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Post by Deleted on Jul 31, 2017 9:09:47 GMT -5
I'd buy the "unsustainable" more easily were we not somehow able to finance weekly golfing jaunts for Trump, giant silly walls between us and Mexico, and tax cuts for the obscenely rich.
I believe that a civilized society does not let its citizens lack basic things. Lots of other societies manage it without going bankrupt. How pathetic are we if we can't?
Fine, ditch Obamacare. But not tp put something worse in its place
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Post by Don on Jul 31, 2017 9:37:32 GMT -5
None of the other things you cite are sustainable, either. Nor are the obscene wars the government engages in (both foreign and domestic, against "heathens and drug addicts"). Also, national infrastructure is rapidly hollowing out. And let's not mention Social Security or Medicare. Oh, and there are a number of government employee "pension cliffs" on the horizon as well.
What happens when all those bills come due on our kid's watch? The political class has eaten the seed corn.
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Post by Deleted on Jul 31, 2017 9:41:37 GMT -5
I'm actually on board with old-school conservatives* on "yeah, you have to look at what things cost. there are no magic candy trees." We need to prioritize and consider how to pay for things. But I also think there's a minimum a civilized society provides and does not allow its citizens to do without. The fact that we have homeless children and veterans is just disgraceful. The fact that our healthcare is both worse and much more expensive than many other nations is disgraceful. Here's one problem I have with the current Republican party -- they seem totally obsessed with the idea that someone, somewhere, might be scamming the system to get more than they have strictly earned -- someone not wealthy, who is a low-scale grifter rather than a high-scale one. They are more worried about this than anything else. (At the same time, of course, they are willing to spend huge wads of money on shit like border walls, so it definitely is not all about fiscal frugality.) To note -- the GOP house ACA replacement devoted 6 of its 60 pages to recipients of medicaid who won lotteries. I mean, what in the holy fuck? Do you know how rarely that will happen? And yet they are so obsessed with it they devote a tenth of their work to it. It's whacked. It's completely whacked. I'm all on board for a repeal and replacement -- when what is replacing the ACA is an actual improvement. Not even the Senators voting for this plan thought that. Both Johnny Mac and Lisa Murkowski think the ACA should be repealed and replaced. (I've heard Susan Collins can live with patching the ACA.) But to their eternal credit, they aren't willing to do it willy-nilly just to placate the president and party-hardliners. They're looking to the actual effect on the majority of people. I respect the hell out of them twice as much for voting as they did despite party pressure and their own desire to repeal. But faced with a choice of a stale bologna sandwich and a shit wrap, they decided to stick with bologna until they could procure something better. *ETA -- I'm using old-school conservatives for lack of a better term because I think the word conservative, unfortunately, has now come, in many people's minds, to sweep in a bunch of whackadoodle stuff I can't get on board with at all, and that is not really all that "conservative." Ditto on "libertarian." Trump and the alt-right put the icing on that cake.
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Post by Don on Jul 31, 2017 11:37:55 GMT -5
As Venezuela is currently illustrating, you can't have any form of civilized society without a functioning economy. Absent a functioning, sustainable economy, there will be more homelessness and ever-worstening health, not just healthcare, for everybody but the most politically connected.
A sustainable economy is the most important long-term goal of any civilization. What we have now is not sustainable. I find that infinitely more troubling than the problems with healthcare, as well as myriad others. And they are ALL related to the long-term viability of the economy. Healthcare can't be fixed in the long run if the economy is unsustainable. All the problems that people seem to think are more important than the economy are what's creating the unsustainability of the economy in the first place.
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Post by Deleted on Jul 31, 2017 11:47:38 GMT -5
As Europe, Canada, and Australia are currently illustrating, you can provide a healthcare system that covers everyone and is better and cheaper than ours and still have a functioning economy. I dunno. I've traveled around Sweden, Australia, Canada, France, Germany etc. -- they do not, at all, look like crumbling Soviet-esque states. Frankly, they look better than we do in just about every way. maxinquaye ! poetinahat ! Adopt me! I'm house-trained and everything.
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Post by Don on Jul 31, 2017 11:54:23 GMT -5
As Europe, Canada, and Australia are currently illustrating, you can provide a healthcare system that covers everyone and is better and cheaper than ours and still have a functioning economy. But as we are illustrating, you can't do all that while acting as the policemen of the world and still have a sustainable economy. I would also far prefer cutting warfare instead of welfare, but that's dreaming of a unicorn government at this point. Both parties are bent on Empire.
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Post by Deleted on Jul 31, 2017 12:07:37 GMT -5
I don't think we're demonstrating anything at the moment except corruption, confusion, ignorance, and pure partisan spite.
We can do better on all fronts.
ETA:
I forgot incompetence and sheer irresponsibility.
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Post by Don on Jul 31, 2017 12:47:08 GMT -5
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Post by Deleted on Jul 31, 2017 13:14:20 GMT -5
This, right here, is a vital question. That did not start with Obamacare (things were pretty preposterously and disproportionately expensive before that) -- but one of the major flaws of Obamacare is that it failed to address it. Another thing it didn't address (and that I believe is essential) is addressing the weird, idiotic way we've tied healthcare to employment. If you get health insurance from your employer, odds are excellent you don't have much idea what it costs every month, much less what the underlying care costs. And you have no clue what it is like for those who don't have employer-provided health insurance. That makes it hard to even rationally discuss it because we're not all on the same page. That's not even getting into how the ACA was implemented differently in different states (which is a big reason it works better in some states than in others). I think the cost of malpractice insurance and the fact that much of our system was set up to enable the insurance industry more than to than help people are big causes of the high cost of healthcare. (Dunno what medical malpractice insurance costs, but I can tell you that the cost of lawyer malpractice insurance is pretty kooky.) Then there is the high cost of getting a medical degree. The really crazy thing is, as high as costs are, most of the doctors I know are far from getting rich. My doctor, my sister-in-law (a doctor), and a friend who is an emergency room doctor all still have student loans. They've been practicing a long time and are not living high on the hog. ETA: And of course, none of the GOP plans so far address (or even acknowledge) any of this, either.
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Post by robeiae on Jul 31, 2017 13:48:11 GMT -5
As Europe, Canada, and Australia are currently illustrating, you can provide a healthcare system that covers everyone and is better and cheaper than ours and still have a functioning economy. Canada has a population less than that of California, a ridiculously low population density, and a boatload of natural resources. Australia has $10 million fewer people than Canada. And Europe isn't all the same. I've been around, too. And I'm sorry but while much of the rest of the world you're talking about isn't full of crumbling states (some exceptions), it's also not simply cruising along, doing a great job at all of this stuff. Some countries are, to be sure. But some of these--in EU--are like Canada: small populations, lots of natural resources. And Don's right: military spending is a big nut and most of the EU hasn't had to worry about this for decades But back to the ACA... You know what the biggest driver is for medical tourism? Cost. Used to be that medical tourists were largely inbound to the US; now it's the other way around. And sorry, but the numbers are going up under the ACA. Why? Because the ACA isn't doing jack to lower healthcare costs; it's doing the opposite, in fact. And it's not lowering premiums. Again, the opposite is happening (I know defenders of the ACA have convoluted arguments about how these increases are somehow not because of the ACA). So okay, granted that we can do better, that we should do better. The ACA is not the way forward, imo. It needs to go. And if the response is that it will be messy, it kinda has to be, if the goal is to really fix problems. Because they need to fully identified and understood before they can be fully fixed (at least correctly). This is an ongoing thing with the healthcare and health insurance industry, that predates the ACA by a long time, imo. No one--in the government--was or is willing to own up to having made a mistake in this field, so we've had to live with bad legislation that should have been repealed (like HMOs), once it became apparent that the legislation wasn't doing what its creators imagined that it would do. *sigh*Technocrats...can't survive with 'em, can't fly 'em all to another planet.
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Post by Deleted on Jul 31, 2017 13:55:40 GMT -5
If things suck as obviously as you say under the ACA, and if people's lives are worse, why is it only 11% of people currently want to replace it with one of the GOP plans? Why are more people in favor of keeping the ACA?
Why is it that even the senators that voted for the GOP skinny plan didn't want it to become law?
NO ONE in this entire thread disputes that the ACA has big problems. NO ONE. Some (all?) of us could even go for repealing and replacing it for a better alternative. So arguing against those points is a strawman.
The trouble is, no one has provided us with a better alternative yet. Not even close. And yanking out the stale bologna sandwich to replace it with a shit-wrap is not a good plan.
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Post by robeiae on Jul 31, 2017 14:22:41 GMT -5
I'm sure plenty of people's lives are better because of the ACA. But again--as I have tried to explain--that doesn't mean it's a good program, that it's a long-term solution.
And again, the ACA is built on two mandates that are just wrong imo: tying health insurance to employment and making health insurance mandatory. As long as those stand, we're not going to have better, more affordable healthcare. But undoing those two mandates collapses the ACA, right? So...options?
And you're right, the Repubs don't have any sort of viable alternative, but imo the longer we go, the harder it's going to be to undo this mess. Really, it may already be too late from a political perspective, because as you say most people are in favor of keeping it (no doubt because they are getting actual benefits from it in the moment). And politicians who tear down things like this probably won't get reelected.
So, fuck it. We're stuck with a boneheaded system now and forever more*. Healthcare costs will keep going up, insurance companies will move in and out of markets to take profits and get bailouts, and health care decisions will be made by these same companies and/or by the government, as opposed to being made by doctors and patients.
* Until it all implodes from the costs, of course.
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Post by poetinahat on Jul 31, 2017 18:46:50 GMT -5
Why does lower population density make healthcare more affordable? I would think it makes it harder to manage. But it's a priority.
Some of the challenges Australia faces:
- Far-flung, low-density population, which makes infrastructure outside the capital cities extremely expensive per capita
- Lack of economy of scale: Production costs are high, so the government protects local manufacturers with import tariffs, so prices are high, etc. It's kind of a surprise that, while the car manufacturers are shutting down their last Australian plants, they even kept them going this long.
- Distance: imports and exports are relatively expensive. We're a long way from everything.
- Quality of life concerns: How do you get a newly minted doctor to locate away from the city, where all the money/cosmopolitan culture is?
A propos the money, Australia does have this neat thing called the Higher Education Contribution Scheme, or HECS: You start paying off university fees after you graduate and are employed -- at which point the government takes a slice of your paycheck. So you don't pay until you're earning over a certain amount.
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Post by Christine on Jul 31, 2017 20:22:00 GMT -5
Cosmetic surgery is optional. This is an apples and oranges comparison. I also disagree when people compare health insurance to car insurance (not that anyone here has done that). The value of even a nice, new car is roughly $40-$50k, though of course there are more expensive cars - and insurance fluctuates based on full coverage (coverage of your own, possibly expensive car) or the minimum (the damage you could do to someone else's car if you were at fault). But... cancer, diabetes, degenerative diseases, prescription meds that keep, well, DEATH, from happening... how do you put a value on that? What is the free-market price tag for living and not dying? The free market doesn't work so great with inelastic demand. We need to take the profit motive, i.e., the free market, out of healthcare. It's time. It's past time. IMHO.
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Post by robeiae on Aug 1, 2017 8:53:36 GMT -5
Why does lower population density make healthcare more affordable? I would think it makes it harder to manage. But it's a priority. Sorry I was unclear, that's not what I'm trying to say. My point about Canada (and Australia, and some European countries) is that their circumstances are such that their governments can not only shoulder much of the healthcare burden, but they can also do it more efficiently, as compared to the US. Canada has lots of natural resources, far more per capita than does the US (and population density is a factor here). That represents a serious safety net for its government. This is true for a number of northern European countries, as well, especially when coupled with their lack of outrageous military spending. They can have much more extensive entitlement programs without fear of blowing up their debt to ridiculous levels. And hey, maybe they don't have as many boneheads in charge, either, making stupid laws, spending money like there's no limit, etc. Jumping back to Cass' earlier point about what a civilized society should be providing, regardless of what that is, the people in charge shouldn't be acting irresponsibility, when it comes to spending other peoples' monies. And yet, that seems to be SOP in the USA.
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