Comments by "Xyz Same" (@xyzsame4081) on "Senator Bernie Sanders" channel.

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  4. 28:46 - the wealthy in the US surprisingly !! all "chose" to have insurance - and good one (and they are the only people who could afford to take a gamble and to have no or insufficient insurance). And you bet the friend of the embassador for sure has very good insurance - and just does not like to have to "subsidize" the lower income people with his taxes. Politics means solving problems that a lot of people have. if you take 10,000 or 100,000 people and you know their age and gender (and the group has not been cherry-picked) you can run the numbers: how many heart attacks, cancer, skin rashes, average visits with the doctor, dental costs, etc. etc. And the poeple who have insufficient insurance do not make a voluntary of informed CHOICE (their employer does not offer it, or they are not able to spare the money). Ted Cruz spoke about the group of young men who maybe would like to "chose" not to have insurance or to have a high deductible. Humans are notoriously bad with assessing risks and integrating the insights of statistics - we are wired to see life optimistically as long as things seem to be O.K. - that's a survival of the species thing. Back in the day life was short, often dangerous, the next day could bring disaster. And people could not really do much to protect themselves. Worrying a lot would have reduced their chances of survival even more - draining their energy and making them LESS able to cope. And of all groups in the population young men are prone to be the most optimistic (even slightly maniac). If you are supposed to hunt down the mammoth you better have the mindset of being a little bit too optimistic. Else you never muster the energy and courage to do that. We do not leave it to the discretion of folks if they THINK they still can drive if they had a drink or a few too much. Sure, they all want to come home safe, and no one wants to cause an accident and harm other people, or wreck the car. Still people underestimate the real risk, overestimate their own capacity to cope - thus we see it fit to ESTABLISH SOME RULES. Or when giving out loans. The potential buyers of a home may be very optimistic about financing it. And then there are the PROFESSIONALS of the bank - for them it is not the emotionally charged "our first home" issue. For them it is routine, they have seen a lot and have more experience. And on them is the burden to grant or deny the loan. That legal requirement is valid in Germany, it was criminally undermined by the US banks and the regulators looked the other way in the build-up of the Great Financial Crisis. The professionals that did the appraisals for the bank loans complained in an open letter that the banks pressured/blackmailed them to give too high estimates - else they would not be hired anymore. This is a sure sign of fraudulent intent - well the authorities colluded with the banksters and ignored the warning sign. The principle is that we live in a multi-level, highly complicated, interconnected, highly diversified and specialized society - and we do not leave all decisions to the discretion of individuals.
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  9. 28:00 LURING the LOWER INCOME folks into the idea that they will deal LATER with the costs of healthcare which will hit some of them for SURE is irresponsible. Those "later" costs cannot be calculated, they will manifest in not covered procedures, or those low income folks will not get the same quality care (thus worse outcomes or more deaths), extra financial stress when you already have health issues. Or high deductibles. Low(er) income poeple need predictable - completely predictable - costs. And that means if they have to pay for insurance at all (certain groups in the European systems are covered for free) it is the monthly payment or the deduction from the wage - and than everything is covered (some minor co-payments maybe - but nothing that really matters or would cause financial troubles). And there is no financial incentive for the providers to DENY CARE (they also do not have the expensive administration that would be necessary to have a system that makes differences between the patients). That payment or contribution to the (usually non-profit) insurance is a % of the wage or it depends on your income - so it is AFFORDABLE. But since even reasonably priced non-profit healthcare is expensive - not as outrageously expensive in the US - but still ..... that means the low income people and people on minimum wages will need some help. Either in form of subsidies or the systems are getting extra tax funding since the funding by the wage deductions will not be sufficient. With high deductibles and treatment denied when you need it (LATER and not foreseeable for the individuals) politicians weasel out of the question how to finance relatively expensive modern healthcare for EVERYONE (even low income people). They kick the can down the road. There is a political advantage to having a monthly, completely predictable payment - and then having FULL COVERAGE no matter the health issue. either everyone (incl. people with a better income) or no one gets certain treatments. The specialized cancer treatment is either covered for everyone or no one. The x-ray or magnetresonance (just to make sure) is either covered or not. That means if treatments and procedures are denied that are beneficial for recovery or to avoid potential damage - the whole country would revolt. In the U.S. it is DIVIDE AND CONQUER. Some get all covered, some a part - and no one really knows for sure unless they are in the middle of a costly health situation. With exception of the people who have an expensive plan or have a company plan from a large company (they usually have some backup - their employer will not tolerate their people being bullshitted). And you do not know what you get - until you desperately need help. Like a young woman who (under Obamamcare) was denied cancer treatement. When getting the contract she had not informed the insurance company about a "preexisting condition" - she had acne treatment as teenager and did not even think that this was something to mention - and that was later the PRETEXT to deny cancer treatment. That is bullshit of course. the insurance company (for profit ! means it is profitable to deny as much treatment as possible) attempted to weasel out of paying for a costly treatment. Sure one can hire a lawyer. So additionally to paying for cancer treatment out of pocket there are also the costs for the lawsuit AND the stress on top of that.
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  13. They do this every time when they do budget reconciliation. Stupid game to delay (some time) and also creating material for attack ads come next election. It is supposed to be only budget finetuning and the majority party can do that with 51 votes. Dems are getting creative (but Repubs did it in the past, too). It is not finetuning it is the whole 1.9 trillion bill. Witht the vote of VP Harris (she can break a 50 : 50 tie) they just have these 51 votes. Alway assuming there are no defectors. Senator Manchin showed some willingness to resist, there was some armtwisting going on in the last days. VP Harris appeared on local WV news talking about the relief bill. Manchin did not like that. even the governor of the state asked for the bill to be passed. Thanks to 2 "Democratic" Senators Sinema (AZ) and Manchin (WV) the bills still need 60 out of 100 votes or the Republicans can filibuster it (talking endlessly, that game of 550 amendments is a version of that, kind of). That would be the normal way. Democrats and Republicans do find easily those 60 or more votes, but never for someething good: insane military spending, trade deals, Patriot Act If Democrats would have 60 Sentators (add some more for the defectors that vote more often with Repubs than their own party) they could pass any bill that Congress sends them and the Republican obstructionists can go pound sand. But getting 60 - 65 Senate seats is almost impossible. So they use budget reconciliation (meant for finetuning) to get the big 1.9 trillion bill passsed. The Repubs can only delay. And typically it also means that the amendments (that will be voted down by the majority party) are then used for attack ads. Like D Senator xx voted against tax cuts for smaller businesses (part of the amendemtn that is mainly for big biz). Or voted against some favor for pig farmers (and then that will be played in the next election to interested audiences. It is technically true. These fake amendments (they all know they will not be passed) are traps to create material for attack ads and a stupid game for time. But Republicans cannot really hold up the reconciliation process. The problem is it can be done only once per budget. Now it seems the Trump admin did not officially pass the last one, so the Dems have 2 chances for "reconciliation". I have that from Rachel Maddow.
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  17. The voters of Burlington and Vermont disagree with your assessment about the value of the work of Sanders, he got himself reelected with ever increasing majorities. His work never included dialling after the dollar and chasing donations (which makes up 30 - 40 % of the time of other representatives). Well, he uses his time to annoy the heck out of Dems and Repubs and their Big Donros alike. Nor does he enjoy the support of think tanks funded by rich persons like for instance Sowell. Now, Sanders could not make a living of running for higher office in the 1970s with an obscure independent grassroots party. So he financed his life with odd jobs - some aligned with his passion (writing articles, making documentaries, radio) others for the money (tax office, preschool education, carpenter, - I think also in healthcare). And he ran stubbornly and diligently for a small political party. I am sure he could have played nice with the democrats, taken the money of Big Donors as usual and found a comfortable niche - but he had other ideas about politics. And he would have needed to bend his political views to what the donors and the party establishment allowed. So he soldiered on - what then seemed to be a futile exercise (they always aimed for higher office - govenor, Congress). In the late 1970s he gave up on those efforts. In 1980 he won completely against the odds the seat as mayor of Burlington - with a majority of 10 votes. Unseating a 4 or 5 time elected Corporate Democrat, the Republicans did not even run a candidate. Then his trouble only started - the buddies of the mayor in the council were not pleased - and he had only the suport of 2 council members - which was not even the veto power. So first thing they fired the secretary and next thing they stonewalled. It seems he did what was possible, they had some shouting matches, and the voters took notice, the next council election (not too long after that, they have the election every 2 years) brought him more supportive members - at least the veto power. And he started to work with Republicans on a case to case base. The next election as mayor he won convincingly in a 3 candidate race (Democrat, Republican and Sanders as Independent) and with much increased turnout. Fast forward to 1991 (after 2 more races for higher office - still without Big Donor money) he was sworn in as member of Congress. I would count a few votes as important work (like the vote against the Iraq war in 1991 and 2003). It is important to have voices of dissent and opposition - he did not get much attention then, but he built his resumee - we have the C-Span clips on youtube. NOW his dissent starts discussions and informs people (and is supported by his consistency).
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  23. Choices: patients have them often. Sometimes they can change the decision of the doctor (asking for a treatment, referal to another doctor or hospital. Sometimes the decision is made for them (emergency, the big stuff, like getting an arm sown on back, after bad accidents, after a massive stroke, or the procedure is specialized). Transport costs are included (ambulance, or airlift if necessary - which the doctor decides). Breaking the arm - the injured goes to the hospital of their choice, usually the nearest. "Not in my network" is not a thing - hospitals all have the contract with the non-profit, public insurance agency. They are either run by the muncipalities (as non-profits of course) or by church charities (coming from a centuries old tradition). For the patients it does not matter. In smaller cities it is either of the one. They do not compete (but benchmarking is possible) and the insurance agency negotiates competitive rates with them anyway. In larger cities they co-exist. Usually then the agency agrees with them on some sort of specialization. people chose from the doctors in their area most of the time - usually more convenient (family doctor, specialist). With the family doctor they show up during open times (so there can be a waiting time - up to 30 minutes, more is unusual). With the specialists they make appointments. Sometimes right away, sometimes they will get or need ! a referal from the family doctor. Waiting time: same day to - 2 - 4 weeks, it depends, if it is serious patients say so, the assistant will squeeze them in. With the usual dental checkup or pap test it will not matter, if aperson has unusual pain, symptoms, if the doctor is concerned it is possible to tell, them so that they speed the examination up. Every day has patients that are a no-show - so with some more waiting time people can be squeezed in. Some doctors tend to refer their patients to a certain doctor, they have informal cooperations. I noticed that for MR and x-rays and laboratries for blood work etc.. Now if another doctor would suit the patient better (nearer to the workplace or they heard good things about a specialist) they can ask for the referal to suit their wishes, if there are no practical medical reasons the doctor will comply. There a plenty of doctors who have a contract with the public non-profit insurance agency no matter where they are. And they can of course also ask for a referal to a doctor w/o a contract - but then they would have to pay for "private" services and out of pocket and would get only the default reimbursment according to contract. X-rays and MR is separated to avoid wrong incentives. (Hospitals have their own departments and weekend staff - they need that). A doctors that thinks it would be a good idea to have a closer look is not the one who will do the images and earn an income of it. On the other hand they are FREE to prescribe and order what they they think it is medically warranted. The DOCTORS HAVE CHOICE. Be it the MR or a form of chemo therapy which they arrange for the patient. Or the emergency doctor that orders an airlift.
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  24. Participation is mandatory - so here no choice for employers or workers. AND it also gives the employee the RIGHT to be insured withou consideration of their health status and they will have FULL coverage with no LATER payment, deductibles, caps, exclusions, or being denied treatment for some reason or other. If a person earns more than approx. 550 USD per month they are MANDATED to pay an affordable contribution (wage deduction as percentage, there is a cap at a wage of approx. USD 5,000 per month, the contribution is matched by the employer. Size of the company, or the hours - part time or full time - do not matter. The system is streamlined - and therefore cost-efficient. Only the "minor" jobs - 550 USD per month are excempt from the mandate. These are the typical student jobs, and they have insurance with the parents anyway until age 26. Such a minor job also gives the right to buy an upgrade, a combo for healthcare and retirement "insurance" for a modest price ( approx. 70 USD per month of which 21 go into retirment - that is a bargain, and approx. 49 into healthcare. Full coverage of course, risks are irrelevant, and dependents will be included. Which means that employees of small businesses get the same healhcare as employees of multinationals. No disadvantage in hiring. The wage related payments are also not nearly enough to fund the system - see next comment - so the rest comes from government funding, from general tax revenue. In the U.S. two thirds of of the expenditures of healthcare come from government funding. One reason: Medicare covers the group that has the highest costs - older people. On the other hand the European countries have 55 - 60 percent of the U.S. expenditures. So the European subsidies go towards an efficient system and fund the deliver of care. Not he profits of shareholders, the drug prices are well negotiated. and the adminstration can be simple in the one size fits all system. One size fits all is a good thing - not for all services but certainly in healthcare. It causes a lot of red tape to deny coverage / treatments, that's a lot of work. Or to chase the money and unpaid bills. The insurance agency gets money from the government and from companies. Doctors, pharmacies and hospitals present their monthly bills and get their money from the agency, which pays punctually of course. No one has to chase consumers / patients for money - and no one bothers patients with bills. There is no room in the system to rip off the patients. The big and the professional players deal with each other. Another aspect: start-ups or businesses that are not (currently ) profitable can ensure their staff gets healthcare for a relatively small contribution from their employer Rich people and already profitable companies indirectly contribute more in form of other taxes - so that lifts from weight from start-ups and they can compete for good employees. Wages may be lower than in the prestigious companies - but when they hire they have no disadvantage regarding healthcare for their staff. And also no adminstrative hassle. Overhead is below 5 % - as compared to plus 20 % in the U.S.
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  25. The medical risks of the insured or family members do not matter. Signing up takes 5 minutes (that is done when the company announce sthe employee to the insurance agency - that is done online. Name, address, birth date, social security number. Plus name and birth dates of dependents. - Some people have no insurance in the usual schemes (with a job, retired, jobless, with parents, spouse committed partnership. One can self-insure which is not a complicated process either. That's it. FREE at the point of delivery (of care) The coverage and the services and places where care is delivered are the same for everyone. If a treatment or mecical drug is in the database/approved by the agency = on principle everyone can get it. Medical need will decide which tools the doctors chose. Treatments and drugs beyond that would need to be applied for. (Highly unusual, they update the catalogue all the time, agencies and the representation of pharmacies and doctors working togehter, but if something is new ....) I would estimate that 20 % of the doctors with their own practice have no contract, and are "private" (usually specialities like accupuncture, some dentists, if they are capacities in their field). There are enough doctors with a contract, so the claim with the waiting times is not based in reality. Even IF there were some inconvenient waiting times let's say for one kind of sepcialist. That one out of pocket visit with a capacity or an accupuncturist will not break the bank. Hospital bills could - and they are covered for sure. And there is no waiting time for urgent procedures. Elected procedures have waitig times. usually there are preparations anyway (like taking blood for conserves if needed during surgery. That ensures they will be completely compatible. People who do not want to wait a few weeks for the hip replacement can go to a more rural hospital. Which means they get a date within 2 weeks. That makes good use of all resources. The visitors will have to drive longer. It is usual that relatives BRING the patient provided they are well enough, but if they need to lie down, or if there is no driver available, they will get a free transport by ambulance. Or they get a cheque which will be accetped by taxi companies or the get reimbursed for transport by taxi. There are no hospitals w/o a contract with the public non-profit insurance agency. I am not aware of any. They could not get enough patients, they could not compete with the hospitals with a contract. There may be clinics for abortions or maybe sports medicine or weight loss - but not for the general needs and certainly not for the big and costly interventions - after accidents, major surgery, organ transplants, sewing on fingers or limbs, heart attacks, strokes, ... Also not for giving birth.
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  26. Per capita healthcare expenditures of nations in USD US 9,200 UK had only 3,900 but they are completely underfunded The wealthy nations in Europe, Canada, Australia are usually in the range of *5,000 - 6,000 USD per capita.*. Germany for instance 5,600. source World Bank 2014, I saw 2016 data in a recent VOX article - with adjusted purchasing power so that can for instance factor in currency fluctuations, and also slighly different costs of living. That said: those expenditures WERE lower than in the dataset I know: Germany around 5,200 - and of course the U.S. was way higher than all the other wealthy nations. So it gives you an overall picture: for 55 - 60 % of the U.S. per capita expenditure a nation can easily have good healthcare. Expenditure: all that is spent on healthcare, no matter who pays for it. Insured or not per capita: divided by number of people even if they are healthy, have no insurence, didn't need the doctor Modern medicine is expensive. A healthy family of four still accounts for an average yearly "budget" per year of 20,000 USD and upwards - that is also the case if they didn't need the doctor that year. At least 4,500 - more like 5,00 USD per capita seems to be necessary to have a system worthy of a First World country. The UK has much less but is clearly and intentionally underfunded. If only they had at least HALF of the U.S. budgets ... Even in a reasonably funded non-profit system with a LEAN budget - expect costs like that. Low income families will not be able to afford that. And no talk about "choice" and "individual repsonsibility" will change that. That is why also in Europe the government steps in with extra funding additionally to affordable wage decudtions. And the insured are not plagued with healthcare questions, co-pays, deductibles. In Europe the funding promotes the efficient delivery of care. The system is in place to make healthcare happen for everyone and to treat patients/ the insured well. Not to make a profit. In the U.S. the funding goes towards profits and also a lot of dysfunction. Medicare cannot even negotiate drug prices or import from other countries. Politicians on behest of Big Pharma outlawed that. Of course it shows in the Medicare costs (old people also need more medication). Only VA is allwoed to negotiate drug prices. Tiny Iceland with 300,000 people pays much less than the U.S. with 325 million people for the same drugs. Iceland could reimport, join forces to buy with other European nations, have a friendly chat with the agencies of other countries what they are paying. Big Pharma cannot rip them off - not in the European setting. The free market cannot work for a product for healthcare. For that all the actors need to have about the same negotiation power. The service requires high expertise to assess the offers, (even doctors will defer to specialists if THEY need treatment). Also high legal complexity. Complexity in the systems that deliver (hospitals). Consumer have often the power NOT TO BUY with other products (I would like it but I can't afford it, or I think it is completely overpriced). That restores a lot of power to them. Medical treatment often does not even allow for a delay (like getting offers for a repair job of a car). It can get very expensive and costs and time of need are unpredictable. Medical bills are often the highest bills a regular person will ever have to shoulder - more than a home. This is the serivce that decides about your future quality of life, ability to care for yourself and family, it can be a life and death issue. Since the patients are so much weaker there is no competition. The profit motive of the companies will deliver toxic and dysfunctional results. Titans of the industry do not squeeze each other - that would only harm both of them. So the insurance companies do not hold Big Pharma to account and they also do not get into the hassle of monitoring the hospitals. The big players know how many opportunities the other players have to game the system. And it would be a lot of work to monitor every move. It is much easier when the huge players have a confortable scheme of peaceful co-esistence. They rip off the patients and they fleece the government - which is possible. Politicians are in bed with them and shower them with a lot of funding (which is not spent in an efficient manner of course). But even well intentioned law makers and reguators could not reign in the big players. Complexity favors them. they can always be 2 steps ahead of the regulators and 4 steps ahead of the patients. The nations in Europe after WW2 decided they a) wanted healthcare for everyone and b) they knew that could not be left to the "free market" which simply does not work for a service like healthcare. They all followed some overall principles, each nation implemented their own system. And they all do much, much better than the U.S.
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