Saturday, February 6, 2016

BernieCare

So the following FB discussion took place, and I promised to post a longer discussion, but as FB is not a good media for that, I have done it here on my blog. The subject is the constroversial BernieCare.

Posted on Facebook:
It’s time to join every other major nation and guarantee health care to all as a right, not a privilege. That's why my ‪#‎MedicareForAll‬ plan provides health care to ALL Americans, including the 50 million uninsured or Underinsured—the only plan that does that.
Medicare for All means no more copays, no more deductibles and no more fighting with insurance companies when they fail to pay for charges. Which means a family making $50,000 would save $5,807 a year under my #MedicareForAll plan.
I replied
1 - single payer - already failed on constitutional grounds when Obamacare wanted to do it. Why should we think Bernie will suddenly make it constitutional?
2 - same standard of care for people everywhere - um, how? works in Europe where a short ambulance ride can take you anywhere in the country - not so much in a country 4000 miles wide. Building that kind of infrastructure is incredibly expensive.
3 - Gov't could negotiate prices... it can now, but chooses not to. Look at Japan, where the gov't negotiates prices without providing the healthcare itself. BTW this is the only part of Bernie's plan that makes sense and is doable, and the least likely to actually be implemented.
The fact is whoever pays for medical treatment gets to say what medical treatment you can get. And when that decision is removed further and further from the patient, the patient has fewer choices about their own body.
and the O.P. replied (in part):
I'm one of the 29 million uninsured. I'm costing you money. I have a couple of chronic conditions that require doctors care that I do not seek out. Every time I do go to the hospital or doctor, I cost you money. I know that. You know that. 
..and with BernieCare you would cost me money whether or not you went to the hospital or doctor. This isn't really an argument for BernieCare but rather against it. But think about this. Obama promised that Obamacare would cover the 29 million (or 20, or 50 or whatever number you want to claim) uninsured. it did not.

It covered (debatably) 17 million people at a cost of $1.35 trillion. Those are the feds' own numbers, not my claim. That means Obamacare cost taxpayers $135 billion per year to cover 17 million people or $8,000 per person per year for insurance. That's not a bargain.

Now Bernie claims if we just do his plan it will cover the 29 million (or 20 or 50 or whatever numer you want to claim) and be cheaper. Why do we think it will be different? I'm reminded of the saying "fool me once, shame on you; fool me twice shame on me."
...I do have some experience with both the pharmaceuticals as well as the health insurance industry. It is an absolute nightmare. What is wrong with streamlining things, what is wrong with having one or a few systems (instead of hundreds...thousands?), more efficient! What is wrong with asking everybody to put some skin in the game? What is wrong with asking those who accumulate the most to contribute their fair share?
What is wrong with streamlining things? Nothing, but making something bigger usually is the opposite of streamlining. There's an underlying assumption that if big medicine was bigger it would be cheaper. Where's the rationale for this? Big medicine is expensive today precisely because it is big.

The is such a thing as "economy of scale" - where the incremental cost of making the millionth widget is smaller than making the first one. That leads to cheap goods through mass production. The problem with applying this to everything is that not everything fits the model.

First off, medical companies (by this I mean pharmaceutical companies, hospitals, insurance companies, etc.) are already big. We're not talking handling a dozen versus a million patients, but handling ten million versus one hundred million. There simply isn't anything more to be gained by economy of scale.

What we do lose is competition and responsiveness. Here I'm going to dive briefly into the principle of subsidiarity. From Wikipedia:
Subsidiarity is an organizing principle that matters ought to be handled by the smallest, lowest or least centralized competent authority. Political decisions should be taken at a local level if possible, rather than by a central authority. The Oxford English Dictionary defines subsidiarity as the idea that a central authority should have a subsidiary function, performing only those tasks which cannot be performed effectively at a more immediate or local level. 
[Subsidiarity] holds that government should undertake only those initiatives which exceed the capacity of individuals or private groups acting independently. Functions of government, business, and other secular activities should be as local as possible. If a complex function is carried out at a local level just as effectively as on the national level, the local level should be the one to carry out the specified function. The principle is based upon the autonomy and dignity of the human individual, and holds that all other forms of society, from the family to the state and the international order, should be in the service of the human person. Subsidiarity assumes that these human persons are by their nature social beings, and emphasizes the importance of small and intermediate-sized communities or institutions, like the family, the church, labor unions and other voluntary associations, as mediating structures which empower individual action and link the individual to society as a whole. "Positive subsidiarity", which is the ethical imperative for communal, institutional or governmental action to create the social conditions necessary to the full development of the individual, such as the right to work, decent housing, health care, etc., is another important aspect of the subsidiarity principle
So I ask, does the federal government do a better job of providing health care than private industry? If we look at government health care, such as the Veterans Health Administration or Medicare, the answer is a resounding NO!

What it has done is lowered the standard of care, treated human beings as products and objects and increased costs through the roof. Why? Because, for one thing, health care regulations are being written by health care companies, not by their patients. So the system is designed to maximize profit, not level of care.

Think of it this way. If you are going to buy a car you will find the one that best suits you at the best price. If you ask a random person to buy a car from you they will buy something that suits them with no regard to what it costs you. So it inevitably is when you have someone else paying the bills.

My mother was recently hospitalized. Medicare does not pay until the patient has been an in-patient for three nights. Guess how long her stay was? Did she need to be there three nights? Did she need to be there longer? That's immaterial. The hospital did what they had to do to maximize profit - they are a business.

Everything in the system is regulated such that the practitioners have to pay for the right to practice, and for the right to be paid. The patients have to pay for the right to get medical care, but also they can only use those providers and treatments that are approved (in other words, those that have paid to play in the system). You yourself have experienced this.

Is making the system bigger, and having less control over it going to improve the situation? No, it's going to give the patient less control over what happens to them.

That's not to say all government involvement in healthcare is wrong. Look at Japan. They have a higher standard of healthcare than the US and at a much lower cost to the patient. How? Not a single payer system, but rather government regulations of consumer cost. But implementing the things that have worked in Japan would mean US big business would become less profitable. Not going to happen here without grassroots effort - and certainly not imposed by a president.
I'll be perfectly honest at this point I don't give a s*** about constitutional, the Constitution guarantees the right to life. This is about providing that right to the people who the Constitution protects this is the ultimate protection. Health care needs to be accessible to all. When you put profits in front of people the people pay the price.

How ironic. First off, you'd darn well better care about the Constitution. The Constitution is the "contract" between the people and their government, which limits the power that the government can have over the people. It doesn't guarantee right per se, but limits the governments power to trample those rights that we have.

Throw it out and you give the government unlimited power over you. You will hold to the state religion, give up your guns, your rights to control your own body, your rights to own property, speak freely, etc. And no, this is not rhetoric. If change is to come it must come through a constitutional means or we have lost the freedoms of this country. even if something you like can't be done, it's still better to have the protections of the constitution than not. Ask the Germans, the Russians etc. about how well that works.

You do realize that giving the government a monopoly on health care means that they will in fact have the power of life and death over you - and they will deny claims. Every insurance company has to - the difference being with single payer there's no alternative when they do.

Secondly, you are right. health care does need to be accessible to all, and when you put profits in front of the people the people pay the price - but what you are suggesting is doing just that - institutionalizing and strengthening a system that puts profits ahead of people.
I'm tired of one person getting an effective treatment for the same condition that somebody else has and their insurance company can deny that coverage even if it will work. 

Again, look at Japan, not Europe. Stop putting more and more power into a bigger and bigger insurance system and start looking at regulating the cost to consumer and getting rid of excessive profits.
I'm so very tired of all this political posturing and bullshit. I feel left out of the entire political system. So I'm going to vote for the wild haired Jew who's impressed me with his humanist proposals. I'm going to vote where my conscience says I should.

And surprise, I agree with you (except for the wild haired Jew part). You should be involved, you should vote your conscience. But be an informed voter. Read beyond the campaign promises and look at what's real.

Both political parties have alienated the majority of American voters by pandering to their own power. I feel left out too. We all do. And perhaps it's time to dump the failed two party system.

But here's the thing - you and I have the same goals - just different ideas of the best means to get there. Too often people (especially on social media) demonize the person as wanting "X" (immigrants, the sick, women, children, etc.) to die, because they dont' agree with a particular law or policy. I frankly am sick of this tribalism (on both sides of the fence). Let's at least presume that people are decent and if they don't want law "X" or policy "Y" it's because they have a different law or policy in mind that they think is better, not because they hate people.

When you say "what's wrong with all people getting decent health care" I say "not a thing - let's do it!" The difference is not that one of us wants good things and the other wants to stop good things, the difference is that we have different ideas about the best way to provide those good things.

I believe that the best way to provide affordable health care is to give more control to the people, not big business. I believe that the role of the government is to level the playing field so the little guy has a voice in getting goods and services, not to be the sole provider of goods and services.

1 comments:

I enjoyed reading this blog post very much.
Dismas Eric McNail

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