Comments by "Xyz Same" (@xyzsame4081) on "The Hill"
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@brian2440 Consumers were probably unaware of the highly unusual situation that Texas has a closed off grid (ERCOT handles 90 % of Tx load, that is the Stand Alone Grid). The free market gibberish certainly did not communicate that TX was the opposite, a closed off, small market, with unusual vulnerabilites. The race to the bottom (energy prices) was more important than being prepared for the catastrophic once in 10 year events. It was so important for politicians that they even accepted to not have access to the much larger market - to export in normal times and to import in an emergency.
Being on their own makes the state VERY vulnerable if they have major blackouts.
Consumers were also not told that the state had major blackout because of winterstorms and extreme (for Texas) cold in 1989 and 2011.
The hurricanes are a known, but then people do not die of the cold, if the house survives, their pipes are not bursting. At worst people have no power and no water, but some emergency supply of water (usually they shop in advance if they get warnings) and the tank full so they can leave if the situation lasts longer.
Of course consumers may have remembered the 2011 blackouts - especially if they lived in the state already. But they may have naively assumed the state, the companies may have learned from the experience.
A Tx govenor (Perry or Abbott) sued the EPA in order to NOT have to winterize the grid.
Tx has the Stand Alone Grid specifically to avoid federal regulation. The very thing that made them so exposed to the risks of a severe cold snap, als prevented them for getting help. There are no (major) power lines that connect Texas with other states. They can't export / import much - or they would be part of the grid. Never mind legalities (that could have been overcome with a federal emergency order) - but it was impossible to export energy.
El Paso region for geographical reasons is on the southwest grid (and that includes Canada). They too were hit hard in 2011. They learned.
They invested into winterizing. Being on ther larger grid means that they are subject to federal regulations - which also mandate to weatherize and to have reserves (after all no state should be a freeloader. All can have the other states as backup, but all must be reasonably well prepared to keep the number and extrent of emergencies down).
El Paso did NOT lose power production. And they met additional demand with importing electricity (via New Mexico from Arizona). These states all stayed functional despite the cold, are subject to federal regulations, were able to cope and had the reserves to help out.
One nuclear power plant in AZ increased output.
In Tx one of two nuclear power plants had to go from the grid (for a time) because their instruments froze.
If you have any idea about safety protocols in nuclear power plants - that is insane. How can an nuclear power plant NOT be winterized in a state that is known to be hit be extreme cold every 10 years.
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Waste of money in the U.S. healthcare system: 1) incredibly complex billing (handling of the multitude of plans instead of ONE dominant streamlined, comprehensive, cost-efficient form of coverage for all).
2) doctors AND even nurses waste their valuable time on the phone arguing on behalf of their patients with the insurance companies. There are many plans where everything has to be pre-approved.
They don't do that nonsense in single payer countries. I live in one: helicopter transport or the new hepatitis c cures, or organ transplants - and the expensive medication for life (and all the other things that are part of a first world medical system) are "on the menu".
The DOCTORS DECIDE (together with the patients). They do not consult the agency for approval in individual cases. A framework has been set up, and the doctors use the tools. In those decisions for-profit does not play a role.
The middle man (insurer = the non-profit agency) also provides their services (to make healthcare happen in the country) w/o profit incentive.
3) The profits, marketing, sales costs of the for-profit players have to be paid.
4) incentive to "milk" better policies with tests and procedures that are not necessary, they do not harm the patient, but there are costs that do not lead to better outcomes.
Doctors and their families have less surgery done than the average of the population, it is as if they know that a surgery isn't going to fix anything in certain cases, or that there are other less invasive, less costly measures that can be tried before.
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If a country pays only half of what the U.S. pays, all actors (government, insured, employers) will pay less. THERE you find the money in a cost-efficient system to pay the people well that actually add value and are necessary: medcial staff (and a small group of administrators) in hospitals. Or doctor practices..
No one needs private insurance when the public system is reasonably set up and properly funded. That is the problem for the insurance industry - they will become obsolete, will keep only a small sliver of the "market" - and no one will miss them. That is why "public option" (Medicare for xx) is their contingency plan, and they have worked the other candidates.
The NECESSARY tasks of an insurer (a non-profit that works for the public good OR a profiteer):
Collect the money pay the bills, get information about new treatments and drugs, and set up programs for preventive care. That is the overlap of for-profit or non-profit (of course the non-profits will have a different take on preventive, they can look at the good of all of society, the for-profits will have a much more narrow angle).
Profit seeking health insurance companies will always have higher costs due to other and additional acitvities: Marketing, sales staff, profit for shareholders. They add administrative complexity, so they have costs and their rates must compensate doctors and hospitals for the extra admin as well. Plus the toxic incentives to game the system (a little bit, or it can get as dysfunctional as in the U.S.)
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Well, all other nations figured it out and most at least after WW2:
With healthcare there is no "free market" possible, the insured / patients are by far the weakest actors in the system. Because they do not have to most important choice of all: The choice NOT TO BUY - that's the superpower of the consumers.
But with healthcare services (and that means realistically having coverage by insurance) the consumers must "buy".
If they are lucky a single payer agency gives them a good deal. All get the SAME treatment at the same facilities. Mandatory costs are LOW, known in advance, no payments later when treatments are needed. The universality and one-size-fits all gives them a lot of political leverage and ease of mind.
Medical care is costs a lot (even in a cost-efficient system, think USD 5,500 per person per year), it is a life and death issue and it is very COMPLICATED. If the profit motive plays a role AT ALL the consumers WILL be exploited because the CAN be EXPLOITED.
Medical decisions are complex (and billing and contracts can be intentionally made complex) - that favors the profiteers and not even well intentioned legislators or regulators can protect the insured or prevent that unnecessary procedures are used. They would have to monitor each and every decision.
The predators will be always a few steps ahead, they find ways to work around the laws (and if that causes red tape and even more costs, so what ? they just pass on these costs as well).
The single payer nations want their insured / patients to be safe from exploitation. They do not play the foolish game.
In my example: there is no value in having the wild animals in your house, and on top of that they WILL cause harm, it is only a matter of time. You do no let them into your living room and then "regulate" them.
You do not let them in. Period. They can roam in the wild, where they have their function in certain eco systems.
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