The Next President is...

[Guardian]

Universal coverage arguments aside, here are less talked about fixes to costs I would push for that I think we could all agree on:
1. The residency program has been capped at the same level due to Congress since the 90s, shortage of doctors has followed since the population has grown significantly. Huge bottle neck at that point in the training pipeline so it needs to be increased.
2. Get rid of the 4 year bachelors requirement for medical school. Info is mostly useless. Most countries do 2 year premed undergrad on core courses + 3 year medical school. Would also help with student loan issue.
3. Redirect funding to preventative programs rather than curative programs.

Actual fixes. That’s an awesome take. I’d like to read more on how this works.

[FLEA]

I lean conservative but I for one could care less about socialized health care, and I think, for the most part, a lot of Republicans wouldn't. This is a great example of a potential compromise. Make an agreement for a balanced budget going forward and get Democrats to cave on an issue Republicans really so care about. 

Dems always want to lump gun control with healthcare. (Under Obama, the Natl Center for Disease Control was responsible for researching gun violence) 

Tell Dems they can have health care full stop but most agree to reciprocity for concealed carry and certain types of fire arms owner ship nation wide. 

Now you have something. 

One thing I wish from the left on this topic is they need to be more honest on it. You will increase access to healthcare but you will 110% decrease quality. If you've never had premium, private health care, it's night and day compared to the goose shit we get from Tricare. (Which is honestly probably better than whatd a full public system would be) 

I played a lot of sports in highschool and also did MMA. Getting access to steroids, pain killers and rehabilitation therapies was 1000X easier than the cluster fuck I need to go through now. Fortunately, I can thank Tricare for a permanent shoulder injury now because I doctor didn't want to jump straight to doing a contrast dye MRI when I knew I had a rotator cuff tear and thought 4 months of physical therapy exercising the tear would just magically make it go away. Great thing I can't sue the government! 

Oh and I want nation wide PT testing. No way I want to pay higher taxes cause some lazy ass doesn't know how to say know to Nachos and sprints to pre Diabetes at the ripe old age of 40. 

 

Edit: Germany is another good example of public compromise. Hope you didn't want anastetic for that minor out patient surgery because there's a good chance the government might not pay for it. Better suck it up! 

Edited October 20, 2020 by FLEA

[slackline]

I’ve already explained why it’s the best. We have the most medically advanced health care which provides a sustainment of life. Even though our society is very very unhealthy and usually by its own choices. Our medical care makes up for that.

And you don’t have to wait. Anyone can go to the ER at any time for almost anything. That’s not really true of socialist healthcare systems.

Opinions disguised as facts? You’re projecting. I don’t see where you have provided facts at all. In fact you take things out of context and make it a half truth then base a narrative on it. Very disingenuous.

You’ve explained aspects that are better than other countries. You’ve not provided data that quantifiably demonstrates that our system is the best. In some aspects, you’re absolutely correct, it is the best. But as a whole? How on earth is that not a subjective decision?

What have I taken out of context? I am no expert, so I’ll readily concede if that’s the case. What have I made a half-truth?

You claim things as irrefutable facts, like saying our nation’s healthcare system is the “best,” but cannot point to any set of data that clearly determines what is the best. When push comes to shove, in drastic measures, wealthy people come to the US to avoid lines. Great for the wealthy...

The provided links are anecdotal at best, but they lend credence to the fact that “one man’s trash is another man’s treasure.”

https://www.cbsnews.com/news/reverse-medical-tourism-points-up-pluses-and-minuses-of-us-healthcare/ Brief summary: rich people come here because US hospitals recruit them because they pay full price, and wealthy foreigners don’t want to wait in line. Middle-class US citizens go abroad because they can’t afford to pay for procedures here. That doesn’t sound like “best.”

https://www.numbeo.com/health-care/rankings_by_country.jsp We’re the bottom of the barrel of “good” healthcare systems. (https://en.wikipedia.org/wiki/Numbeo)

You continue to make the point that if someone doesn’t agree with you, they’re wrong, and you’re “facts” are the only valid ones. You immediately dismiss almost everything when it doesn’t line up with your line of thinking.

I know for a fact, I don’t have all the answers, and healthcare isn’t my strong suit. Some of your stuff doesn’t require you to be an expert to recognize that it is right along party lines. I’m all for individuals paying for their own healthcare, not having “wealth” taken from one to pay for another’s mistakes. I simply argue that, as has been pointed out on here by people smarter than me, there are ways to make the system cheaper and more accessible for those who aren’t as fortunate as I am. I don’t want to pay for their crap, but I do agree they shouldn’t have to go into massive debt to pay for it themselves.


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[GrndPndr]

2 hours ago, Negatory said:

Fine, I’ll concede Canada. There are bad examples, see my last post. But out of the 11 countries on there, 10 of them provide government healthcare. The US is the only one that says it’s impossible.

Who is paying for the healthcare in those ten countries?

[jazzdude]

Universal coverage arguments aside, here are less talked about fixes to costs I would push for that I think we could all agree on:
1. The residency program has been capped at the same level due to Congress since the 90s, shortage of doctors has followed since the population has grown significantly. Huge bottle neck at that point in the training pipeline so it needs to be increased.
2. Get rid of the 4 year bachelors requirement for medical school. Info is mostly useless. Most countries do 2 year premed undergrad on core courses + 3 year medical school. Would also help with student loan issue.
3. Redirect funding to preventative programs rather than curative programs.

4. Assess what is actually needed in the residency programs. They have been increasing in length over the years. You could argue it's to increase knowledge. You can also argue that hospitals are using residents as cheap labor (80 hour work weeks for $30-60k/year) to pad their budgets, and since new doctors must complete a residency, they have no real negotiating power for salary or work schedules, and can't just go to another program (since it is controlled by a central match board).

5. Increase the number of nurse practitioners and the scope of what they can do. This one has been on the rise in the last decade or so, and is a pretty contentious issue within the medical community, as they don't complete a residency before they can practice, and the scope of their training is more narrow. On the other hand, it makes for a cheaper, more accessible alternative to seeing a doctor, though the quality of diagnostics may not be as good. This is essentially how your bullet #2 has been put into practice.

But on bullet 1-that's federally funded... And you can't receive medical treatment from a doctor in the US unless they completed a US residency program. Who pays for that? (Taxation is theft!/s) Should Congress control the limits on residency program seats? Why hasn't the free market increased the number of residency seats due to a demand for doctors? Also, one private organization runs the match process, so there's no other way to attend a residency than to go through that organization. It's not a free market for doctors looking to work in the US. And if a doctor wants change specialties (say they are burned out working in an ER and want to switch to family medicine), they have to go back through a new residency program, which takes a seat away from a new doctor. Why can't a doctor just apprentice to an experienced doctor with X number years experience outside of a match process to satisfy their residency requirement?

On bullet 3, how do you encourage preventative care, especially for people without insurance, or have insurance with high deductibles/coinsurance costs?

I like your approach to this discussion-too often the issue gets distilled into a soundbyte about universal healthcare and polarized by both political parties, when the truth and heart of the debate really is in the middle. But that doesn't make for good news entertainment, not does it rile up the voting base, so...

[Negatory]

1 hour ago, Guardian said:

Disingenuous. They don’t say that it’s impossible. Just not cheap and won’t help the country as a whole and will infringe on rights and take wealth.

Semantics. They have universal healthcare we do not.

Oh and that’s with roughly the same quality of life that comes with living in a standard first world country.

Edited October 20, 2020 by Negatory

[jazzdude]

Oh and I want nation wide PT testing. No way I want to pay higher taxes cause some lazy ass doesn't know how to say know to Nachos and sprints to pre Diabetes at the ripe old age of 40. 

This line of reasoning gets really weird really fast, where the activities I enjoy are fine and of acceptable risk, but those other activities I don't enjoy are dangerous and shouldn't be covered. Maybe I don't want to pay higher taxes for people injured participating in MMA (or insert any moderate to high risk activity). Maybe I don't want to pay higher taxes for treatments for alcohol related issues, both acute or long term effects. I'm sure no one here has ever lied to their PCM about how much they drink at their annual physical. I do understand your sentiment here though regarding personal responsibility and taking an interest in one's own health.

This is the biggest thing that worries me about universal healthcare (especially when the line of discussion is to get rid of all insurance companies and go to solely government provide healthcare): access provided by the government may come with conditions that limit my choices elsewhere in life.

My other concern is that we essentially already have a nationalized healthcare system for a select group of people: the VA healthcare system. I can't imagine implementing something, which would probably look similar to the VA, for everyone in the US. Lots of people would be very disappointed, and we would've wasted a lot of money.

[17D_guy]

Thanks to DosXX and JazzDude, those are really interesting ideas and along the lines of what I was thinking.  There are real, tangible things we can do within out current system before we blow it all away.

That being said, a lot of the cost for care comes as early detection and follow-up weren't done as a part of routine care...because of a lack of insurance.

2 hours ago, Guardian said:

Disingenuous. They don’t say that it’s impossible. Just not cheap and won’t help the country as a whole and will infringe on rights and take wealth.

Said the same thing about a lot of programs by the government (ex. Social Security, Workers comp, etc.) yet here we are.  It's amazing to me we're one of the few Western nations that has this debate, and the fall back is, "It costs money, my freedom is being taken."  I lived in a lot of places during my active years all of them Western (except for a horrible stint in Korea) and I asked a lot of people about their health care, because like I said...family issues, and none of them bitched about it. Canadians, Australians, UK'ers, Germans.  Anecdotal, I know. (From that group Ozzies partied the hardest...by far.)

I read all your comments Guardian, a lot of it seems to boil down to, "I got mine, don't get sick, stop being poor."  I guess we'll keep helping each other with medical costs via GoFundMe.

[Lord Ratner]

On 10/17/2020 at 3:50 PM, slackline said:

We need a reset button. By no means advocating revolution, it would just be awesome to fire every single elected official at the federal level, so people understand their job security isn't so secure, and then elect people that understand what their job is: make the country work well.

That's not so much to ask, right? Haha


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Spread it out. Move the major federal institutions to different states. Dept of Education in Iowa, NRO in Maine, HUD in Alabama. You get the idea. D.C. is a big part of the problem. It's 2020, you can operate with physical separation.

Build a government made of the people who make up the country. 

[Homestar]

[slackline]

Spread it out. Move the major federal institutions to different states. Dept of Education in Iowa, NRO in Maine, HUD in Alabama. You get the idea. D.C. is a big part of the problem. It's 2020, you can operate with physical separation.
Build a government made of the people who make up the country. 

I’d never heard that before. I really dig that idea! Absolutely true as well. They’ll claim that for coordinating purposes it makes more sense to be together. I’d put money on the fact that they almost never talk to each other anyway... They can never talk to each other virtually! Some things have to be co-located, but I’d bet a lot less than people think.

Thanks!


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[Guardian]

Semantics. They have universal healthcare we do not.
Oh and that’s with roughly the same quality of life that comes with living in a standard first world country.

It’s not semantics. It’s taking something not true and trying to pass it off as true. That’s not the definition of semantics.

[Guardian]

Also in socialized health care a board can decide if you need the medical care or not or prioritize others health when you are deemed to be to old or too close to death, etc etc to get any long term value from the procedure. That’s how social medicine works. It can’t be readily available to everyone if it’s good. Think about that loved one in your life that has passed on or not and somehow benefitted from a life saving or altering procedure that they might not on the onset needed. Like someone who has a terminal illness getting an unrelated major proceedure that allows them to live a few years more under their terminal illness. In socialized Medicine a board can opt out of that procedure severely reducing the remaining quality of life or even ending the life early. No thanks. Socialism sucks. Capitalism allows us to take advantage of everyone’s talents for all involved’s benefit.

[Guardian]

Wish I had his hair. Glad I don’t have his wild ideas or religion.

Don’t know what you are implying with Matt And slack line. But I’m hoping you aren’t calling him a sexual deviant and woman abuser. Let’s stay above the personal attacks.

[Negatory]

36 minutes ago, Guardian said:

It’s not semantics. It’s taking something not true and trying to pass it off as true. That’s not the definition of semantics.

I think you, as someone in good faith who is clearly trying to understand what I’m saying, understood that the word “impossible” did not literally mean that it was not possible. It meant that some people argue that it couldn’t possibly work in the US. Or am I missing something here?

[Guardian]

Words mean stuff. Thanks for your retraction.

[Lord Ratner]

8 hours ago, slackline said:

You're ignoring the point. Car insurance is mandatory, and you can face repercussions/fines/penalties for not having it. Just because it doesn't come out of your paycheck upon receipt, doesn't change the law. Is that somehow unconstitutional?


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It's not necessarily mandatory. If you can demonstrate that you have a certain amount of money, insurance is optional depending on the state. The rule is there to protect other drivers from your mistakes. Not to protect you from anything at all.

 

In either case, you have a choice. 

[SurelySerious]

Devil’s advocate: you’re also not required to have a car with respect to the car insurance is mandatory aspect. 

[Prosuper]

Just now, SurelySerious said:

Devil’s advocate: you’re also not required to have a car with respect to the car insurance is mandatory aspect. 

Driving is a privilege not a right, the Government provides the infrastructure as in roads and bridges to grow economies and commerce. We to have follow the rules of the roads, if we continually violate the rules you lose your privilege. Does that stop you from driving, no, but the penalties of getting caught are severe. Just like our FAA issued Airmen certificates, it says  "Qualified to Exercise the "Privileges" of a pilot or mechanic. If we fly drunk or sign off shoddy work we lose that privilege .

[Homestar]

1 hour ago, Guardian said:

Wish I had his hair. Glad I don’t have his wild ideas or religion.

Don’t know what you are implying with Matt And slack line. But I’m hoping you aren’t calling him a sexual deviant and woman abuser. Let’s stay above the personal attacks.

Haha, I would never.... You're both good dudes....it's just the image that came to mind while watching this "discussion" on psychiatry....er, public health care and the U.S. Constitution.

[Prozac]

2 hours ago, Guardian said:

Also in socialized health care a board can decide if you need the medical care or not or prioritize others health when you are deemed to be to old or too close to death, etc etc to get any long term value from the procedure. That’s how social medicine works. It can’t be readily available to everyone if it’s good. Think about that loved one in your life that has passed on or not and somehow benefitted from a life saving or altering procedure that they might not on the onset needed. Like someone who has a terminal illness getting an unrelated major proceedure that allows them to live a few years more under their terminal illness. In socialized Medicine a board can opt out of that procedure severely reducing the remaining quality of life or even ending the life early. No thanks. Socialism sucks. Capitalism allows us to take advantage of everyone’s talents for all involved’s benefit.

Substitute ‘for profit insurance company’ for ‘socialized medicine board’ in your example. I’m not sure which one’s better but I at least theoretically get a vote with one of those examples. 

[ViperMan]

On 10/19/2020 at 4:30 PM, Breckey said:

We as a country have determined that we want certain segments of the population to have government supported health care and have for more than 50 years. Why is expanding this out to include others a bad thing if the voting populous determines that is what they want? 

Put simply, because of the cost. Healthcare is inordinately expensive.

On 10/19/2020 at 4:31 PM, Prozac said:

How do you separate the insurance aspect from healthcare? I’m not sure there’s a conversation to be had about the”best healthcare system in the world” without considering insurance in the equation. As far as “healthcare is not a right”, it’s abundantly clear that the majority of Americans would like it to be. https://www.pewresearch.org/fact-tank/2018/10/03/most-continue-to-say-ensuring-health-care-coverage-is-governments-responsibility/ 

The majority doesn't determine what is and is not a "right." Rights pre-exist government - they're not things that we all agree we should collectively pay for.

23 hours ago, drewpey said:

Are we as a culture ok with people falling into unrecoverable lifelong poverty and never returning to be productive taxpaying citizens for what amounts to losing a medical lottery?

I think the large majority of people would agree something should be done.  If so, what?

Not necessarily, but I am ok with it when people don't take care of themselves and become a burden on society. What is the balance? Take a look at many other modern cultures in the world - or non-modern for that matter. They do not look like us. From google (1st hit via the CDC: https://www.cdc.gov/nchs/products/databriefs/db360.htm#:~:text=Among men%2C the prevalence of,those aged 60 and over.😞

"Among men, the prevalence of obesity was 40.3% among those aged 20–39, 46.4% among those aged 40–59, and 42.2% among those aged 60 and over. Among women, the prevalence of obesity was 39.7% among those aged 20–39, 43.3% among those aged 40–59, and 43.3% among those aged 60 and over. None of the differences by age were significant."

Well over 1/3 (approaching 1/2) of Americans are medically obese. Let that sink in. Walk around Japan or Poland and you'll notice we do not look like them. They are thin. They are healthy. There is no way in hell I'm interested in paying for end of life care for approximately 1/2 of America, when it's visibly provable that they do not care about themselves. I'm not even interested in hearing arguments about it. I'm a hard "no." Now, we un-screw our food system and the way we eat and feed ourselves in this country and shape up our act, cool, let's start the conversation again.

22 hours ago, lloyd christmas said:

It doesn't.  Even if health care is believed to be a "right", the gov doesn't subsidize any of our other rights provided by the constitution.  Why should health care be any different?  Especially when so many of us do not take care of ourselves.  

Shack. You're 100% correct. Should the government pay for me to open a newspaper or buy me a bull horn? Freedom of speech is a right!! What about a gun. Right to bear arms!

21 hours ago, jazzdude said:

Why should the government provide healthcare coverage for military families/dependants at extremely low cost to the member? Should service members pay insurance premiums comparable to the national average for premiums?

At least for the service member, you could argue they should have healthcare coverage to protect the investment made in the service member if they have a critical skill. Should service members be covered for a pre-existing condition, or for medical accidents that happen not in the direct line of duty (say, breaking your arm while skiing on leave)? Or pay for coverage to cover non-line of duty accidents?

The government subsidizes lots of things. Food stamps, social security, medical research, basic science research, education, arts, conservation of wilderness areas, roads, housing, etc. It also (heavily) subsidizes defense. Basically, it's all an investment in our society to hopefully make us all better, even if it's not a "right."

What about combat zone tax exemption? Why not eliminate that? What purpose does it serve, besides essentially being a pay raise for doing the job we signed up to do? (Especially since HFP/IDP also exists)

 

"Should" they is a fine question - they don't have to. The argument is that they do because it makes a career in the service of your country more attractive. Take away that "right" (benefit) and you'll likely see recruiting and retention decline. Military healthcare is not a right - it's part of the compensation you're being given as part of the contract of your service. Same goes for your family.

11 hours ago, slackline said:

That’s all most of us are getting after in here, not advocating for a specific way to do it, but we maintain that the richest country in the world ought to be able to do a better job at taking care of its people than we do.

Stop blaming it on unhealthy fatties as well! There’s hundreds of thousands in this country that lost the lottery, and just have crappy health. No amount of eating right or exercise will change their health issues. Shouldn’t we help them without bankrupting them?

Half of America is OBESE!!! This kid is 10!!!! (Edit - he's 4). Let's fix this first. No it's not all the problem of obesity, but this is only one (1) problem that contributes to the health crisis in our country - there are many others.

10 hours ago, slackline said:

That's quite a stretch to say I'm looking for universal healthcare based off me saying it should be accessible. Nott looking for free, but we shouldn't be bankrupting anyone because they got cancer. Why is that so ridiculous a request?

I also said I don't have the answer. But certain people are unwilling to start the conversation because you can't get passed, "no, it's expensive". I've always told my guys, tell your boss "yes, but" and I've always told my bosses "yes, but". That should be the starting point. "No!" seems to be the only starting point some of you are willing to consider...
 

It is no until we fix some other underlying issues first. I'm not interested in forsaking people who truly lose the health lottery in life. But we MUST differentiate between those, and just blanket providing hundreds of thousands of dollars of care at the end of life for every American.

Edited October 21, 2020 by ViperMan

[Guardian]

Haha, I would never.... You're both good dudes....it's just the image that came to mind while watching this "discussion" on psychiatry....er, public health care and the U.S. Constitution.

Just being ornery. Didn’t think you were implying anything other than I’m a crazy loon. Probably true.

[slackline]

It is no until we fix some other underlying issues first. I'm not interested in forsaking people who truly lose the health lottery in life. But we MUST differentiate between those, and just blanket providing hundreds of thousands of dollars of care at the end of life for every American.

I get it, you don’t want to subsidize the healthcare of fat people. It pisses me off as well. The military has destroyed my body, back and neck are 10 kinds of jacked, but I take care of myself. I believe a lot more people should and could do a lot of the same thing. I eat right, and I exercise a ton. That takes care of a lot of my issues and keeps my QoL higher than it would be. If I can do that, they can do that... to an extent. Food that is healthy is waaay harder to get for low income families. Not just the prices (healthy food is more expensive than garbage food) are messed up, but there’s the time aspect. People working multiple min wage jobs often times have very little free time, so popping in the microwave dinner is faster than preparing healthy food.

That doesn’t excuse a gross neglect of your own health on the part of many fat people. I’m simply making the point that it isn’t as simple as “fat people should all die of diabetes because they’re lazy” which seems like what you’re advocating (heavy on the sarcasm there in case you were unsure). Oh, and guess what, there’s tons of fat people in the military driving up our healthcare costs. Fix that problem for us while you’re on your high horse (again, sarcasm meter should be in the ON position).

BL: we can do better, and if fat people get to go along for the ride, so be it... Again, people other than fat people need healthcare.


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[jazzdude]

Also in socialized health care a board can decide if you need the medical care or not or prioritize others health when you are deemed to be to old or too close to death, etc etc to get any long term value from the procedure. That’s how social medicine works. It can’t be readily available to everyone if it’s good. Think about that loved one in your life that has passed on or not and somehow benefitted from a life saving or altering procedure that they might not on the onset needed. Like someone who has a terminal illness getting an unrelated major proceedure that allows them to live a few years more under their terminal illness. In socialized Medicine a board can opt out of that procedure severely reducing the remaining quality of life or even ending the life early. No thanks. Socialism sucks. Capitalism allows us to take advantage of everyone’s talents for all involved’s benefit.

This is also how medical insurance works in our country. Except that it's not the government making the decision, but a private company out to make money for it's shareholders making that decision. And even with insurance, you can still run up some significant bills that wipe out savings pretty quickly. Especially if you end up at an out of network emergency room for a catastrophic event.

I think many countries that have socialized medicine also have a second layer of medical care, where you can buy treatments above/beyond the basic coverage, or accelerate timeline.

Even if you got rid of insurance and socialized medicine, so long as medical care is a limited resources, there will be some level of triage and prioritization of care

Either way/system, money buys options. Unfortunately, I'd wager that most of us don't have that kind of money laying around