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Breaking it down for Pickles

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  • Breaking it down for Pickles

    I don't understand Elok's word salad but if I gather something is that he claims that a privitized health care system if rife with corruption?

    funny. that would be the argument for a state health care system


    Noone wants to pay for another in Europe but there are some things called human dignity. having a state that will look after you if oyu fall ill is one of those dignity things.​
    Okay. Assuming the forum software works, somewhere on this post you should find a pie chart of America's budget from last year. Note that we spent about $840 billion on Medicare (healthcare for old people) and another $558 billion on Medicaid (healthcare for poor people). I did some quick math, and those two together add up to about 21% of the total budget. In passing, also note that the $1.4 trillion that adds up to is much more than we spend on the military, favored whipping boy of dumb internet complaints ("We can spend this much to buy bombers, but not ..."). Actually, we can't afford any of it at this point, which is why the chunk in the upper-left, dedicated just to paying the interest on the debt we've racked up, is about equal to what we spend on the military, and growing rapidly. And Medicare + Medicaid is still only part of what the government spends on healthcare; "Other mandatory," $1.3 trillion, also includes a fair amount of healthcare stuff, like healthcare for veterans and (I think) federal employees. Don't know the exact breakdown. Suffice to say that at least a quarter of every year's budget gets dumped into healthcare. That would be the public part of America's healthcare system. It is not at all cheap. It's not that the government is not spending a lot of money on this stuff. It's that it's getting absolutely lousy value. "Nondefense discretionary" is just about the entire Federal government as we usually think of it, minus the military and entitlements, and it's only slightly bigger than what we pay for Medicare alone. Old people still have to pay out of pocket for a number of things after this. And if you are not old/poor/working for the government somehow, this does not cover you. If we actually attempted "Medicare for all," frankly I don't even know what this graph would look like, but I am confident we couldn't afford it, because we can't really afford what we have already. Again, slice in the upper left! That is a lot of money! And Medicare is still due to go insolvent (as is Social Security) sometime in the next decade.

    "Corruption" as such is probably much more common with Medicare and Medicaid than with private insurance. Medicaid is basically required by law to pay providers very, very badly; there's a rule that providers who deal with Medicaid have to give Medicaid the best possible price, so if they give a service to any insurer for, say, $400, Medicaid will not pay above $400 for that service. In practice, this means it's often hard to find providers who will take Medicaid, and also providers who take Medicaid and also other insurance will give the other insurance worse deals for fear of being forced to lower their Medicaid reimbursements. This is just one example of what they call "perverse incentives" built into the system. In the meantime, one great way to make money off Medicaid (possibly the only way) is to submit bills for services that were never actually performed. This also works to some extent for Medicare; I know at least one doctor at my hospital is grossly overbilling for hours compared to what he actually spends taking care of patients. I don't report him, even though there's a 10% bounty for catching this stuff, because I don't trust the government to successfully prosecute this stuff and protect me from retaliation. It's a huge problem, and it doesn't get solved because the government frankly doesn't have the manpower (or the ability to hire enough sufficiently clever people) to prosecute a tenth of the theft. Leaving aside grey areas; for example, that same thieving doctor is very fond of performing a specific procedure because it is quick, low-risk, and earns him a fair amount of cash. It is also easy to justify as maybe medically necessary, so he will do one of these things at the least excuse. Is this "fraud"? Not provably. But if people actually paid for their healthcare, they might say, "hey, what's this procedure? I don't think that was necessary, and I'm not paying that much for it." Since the government pays, and the government isn't that great at telling what's necessary, my doctor buddy keeps on racking up the easy money with these damn procedures.

    As for private "insurance": it gets criticized as a failure of capitalism or free markets. But any economist will tell you that markets require certain conditions to work. Most relevant here, people have to know what stuff actually costs. So-called insurance, as it exists in America, hides the real price; you pay your insurer some amount of money as a premium (and your employer may pay significantly more, which works out to you essentially "paying" far more to the insurer than you realize), and they invisibly negotiate prices on your behalf and spit out some number on the other side, and you get some services, and even if you abide by all the rules (and there are often a lot of rules), you may still have to pay something, or not, but it's usually very hard to tell going in how much you will have to pay. As for what your insurer finally pays, you will almost certainly never find that out at all. You may be presented with a bill, but the insurer will do some dickering after the fact. The whole system is so complicated that it's extremely hard to tell whether you're getting good value or not, or what a good value even is. "Insurance" here is not really insurance, unless your insurance is what we call catastrophic insurance, designed only to cover really big costs. Otherwise what we call insurance is actually just a giant, price-obscuring middleman, which we illogically expect to save us money. And you can't even really shop around for insurance; you can accept your employer's insurance, or pay for your own insurance (which I think almost nobody does, because it's inferior even after government subsidies). Or, if you are poor, you can use Medicaid, which kind of sucks and is miserable to deal with but strictly speaking is better than nothing.

    I could say more, a LOT more, but I suspect you won't really read what I've written and it took too damn long to type it all up.
    1011 1100
    Pyrebound--a free online serial fantasy novel

  • #2
    He called your posts "word salad" so you decided to double down and write even longer paragraphs

    Comment


    • #3
      "Word salad" generally implies that the text critiqued is jumbled, disorganized, or otherwise makes no sense. I was trying to say a lot in a small space in the quote he replied to. Here, I tried to break it down. This is probably wasted effort, but I felt like expanding on it.
      1011 1100
      Pyrebound--a free online serial fantasy novel

      Comment


      • #4
        I'm sorry that I didn;'t amnd won;t read any of that. I just browsed through it

        I hope it helped put your own thoughs in order.


        when I hear that you have to pay to go to the hospital in the US or people think about calling an ambulance, it's where the conversation stops

        Comment


        • #5
          Okay, but there is a very good reason for that. It's just a very complicated reason, stemming from an innocent decision by Franklin Roosevelt the better part of a hundred years ago.
          1011 1100
          Pyrebound--a free online serial fantasy novel

          Comment


          • #6
            Pan - european state health coverage steams from bismarck (spelling?) some german bloke

            anyway it works very well

            Comment


            • #7
              Disclaimer: you are kick ass


              You have made discoveries possivle that made life possible for large percetnage of peoploe



              eureopeans came to your shores, you gave them eyverthing they need and they made tremdendolus breakthroughs in scince that saved lives. not talking long ago. talking about the '90s and onward

              America and its innovation spirtit made possible for hundrend of thousand of people to be alive

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              • #8
                then european national health care sytems took over those inventions and applied them to thge benefit of their people

                did you do the same?

                I sure hope you did but I know that you didn't and that's smoething that must be fixed

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                • #9
                  I'm strictly a Dill pickle guy.
                  Life is not measured by the number of breaths you take, but by the moments that take your breath away.
                  "Hating America is something best left to Mobius. He is an expert Yank hater.
                  He also hates Texans and Australians, he does diversify." ~ Braindead

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                  • #10
                    Sweet Gherkins FTW!
                    No, I did not steal that from somebody on Something Awful.

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