Comments by "Xyz Same" (@xyzsame4081) on "The Humanist Report"
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Fox News shills seem to be clueless about the MASSIVE role of tax funded BASIC RESEARCH in the U.S. (see Noam Chomsky "The role of the military is misunderstood. When he was active at the MIT in the 60s, 70s, it was almost 100 % funded by the military. The companies producing electronics were there and got their basic research financed, those have vanished from campus, now Big Pharma is everywhere on MIT campus).
The tax payers shoulder a lot of financial risks - when something looks promising the for-profit industry will gladly take it and run with it (and they have much increased chances to get a blockbuster out of it - and can leave the taxpayer with the costs for the inevitable failures).
One of the advantages of entrepreneurship has a lot to do with finding out which products the customers would like and then to have product differentiation and MARKETING. (Is Nike sportswear "better" than that offered under the label of Addidas ? ).
That creativity and entrepreneurial spirit is "rewarded" with profit. Also one of the motives of capitalism is to SELL MORE.
So let's apply that to pharmaceuticals: Now, which diabetes medication would consumers like to take ? None at all - they would rather be healthy. But IF they need one, which one would they like ? Well the one the helps best and has the least side effects. how do you "design" such a product. Well, not at all. You pour a lot of money at such projects and hope that a least of few of them work out. I think with technology and product innovations many branches have it better than pharma. If Mercedes (or the companies that serve them) wants to get a better engine or a better airbag and if they pour resources and workforce at it - they have a pretty good chance to come up with some useful innovation. Much better chance than pharma (dealing with the processes of live and there is always the risk of unexpected bad side effects).
So - regarding product DESIGN there is not much creativity needed - and not much one can really do to get a better outcome. If is unpredictable if a drug will do what it is supposed to do AND heaven forbid not have any drastic side effects (Contergan likely did a good job with dealing with morning sickness in pregnancies - but the side effects were dramatic ...). So from that point of view: Pharma is not such a good fit for "entrepreneurship" and the "free market".
I am convinced a publicly owned agency that hires promising talent regarding research, that pays good salaries and offers a well funded research environment would come up with innovations regarding drugs as well (It has been done for other fields like IT in Europe, where "research centers" are funded like public universities). And they would avoid one inefficiency: The profit for the investors.
Moreover such a publicly funded pharma research institution could also do research and then SELL medications for rare diseases (they might not bring as much in sales revenue but could save a lot of costs in treatment - something that is not relevant to a private for-profit pharma company - but would make the investment even economically viable for society if you look at the larger picture).
Even poor Cuba has some medical inventions (something regarding lung cancer, needless to say it is not approved in the U.S. until now).
Last but not least: if new drugs are tested 1) ordered by the developing companies or the government. The results are always rosier in the tests of 1). Imagine a profit oriented company develops a new drug, it is doing it's job, it is safe to use. But it is hardly better than the stuff that was already around for a decade or longer. A for-profit corporation CAN and WILL have the study influenced (never mind the "neutral" institution that does the testing and hopes to get more such contracts in the future. The outcomes will lean to the very promising, positive side. While the independent government funded really NEUTRAL studies without any financial bias find hardly or only a slight improvement. (And there are studies that prove that pattern).
Let's not forget: the old drug has the advantage that it has been around for some time, so it is better tested for adverse (completely unexpected) side effects (that may have went unnoticed during the process of approval).
Now that is the more harmless scenario. It get's more sinister when we look at the OPIOD crisis. Those painkillers are very powerful, the company KNEW they were addictive. So at the maximum they could be used with a lot of caution in rare cases - then they would have been maybe a good (but potentially dangerous) tool.
The problem with such a responsible approach: not enough revenue if those drugs would have been used as sparingly as would have been prudent. Or more likely they would not have been approved in the first place.
So the company rushed through the approval process, probably presented a doctored study (or got help from those doing the testing), and let the family doctors and hospitals believe that those drugs are harmless. Which presicribed/used them, many people got addicted. After some time the dangers became more obvious, accesss to the drugs got much more restrictive and now these patients (unintentionally addicted) switch to heroin. Which has the same effects as the opiodes - Duh.
A non-profit institution would have no incentive to lie and mislead about the possible dangers related to a newly developed drug. They could "justify" the costs of the development of the painkiller with - it is effective, but should be used very, very cautiously - so it was a success, just not a commercial success.
There is a U.S: lawsuit (not sure which state) against the criminals who caused the extremely costly * opiod crisis, it started summer 2017 - criminal charges, not a civil suit for financial damages. Usually Big Pharma think they are above the law.
* costly in destroyed lifes and familis, in deaths, and also excessively costly if the U.S. now tries to offer rehab for these patients.
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part 2 / 2 When it comes to a CHANGE OF PARADIGM - the ACTIVISTS always had be be way AHEAD of the professional politicians (Civil Rights movement, LGBT rights, marijuana, womans suffrage, end the Vietnam war, end slavery in the UK). It might have to do with cowardice, with political smartness, with how much a politician can require of the establishment w/o becoming the target of a smear campaign and losing too much political capital.
When MLK started to speak out against the Vietnam war, that cost him a lot of "political capital". His "ratings" dropped. That can severely damage your wriggle room in politics or activism - you have to be able to "afford" such a drop in ratings w/o losing everything you fought for - including the support for other good causes, and of course the career.
We know NOW: Had MLK lived longer, his integrity would have turned into a huge political advantage - the public seeing how he was AGAIN ahead of the curve. - On the other hand that might have been the reason he was killed - being against the war and organizing a March on Poverty (poor people of all races !! )
"MLK was not MLK in his time" - meaning he was not even that popular within the black community, many were afraid he would make things worse, if the rocked the boat too much. And going against what was considered "patriotic" did not help either.
He could not know if his position would "pay off" later - and he did not compromize because of such considerations - if the U.S. would have pulled off something that ressembled a victory and if less U.S. soldiers had died, the U.S. citizens (well at least not the majority) would not have cared that the warS in ASIA were unjust or how many Asians were slaughtered and harmed.
The resistance to the war in Vietnam could as well have remained a stain on his reputation, giving ammunition to his enemies.
The Civil Rights Movement had to strongarm even well meaning politicians. They incl. MLK were told be be more patient, it was not YET the time. (P.O.C. still would not be able to vote IF the Civil Rights Movement had CONTINUED to WAIT). - Well they did NOT wait, they used the power of the media, the fact that enough white, decent people were already uneasy about the situation.
In 1963 the police in Birmingham (a stronghold of white supremacy) arrested hundreds of nicely dressed children (age 8 - teenager) singing church songs and in that manner protesting segregation. They used dogs and fire hoses - luckily no one got seriously harmed - the pictures made it onto the front pages worldwide.
The racist mayor of Birmingham and his rabid police chief were SHAMED into giving in.
And JFK was FORCED to take a stand - he gave a statement the next day.
The activists in most cases shift the Overton Window - what is "allowed" to discuss. How far a politician can go.
As Sanders has shifted the Overton Window on Healthcare.
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Sanders and Nina Turner (the Dems would have a HARD time pulling the misogyny / racism card). She is a good speaker, has a spine !!, comes accross as honest and down to earth and could activate the black vote. Being VP would allow Nina to develop her profile, gain experience.
And of course with a role for Tulsi Gabbard as well - she is very young, so if she is interested in higher office - she has time.
I think she would do well with conservatives, especially conservative women.
A president (or VP) does not need to know everything. But some intellectual curiosity would be good (I think GWB did not have that, and Trump certainly does not have it, neither did for instance Sarah Palin).
Some life experience and a well developed bullshit meter (so your advisors cannot fool you). The ability to process nuance and complexity and to do so quickly if necessary.
And then of course the willingness to select advisors (the right kind that will SERVE the people not the donors) and then to delegate to them. Letting them work on the long leash (while having the before mentioned BS meter - there is always a huge incentive (power, money) to pull the wool over the presidents eyes.
And beyond that advisors can have "pet" projects and ideological bias.
JFK did not listen to the top generals in the Cuban missile crisis - they advised him to strike first. - Given that the Soviet Union stepped down from the Arms race and the Cold War voluntarily at the end of the 80s beginning 90s (much to the shock of the Military Industrial complex which all of a sudden lost a very reliable enemy) - this would have been lunacy.
I think JFK had learned from the Bay of Pigs disaster and "was his own man" - he implemented rules to prevent any "accidental" escalation. Any high ranking military that would try to provoque an escalation, practically forcing the presidents hand) would have needed to violate the chain of command. They could not claim a misunderstanding later.
I think JFK knew very well why he established the rule that no ship in the waters around CUBA could be forcefully searched w/o the explicit order of POTUS for instance. That could have increased the tensions even more. (They did search ONE ship - and that was one that for sure was a commercial ship, had a "just for appearances" vibe about it. They for sure left ships alone that some military would have like to search).
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Transcipt 3 of 3 - please upvote 17:49 Here's what I said about these individuals and why they're so wrong and why they don't have facts on their side. First of all contrary to popular belief abortion isn't tantamount to baby killing. Furthermore the abortion rate in general continues to decline in the United States year after year. But for the few abortions that do occur over 90 percent of them happen fewer than 13 weeks into pregnancies, which is the pre gestation period.
And just over 1 percent of abortions are performed after 21 weeks. Now note that states do not offer abortions to women if they are within the 22 to 24 week period of their pregnancy. Additionally nearly 1/5 of abortions are medically necessary.
And on the moral side of things if you think abortions are immoral because fetuses may have the ability to feel pain … while the Royal College of Obstetricians and Gynaecologists found that a fetus can't actually feel pain before 24 weeks. The University of California found that they actually aren't able to feel pain until 28 weeks, and these are all statistics that are provided by the Guttmacher Institute.
If they're not convincing to you that's perfectly fine because if you still are against abortions, if you're morally opposed to abortions, that's fine. There is one tried-and-true method that absolutely reduces the number of abortions: Contraception ! Greater access to contraception not only reduces teen pregnancy but it also is much more effective at reducing abortion than prohibitive laws.
19:14 As the intercept's Zaid Jilani explains participants of the March for Life know exactly how to reduce abortions: they can push their government to fund contraception. People who are marching in the so-called March for Life protest they're not advocating for greater access to contraception.
In fact they're against abortion and contraception, so they want to have it both ways. On one hand they want to ban abortions but on the other hand they also want to ban contraception which just so happens to be the one thing that actually reduces the number of abortions.
Now I know that instinctively you might be inclined to say: Well, there's one thing that can reduce abortions for sure. You just ban it, but that's actually not true. In fact abortions, the abortion rate generally speaking in the United States overall was higher before it was legalized.
So legalizing abortion actually does decrease the number of abortions, I know that sounds odd, but that's the numbers, that's the statistics that are widely available. I think that I've said everything I needed to. Anyone who is supposedly pro-life nine times out of ten they're gonna be completely hypocritical and not care at all about war.
The next time you are confronted by someone who's pro-life, who tells you that you should support Brett Kavanaugh voting to overturn overturn Roe versus Wade possibly. Why don't you ask them if they realize that overturning Roe versus Wade won't necessarily do what they think it will do in curtailing the number of abortions ?
20:42 Why don't you ask them why they're not supporting initiatives to expand access to contraception ?
Why don't you ask them what they thought about Saudi Arabia bombing children with bombs that our military gave them ? What do they think about Saudi Arabia committing an actual genocide in Yemen with our approval and support ?
Ask them what they think about those issues and if they don't actually speak out and have a lot to say about Yemen, or the Iraq, or Afghanistan wars, or our drone strikes being carried out in Pakistan, Yemen, and Somalia - they're not pro-life.
We cannot keep calling these people pro-life, because I've said it once, I'll say it again: You cannot be pro-life if you are simultaneously pro war. And you can't just even be ambivalent towards the idea of war, if you are truly pro-life, then you better be one of the loudest people in the country speaking out against wars.
Seeing that most pro-lifers - quote "pro-lifers" mind you - vote for Republicans all the time and they're currently trying to ramp up tensions between the United States and Iran, which will be a war that would kill millions of people potentially, we all know that they're not truly pro-life.
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+terriej123 good comment - AND: following the UK politics, the neoliberal wing of the Labour party has been throwing the same tantrum. The integrity of elections is granted in the UK, purging voter lists (even for the elections within parties) is much harder, so the last coup against Jeremy Corbyn failed. (Purging the voter lists for General elections is impossible, it is easy to register, they have enough polling stations, and one can vote from early moring till 10 p.m. They have hand count in public halls, which are reported by phone (often with live notification on TV). The end results of each district is read to the crowd watching the count in the hall. It is not possible to rig the results. So if a politican can acitivate the non-voters, his opponents cannot exclude them from voting (like poor or young people).
The result of the Brexit vote in June 2016 was his declared his "fault" never mind their political opponents called the referndeum, while they were completely split on the issue. The official Labour party position was Remain which Corbyn supported although he had been highly critical of the EU before - and rightly so. - The plotters and backstabbers had been active for one year, they reduced their efforts a little bit before the referendum. Many of the people blaming HIM for the Brexit result were people who had NOT bothered to campaign (much) for Remain.
Anyway it was a good PRETEXT to start another palast revolt. - The idea was he would step down - he didn't. They planned to NOT put him on the ballot in the vote where they challenged his position (although he had won the party leadership convincingly being directly voted in by the party members).
One year later the COURTS decided that the party MUST let him compete for the challenged position. And they MUST adhere to their own rules as written down. Meaning: the party base votes the leader, if you want to change that, the party MEMBERS must vote on that.
so that was a lost cause as well.
He won that challenge with even higher margin, campaigned all summer 2016 on it.
The polls were terrible in spring 2017 (no wonder with a party in constant backstabbing mode). The Conservatives thought they could increase their narrow majority and their politcal weight with snap election. That backfired. And Labour pulled the situation around within 8 - 9 weeks after the party - for once - united behind the leader. He is doing very well in campaign mode - Sanders style rallies - and they had Sanders campaign member to help them - social media, etc.
The big shots and the neoliberals hate Corbyn like always. But the regular Members of Parliament (which are also part of the "party establishment" although of course they are often not the big shots) were scared as hell that they would lose their seats (polling predicted a landslide win of the Conservatives).
On the contrary: The Conservatives lost their absoute majority and had to strike a coalition deal with an small, extreme Irish party - and Labour got MORE seats in Parliament. So many Labour MPs are NOW glad to have kept their job, see that the strategy is appealing to the voters and will support his populist and popular proposals.
The usual suspects have to shut up. - And the constant "Corbyn is unelectable" is off the table since the snap election in May 2017.
Lesson: If the courts would not have ruled in favor of Corbyn, or if he had given up - the neoliberals NOW would be back in power in the party and on their way to complete electoral wipeout.
In UK the parties get public funding and since they are instrumental in politics, they cannot just act like any private organization. Society has some claims over their actions and can take them to court (in the US parties can do as they please. The Labour party could have excluded Corbyn from the 2nd leadership, too - if such procedures had been agreed upon in the party rules BEFORE).
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+ Hillary Clinton Universal healthcare/Single payer is HIGHLY popular among the PEOPLE. (so is Money Out Of Politics which is the root cause for depriving the citizens of delivery of healthcare worthy of a First World country. Sure 40,000 people die needlessly per year in the U.S. because of lack of adequate healthcare, plus the hassle, worries and high costs for the rest of the population (and that was under ACA with the funding under Obama).
You add 45 % to the German per capita expenditures and you land at the U.S.per capita expenditures - source World Bank. The Germans - all 82 million people in the country - have a good system, for everyone as I know from first hand experience. All wealthy European countries have those public non-profit insurance agencies, the contributions are everywhere based on what the citizens can afford, not on risk and there are no added payments WHEN someone needs care. The treatment is delivered by public and/or private players (and the private ones are either non-profit or for-profit, that differs and the countries have installed different ways to finance that - a mixture of payroll contributions and tax funding usually).
All these wealthc European countries realized after WW2 that healthcare is a very bad fit for the free market (and some them had been the mortal enemies of each other in WW2). But on that point they all agreed (it's logical). So you have 70 years of experience and plenty of models that have been tested. The Canadians came on board in the 1970s, not sure when Australia and New Zealand implemented it.
Germany BTW was the first country to implement a very basic version of Universal healthcare in 1873. Despite it being a monarchy, the Social Democrats and other left leaning worker friendly movements were on the rise there. The conservative, rigid, and traditonal government did not like them (at all) and their demands to better the lot of the poor people.
So granting healthcare was an attempt to steal their thunder - and when the young men were drafted for the military (I think there was military mandatory service) they found that many of them were unfit for military duty due to poor health.
The regime was not so benevolent - but at least they were smart enough to recognize that it is an disadvantage of the whole country if you allow to health of the little people to suffer.
And no one could accuse Bismarck of not being smart.
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I have a crazy idea: imagine the U.S. would have a DEMOCRACY. You know, the system where people elect the government to represent them and take care of the details and organization and laws that should ensure the wellbeing of the citizens - not only the affluent - ALL of the CITIZENS.
And imagine a project that has become very popular (thanks the efforts of one Senator) - and I mean healthcare not the means of production * in the hand of workers, that has not been an issue Sanders campaigned on.
And imagine the representatives that are elected by the people (and PAID by them) would actually DO their job.
Now there are of course issues, where people have different opinions or a specific worldview/ideology is the base for a position on an issue.
Healthcare is NOT one of them where PUBLIC SERVANTS could legitimately have ANY OBJECTIONS. The experiment has been going on for 70 years. The systems of all other wealthy nations beat the U.S. and with a wide margin and on many parameters . There is no logical or defensible argument to not support Medicare for all (the current Bill is a not very strong draft and is unlikely to pass right now anyway - but it is a start).
All that are not even on board with the weakened attempt are doing so because they REFUSE to serve the citizens and because the try to getting away with serving the special interests - for their own financial/professional advantage. They are not doing their job - it is like being hired and taking the salary from one company and then quite openly working for the competitor. That would get you fired everywhere.
Politicians used to need the Big donors - for their own campaigns and they are also expected to raise money for the party or at the minimum to not piss off the Big Donors who buy their collegues.
Now, in that respect Sanders has shown the way - they would not be left alone in the cold, the progressives would flock to their support to get them reelected. In the end money in campaigns is only usefully if it is transformed into votes and voter activation.
And massive grassroots support can trump Big Money. People react better to personal conversations than to ads. The Civil Rights Movement or the Anti-Vietnam war movement did collect and need SOME money. But not nearly as much as they had impact, work done for free, never mind the danger and hassle folks put themselves into.
That's the advantage of have a good and just cause - you do not need to PAY people to support it and spread the message. (Me being a good example - I was incensed by your comment, you might be a paid troll of course - but then there are other people browsing throught the comments - I do often and I learnt a lot)
The other problem of Big Money and Special Interests in politics is of course the cushy positionsthat ex-politicians are getting by the Special interests - if the former politicians served THEM well when active and thus betrayed their voters.
Cushy position can mean hiring a family member for an excellent salary, a career as lobbiyest, or serving on a board of a company - Example: like Walmart had HRC on their board while her husband was the Govenor of Arkansas. Sure Hillary is a smart, well educated lawyer ,but there wee no doubt plenty of those around, do you really mean she would have gotten that position if her husband had not held that office ?
There is help with selling a book of the politician or ex-politician (such Big Donor support was mentioned in the Podesta emails - the idea was that the Clintons OWED someone for support during a book tour and that they should adapt their actions if they wanted that kind of support in the future), contracts for political advisors or consultants, or stragist.
The whole beltway circus.
That means that a politician must be a good fit for being a politician for longer time (because else they will have to start over in the middle of their life and if they did not sell out during office some powerful corporations might hold a grudge against them - they might have it harder than other people of their age to find a job).
On the other hand the pay, the benefits are good and planable for a period of time.
Take someone like Sanders: he was and is SATISFIED with the salary and benefits he gets as politician, he likes to be a politician (he stubbornly - and for a long time w/o success - followed that passion. His career took off at the age of 40 years when he WON his FIRST election as mayor, so no doubt he liked the better pay and financial stability (for 2 years, they vote for mayor every 2 years) - AND that was ENOUGH for him.
No chasing after additional benefits from the Big Donors. And enough grassroots support to get himself elected on his own merit.
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I would have won but they stole the election saves the face of the narcissist. AND they FUNDRAISE on the gullible cult followers. The stipulations: the first 8,000 USD that they collect per donor can be used by Donnie personally, he does not have to use the first 8,000 USD per person for lawsuits, he can use it to settle his personal !! lawsuits, pay his campaign debts etc. The big donors have abandoned the conman. They quite happily accept neoliberal Biden.
If only Sanders had been the nominee. He might not have won GA and AZ. But he would have had a chance in Florida, in Texas even (thinking of it, they killed it with Latinos so AZ would have been in play even if Cindy McCain would not have campaigned for Sanders like she did for Biden).
But Sanders would have had solid wins in Michigan, Pennsylvania. Biden lost Ohio by a wide margin too (Obama won in TWICE), Trump got a LOT of union votes there. Mind boggling. (He did not even do anything for the blue collars there).
The margins were too close for comfort in all of the Rustbelt (and only thanks to the progressives who organized on the GROUND there was the groundswell that carried Biden in Michigan, PA, also Minnesota). The grifters in the Industrial Election complex get all the money so no money for grassroots to ORGANIZE on the ground.
Abrams and grassroots there (to the left of Abrams) did a voter registration drive in Georgia. To be sure the suburbs delivered for Biden (and who knows if they would have voted for Sanders as well). But the organizing was done by the grassroots. That is crucial but of no monetary interest for the industrial election complex. The workers are either unpaid OR they are regular staff. so money is paid and it delivers a good outcome - but no one gets rich of it.
That is why the party and usual primary campaigns are much more interested in TV ads (and the networks reciporcrate by offering jobs for obedient shills if they leave politics).
The Sanders campaign INVESTED IN THE COMMUNITIES. They wanted to win over Latinos ? they hired people from the communities who did grassroots works and leveraged the unpaid volunteers. with great results. So voter outreach would have been much better in the Rustbelt, in Florida (with secret weapon AOC) and in AZ. And Sanders would not have abandoned Ohio either.
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Okay: Good cop / bad cop strategy. Sanders is too polite to the Dems - hopefully he is calculating that this fans will raise hell anyway, but noone will be able of accusing HIM of damaging the party etc., etc. (well, noone but the hardcore Hillary supporters, or those who are part of the consultant and political adviser class). - When he was calling out Cory Booker in January (defecting from the "import Canadian drugs bill"), Sanders did so politely, not saying very much, and never mentioning the 12 or 13 other Democratic defectors by name (even Ted Cruz supported Sanders with this bill, competition and price control). - Booker was not pleased, came up with a lame argument, promised to be on board next time, it was just his concerns about "safety".
Sanders was too polite for my gusto, but then - the defectors got the Social media response and townhall treatment - while Sanders did not burn any bridges and Booker had to give a good impression of being gracious.
That or he is simply not as forceful as he needs to be.
still doing good of course by relentlessly campaigning.
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Australia: the basics (that can get very expensive, think hospitals, big surgery, ongoing costly medication) are publicly covered - of course ! Some services like specialists, likely also dentists are left to for-profit insurers and of course then the doctors can demand and will get higher rates.
I read an interesting comment by an expert (this was not about Australia, in general): if private insurers play a major role in a healthcare system, they have a bidding war on the services of the providers (doctors, hospitals). The providers can demand more.
even if there are for instance specialists that offer dental or eye care under the public contract: either the public agency has to pay more (to compete with the private insurers for the resourse = doctors) or the services open to publicy insured will be inferior because not many doctors will play along when they could get more, if they just insist on being "private". One way to handle this would be to dedicate only very short time to every patient.
Doctors demanding higher rates (because they can) is not "free market". Because the consumers / patients that need the specialis have not choice.
If the government decides to set up the system so that the doctors can earn more (at least SOME doctors = specialis, not necessarily those in the hospitals) and the for-profit insurance companies get a part of the market for no good reason at all - in the end the insured / patients will have to pay more (in premiums, in taxes, ...)
In wealthy single payer countries the doctors make a good living, but they do not have the high income of their U.S. peers. Especially in the U.S. the AMA (American Medical Association) made sure that not too many doctors graduate, they keep the numbers down. Rejecting good candidates for medical school, immigrant doctors are discouraged (certification not accepted).
The comment about bidding war came from an U.S. expert.
If the public coverage for some weird reason does NOT cover certain segments (eye care exluded or even basic dental), the budgets can be kept lower for the public insurance agency. These agencies always need additional subsidies to keep the mandated payroll tax affordable for companies and employees (goal universal coverage) - so there is extra government funding made possible with taxes from the upper income segments. (You get my drift).
The citizens cannot refuse to "buy" if they need a service, they do not benefit from the lower budgets of the public insurance agency, they will be made to pay one way or another.
So reserving space for private insurance = doing favors for certain groups. The strategy is typical for right governments.
More bang for you buck is possible with a comprehensive public coverage, enough budgets to make good services for all possible and leaving as little room as possible for private insurance. Or for-profit hospitals - or doctor practices that are private-insurance / out of pocket only - unless the doctor really offers something special.
If the public insurance agency is the dominant player, normal good doctors will have to accept the public contract. Else they would not get enough patients. If they think they do not earn enough they can take it to the court of public opinion. If their grievances are justified they will have the patients / voters on their side.
if the public agency covers most and all that is really expensive - but leaves out some services that are not life and death but still necessary (specialists) - the profiteers can make some hay of that segment. That is the Australian system:
it is NOT a public option because that would mean either full public coverage or full coverage by a private insurance company. (not that the private insurers get a monopoly for services that not super expensive but still hands them over a part of the "market").
I assume this setup was an Australian governments doing favors for industry, wealthy individuals and doctors. The Germans have another version of that.
I does not make things more cost-efficient. Or fairer.
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@mindped All insurers are adminstrative middlemen (for-profit or public non-profits). The non-profits just do a better jobs (for a service like healthcare and in general for natural monopolies). That is the case everywhere on the planet, there is not one private insurer that could beat the non-profits reg. cost-efficiency.
I know only of Taiwan, Switzerland and U.S. who rely on private insurers.
Taiwan: cost of living / wages not comparable (not sure if the services are quite comparable) and their spending per person has steeply risen in recent years.
The Swiss have 78 % of the U.S. spending per person - which is a lot compared to 50 - 54 % for most wealthy nations. Or 56 % in Germany (90 % under public coverage, they have the public option for the few privileged).
And of course the U.S. spending per person (in 2017) of USD 10,260 (which I took as base for the comparsion so that is 100 % - and insanely high - it is roughly doube than the amount of most other rich nations).
To be sure the Swiss have higher costs of living /wages - but the Germans have the higher average age. (Globally Germany is a close second after Japan). That is important because age is also a major driver of spending. So a lot of the 22 % gap is due to giving private insurance so much space in the Swiss system.
If the public coverage is comprehensive and reasonably funded and services are good - as they should be - there is no reason to have supplemental insurance. I find them expensive (I live in Austria). If you have expensive dental once in your life (basic is covered) or want accupuncture sessions it is cheaper to pay out of pocket. That way you are not tied to a long term insurance contract and have to finance the profits, admin, marketing, sales team of the private insurers. These contracts used to be tax deductible but do not get that boost anymore.
Even if insurers would be honest players (they are certainly not in the U.S.) they still would have higher costs than the non-profit agency Medicare. Think marketing, sales and of course the profit - profit does nothing for a better insurance product (which is admin ! *) - not with healthcare or natural monopolies. So profit is only a cost factor, does not give good incentives and on top adds toxic incentives.
the admin that is necessary: collecting contributions, negotiating contracts, paying bills, some plans around preventive care. That is what the public insurance agencies are doing. everything else adds nothing of value if you organize the healthcare for all of the country at low costs.
if private insurance gets you better services than the only reason is that some citizens get better budgets awarded than others (because they are veterans, teachers, work for a certain industry). Why should such differences exist regarding a life and death service.
Healthcare is also a black and white issue: either it is good or not. There is no such thing as a plain versus a gold plated gall bladder surgery. What would plain be ? they do not clean the operating room as carefully ? healthcare is systems, protocols, standards, it is about a uniform service where different qualities (basic versus luxury) make little sense.
There are often offers to have your own room, or better food - that is medically of no relevance, and when you need intense care you are on the drip and not alone in a room anyway. So those privileges play out for harmless procedures and become meaningless when you really get hit (and the large costs manifest).
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part 1/ 2 It might be a case of "Choose Your Battles Wisely" - a) the movement must be better than the leader b) Sanders invited Noam Chomsky as mayor of Burlington in the early 1980s *, he disagreed very much with the Latin American policy of Reagan. (I heard him mention recently the destructive war/regime change the U.S. unleashed onto Guatemala - he got really animated.
Noam did the usual gig: highly critical of U.S foreign policy, including the policy towards the the State of Israel. Military Industrial Comples. The media as gatekeeper - Manufacturing Consent, one must not overdo it with democracy, the unwashed masses must be controlled by the "elites". - It is depressing how that speech is as relevant as it was in the 1980s.
Sanders is a coward AND / OR smart when it comes to the immensly powerful Israeli lobby and the even more powerful Military Industrial Complex.
One could say he creates enough vicious enemies with advocating for good healthcare, breaking up the banks, taxing Wallstreet and getting money out of politics (reform the campaigns and the Citizens United decision - the latter is not that much mentioned anymore, isn't it ? And to be clear: Citizens Unites was only the last nail in the coffin, other supreme court decisions since the 1970s had paved the way for undue influence of Big Biz in politics.)
Of course bringing good healthcare to the people would give any politician a lot of political capital to work with, some leverage to take care of more controversial topics.
JFK and LBJ might have been sympathetic to the cause of the Civil Rights movement. But did that mean they would take POLITICAL RISKS for the cause ?? Well LBJ did jump into the cold water - and he was aware that the Democratic Party would lose the South for decades (..."those negoes better vote for us because we will lose the South for decades ..." - nice statement).
A lot of good (or at least not bad) people ignored, or at least put up with the lynchings that were going on in the South even in the 1920s and 1930s. Due to the difficult economic situation black people could not even migrate to the North where the law was not as brazenly disregarded and the police not (or to a lesser degree !!) infiltrated by the Klan.
Many people in the Northern States had KNOWN for a long time that the law was violated that granted black people the vote. They just could not see how that could be changed (can't somebody do something about it !) or they were busy with their own affairs (Great Depression !! and then WW2)
Politicians, media owners wanting to sell books and films just would not upset the WHITE voters / citizens in the South who always had been above the law and above the consitution regarding the treatment of People of Color.
When the cartoon Peanuts started covering a black boy (and what was worse: to show black and white children in school situations together !) some Southern newspapers stopped publishing the cartoon. To give you an idea: that was AFTER MLK was shot and the cartoon was very poplar. Actually the assiassination of MLK inspired a white a school teacher to write to the artist and to ask him to draw black kids as well - and he acted on her suggestion.
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part 2 of 2 Civilized norms for a First World country (one of the richest on the globe if you take per capita GDP as an indicator) and the fact that the plebs still can vote require that people are not left to die on the street. So an excessive paper shuffling operation is necessary to keep up the appearance of giving coverage.
Even when people think they have coverage - when they really NEED treatment they find out that it does not cover all. It is a lot of work to deny care or make the furious / desperate patients jump through 4 hoops.
So all these subsidies sustain the profits AND the dysfunctional red tape (that is necessary because of maximizing profits within the need to maintain the facade).
The European systems have almost always the insurance via a non-profit public agency (insurance is mandatory, income based, FULL coverage, the duty and the RIGHT to have full insurance, no exclusion for any medical conditions, monthly forseeable payments = modest wage deductions. And that's it. No later bad surprises for co-pays, deductibles, caps and what not).
That agency negotiates with the non-profit or for-profit actors. And usually at least a part of the hospitals (where the large costs per case manifest) are non-profits. The for profit operations are often church run hospitals, they come from a charitable tradition, so even if they earn the church a modest profit - they can be compared to the other non-profit hospitals (benchmarks)
They are heavily regulated and there is an incentive for them to not spoil their reputation by exploiting patients or denying care (which would be impossible anyway, they send the bills to the insurance agency, and they are not allowed to charge the patients extra. The only way to "save" costs would be negligent care. Well - unlike the child abuse cases - that would go public quickly. So they don't abuse their strong market position. (Many of them operate in Germany and Austria for historic reasons, but they serve the common good).
The U.S. industry would prefer predatory capitalism - have the un- or underinsured die like they do in India for instance - but keeping appearances "nice" is part of the deal - so they resign themselves to the 2nd best option: make the system incredibly complex - that favours the big players against the patients. And even IF the regulators were on the side of the patients - the industry will always be 4 steps ahead of the patients and 2 steps ahead of the regulators (never mind they are usually bought off, or understaffed).
Patients are even more vulnerable since healthcare is often a life / death / later quality-of-life issue. Good and promp medical attention decides if you will live, how good your life will be and if and when you will be fit to work and take care of yourself and your family.
It is one thing to be ripped off by cable TV and internet providers with quasi monopolies - healthcare is much, much more important, cannot be avoided with some inconveniences - and is also much more expensive.
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2017 healthcare spending per person of nations (Keiser Foundation also see World Bank). The U.S. 10,260 USD for every person in the country on average. Most wealthy nations (usually with some form of single payer) are in the range of 47 - 56 %, the most common range is 50 - 54 % (Sweden, Finland, Austria, ....), Germany 56 %. France Belgium, Australia, Canada even below 50 %
....and then there is the U.K. with 42 % of U.S. spending levels.
I looks like first world medicine with a certain age structure needs around 5,400 - 5,800 USD per person per year (level 2017). Or a little less if you are France, Belgium, Iceland, Japan ....
If the NHS would get the proper funding (which would of course show up in the per capita healthcare expenditures of the nation) the U.K.would still be at the lower end of the average rich nation - and the NHS would run like a charm.
Which would of course do away with all pretext why it has to be privatized or why they would need private contractors to make the NHS "better".
The Tories have been openly hostile towards the NHS in the 1950s, but they had to tone it down, because the voters loved it (incl. their own base, they cannot win with the vote of the affluent and rich only). Thatcher promised to leave the NHS alone to get elected but had of course other plans. Her inner circle implored her to leave the NHS alone (they should have let her !), they feared the backlash.
even when run cost-efficiently (so as little private for-profit as possible) healthcare is 7 - 11 % of GDP in most wealthy nations, again the usual rate is 8 - 10 %. That is a large part of the national economy. The Tories have always found it very offensive that it should be mostly off limits for the profiteers, "investors" and the landlord class.
The crisis caused by the banksters was a welcome pretext to have austerity and to defund the NHS (that had a lean budget to begin with). Running it into the ground was the necessary condition to "justify" more private contractors. Which do nothing to make things more cost-efficient, they add complexity, dysfunction and extract profits.
And no doubt donate to the Tories and provide cushy jobs for former politicians.
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+ Joe Marks - actually having a "war on terrorism" is BRILLIANT. - The CIA did not foresee that the Soviet Union would step down from the Cold War - the S.U. deserted from being a reliable boogeyman and w/o much prior notice ;) - The Soviet army (and later the Russian army) resp. the governments are WELL DEFINED entities. They have a chain of command. And when the command is "it's over" then it is over. So there is the danger of an official END that is actually enforced by the other side.
Of course one can try to provocate a renewed arms race, the U.S. with the assistance of some foolish European Nato states has been busy doing that - it became quite obvious since 2008, but I assume it has been the plan since 2000 when Putin replaced the puppet of the West, Yeltsin.
Putin is too smart to take the bait to start another ARMS RACE - the Russian economy can't sustain it - so they use asymmetrical, much cheaper methods and of course keep their nuclear arsenal up to date. The Russian budget is the same or after some cuts even less than the recent INCREASE (for wthich almost all the Dems and the Republicans voted )- an increase by 80 billion USD to a total of 700 bn yearly regular military budget.
The trillion USD wars are extra. The letter agencies like CIA, FBI, NSA .... VA get 1,2 trillion per year. That makes a lot of private for profit contractors happy.
The M.I.C. would not suffer such a shock like in the early 1990s once more. Much better to have an undefined enemy, erratic war lords and religious fanatics that change their military allegience, the names of the groups, the financiers all the time. There can never be an end to the "War on terror".
And it is much easier to secretly fuel those conflicts with covert financing and regime changes, and what not. - The military budget during the Cold War was an official affair and a lot of it was "justified" with the "threat" of the Soviet Union.
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