Comments by "Xyz Same" (@xyzsame4081) on "The Humanist Report"
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The customers AND ONLY the customers should pay for intense use of broadband - like for instance watching NETFLIX. This (and similar) services increased traffic in the course of few years (and in an unexpected manner) so the providers may have to increase infrastructure investments.. Before, the providers offered unlimited packages, that made sense then, but maybe did not cover the extra costs of that intense use.
Let me explain: It may seem attractive for customers that NETFLIX SEEMS to pay a part of the costs of those infrastructure investments for the consumers (or seems to pay for the extra profit the providers, often monopolies, wish to make) - but these costs WILL shop up on your bill - one way or another.
Worse: These business practices ALSO keep new competitors (for example for NETFLIX) out of the market.
NETFLIX can easily pay the extortion fee of the providers. And when they are the only option (or beat everyone else because they have by far the best offer and no competitor can challenge them) they will be able to slap the extortion costs on the bills (and then some) and get away with it.
It also makes pricing very intransparent if a company APPEARS to COVER a part of the REAL costs of the service for the consumers.
And will allow the few large players who dominate the marke,t to impose intransparent costs at several points. While preventing competitors from entering the market. Especially smaller companies.
Once the providers have the systems in place to throttle some service sometimes they can and WILL get "creative". That includes extortion and worse - political and other CENSORSHIP.
Some of that is already going on. Facebook - what is trending, Google on the search results on Hillary Clinton (sure a lot of nonsense going on, but that is free speech, the search results did not reflect what was going on on the web).
People say some videos which they upload on FB are not shown, etc.
Just saw "Google turning into censorhsip engine" by RT America as youtube suggestion. lol
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It takes indeed a lot of work to NOT provide care. **Growth of Physicians and Adminstrators 1970 - 2009**. I found a BLS graph, * the number of physicians roughly doubled, number of administrators is TIMES 32 -
* Growth of Physicians and Adminstrators1970 - 2009
Source: Bureau of Labor Statistics; NCHS; and Himmelstein /Woolhadlerer analysis of CPS
These are the titels and descriptions directly at the graph (screenshot from Keiser Report)
I have it from Keiser Report Fake Healthcare
-or you can search with the headline titel ** - that and similar graphs (for other time periods or compared to Canada) show up in other reports on the web
As it is the GROWTH (in this case in number of persons) that is visualized, both lines start at "zero" in 1970, I would estimate it is 100 % in 2009 - that means it has doubled until 2009.
Really interesting is the numbers of administrators around 3200 % (yes threethousandtwohundred) that means the number of 1970 multiplied with 32.
In a reasonable, streamlined system where everyone gets the same treatment, not exceptions, no co-pays, deductibles (when it is medically warranted = single payer as is practiced in Europe) you would likely have MORE staff to provide goods service w/o waiting times (so more physicians, nurses, and therapists, etc.). But it would hardly need more administrators to organize them to deliver the care.
If you double the medical staff you do not need to double the number of adminstrators - not even close. Let alone times 32
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Johnny Lee Clary, former high ranking Klan man, had a little black book with names (incl. the names of "respectable" citizens who did not want to openly associate with the KKK but gave them money. He also says there were a lot of policemen in the KKK or they were supportive, (also the police of L.A. was undermined by the Klan).
Clary's fiance was a FBI mule, the FBI got the notebook and the names, so these "orderly" citizens were visited by the FBI, often on their workplace. Oopps.
Search with his name and ABC Australia, the format was called "Enough Rope", there are only clips of it on youtube (4 minutes very funny). But on the ABC website there is a transcipt of the video, unfortunately the video.
(One can understand why he was the speaker and recruiter for the Klan, he is funny). It is also a hilarious story how one black reverend impressed him in his Klan days against his will - and how they became close friends after he changed his ways and had left the KKK:
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Yes, he is a coward. A black professor that returned to his home in a good neighbourhood was arrested on his porch. When Obmama mildly commented on it police were upset. Needless to say Obama backpaddeled. He would like to meet that member of the police member for a beer - bla, bla. - on the local level the Dems collude with police.
In all first world nations the population in the urban area tends to vote for the more left parties in the country and the rural voters tend more to the right. In the U.S. that means that the cities vote for center-right neoliberal Dems that are to the left of Republicans.
In the city good money is to be made from collusion with real estate "developers". Pricing the locals, that live and work in the city out from the housing market. That comes at a price - there will be a permanent underclass (they never get ahead because so much income is spent on housing, schools are terrible, etc.
Neoliberal Dems and Repubs also have undermined manufacturing in the country, so people have to flock to the densely populated areas where there are the lower paying service sector jobs. Manufacturing jobs can be in the more rural areas too, the goods are distributed anyway, but service sector is where the people are. if more people got to the cities the rents explode.
you need an oppressive police force to keep those people down and show them their place. Stop and Frisk was a) unconstitutional and b) utterly useless to find people that had drugs or weapons on them. But Giuliani and Bloomberg and the NYPD carried on anyway. Why, if it was not effective ? It was never about preventing crime - it was a show of dominance and they targetted the part of the population that is the most feared by oppressors. YOUNG MEN. If a disenfranchised group will give them trouble - it will be their young males. (if the struggle is violent. but even in non-violent protest, at least in the 1960s and 70s it was like that. Nonviolent protest is the worst for the powers that be. but they also fear riots
On top of that police unions are well organized and have money. Neoliberal Dems have nothing to offer for their base, so a coordinated effort of police unions could hurt the reelection. And they also want the donations from the police unions.
These are the major reasons why the blue cities (= large cities) are the worst regarding police brutality.
Another international trend, the large cities have the highest crime rates in the country. No matter how high or low it is always higher there. So police is more stressed there, and will of course be more reactionary.
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+ Don Parnell What do you mean you cannot compare a nation of 60 millions (or 82 millions like Germany, or 30, or 8 like Austria, or 300,000 like Iceland) with the 340 millions of the U.S. - you can scale the system up and down.
Even small Austria has approx 16 subdivisions in their system (the insurance agencies - but there is ONE head agency and they negotiate drug prices together and know the price list for procedures of the others. The patients do not feel that. If you have an out of state treatment or go to a very specialized center (organ transplants) the agencies have that figured out between themselves. The patient is not bothered with any tariffs or bills.
Same with Germany. Costwise it does not really matter if the country has 8 or 82 million people. Around 20 % of people cause 80 % of the costs. Most modern treatments target certain relatively common conditions. All sorts of cancer, standard surgeries (like gallbladder, appendix,....). Treatment of diabetes, of broken limbs, treatment after accidents, childbirth, ....
I guess if they have the need for an organ transplant in Iceland (which may be too much for the small pool of 300,000 they fly the patients to Denmark, Sweden and Norway and have it done there.
If anything the U.S. should have an advantage because of its size - although I do not think that the economy of scale really matters with healthcare. (On the other hand there are the states, so that makes things more complicated because they insist on individual solutions).
You need pharmacies, hospitals (placed all over the country so the transport ways will not be too long in case of emergencies), familiy doctors, and specialists. A central agency (or several) to administrate. Universities to train the doctors and institutions to train the massage therapists, nurses, ....
What about that is not SCALEABLE ?? Dependant on the number of USERS.
World Bank data 2014, per capita healthcare expenditure of nations ins USD:
UK with 65 million 3,900 * Germany with 82 millions 5,600 Austria with 8 million people 5,400
the U.S. 340 million people - and 9,600 (my number for the U.S.is 327 but anyway)
the NHS covers most of the UK expenditures and starting from a point where they had a very lean budget, their funding was cut - but I guess with around half of the U.S. per capita expenditures the system could run like a charm.
- it looks like a wealthy nation (wage level ! is important for the costs) needs at least around 4,500 USD per capita. Most wealthy European nations and Canada NO MATTER THE POPULATION SIZE are in the 5 - 5,500 USD range.
Countries like Candas and Australia maybe have higher costs because of servicing the outback (or the people there have to accept longer distances which may result in more casualties unless they use helicopters - which again is expensive.
Germany's population is on average older than the population of the typical immigration countries U.S., Canada, Australia. - so the U.S. should beat Germany on demographics alone
These are factors that DO play a role, the population size does NOT mattter (if I remember Iceland has lower costs than Germany).
Also: if the system only covers the basics and allows a 2 tier system this will immediately result in higher expenditures, it requires the additional buraucracy that has nothing to do with delivering treatment and 2 tier systems give dysfunctional incentives that are hard to weed out because there is such a gap of knowledge.
(If you pay for and upgrade insurance plan: is the test really necessary ? Or is it a way to bill more money (and the test will not harm you - but will do no good either).
If everyone either gets that test or not according to need, it would become too expensive to administer it - just because. When it actually helps the costs will be argued. Else it will not be used. Healthcare costs are constantly rising (ageing population, better treatments that cost more). So in an non-profit PUBLIC system with a certain budget that is expected to deliver the SAME GOOD care for everyone, there is an automatic pressure to search for and weed out unnecessary and frivolous treatments.
That is one of the advantages of "the exact same treatment and the same places for everyone". If the more affluent citizen get the same as the less wealthy - you bet the system will be good.
The affluent citizen pay more because the contributions are only according to what you CAN pay and not according to risk. And no more bills for treatment. The funding is with payroll deductions (businesses, all sizes tiny or multinational, and the employees - and they all pay the same percentage, plus some tax funding on the federal, state, and local level). So in the end the whole country has a stake in the system (so the CEO having an accident lands in the same hospital as the minimum wage worker, and there will be no difference in the treatments).
That in absence of the usual market forces * keeps quality good and costs reasonable.
* Healthcare is a terrible fit for the "free market" it shows in the U.S. costs and dysfunction) that .
The most cost-efficient systems have "one size fits all".
And healthcare is one of the few products where that is a good thing.
If you think about it: which kind of gallbladder surgery do you want - the basic or the luxury version ?
Well none, if possible. And if it must be done, than as little as possible and as much as necessary.
And if you think about that in combination with the effects of healthcare - or insufficient care - on life, health, the ability to take care of your family and yourself and your job - that is a unique situation which we do not have for any other service. so healthcare is not a product like milk, or a gym subscription or the repair job for a car.
Would you insisit on 5 cycles of chemotherapie (because you have the platinum insurance plan and want to get something for your buck) - when the doctor says surgery and then 3 rounds of chemo.
And if a person has only the basic plan - do you whithold the chemo, or do only 2 rounds ? (And the provider of care running the risk of "wasting" all the efforts - because the full treatment with the 5 cycles would have given the optimal chance for survival).
With many products there is a basic version and the better version. That is fine with restaurants and cars. But in matters of life and death or future health ?
For profit businesses usually want to sell more (the leather seats and the stereo sound system in the care). And they MARKET their services.
Selling extra for medical drugs and medical surgery ?
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Another aspect: the veterans would be a STRONG ALLY for regular patients to make the system good and cost-efficient: Healthcare is a very bad fit for the "free" market. So in absence of the market forces OTHER MECHANISMS must keep the non-profit, public, solidarity based system good (quality) and cost-efficient. - In countries like Germany or Austria (which I know) that works well, almost everyone has a stake in the game: employers plus employees fund it, plus some tax funding for the hospitals, politicians would be blamed if there is a hiccup, employees (low AND high income !) are also patients, and business owners want a healthy workforce and land in the same system if they or their family is sick. Add to that the doctors (small entrepreneurs) and non-profit hospitals. The "single" payer public insurance agency wants things to run smoothly as well. They just have to stay within their budget. No need to make a profit/surplus, no investors to please. If they need a higher budget they have to provide a very good reason (rising wages mean higher payroll contributions so that takes care of inflation).
The WHOLE COUNTRY is in ONE BOAT (the hospitals are with very few exceptions non-profit institutions who have contracts with the public insurance agency. Some hospitals are private non-profits (church), some are run by local governments.
Only the pharma industry and the medical equipment industry is not IN the boat. So it is for example Big Pharma vs. 8,7 resp. 82 million people (Austria / Germany).
The Veterans would be a very valuable "asset" to keep or make a system good.
If the system sucks, it sucks for everyone and everywhere - but due to the respect veterans get in society they get more attention when they complain. I know VA services are often said to be of low quality. Veterans have one disadvanatage - they do not have the numbers ! (Compared to the 325 million people in the U.S.)
Regular patients and veterans could help each other, the veterans have the reputation and can command more media attention, the regular patients have the SHEER NUMBERS.
"Divide and Conquer" helps the powerful. Having ONE reasonable ! funded system for all (incl. the veterans) would reverse Divide and Conquer and help all (veteran or not).
ONE system works because in healthcare it is ONE SIZE fits all. We want cars with a lot of different feature and completely different prices (or no car at all) - but WHICH CANCER TREATMENT do people WANT ? The ONE that based on the medical diagnosis is likely to help best.
So this is always about weighing the medical chances. Not about product preferences, product diversifications, marketing and whatnot.
I do not need or want CHOICE when I have a broken arm (I would not know anyway), and do not want overtreatment or undertreatment - I want the ONE treatment (incl. tests or X-rays) that is medically reasonable and necessary.
And I expect to be helped by someone who has NO INCENTIVE for over- or undertreatment (NON PROFIT). And is not distracted by a huge bureaucracy like in the U.S. (it is expensive and needs a lot of work to DENY TREATMENT or to charge extra).
I can choose to which hospital or doctor I will go. I expect them to be in reasonable distance and I expect to get the adequate treatment in a professional setting in reasonable time.
For more specialized and plannable procedures like hip replacement, eye surgery, ..... there will be referals, hospitals specialize in PLANNABLE procedures. That means more expertise because of the higher case load, which means better outcomes and cost control.
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It is no coincidence that NO country uses the public option. In single payer nations with currently well behaved profiteers (who get a small slice of the pie at most) it would slowly erode the system. Making it more bureaucratic, add dysfunction and unfairness and the costs would go up over time.
But note that in almost all other countries the for-profit insurers never got their hands on (much of) the healthcare market. Healthcare is a large chunk of the economy even when delivered in a cost efficient manner and by non-profits.
8 - 11 % of GDP in wealthy countries (versus 19 % in the U.S.).
That would be highly attractive - but private insurers there know there is no chance for them to expand their "market share", that the non-profits (insurance agency AND hopspitals !) dominate the field and no political party is going to help them.
They know it would not fly - and since the non-profits do a good job there is no justification to talk about privatization or handing a part of the system over to the profiteers.
Most countries overhauled or started the system after WW2, and they applied the crucial conditions of single payer: have as little for-profit as possible, especially where the complex decisions are made and a lot of costs manifest (insurance and hospitals). If you have for-profit players they must be small companies.
Do not allow an opt-out.
Big pharma = large and powerful for-profit playera but they have internationally standardized products - so the insurance agencies can contain them (they can compare costs with agencies of other countries, as non-profits they have no reason to "guard an information advantage" about the results of their negotiations).
All countries did their own thing most in the late 1940s, so the systems do have differences. Some did the "set-up" better than others U.K. did best, they reduced the for-profit players the most, even general practicioners are employed with the NHS. In most countries the doctor practices are like small companies.
see their spending only 42 % of the U.S. spending per person. The Tories cut funding for the National Health Service and it starts to show, with better funding - still low for a wealthy European country - the NHS would run like a charm. - Most wealthy nations are in the range of 50 - 54 %, Germany has 56 %, Switzerland whopping 78 % - with private insurers, they mandate that people have insurance, so it is universal - but it is not single payer.
The single payer systems are UNIVERSAL, the affluent / young and healthy cannot opt out from paying into it. So even the affluent can as well use the same providers as everyone else. No political party can make hay of opposing the system - voters of "conservative" or right wing parties like it, too.
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