Political Confessional Threadi

[Aeson]

It's greedy doctors screwing the children. Get it together, Aeson.

I know you're being sarcastic, but will address the point.

All things considered (income, tax, other benefits) Australian medical professionals only make slightly less than their American counterparts. Most of that loss is on the upper end. On the lower end they generally get more total compensation.

Medical professionals being paid well are not the problem.

[Geronimo]

the black hole that so much of that money disappears into is to lawyers and to liability insurance policies intended to make paying their astronomical settlements survivable. certainly the US tort system inflicts a *vastly* higher cost on US healthcare expenses than all healthcare insurance related profits combined. Keep insurance under a magnifying class sure but please don't ignore our vile tort industry.

[Elok]

That's fair. Fear of lawsuits certainly does terrible things to way we treat people, including raising costs (both directly and because they encourage unnecessary tests and treatments as "defensive medicine") and is not easily captured by glib claims about Australia. This disaster dates back to FDR; it's not a one-dimensional problem.

As for Australia, I realize this is my fault for not being laser-specific, but were you, Aeson, under the impression I was saying we're going into debt from rinky-dink visits to the GP to get scripts for antibiotics or birth control? No, we are not. In fact, American GPs and such are declining in numbers, last I heard, because if you're going to go through the nightmare and expense of medical school becoming a specialist is a much better RoI. Billable procedures are where it's at, and may not even be captured in comparisons of salary. Checked it earlier today, and yeah, something like 90% of surgeons in the US receive pay over and above their official salaries. Said official salaries may be quite high--trauma and CT surgeons both average something like $500K/year--but when you add in pay for specific procedures, boy howdy. This would be "at the top," where pay reputedly diverges, even on your figures (for which I will take your word).

Did I mention I've been working in this industry for almost a decade now? Because I have.

[Aeson]

As for Australia, I realize this is my fault for not being laser-specific, but were you, Aeson, under the impression I was saying we're going into debt from rinky-dink visits to the GP to get scripts for antibiotics or birth control?

No. I was under the impression you are trying to give insurance corporations a free pass by pretending their tens of $billions in profit isn't part of the problem.

I was also under the impression you were arguing against learning from other nations who have solved this affordability problem.

Since you were.

[Aeson]

the black hole that so much of that money disappears into is to lawyers and to liability insurance policies intended to make paying their astronomical settlements survivable. certainly the US tort system inflicts a *vastly* higher cost on US healthcare expenses than all healthcare insurance related profits combined. Keep insurance under a magnifying class sure but please don't ignore our vile tort industry.

It's a part of the problem, but not vastly higher. $50 billion a year.

Also, there does need to be some type of recourse against malpractice, so not all of the tort costs are superfluous. The estimates of national tort reform bills (which claimed a vastly higher total of $300 billion a year) are $15 billion a year savings.

We could probably learn from other nations who don't have this problem, and have better health outcomes, about how to handle it.

Profits off insurance are unnecessary for a functional healthcare system. There's a lot of expenses they incur that are also unnecessary. Like campaign donations, lobbying, speakers fees, executive compensation, etc.

[Ben Kenobi]

Yes. This site is now mostly about three drunks and their shenanigans. We have a Greek drunk who talks almost entirely to himself and deletes most of what he types, a Russian drunk who says offensive and provocative things and gets mocked for it, and an American drunk who says offensive and provocative things and gets mocked for it. A while back, it was revealed that longtime scourge Ben Kenobi got married and has a life now, but we can't get enough hits off that dunking-on-idiots pipe. Also sometimes Geronimo tries, God bless him, but he's only one man.

Anyway, it occurs to me that I didn't properly answer your question. I am open to the possibility that other governments work better than ours, since I have no experience elsewhere, but I'm inclined to skepticism and I mostly don't care. Ours kind of sucks, is all I know.

As to the claim that Europe has learned to do healthcare great by harnessing the power of the Big Rock Candy Mountain: this sort of claim gets made about a lot of other things, and on the rare occasion I bother to dig into it I find that it's something of a mirage, essentially an updated version of Tacitus telling us the Germans are totally more virtuous and awesome than the Romans (see also "these rando tribal cultures you never heard of have sophisticated conceptions of transgenderism." Investigation of these tribal cultures often finds the reality more complicated.). In particular, other Western systems seem to work by aggressively rationing access to healthcare in a way that most Americans would not like at all. Also historically they've been grossly underspending on defense, etc, etc.

Really, as somebody who's actually worked in US healthcare for close to a decade, all this is missing the point. Assuming for the sake of argument that Europe is healthcare nirvana, saying "we just need to be like Europe" is kind of like saying Afghanistan "just needs to become a liberal democracy." When an American patient, or their family, is told something they don't like by a doctor, their reaction is very frequently:

1. But the internet says ...
2. I will be contacting my lawyer.

Why exactly we overspend on healthcare is an immensely complicated question, but at the heart of it is that we have a system where money goes in, healthcare comes out, and virtually nobody sees or understands what the hell happens in the middle. However, the public firmly believes, against all logic, that they should receive services whose value vastly exceeds the amount they pay for them. "The Government" should pay for it, or "the Rich," or else "healthcare should be a human right." They have "health insurance," which is sometime insurance but is mostly a middleman which doubles as a whipping boy. We have inserted this vast network of bureaucracies full of people who need paying, and expect this to work out to a substantial net savings, and when it doesn't it's because insurance companies are greedy. This makes no sense whatever, but we believe it so passionately that we will cheer when an insurance executive gets assassinated in the streets.

Because it's unusual to be confronted with a price-tag for a specific service, we have a tragedy of the commons situation where everybody is incentivized to pour as little as possible into the pot while extracting maximum value, insisting that it's the system's job to pay for it. Often this is not even a conscious decision, just a tacit assumption. For example, I often deal with end-of-life situations at work. When asked how far they want to take this, many if not most families will say, "we want everything done." This is because only a cold-blooded monster would explicitly put a price tag on the use of finite resources to prolong an increasingly unpleasant and precarious existence. Insurance will pay for it. So there's no kind of market discipline, and "how far" is usually translated to "how much do you love Uncle Bob?" The correct answer, of course, is "thiiiiiiiiiiis much!" The actual process ... well, this post is long enough, but holy **** is it ugly. Love can be astoundingly cruel, let me tell you. Incidentally, it's also extremely expensive, and ends up in a game of chicken between the doctor and the family. The house always wins, in the end.

And then people tell me, "Oh, the Europeans have discovered that if you rearrange the opaque system to pay for everything this way, you get substantial savings!" and I'm like "er, maybe Euros just have different mental wiring? Wouldn't make a damn bit of difference here. They'd just have irrational expectations of a different bureaucracy."

Unlike most, I've experienced both systems. There are positives and negatives. In Canada I can't get a doctor for my family. In the US I can't get a doctor for my family for very different reasons. Is the system that cannot provide me with a doctor because there's a shortage objectively better than the system where doctors are available, but expensive? In the latter, there is the hope that with a good job with health insurance that I will be able to access decent health care. In the former? Maybe in 20 years the fundamental brokenness of the system will provide a doctor. I'll take hope over hopelessness anyday.

[Ben Kenobi]

I’m from New Zealand, Elok. I couldn’t tell you about European healthcare other than the NHS, which my uncle used to work for. Canadian single-payer healthcare works pretty well. Aeson already said what I was going to say. Other countries spend much less than the US on healthcare for better results. This isn’t because we are more virtuous or smarter than Americans—it’s because our political system allows the government to do things while keeping it responsive to public opinion. My country changed its voting system in my lifetime for this reason. We would change it again if needed. The constitutional straitjacket prevents the US Federal Government from making these kind of changes.

Good for Ben on getting married. As a fine lady said, “every old sock finds an old shoe.”

Welcome back Agathon! Now that's a blast from the past.

Yeah, things are going really well for us. Couldn't be happier. Glad to hear you've hit what, 25 years? You got a much earlier start than us.

[Ben Kenobi]

Inspired by something Lori said in (checks) the Kamala-is-a-commie thread, this is a thread where we identify the political faction or party we identify most closely with, and explain why a thing they did or do is or was stupid, wrong, cruel, or embarrassing. Please do not point out the misdeeds of a party you don't belong to or identify with, and especially not one you actively oppose.

I'm a registered Libertarian, so: the Libertarian Party is generally a clown show which fixates on a boutique cluster of extreme niche issues at the expense of making a broader case for classical liberalism. The Mises Caucus or whatever appear to be troglodytes but the guys they were fighting don't seem much better. Reason magazine in particular tends to recycle a lot of the same talking points over and over again instead of branching out into new territory when I know there are a lot of new frontiers to explore. They're almost certainly in hock to their wealthier donors. John Stossel comes across as an oily huckster, which isn't surprising as he's a Fox News transplant. I've caught the Cato Institute engaging in blatant statistics-fudging bull**** at least once (though that was in the cause of defending increased immigration, not something outright evil). While the Second Amendment is here to stay for practical reasons, it really doesn't make any sense that gun ownership is an inalienable right while the far more vital and versatile ability to drive a car is a license you must earn and keep via good behavior. People who defend capitalism by condescendingly explaining that rich people are just creating more value and therefore deserve it? Need a good hearty dick-punch. Ayn Rand was just plain awful, obviously. Probably more but that's enough for now.

C'mon, everybody! Own your team's terrible, terrible ideas and practices!

Trump's funding for fertility treatments is a bad idea. US has a lot of debt already. 50k per kid when you aren't willing to give new fathers and mothers 50k to start their family? Would be far more cost-effective to provide 5k on the birth of the child.

[Elok]

It's sixteen years and change for me. Three sons. Life is good in general.

[Ben Kenobi]

Happy for you Elok! Glad that all is well.