Healthcare Hypocricy?

[RoyalShock]

A less effective system is justifiable if the alternative violates the Constitution. That's the bottom line for me.

[Kung Wu]

There are many factors causing costs to Americans for health care to increase, by I suspect the largest reason is GOVERNMENT INTERVENTION in the health care industry. Let me Google that ... ooops, yup, look at that. Right off the government's own website: http://www.usgovernmentspending.com/healthcare_spending

Take a little look at that blue chart right there. That is showing state + federal combined GOVERNMENT spending as a percent of GDP -- forget the private sector. Government alone, from the time it founded medicaid/medicare caused the health care expenditure in the US to jump from below 1% in 1960 to over 7.5% in only 45 years. All. By. Itself. Now who has to cover those costs? Ohhhhhh, it's the people that cover those costs that ALSO HAVE TO COVER THEIR OWN. So now the middle class is shouldering the burden of the government's overspending to the tune of 7.5% of the GDP plus having to buy their own insurance on top of that -- and boom you now have a population paying 17.6% of the GDP on health care.

Another factor driving up costs is that Americans aren't paying squat out of pocket anymore. They have cashed in responsibility and proper use of insurance for maintenance insurance. This has the side effect of Americans not "feeling the pain" when they go to the doctor for every sniffle -- oh but they are paying for it in the form of increased premiums. Guess what ObamaCare makes that WORSE because it caps the out-of-pocket expenses -- but you won't feel that dagger until 2015. Here's a nice little chart showing you how the government plus maintenance program attitude has taken over (hit the play button at the top a couple of times and it will sink in what you are looking at):

http://www.chcf.org/publications/2013/09/data-viz-hcc-national

As the green and auburn color gets bigger and the orange decreases, insurance and the government is covering a higher and higher percent of medical costs. That means the insured's premiums AND taxes are going up and up. You want those premiums and taxes to decrease? You need a LOT more orange and a LOT less green and auburn. But ObamaCare is doing EXACTLY the opposite of that. It's making the green as large as it possibly can and putting as much pressure as possible to increase the auburn boxes. And that's why rates are going through the roof as we speak. We haven't even seen the caps and other crap hit the fan yet -- those don't happen until after the next election cycle.

The US does have higher salaries for most positions, though that is not always the fault of big scary government.

Huh?

I laugh at the idea that the US has more "liberty" because we pay our doctors more though; freedom is not measured in dollar bills.

Laugh like a fool if you want to, but liberty most certainly involves having choices. The choice to go to the most expensive doctor at the best hospital in the world, John Hopkins, or the choice to go to the county clinic where your service will be free. Single payer absolutely tears at the fabric of being able to make informed economic decisions about your own health care.

However, if we are going to judge people solely by their economic freedom, we need to get to get a more complete picture. Looking at the facts, both our doctors and our general populace has less economic freedom than their European counterparts. Let me explain what I mean:

Here is a chart showing average compensation for specialists, general practitioners, and nurses in most of the world. And yes, US healthcare professional make more money.

Ain't it great to be an American?

But what chart doesn't tell is the debt needed to get a medical degree in the US. As you can see here, the average debt for a US medical school graduate is $161,000, with over 3/4 of the students graduating with at least $100,000 in debt. Meanwhile the cost of entry in European countries is much lower, or even non-existent.

Guess what? You are welcome to apply at ANY university in the world to get your medical degree. Capitalism at work bay bay. If you choose to go to medical school in the United States and eat $100,000 in debt before you get started, whose decision was that? If it's so terrible why didn't they go overseas to get that cheap ass education? Why do so many foreigners choose the U.S. for their medical education, when it's the most expensive? They aren't being coerced to. Hmmm. Maybe, just maybe, it's because the U.S. has the best health care universities in the world?

Yet in your mind it's completely reasonable that the U.S. is spitting out doctors that are providing worse health care than 36 other countries.

So while US healthcare professionals make more, they give a large portion of that back to pay off their debts.

So specialists plus general practitioners are averaging about $200k/yr in the US in income. If the government wasn't taking 40+% of their income they could have the $100k debt paid off in a year. But they get half their ass taken from them right off the top in order to pay for the failed social programs you champion, so it takes a few more years. Hmm, maybe that's why so many foreigners come over for education in the U.S.? They get the best education and can make a nice coin providing the best health care in the world to Americans.

And now look at what our healthcare system does for the economic freedom of the average citizen in the US.

WRONG. The "average citizen" in the US HAS INSURANCE. About 85% of Americans ARE INSURED. This is BEFORE ObamaCare. That number could very possibly DECREASE due to ObamaCare, not get better.

To jump straight to the point, medical bills are the leading cause of bankruptcy in the US.

The VAST majority of the remaining 15ish% (I think it's actually smaller -- but about 40 million people) uninsured WANT to be uninsured. If they are poor, they have access to medicaid and have chosen not to take the insurance. If they are middle class, they have made a choice not to buy insurance. In fact, some people intentionally don't have insurance because their non-medical related debt load is so high that they figure if they have a sudden illness they can use bankruptcy as a pressure relief valve -- yet they still have access to the best health care in the world.

Now of those 40 million, there are DEFINITELY people in an "uninsurable" situation due to pre-existing conditions. They are less than 1% of the population (about 2.5 million of them). Those are the people we have to focus on and giving consideration to pre-existing conditions compromises is reasonable -- but it has to be well thought out. It will raise premiums no matter what and we just have to stomach that. But if not well thought out it is doomed to cause serious economic problems.

So to say that we are more free because we pay our doctors more is simply incorrect.

That's not what he implied. He implied we are more free because we have the CHOICE to seek out higher quality doctors if we can afford it and choose to do so.

If we account for our high medical debts and bankruptcies from the high cost of our healthcare, we find that the US's system is prohibitive to economic freedom.

I'll just let that wrong sauce stew in the pot it's simmering in.

[CBB_Fan]

A less effective system is justifiable if the alternative violates the Constitution. That's the bottom line for me.

It may be against not mesh with a strict interpretation of the Constitution favored by many small government advocates, but ever since the New Deal the Supreme Court has held that Congress has the authority to address all activity, "whatever its nature ... if it exerts a substantial economic effect on interstate commerce."

If the strategic character of this industry in our economy and the chaotic conditions which have prevailed in it do not justify legislation, it is difficult to imagine what would. To invalidate this Act we would have to deny the existence of power on the part of Congress under the commerce clause to deal directly and specifically with those forces which in its judgment should not be permitted to dislocate an important segment of our economy and to disrupt and burden interstate channels of commerce . . . . Congress under the commerce clause is not impotent to deal with what it may consider to be dire consequences of laissez-faire.

(source: Sunshine Anthracite Coal Co. v. Adkins, 310 U.S. 381, 395-96 (1940).)

This applies to the healthcare problem, which as the bankruptcy data shows is perhaps the largest financial issue in the US. By the argument put forth after the New Deal, Congress has the ability to deal specifically and directly with healthcare in order to gain social, health, and economic advantages for the American people.

[Kung Wu]

So when I look at healthcare, I don't care the morality of government social programs, or slightly higher taxes. Those don't matter to me unless they actually have big picture consequences. To me, what matters is:

A) How much healthcare actually costs, both for the individual and to the government
B) How the healthcare system affects the economy, especially in regards to how it affects individual financial freedom (defined as how likely it is an individual will be financially ruined by high healthcare costs)

Aha! We're getting somewhere. You don't care about:

C) How good the health care in the U.S. is.

You only care whether each person has EQUAL access to it. Margaret Thatcher summed up your position nicely, you "would rather that the poor were poorer, provided that the rich were less rich."

[SB Shock]

Here's a map of how the ACA prices are expected to be effected by state. It was done by the Society of Actuaries

Here is the graph....I'm sure '79 wants to see it. Sucks to be CA.

Capture.JPG

[CBB_Fan]

There are many factors causing costs to Americans for health care to increase, by I suspect the largest reason is GOVERNMENT INTERVENTION in the health care industry. Let me Google that ... ooops, yup, look at that. Right off the government's own website: http://www.usgovernmentspending.com/healthcare_spending

Take a little look at that blue chart right there. That is showing state + federal combined GOVERNMENT spending as a percent of GDP -- forget the private sector. Government alone, from the time it founded medicaid/medicare caused the health care expenditure in the US to jump from below 1% in 1960 to over 7.5% in only 45 years. All. By. Itself. Now who has to cover those costs? Ohhhhhh, it's the people that cover those costs that ALSO HAVE TO COVER THEIR OWN. So now the middle class is shouldering the burden of the government's overspending to the tune of 7.5% of the GDP plus having to buy their own insurance on top of that -- and boom you now have a population paying 17.6% of the GDP on health care.

Another factor driving up costs is that Americans aren't paying squat out of pocket anymore. They have cashed in responsibility and proper use of insurance for maintenance insurance. This has the side effect of Americans not "feeling the pain" when they go to the doctor for every sniffle -- oh but they are paying for it in the form of increased premiums. Guess what ObamaCare makes that WORSE because it caps the out-of-pocket expenses -- but you won't feel that dagger until 2015. Here's a nice little chart showing you how the government plus maintenance program attitude has taken over (hit the play button at the top a couple of times and it will sink in what you are looking at):

http://www.chcf.org/publications/2013/09/data-viz-hcc-national

As the green and auburn color gets bigger and the orange decreases, insurance and the government is covering a higher and higher percent of medical costs. That means the insured's premiums AND taxes are going up and up. You want those premiums and taxes to decrease? You need a LOT more orange and a LOT less green and auburn. But ObamaCare is doing EXACTLY the opposite of that. It's making the green as large as it possibly can and putting as much pressure as possible to increase the auburn boxes. And that's why rates are going through the roof as we speak. We haven't even seen the caps and other crap hit the fan yet -- those don't happen until after the next election cycle.



Huh?



Laugh like a fool if you want to, but liberty most certainly involves having choices. The choice to go to the most expensive doctor at the best hospital in the world, John Hopkins, or the choice to go to the county clinic where your service will be free. Single payer absolutely tears at the fabric of being able to make informed economic decisions about your own health care.



Ain't it great to be an American?



Guess what? You are welcome to apply at ANY university in the world to get your medical degree. Capitalism at work bay bay. If you choose to go to medical school in the United States and eat $100,000 in debt before you get started, whose decision was that? If it's so terrible why didn't they go overseas to get that cheap ass education? Why do so many foreigners choose the U.S. for their medical education, when it's the most expensive? They aren't being coerced to. Hmmm. Maybe, just maybe, it's because the U.S. has the best health care universities in the world?

Yet in your mind it's completely reasonable that the U.S. is spitting out doctors that are providing worse health care than 36 other countries.



So specialists plus general practitioners are averaging about $200k/yr in the US in income. If the government wasn't taking 40+% of their income they could have the $100k debt paid off in a year. But they get half their ass taken from them right off the top in order to pay for the failed social programs you champion, so it takes a few more years. Hmm, maybe that's why so many foreigners come over for education in the U.S.? They get the best education and can make a nice coin providing the best health care in the world to Americans.



WRONG. The "average citizen" in the US HAS INSURANCE. About 85% of Americans ARE INSURED. This is BEFORE ObamaCare. That number could very possibly DECREASE due to ObamaCare, not get better.



The VAST majority of the remaining 15ish% (I think it's actually smaller -- but about 40 million people) uninsured WANT to be uninsured. If they are poor, they have access to medicaid and have chosen not to take the insurance. If they are middle class, they have made a choice not to buy insurance. In fact, some people intentionally don't have insurance because their non-medical related debt load is so high that they figure if they have a sudden illness they can use bankruptcy as a pressure relief valve -- yet they still have access to the best health care in the world.

Now of those 40 million, there are DEFINITELY people in an "uninsurable" situation due to pre-existing conditions. They are less than 1% of the population (about 2.5 million of them). Those are the people we have to focus on and giving consideration to pre-existing conditions compromises is reasonable -- but it has to be well thought out. It will raise premiums no matter what and we just have to stomach that. But if not well thought out it is doomed to cause serious economic problems.



That's not what he implied. He implied we are more free because we have the CHOICE to seek out higher quality doctors if we can afford it and choose to do so.



I'll just let that wrong sauce stew in the pot it's simmering in.

As a large portion of your post is based around factual inaccuracies and assumptions, I'll address those first.

#1. Government intervention is causing high prices.

I've addressed this several times, and it simply is illogical to think that government intervention in the form of a single-payer system would increase prices, given the statistical evidence that shows single-payer systems are more efficient than our current form of insurance.

#2. Government insurance premium and taxes go up at the same time, therefore one causes the other.

Correlation does not imply causation.

#3. Americans get more healthcare options now than they would with a single payer system.

This is false, and actually the total opposite is true. Only 10% of Americans have insurance that isn't from an employer, which means that very few Americans actually have the ability to choose between insurance providers. Because insurance companies control which procedures are covered, this means that Americans actually don't have control over those choices.

#4. Single payer systems eliminate choice

Single payer systems almost always have private supplemental insurance, and transparent cost structures. This means most European citizens have the ability to pick and choose which procedures they want covered and how much they want to pay (including "nothing outside of taxes"). Your analogy actually is completely backward in that regard.

#5. You can apply to any university you want and get the same benefits as citizens

This is false. While some European countries do allow foreign citizens to have access to their subsidized education, it is not true that any American could apply to a European college and receive the same debt-free education that a citizen of that country could.

#6. The US has the best medical colleges in the world

This is somewhat true, but the idea that the US has a monopoly on top notch medical schools is not true. Out of the top three schools, two are in Britain. Out of the top 10, 50% of them are foreign colleges (a trend that extends downwards through the rankings).

#7. Doctors are coming to the US from subsidized education countries to get better schooling

This is incorrect. The vast majority of incoming students are coming from industrializing nations (India, China, Saudi Arabia) with rapidly expanding upper classes. These students are coming to the US because the US has better colleges than their home country and a shortage of doctors. A few European students also study in the US, but not necessarily more than the students from the US getting degrees in Europe.

#8. The US has the best doctors in the world

While US doctors scored slightly better in exams and had higher marks in reviews during the 1990s, this gap hasn't existed since the 2000s.

#9. US doctors would be fine without social programs taking their money

As with #1, single payer systems cost less than the current government subsidies, so this simply is not correct. There are other problems in this bit of logic, but I only have a limited amount of time right now.

#10. Insurance = economic freedom

It doesn't matter whether or not the majority of Americans are insured or not. The question is whether or not medical care is prohibitively expensive, and it is, even with insurance. In the link about bankruptcies, other data showed that nearly 10 million people with year-round coverage will file for bankruptcy from high costs each year. It further shows that 11 million people will use credit card debt to pay for medical bills. 15 million will deplete their savings to pay for healthcare, and 10 million will be unable to pay for necessities because of medical expenses.
#11. As long as we have the best healthcare for the rich, we can ignore the poor's inability to pay

Note, I don't think we have better healthcare even for the rich, or more choice. But even the basic premise that it is okay to ignore poor people as long as the rich can choose their doctor (aside from the fact that they have the same ability in Europe) is both immoral and economically unfeasible. Viewing baseline healthcare as a necessity, and not a luxury is vital to our nation's economic health and the health of our citizens (ALL of our citizens)

There are more, but I am running out of time, so I'll wrap this up. Basically, you have an inaccurate view of both our current situation and the reality of a single-payer system. I'll note that I have never endorsed Obamacare as an effective plan for healthcare, so attacking me on how Obamacare is failed policy isn't really an attack on my position. I believe Obamacare is middle-ground solution that accomplishing nothing in a very expensive way.

I'll also note that I am not totally against a private insurance system; Switzerland proved it can be done. The difference between the Swiss system and ours is that we have localized monopolized and oligarchies subsidized by the government (very much like ISPs), but the Swiss have a true competitive free market on the high end with prices kept low by government set minimums. To approach the Swiss system, we'd need to remove restrictions about buying out-of-state insurance, eliminate employer-based coverage, mandate and set minimal levels of coverage, and subsidize costs past a certain portion of the recipients income.

Aha! We're getting somewhere. You don't care about:

C) How good the health care in the U.S. is.

You only care whether each person has EQUAL access to it. Margaret Thatcher summed up your position nicely, you "would rather that the poor were poorer, provided that the rich were less rich."

I believe that the affordability of healthcare coverage is the most important issue, yes. Care that is prohibitively expensive for all practical purposes does not exist as an option for most Americans. Your summation is entirely inaccurate, in that any effective plan would increase the affordability for low and middle class citizens while keeping options open for those that can pay (IE, like every European country does). Again, single-payer systems still offer choice, in the form of supplemental private insurance; in many ways that system provides more choices for the average citizen than our current healthcare plan does.

This also ignores that the US does NOT have the best healthcare, even for the rich. As I previously posted, even rich white Americans die at higher rates than their European counterparts. In fact, we rank badly on almost every health related standpoint, even if we ignore the higher costs.

[1979Shocker]

Here is the graph....I'm sure '79 wants to see it. Sucks to be CA.

[ATTACH=CONFIG]929[/ATTACH]

Is there an updated map? That one is from March 2013.

New York wouldn't be that bad if everything else there wasn't so high.

[SB Shock]

Is there an updated map? That one is from March 2013.

New York wouldn't be that bad if everything else there wasn't so high.

I'm sure there is.

BTW, California opted out of the Government exchange.

[shock]

Was browsing reddit, getting ready for my daily dose of socialist agenda from my Age of Total War professor, when i found this--

You have to keep in mind that these are really smart people. You really have to conclude that they are evil-to-the-bone to constantly harp on something without any valid reason to do so. Is every single smart person that is against Obamacare really that evil? Ted Cruz graduated cum laude from Princeton and magna cum laude from Harvard Law School, where he was an editor of their Law Review. He clerked under William Rehnquist, Chief Justice of the US Supreme Court. That's only the #1 most prestigious job that a newly minted lawyer can get. The point is that he has more brain power than both of us put together (and I went to a top tier school). So is Ted Cruz really THAT evil?
Hopefully now you are starting to contemplate whatever possible merits their position might have. One is very obvious: it is a huge disruption to a very large sector of the economy. A system that was already operating at near over-capacity is about to get a flood of new patients. It takes physicians four years to graduate medical school. It takes longer than that for medical schools to bolster their facilities in order to accommodate larger medical school class-sizes. The new medical campus in my state only opened last year, so it will be another three years before those first students are even in residency programs. When we zoom out from the daily political nonsense, what we have is very big change occurring in a relatively short time-frame, in a sector that makes up roughly 18% of US GDP. The risks inherent in that scenario should be obvious to anyone that truly gives the issue some critical thought.
I know this won't be popular, and I truly apologize for the tone of my response to your very well-written comment (no sarcasm, it had really good points and I enjoyed reading it), but I flat-out disagree with the demonization of Republicans when it comes to Obamacare. I agree with the stated goals and intentions of Obamacare (however there were some pretty obvious solutions that Democrats intentionally left out, such loosening the restriction on drug importation and reimportation from foreign countries, allowing Medicare to negotiate better drug prices, and implementing some statutory caps on tort liability, but that's for a different argument). Despite those good intentions, Obamacare is a logistical train wreck. Hardly anyone is ready for the floodgates to open (and going back to my point about the time delay in training more doctors, it isn't just from dilly-dallying). If you look into some of the behind-the-scenes action occurring in Republican governor administrations, you'll see that many of their actions sharply contrasted with their rhetoric. They made these behind-the-scene moves because they knew that completely stalling would only worsen the train wreck. Especially now, it is completely clear that the political goal was always in delaying Obamacare, not repealing it (you can't tell me the Ive League-educated Republicans legislators honestly believed they could repeal Obamacare with the law's namesake still occupying the Oval Office. Repealing it however many times they did was a tactic, not the futile repetitive attempts of a mental patient).
My main point is that all of this demonization of the other side, on both sides, amounts to a mental shortcut. To be a bit more explicit, it is intellectually lazy. It is really easy to dismiss your opponent as being an idiot, or being evil. The really hard part is putting your own biases aside and making a sincere and rigorous effort to see the merits of the other side's argument. To see how a well-meaning and intelligent person could hold the other side's position. If people do that, I think they will find that there are some legitimate concerns with Obamacare going live in 2014, that could result in collective hardship that outweighs the hardship of some going without health insurance for another year.

[Kung Wu]

As a large portion of your post is based around factual inaccuracies and assumptions, I'll address those first.
#1. Government intervention is causing high prices.

I've addressed this several times, and it simply is illogical to think that government intervention in the form of a single-payer system would increase prices, given the statistical evidence that shows single-payer systems are more efficient than our current form of insurance.
[/URL]

Ooooh, YOU have addressed it several times, therefore it must be proved. I see.

I didn't say single payer insurance wouldn't be cheaper than what we have now. I'm saying single-payer insurance will be more expensive with less quality than we would have if we dropped medicare and medicaid. In other words, remove government interference from the free market system and watch premiums and medical costs free fall.

Here it is again, combined state + federal spending as a percent of GDP, demonstrating pre-government interference levels with a slope of about 1 percent/70 years versus a slope of about 6.75 percent/45 years!



The government's own chart clearly shows that health care spending by our governments is approaching other country's spend per GDP _by itself_ -- forget the private sector. It also clearly shows that slope began in the late 1960's/early 1970's. That's to cover 30% of the population! In other words 7% of our GDP, which is entirely under the government's regulation, is spent on health care to cover 30% of the population. And that coverage doesn't provide equal access to health care, by the way.

But you want MORE of it.

An entire magnitude in spending increases has occurred since the government began interfering in the free market system. To you that's just a coincidence. 60+ years of precendence means nothing.

A single payer system would also definitely curb the costs of what we see now, but not NEARLY as well as the free market system has already proven it would, and with the additional extremely negative side effects of reduced quality in health care and choices.

[MoValley John]

Nice graph. What is interesting about this graph is that if you overlay the inception of medicare in the mid 60's, and you continue on with each major medicare overhaul, the dates of the medicare policy changes correlate almost exactly with the rises of medical costs on the graph.

I saw another graph recently that showed US healthcare expenses vs other countries in the world. In 1970, US healthcare was cheap compared to the world. That advantage was lost with each change the government made to healthcare.

Medicare is the problem.

[pinstripers]

“It is a massive entitlement to end all entitlements. It is going to cause a fiscal hemorrhage that is not even yet anticipated. It will tie up one-sixth of GDP in the most monstrous, massive, bureaucratic snarl that you can’t imagine. "

David Stockman

[Kung Wu]

Medicare is the problem.

Somebody's gonna get audited by the IRS, and I mean like soon:

[WuDrWu]

Love me some Neil Cavuto.

Except it's all the fault of Faux News. And Bush.

I am eagerly awaiting the first person that is excited to buy their insurance through the exchange, then compare what they are going to pay vs what they would have paid. It seems like Democrats are really excited about it, as long as someone else buys it.

[ShockTalk]

“It is a massive entitlement to end all entitlements. It is going to cause a fiscal hemorrhage that is not even yet anticipated. It will tie up one-sixth of GDP in the most monstrous, massive, bureaucratic snarl that you can’t imagine. "

David Stockman

Well, maybe. What about this?