Obamacare implosion

Spacekiwi said "Yes we dont cover as much of the advanced stuff as the Americans do due to population size, but for that which we dont cover, people often head over to australia which has the population base to support it, which has an average lifespan of 82, despite having treated the aboriginal population worse than the US treated black people.

So we spend a lot less on healthcare per person than the US does, and have it done by an inefficient government body, yet still have healthcare good enough to have an average life expectancy around 3 to 4 years longer than the US. So our socialised medicine systems are cheaper than the capitalistic US system, yet according to the WHO, Australia has a better performing healthcare, and NZ an almost equal performing healthcare system, despite NZ and Australia spending around half as much as the US as a percentage of GDP."

Fully agree with the information and sentiment expressed. I unfortunately have to add that our own indigenous population of Aboriginal and Torres Strait Islanders only makes up 2% of our population, yet their overall life expectancy is so bad that if we only count the non indigenous population our life expectancy ranking goes from 3 to 5 (fluctuating by year and reporter) up to a clear world leader. Why? Some is similar to what Namelessfly says, they are targeted by fast food and alcohol companies, some is generationally entrenched poverty, and some is genetic in that overall they have a greater chance of suffering type 2 diabetes and alcoholism (we Europeans had done our culling of those tendencies over the past few hundred years). Our national shame, but not easy to fix quickly.

We have some restrictions on free funding of the most expensive treatments, plus our free basic cover makes you wait for surgery on non fatal problems. We do have an efficient second tier that many are in, costs my wife and I $250 a month for us both to have top treatment.
As to euthanasia my paternal grandfather had pneumonia at 96 that was not aggressively treated, and more recently my father in law was let slip away with palliative care.
From the published literature I believe that given enough money we can access similar expensive cutting edge treatment as is available for some in the US.

But as I have pointed out to you before, (guns thread i think), the NZ Maori population has a similar level of crime, death and health problems to the US African american population. 50% of the maori population, and 70% of the islander population is obese, for example.

namelessfly wrote:You missed a point that I intentionally did not emphasize for fear of taking the thread off topic. Just as US homicide statistics are dramatically affected by the astonishing murder rate for African Americans (varies from the current low of about 40 per 100,000 to a high of 80 per 100,000 back in the 1990s). African Americans suffer from high mortality rates from other causes with obesity related illnesses being an extreme, life threatening condition. Part of the problem is the AA diet. If you watch American TV you will notice that adds for McDonalds, KFC and all the other American fast food restaurants that you dislike feature black people because this matches their customer demographic. Black people generally do not imbibe in fast food only occasionally. Fast food is a major part of their diet.

All of these points being made, I will concede that nationalized healthcare systems generally do better than the US in providing basic healthcare. The US does not have this mechanism which results in the poor and uninsured getting no preventive care and seeking urgent care from emergency rooms. This needs to be changed but Obamacare is not the solution.

namelessfly wrote:Most of what you say here is agreeable to me.

In it's purist form, capitalism inevitably culminates with all wealth being concentrated in the hands of a vanishly small fraction of the population while the remainder live in poverty. Obviously; we can agree that this is a bad thing.

In its purist form, socialism tolerates no disparity in wealth, income or living standards and imposes no requirement on working to receive these benefits. Hopefully; we can agree that this is a bad thing.

Less obvious, to make socialism work you need to have a powerful government that takes from the productive and prudent to give to the. Indolent and impudent. The NAZI holocaust as well as the megadeaths committed by Stalin, Mao and Pol Pot were all perpetrated as part of a camaign of wealth redistribution.

snip

What I read here is that both private wealth (capital) and centralized authority will grow into tyranny if left unopposed. Each needs the other as a check and balance to maintain its optimum contribution to society. Those from a sovereign state tradition approach socialism as a means of expanding the privileges granted to them by government. Those from a sovereign citizen tradition see socialism as a shield against the dominance of capital in the political process.

The problem is that socialism marries capital and politics. By embracing socialism the state provides a mechanism to further expand this marriage. Soon capital becomes central authority and central authority becomes capital. This is the sine qua non of tyranny. Whether that tyranny looks like an absolute monarch, Hitler's Germany, Stalin's Soviet Union or the People's Republic of Haven doesn't matter. Tyranny is tyranny.

Yes, government is necessary. Powerful government is even essential to the well being of a nation. What needs to be limited is the scope of government in addressing internal matters. It must function to prevent the consolidation of wealth beyond a certain threshold without inhibiting the accumulation of wealth below that threshold. Furthermore, it must do so without funneling that wealth through its control. If a powerful government can accomplish these three things, that nation will be staggeringly wealthy and that wealth will be distributed more evenly than in any other nation.

In tandem with limiting government's scope, individuals must also accept greater responsibility seeing to their own needs. Some people simply do not have the capacity to function without assistance. Others do not have the desire to function without assistance. Finding ways to help the former and provide tough love to the latter is not insurmountable. What appears to be insurmountable is keeping the bottom-dwellers from turning these intentions into government programs that end up to buying votes or repaying cronies.

The best approach as I see it is to privatize the safety net. Yes, the government must provide aggressive oversight, but funding must be voluntarily given to the NGO as a check against abuse. Healthcare can follow a slightly different tack but maintain the same theme. Regulate the quality of care but leave the delivery of care to the market place. Expand the market beyond individual states and make the markets more transparent through legislation. Provide tax incentives to providers that help the poor. Encourage non-profits into supporting clinics in poor neighborhoods. Reduce the cost of maintaining these clinics through a reduction in overly intrusive regulations.

Again the ideas are simple enough and will work. The problem is that these approaches destroy the ability of regulators to funnel money through government programs. This means less power for them to wield and wealth for them to steal.

The best approach as I see it is to privatize the safety net. Yes, the government must provide aggressive oversight, but funding must be voluntarily given to the NGO as a check against abuse.

This might work but I'd really like to see it tested first. For example give 5 states a 100% exemption from the federal regulations for the safety net. Transfer all federal safety $ to the states for them to use in this sort of program (perhaps having people designate which NGOs they want to receive their "share" of the federal $ on their income tax forms). And since the outcomes of this are likely to be long term, give the states 20 or so years to prove that it will work.

This might work, but it is much easier said than done. And while it looks good in theory, I'm not at all sure that it will work in practice.

biochem wrote:
This might work but I'd really like to see it tested first. For example give 5 states a 100% exemption from the federal regulations for the safety net. Transfer all federal safety $ to the states for them to use in this sort of program (perhaps having people designate which NGOs they want to receive their "share" of the federal $ on their income tax forms). And since the outcomes of this are likely to be long term, give the states 20 or so years to prove that it will work.

This might work, but it is much easier said than done. And while it looks good in theory, I'm not at all sure that it will work in practice.

No argument from me.

Even if the states took greater control over a public safety net, it would be better than the feds. Push come to shove we can leave a badly executed system for another state. That is a check of sorts.

namelessfly wrote:The healthcare debate is the result of advances in medical technology and changing demographics that have resulted in healthcare expenses becoming a huge segment of the economy. No country can afford to provide all of it's citizens with the best possible healthcare. The countries with "socialized" healthcare have considered this aspect soon because their populations are older and the governments have controlled access to healthcare for generations. Your healthcare costs are lower than the US partially because you don't have an underclass that experiences unusually high mortality rates due to genetics and life style choices, you are better at providing basic, preventive care, and because you severely limit the availability of very advanced medical care. It is arguable that the most advanced medical care does not produce enough benefits to justify the costs. However; should that decision be made by government experts or by individuals and their doctors?

The thing is that it's not an either/or choice. AFAIK the majority of nations with UHC have a parallel private insurance industry for everything beyond basic health care; effectively, you can pay to access the most expensive treatments even in cases where otherwise it might not be approved or alternatively to shorten the queue (and at least here, said insurance is fairly inexpensive.

I should also note that while I can't speak to the UK experience, that UHC inevitably leads to extended waiting times isn't necessarily true. When my mother broke her hip and required surgery, they could have had her in the OR within 24 hours; it was delayed due to emdical considerations.

PeterZ wrote:The problem is that socialism marries capital and politics. By embracing socialism the state provides a mechanism to further expand this marriage. Soon capital becomes central authority and central authority becomes capital. This is the sine qua non of tyranny. Whether that tyranny looks like an absolute monarch, Hitler's Germany, Stalin's Soviet Union or the People's Republic of Haven doesn't matter. Tyranny is tyranny.

The marriage of capital and politics is an even bigger problem in pure capitalism, though, if slightly less directly.

Eyal wrote:

PeterZ wrote:The problem is that socialism marries capital and politics. By embracing socialism the state provides a mechanism to further expand this marriage. Soon capital becomes central authority and central authority becomes capital. This is the sine qua non of tyranny. Whether that tyranny looks like an absolute monarch, Hitler's Germany, Stalin's Soviet Union or the People's Republic of Haven doesn't matter. Tyranny is tyranny.

The marriage of capital and politics is an even bigger problem in pure capitalism, though, if slightly less directly.

I totally agree. Maintaining the government as a viable and powerful counter weight is essential. Also, the true danger is when sufficient wealth is concentrated into a small enough number of hands. If capital is spread widely enough, the multitude of different owners of capital tend to limit the influenced by the wealthiest few.

Nameless was right to decry the increasing concentration of wealth.

biochem wrote:It all depends on what it would take to be called a socialist. Obama is a leftist true believer and he has given every indication that if he had a magic wand, he would magically transform the country into a socialist one.

He would make all industry owned and controlled by the state?
All production of goods and services would be made to be by need instead of for profit?

Uh, just no. Not a chance.

I suggest you read this:
http://en.wikipedia.org/wiki/Socialism

biochem wrote:So, many politicians who like socialist ideas

There´s a HUGE difference between "liking socialist ideas" and being a socialist.

biochem wrote:(Obama among them) have adopted an incremental approach attempting to move the US closer towards socialism. The policies they advocate are not socialist ones but simply a step closer to socialism than the policies that they wish to replace.

Ehm... That´s a conspiracy theory with about as much truth in it as the "we never went to the moon" one.

And that´s one reason US politics are so amazingly screwed up, rubbish like that is taken for real, without anything to actually support it.

That´s a signicant marker for a very, very sick political system by the way.
And society.

biochem wrote:There are good things and bad things about how health care works here. On the bad side pre-Obamacare we had about 15% of the population uncovered by insurance. In an attempt to fix things for that 15%, Obama has managed to screw things up for the 85%. And at the end of this we may very well STILL have 15% uninsured!

I'm not entirely sure Obamacare IS fixable. It is such a massive boondoggle and so poorly written that if I had the magic wand I'd get rid of it entirely and start over from scratch!

And hopefully, this will eventually happen because of "Obamacare". Think about what would have happened if someone didn´t push something through?

Then it would just be business as usual ever after until bankruptcy.
Because many(most?) politicians in USA have been perfectly aware that the system as is, just wont work if it stays the same, but the inertia and the special interests that are making big money from it, doesn´t want any change.

If Obama hadn´t pushed it, then it would just have gotten worse until someone else had the courage to try, or if really unlucky, was forced to deal with it.

Even the original plan, before a lot of morons(politicians) from both parties meddled with it to satisfy their lobbyists, would likely have been a fair deal better.

But the important part is that something is done about it.

biochem wrote:Very true. In the US 90%+ of the media votes for the DEMOCRATS

The same claim is repeatedly made here. And it´s just as much of a lie here.

It´s a bold and even outright stupid lie, and you´re buying it hook, line and sinker.

And it´s just sad. Because you´re not alone in doing so.

biochem wrote:So what most of you in other countries are seeing is not a balanced picture but the point of view of only 1 side.

Balanced? News are news, balanced news aren´t news, that´s called propaganda.

biochem wrote:The only major national media outlets that provide the right of center perspective are foxnews and the Wall Street Journal, the rest are on the left. If you truly wanted balanced news from the US, read www.foxnews.com (the Wall Street Journal has a nice website as well, but about 80% of it you have to pay to get access to) for the right of center perspective and www.cnn.com for the left of center perspective.

Do you realise why it´s a standing joke to talk about "balanced news"? Because Fox news is a complete and utter joke.

Because Fox news is total lack of even any hint of objectivity.

Fox news is the US version of Pravda.

Chinese news agencies provide less biased news than Fox does.

Fox even outright tells you that they´re selling you propaganda. "Fair and balanced".

News means reporting what IS. Reality isn´t fair, and most certainly not balanced.

You are being manipulated by Rupert Murdoch and his cronies, and you´re taking it all in as "THE TRUTH!".

Michael Riddell wrote:
Very true, Daryl. From observing this and other forums that I frequent, I have come to the fundamental conclusion that US citizens do not understand how things work in other countries in the same way as NON-US citizens do not understand how things work in the US.

The basic life experiences and culture in which we respectively live are fundamentally different. Therefore we view each other with incomprehension.

A single forum like this is a poor barometer of what other countries are like. As it's an American based forum, I suspect that most members are American with a comparatively small number of non-US contributors. It doesn't give you enough of a population cross section to give a more accurate idea of what it's like to live in Australia, Sweden or the United Kingdom. If you, as I do, use a number of different forums on different subjects, you do get a very basic impression rather than just relying on one forum exclusively - I'm including Baen's Bar here as well. It's footprint very similar to this one.

The relatively few people in the US that are really interested in the outside world, they most certainly do understand it, while people outside of USA tends to get bombarded by both entertainment and newsmedia from USA and generally can´t avoid having some degree of understanding.

If you ask 50 average americans about the politics of Sweden, then you might get 1 or 2 correct answers, and you´re more likely to be told that the monarch rules politically, oh yeah... *lol*

If you ask 50 average Swedes about USAs politics, you´re going to get plenty of correct answers and probably a fair amount of analysis that you could do a straight translation and run on a US newsmedia without anyone even noticing that the source isn´t from the US.

Michael Riddell wrote:The only way to understand is to actually live in the country your discussing. Nameless is therefore correct in saying that non-US people should stay out of a discussion involving internal American dynamics, but, as this is the internet, that is impossible as everyone likes to stick their oar in!

Mike.

Bullshit.

First of all, fine, USA quits messing around with the rest of the world, then i might not bother commenting. Yeah right, that´s not going to happen anytime soon.

Secondly, USA is the worlds largest cultural exporter, people overall around the world know a fair amount about USA, the opposite is only rarely true.

Thirdly, are you really claiming that it´s impossible to discuss anything unless you´re an expert on the subject?
That would cut down total conversation, both on internet and in real life by at least 90%, probably closer to 99%.
I mean, come on, it would mean that most people aren´t even allowed to talk about the weather!

Fourth, would you say the same if the subject was North Korea and said by a North Korean?
Would you say the same if a Syrian demanded you to get lost from a discussion on Syria?
Not bloody likely.


And if anything, NOT staying away from discussions about other countries is highly preferable, because even if someone is wrong about it, their opinion may still provide another point of view.

And really, understanding other nations does not require living there. That´s just being silly.


And in the end, Fly is 1) just being grumpy and 2) doesn´t have any kind of authority to restrict my freedom of speech. Only the owner/admin of a forum can do that. And IF they do such a thing, then they turn the forum into an insular little club of internal admiration, which is essentially so useless that they tend to die off due to lack of interest from users.

PeterZ wrote:...

The best approach as I see it is to privatize the safety net.

...

That´s like begging for corruption. Realise, that this would be to turn back the time about 150 years or more. You might want to read some of the classic literature that touches on the subject, and take note just how awfully poorly it worked. Or more like NOT worked.


I can say this, about as close as i can get with relevance, that in the last 20 years, Sweden has denationalised healthcare a lot, the result has mostly been reduced efficiency and higher costs.

Social security was moved from state to local responsibility, result was massive issues with uneven costs vs income for local government regions.

Likewise, school was moved to local level, and now we´re looking at Sweden dropping in the latest PISA test. Funny thing though is that the rightwing govt, after 7 years in power, STILL blames that on the former government.

Even more funny is the fact that it´s the rightwing parties that have done all the big reforms and modifications for the school politics for the last 30 years. Yet they still talk about the "flummiga sosseskolan", hazy/muddled/stoned social democrat school...