CS314 - Unhealthy Numbers

[Martin Hash]

Fife, tell me again why opening up Medicare to everyone is a bad idea?

p.s. If you say "cost" then that's ALWAYS been the problem.

[Fife]

Tell me how that program provides a public good.

[TheReal_ND]

I kinda like what Capp proposed today: a free public option anybody can choose (Medicare probably), along with traditional insurance-based for those who want/afford it.

This sounds reasonable to me. My only problem with the AFCA was the penalization you would incur during a lack of coverage. I think that's bull shit. Well that and the fact that it is a lot of money for shitty coverage.

[Fife]

Step One: full repeal, full stop.

As for step Two, I found some merit in RandyCare, as we discussed before. viewtopic.php?f=63&t=1605&p=23717

Repeal and replacement have to be the same bill.

Specifically, what do you want to do about all the people who are losing health care, can't afford it, etc?

Permissibility to pool; no artificial interstate prohibitions, &c. Basically, get the state out of the equation. Veterans get vouchers for care they are obliged contractually to get on the market.


The state and its cronies have this system fucked up nine ways to Sunday; I'm ready to contemplate a way forward without the state's continued fuckery (see, e.g., Paul Ryan).

[Martin Hash]

Tell me how that program provides a public good.

Dude, a "public good" is when 51% of the people want it. Maybe you don't think that's the case?

[Fife]

Tell me how that program provides a public good.

Dude, a "public good" is when 51% of the people want it. Maybe you don't think that's the case?

Right. It's not the case.

There is no legal authority in the U.S. for the Lord of the Flies fantasy in your mind about some O.W. Holmes "democracy" washing the streets in blood.


... and, you know what a public good is, right?

[Martin Hash]

WTF?! Didn't your Law license come from The State?

[Speaker to Animals]

WTF?! Didn't your Law license come from The State?

Guam technically is a territory.

[tue4t]

I've lurked and listened to Carlin for a while now but in addition to all the nuclear Trump, this is probably the last common sense for me. There are so many gaps and holes in his analysis you can really tell politics and constitutional issues, not economics or healthcare are his strong suite. Nothing against him, his hearts in the right place but I don't really get anything out of it anymore other than severe frustration.

Dan starts by stating high cost, low outcomes, and huge public expenditure as principle problems, and then inexplicably in the same breath proposes a single taxfunded health pool which addresses neither of the two issues he built his entire case on. His solution to the leaky bucket is to pour more water in it.

Never does he ask "how do we more efficiently supply healthcare?". Probably because left-minded thinking is too afraid to come to the inevitable conclusion that competitive free markets are exceedingly better than government in this task. Kind of like the guy who lost his keys and is only looking for them in the small spot where the street light is shining.

He blames employer provided healthcare on the free market as "socialised bleed" as if people were stealing money from the government when it was their money to begin with. Again oblivious to US businesses only doing this because of the tax code slanting the board that way. When you're paying for something with tax free money, it's no surprise that people are willing to salary sacrifice more into health benefits than if they were doing so with after-tax money in many of the countries that Dan thinks are comparable. It's an obvious redistribution from low income earners to high income earners and should be gotten rid of.

He drops the old boring "but healthcare is a different market, it's not like buying things at the shop!". Oblivious to other goods and services that are also price inelastic, time sensitive, and necessary to life having no difficulty being privately supplied. Water, Food, Gas, Electricity, Shelter.

He doesn't seem to understand supply and demand and how prices respond. If medical procedures are so much bang for buck in other countries, why don't people just take a flight somewhere else problem solved? Dan is going to have to explain why 50,000 canadians are going overseas for their healthcare when it's free in their own country. When single payer systems refuse to pay, they do not reduce costs, they only reduce availability.

His surface analysis of costs and outcomes is really quite crude. How is Dan so sure that the problem is "profit bleed", but not artificial bottlenecks in supply or inflation of demand? How is Dan so sure that that the US doesn't just have different supply and demand curves? The only thing of certain is that he references no studies.

If Dan had cared to take a look at a historical graph of US healthcare costs, he would have seen that it only started to outpace cpi during the 1970's, coincidentally after the passage of medicare and medicaid in 65, restrictions on hospital licenses in 84 etc. Surely if it was instead because a free market healthcare system is fundamentally flawed, we would expect to see systematic inflation above cpi for all years.

https://mises.org/blog/how-government-r ... -expensive

Nobel Prize-winning economist Milton Friedman wrote that medical price inflation since 1965 has been caused by the rising demand for health-care coupled with restricted supply [Capitalism and Freedom, Friedman 1992].

• In 1965, nationalization was started with a government buyer monopoly after the Johnson Administration led passage of Medicare and Medicaid which provided health insurance for the elderly and poor, respectively.
• In 1972, institutional provider monopolization was strengthened after the Nixon Administration started restricting the supply of hospitals by requiring federal certificate-of-need for the construction of medical facilities.
• In 1974, buyer monopolization was strengthened during the Nixon Administration after the Employee Retirement Income Security Act exempted employee health benefit plans offered by large employers (e.g., HMOs) from state regulations and lawsuits (e.g., brought by people denied coverage).
• In 1984, prescription drug monopolies were strengthened during the Reagan Administration after the Drug Price Competition and Patent Term Restoration Act permitted the extension of patents beyond 20 years. (The government has also allowed pharmaceuticals companies to bribe physicians to prescribe more expensive drugs.)
• In 2003, prescription drug monopolies were strengthened during the Bush Administration after the Medicare Prescription Drug, Improvement, and Modernization Act provided subsidies to the elderly for drugs.
• In 2014, nationalization will be strengthened after the Patient Protection and Affordable Care Act of 2010 (“Obamacare”) provided mandates, subsidies and insurance exchanges, and the expansion of Medicaid.

Drug development costs also coincedently started skyrocketed during the 70's
https://www.scientificamerican.com/arti ... eeds-2-5b/


Also shocking how easily he singled out and praised the FDA as one of the only good things in the system for stimulating drug development when its effect is significantly in the opposite direction with obscene monopolies and ridiculously long drug approval times approaching 10 years from start to market. There's a reason Shrekli thought he could pull off that Daraprim pricing stunt with low risk of being punished by competitors undercutting him.

Next podcast Dan should talk about food reform.

https://en.wikipedia.org/wiki/Big_Mac_Index
A Bigmac costs $6.35 in Switzerland, $5.06 in the US, and only $2.15 in Taiwan. Same product, vastly different prices. Makes no sense if one doesn't understand supply and demand.

[Martin Hash]

Nice post. Welcome.

I'm an M.D. I use Obamacare, specifically Kaiser. I was also on NHS for a year. I like socialized medicine, never had to wait, have no idea what people who say that are talking about. Give me "Medicare for Anybody" as an option & I'm onboard with the U.S. system too.

p.s. I just had retinal surgery last week. Got an appointment THE DAY I arrived home from traveling. The NEXT DAY I saw a specialist. Two days later I was in the operating theater. In England (the NHS), my wife got foot surgery the NEXT DAY after seeing the doctor. She paid $35.