What A Sustainable Health Care System In The U.S. Might Look Like

Reserving our health care for those with money is about the most disgusting ideas one could possibly put into words.

Health care is not a house, not a car, it is LIFE.

This is fundamental to the problem we in America face.

We think life is a product an individual may choose to buy.

It really can't be more amoral than that, even if being amoral was our ultimate objective.

And, suggesting that reserving health care for the wealthy is Christian is absolute BS. There is NO way to interpret Jesus as suggesting that people be denied health if they can't pay. In fact, Matthew points out that those Christians who are not seeking out the sick to give them help (as well as seeking out others in need) are going to HELL.

 

I do: the AMA's monopoly has been worth millions to you.

How about restoring the individual right to liberty that the monopolies removed?

Try to understand: there is a difference between profiting by relieving scarcity and profiting by inflicting and aggravating it.

Not quite. Americans pay FAR more for health care than the people of ANY other country, including countries that have a higher per capita income.

In many cases the monopolies are absolute, explicit, and legally mandated.

Treatments and preventive care that are not under monopoly privilege are actively suppressed, because the profits from monopoly treatments are astronomically greater.

That is what people now pay under the monopoly system. Economics informs us that a monopoly will reduce production until it can charge the maximum amount people can afford.

Why not just rescind the monopoly privileges, and let the Invisible Hand of competition make health care as affordable and effective as the free market makes everything else?

People's dysfunctions are nothing compared to the economic dysfunction of monopoly.

Except the monopolists, who have to continue to have trillions of unearned dollars shoveled into their pockets?

The sane way to approach it is not to shovel trillions into monopolists' pockets for aggravating scarcity.

Try to understand: the privileged do not mind murdering people for money. If they can get a dollar for legally killing someone, they'll do it.

It's not technology that is unaffordable. It is monopoly privilege.

Technology costs $X. The exact same technology under monopoly privilege costs $10X. Is it technology that is bankrupting the country, or monopoly?

Never attribute to malice what is adequately explained by stupidity, and never attribute to stupidity what is adequately explained by the greed of the privileged.

 

Interesting.... And just what do you imagine "healthcare" was like over two thousand years ago, during the Roman Empire in St. Matthew's day...?! You may also remember that the Christ himself is recorded in the Bible as having said, “The poor you will always have with you” (Matthew 26:11).

Does anyone else remember that until the GOVERNMENT set up a whole smorgasbord of welfare programs involving the medical sector, costs for Americans were reasonable and the quality of our healthcare was the best in the world? But, once private investment corporations and insurance companies started buying hospitals, diagnostic centers, and setting up their own 'stables' of associated physicians, everything became much more expensive -- and -- what fueled this as much as anything else was the lavish amounts of money poured into the entire sector by the GOVERNMENT in Medicare and Medicaid. A thoroughly corrupt U. S. Tax Code enabled even greater profit margins than ever before, and so we had a perfect-storm for exploding costs to American citizens.

Thus, over the years, working Americans were forced to pay into the FICA system and commit themselves to one of a handful of health insurance providers, usually through the company they worked for. The related charges for medical care skyrocketed, bloated beyond reason (for tax purposes), but "insurance covered most of it". And, for those who couldn't/didn't/wouldn't pay for their medical care, the hospitals and doctors' consortiums simply wrote-off whatever they couldn't get the GOVERNMENT to pay for.

Now here we are... and the only thing I see that we can do at this juncture is to develop a single-payer national healthcare system that can NEGOTIATE healthcare for a customer-base that would be the largest of any in the world. But, the GOVERNMENT would still have to maintain the Medicaid system for those who don't/can't/won't pay to be part of the single-payer system customer-base. More and more people are on welfare and "subsidy" programs now than ever before, and as long as they are allowed to take unearned benefits from the GOVERNMENT -- and retain the right to vote in all elections -- they will demand their "right" to free stuff....

 

What does any of this have to do with what I wrote?

 

First off, I am on your side!

Secondly, there is some truth to what you are saying because technology should bring prices down, but here you have a situation where you are investing nearly unlimited amount of money into a system that is creating some crazy technology that is VERY expensive on many levels [monopoly control or not]. It would be similar to trying to buy everybody a Ferrari. Certainly you could produce Ferrari's considerably cheaper at scale, but they will still be pretty damn expensive!

Human nature is what is is. The best you can do is have the freest and most transparent system possible with adequate checks and balances, no regulatory capture, and hope for the best!

 

In the OP, you are still talking about a for-profit system, even though it's clever to alter the price structure.

In a less economically advantaged area, healthcare providers operating under your plan will not be able to offer the same kind of healthcare that they could offer in an area where there is wealth.

The essential change of your system is to have the healthcare provider be the source of financial load leveling, rather than having insurance companies do that.

But, providers don't have that capacity.

Even today we see hospitals having this problem. If they have an ER, they have to serve those who walk in. And, there are only a percent who are covered by insurance or are capable of paying. Today, that puts a load on our ERs that is being addressed by raising costs for all patient care, getting government financial help, etc. So, we pay for that with higher insurance premiums and taxes.

If insurance and taxes were removed, the hospital would be totally screwed, as an even higher percent of their ER patients would have no way of paying the cost (not the price) of services rendered.

The same would happen in more rural regions, in the US South, and in any state where a local area is populated by those who aren't capable of paying the cost of their care plus the cost of their neighbor's who can't cover their own costs of care.

I don't believe even local walk in clinics would survive.

 

Yes. We've come a long way.

Our standard of living is FAR better than what people experienced in Biblical times - in pretty much every single dimension one can imagine.

And as a super wealthy nation we've been able to spread that to our population.

 

The idea that everybody should enjoy state-of-the-art health care is a fantasy. It is simply not affordable when you are dumping unlimited amounts of money into medical research. What percentage of GDP would you like to spend on state-of-the-art health care for all 340M of us?

 

What does any of this have to do with what I wrote? Of course things are 'better' than they were 2,000 years ago... that wasn't the point. Moreover, IMHO, healthcare is worse today than it was 40 or so years ago because GOVERNMENT barged into it and set up welfare program 'fiefdoms'. Sure, technology is orders of magnitude better now than it was, but that's not the issue at all. In your mind, how should we PAY for a new-and-improved healthcare system? Single-payer? "Medicare for all"? Give everything away for free and watch every waiting room in the country SWAMPED by masses of people who don't/can't/won't PAY to be enrolled in a new system?

 

Yes - that's a serious issue. One can estimate future costs of healthcare, and it is definitely scary.

I don't believe we are there yet. Every first world country has a solution that meets measures of equality and that costs far less than ours.

These are hard changes to make, because there are vested interests reaping gigantic sums from both government and individuals.

It's going to be an incredibly serious battle to go after those stupendous profits - profits not found to be necessary in other countries.

 

Our healthcare is better in every way than it was 40 years ago. Let's not go there.

There is NO other country of note that pays for healthcare in the way that we do - as a for-profit product.

And, the result is that we pay WAY more for healthcare than they do.

It's not a legitimate system if what it does is make healthcare less expensive to those who can pay by refusing to serve those who can't pay. Let's remember that 40% of Americans don't make enough money to pay income tax. Pricing 40% of Americans out of healthcare is not an option.

 

You do make some accurate observations, but so did I -- healthcare WAS affordable forty years ago, to nearly everybody in this country, until GOVERNMENT made a big welfare 'circus' out of it and completely changed the economics of the entire medical sector. But, boo hoo, 'that was then'... so, where do we go now?

So many people today re on various forms of 'welfare-suck' (and "subsidies", which is just another word for welfare) that we have to give them free healthcare. That system already exists: MEDICAID!

But, for the rest of our population, how would you pay for a new healthcare system in the United States? I asked you for your opinion before, and I ask it again.... I suggest a single-payer system where everyone who is part of this largest customer-base in the world pays to be enrolled and covered. What do YOU suggest?

 

You have to step back and look at the entire system and what you are up against. Although the profits are absurd, that's not the real problem. The real problem is that you cannot afford to "allow" you population to be incredibly unhealthy with the guarantee that the government is going to bail them out with incredibly expensive technology. That only works if you have a small group of people many fortunes off of such insanity.

The only long term solution is to change people's health habits by making them responsible for their own health and health care [just like you make them responsible for their own vehicle maintenance. The countries you are comparing us with are MUCH smaller and much more homogeneous. As well, everybody else has been benefiting from the fact that the U.S. has been funding much of the research.

I know that you socialists want everybody to have everything, but this is a fantasy. The Universe simply does not work this way.

 

Your "welfare circus" is what brought healthcare to those who couldn't otherwise afford it. You hate Medicaid. That is there in order to allow a low income demographic to have access to our healthcare. You are demanding that those people NOT get healthcare so you can more easily pay! What made you think there is any morality in that direction??

Plus, healthcare has made stupendous advances in drugs and equipment and has raised training and education requirements over the last 40 years. These advancements require higher prices for use, regardless of profit by any sector.

I repeatedly point out that the systems used by other first world countries give essentially equivalent results while costing far less than what the USA pays.

And, the REASON for that is that they use single payer systems and we view healthcare as a product to be purchased by individuals, pretending that capitalism will keep costs under control.

But, healthcare isn't a product like a TV is. If you get sick, you do not have the choice that is so central to capitalism. You need healthcare.

 

I agree that on average, people could make far better lifestyle choices.

But, we see over and over again that it's not easy to cause people to change. Our national resistance to making sound personal health related decisions is just plain astounding. In fact, we're STRONGLY opposed to even giving direction or education on topics such as nutrition, vaccination, sexual behavior, etc.. It's especially hilarious how we give a few weeks of nutrition education and then have school lunch programs that teach the opposite, every single day.

If you have ideas on how to get Americans to make healthier decisions, I'd be interested. I know what happened when Mrs. Obama suggested improving diet education. I know what happened when it was pointed out that wearing a mask is a way to reduce transmission of communicable disease. I know what Kennedy and other stark raving sociopaths say about vaccination.

 

The way you do it NEVER top down. You make people responsible for themselves and stop treating them like children. Once people see the result of this kind of dys-functional behavior [that is not bailed-out], believe me, people will change.

This is what happens with the Nanny-state. The way you empower people is by making them responsible for themselves. Sure you can teach some of these things in school, but 99% of people who have good habits learn them from their parents. This is the way it used to be until the corporations took over child rearing via tv, movies, internet, social media, etc.

 

Our healthcare is NEVER, EVER going to be priced such that most Americans can buy it as a product. That is just not a valid objective in this case, because the cost of a wide range of healthcare procedures is enormously expensive.

Insurance companies know that. They know what healthcare costs, and set their premiums such that they are nicely profitable. A significant percent of Americans don't have enough money to pay what insurance companies know to be today's healthcare costs.

Maybe what you are forgetting is that healthcare is a human requirement, like food and housing. Healthcare is NOT like a TV or car, where there are perfectly good alternatives that have major differences in price. Also, America is better off with a healthy population - fewer days of lost work due to disease or helping family members, fewer sources of communicable disease, better ability to fulfill commitments on payments and loans, etc. Besides the moral questions of treating people who need to be treated, we're simply better off with a healthy population.

We have MANY countries that have demonstrated ways of getting healthcare cost under reasonable control.

 

Bingo. And what you are up against, above all else, is monopoly rentier privilege.

Huh? Monopoly rent seekers charging 10x production cost for medical products and services, and consequently spending twice as much on marketing as they do on research is not the real problem?

Run that one by me again.

People don't want to be unhealthy, and the fact that they don't bear the resulting medical costs is a very minor factor in their lifestyle choices. Remember: people didn't quit smoking because of lung cancer; they quit when the tax on cigarettes was increased to the point where they couldn't justify the here-and-now cost.

Nonsense. If the American people improve their health to the point where lifestyle diseases are cut in half, but the medico-rentier monopolists just increase their prices from 10x production cost to 20x, what has been gained (other than more profits for the monopolists)?

You have not explained how that is relevant. The US restaurant industry seems to be able to feed the population -- even the Chinese one feeds the Chinese population, and their population is 4x the US population. The larger population implies a commensurately greater ability to fund the cost.

Actually, most of the basic research that actually results in better treatments is funded by other countries. US drug companies spend astronomical sums on a lot of spurious clinical trials because they are totally focused on patenting drugs they can charge monopoly prices for, even if they are less effective and more dangerous than existing public domain drugs. When they get such drugs approved, they then spend astronomical sums promoting them, to convince doctors and patients that they are better than the existing public domain treatments, when they are actually worse.

It is impossible to overstate how evil and destructive the drug patent system is.

That is an absurd strawman fallacy that does not add to the discussion.

 

I understand what is going in the system, but this is NOT the main problem. The main problem is the desire to give your entire population state-of-the-art health care, and a population that is horribly unhealthy, to boot.

I gave this example before but it is worth repeating. Let's say you wanted to give everybody in your country a new Ferrari. And let's say the U.S. bought out Ferrari and instituted the most efficient method of building these car. If you could cut the cost from a half mil down to say 200K, these cars would still be prohibitively expensive for everybody to be given one. This is the same situation in health care. Even if you could bring the costs down administratively, the cost of providing really high quality health care to an unhealthy population is astronomical. You would be broke in a week and a half.

No, many people are not willing to make the commitment to be healthy. And, btw, when people found out about the true ricks of smoking, millions quit.

This is not agriculture, that is finding more efficient way s to grow wheat and corn. Technology in health care is exploding and it costs BIG BUCKS.

Please give me some examples.

 

It doesn't have to be state-of-the-art -- which just means "patented."

No, because people do not want to be sick, and often avoid seeking health care even in countries where it is free.

No. The main reason Ferraris cost so much is that so few people want one, economies of mass production are not available.

That is true, and it is one reason taxation is a better incentive than health care costs.

Nope. If you look at country comparisons, people in places like South Korea still smoke like chimneys because the tax is so low, and the same goes for their alcohol consumption. They are perfectly well aware of the health risks.

It costs big bucks because of the monopolies.

"Of almost 3,000 articles published in biomedical research in 2009, 1,169, or 40%, came from the United States."

https://www.forbes.com/sites/matthe...ries-in-biology-and-medicine/?sh=154fe731a714

"The super effective single-dose breast cancer treatment

Led by researchers at University College London in 2020, a pioneering breast cancer therapy was found to be as effective as conventional treatment – while taking just 30 minutes.

Key facts

• The study was funded by the NIHR’s Health Technology Assessment Programme and Cancer Research UK, and involved 32 hospitals in ten countries."

https://bepartofresearch.nihr.ac.uk/Articles/Health-research-breakthroughs/

 

No, it's not a matter of "hating" Medicaid... "hating" any of Lyndon Johnson's, or Barack Obama's socialistic welfare-based health systems hasn't got anything to do with it! This is 2023! We're stuck with the Medicaid now, and NOW is when we must come up with alternatives for the large percentage of Americans who actually support themselves -- which brings me to the single most important thing I believe that you and I actually AGREE on... a single-payer healthcare system! I don't care at all about a gaggle of socialists prating on and on about "morality"; on the contrary, when it comes to an initiative that is very likely to cost over a trillion dollars initially, my focus is tightly upon the ECONOMICS of the system!

And, if set up correctly, single-payer systems can provide all those who are part of the customer-base with better healthcare than we have now, and a MUCH lower cost. Why? Because the government would issue an IFB (Invitation-For-Bid) to the entire healthcare sector, and they would have to COMPETE for the business opportunity involving the largest customer-base in the entire world! Winner take all, and those who do not submit competitive bids lose everything!

But to be part of the single-payer system, each person must PAY for he coverage, and the amount involved can change according to which plan the enrollee wants for coverage. Those who cannot/do not/will not pay to be members of the customer-base can always fall back on MEDICAID, which, as before, would be free! Surely even a devout socialist would approve of that much....

 

Healthcare is NEVER going to be up for bid like that. There are numerous specialties and types of need.

If the US made the wise decision of moving to single payer, there would be a number of design issues to address. One could look at the various systems other countries have demonstrated, as they have had to answer the same questions.

 

Yet you ignore the elephant in the room: the ECONOMICS of IP monopolies.

Try to understand: patent holders DON'T and WOULDN'T have to compete, because no one else is allowed to compete with them.

 

That's only one factor. Do you believe that the only reason the U.S. military is so expensive for the same reason...or might it be that they are creating newer and better super high technology weapons systems? Think an aircraft carrier is cheap?

Although economies of scale help, technology is accelerating at rate where nothing remains the same very long. Again, it's not like your are finding newer and more efficient methods for doing the same thing [like growing crops].

You seem to be fixated on only one factor [which is not anywhere close to the most significant]. Although a socialist system may save money in a couple of areas, you'll end up with what you always end up with in socialism...poor quality and higher costs [eventually].

TPTB care a hell of a lot more about defending the empire than they would about a national health care system. Read about the care veterans used to receive [and still do].

 

So, you advocate elimination of Intellectual Properties (IP)...? Then you approve of the Chinese (for instance) stealing other people's ideas, making 'knock-offs' and profiting immensely from it? Does the inventor of a product not deserve to enjoy the 'fruits of his labor'...?

As far as "patent holders" go, in pharmaceutical medicine (I guess that's what you mean): "Currently, the term of a new patent is 20 years from the date on which the application for the patent was filed in the United States. Many other factors can affect the duration of a patent." Link: https://www.fda.gov/drugs/development-approval-process-drugs/frequently-asked-questions-patents-and-exclusivity#:~:text=Currently, the term of a,the duration of a patent.

Ostensibly, patent holders of new medicine created in mid-2003 can expect to see their products go 'generic'. This covers the newest medicine, but we have a great deal of pharmaceutical products that were invented, prescribed, and used by millions of people prior to 2003! They are still used to this day!

You seem to be resolutely opposed to anyone making a profit. How are taxpayers supposed to make enough money to pay the taxes that support the government welfare and subsidy programs if they're living a threadbare paycheck-to-paycheck existence? What if people with enough mentality and initiative to invent new products say, "Ah, to hell with it... I'll just live off the government all my life...."