Thread: By any other name ...

I don't see it as anything close to the same thing. I mean, it would still probably cause a lot of unforeseen consequences but there is a marked difference between being able to keep more of your own money or being force to pay out more from your own money.

ahoy Dblack,

from a conservative's point 'o view, i'd say that yer not gettin' yer taxes raised if ye don't decide to get healthcare. the GOP plan would just reward me fer somethin' i already have, which be health insurance. i think thats terrific, 'tis like givin' me a tax break fer breathin' or drinkin' rum. i am unclear how this would lower the cost 'o healthcare, and imma really unclear how this provides them who can't afford health insurance the resources to purchase it.

i think the Obama plan be more pro-business. its far better fer health insurance providers and it does a good job protectin' shareholder value in big pharma companies - it forces Americans to buy thar drugs here in our great and christian land. Merck can outsource...but you cannot. if ye own stock in Merck, this be a wonderful thing.

aye.

- MeadHallPirate

Originally Posted by MeadHallPirate

ahoy Dblack,

from a conservative's point 'o view,

(so, can I assume that everything after this intro is intended to not make sense? )

... i'd say that yer not gettin' yer taxes raised if ye don't decide to get healthcare. the GOP plan would just reward me fer somethin' i already have, which be health insurance. i think thats terrific, 'tis like givin' me a tax break fer breathin' or drinkin' rum. i am unclear how this would lower the cost 'o healthcare, and imma really unclear how this provides them who can't afford health insurance the resources to purchase it.

i think the Obama plan be more pro-business.

- MeadHallPirate

- - - Updated - - -

Originally Posted by fishjoel

I don't see it as anything close to the same thing. I mean, it would still probably cause a lot of unforeseen consequences but there is a marked difference between being able to keep more of your own money or being force to pay out more from your own money.

so, essentially you're saying "This one goes to eleven!"

Originally Posted by dblack

(so, can I assume that everything after this intro is intended to not make sense? )

- - - Updated - - -

so, essentially you're saying "This one goes to eleven!"

ahoy Dblack,

i don't know that the mighty Fishjoel saw that movie, but his response goes right to me point.

a conservative will see the two plans as different. i get a tax break if the GOP proposal wins the day, and you won't get it, but yer taxes won't go up.

the Affordable Care Act will penalize ye if you don't have health insurance, by raisin' yer taxes.

again, what imma baffled about be how the GOP way 'o doin' things insures them who can't afford such coverage.

- MeadHallPirate

Originally Posted by dblack

(so, can I assume that everything after this intro is intended to not make sense? )

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so, essentially you're saying "This one goes to eleven!"

MHP hit the nail on the head as I have no clue what you're talking about.

Originally Posted by fishjoel

MHP hit the nail on the head as I have no clue what you're talking about.

Ahh... guess I'm showing my age. It was an old movie quote. Sorry about being obscure. Look it up - maybe with "spinal tap" in the search line as well. It's funny stuff.

Anyway, the point I'm making is that there is no practical difference between tax incentives and mandates with tax penalties. Each creates the same relative situation - people who don't do what the government wants get punished with higher taxes. The only difference, which I guess is what you're focusing on, is that mandates actually raise tax revenues. Which makes mandates somewhat more fiscally responsible than tax credits as they aren't simply spending us into more debt.

There are probably other minor differences between the plans as well, but the core premise of the individual mandate, the idea that we should punish people who refuse to buy government approved insurance plans, is still there in all it's "glory".

And I suppose MHP is right, conservatives will fall for it. The insurance companies will have their way with us regardless. I suppose I was getting worked up about the Court's decision for no reason. It seems moot in light of Republican 'alternative'.

All I can hope is that the revised proposal to hopefully better manage medical care costs and thereby provide better access to those who chose to do so, will not be written in the failed and failing micro-management style of previous congressional legislation.

Both democratic and republican ideas pale in comparison to non-profit single payer and universal systems..

Health_spending_vs_physicians_oecd_2008.png



Life Expectancy

Japan........82.6 (non-profit universal)
Canada......81.4 (single payer)
France.......81.0 (non-profit universal)
Italy..........80.5 (universal)
Germany...79.8 (universal)
USA..........78.1 (for-profit)

Cost Per Capita

USA...........$7,437 (for profit)
Canada.......$3,844 (single payer)
Germany....$3,724 (universal)
France........$3,679 (non-profit universal)
Italy...........$2,771 (universal)
Japan..........$2,750 (non-profit universal)

% of Costs Paid by Government

Japan........%80.4 (non-profit universal)
France.......%78.3 (non-profit universal)
Italy..........%76.6 (universal)
Germany...%76.4 (universal)
Canada......%70.2 (single payer)
USA..........%45.1 (for-profit)

% of Government Revenue Spent on Healthcare

USA..........%18.5 (for-profit)
Germany...%17.6 (universal)
Japan........%16.8 (non-profit universal)
Canada.....%16.7 (single payer)
France.......%14.2 (non-profit universal)
Italy..........%14.1 (universal)

1111.png

Originally Posted by Criminal Rock

Both democratic and republican ideas pale in comparison to non-profit single payer and universal systems..

Health_spending_vs_physicians_oecd_2008.png



Life Expectancy

Japan........82.6 (non-profit universal)
Canada......81.4 (single payer)
France.......81.0 (non-profit universal)
Italy..........80.5 (universal)
Germany...79.8 (universal)
USA..........78.1 (for-profit)

Cost Per Capita

USA...........$7,437 (for profit)
Canada.......$3,844 (single payer)
Germany....$3,724 (universal)
France........$3,679 (non-profit universal)
Italy...........$2,771 (universal)
Japan..........$2,750 (non-profit universal)

% of Costs Paid by Government

Japan........%80.4 (non-profit universal)
France.......%78.3 (non-profit universal)
Italy..........%76.6 (universal)
Germany...%76.4 (universal)
Canada......%70.2 (single payer)
USA..........%45.1 (for-profit)

% of Government Revenue Spent on Healthcare

USA..........%18.5 (for-profit)
Germany...%17.6 (universal)
Japan........%16.8 (non-profit universal)
Canada.....%16.7 (single payer)
France.......%14.2 (non-profit universal)
Italy..........%14.1 (universal)

1111.png

All of the life expectancy numbers you put up there for the US are skewed low because our great medical care system is not distributed to all the people. A better comparison would be to subtract all of those without insurance from N and ascertain what the life expectancy would be then. Every scientific study to be accurate must only compare like subjects who have similar situations. It may be a good argument to cover everyone, something I support, but it still is not representative of how good our medical care really is and it is not a very scientific way to do a study.

We can assume that some of our excessive costs per person are also skewed to some extent by the indigent using ERs for basic care; and not getting the advantage of preventive medicine. Another reason for our high costs is the "cover your ass syndrome" practiced by doctors and hospitals to mitigate potential malpractice suits. So we can reasonably assume if we cured those two problems we could save a lot of money.

One of my personal favorite ideas (of course I did not dream this one all by my little self) is to require ALL HOSPITALS WHICH TAKE GOVERNMENT MONEY TO OPEN OUTPATIENT CLINICS to treat all indigents and to take the expense and burden of ERs.

Originally Posted by dnsmith

All of the life expectancy numbers you put up there for the US are skewed low because our great medical care system is not distributed to all the people. A better comparison would be to subtract all of those without insurance from N and ascertain what the life expectancy would be then. Every scientific study to be accurate must only compare like subjects who have similar situations. It may be a good argument to cover everyone, something I support, but it still is not representative of how good our medical care really is and it is not a very scientific way to do a study.

According to both the CIA and the UN, life expectancy in America is around 78 years. What you could say about this is the number doesn't represent the quality of life of those who can afford the most expensive insurance policies, but there is no legitimate reason to believe these numbers are skewed as they are not meant to selectively represent the dead who were able to afford the best doctors when they were alive. Regardless of the average life of those who can afford high quality care, the term "life expectancy" is a general consensus of human populations, "general" including both the poor and the rich.

So given the numbers aren't skewed, it still doesn't make sense to compare the life expectancy of the qualitative best cared for in America with that of, say, the UK because the way these two countries run their healthcare systems are inherently different. In the UK healthcare is meant to be accessible to all and affordable, in the US it's meant to be high quality and expensive. I hear what you are saying but life expectancy numbers have nothing to do with quality, only the average age when people die, so you can't say the numbers are skewed.

Originally Posted by dnsmith

We can assume that some of our excessive costs per person are also skewed to some extent by the indigent using ERs for basic care; and not getting the advantage of preventive medicine. Another reason for our high costs is the "cover your ass syndrome" practiced by doctors and hospitals to mitigate potential malpractice suits. So we can reasonably assume if we cured those two problems we could save a lot of money.

One of my personal favorite ideas (of course I did not dream this one all by my little self) is to require ALL HOSPITALS WHICH TAKE GOVERNMENT MONEY TO OPEN OUTPATIENT CLINICS to treat all indigents and to take the expense and burden of ERs.

Going to the ER is certainly expensive, I once worked with a guy who injured himself and went to the ER, setting him back like $13,000 for a cat scan, a few x-rays, and a consultation visit with a doctor. Having an open clinic for those who can't afford emergency care definitely would help with accessibility, but I am hard pressed to believe more doctors, more beds, more nurses, which I assume is necessary to open an Outpatient Clinic, would drive down longterm costs unless it was strictly preventative care where then people would still need to go to the ER for emergencies.

Fuck the ACA, fuck the GOP's bullshit.. single payer is the way.

Originally Posted by Criminal Rock

According to both the CIA and the UN, life expectancy in America is around 78 years. What you could say about this is the number doesn't represent the quality of life of those who can afford the most expensive insurance policies, but there is no legitimate reason to believe these numbers are skewed as they are not meant to selectively represent the dead who were able to afford the best doctors when they were alive.

If one is measuring the quality of our medical care system those not covered should be removed from the study. If measuring how well we cover our people then by all means keep everyone in the study. But studies are mean to determine what is good or bad about a system, primarily to show how far behind one group may be from another. If this were done then we would be graded well on the QUALITY of our medical care, but we would be graded poorly on how we DISTRIBUTE our medical care.

Regardless of the average life of those who can afford high quality care, the term "life expectancy" is a general consensus of human populations, "general" including both the poor and the rich.

Granted! But in my opinion by doing it that way it doesn't tell the true story as to how poorly we treat those without adequate coverage. IE, if we were to show that for that 85% who have good health insurance the life expectancy is 82 (fictional number) but the life expectancy of those without good health insurance is only 63 that would tell a much more accurate and usable statistic and show us exactly what we have to work on.

So given the numbers aren't skewed, it still doesn't make sense to compare the life expectancy of the qualitative best cared for in America with that of, say, the UK because the way these two countries run their healthcare systems are inherently different. In the UK healthcare is meant to be accessible to all and affordable, in the US it's meant to be high quality and expensive. I hear what you are saying but life expectancy numbers have nothing to do with quality, only the average age when people die, so you can't say the numbers are skewed.

I disagree, but only for the reason the poor service we give our poor does not see the light of day when all of N is lumped into one census.

Going to the ER is certainly expensive, I once worked with a guy who injured himself and went to the ER, setting him back like $13,000 for a cat scan, a few x-rays, and a consultation visit with a doctor. Having an open clinic for those who can't afford emergency care definitely would help with accessibility, but I am hard pressed to believe more doctors, more beds, more nurses, which I assume is necessary to open an Outpatient Clinic, would drive down longterm costs unless it was strictly preventative care where then people would still need to go to the ER for emergencies.

At issue is, our ERs have to be overstaffed for emergencies because of the non-emergencies they must see. I could tune the idea a bit more by saying that daytime out patient care could be handled by county health units with the addition of a few PAs, and moving on or two nurses or PAs to an outpatient non-emergency clinic for non-emergency evening hours would save money and lives.

Fuck the ACA, fuck the GOP's bullshit.. single payer is the way.

I don't buy that part at all. I lived in Europe for 16 years. The German system is pretty good, but waits are longer for non-emergency services and the people who want better service have to buy a private policy to bridge the gap. In Spain the care is very slow if you don't go to the hospital gushing blood.

The quality of care we have for the 85% works well and is very good. The issue is covering everyone else. I have proposed automatically issuing everyone a medicaid card, then using IRS returns, if one does not have his on private coverage bill him to cover the costs. If the individual is poor, let the government pick up the bill. But if it is simply one of the 8% of our people who simply opt out (for cash) of the care offered by their employer, watch how fast they jump through hoops to get coverage.

Originally Posted by dnsmith

If one is measuring the quality of our medical care system...

Hold up for a second... define quality. This is, I believe, where we start to see things differently. I don't know which particular study you are referring to, but my statistical analysis presumes accessibility as one of many qualities of a healthcare system. So given that it is a part of a health care systems overall quality, how else are you going to measure and compare said quality between various systems when in one country they enact policies that insure only those who can afford it and the rest enact policies that insure the entire population? Also, my analysis, nor other studies like it for that matter, never implicates the quality of care America has to offer, which seems to be the crux of your argument, but instead compare the quality of healthcare systems between countries, and the resulting life expectancy of population, cost per capita, % of cost paid by government, among other effects these policies have on the entire population.

The simplest way I can put my argument is, a populations access to a healthcare system helps define its quality. Therefore in order for an analysis like mine to remain scientifically literate it would need to include the average lifespan of all citizens and not only those who have access. Or in this case, not only those who can afford quality care. I can't find any reason to exclude one demographic in one country simply because they are too poor to afford insurance since the entire point was to illustrate how costly and exclusive our insurance policies are compared to other systems and the resulting effect it has on the entire country.

In the end would qualifying the statistics your way really make that much of a difference? the poor will still be without insurance and will still be dying much earlier because of that, and at the same time we would remain behind other countries in overall life expectancy. All this would do is break down what we already know.. those who can't afford insurance die earlier, and those who can afford insurance live longer. It's also impossible to compare the life expectancy of those without insurance in america with any other industrialized country since everyone else in those countries are insured. In a head to head analytical comparison of healthcare system policy like mine your statistic would be useless.

Originally Posted by dnsmith

At issue is, our ERs have to be overstaffed for emergencies because of the non-emergencies they must see. I could tune the idea a bit more by saying that daytime out patient care could be handled by county health units with the addition of a few PAs, and moving on or two nurses or PAs to an outpatient non-emergency clinic for non-emergency evening hours would save money and lives.

Sorry I don't know enough about that to have an opinion.. any links?

Originally Posted by dnsmith

I don't buy that part at all. I lived in Europe for 16 years. The German system is pretty good, but waits are longer for non-emergency services and the people who want better service have to buy a private policy to bridge the gap. In Spain the care is very slow if you don't go to the hospital gushing blood.

Is that supported by any evidence? I tried searching for something, the only relavent fact I see is that Germany, back in 09', had a better doctor to patient ratio than the US according to wikipedia, perhaps the doctors are spending more time with their patients?

I worked in the UK for a little over a year back in 07-08' and was insured through a training program while there, but never needed to use the system. The English seemed to take a lot of pride in the fact that everyone was covered even for working foreigners like myself. Wait times were an issue there too, but this seems to be an issue everywhere, even in the Americas.. though in my opinion, as long as emergencies are prioritized accordingly (for children, the elderly, people with pre-existing conditions, and of course for the dying...), it probably won't make a difference in the overall quality of a healthcare system if say a 25 year old man has to wait a few more hours for a doctor to see his broken arm. All I know is I look forward to the day we can have a debate over which system has shorter waiting times for such superficial injuries..

Originally Posted by dblack

And here comes the stupid. Republicans are planning to offer up a radical alternative to Obamacare - repealing it and replacing it with.... (wait for it)....

The same fucking thing!!!

See, Obama wants to mandate that we buy insurance and make people who don't pay more in taxes. Republicans want to encourage us to buy insurance by making people who don't pay more in taxes. Different as night and day.

I don't understand how it could be different. Let's suppose it is, I don't understand how it would be more efficient. Let's suppose it is, I don't understand how it works. One single sentence completely lost me:
"One question is how to structure such tax credits. Are they available just for the uninsured?" What does it mean?! One proposal is to make health insurance tax free for all - instead of just employer plans - so it would be available to all but the uninsured... and what, once they get insured they lose the incentive? What the... however it's done it will end up encouraging people who already have health insurance to buy health insurance, and even if that was a sane way to throw one's money out of the window, it's just a more costly ACA...
There are lots of details to go through but I don't want to work that out, for now it's just some analysts proposing ideas, good or bad, for politicians it's still the Ryan plan.