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05 November 2019

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walrus

What about Hilary?

plantman

I don't think the Dems are losing because of their policies, but because they show no interest in governing. The last 3 years has been one lousy investigation after the other producing nothing of any value for the people who for them.

Name one Democrat who has tried to promote 'Medicare for all' legislation in the House or Senate in the last 3 years?

No one. So why should I believe they'll support it when they get elected?

They won't because its just a prop to get them into office. It's all a big ego trip. Just look at Joe Biden, the man thinks he walks on water, fer chrissakes.

These people are going to do what they say. It's all a joke. At least Trump is honest about it.

Jack

Sir

IMO. our runaway healthcare costs will bankrupt the federal government in the not too distant future. There’s no political will or consensus to reform our healthcare system to reduce costs and bring per capita expenditures to a level comparable to other western countries, which would mean expenditures of half what we spend today.

The Democrats Medicare for All does nothing to reduce systemic costs but just changes the payments to the current runaway cost structure to the federal government. As it is within couple decades half of federal government expenditures will be for healthcare and add in interest payments on the rapidly growing federal debt and we’ll see a significant squeeze in all other areas of government.

In 1960 we spent 5% of GDP on healthcare, today we spend nearly 18%. How long is this growth rate tenable before our healthcare system financing collapses?

I have read many studies that show that not only do we spend twice per capita compared to other Western countries but our health outcomes are worse.

“...U.S. has substantially higher spending, worse population health outcomes, and worse access to care than other wealthy countries. For example, in 2016, the U.S. spent 17.8 percent of its gross domestic product on health care, while other countries ranged from 9.6 percent (Australia) to 12.4 percent (Switzerland). Life expectancy in the U.S. was the lowest of all 11 countries in the study, at 78.8 years; the range for other countries was 80.7 to 83.9 years. The proportion of the U.S. population with health insurance was 90 percent, lower than all the other countries, which ranged from 99 to 100 percent coverage.”

https://news.harvard.edu/gazette/story/2018/03/u-s-pays-more-for-health-care-with-worse-population-health-outcomes/

Norbert M Salamon

Sir :
I do not know how to fix the US healthcare system. The present system is not working for the costs involved :

U.S. health care spending grew 3.9 percent in 2017, reaching $3.5 trillion or $10,739 per person. As a share of the nation's Gross Domestic Product, health spending accounted for 17.9 percent.

Source:
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

Life expectancy falling, medical costs are the prime reason for personal bankruptcies, compared to OECD countries the US system can be considered a relative disaster.

Seamus Padraig

Warren admits that around 2 million jobs would be lost in the health insurance business, and other health connected services. Her response to people rejecting such an outcome is to say that these people can go find work elsewhere, somewhere.
Not to defend Elizabeth Warren generally, but single-payer system would still be much cheaper and more cost-effective than the bloated private-insurance system we've got. Have you noticed that there's no country on earth that pays more per capita for health care than the US? And despite that fact, a great many 1st world countries--and even a few 3rd world countries like Cuba!--still have longer lifespans and lower infant mortality.

As far as the 2 million people who would lose their jobs--well, the principle purpose a healthcare system is to take care of people's not health, not to employ them. Most of those who would lose their jobs are just insurance company administrators and paper-pushers anyway; they can always transfer those skills to some other sector--or hell, even to the government! As long as the total number of patients doesn't decrease, we won't be seeing many laid-off doctors or nurses.

turcopolier

walrus

Waiting in the wings, my Hildar tell me that she has contributed much to the disruption in the Dem Party.

catherine

''Not to defend Elizabeth Warren generally, but single-payer system would still be much cheaper and more cost-effective than the bloated private-insurance system we've got. Have you noticed that there's no country on earth that pays more per capita for health care than the US? And despite that fact, a great many 1st world countries--and even a few 3rd world countries like Cuba!--still have longer lifespans and lower infant mortality.''

The overhead cost of administering the Medicare system is 2%...the overhead cost for private insurers is more than 20%.

Case closed.

Let the displaced for profit insurance workers get jobs with the expanded Medicare system.

turcopolier

All
My post is about the handicaps the Democrats face in trying to get one of them elected president, not about the US health system. I do not know how to fix that. "Medicare for all" is not "expanded Medicare." It is a totally new system in which there would not be premiums paid, just enormous government expenditures. Canadian and other single payer government systems operate on the basis of rationed health care for optional procedures like hip replacements. Funds are allocated or things like that and if they run out of money before they get to you, you wait for a further allocation.

Eric Newhill

Jack,
Repeating shallow sound bites isn't helpful.

We're spending more, as % of GDP, on healthcare now because new technology has been introduced that a) costs more b) allows each person to be treated - and treated more intensely - for more conditions c) allow more people to be treated for more conditions d) the aging of the baby boomers.

The socialized systems do not utilize the new tech as much and they ration care. BTW, in places like Australia, 50% of healthcare is paid for by private insurance. So a fair number of Australians don't believe their socialized system is so glorious. They don't like the rationing and they want the level of care that most Americans enjoy. They buy supplemental private insurance if they can afford it.

On a condition + demographic to condition + demographic comparison, the socialized systems do not perform better than the US. In fact, they perform worse. The life expectancy metric is not a good proxy for quality of care delivery. First, it is significantly skewed in favor of the socialized systems by differences in how infant mortality is defined. In the US if a baby dies after a day, it is considered a dead human citizen that lived one day. In the socialized systems, it is not considered a dead human that lived one day. Then there are all the drug abuse deaths and homicides in the US. There are also pockets of severe poverty in the US, mentally ill living on the streets; that sort of thing that helps drive down average life expectancy in the US. The US is not Europe.

Medicare for All, as expressed by Warren, would be a disaster for rural Americans. There is no way that care providers in lower patient volume zip codes can make it on only Medicare reimbursement rates. They will close their doors and move to higher patient volume areas. The best specialists everywhere will move to boutique practices where they accept only patients who can pay a higher fee out of pocket. This is not speculation. It is a proven fact that is seen each time insurance tries to lower reimbursement in these kinds of areas. BTW, by wiping out private insurance, there's also around $600 Billion in equity in insurance companies that would be evaporated over night in addition to the 2 million jobs.

Why does no one ever talk about how much healthcare insurance in the US is delivered by not-for-profit companies like Blue Cross/Blue Shield? How do those ubiquitous companies fit into the socialist sound bite model of greedy "bloated" companies raping the poor citizen?

The cost growth of Medicare for All gets worse because all of the D candidates have stated they want to make it available to all of the increasing illegal immigrants that come across the open borders they promote.

Then there's the Green New Deal and other so called climate change initiatives that would cost untold $trillions.

They're either lying to socialist minded dummies or they're really crazy; Either way I don't see how anyone votes for them.

Eric Newhill

Catherine,
No. Medicare does not administer for less. It is a dishonest statistic.

It works like this:
8/100 = .08 (or 8%) and 8/400 = .02 (or 2%). Medicare enrollees cost 4 times more than the < 65 population. If percent admin costs are calculated as admin costs divided by total healthcare expenditures then, holding admin costs constant, raising health care expenditures 4 times lowers your admin costs by a factor of 4. That's how they get to say that Medicare delivers healthcare more efficiently. It's an artifact of the way they calculate the statistic.

Medicare is not more efficient/cheaper and Medicare knows this. They openly admit it themselves. It's why they passed Medicare administration and risk off to private insurance. See Medicare Advantage and the history of it.

Also, a lot of private insurance overhead is committed to dealing with the massive and onerous regulations imposed by the federal and state govts.

Ytkealoha

Most of the military here have had socialized medicine their whole lives. Great for them but not for us workin stiffs

Eric Newhill

Sir, I contributed to the tangent. I won't anymore.

The democrats are trying to appeal to a very narrow slice of the population with their policies. As the economy improves, that slice becomes smaller. No one wants to give up their excellent employer based private healthcare coverage or pay the massive taxes associated with MfA or the GND. All they have left is "orange man bad!". When the impeachment falls apart, either in the house or the senate, what will they do next to keep the meme going?

I too think that Hillary is behind a lot of this and is just waiting to be invited - nay begged - to return to the stage.

Fred

plantman,

"they show no interest in governing"
California, Illinois, NY are all governed by Democrats; as are San Francisco, Seattle, LA, Detroit, NYC and many others. It is the Democratic party's policies as implemented by those democratic elected and appointed officials that are turning all of them into 3rd world standard states and cities.

Fred

Norbert,

Life expectancy is not fall because of cost. Cost "per person" is misleading on purpose. What percentage of those costs are on people 70+ years old and just what is it that costs so much?

Fred

Ytkealoha,

If only there was some other company out there to work for besides the one you imply gives you no health care. Perhaps you should enlist to get that health care as a part of your compensation.

Fred

The Michigan Democrats are planning on legislation to expunge felony convictions. Nothing like coddling criminals. When asked by multiple constituants how many people who made plea deals to avoid more serious charges are going to have sentances voided my state senator did the 'mass incarceration' song and dance. When asked when he will introduce legislation to hold prosecutors responsible for misconduct we got more shuck and jive.

http://www.legislature.mi.gov/documents/2019-2020/billintroduced/Senate/pdf/2019-SIB-0416.pdf

Other legislation out there that is criminal friendly are those passed in California chaning the felony level for theft to $900. That's driven a wave of crime across multiple cities in the state.
https://sanfrancisco.cbslocal.com/2016/05/14/shoplifting-california-prop-47-reduced-penalties/

I don't see this selling anywhere outside a lefty stronghold, but they are still pushing hard.

David Solomon

No Hilary, No Bill.... I Detest Trump, but I would not vote for Hilary, Bill, Biden, Obama or any of the other corporate patsies. We got Trump because of the trash that came before him.

casey

Tulsi? An unknown quantity, to be sure, but has she any chance?

Jay P. Tee

I'm going to take a wild guess that you never served in the military. Active duty members have Tricare, which they pay a premium for. I've been retired for quite a while so I don't know what those premiums are. If they leave active duty before they have the option to retire, they are no longer covered. If they do retire from the military, they have the option for several levels of Tricare insurance, which again, they pay a premium for. Once/If they reach the age of 65, they are entitled to Medicare, which they've paid into their entire working lives. The annual premium they get to pay for the privilege to enroll is dependent on which level of coverage they want. Oh, and they get to keep their Tricare as a secondary insurance, as long as they continue to pay their premiums.

"The opinion of 10,00 men is of no value if none of them know anything about the subject" Marcus Aurelius

Jack

Eric,

I understand you have an axe to grind to promote private for-profit health insurance. As Upton Sinclair noted: "It is difficult to get a man to understand something, when his salary depends upon his not understanding it."

You’re missing my point. I’m not arguing for or against private insurance or socialized medicine. Neither am I focused on sound bites. I’m purely focused on cost structure of healthcare delivery.

The indisputable facts are that the US spends double every other western country on a per capita basis. That removes the argument about population size. Second, US healthcare expenditures have grown from 5% of GDP in 1960 to 18% now. So, two things about that - healthcare costs growing faster than GDP growth and second growing at a rate where costs are doubling every 8 years. How sustainable is this growth rate of costs? What percentage of GDP should healthcare expenditures be?

You say this very expensive cost structure is due to technology and more intensive treatment. OK, what are the benefits - the ROI on this increased expenditure compared to other western countries? The Kaiser Foundation did a study on treatment of coronary and cardiac disease comparing treatment costs and outcomes across the OECD countries a few years ago. The US cost was 3x to 7x more than France, Germany & Canada for example but the outcomes were no better. Where’s the ROI? Take another example, many pharmaceutical drugs are 10x the cost in the US for the exact same drug compared to Europe. Why isn’t there a free market for pharmaceuticals in the US? Why is there a government imposed market cartel? Isn’t that socialism?

Germany and Norway and France and Canada and Australia are able to provide as good quality of health services as the US on metrics that matter like prevention and treatment of most common ailments in western societies like infectious diseases, cardiac diseases, gastrointestinal diseases, cancers at HALF the cost. People are not dying prematurely there nor are they suffering needlessly due to lack of adequate medical services.

The problem with the discussion on healthcare care in the US is that it always veers off into socialism vs capitalism; private vs government insurance; death panels and other forms of distractions and never into the nuts and bolts of cost structure and ROI on expenditures. There is no quantitative evidence that I have seen that show that the US healthcare care cost structure delivers DOUBLE the benefit compared to Germany or Australia.

blue peacock

Col. Lang,

Your note is exactly why Nancy Pelosi and the Resistance are intent on impeaching Trump. Rep. Al Green said it best, to paraphrase - We need to impeach him or else he'll get re-elected. The Dems don't want the American people to decide the Ukraine "quid pro quo" or Russian Collusion or any of the matters that they've been harping on since he was elected much to their surprise.

Unfortunately for us Trump is not a very good POTUS either. He clearly does not have firm grip on his administration and is not showing any kind of management ability of a large bureaucracy. Of course in his defense neither have other recent Presidents shown that ability. Another issue is that what he tweets and possibly what he intends policy to be and its actual implementation are two different things. A case in point is his recent "order" to withdraw our military from Syria. It seems we are still embroiled there militarily.

As we have been discussing here at SST on other threads, our politics have devolved in so many tangential ways. From increasing identity politics to blatant corruption wherein political & top governmental office have now become primarily a path to personal wealth & celebrity. The coastal and urban elites are on a different plane than the flyover Deplorables and there is no intersection. We see how this type of divide and outright corruption of the political & financial elite is creating populist unrest across the world from Lebanon to Iraq and Ecuador to Chile.

I wonder how the social forces will evolve over the next decade?

JamesT

Tulsi's only chance is if someone picks her as VP. She would make a *terrific* choice for Bernie and I think this is what she is aiming for. She has positioned herself as centrist as in "she appeals to those who vote republican" rather than "she is a corporate sellout".

I hope Bernie is smart enough to pick her as his running mate. I don't think Warren would, and Biden is bleeding from the aorta.

JamesT

As we all learned in high school math class, "mean income" is average of all incomes while "median income" is the income of the "average American". In other words if you lined up all Americans from the lowest earner to the highest earner, the one in the middle of the pack would have the "median income".

This is a chart of median incomes over time for eight OECD countries:
https://ourworldindata.org/uploads/2015/03/Median-HH-Income-Growth-Since-1980.png

The USA is ranked dead last. Just because the economy is growing doesn't mean the average American is sharing in that growth.

Norbert M Salamon

Fred you observation is correct [but also apples to all other countries], however, the figure of $10000.00+ per capita is just a marker for comparing USA to various nations.

The next most expensive country is Switzerland with $7900.00 while your neighbor [Canada] is at $4500.0 all these have longer life expectancies than USA .

It is true that I as a retired person only pay approx. 20% of prescription drugs, have to pay for denture, and glasses [as our family's income is over the threshold], but all other costs are covered by the state [including double hip-replacement in the near future for my wife].

Dave Schuler

Bernie Sanders is irrelevant. He will not be the Democrats' nominee. From the DNC's point of view his becoming the nominee would actually be worse than Trump being re-elected. He's not a member of their club. His being nominated would mean that being a Democrat means nothing.

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