch by many, and any who saw it please weigh in below!

 

[Yoshi King]

Thanks for this thread, Chou. Always good to have a strong post from the start! (Not to mention bringing awareness... I had no idea this happened until seeing your topic!)

I don't have much to say, being a Canadian, except I would very much like to touch on the points made about a third of the way through the debate regarding our health care and other incredibly disingenuous statements made by Cruz.

1. He has no right to act as if he's Canadian. He's the furthest thing from what the majority of our citizens (60+%) believe in politically. He even references this when he said "Conservative is a relative term." (I recognise this first point is an ad hominem attack, if not full-blown name calling, but this has to be said because it pissed me off so much.)

2. Right now Ontario specifically has an issue with government mismanagement that Cruz definitely could have capitalised on with his bullshit fear mongering, but didn't. The issue is that our healthcare system is underfunded because the government has made extremely detrimental cuts to it, meanwhile painting doctors and other healthcare practitioners as "greedy." THIS is, in my opinion, the bigger concern with healthcare, but it is not a bureaucratic issue as Cruz would suggest. It's an issue of the government making cuts in the wrong places. Ontario has other issues (mainly our hydro price crisis) that play into this.

3. Wait times are not as bad as Cruz would have you believe. Clearly, he was citing horror stories of a failed healthcare system and there are anecdotal stories like that all over the world. Real talk: My mother was diagnosed with colon cancer in February 2015 and was treated in weeks, then had her surgery the following August. She lost her temp job because she couldn't work after her surgery, but her treatment didn't cost her and my father anything and she was able to claim disability insurance/aid. She has just been confirmed to be in remission.
My father had a stroke last November and was temporarily paralysed on his right side. He was immediately placed into rehab... he's still in rehab, and again we haven't paid anything. While I think his treatment on the day he actually had his stroke could have been a little better (he was denied blood thinners for arbitrary reasons) I am grateful that we have the healthcare system we do as we would be bankrupt without it. America needs to get with the fucking program here. Even then, we still have private healthcare practices that charge money for 0 wait time if you have that much disposable income and you're that desperate to get immediately serviced.

4. Canadians border crossing (52000, if I correctly recall Cruz stating) is a fucking piddly-shit nothing number. We have over 35 million citizens-- unless my math is wrong, that is less than 1%. What other number happens to align with the richest people in any given nation? HMMMMMMMmmmmmm
Now, not every rich person is going to be going-- I'm sure there are some middle class families that crowdfund, or need a very particular specialist, etc.-- but let's not pretend for a second that this is some sort of epidemic and that Canadians are moving in droves to the U.S. for any sort of regular or 'special' health care service.

5. The Newfoundland governor? get it together you fucking cowboy premier who went to America for heart surgery that Cruz so delightful lauds as the prime case for his cause just so happened to be a millionaire. I'll just leave that point as a followup to #4.


Hope that clears up the Canadian side of things since it took up about 5-10 minutes of the debate... not to mention Cruz is just factually wrong on so much of our healthcare that him claiming his being born in Canada (as any sort of rebuttal to Bernie) is an insult.

 

[viol and bass]

Thanks for this thread, Chou. Always good to have a strong post from the start! (Not to mention bringing awareness... I had no idea this happened until seeing your topic!)

I don't have much to say, being a Canadian, except I would very much like to touch on the points made about a third of the way through the debate regarding our health care and other incredibly disingenuous statements made by Cruz.

1. He has no right to act as if he's Canadian. He's the furthest thing from what the majority of our citizens (60+%) believe in politically. He even references this when he said "Conservative is a relative term." (I recognise this first point is an ad hominem attack, if not full-blown name calling, but this has to be said because it pissed me off so much.)

2. Right now Ontario specifically has an issue with government mismanagement that Cruz definitely could have capitalised on with his bullshit fear mongering, but didn't. The issue is that our healthcare system is underfunded because the government has made extremely detrimental cuts to it, meanwhile painting doctors and other healthcare practitioners as "greedy." THIS is, in my opinion, the bigger concern with healthcare, but it is not a bureaucratic issue as Cruz would suggest. It's an issue of the government making cuts in the wrong places. Ontario has other issues (mainly our hydro price crisis) that play into this.

3. Wait times are not as bad as Cruz would have you believe. Clearly, he was citing horror stories of a failed healthcare system and there are anecdotal stories like that all over the world. Real talk: My mother was diagnosed with colon cancer in February 2015 and was treated in weeks, then had her surgery the following August. She lost her temp job because she couldn't work after her surgery, but her treatment didn't cost her and my father anything and she was able to claim disability insurance/aid. She has just been confirmed to be in remission.
My father had a stroke last November and was temporarily paralysed on his right side-- he was immediately placed into rehab... he's still in rehab, and again we haven't paid anything. While I think his treatment on the day he actually had his stroke could have been a little better (he was denied blood thinners for arbitrary reasons) I am grateful that we have the healthcare system we do as we would be bankrupt without it. America needs to get with the fucking program here. Even then, we still have private healthcare practices that charge money for 0 wait time if you have that much disposable income and you're that desperate to get immediately serviced.

4. Canadians border crossing (52000, if I correctly recall Cruz stating) is a fucking piddly-shit nothing number. We have over 35 million citizens-- unless my math is wrong, that is less than 1%. What other number happens to align with the richest people in any given nation? HMMMMMMMmmmmmm
Now, not every rich person is going to be going-- I'm sure there are some middle class families that crowdfund, or need a very particular specialist, etc.-- but let's not pretend for a second that this is some sort of epidemic and that Canadians are moving in droves to .

5. The Newfoundland governor? get it together you fucking cowboy premier who went to America for heart surgery that Cruz so delightful lauds as the prime case for his cause just so happened to be a millionaire. I'll just leave that point as a followup to #4.


Hope that clears up the Canadian side of things since it took up about 5-10 minutes of the debate... not to mention Cruz is just factually wrong on so much of our healthcare that him claiming his being born in Canada (as any sort of rebuttal to Bernie) is an insult.

Thank you for this. Yeah, Cruz's criticisms of the canadian health care system were so far off-base. I know a lot of people joke about moving to Canada from the US as a last-resort option in the age of Trump, but i've been legitimately looking into moving there because I've really loved it the few times I've been there, and it seems like an actually sane country. That said, being accepted to immigrate is pretty difficult and I'm not sure how feasible it is.

 

[Saz Chan >^-^<]

Thanks for this. Watching the debate with my cat and a lovely mug of coffee.

As a Brit, I won't comment on the state of American healthcare, but I am deeply dissatisfied with the NHS, my own country's universal healthcare system. A service that is offered for any reason other than profit is inevitably going to be lower quality, and more expensive overall, than a service offered for profit. The NHS has literally nothing going for it apart from the fact that it is "free". The quality is poor, the waiting lists are long, there is precious little accountability. Not to mention the fact that it is colossally expensive to the country. "Free healthcare" is a myth.

I personally do not support such a system. My uncle had a mole removed last year on the NHS, and he is very wealthy. I can see merit in a system of State healthcare which provides an affordable service for those would not otherwise be able to afford it, but I see no reason why it should provide free healthcare for those who can easily afford it. I advocate wholesale reform of this system.

In passing, I found part 2 of the debate a glorious testimony to the negative economic effects of excessive regulation. I love how Sanders openly acknowledges that limiting the growth of small businesses and job-creation is a price worth paying for guaranteed health insurance. On issues such as this, I find myself agreeing very much more with the Republicans.

 

[viol and bass]

Thanks for this. Watching the debate with my cat and a lovely mug of coffee.

As a Brit, I won't comment on the state of American healthcare, but I am deeply dissatisfied with the NHS, my own country's universal healthcare system. A service that is offered for any reason other than profit is inevitably going to be lower quality, and more expensive overall, than a service offered for profit. The NHS has literally nothing going for it apart from the fact that it is "free". The quality is poor, the waiting lists are long, there is precious little accountability. Not to mention the fact that it is colossally expensive to the country. "Free healthcare" is a myth.

I personally do not support such a system. My uncle had a mole removed last year on the NHS, and he is very wealthy. I can see merit in a system of State healthcare which provides an affordable service for those would not otherwise be able to afford it, but I see no reason why it should provide free healthcare for those who can easily afford it. I advocate wholesale reform of this system.

In passing, I found part 2 of the debate a glorious testimony to the negative economic effects of excessive regulation. I love how Sanders openly acknowledges that limiting the growth of small businesses and job-creation is a price worth paying for guaranteed health insurance. On issues such as this, I find myself agreeing very much more with the Republicans.

Your NHS may be subpar, but you don't have 26,000 people dying prematurely every year due to lacking health insurance. That's the figure for 2010 in the US, according to this report. Can't speak to how reputable of a source it is with a name like FamiliesUSA, but I think as a figure it makes sense. Tens of millions of us completely lack health insurance, and as a result, we simply don't go to the doctor, ever. And many of us die prematurely as a result. Any healthcare system has flaws, and there's no question that Britain's isn't the paragon of universal healthcare systems. However, I would take it over what we have any goddamn day. The fear that if you get very sick, you'll either go into bankruptcy as a result, or you simply won't get the treatment you need, is very real for millions of Americans. It's absolutely inhuman given that we have the means to fix this. It's also worth mentioning that that feeling of fundamental insecurity is horrible for our economy. Obamacare was far from perfect, but it reduced the number of uninsured Americans by 20-30 million, and saved thousands of lives as a result. Now they're trying to eliminate it. This needs to end. As Bernie often says, we're the wealthiest nation in the history of the world. It's time to spend that money helping the most vulnerable among us.

Edit:

In passing, I found part 2 of the debate a glorious testimony to the negative economic effects of excessive regulation. I love how Sanders openly acknowledges that limiting the growth of small businesses and job-creation is a price worth paying for guaranteed health insurance. On issues such as this, I find myself agreeing very much more with the Republicans.

IT IS A PRICE WORTH PAYING! For a multitude of reasons. Are you serious? That 26,000 a year die is the most obvious reason, but also there's the fact that it puts a big damper on an economy when people are afraid to take risks, due to for instance the fear of getting ill and going bankrupt, or the fear of losing their health insurance if they switch jobs. Then there's the simple fact that sick people make shitty workers. I almost can't believe anyone would make that argument....

 

[Saz Chan >^-^<]

IT IS A PRICE WORTH PAYING! For a multitude of reasons. Are you serious? That 26,000 a year die is the most obvious reason, but also there's the fact that it puts a big damper on an economy when people are afraid to take risks, due to for instance the fear of getting ill and going bankrupt, or the fear of losing their health insurance if they switch jobs. Then there's the simple fact that sick people make shitty workers. I almost can't believe anyone would make that argument....

If you look at the question that the good lady asked Sanders in part 2 of the debate, you'll see that she was reluctant to hire more than 50 people, because it was simply uneconomical to do so. Once she hired her 50th employee, she would have to supply health insurance for all. So what does she do? She hires only as many as she can without having to pay this cost.

So how many people has this regulation helped? The answer, of course, is no one. It has not helped the employer, because they are prevented from expanding their business and increasing their profit margin. It has not helped the 49 employees they hire because the regulation kicks in at 50. It has not helped the unemployed people that would otherwise have been hired, because they don't have a job and therefore won't have health insurance provided for them either. And it doesn't help the general populace, because they are denied access to the goods and services that they would otherwise be prepared to pay for if the business were given the freedom to expand.

This law is not fit for purpose. It serves only to disincentivize small-business owners from reaching their potential.

 

[viol and bass]

If you look at the question that the good lady asked Sanders in part 2 of the debate, you'll see that she was reluctant to hire more than 50 people, because it was simply uneconomical to do so. Once she hired her 50th employee, she would have to supply health insurance for all. So what does she do? She hires only as many as she can without having to pay this cost.

So how many people has this regulation helped? The answer, of course, is no one. It has not helped the employer, because they are prevented from expanding their business and increasing their profit margin. It has not helped the 49 employees they hire because the regulation kicks in at 50. It has not helped the unemployed people that would otherwise have been hired, because they don't have a job and therefore won't have health insurance provided for them either. And it doesn't help the general populace, because they are denied access to the goods and services that they would otherwise be prepared to pay for if the business were given the freedom to expand.

This law is not fit for purpose. It serves only to disincentivize small-business owners from reaching their potential.

Yeah, that's a pretty stupid aspect of the law, which is why we should have universal single-payer healthcare and not have to deal with this mess. As Bernie believes.

 

[Saz Chan >^-^<]

Yeah, that's a pretty stupid aspect of the law, which is why we should have universal single-payer healthcare and not have to deal with this mess. As Bernie believes.

So what happened to "IT IS A PRICE WORTH PAYING FOR!"? I thought the question at hand was whether stifling the expansion of small business and job-creation is a price worth paying for requiring employers to furnish their workers with insurance? It seemed to be my answering "no" to this question that you took such exception to.

I agree that a single-payer system would be preferable to placing large costs on small businesses. But this seems to be something of a shifting of the goalposts as far as what we were discussing.

 

[BenTheDemon]

This is similar to the Bill Nye / Ken Ham "debate" in the sense that it's barely even a debate, as one was simply stating empirical facts, while the other was spewing logical fallacies and flat-out inaccuracies.

I love Bernie as much as the next guy, but I often feel that being a sitting Senator puts him at a disadvantage, as he cannot tell Ted Cruz that he's a lying piece of shit. Every time an audience member asks Cruz a question, it's basically, "Ted, I can't afford my health insurance. Are you gonna let me die?" and Ted will have his little politician smile and say, "Of course I won't let you die." and then any time he has the opportunity to put his pen to the paper, he votes to drop people from health insurance, suck up to big pharma, and blame the deaths he signed away on Democrats.

This idea that private health care gives you some sort of "choice" is complete and utter garbage. It's no more than a lottery system. Under a single-payer system, there's no choice to be made. It's, "You get get sick? You're covered." In my completely superior, and not-so-humble opinion, I believe that any industry that profits on human suffering has no right to exist.

 

[Chou Toshio]

Thank you for this. Yeah, Cruz's criticisms of the canadian health care system were so far off-base. I know a lot of people joke about moving to Canada from the US as a last-resort option in the age of Trump, but i've been legitimately looking into moving there because I've really loved it the few times I've been there, and it seems like an actually sane country. That said, being accepted to immigrate is pretty difficult and I'm not sure how feasible it is.

I already got my backup country, Japan. Well, more like I'm doing alright here, and I'm not about to leave now.

I've mentioned elsewhere, but it's pretty crazy that here as a middle-class household* with only 1 income, I can pay 1/6th of my salary to cover the entirety of my national taxes which INCLUDES health insurance for myself, my wife, and my 2 kids. Okay, so I pay another 30k yen (300 USD) a month on local taxes, but then the local government pays me a $150 monthly stipend per kid up through elementary school, plus 100% covers all the kids' medical expenses not covered by insurance, so net they end up paying me.

And as I mentioned, the Japanese have on average SHORTER wait times on top of cheaper drugs, and prices for everything are universal (a night at a hospital in downtown Tokyo is the same $30 as in rural Hokkaido). It's not unusual for a local government like mine to just foot the difference to make health care for kids 100% covered. Most right-minded working Americans who know nothing of the outside world probably cannot imagine such a system exists.



Now, to Saz Chan's point about quality-- I have lived as the son in a wealthy American household, so I know exactly what Bernie means when he says that "the finest healthcare in the world exists in America... if you are very rich." When my parents were covering me with a monthly premium that equates to 60% of my Japanese total taxes/insurance costs, I got the most detailed testing for everything, constant follow-up, and length personal consultation. None of that exists in the Japanese health care system-- I'll admit that at first it was a shock for me to take a number amongst countless people at a University hospital, be rapidly sped through time with my doctor (with no expectation to have a lengthy, detailed conversation), and have so many care services built practically like processes at a Toyota plant. BUT when I think of the service quality that is delivered at speed to that volume of people... you have to think it impressive.

And I don't think that the average American is looking for a medical system that ensures high-paying wealthy plan holders get the extra 15 minutes of 1-on-1 consultation, access to a higher class of doctors, or an "ecosystem of responsive health professionals"-- I think most Americans care about what I've seen in the Japanese system, which is universal care, cheaper care, and a system of care that has the health stats to prove that its serving the population better. If Republicans stated it honestly in this way, the public opinions would become real clear, real fast.


Private companies can create all the "options" that they want, and that's fine in an industry where not being serviced isn't life and death. However, when we are talking about healthcare which is needed by everyone who is sick and anyone can get sick, we shouldn't be going with a model that sets the price point to "the optimal price where revenues from additional customers does not not compensate decreases in profit margins." An open market is inevitably a market that denies access to some, just by the nature of demand and supply curves.

Competition isn't some type of magic that drives prices ever downwards-- it drives them down to the right point where driving it down further to attract more customers becomes unprofitable. And in the case of a good like healthcare, the profit maximizing price is high even under perfect competition. That means more people, not less, left out in the cold.


*Keep in mind, that when I say a livable wage-- not in the red, in the black, but just enough to make modest savings each year and live comfortably without excess-- I'm talking about the salary I make as an MBA holder, graduate from an elite economics program in the US, fluent Japanese/English bilingual, working in brand management/advertising at one of the world's biggest IT companies. That's the face of the 1 income middle class household in this era. I'm probably not doing as well as a steel worker from a generation ago when adjusting for inflation. Less educated folks are correspondingly lower in this race to the bottom.

 

[viol and bass]

So what happened to "IT IS A PRICE WORTH PAYING FOR!"? I thought the question at hand was whether stifling the expansion of small business and job-creation is a price worth paying for requiring employers to furnish their workers with insurance? It seemed to be my answering "no" to this question that you took such exception to.

I agree that a single-payer system would be preferable to placing large costs on small businesses. But this seems to be something of a shifting of the goalposts as far as what we were discussing.

Yeah, sorry, that was unclear. I was just saying that I think it's wrong to prioritize business expansion over providing healthcare. You're right that the way the law currently works ends up benefitting basically nobody. But if healthcare is tied to employment, I think healthcare must necessarily be considered a business expense. I don't see any way around that without decoupling healthcare from employment. This woman was essentially saying that she shouldn't be obliged to provide healthcare for her workers and should be allowed to expand her business without doing so. I guess I disagree.

 

[Cresselia~~]

I already got my backup country, Japan. Well, more like I'm doing alright here, and I'm not about to leave now.

I've mentioned elsewhere, but it's pretty crazy that here as a middle-class household* with only 1 income, I can pay 1/6th of my salary to cover the entirety of my national taxes which INCLUDES health insurance for myself, my wife, and my 2 kids. Okay, so I pay another 30k yen (300 USD) a month on local taxes, but then the local government pays me a $150 monthly stipend per kid up through elementary school, plus 100% covers all the kids' medical expenses not covered by insurance, so net they end up paying me.

And as I mentioned, the Japanese have on average SHORTER wait times on top of cheaper drugs, and prices for everything are universal (a night at a hospital in downtown Tokyo is the same $30 as in rural Hokkaido). It's not unusual for a local government like mine to just foot the difference to make health care for kids 100% covered. Most right-minded working Americans who know nothing of the outside world probably cannot imagine such a system exists.



Now, to Saz Chan's point about quality-- I have lived as the son in a wealthy American household, so I know exactly what Bernie means when he says that "the finest healthcare in the world exists in America... if you are very rich." When my parents were covering me with a monthly premium that equates to 60% of my Japanese total taxes/insurance costs, I got the most detailed testing for everything, constant follow-up, and length personal consultation. None of that exists in the Japanese health care system-- I'll admit that at first it was a shock for me to take a number amongst countless people at a University hospital, be rapidly sped through time with my doctor (with no expectation to have a lengthy, detailed conversation), and have so many care services built practically like processes at a Toyota plant. BUT when I think of the service quality that is delivered at speed to that volume of people... you have to think it impressive.

And I don't think that the average American is looking for a medical system that ensures high-paying wealthy plan holders get the extra 15 minutes of 1-on-1 consultation, access to a higher class of doctors, or an "ecosystem of responsive health professionals"-- I think most Americans care about what I've seen in the Japanese system, which is universal care, cheaper care, and a system of care that has the health stats to prove that its serving the population better. If Republicans stated it honestly in this way, the public opinions would become real clear, real fast.


Private companies can create all the "options" that they want, and that's fine in an industry where not being serviced isn't life and death. However, when we are talking about healthcare which is needed by everyone who is sick and anyone can get sick, we shouldn't be going with a model that sets the price point to "the optimal price where revenues from additional customers does not not compensate decreases in profit margins." An open market is inevitably a market that denies access to some, just by the nature of demand and supply curves.

Competition isn't some type of magic that drives prices ever downwards-- it drives them down to the right point where driving it down further to attract more customers becomes unprofitable. And in the case of a good like healthcare, the profit maximizing price is high even under perfect competition. That means more people, not less, left out in the cold.


*Keep in mind, that when I say a livable wage-- not in the red, in the black, but just enough to make modest savings each year and live comfortably without excess-- I'm talking about the salary I make as an MBA holder, graduate from an elite economics program in the US, fluent Japanese/English bilingual, working in brand management/advertising at one of the world's biggest IT companies. That's the face of the 1 income middle class household in this era. I'm probably not doing as well as a steel worker from a generation ago when adjusting for inflation. Less educated folks are correspondingly lower in this race to the bottom.

In Taiwan, the government pays every citizen's health insurance. You only need to pay 1/7th of any medical expense from seeing doctors/ scanning/ surgery, etc.
But technically, all hospitals and clinics are private.
And I'd say Taiwan has probably the greatest health care quality in Asia, maybe only slightly behind Japan.
It all sounds too good to be true, but in fact, health care is one of the major reasons of Taiwan's debt.
But the government doesn't want to lose votes for contributing less into health care at all.
So? I don't know how to fix this at all.

On the other hand, Hong Kong's public health care is a pure joke. And it isn't even free. You still need to pay something.
You need to wait like 2 years in order to see a specialist, and more than 1 year if you need brain scans.
You know you'll just like, be dead before anything's scanned.
This is what happens when your government gets very little from taxes, and spends too much on commercial industries or construction industries, building railways that you don't need.
I'd say, the Hong Kong government can either try taxing rich people more, or try to build less of these useless trash that we aren't going to need.
But sadly, it's never going to happen because a lot of bribery is going on.

 

[Saz Chan >^-^<]

Yeah, sorry, that was unclear. I was just saying that I think it's wrong to prioritize business expansion over providing healthcare. You're right that the way the law currently works ends up benefitting basically nobody. But if healthcare is tied to employment, I think healthcare must necessarily be considered a business expense. I don't see any way around that without decoupling healthcare from employment. This woman was essentially saying that she shouldn't be obliged to provide healthcare for her workers and should be allowed to expand her business without doing so. I guess I disagree.

I hate to beat a dead horse, but I think the point still needs to be made that healthcare should not be a business expense. If you believe it should be, then presumably you would say to the Salon owner, as Sanders did, that she should be furnishing all her employees with insurance already. This would bankrupt her, and therefore help nobody.

If we are in agreement that the 50-employee watershed is ineffective as it stifles business expansion, then I don't see how it would be a solution to compel employers to provide all their workers with health insurance, regardless of the size of the business. This would just make the very same problem worse. Instead of preventing businesses from expanding past 50 employees, you prevent them from even getting off the ground.

I agree entirely with the woman that she should not be prevented by the government from expanding her business. Why should she? Whom would it help? As I pointed out above, the answer is "no one". To suggest that it is appropriate for the government to suppress business expansion is to trivialise the problems of unemployment and lack of economic growth.

The point is, a law which says that employers must furnish all their workers with health insurance really does very little to achieve its intended purpose: namely, actually providing people with health insurance. You have to make a choice: do you want a situation in which businesses can't even get off the ground, or a situation in which they are given the freedom to expand? It does no good to argue for the provision of health insurance for everyone, because then you just get the first option, and no one is helped at all. You say that you disagree with the idea that business expansion should be prioritised over healthcare. How would you propose this be changed?

The alternative, as you suggest, is decoupling healthcare from employment, which is precisely what needs to happen, pronto. But this, of course, would mean acknowledging Obamacare as a failure, which is too much for many Democrats to admit.

 

[Steel With It]

The alternative, as you suggest, is decoupling healthcare from employment, which is precisely what needs to happen, pronto. But this, of course, would mean acknowledging Obamacare as a failure, which is too much for many Democrats to admit.

This, right here, is where you let us all know that you don't actually know anything about the subject and just want to shit on liberals.

Because, if you did, you'd know that what we want is universal socialised healthcare and that Obamacare was simply the closest thing to a stop-gap compromise the Dems could push through against a government packed with Republican Randroids (and even then, they haven't shut up about "COMMUNISM!!!" since). It's not perfect and nobody will claim it's perfect, but it's certainly better than the GOP's "Kill 'em all and let the corporations sort it out" garbage, and these will literally be the only two options for as long as the GOP as we know it exists.

If you - general you, not you specifically - value businesses and profits over human lives, you are evil. Period.

 

[Saz Chan >^-^<]

This, right here, is where you let us all know that you don't actually know anything about the subject and just want to shit on liberals.

Because, if you did, you'd know that what we want is universal socialised healthcare and that Obamacare was just the closest thing to a stop-gap compromise the Republican Randroids would let the Dems push through (and even then, they haven't shut up about "COMMUNISM!!!" since). It's not perfect and nobody will claim it's perfect, but it's certainly better than the GOP's "Kill 'em all and let the corporations sort it out" garbage, and these will literally be the only two options for as long as the GOP as we know it exists.

If you - general you, not you specifically - value businesses and profits over human lives, you are evil. Period.

Precisely this kind of vacuous moralising that the far left engages in so as to avoid discussing the substance of the issue.

I know exactly what "you" (I assume you mean Democrats) want. The mistake is to think that Obamacare is some sort of step in the right direction. It simply will not do to say "Obamacare may not be perfect, but it's all the Republicans would grant us". Don't blame your political opponents for your own bad laws.

Nobody expects a law to be perfect. But I think that we can be forgiven for wanting it to be not shit.

The point I have made (and if you don't think I have made it sufficiently, then maybe try engaging with it) is that "valuing businesses and profits over human lives" is not the choice with which Obamacare provides us; at least as far as small businesses are concerned. The choice it forces small-business owners to make is "Do I keep my business the size it is now, or do hire a 50th employee and bankrupt myself?" Exactly which of these two options results in more human lives being saved?

When all's said and done, either Obamacare is fit for purpose or it isn't. If you think it is, then you might try defending it rather than firing empty shots across the bow. And if you think it isn't then you should be agreeing with me.

 

[gvmgvm40]

If you look at the question that the good lady asked Sanders in part 2 of the debate, you'll see that she was reluctant to hire more than 50 people, because it was simply uneconomical to do so. Once she hired her 50th employee, she would have to supply health insurance for all. So what does she do? She hires only as many as she can without having to pay this cost.

So how many people has this regulation helped? The answer, of course, is no one. It has not helped the employer, because they are prevented from expanding their business and increasing their profit margin. It has not helped the 49 employees they hire because the regulation kicks in at 50. It has not helped the unemployed people that would otherwise have been hired, because they don't have a job and therefore won't have health insurance provided for them either. And it doesn't help the general populace, because they are denied access to the goods and services that they would otherwise be prepared to pay for if the business were given the freedom to expand.

This law is not fit for purpose. It serves only to disincentivize small-business owners from reaching their potential.

Am I missing the point here? Of course some people benefit: workers who work in businesses hiring over 50 workers, who now get access to healthcare.

Not everybody can start a business: you need at least some capital for that. What Obamacare does is, effectively, increase this threshold to entry. You can ask whether the corresponding economic loss for small businesses and unemployed people is worth it, but to say nobody benefits is patently false.

 

[Saz Chan >^-^<]

Am I missing the point here? Of course some people benefit: workers who work in businesses hiring over 50 workers, which is probably the overwhelming majority of the employed workforce.

Not everybody can start a business: you need at least some capital for that. What Obamacare does is, effectively, increase this threshold to entry. You can ask whether the corresponding economic loss for small businesses and unemployed people is worth it, but to say nobody benefits is patently false.

You'll see from the context, I was pointing out that nobody benefits in the situation I described. The problem is that this situation is very common. That the 50-employee threshold is a bad idea is not particularly controversial here, it seems to me. That's why Sanders fluffed it during the debate.

Of course not everybody can start a business. You need capital, or an investor, and goods or services that are going to sell. The problem is that you can have all this, and yet be utterly prevented from getting your foot in the door, simply because of a government regulation; one which is preventing you from creating jobs and giving people the goods and services they are prepared to pay for.

Why? So that more people have health insurance? Except, they're not getting health insurance since they're not getting employed. And even if they do get employed, they still won't be furnished with health insurance unless another 49 people get employed with them, which small businesses have a greatly diminished incentive to do.

Much of what motivates these kinds of socialist policies is a general cynicism towards commercial-mindedness. Chou notwithstanding, every critic of the Republican position in this thread has exhibited this very mindset. The problem is that commercial-mindedness, and the pursuit of self-interest in competitive environments, is what gave us everything we own, and provided us with every opportunity we have ever had. Does such a system deny us things, and deny us opportunities as well? Of course it does: nirvana is not for this world. The question at hand is what kind of system does it better. In the case of healthcare, there may well be a better alternative to the free market. But that alternative is not Obamacare.

Back in the day - that is, the 2008 election - one of the vindicating features of the proposed ACA was supposed to be that small businesses would be exempt from providing health insurance for their employees. As I recall, McCain's ignorance of this was heralded as a big "gotcha" moment during one of their televised debates. And yet what the Sanders-Cruz debate made clear was that this very exemption serves to prevent small businesses from becoming larger businesses, thereby stifling economic growth and job opportunities. "Would I rather have a job and no health insurance, or no job and no health insurance?" This is what many an unemployed person should be asking themselves when considering how much Obamacare benefits them.

 

[viol and bass]

You'll see from the context, I was pointing out that nobody benefits in the situation I described. The problem is that this situation is very common. That the 50-employee threshold is a bad idea is not particularly controversial here, it seems to me. That's why Sanders fluffed it during the debate.

Of course not everybody can start a business. You need capital, or an investor, and goods or services that are going to sell. The problem is that you can have all this, and yet be utterly prevented from getting your foot in the door, simply because of a government regulation; one which is preventing you from creating jobs and giving people the goods and services they are prepared to pay for.

Why? So that more people have health insurance? Except, they're not getting health insurance since they're not getting employed. And even if they do get employed, they still won't be furnished with health insurance unless another 49 people get employed with them, which small businesses have a greatly diminished incentive to do.

Much of what motivates these kinds of socialist policies is a general cynicism towards commercial-mindedness. Chou notwithstanding, every critic of the Republican position in this thread has exhibited this very mindset. The problem is that commercial-mindedness, and the pursuit of self-interest in competitive environments, is what gave us everything we own, and provided us with every opportunity we have ever had. Does such a system deny us things, and deny us opportunities as well? Of course it does: nirvana is not for this world. The question at hand is what kind of system does it better. In the case of healthcare, there may well be a better alternative to the free market. But that alternative is not Obamacare.

Back in the day - that is, the 2008 election - one of the vindicating features of the proposed ACA was supposed to be that small businesses would be exempt from providing health insurance for their employees. As I recall, McCain's ignorance of this was heralded as a big "gotcha" moment during one of their televised debates. And yet what the Sanders-Cruz debate made clear was that this very exemption serves to prevent small businesses from becoming larger businesses, thereby stifling economic growth and job opportunities. "Would I rather have a job and no health insurance, or no job and no health insurance?" This is what many an unemployed person should be asking themselves when considering how much Obamacare benefits them.

I understand your argument, but here's why I disagree with it. Unemployment didn't increase after the passage of Obamacare. It decreased greatly. Which is why I believe that this 50-person rule, while an inconvenience to certain businesses in preventing them from expanding, isn't a huge part of the bigger picture. You're calling the law a failure because certain businesses are hamstrung from expanding beyond 49 people. I'm calling it a success because this did not increase unemployment, in fact it did the opposite, while providing healthcare to 20-30 million people who needed it. I'd call that a rousing success. Of course I'd prefer universal single-payer healthcare, but that's not what we're arguing. We're arguing whether Obamacare was a success or not, and whether repealing it would be detremental. My sister is a bioinformaticist without health insurance, because she's on an extended leave from her job, which is fine, they shouldn't have to provide her with healthcare because she's on leave. But while she has the money to do so, she's not signing up for healthcare on the obamacare exchanges. She doesn't see the point since Obamacare will be repealed shortly. So she's currently without health insurance. She probably could deal with some healthcare costs if it came to that, but many don't have that luxury. That's the practical impact of repealing this law. Thousands more people will get sick, and thousands more will die.

Edit:

Much of what motivates these kinds of socialist policies is a general cynicism towards commercial-mindedness. Chou notwithstanding, every critic of the Republican position in this thread has exhibited this very mindset. The problem is that commercial-mindedness, and the pursuit of self-interest in competitive environments, is what gave us everything we own, and provided us with every opportunity we have ever had. Does such a system deny us things, and deny us opportunities as well? Of course it does: nirvana is not for this world. The question at hand is what kind of system does it better. In the case of healthcare, there may well be a better alternative to the free market. But that alternative is not Obamacare.

OK but in the US, what most of us have experienced for our entire lives is unchecked commercial-mindedness. We had a social safety net once, sort of, but it's been dwindling away for decades at the hands of mostly republicans, but democrats too. What we're left with is a fabulously wealthy society that simply doesn't protect its most vulnerable. None of us had seen a candidate who proposed anything remotely close to socialism, or even questioned this unchecked commercial-mindedness, ever, prior to Bernie. It's all new to us. Both the democratic and republican parties are corporatist through-and-through. I'm not saying that capitalism didn't give us most of what we have. I'm just saying that unchecked capitalism is dangerous as hell. It doesn't care a bit about destroying the environment. It doesn't care a bit about turning workers, the backbone of our society, into glorified wage slaves.

Here in the US, we NEED a bit of socialism, because we've known nothing but unchecked, unquestioned capitalism all our lives.

 

[gvmgvm40]

You're not addressing my point at all. I'll paraphrase myself, I guess.

Why? So that more people have health insurance? Except, they're not getting health insurance since they're not getting employed. And even if they do get employed, they still won't be furnished with health insurance unless another 49 people get employed with them, which small businesses have a greatly diminished incentive to do.

Common sense tells me that the overwhelming majority of workers work in companies that hired over 50 workers before Obamacare and still hire over 50 workers. Many of these people had no access to healthcare. Now they do. Hence the percentage of uninsured people falling from %16 to % 8.9 between 2010-16. Are small businesses worse off now? By extension, does this stunt economic growth and job creation? Yes to both. Has the number of uninsured Americans fallen by 20 million? Yes to that as well. It's a payoff, not a net negative effect. You might put one before the other and agree or disagree with it, but don't deny the facts.

Why? So that more people have health insurance? Except, they're not getting health insurance since they're not getting employed. And even if they do get employed, they still won't be furnished with health insurance unless another 49 people get employed with them, which small businesses have a greatly diminished incentive to do.

You'll see from the context, I was pointing out that nobody benefits in the situation I described. The problem is that this situation is very common.

How common, exactly? Far more people work in 50+ workplaces than 50- workplaces and consequently statistics show that far more people (20 million, in fact) gained healthcare than lost access to it. If you're specifically talking about the scenario you described, sure, but your scenario is just a scenario, not reality itself.

 

[Saz Chan >^-^<]

I understand your argument, but here's why I disagree with it. Unemployment didn't increase after the passage of Obamacare. It decreased greatly. Which is why I believe that this 50-person rule, while an inconvenience to certain businesses in preventing them from expanding, isn't a huge part of the bigger picture. You're calling the law a failure because certain businesses are hamstrung from expanding beyond 49 people. I'm calling it a success because this did not increase unemployment, in fact it did the opposite, while providing healthcare to 20-30 million people who needed it. I'd call that a rousing success. Of course I'd prefer universal single-payer healthcare, but that's not what we're arguing. We're arguing whether Obamacare was a success or not, and whether repealing it would be detremental. My sister is a bioinformaticist without health insurance, because she's on an extended leave from her job, which is fine, they shouldn't have to provide her with healthcare because she's on leave. But while she has the money to do so, she's not signing up for healthcare on the obamacare exchanges. She doesn't see the point since Obamacare will be repealed shortly. So she's currently without health insurance. She probably could deal with some healthcare costs if it came to that, but many don't have that luxury. That's the practical impact of repealing this law. Thousands more people will get sick, and thousands more will die.

I'm not sure how all of that coheres with what you said here:

Yeah, that's a pretty stupid aspect of the law, which is why we should have universal single-payer healthcare and not have to deal with this mess. As Bernie believes.

Or here:

You're right that the way the law currently works ends up benefitting basically nobody.

But anyway.

I'm sure you're not suggesting that Obamacare caused the reduction in unemployment, since the UK unemployment rate followed a very similar trend since 2010. And that being the case, what makes you think that Obamacare has not stifled this reduction from being even greater, as many economists believe?

Why do you believe that the 50-person threshold is a good idea? And if it's not, would you do away with it altogether? As I pointed out above, this would only serve to stop businesses from getting off the ground.

If you believe Obamacare to be a rousing success, then you are actually on the wrong side of both Cruz and Sanders in this debate. Neither of them believes that and, as far as I can glean from across the pond, democrats don't in general. What is more, this is to ignore many of the concerns that average Americans have with it down on the ground, several of which came up in the debate. One of which was the fact that many who now have this insurance are suffering from huge deductibles and extortionate premiums. The fact that they have this insurance is not enough. They need to be able to use it. The fact of Trump's election is a resounding testimony to the general dissatisfaction with Obamacare.

You're not addressing my point at all. I'll paraphrase myself, I guess.



Common sense tells me that the overwhelming majority of workers work in companies that hired over 50 workers before Obamacare and still hire over 50 workers. Many of these people had no access to healthcare. Now they do. Hence the percentage of uninsured people falling from %16 to % 8.9 between 2010-16. Are small businesses worse off now? By extension, does this stunt economic growth and job creation? Yes to both. Has the number of uninsured Americans fallen by 20 million? Yes to that as well. It's a payoff, not a net negative effect. You might put one before the other and agree or disagree with it, but don't deny the facts.




How common, exactly? Far more people work in 50+ workplaces than 50- workplaces and consequently statistics show that far more people (20 million, in fact) gained healthcare than lost access to it. If you're specifically talking about the scenario you described, sure, but your scenario is just a scenario, not reality itself.

I understand perfectly what you're saying, I just don't see how it's relevant to the point that I was making. The fact that 20 million more people now have health insurance is little comfort to the salon-owner who can't afford health insurance because she is prevented by the law from increasing her profit margins, or to the 49 people she employs who don't have health insurance, or to all the unemployed people she would otherwise be hiring, who don't have health insurance either. If you're arguing the case that "Obamacare had positive effects in addition to the negative", then fine. But merely pointing out the positive effects is not a rebuttal of the negative. If you think it is, then I guess you would join with Sanders in telling the Salon-owner "tough titty-poo for you".

And I do not think you should trivialise the stifling of economic growth and job creation brought about by the expansion of small businesses. Against Trump's trickle-down economics, Hillary campaigned on the basis of growing out the middle class, which is the very thing to which Obamacare poses a threat. What is more, as I pointed out above, and as came up in the debate, just because someone has this insurance does not mean that it is going to be useful to them. When deductibles go up and premiums go up, many who take out this insurance may find themselves unable to use it, and many, I'd wager, regret it. See Trump for details.

 

[Deck Knight]

Having worked in insurance billing for around a decade in the US, I could give a massive speech on the problems with our system.

Before I make any further commentary, please realize there are two very, very different things being discussed here.

Health Insurance: A plastic card that says someone else will pay for your health expenses under certain conditions.
Health Care: The actual care that taken in aggregate describes patient outcomes. Health Care is provided by either doctors directly or through medications developed by the R&D departments of pharmaceuticals, products which your doctor will assess and potentially prescribe for treatment.

Even if you prefer "Affordable Care Act" to "Obamacare" the law is still misnamed. Properly it would be named the "Affordable Insurance Act." It was an act designed to impact the health insurance market. It did so in incredibly negative ways by punishing the few reforms (like Health Spending Accounts / HSAs) that were making affording health insurance easier and by increasing taxes to form an unnecessary parallel state system (raiding Medicare funds in the process and using government 10 year budgeting windows to manipulate its stated cost.)

NONE of the problems we have in health care would do anything but get worse under a high-tax, government bureaucracy targets-based system of health insurance. Those systems, being government-run, have the luxury to cook their books, change their definitions, and completely ignore the fundamental purpose of health care which is patient outcomes. Both private insurers and government insurers have different priorities. The first needs to maintain profitability, the second needs to make sure it spits out some target number for political purposes. Patient outcomes place significant pressure on the former, and none on the latter. People who die when public systems are incompetent or non-responsive are called statistics, and have no viable recourse. You can sue your government (sometimes) but it just increases your own tax bill.

Bottom line, if you want someone who cares about patient outcomes, talk to a doctor. Doctors are skilled medical professionals who require massive amounts of education and training in order to be able to heal your medical ailments. They are not merely grunts providing a natural commodity like farmers do grain. BenTheDemon can wish it so that no one profit off human suffering, but until people can spend from their MP pool and use "Cure" and "Esuna" to treat all matter of ailments, we're stuck in a reality where human beings expect to live well in exchange for spending intensive time and training to effectively treat fellow human beings. Yes, this includes the R&D Employees of major pharmaceuticals, who are also providing health care, not health insurance.

The entire debate has been warped (on both sides) by the conflation of health insurance and health care. Health insurance is a discussion about how to pay for health care, especially for expensive surgeries or treatment of chronic conditions. If you had a billion dollars saved up, the entire health insurance industry is irrelevant to you, doctors will happily accept cash and checks for services rendered. Health insurance on the other hand has several pressures that negatively impact costs, including minimum mandates on coverage, setting reimbursement rates too low (this forces the dollar value of billed charges upward so that non-covered patient payments make up the difference), and limiting competition among health insurers for the lowest prices, or trying to "compete" with insurers by setting up their own system. But governments do not compete because they have no pressure to do so. If they have cost overruns, they just demand more taxes on the back end where a private insurer who can't control costs or improve outcomes would be killed by the market before any negative externalities occur.

Like I said, I could give a speech. But the general direction of Cruz/Trump and Republicans is what both health insurance and health care in the United States need. Sanders and socialists like him want you to get very morally outraged that someone, somewhere is making a living off healing the sick. That misguided moral outrage has condemned millions to die from sicknesses that only motivated and skilled medical professionals and pharmaceutical developers have even a chance at treating and possibly curing. Medicine can only advance as a discipline if it remains protected from being Socialized.

 

[Soul Fly]

Regardless of what actually went down in the debate, since the above post barely deals with that, two points:

1. Cruz was even guiltier of blurring nomenclature if anything, justify the massive benefit of doubt you're giving to Cruz seemingly contrary to the literal words he uttered in the debate. Sanders, on the other hand was clearly debating from the ambit of insurance, given that this is the only reasonable common ground he can fight for as a US senator, given the country's abhorrence of any system that completely excludes private enterprise. Not to heavily speculate, but he'd personally probably be more on board with free health care rather than going through loopholes and kafkaesque legislative and beaureaucratic nightmares of regulating and mandating health insurance through private players; say something like the NHS.

2. WRT to the above, what do you feel about a system like the NHS, which completely foregoes private players in favour of an opt-out govt. funded system? Clearly stands at odd with your shallow hypothesis since the UK hasn't collapsed into dystopian economic hellfire. Quality of living and access to healthcare remains high and universal, while they regularly keep churning out groundbreaking innovations and solutions despite complete governmental control over healthcare, and a seeming absence of "pressure to compete".

just curious.

 

[Mr.E]

For the record, I had to work so I wasn't able to catch the debate at all and can't really muse about what Cruz or Sanders said verbatim.

As has been brought up previously, healthcare is an inelastic service. For less severe illness/injury one can simply choose to forgo care entirely, but their quality of life is still impacted. The more severe you go, the less choice one has to not receive treatment unless you're cool with people "choosing" to die. (And I don't think most people are, or abortion wouldn't be an issue and society wouldn't place a high value on treating depression and other underlying things that drive people to suicide.) Healthy people don't need healthcare at all, except basic preventive services have proven to severely mitigate the impact of more severe health problems down the road. To an extent, healthcare providers need to make a profit to drive discovery and innovation but leaving it unregulated leads to exorbitant cost increases because everyone knows people can't simply "choose" not to get chronic illnesses or have their broken arm fixed or whatever. Is not the purpose of a government to ensure the prosperity of its citizenry? I'd argue that it is irresponsible of a government to not socialize healthcare. As a private investor, you can either accept these modest though nigh-guaranteed returns or enter a less socially required "business" if one wishes to chase maximum potential profit.

The main issue of all these insurance-based solutions is that they don't address the problem of rising healthcare costs in the U.S. As something Deck Knight alluded to, but took things in the direction of defending a classic Republican talking point instead (Big Govt stifling muh private interests), politically we seem only concerned about paying the costs of healthcare as-is rather than figuring out how we get those costs down so they're more affordable in the first place. That's the main benefit of a universal public option! As-is, you have healthcare providers and insurance companies trying to one-up each other to maximize profitability. Ultimately, this just drives prices up at an exorbitant rate: costs go up, insurance companies raise rates to maintain a similar level of profitability, costs go up more so healthcare providers can effectively leech that excess profitability back off, so insurance rates are raised again... ultimately, the costs still get passed to "consumers." A government option, that everyone rather than just a subset of people can join (Medicare/Medicaid), would give people the ultimate collective bargaining power that would all but force prices down. Private insurance should be a luxury that the rich purchase for risk mitigation, not a mandate forced on healthy poor to pay for exorbitant healthcare costs that wouldn't exist if a public option were available.

But that's socialism and we can't take the cavier out of rich man's mouth to put bread on the table for a few poor families who just need to pull themselves up by their bootstraps! I feel like Obamacare has tried to make the best of an inherently broken system. It has clear flaws, but ultimately it has gotten millions of people insured such that they can at least get basic preventive services and aren't financially if not literally dead in the face of medical catastrophy. On the flip side, the corporate cronies backing Big Insurance gotta love having an entire population of people (in the wealthiest country in the world) being mandated to purchase their product. For now everyone has been placated, but ultimately the issue of ballooning healthcare costs isn't solved.

But I think our government is too bought and paid for at this point, both the entirety of the right-wing side and the more centrist of the left-wingers, for the most progressive options to gain serious traction in this country. Kinda makes me sad and I just hope I die before the entire system comes crashing down on me.

Divorcing employers from providing health insurance would be a good start, it eases up regulations on small businesses (responsibility is pushed to the individual to shop the exchanges) and helps to mitigate people being tied down to bad jobs, but I'm not confident it does enough on its own to solve the real problem of healthcare costs being too high. If you still require people to buy private insurance, insurers and healthcare providers are still going to participate in the game of one-upsmanship that ultimately leaves individual citizens high and dry.

 

[Chou Toshio]

So, my Mom recently took a C-level executive position at one of Hawaii's major Insurance companies, and being home now for a bit we were talking about this subject. Really interesting, every time I talk to her, the prerogatives wildly go against my expectations.

First off, I didn't really understand what it meant that Hawaii's largest health care insurance provider is a non-profit organization; instead of being owned by stockholders expecting returns, it's more like a credit union that's controlled by it's members. So just based on the organization's mission, it's never been an option to turn away the most unhealthy from services. On one hand, it's a good model for aligning public health with insurance objectives, because it means that the organization's interests are highly aligned with the public's-- since they are ultimately footing the costs for a huge percent of the population, their number one operational goals are aligned to public health; shaping the health landscape to improve preventative services, and marketing to shape culture/improve public awareness of health issues-- doing all they can to get the public to live healthier, and therefore reduce costs. As a marketing/communications professional in a private company, it's fascinating to me that they have more than twice the marketing spend aimed at public awareness of health research and issues than on building the brand. They're really cutting at the margins though, since Hawaii is one of the healthiest states in large part due to health being highly socialized even before Obamacare (relative to other states).

To my Mom's organization, Single Payer health care is not only the most desirable system, they see it as an eventuality.

On why it's desirable: Since their organization can't turn people away, they inevitably foot the greatest costs from the most expensive individuals. In a Single Payer health care systems, organizations like theirs would become only responsible for supplementary medical insurance (as opposed to also covering the basic, critical health insurance). Of course this greatly reduces the overall scale of the business, but it also means that they become a lot more free to act more like for-profit businesses in other sectors-- making different products/services/options at higher profitability due to focusing operation on supplementary, and not essential (therefore less regulated). Single Payer also reduces the prices of many health services, and therefore benefits both their organizations mission to improve Hawaii's overall health, as well as ultimately reducing costs to their bottom line.

On why they see single payer as inevitable: This is largely due to the reasons argued in this thread about connecting jobs to insurance-- businesses don't want to pay for it. Eventually, big parts of the private sector will demand that the government figure out how to keep the citizenry healthy/productive, without requiring companies to take such a central role in providing insurance to employees. The escalating costs of the current US market-- businesses don't want to pay for it, citizens can't afford it, it's unsustainable. If Obamacare's current mandates stay in place, this motivation to move towards single payer gets even stronger because private insurance companies get put in the same position as my Mom's organization where they aren't free to turn down folks with pre-existing conditions, and therefore find themselves footing the costs of whole situations. The longer you can keep the current mandates in place, the more private health insurance companies come to realize that shrinking the business would be better if they can act more for-profit in competing within the supplemental, and not essential insurance space-- while not having to directly cover the most expensive costs from the sickest individuals.

Of course the greediest private companies want to "ride the wave", in getting Republicans to fight for removing those mandates, skip out on high-cost individuals, while still raking in the large revenue from basic insurance for the healthier parts of the population. Pure corporate greed. But this is kind of akin to fossil fuel companies that on the face constantly deny climate change in order to ride the wave big as possible now while knowing that the current system is unsustainable and that phasing those energy sources out is an eventuality. It's all about how long they can put it off for profit. Eventually though, Republican's probably won't be siding just with Pharma and the greediest parts of the insurance business, as it becomes a battle of their voices versus those in the rest of every other private sector.