Comments by "Xyz Same" (@xyzsame4081) on "GBH News" channel.

4:00 next hack: you come from the conclusion that it MUST be Biden versus Trump. Plus 20 candidates run in the primary. Biden is a terrible candidate anyway, never mind the Tara Reade story. it was Democrats who argued that Kavanahaugh was disqualified for a high office. The hypocrisy meter is stretched beyond capacity. - Trump and Republicans BAD - so what. Have a decent candidate with good policies and WIN ON THAT. Biden runs on "not-Trump", and "at least in person I am a decent guy." (his voting record is terrible as well). That is extremely thin to begin with - and it is not even true.
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3:00 the guy is a hack. Tara's story has NOT changed. She came out with the less terrible part first (harrassment) - victims often do that (see Weinstein). She told family and friends of the ASSAULT in 1993 and except for her mother all people she told then (and in 1995) are alive and can testify. One friend she told in 1993 does not want to be on the record for fear of retaliation (she worked as a staffer then, she has a company now, probably some biz related to D.C.)
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5:00 hack no. 3: No, the NYT only reported because the independent outlets on the internet forced them to by staying on the story and not shutting up.. And with a delay of 1 month or so. They redacted their article on the request of the Biden campaign, and while the article seemed to be "neutral" (certainly better than any coverage she had gotten by established media before) it was clearly coming from the point of sowing "scepticism" about the claims of Reade. There is sound scepticism and then there is stressing some points in the top paragraphes and doing the CYA statements down below. For SHAPING OPINION headlines and the first two paragraphes (maximum) are important. above the fold - the NYT KNOWS about that effect of course.
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You explain the disadvantages of the "public option" (Medicare buy in, Medicare for some) to the voters: 1) losing a lost of cost savings potential for a very streamlined admin 2) loss of a unified electorate = loss of political leverage 3) the insurance companies get an even MORE cherry picked pool. (Medicare covers already the most costly patients group, plus 65 years). A system TO DELIVER CARE can either be good for the patients OR have a lot of for private players extracting profits (starting with private for-profit insurance companies). The private insurance companies BRING NOTHING TO THE TABLE, if a public non profit insurance agency (dealing with non-profit or for profit players) is reasonably set up (it is not rocket science ALL single payer nation are capable of doing it much better than the U.S.) And of course the agency must be reasonably funded (read HALF THE SPENDING of the U.S.) - so they can pay well negotiated but adequate compensations to doctors and hospitals. Then there will be very little room for private insurance companies, and no one is going to miss them. In countries with single payer the patients / insured have little to do with the public insurance agency and they do not miss that. At. All. - when there are contacts they are usually well organized and polite - and that's it. Patients may be attached to the doctors, or appreciative of a hospital (more likely a department where they got care for non-trivial health problems) - the rich and wealthy (if they are healthy !) will OPT out and will not see any reason to help fund the public option. They (or their employers) will pay too much into the overpriced contracts (considering how much the pool has been purged) - but their CARE is at least good and they can afford it. Except of course when they have pre-existing conditions - then they will land with the public option. Another effect is that the private insurance packages can appear to be reasonably prices (while being too costly considering that they keep only the good insured). On the other hand the public coverage will appear to be expensive (they miss out on the higher contributions of good earners and they have all the costly patients). The Republican party can then howl about the "inefficiency" of the "socialist" system (and don't expect the Corporate donation chasing Democrats to hold strongly against it). They can sneakily and openly defund it - they did that btw: Medicare and Medicaid will get less funding over the course of the next 10 years - if the Trump admin cuts remain effective. The taxcuts for the rich and super rich have increased debt and deficit and someone has to pay for it. And WHAT would be the rational to have Medicare and then offer another public non-profit package but it is NOT Medicare ??? More complicated admin ? The problem with Medicare for All - it would be almost impossible to get rid of it and much harder to defund it. When the wealthy cannot opt out from paying and they get the full coverage like everybody else - most of them will USE it. So they have a STAKE in the system. And there will be not political divide between the voters of the Republican party. They TOO have skin in the game and want the system to be GOOD and COST-EFFICIENT.
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even cost efficient systems spend 5000 USD for every person. That is 20k for a a family of four. Primary care out of pokcet puts you at the mercy of the doctors or the hospitals. At least half the country has NOW a problem when they would have to come up with extra 400 USD.
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your proposal is nowhere realized and with good reason. If you have hospitals that serve the region (enough but not too many) no other hospital can exist. They would have to SELL UNNECESSARY TREATMENTS. Unlike with restaurants or other consumers goods that is unethical, counter productive and very expensive. And unlike with garments and other consumer goods (think restaurant dinners, cars, ..) consumers cannot chose, the doctor, hospital have a massive information advantage.
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Want to know how the countries do it that spend 41 - 55 % of what the U.S. is already spending per person ? Per capita healthcare expenditures means ALL that is already spent no matter who pays for it: insurance, out of pocket, subsidies DIVIDED by all people in the country, young or old, sick or healthy - and in the U.S. it includes people that do not even have coverage or go broke). I live currently in Austria and know the German systems well (theory of how it is set up AND as user or seeing it in action with friends, collegues). So bear with me: Other nations have independently set up national systems after WW2 that follow certain principles typical for single payer - and they ALL beat the crap out of the U.S. At the minimum !! they have covered all that is costly in medicine: 1) insurance - the publice non-profit insurance agency is either dominant or completely dominant. If it is reasonably managed and gets sufficient funding (think HALF of the U.S. level) the private insurers simply cannot compete. These nations after WW2 came all to the same conclusion: that they do not want to leave healthcare coverage / insurance to private for-profit insurers. Only Switzerland leaves it to private insurers. Their system is good and they are WELL regulated. So they spend 8000 USD for every person in the country, versus 10,240 USD in the U.S. versus 4,900 - 5,700 USD in the countries that were lucky enough that the decision makers after WW2 got that right. 2) hospitals are ususlly non-profits, no chains allowed, nothing like the for-profit hospitals in the U.S., likewise pharmacies are usually not allowed to organize in chains (there are drugstores and then there are pharmacies) 3) the only powerful for-profit player in the system is Big Pharma. Luckily there is price transparency in the market, they have a very standardized product (so I assume the large countries somewhat protect the smaller countries - which can have a general ideal what much larger nations are paying. All other costs can be scaled up and down by multiples of thousands, and the small countries cannot be ripped off by big pharma).
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ACA was a "solution" that made sure that the overpriced U.S. system could continue (else the pitchforks would have been on the streets long ago). ACA was an insurance-friendly set-up (that is why the Corporate Dems defend it and are "sceptical" about the solution that functions everywhere else in the world and for decdades and at much, much lower costs). ACA made sure that the profiteers could continute to extract profits. And since the costs are outrageous (double spending of what would be necessary, and that is no hype) - there need to be a lot of subsidies - but these fund the dysfunction and the profits - not a good and cost-efficient hassle-free system like in the single payer nations. It is true that the single payer systems also need plenty of subsidies - but NOT as much as the U.S. already susidizes per person. In a single payere system the government pays LESS and patients/workers and companies pay much, much less.
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It is true that the single payer systems also need plenty of subsidies - but NOT as much as the U.S. if you compare the subsidies per person * In a single payer system the government pays LESS per person and patients/workers and companies pay much, much less. * Only that comparsion makes sense if you have countries in all sizes from a few millions - like 3, 30, 60, 85, 127 or 238 ** (Denmark, Netherlands, Italy/France/UK, Germany, Japan, the U.S.)
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** estimate for the U.S. in 2017/2018 (those numbers include the undocomented immigrants; roughly 3 - 3,5 % of the population = 10,5 - 11 million people. Now I have seen claims that their number is higher - more like 20 millions. Well that would account for another 3 %. That segment is younger on average, so either children, teenagers, or adults that are working - less retired persons (which are a costy group, healthcare wise). So they CONTRIBUTE to the economy - and should get healthcare coverage for that - whoever may benefit from their often lower wages, should be made to pay for their they are younger than the average U.S. citizens (so they cause much less costs in the system). The argument is often that they are "leeching off the system" or that they would if they would get a path to legal status. Well if the U.S. is spending 90 - 100 % more than other wealthy nations the official 3 % - or worst case scenario 6 % of the population - are NOT the problem that needs the most attention. Moreover they may avoid using medical services - but when a condition / illness gets severe they will need to (and in some cases that might attribute to higher costs in the end, because they do not get care until there is considerable damage). So they WILL cause costs then - which may be hard to recuperate by the hospital / doctor. If they are broke, they are broke (even if you deport them - you are not going to let them die on the steps of the hospital, let alone their children). So if they have insurance and coverage it would not add to the overall spending but DETRACT from the administrative costs for EVERYONE. A lot of out of pocket spending is already included ! in the total spending in the country. There are rumours that they use forged SS cards, or maybe charities pay for them or they have a GoFundMe. Either way, their numbers are factored into the population numbera and the numbers for their healthcare expenditures is factored in as well in the "per capita healthcare expenditures" of the U.S.
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The "free market" can impossibly work for healthcare. - There is no need to reinvent the wheel. If so many countries (small, medium and large) did their individual version of Single Payer, usually since the late 1940s, and they ALL end up with AVERAGE spending per person between 4,900 USD and 5,700 USD (we are talking about rich nations like France,Belgium, Japan, Canada ...... Germany) As opposed to the spending per person of USD 10,240 in the U.S. (Keiser Family Foundation, numbers for 2017 based on OECD data). Then you can draw conclusions: 1) a first world nations will need to send approx. 5,000 USD per person per year if they want to have a good hassle free system for everyone. (which is still a lot of money, a healthy family of four will have a "share" of 20,000 and more year, after year. of course the spending that does not occur for them goes to the rare cases when people end up with high treatment costs for severe illnesses. And a lot goes into care for old people. Modern medicine can add more life time - but that comes at a cost. 2) The more public non-profit a country has in their system - the more cost efficient they can have their GOOD services. So it is better to have non-profit public hospitals than have contracts with for-profit hospital chains. The for-profit hospitals even if well regulated WILL try to sneak in something and medicine is so complex that there are countless ways to do so. That is why most nations removed the profit motive from the situations with COMPLEX decisions (or at least they restrict the power of the for-profit players - like that no chains are allowed for hospitals). STILL: the NHS leans the most towards public non-profit and has the U.K. has the lowest spending per person. Likewise if a nation allows some room for the for profit insurance companies and "privately insured only doctors" they end up with higher costs for everyone. That is usually when the public coverage is underfunded so quality will suffer OR the public coverage is not comprehensive and unified. Unified means: everyone gets the same treatment in the same places - provided a doctor decides it is medically warranted. and that doctor is not influenced by a profit motive, nor does he or she have to consult anyone - like the insurance agency. The insurance agency only negoatiates the framework, like drug prices, costs for ambulance transports, what a day in the hospital costs, etc.) - the doctors use the tools as they see fit and MAKE THE COMPLEX DECISIONS. There are incentives for doctors to game the system, to "milk" good insurance packages (not better outcomes, but unnecessary procedures, keeping the "good" patients longer in the hospital, unnecessary tests, etc.). Even if they would not do that (they inevitably will, the complexitiy allows for that) - they system is not nearly as streamlined as it could be. so they miss out on the cost savings of a simple administration. The NHS even runs the doctor practices and hospitals (so they donot have a contract with the hospital or the doctor practice that may be private or public - they doctors and hospitals are part of the structure). Most of the spending in the UK happens via the NHS (and spending on private insurance and out of pocket for "private only" doctors makes things only more expensive). They have a record low level of spending per person. For a wealthy country with the typical age structure of a mature economy: that is important. Sandard of living influences wage levels and that is important for costs in healthcare. Another factor is that everyone gets all that modern medicine has to offer. And AGE is a huge cost factor because with old age the most costs manifest. So you cannot compare Hungary (look at their wage levels and minimum wages), and you cannot compare Israel and Taiwan with Germany, Denmark, France or Japan. They might offer modern medicine for everyone but their population is much, much younger on average. The U.S. btw has also a much younger population on average (immigration !) - and only for that reason should beat the Europeans or Japan cost-wise.
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Next time you hear that there are waiting times in Canada (they have systems and provisions per province) or that the NHS in the U.K. is struggling ..... True - and Canada spends ONLY USD 4,800 (in that range, numbers 2017) per person and the U.K. spends only 4,250 USD per person. You increase the budgets (which would come from gov. funding to avoid the problems with persons that cannot afford the higher spending on the individual level) to only HALF of the U.S. spending and the healthcare systems in Canada and in the U.K. would run like a charm. (and beat the crap out of the U.S. system). Currently Canada spends 47 - 48 % of the U.S. and the U.K. spends only 41,5 %. Getting HALF = 50 % would be a considerable improvement. It speaks to the efficiency of the very "public, non-profit" oriented NHS that they pull it off at that level of underfunding. but with the yearly flu wave in winter they are hanging in the ropes - the "winter crisis". Of when social services for the elderly are cut and they have to KEEP seniors after treatment has been finished because they defunded the public care centers and they cannot afford the private for-profit care homes for the elderly. Tory insanity (but it becomes understandable if you realize that they want to run the system into the ground to "justify" a privatization through the backdoor).
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