• Sen. Sanders unveils Universal Healthcare bill
    105 replies, posted
Bernie did an interview with WBUR today to talk about the socialized medicine plan. Cited a cost of about $18,000 per-person per-year (some $5.8 trillion) for health insurance as it is now. Suggested a 7.5% payroll tax to help pay for the government absorbing this cost after the closing of the private insurance industry, as well as higher income taxes for everyone. [URL]http://www.wbur.org/onpoint/2017/09/14/democrats-single-payer-plan[/URL]
[QUOTE=thelurker1234;52682025]Salary isn't intrinsic to any of these systems really. Canadian doctors make a good deal less on average, but NHS doctors only fall somewhat below US ones. The concern of cutting pay isn't really current doctors, but future ones. All of that time with pay comparable to or less than what you could get with just a 4 year uni degree would discourage a lot of people.[/QUOTE] Maybe I'm wrong, but I think the amount of medical students (especially with a system as tough to get through as the one in the US) who would be studying something else if the pay was 75% of what it currently is, is surprisingly small. Furthermore, it's not like the supply of talented, aspiring students is small - even if a fairly large part decided not to become doctors, people with slightly less awe-inspiring CVs would take their place. You could then argue that suddenly all doctors will be unqualified hacks, but I sincerely doubt that is true. [editline]14th September 2017[/editline] [QUOTE=Chonch;52682078]Bernie did an interview with WBUR today to talk about the socialized medicine plan. Cited a cost of about $18,000 per-person per-year (some $5.8 trillion) for health insurance as it is now. Suggested a 7.5% payroll tax to help pay for the government absorbing this cost after the closing of the private insurance industry, as well as higher income taxes for everyone. [URL]http://www.wbur.org/onpoint/2017/09/14/democrats-single-payer-plan[/URL][/QUOTE] Know where he got the $18,000 per year claim from? Seems high to me.
[QUOTE=GoDong-DK;52682080]Maybe I'm wrong, but I think the amount of medical students (especially with a system as tough to get through as the one in the US) who would be studying something else if the pay was 75% of what it currently is, is surprisingly small. Furthermore, it's not like the supply of talented, aspiring students is small - even if a fairly large part decided not to become doctors, people with slightly less awe-inspiring CVs would take their place. You could then argue that suddenly all doctors will be unqualified hacks, but I sincerely doubt that is true.[/QUOTE] It's not that the US system is über-hardcore compared to others, but our education pipeline is crammed. We still have a shortage anyhow. 75% will see a decrease in potential doctors, (canada is like 60% of what ours is) but even worse is when you bring in the taxes, included in this bill and other Bernie projects, that will hit these people quite hard.
[quote=ilikecorn]I mean it really comes down to the fact that that 40$ pill costs around .90 cents to make, and around .10 cents to package. But they'll charge you 40 dollars for it, and pocket 39$. [/quote] I don't think you quite understand. If they sold them at cost, insurance companies would then ask to only pay 5 cents for it. It's not a rationality built on wanting to only pay at cost - it's a rationality built around 'what is the [B]maximum[/B] amount of money we can get thrown away here - how hard can we lean on them' If it was as simple as 'we know that bottle costs $10' to make then they wouldn't start off by saying 'we'll pay $1'.
US companies are also able to abuse the ever-loving shit out of patent law too. The US loves intellectual property. Disturbingly so.
[QUOTE=ilikecorn;52682125]I mean your not wrong, but if we can start attacking the supply issues (like 2$ bags of normal saline costing 100$), then we can simultaneously attack the insurance issue as well. Again, profit caps would be acceptable, especially considering healthcare is effectively a cartel, and should be treated like a monopoly. (just like your power company, they can't make more than x% profit in a year, so they have to keep prices "reasonable")[/QUOTE] One start to this would be allowing medicare to negotiate prices. They comprise about a large chunk of consumption aaaaaaaand.... they're legally forbidden by congress to even try.
[quote=ilikecorn]if we can start attacking the supply issues (like 2$ bags of normal saline costing 100$), then we can simultaneously attack the insurance issue as well. [/quote] A lot of that is defensive to said insurance companies. The cost doesn't come from the provider, it comes from the hospital who pre-emptively jacks up the charges and 'costs' of said items just so that, at the end of the day, the insurance companies walk away feeling smug that they 'got a lot of money thrown out' and the hospital gets to keep its head above water. Rather than negotiate that a 5 cent cup should be paid for at cost, they'll instead say each 5 cent cup costs 4 dollars - that way when the insurance company goes 'nah, we'll only pay like 20 cents a cup' then they're still at least making a small amount of profit.
[QUOTE=GoDong-DK;52682080]Know where he got the $18,000 per year claim from? Seems high to me.[/QUOTE] I'm afraid I don't know, though given the context of the conversation, I have a sinking feeling Sanders was paraphrasing [URL="https://www.wsj.com/articles/average-cost-of-employer-health-coverage-tops-18-000-for-family-in-2016-1473865200"]this headline from one year ago.[/URL].
[QUOTE=thelurker1234;52682112]It's not that the US system is über-hardcore compared to others, but our education pipeline is crammed. We still have a shortage anyhow. 75% will see a decrease in potential doctors, (canada is like 60% of what ours is) but even worse is when you bring in the taxes, included in this bill and other Bernie projects, that will hit these people quite hard.[/QUOTE] Well, is the tax in the US higher than in Canada (including the Bernie Tax™)? If not, what spurs a Canadian student to become a doctor? I know for a fact that taxes are higher here in Denmark (that's putting it mildly), and the pay is lower, so it seems that the supply side (students) should be large enough in the US to saturate the pipeline even at a significantly lower pay.
[quote=ilikecorn]I mean it costs the hospital like 50$ for the 100$ bag, and they bill the insurance company for 100$, and the insurance company pays 51$, and all for a bag that costs no more than 2$ to make.[/quote] Probably more along these lines: Bag-cost to manufacture: $1/unit Bag-shipping-cost: $1/unit Hospital bag buying price: $10/unit Hospital bag selling price: $100/unit Insurance company's starting bid: $5/unit Hospital's counter-offer: $30/unit Final offer: $20/unit Profit for hospital: $10/unit. (50%) Amount shaved off from sticker price: $80 (80%) The big problem here comes from neither the supplier or the hospital (directly): it comes from a hostile insurance company who begins negotiations on any line-item by saying "We'll pay 5% of whatever you wrote down". Naturally, the hospital will adjust itself accordingly and raise prices knowing that no matter what they do the insurance company in question will request such a ridiculous drop in price. Those really impacted in this case are those who aren't fighting with the insurance companies. Mr. Joe doesn't have insurance; he doesn't know that his $4000/night hospital stay in reality costs something like $200. All he'll see is a $12,000 hospital bill and have a near-heart-attack. The hospital will then offer to reduce his payments to something like $2,000 because they can't lower them much further while still justifying the sticker price to insurance companies - knowing he only really cost them something like $600 in full costs for a bag of saline and occupying a bed and a few minutes of a few doctors' time. So the ones who really lose out here are the uninsured.
I'm sure you could help mitigate the doctor shortage issue if you incentivized immigration for foreign doctors but hahaha that will never happen with this current government.
[QUOTE=Lambeth;52682208]I'm sure you could help mitigate the doctor shortage issue if you incentivized immigration for foreign doctors but hahaha that will never happen with this current government.[/QUOTE] Don't they? Though I dunno maybe the h-1b program needs improving. [QUOTE=GoDong-DK;52682176]Well, is the tax in the US higher than in Canada (including the Bernie Tax™)? If not, what spurs a Canadian student to become a doctor? I know for a fact that taxes are higher here in Denmark (that's putting it mildly), and the pay is lower, so it seems that the supply side (students) should be large enough in the US to saturate the pipeline even at a significantly lower pay.[/QUOTE]Canada is experiencing a doctor shortage right now. And denmark lightly does as well. Anyways, that's not how it works. Individuals have their own motivations and limits, and even if being a doctor paid 40k a year, there would still be some incredible people willing to do it, but it would be lower than at 50k, 60k, and so-on. I'm not going to say that a country with low pay for doctors will have no doctors. Just that it reduces the supply, whether a pay cut causes a large problem depends on where the equilibrium is and other factors such as general interest in the field.
[QUOTE=thelurker1234;52682220]Canada is experiencing a doctor shortage right now. And denmark lightly does as well. Anyways, that's not how it works. Individuals have their own motivations and limits, and even if being a doctor paid 40k a year, there would still be some incredible people willing to do it, but it would be lower than at 50k, 60k, and so-on. I'm not going to say that a country with low pay for doctors will have no doctors. Just that it reduces the supply, whether a pay cut causes a large problem depends on where the equilibrium is and other factors such as general interest in the field.[/QUOTE] Actually the latest (as far as I'm aware) prognosis is currently that we won't be lacking doctors: [url]http://nyheder.tv2.dk/samfund/2016-03-13-ny-prognose-afblaeser-truende-laegemangel[/url] But what is a doctor shortage anyway? When patients no longer need to wait at all? When less threatening diseases see reasonable waiting times? When morbidity rises a little bit? And yeah, sure, there's a limit to how much you can reduce the wage, but I'm not suggesting anything outlandish - I'm suggesting that the wages in the US could be put in-line with other countries' without it really affecting how many qualified doctors the US could output a year.
[QUOTE=GoDong-DK;52682289]Actually the latest (as far as I'm aware) prognosis is currently that we won't be lacking doctors: [URL]http://nyheder.tv2.dk/samfund/2016-03-13-ny-prognose-afblaeser-truende-laegemangel[/URL] But what is a doctor shortage anyway? When patients no longer need to wait at all? When less threatening diseases see reasonable waiting times? When morbidity rises a little bit? And yeah, sure, there's a limit to how much you can reduce the wage, but I'm not suggesting anything outlandish - I'm suggesting that the wages in the US could be put in-line with other countries' without it really affecting how many qualified doctors the US could output a year.[/QUOTE] That's good, the stuff I heard about that shortage was a couple years old. I mean, technically when patients no longer need to wait is ideal. But that's an ideal. It's in comparisons to other countries (physicians per 1000,) and the opinion of consumers. And yeah. You're right. But I would want to focus on other things first than direct salary cuts. Such as the other bottlenecks in the education pipeline, which in itself will cut salaries. The overuse of specialists, which too will reduce salaries, and so-on.
[QUOTE=thelurker1234;52682347]That's good, the stuff I heard about that shortage was a couple years old. I mean, technically when patients no longer need to wait is ideal. But that's an ideal. It's in comparisons to other countries (physicians per 1000,) and the opinion of consumers. And yeah. You're right. But I would want to focus on other things than direct salary cuts. Such as the other bottlenecks in the education pipeline, which in itself will cut salaries. The overuse of specialists, which too will reduce salaries, and so-on.[/QUOTE] Yeah, making it easier to study medicine (and study in general) in the US sounds like a good idea - from what I've heard, it's a pain in the neck. Here in Denmark you basically just finish high school and apply with your grades. If you can't hit the average to get in, you can apply through quota 2, which basically means a written application where you qualify yourself in that way instead. It's not a perfect system by any means, but it definitely leads to less "faffing around" putting stuff on your CV.
[QUOTE=GoDong-DK;52682385]Yeah, making it easier to study medicine (and study in general) in the US sounds like a good idea - from what I've heard, it's a pain in the neck. [B]Here in Denmark you basically just finish high school and apply with your grades. [/B]If you can't hit the average to get in, you can apply through quota 2, which basically means a written application where you qualify yourself in that way instead. It's not a perfect system by any means, but it definitely leads to less "faffing around" putting stuff on your CV.[/QUOTE] That's interesting. Apparently it takes 6 years there too? Here's quite a pain in the ass, where you have to finish a 4 year uni degree before even thinking about applying to do 7 more years of education.
[QUOTE=thelurker1234;52682452]That's interesting. Apparently it takes 6 years there too? Here's quite a pain in the ass, where you have to finish a 4 year uni degree before even thinking about applying to do 7 more years of education.[/QUOTE] Well, it's a three year bachelor's, a three years master's and then one year of interning. Then you spend maybe a couple to a maximum of six years before you start your specialization.
[QUOTE=ilikecorn;52682650]Bear in mind its a 4 year degree in something that might be fairly useless (like general chemistry), just so you can get into the 7 year schooling. Bear in mind that those 7 years of schooling cost like 100k$, also those 7 years are just for general practice, you wanna specialize, then enjoy another 5-10-15 years of school.[/QUOTE] Although to be fair, in the latter 3 of those 7 you're working residency for what appears to pay an average of about 50k a year.
How would this even be paid for? Here in Aus we have a separate tax dedicated for our Medicare system, which is a percent of income and is pretty hefty. I don't see Americans warming to the idea of a huge Medicare tax on everyone.
[QUOTE=LAMB SAUCE;52682820]How would this even be paid for? Here in Aus we have a separate tax dedicated for our Medicare system, which is a percent of income and is pretty hefty. I don't see Americans warming to the idea of a huge Medicare tax on everyone.[/QUOTE] The bill has some vague mentions (some of it horrifying) of how. We'll probably get more details about what this thing entails exactly when the CBO has gotten their hands on it. [QUOTE=ilikecorn;52682828]Yea, but you're also being treated like hammered dog shit for the first 1.5 of those 3 years, with the other 1.5 being pretty OK. Also keep in mind this is just to become a GP, not for any form of specialization at all.[/QUOTE] Hmm. I guess that's why when I asked one of my family members about how residency was I got a big "ehhhhhhhhhh" as a response. (The japanese would probably say that these people should work less hours) Where did you get the 5-10-15 extra years figure for specialization btw? Cursive search on google indicate that it's typically just a couple years extra. Usually 3, of not strictly schooling.
[QUOTE=LAMB SAUCE;52682820]How would this even be paid for? Here in Aus we have a separate tax dedicated for our Medicare system, which is a percent of income and is pretty hefty. I don't see Americans warming to the idea of a huge Medicare tax on everyone.[/QUOTE] Considering that introducing a universal healthcare system would probably reduce economic activity, a tax is probably the last thing they should tack alongside it
[QUOTE=Goberfish;52683026]Considering that introducing a universal healthcare system would probably reduce economic activity, a tax is probably the last thing they should tack alongside it[/QUOTE] From older people leaving the workforce right? There might be a dip in unemployment if Universal Healthcare was enacted and there was a sudden demand to fill jobs that had previously been full.
[QUOTE=Goberfish;52683026]Considering that introducing a universal healthcare system would probably reduce economic activity, a tax is probably the last thing they should tack alongside it[/QUOTE] While it would certainly shrink the health insurance industry, universal health insurance wouldn't keep people from working since you have to be working pretty good jobs to get healthcare benefits as it is, people aren't going to quit their minimum wage jobs because they don't have to work for healthcare anymore, they didn't have healthcare before they had that job, and they will have more disposable income without having to dish out for healthcare costs which are enormous in the US
[QUOTE=Lambeth;52683045]From older people leaving the workforce right? There might be a dip in unemployment if Universal Healthcare was enacted and there was a sudden demand to fill jobs that had previously been full.[/QUOTE] Possibly, but I was considering more the effects of shrinking the health insurance industry [QUOTE=Sableye;52683066]While it would certainly shrink the health insurance industry, [/QUOTE] Thanks :alien:
[QUOTE=laserpanda;52681424]Dental is largely cosmetic though. If something requires oral surgery because it's a health issue, it will often fall under medical.[/QUOTE] Dental maintenance necessary to prevent serious health issues isn't covered though. If you only go in once you have a catastrophic issue, your teeth will already be really fucked.
[QUOTE=RenegadeCop;52683030]I already pay ridiculous amounts for shit coverage. I don't mind replacing my insurance payments with taxes.[/QUOTE] Unfortunately a lot of people don't think about it like that and just see it as government double dipping
[QUOTE=srobins;52683133]Dental maintenance necessary to prevent serious health issues isn't covered though. If you only go in once you have a catastrophic issue, your teeth will already be really fucked.[/QUOTE] Which they can't do if they can't afford it. Source: Myself. There's a good 10k worth of dental work earmarked for my pie hole, yet I can barely keep myself fed. So that dental work just has to wait. Its not a state I enjoy being in but that's the way things are and they're not gonna get better unless either I see myself doubling my income or dental work gets mandated coverage. There's no way I can pay OOP for $10,000+ of teeth work when I have to choose between grocery shopping and replacing two dry rotted tires w/ no tread and broken belts. I've been on the 'don't get hurt' health plan for so long I lost count of the years.
Oral health is just as important as any other kind of health. There's really no good reason that it often isn't included in insurance (even here in Denmark when you're 18+). If I fall and break my legs I can go to the doctor and it's covered, but if I fall and fuck up my teeth it isn't? Like what the fuck.
[QUOTE=RenegadeCop;52684276]Not to mention that dental issues can actually lead to heart problems, somehow.[/QUOTE]Some heart problems are caused by actual infection, and rotting teeth is as good an entry point as any for bacteria.
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