Comments by "Xyz Same" (@xyzsame4081) on "Eric Swalwell's Loony 2020 Plan For Bipartisanship" video.

  1. part 5 of 5 If a nation allows the private insurers a share of the market (public option) it inevitable will get more expensive for everyone. Example well regulated Switzerland (private insurers) USD 8,000 per person. - Australia also has higher costs - they have basics and the high expenditures (hospital, ongoing costly medication) covered by the public option, but lawmakers carved out a niche for the private insurers (and for doctors who are eager to only take patients with extra private insurance because it is more lucrative). They did not go the full mile in Australia - if the public agency CAN deal with the really expensive stuff - why not let them offer ALL that can become necessary in a first world medical system ?? The private insurers get a cherrypicked pool (high risk patients will not be accepted or they get prohibitively high offers). Some specialists simply will not have a public contract (think dentists, eye doctors, ....) so being "only" publicly insured means longer wait times for some fairly normal medical offers. It therefore creates the "need" for the better packages - which will be overpriced (they must cost more even if the insurance companies would be completely benign: they have costs of marketing, the sales force, more complex admin must be financed - for doctors, hospitals and the insurance companies, plus some profit). It also drives a wedge between the low-income and the affluent citizens. If the wealthy use the reasonably funded and comprehensive ! public coverage it is much harder to defund a public system Conservative parties like to do that if they get the austerity bug - but if their voters too mostly rely on the public insurance coverage (for ALL that is medically warranted, and there is no rational to exclude dental or eye doctors, or gynaecologists from that) it is much harder to defund the public system. If the whole population is mandated to pay into the public system (no chance to opt out and retreat to a "gated community") all citizens will tend to use the public system. Doctors will need to accept a contract with the public agency, or they will not have enough patients. The contracts usually forbid them to discriminate between patients. If the lawmakers create the need / market for private insurance more doctors can make do without the publicly insured patients. If all the population uses the comprehensive offer of public insurance doctors MUST accept them as patients (there will be some private doctros - but they will need to bring something special to the table, either they earned themselves an excellent reputation, or they are an internationally renowed capacity, or they offer a speciality like accupuncture, or are really good with little children, ....). Even so - speaking from experience in European single payer nations: if you want once in your life the services of the private doctor that is said to be good with dental implants or has this new laser surgery for short sightedness, or the dentist that knows how to deal with your screaming little child ..... You can pay for that out of pocket, no need to pay year after year to a private insurance company. That way you pay only for treatment when you want it (treatment that is not absolutely necessary but nice to have). But you do not finance the insurance administration or the profits of their shareholders. These additional extra insurance packages on top of a good public service exist - but they tend to be fairly expensive, so I never got the rational to have them in the first place. Very likely they will cost you much more than you ever get out of them, and they deal with "risks" that can be easily shouldered or navigated by the individual. Those packages are never necessary for inevitable treatments (the medically necessary treatments are covered by the public agency, and that is important because those can get very, very expensive). The treatments they cover are not super expensive. Sure - first class dental care can cost several ten thousand dollars - but you can make do w/o and use the basic care of the public insurance. It is nothing like what chemotherapy can cost or surgery. It is avoidable, can be delayed, some patients go to other nations for cheaper dental care, and you can use the publicly funded dental solutions (maybe as provisory while you save up) - which are O.K. Those insurance packages for extras used to be tax-deductable (which made them popular with sales agents and of course affluent citizens). In some regions (Germany, Austria) in the 1960s and 1970s the hospitals still had 4 - 5 bed rooms, that situation has improved. So while there was an incentive then to have private insurance for extras (which was then also supported by tax laws) that rational is not valid anymore.
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  2. 8:40 the public option means: the pool will be even MORE CHERRYPICKED for the for-profit insurers (Medicare already takes care of the most expensive patient group, the plus 65 year old, and disabled persons are covered by Medicaid). The profiteers would shove the higher risk patients to the public system (or harrass them enough the make patients flee to the public system in case they need costly treatments). 90 % of medical spending is caused by 10 % of the patients, old age is a major factor, the next important is pre-existing contiions. 90 : 10 is an extreme ratio - it currently makes the insane administrative spending "reasonable" for the profiteers - if they can find those 10 % patients (other than the elderly that are already under Medicare) they can massively improve the profits. The high advinstrative costs (it is a lot of work to find those 10 %, and late to try to deny as much payments as possible) are just cost of doing business for them. It also means that the public insurance agency costs per person cannot be compared on an international level (no other nation is foolish enough to cherrypick that way) The private offers can look "reasonable" due to the 90 : 10 ratio (while being completely overpriced). The public agency can be smeared as being too expensive (of course - they have to deal with all the expensive patients) The wealthy can retreat to the equivalent of "gated communities". Sure their contracts will be overpriced (they will not use the starved public system) - but on the other hand they would have to pay more into the public system. Yo can bet they will resist to pay into the public system, and massively lobby to cut those contributions, when they cannot even use the public system (because wait times are too high). Nothing like having the affluent use the same system like everybody else - they will make sure it is good. It also makes it very hard for politicians hostile to a public non-profit system (or in the pockets of the industry) to sneakily defund the public system if ALL use it. see my comment part 5 of 5 - regarding Australia
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  3. part 3 of 5 Healthcare is also a service where "one size fits all" is a good thing. Aas opposed to consumer goods where we have difffernt needs, tastes, levels of affordability. We accept that not everyone will be able to afford a luxury or even a nice new car or home - but what about life saving expensive surgery or chemotherapy ? For ethical reasons most people will agree that it should not be treated like expensive luxury goods (even though the medical treatments can get much more expensive). if a low-income person / family was unable to afford the higher insurance premiums up-front they will not be able to pay down debt accrued by expensive treatment either. What is more: the hospitals for ethical reasons are expected to deliver the same good care - while KNOWING they are not going to be paid, so that puts a for-profit or even a non-profit hospital in a impossible position when they often get patients that are unlikely to pay the bills (and it is another incentive to "milk" the contracts of well insured patients with unnecessary procedures and tests. The idea that low-income people should wait until high medical cost hit them - they will get treatment and then let's see how they cope with payments - is ridiculous. It is kicking the can * down the road. * the "can" are the inevitable massive problems for some individuals - healthcare systems are set up for millions of people - it WILL manifest ! It also a means to transfer the wealth from middle class people to the shareholders of the healthcare insurance industry, pharma industry, ... The citizens go (almost) broke or are required to sell their house (so their kids miss out on the modest accumulation of wealth over generations - it can be gone with one cancer diagnosis or severe accident).
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  4. part 4 of 5 The U.S. spends double per person what it should pay (5000 - 6000 USD other wealthy nations, versus approx. 10,200 USD) - some of that is wasted on an insane bureaucraZy. And a good chunk goes to profiteers - extracting wealth for low(er) and middle income people up to the top. It is the most profitable for private insurers to deny as much treatments as possible, to have law suits (even if they lose them, they have chilling effect on lower income people considering to sue). It is the most profitable to weed out as many higher risk patients right in the beginning when they apply. That work is wasted on dysfunction, it does not contribute to make the DELIVERY of healthcare better for patients, or the medical staff that does the work. And a part of what is spent too much goes to the shareholders - which are usually wealthy and rich people (70 % of shares in the U.S. are owned by a tiny segment of the population. The modest dividends a regular person may get from a well diversified portfolio - incl. the ill gotten gains of the healthcare industry - will never compensate them for the overpriced healthcare premiums, co-pays, and the risk they have if someone in their family needs costly treatment. That calculation works only for people who have a LOT of capital gains and own huge amounts in form of shares. They can easily pay for their excellent healthcare even if it is overpriced - they are in a position to profit very much from the dysfunction.
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  5. Part 2 of 5 As long as MAXIMIZING profit is a allowed goal (free market, the usual capitalistic incentives like to sell more !) EVERY VULNERABILITY WILL be exploited, and the high complexity and urgency to use the services means that the for-profit players will always be 3 steps ahead of the patients and 2 steps ahead even of well-intentioned lawmakers. complexity always favors the for-profit players (espcially when they are large companies with a lot of resources, think staff, lawyers, software, political lobbying) - once you allow for-profit in complex scenarios - it is almost impossible to "regulate" it to avoid abuse. That is why almost all nations after WW2 made sure that the profit-motive is eliminated whenever it gets complex: Medical decisions are made by doctors with no profit incentive attached. The public agency negotiates a framework, a list of tools and treatments that are on principle availabe for EVERY patients. Like the prices for pharma drugs, or airlifts, or ambulances, or what a normal day in hospital will cost or a day if you are on life support. If there are "for-profit" players it is made sure (legally) that they are not too powerful and they are regulated (small pharmacies and doctor practices, no chains allowed, per regions only a certain number get a contract so they can make a living even if their margin is not high). Or even better: the provider is also a non-profit - like public non-profit insurance agencies and non-profit public hospitals run by a town, city or a state (and they all have contracts with the public insurance agency). In single payer nations the only powerful, large, for-profit player is the pharma industry. Their products are highly standardized and internationally comparable. That makes it easier for the national non-profit public agencies to negotiate. Smaller nation can have a pretty good idea what other much larger nations are paying - I think there are confidentiality clauses to restrict the price information to being available only within the nation - but the info fits easily on a thumb drive ... so ...behind the scenes there will be exchange of information. And unlike for profit insurance companies the national public agencies have no commercial reason to "guard an information advantage" - so an agency of an European coutnry might be willing to help out Iceland (with only 300,000 people or Denmark with only 3 million. The Danes might be interested on the prices levels of large neighbour Germany with 85 million people etc.)
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  6. part 1 of 5 Dummie spouts "free market" rhetoric. A "free market" functions only if ALL the actors in the market have about the same power. It restores a lot of power to consumers - even if the product / service is complex, or if the suppliers are powerful multinationals with hordes of lawyers - if they have the power TO NOT BUY AT ALL. "Free market" works well enough if it is a individual ! diversified, nice to have can-do-without product or service. Of course in capitalism external costs are very often not factored in - but usually consumer exploitation is much harder to pull off when consumers DO HAVE A CHOICE (a real one - as opposed to a scenario where it will be either "pest or cholera"). If consumers can use alternatives (or make do without, improvise around it, delay purchasing, wait for better offers, etc, etc.) Nothing of that applies to healthcare - it is an unlucky combination of a few factors (and all work against the consumers and they make it also IMPOSSIBLE for regulators and lawmakers to PROTECT consumers even if they wanted to. healthcare is also a service where "one size fits all" is reasonable (as opposed to consumer goods where we have diffferent needs, tastes, affordability). We accept that not everyone will be able to afford a luxury or even a nice new car or home - but what about life saving expensive surgery or chemotherapy ? For ethical reasons most people will agree that it should not be treated like luxury goods (even though the medical treatments can get much more expensive). Healthcare leans in the direction of natural monopolies (pharmaceuticals if they are under patent protection, or running of a hospital). It often decides over life and death (or at least future quality of life, ability to take care of yourself, your family, and earn an income by work). It is COSTLY even in the best case. Consumers cannot forgo having healthcare treatments and they will need in every stage of life (literally from birth till death) Plus it is highly complex (even doctors consult other specialists if they need treatment or feel unwell). Diagnosis, treatment options are often complex and the BILLING (or insurance contracts before that) can be made very, very complex. To make things worse it is expensive. Even in the cost-efficient single payer systems in rich countries USD 5,000 - 6,000 are spent on every child, adult in the country per year. That is the average that includes healthy persons, too. So a family of 4 will account for 20k or more - year after year after year - ON AVERAGE. some data form a Keiser foundation paper, healthcare expenditure per capita for 2017: Germany USD 5,800 Austria 5,500, Japan, Belgium France in the range of 4,700 - 4,900. Netherlands, Canada, Sweden somewhere inbetween (go to the short clip of Washington Post the lingering questions about medicare for all if interested in details, it is a youtube upload). And then there are the outliers: Switzerland one of the very few nations tha made after WW2 the decision to leave insurance to private for profit companies. USD 8,000 per person per year (it is good, everyone isinsured, the insurers are well regulated, and low-income persons get subsidies. The citizens are mandated to BUY insurance (so no mandatory contributions of the employers), the insurance companies are mandated to have a basic package (with legal requirements what must be covered) and the price must be the same for everyone in a certain age group. So no pre-exisiting condition. Some deductibles are allowed, but nothing like in the U.S. Staff is also well paid and costs of living (and therefore wages) are higher anyway in Switzerland. That said that explains only a part of the much higher costs compared to neighbour Germany forinstance who are not cheap with 5,800 per peson either. Australia also has higher costs - they have basics and the expensive stuff (hospital) covered by the public option, but lawmakers carved out a niche for the private insurers (and for doctors who are eager to only take "privateley" insured patients because it is more lucrative). They did not go the full mile - and it shows in the costs of USD 6,000 (that is in 2014 already World Bank data - I do not have the numbers for 2017). And then there is the U.S. 10,240 for every person in the country (no matter if they are healthy, if they even have insurance). A family of four would account for 41,000 year after year after year.
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