Comments by "Xyz Same" (@xyzsame4081) on "Vox"
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No, ACA was a weak proposal right from the beginning, and THEN one or a few of the Blue Dogs killed the public option- Big Donors !!
(public option means people chose between a non-profit public insurance agency - likely Medicare - and the private agencies. Less than ideal - but a start). And then they tried to appease the Republicans and weakened it further.
And it was never a question that they would touch the profits of the for-profit industry. - THAT is why the U.S. system is so much more expensive. the profit has to be financed - and the desire to maximize profit is toxic for a product like healthcare and cause excessive red tape, the attempt to cash in on patients who can pay (many do no pay their bills) they have to chase the money. The ininsured end up in emergency rooms - which is very expensive and also has worse outcomes (too late often, no prevention, and if they cannot pay no consisent and constant treatment, the hospital must stabilize such patients - and then they try to get rid of them).
The free market works only when all partners have about equal power. The patients are much, much weaker. And worse - the service decides over the future ability to work, care for your family, quality of life, often over life and death.
Complexity favours the big players. And they are always 4 steps ahead of the patients and 2 steps ahead of the regulators (if they would do their job).
And it can get excessively expensive (even if the service is delivered cost-efficient).
That is a very bad combination for the consumers/patients.
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per capita healthcare expenditures of nations in USD World Bank in 2014) UK had 3,900, Germany 5,600 and the U.S. 9,200. The average range in Europe (wealthy countries) is 5,000 - 5,500. - In short the NHS has a much, much leaner budget !
the UK expenditures are the lowest worldwide among the wealthy nations, certainly in Europe. "Wealthy" matters because of the wage levels, that influence the costs.
Japan was slightly below the U.K. which is remarkable - data are from 2014.
I assume with U.K. expenditures around 4,500 - 4,800 per capita (most of it would be spent via the NHS) the NHS would run like a charm.
But then it would be off limits for the investor class, no ?
No justification whatsoever to "improve" it with privatization.
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The negotiations were about a weak plan and dragged out, and Obama did not keep in contact with the base - of course not - they were trying to square the interests of the Big Donors with that of the insured/patients. - no exciting news for the base. The midterms in 2006 were strong (the Democrats wisely packed the races with Wallstreet Democrats, I think some insiders expected the bubble to burst at some time), progressives were sidelined to the best of their ability. In 2010 the enthusiasm of 2008 was gone - and Obama did not want to keep that level high, he did not try to keep in contact like FDR did when he pushed the New Deal.
Obama had no intentions to be a president with populist economic measures (he had campaigned as such) - he was a centrist neoliberal sellout (like many others). So he certainly did not want the base engaged and on alert and ready to take it to the streets or townhalls.
The 2010 midterms reflected that, and it cost them the majorities to pass something (and saved them from the embarrassment of having a majority - no more excuses why they do not work for the people).
ACA despite the Republican tantrums passed in a window of time of 60 days in spring 2010. Then they could have passed EVERYTHING - incl. of course Single payer, or gun reform.
In 2009 when they started with the issue Senate had a hearing regarding healthcare reform, they did not even invite experts on Single Payer (European style systems, with a public non-profit insurance agency, usually also many or all hospitals are public non-profits. Those systems are much more cost-efficient). Good thing the industries were invited and could present THEIR case to the Senators and the public.
The Obama admin also let millions of homes be forclosed (they could have prevented that - but Obama sold out to Big Finance already in 2008.
Remember Tim Geithners appointment ? The wolf in charge of the henhouse, that was the first red flag.
The leaked Podesta emails approx. 8 years later confirmed it: citibank had sent an email about cabinet proposals - their candidates were appointed.
So the banks werere first bailed out, later they were showered ! with TRILLIONS in form of QE for the banks in order to "improve" their balance sheets. That form of money creation could have been used to rescue the homeowners, too.
Needless to say Big Finance does not want the unwashed masses to understand such concepts or that they could be (selectively and wisely) used for the good of the common people.
(Which would be a revolution also for partially financing goverment budgets and big projects) - if interested see QE for the People or Dr. Richard Werner Debt and Interest Free Money or Dr. Stephanie Kelton MMT or the videos of positivemoney(dot)org, they call the concept Sovereign Money.
Anyway: Wallstreet knew they would be safe with Clinton or McCain, they decided to buy the newcomer in 2008 as well - just in case - and they saw that he would be a much needed good distraction.
That distraction (Hope and Change) was very much needed, the voters were furious about the GFC.
So Obama got the campaign contributions, he talked a good game - even about Single Payer and Wallstreet regulation.
And mainstream media got the green light that they could report regularily and positively about Obama (not Fox of course).
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You should not "NEED" to find out these prices in the first place. Healthcare is a TERRIBLE FIT for the "free market" and the incentives of capitalism: the patients have much, much less information, and expertise and can easily be duped. As soon as one needs more than standard procedures (meaning often complications ) - they can demand whatever they want.
She just cannot stop giving birth because they now introduce new procedures - which may or may not be necessary.
The service (healthcare) most of the time cannot even be delayed - even a harmless uncomplicated broken arm needs to be treated right away - or it will become a major problem (risking your quality of life, ability to work, even life). And then there are the immediate life and death scenarios.
with "nice to have can do without" products the consumers do have power. even if they do not have specific expertise - if something seems to be overpriced, or they cannot afford it - they JUST DO NOT BUY.
Repair (unpleansant but necessary expenses) can often be delayed, alternatives found (like car sharing) - and the costs are NEVER as high as they can easily get with healthcare.
Car breaks down at an untimely moment - if the repair would cost USD 4,000 or 10k or 100k - you would reconsider repairing it at all. Shop around - 10k is a LOT - many cars would not warrant those costs. 100k repair ? non existent.
for all those reasons most wealthy countries have a system with many non-profit elements, mandatoy insurance - every must be in the system and IS ALLOWED in the system. Contributions in advance (only), affordable, income based, the rest of the costs of the system comes from government funding. And it is a good idea to have the same facilities for everyone. (One size fits all is good in healthcare - only the doctors when they decide WHAT is medically necessary should have a choice and differentiate).
The bill is sent by the hospitals directly to the non-profit public agency that has the task to work for the common good - and to play a supportive role in the system.
Hospitals: non-profits run by the ELECTED local government or for-profit but heavily regulated, usually run by religious organizations - that has historic reasons.
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The bill is sent by the hospitals directly to the non-profit public agency that has the task to work for the common good - and to play a supportive role in the system.
Hospitals: non-profits run by the ELECTED local government or for-profit but heavily regulated, usually run by religious organizations - that has historic reasons.
There are price lists for the hospitals (and general practicioners or specialists, they all have a practice) they have general elements (compensation per day per patient) and elements for special treatments (like let's say mammographie). The picture is sufficiently complex so that it would be very hard for the hospital to game the system.
(even non-profits have an incentive, for instance to help their muncipality when they extract more money out of the insurance agency). So that keeps "playing the system" at bay. There will be some inefficiencies but it is not too bad.
Of course there is benchmarking possibe between the church run hospitals and those who a run by a city w/o a profit motive.
The hospitals must offer good services any attempt to extract extra pay from patients (beyond cable TV) would not sit well with the locals and is illegal anyway. (They often have cafes to go with the visitors. Cafe and something to drink is free (even outside meals). Visitors will often bring flowers, treats, chocolate, fruit juice, but the snacks are not really necessary.
Muncipalities took pride in getting "their" hospital serving the region in the post WW2 era. The mayor looks good when they can offer the jobs and short distances for the locals. So they function in an orderly fashion, like clockworks and there are no attempts to dupe patients.
There are quotas for how many doctor practices and hospitals with a CONTRACT are in every region (per 1000 or 10,000 people). The non-profit insurance agency offers only a limited number of contracts - so that those who get a well bargained compensation only have enough patients to make it economically viable.
They are evenly spread out over the country, so even rural areas are served and the transport distances are not too long.
Private hospitals w/o contract are possible (but very rare) - a few more private doctors are around (maybe 20 %) they just have to find the patients. Usually they have a speciality, the general medical care is delivered by the public service and they cannot compete with those priced.
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