Comments by "Xyz Same" (@xyzsame4081) on "The Humanist Report"
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World Bank data 2014 - per capita healthcare expenditures
U.S. USD 9,200 then (now 10k), Germany 5,600, most wealthy European countries between 5,000 and 5,500, Canada is in that range too, Australia has 6,000.
There are outliers like the U.K. (only 3,900 but they are definitely underfunded - but with only HALF the U.S. expenditures their non-profit NHS which delivers most of the services would run like a charm).
On the other hand Norway had 8,400. (High wages, likely very high standard incl. dental).
Or Switzerland 9,600 they were even higher than the U.S. - but then they pay staff very well, and everybody is insured.
Switzerland is one of the very few developed countries that do not have a non-profit public insurance agency but let the for profit private players have that niche . Well, it shows.
I do not know of any larger country (except the U.S.) which lets for profit actors handle (most) of the healthcare insurance market. Switzerland has less than 10 million people, I think Singapore might lean strongly towards a private system.
Let me add that most developed countries beat the U.S. when it comes to life expectancy and infant mortality.
Most (or all) wealthy European countries have a population that is on average older than the people in the U.S. (so that should result in LOWER expenditures for the U.S.)
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The non-profit agency has a budget and has to stay within - that said, if they can prove the benefit of an effective new treatment method for society in general (often medication) - which would however overwhelm their budgets - there would be a political and lively discussion about how to increase their funding.
These costs may well pay off for society ! even if one cannot put a price tag on the indirect benefits (elderly people can live longer unassisted, people can take care of their family, avoid the trauma of losing a family member to cancer, restore (quicker) the ability to work, how will that person fare in 20 or 30 years in their old age, ….)
None of these considerable benefits _manifest for the insurance agency._, Since they serve the public and not the shareholders (with the incentive to maximize profits and think only short term) - they can include these considerations.
The agency must have a reasonable budget - healthcare costs are always on the rise and the population is getting older - so that alone forces them to be economic and to weed out inefficiencies.
Most doctors and hospitals have a contract with the non-profit agency - they bill according to the negotiated contract / price list.
(Private doctors w/o a contract do exist - maybe 20 - 30 % of the practices. Private hospitals w/o a contract are rare, they would have a hard time finding patients).
There are quotas - in an area with a certain population there will be only a limited number of doctors and specialists and hospitals that get a contract. (Consideration for touristic regions, saisonal demand in winter - skiing - and for very rural areas can be made to make sure they are served well).
The patients often have a choice where to go - but that the number of contract for doctors/hospitals in limited, ensures that they have enough patients and revenue while working for very competitive rates.
The Pharma industry has a negotiation partner that represents 300,000 or 85 million people (Iceland / Germany -). Now, Big Pharma cannot rip off little Iceland, the Vikings can have a friendly chat with the other Nordic countries (or the UK or Germany, or Netherlands). Or they could pool their purchasing with another country or threaten to allow imports from other countries.
They will have a general idea what other countries pay for pharmaceuticals, machines, devices - these are the costs that a country / non profit system cannot control and where they could be taken advantage off.
They control the wages for staff, the costs for training doctors and nurses, or the costs of construction and ongoing operation of a hospital - all these expenditures also contribute to the local economy and the country can provide the resources and also effectively negotiate the prices for them. Even in a small country.
If they train doctors and nurses for free in the public education system (which is almost always the case) - they will not lose those potential employees in large numbers to other countries.
That is one of the reason why Vermont did not succeed to have their own Medicare for All system - while Iceland beats Germany when it comes to per capita expenditures.
They have about the same number of people - 300,000 - but Iceland CAN import drugs if the pharma industry would like to play games. And their doctors make a nice living but they will not leave for the next state because they can earn double. The income situation for doctors in the wealthy European nations is not that different and most do not care to move (even if though they can within the EU).
Vermont would have lost many doctors to other states. The medical profession in the U.S. has very effectively made sure they do not have competition in the job market. Doctors cannot migrate to the U.S. - their training will not be recognized and it is expensive and time consuming to do it again - so not many are coming.
And there are mechanisms to make sure not too many doctors are trained in the U.S. (like high costs for medical school). - That is why doctors earn almost double of their European counterparts (which have more competition so most of them are willing to accept the rates of the public contract - if they can get one). They are doing well btw, no need to pity them.
But of course unless the availability of enough staff is tackled the U.S. will have a problem.
The insurance agency is of course a powerful buyer on behalf of the patients.
But: if most doctors CAN refuse to work for a a lower income than other (not exceptional doctors) are getting then there will be a shortage and problem for hospitals and general practicioners that have most revenue from Medicare for All contracts:
Then the quality and/or waiting times will suffer and the doctors can promote a 2 tier system. Where people are effectively forced to accept the high rates of private doctors IF they want good treatment. with all the games of the private insurance companies
2 tier systems are invariably more expensive - and that is even in the European environment where the private patients profit from the fact that the competition from the non-profit sector somewhat prevented the worst excesses (like they are common in the U.S.)
The government could of course invest in a public training system (with some forgiveness of student debt if they work for a certain time in the U.S.) Or losen the rules regarding immigration.
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No, the oligarchs in the U.S. leverage the power of government, military, intel agencies, diplomacy. They HATE the governments that overthrow right wing dictatorships or nationalizee natural recourses or give land from rich landowners to poor peasants. - the problem is not the dictator (or democratically elected perfectly reasonable leader see Chile 1973).
the U.S. governement and the media are supportive of much worse dictatorships. But dispossessing the rich is the worst crime there is, even forcing the rich to give up control over resources (with compensation) is terrible.
They might get compensated for the equipment, etc. but they are not getting compensated for their future HUGE profits, that goes into the budgets and is used for the poor populaton (see Venezuela, as long as the lower oil price and sanctions did not get them into economic trouble).
also Bolivia recently.
getting rid of the oligarchs ? and taking back control of major industries and resources ? - that could be a very bad example for the U.S. citizens, they might be getting ideas.
The Cold War / Red Scare (the letter was meant for domestic purposes !) was part of that propaganda mission.
So the U.S. MUST make sure to undermine the economy of such nations, to goad them into war or an arm's race (Iran, Soviet Union, maybe Iraq in 1990 into invadin Kuwait). Heaven forbid Castro would have created a relatively open society and the population would do much better under left economic policies.
That explains the sanctions from the 1960s until Obma era. Obama loosened them, Trump reinstated them (rich exile Cubans = donors). Cuba has never attacked the U.S. has never committed acts of terrorism (but the U.S. has against Cuba explosives in civilian ship freight), couldn't be a threat for the U.S. if they wanted to.
See the end of monarchy in Russia in 1917.
In the U.S. a united left (all parties incl. Communists and unions) were very active in 1932, enough oligarchs saw the pitchforks coming. They remembered the Russian Revolution and FDR's New Deal (from 1933 on) was the lesser evil.
The Democratic establishment had to put up with FDR, but their man Truman was shoved into the VP position when it mattered (the insiders knew that FDR would die from his untreatable high blood pressure, it was only a question of time, he was already in bad shape in 1944 when he was reelected). They sidelined popular one term VP Wallace (and rigged the nomination process at the party convention).
Truman restarted U.S. imperialism in Latin America and he immediately started to be hostile towards the Soviet Union even before WW2 was over.
THEY wanted an enemy to villify the Left IN the U.S. and to justify an arm's race and the invasion of foreign countries 'cause Soviet Union (or China !).
Violent revolutions very often lead to a new authoritarian regimes - it is not the mild mannered democratically minded leaders that prevail in such situations.
Fidel Castro was paranoid about his security - or better he HAD to be because of the hare brained attacks of the U.S. and even wilder schemes that they considered (there is a memo that was declassified:
the idea (put down in writing ! - even if they did not make concrete plans for that) was to shoot down an U.S. civilian aircraft and to blame it on Cuba). Likely as pretext to start a war with public backup.
you would be excused from thinking think that Cuba was this powerful enemy to trigger even such ideas - nothing could be further from the truth.
A right wing brutal dictatorship would have been completely O.K. but they went nuts that the Revolutionaries seized the property of rich Americans, rich Cubans and kicked out the mob for good measure.
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Is Wales Corbyn country ? - well deserved. - So people were having second thoughts at the end according to Clinton. Those poor dummies fell for a combination of Russian interference - and what was the second thing ?? Comey. - Anyway: Sanders would have wiped the floor with Trump and with him an "interference" - Russian or otherwise - would just not have mattered. He does not have one email scandal after another. And I doubt if his campaign had been hacked resp. if there had been a whistleblower that it would have uncovered any embarrassing material (leading to the resigning of leadership figures like with the DNC).
And when the queen was anointed - because the party in its infinite wisdom did not think the several SELF-INFLICTED scandals and an ongoing FBI investigation would matter - Comey had not yet confirmed that she was off the hook. So the uncertainty went on well into summer, with the country voting in late fall. If she had graciously and voluntarily !! handed over to Sanders AND would have encouraged her fans to support him - it would have been a lovely 9th November. She could have travelled the country to close a cycle regarding healthcare. (and reap the honor, she tried as First Lady now she pulled if off, and she had enough stateswomanship to pull out for the sake of the country and to play it safe. After all nothing would be worse than even the remote chance of Trump winning.
With Sanders such an late "interference" (Comey thinking a few days before the elections maybe we have something new on her) would not have happend.
Bhengazi was avoidable as well. The abassador was there to send weapons over to Syrian "rebels" to further the uprising against Assad. UK, France and Hillary Clinton wanted war with Libya (and then regime change in Syria). Even though Obama hesistated, in the end the pro regime change/war fraction pulled off a narrow win in the cabinet and Clinton, France, UK got their war. Without that war the Bhengazi assault would not have happened. Say what you will about Gaddafi - at least the Islamist were not at large and the police and army controlled the country - it was not a failed state.
And because of the Benghazi hearings it came out that she had a secret server in the basement.
At least a little bit of karma.
So she won the primaries so gloriously - never mind the cheating, and never mind they started the primaries in the South where the Clintons are a household name and Sanders was completely unknown. Bill Clinton was the "first honorary" Black president. So she got a LOT of votes there. And 1 million votes were uncounted in California when the DNC already heralded the results in the last days before the convention.
Do the 4 million votes more in the primaries include the votes AFTER 1 month or 2 when the count was finished ? and conveniently huge New York makes it impossible to switch registration for a "newcomer" candidate .
So with same day registration, with starting out with SMALL states, with having enough polling stations, enough debates and not at impossible times - does Clinton really think she would have led in the primaries with 4 million votes ?
And talking about the primaries (many not open for people who are not registered as Democrats) - what weight does that have considering the largest voting block are INDEPENDENTS ?
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The Supreme Court IS very partisan. And writing a good dissent does not change the impact it has over long time when 5 of the judges shape the future life of million of people.
Voter protection for low income and minority areas IS necessary. the Supreme Court was dead wrong to remove that. And they should have known. We can observe all the underhanded tactics to make voting harder (they had the voter suppression laws ready).
I read comments from Trump supporters how happy they were on Nov. 8th/9th 2016. Two mentioned in passing that it was totally worth 2 hours waiting in line.
- WHAT ? - and that on a workday !
(that was in In Pennsylvania, but remember the primaries in Arizona ? And they cut polling stations also in other areas)
Other countries have elections of a sunday or holiday - and if they wait 15 minutes it is long. And they have PLENTY of polling stations.
Well, it shows in the turnout.
The decision to allow so much money into politics in the 1970s was desastrous on the long term.
And the Dems were excited that THEY now also could get the big bucks so they never bothered to change it.
The court allowed for instance that the GOP makes up arbitraty "safety" rules for abortion clinics - that make it impossible to keep the facility open.
Or forcing a waiting period and more than one date, long drives, overnight stay on a woman. For no reason at all. Certainly not a medical reason. Scalia claimed it was to prevent the psychological damage from the female - w/o proof that there were such damage.
Abortions are legal, so any extra burden should be based on facts ,studies medical needs or real dangers.
There are none, there are many harmless procedures that are still more endangering than abortions. To have wide corridors is essential in a busy hospitals. They must be able to pass with 2 trolleys side by side. They have more visitors and patients, they must be able to quickly evacuate in case of a fire, etc. etc.
None of that applies for abortion clinics, it is not even a surgical procedure (in most cases). so no stretchers of trolleys. And they do not have that many patients, which are not bedridden, and not of old age and have hardly any visitors.
Hospitals have those spacey facilities, abortion facilites never had them - of course not they are not needed.
So the GOP DEMAND the unnecessary burden knowing full well, that the clinics do not have the conditions and will not find a building for rent that can fullfill them. And of couse hospitals are bullied to not do abortions.
THAT was found constitutional.
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+ Don parnell Even cost-efficient healthcare costs 5,000 USD per capita - so that would be around 20k for a family of four (in a non-profit public system). That means low income families NEED some form of subsidies/help if they are to get healthcare that is worty of a First World country. And that budget has to be set up somehow. - Medical drugs are a another large cost factor - they cannot be negotiated right now in the U.S.
Plus the hospitals are still for-profit enterprises. So that would explain why single payer has not yet been installed in Vermont and California (you mention Blue California). In Vermont for instance they had problems with drug prices. Canada across the border is doing much better - also in that respect.
In the European style systems the hospitals (where the highest costs occur) are in most cases NON-PROFITS (private = often confessional institutions, or public - run by the muncipalities for instance). Small players like family doctors or pharmacies are like small businesses - the revenue covers the costs (practice, shop, equipment, the few employees), the surplus or profit is like the "salary" of the doctor or pharmacist who runs the business.
But no "free market". For instance there are quotas: how many doctors are even getting a contract with the public insurance agency in that town/area. Not more than can be expected to make a living in that community. The "price list" for the services is negotiated. The bills go only to the public agency. (Very streamlined, free of hassle and cost-efficient, but no free market either). Doctors are restricted in their marketing (especially if they have a contract with the public agency).
The problem is not only that someone has to pay for the profit of the shareholders or owners of the hospital (an extra cost).
The moment the profit motive is introduced into the healthcare system it produces dysfunctional incentives. That results in exploding bureaucraZy and high additional costs. Plus of course the inevitable ripping off of patients (which WILL happen, they have all the disadvantages and are in a much, much weaker position - again a very bad condition for the "free market")
Much less knowledge and usually a high (often immediate) need, and enormous disadvantages when they do not get treatment - in most cases right away. You can wait to have your car repaired, get a second offer, or save up the money for a later repair, or decide not to have it repaired and make do w/o car. Try that even with something harmless like a broken arm.
Healthcare is a very bad fit for the "free market" including the profit incentives - which works (well) in that system.
While the profit motive wrecks havock when applied to the product "healthcare".
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