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A Thought About Healthcare

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  • A Thought About Healthcare

    Several years ago, Thomas Frank wrote a book called "What's the Matter with Kansas?" In the book, he asked a question: why is it that many of the poorest people in most of the most rural areas are continually voting against their own best financial interests?

    Today, I was listening to a podcast about what is happening with healthcare in rural areas, and the picture is glum. Rural hospitals are closing down right and left. One story was about a man who was bitten by a venomous snake, and because he had to drive two hours to get to a hospital, he lost most of the use of his hand. Why is this happening? The free market in operation.

    You see, without a universal insurance program, the poorest people cannot afford and do not get insurance. In deeply rural environments, this has a devastating effect on healthcare because there is a disproportionate percentage of lower income in such settings, and the smaller population feeding local hospitals means the hospitals are trying to serve people who often cannot pay their bills. In a large community, the cost of serving those who cannot pay can be more easily absorbed by those who can because there are simply more of the latter to do so. So healthcare and hospitals are doing exactly what the free market predicts: going to suburban and urban settings where there is a large population and greater opportunity for revenue, leaving rural districts under-served and at risk.

    And these same rural communities are the ones speaking against (and voting against) a single-payer (or anyone other universal healthcare) system. They are essentially voting to become the man with the bad hand. Strokes are time-sensitive. Heart attacks are time sensitive. Some allergic responses are time sensitive.

    So the question comes around yet again - why are these people consistently voting against their own self-interests? If hospitals had guaranteed payment through a single payer system, they would no long have to face the choice of shutting down or go bankrupt serving communities where a high percentage that cannot pay. Healthcare could stay close to the people who need it, in both rural and urban settings.

    Any ideas...?
    The ultimate weakness of violence is that it is a descending spiral begetting the very thing it seeks to destroy...returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that. Martin Luther King

    I would unite with anybody to do right and with nobody to do wrong. Frederick Douglas

  • #2
    And they'd only have to wait 10 hours in an emergency room and 18-24 months for hip surgery or 6-8 months for an MRI or CT scan or 6 months to see a specialist.


    Securely anchored to the Rock amid every storm of trial, testing or tribulation.

    Comment


    • #3
      Because people are gullible, and the oligarchs running the Republican party are sociopathic and play on the gullibility of the masses through propaganda in order to get them to vote against their own interests.

      My country has had government-run healthcare for over 75 years. You tell people here that America doesn't have that and they don't quite believe you, their response is usually something along the lines of "but America's not a third world nation, of course their government must be providing free healthcare for everyone!?" To people here it's like imagining a country that doesn't provide citizens with drinking water or roads or sewage treatment.
      "I hate him passionately", he's "a demonic force" - Tucker Carlson, in private, on Donald Trump
      "Every line of serious work that I have written since 1936 has been written, directly or indirectly, against totalitarianism and for democratic socialism" - George Orwell
      "[Capitalism] as it exists today is, in my opinion, the real source of evils. I am convinced there is only one way to eliminate these grave evils, namely through the establishment of a socialist economy" - Albert Einstein

      Comment


      • #4
        Originally posted by carpedm9587 View Post
        Several years ago, Thomas Frank wrote a book called "What's the Matter with Kansas?" In the book, he asked a question: why is it that many of the poorest people in most of the most rural areas are continually voting against their own best financial interests?

        Today, I was listening to a podcast about what is happening with healthcare in rural areas, and the picture is glum. Rural hospitals are closing down right and left. One story was about a man who was bitten by a venomous snake, and because he had to drive two hours to get to a hospital, he lost most of the use of his hand. Why is this happening? The free market in operation.

        You see, without a universal insurance program, the poorest people cannot afford and do not get insurance. In deeply rural environments, this has a devastating effect on healthcare because there is a disproportionate percentage of lower income in such settings, and the smaller population feeding local hospitals means the hospitals are trying to serve people who often cannot pay their bills. In a large community, the cost of serving those who cannot pay can be more easily absorbed by those who can because there are simply more of the latter to do so. So healthcare and hospitals are doing exactly what the free market predicts: going to suburban and urban settings where there is a large population and greater opportunity for revenue, leaving rural districts under-served and at risk.

        And these same rural communities are the ones speaking against (and voting against) a single-payer (or anyone other universal healthcare) system. They are essentially voting to become the man with the bad hand. Strokes are time-sensitive. Heart attacks are time sensitive. Some allergic responses are time sensitive.

        So the question comes around yet again - why are these people consistently voting against their own self-interests? If hospitals had guaranteed payment through a single payer system, they would no long have to face the choice of shutting down or go bankrupt serving communities where a high percentage that cannot pay. Healthcare could stay close to the people who need it, in both rural and urban settings.

        Any ideas...?
        And with Obamacare many of them still couldn't afford health care but the government could now punish them for this

        I'm always still in trouble again

        "You're by far the worst poster on TWeb" and "TWeb's biggest liar" --starlight (the guy who says Stalin was a right-winger)
        "Overall I would rate the withdrawal from Afghanistan as by far the best thing Biden's done" --Starlight
        "Of course, human life begins at fertilization that’s not the argument." --Tassman

        Comment


        • #5
          Originally posted by mossrose View Post
          And they'd only have to wait 10 hours in an emergency room and 18-24 months for hip surgery or 6-8 months for an MRI or CT scan or 6 months to see a specialist.
          Examples are not arguments. No medical facility is going to have a perfect record. The medical world also has the concept of "triage."
          The ultimate weakness of violence is that it is a descending spiral begetting the very thing it seeks to destroy...returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that. Martin Luther King

          I would unite with anybody to do right and with nobody to do wrong. Frederick Douglas

          Comment


          • #6
            Originally posted by Starlight View Post
            Because people are gullible, and the oligarchs running the Republican party are sociopathic and play on the gullibility of the masses through propaganda in order to get them to vote against their own interests.

            My country has had government-run healthcare for over 75 years. You tell people here that America doesn't have that and they don't quite believe you, their response is usually something along the lines of "but America's not a third world nation, of course their government must be providing free healthcare for everyone!?" To people here it's like imagining a country that doesn't provide citizens with drinking water or roads or sewage treatment.
            You are preaching to the choir on this one. I would be happy to see my taxes climb $20K or even more to pay into a universal healthcare system. For me, that would actually be a savings, since my premiums and annual out-of-pocket medical costs regularly exceed $25K. They were climbing before the ACA, then the rate slowed during the Obama years, and they have skyrocketed since Trump took office and all of the confusion got tossed into the market.
            The ultimate weakness of violence is that it is a descending spiral begetting the very thing it seeks to destroy...returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that. Martin Luther King

            I would unite with anybody to do right and with nobody to do wrong. Frederick Douglas

            Comment


            • #7
              Originally posted by rogue06 View Post
              And with Obamacare many of them still couldn't afford health care but the government could now punish them for this
              The ACA was never perfect. It was too much politics and too much compromise to get all the players on board. The problem rests with Congress - which is so polarized nothing can get done. So instead of working to fix some of the ACA's problems, Republicans have been systematically torpedoing it, and Democrats are stonewalling on everything.

              I look around at countries who have socialized their medicine in the same way they have socialized their roads and other basic necessities not well handled by the private sector, and I find myself envious. When it comes to this, we are indeed a 3rd world country.
              The ultimate weakness of violence is that it is a descending spiral begetting the very thing it seeks to destroy...returning violence for violence multiplies violence, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that. Martin Luther King

              I would unite with anybody to do right and with nobody to do wrong. Frederick Douglas

              Comment


              • #8
                Originally posted by carpedm9587 View Post
                I would be happy to see my taxes climb $20K or even more to pay into a universal healthcare system. For me, that would actually be a savings, since my premiums and annual out-of-pocket medical costs regularly exceed $25K. They were climbing before the ACA, then the rate slowed during the Obama years, and they have skyrocketed since Trump took office and all of the confusion got tossed into the market.
                It always shocks me how expensive healthcare is in the US. I guess it's a result of having for-profit systems on every level, taking out the profit, pumping up prices, and needing hordes of lawyers and billing clerks etc. Oh, and paying full price for pharmaceutical drugs.

                Here the government spends about $2,200 US per person per year in the budget and that money runs all the hospitals, employs all the doctors and specialists, bulk-buys all the drugs, subsidizes the local family doctors (GPs), etc, making hospitals and operations free to the user, drug prescriptions $3 US each, etc. Some people still do choose to go to private hospitals & have health insurance because that allows them to pay for cosmetic procedures and bypass any triage based queues. To be fair, I do think the govt spending of $2,200 pp/year is a bit low and I am personally a fan of high-tax high-spend social policies, so would love to see the govt choose to double healthcare expenditure to match what many other OECD governments choose to spend on healthcare.

                From looking at various systems internationally, it seems to me that the secret to keeping healthcare spending low is getting private profit out the industry as much as possible: So hospitals and insurance companies (if those exist) all need to be not-for-profit entities. The cheapest model seems to be what we have here, where the govt directly runs the hospitals and buys the drugs and the average person has no insurance but the downside is that politicians can tighten the budget purse strings and limit healthcare spending a bit too much (and waiting lists get long as a function of that). Another model that works well is where hospitals and insurance companies are all not-for-profit entities that run themselves but are regulated really heavily by the government, and healthcare insurance is either mandatory or done via the govt. That model results in slightly higher prices because the insurance companies add a layer of administration & billing etc, but also stops the govt being too much of a skinflint with health spending because the hospitals and not the govt are setting the prices and so the govt just has to spend whatever it costs rather than being the one to decide how much they are going to spend.
                "I hate him passionately", he's "a demonic force" - Tucker Carlson, in private, on Donald Trump
                "Every line of serious work that I have written since 1936 has been written, directly or indirectly, against totalitarianism and for democratic socialism" - George Orwell
                "[Capitalism] as it exists today is, in my opinion, the real source of evils. I am convinced there is only one way to eliminate these grave evils, namely through the establishment of a socialist economy" - Albert Einstein

                Comment


                • #9
                  Originally posted by carpedm9587 View Post
                  The ACA was never perfect. It was too much politics and too much compromise to get all the players on board.
                  Heavily fining folks was pretty much always part of the plan and not the result of any compromise worked out among the Democrats who passed it.

                  Originally posted by carpedm9587 View Post
                  I look around at countries who have socialized their medicine in the same way they have socialized their roads and other basic necessities not well handled by the private sector, and I find myself envious. When it comes to this, we are indeed a 3rd world country.
                  Many of those countries rely on the U.S. to protect them so they have minuscule defense budgets.
                  Last edited by rogue06; 06-16-2018, 08:08 AM.

                  I'm always still in trouble again

                  "You're by far the worst poster on TWeb" and "TWeb's biggest liar" --starlight (the guy who says Stalin was a right-winger)
                  "Overall I would rate the withdrawal from Afghanistan as by far the best thing Biden's done" --Starlight
                  "Of course, human life begins at fertilization that’s not the argument." --Tassman

                  Comment


                  • #10
                    Originally posted by carpedm9587 View Post
                    Several years ago, Thomas Frank wrote a book called "What's the Matter with Kansas?" In the book, he asked a question: why is it that many of the poorest people in most of the most rural areas are continually voting against their own best financial interests?

                    Today, I was listening to a podcast about what is happening with healthcare in rural areas, and the picture is glum. Rural hospitals are closing down right and left. One story was about a man who was bitten by a venomous snake, and because he had to drive two hours to get to a hospital, he lost most of the use of his hand. Why is this happening? The free market in operation.

                    You see, without a universal insurance program, the poorest people cannot afford and do not get insurance. In deeply rural environments, this has a devastating effect on healthcare because there is a disproportionate percentage of lower income in such settings, and the smaller population feeding local hospitals means the hospitals are trying to serve people who often cannot pay their bills. In a large community, the cost of serving those who cannot pay can be more easily absorbed by those who can because there are simply more of the latter to do so. So healthcare and hospitals are doing exactly what the free market predicts: going to suburban and urban settings where there is a large population and greater opportunity for revenue, leaving rural districts under-served and at risk.

                    And these same rural communities are the ones speaking against (and voting against) a single-payer (or anyone other universal healthcare) system. They are essentially voting to become the man with the bad hand. Strokes are time-sensitive. Heart attacks are time sensitive. Some allergic responses are time sensitive.

                    So the question comes around yet again - why are these people consistently voting against their own self-interests? If hospitals had guaranteed payment through a single payer system, they would no long have to face the choice of shutting down or go bankrupt serving communities where a high percentage that cannot pay. Healthcare could stay close to the people who need it, in both rural and urban settings.

                    Any ideas...?
                    A lot of the hospitals shut down because of Obamacare.

                    Comment


                    • #11
                      Originally posted by carpedm9587 View Post
                      Examples are not arguments. No medical facility is going to have a perfect record. The medical world also has the concept of "triage."
                      mossy lives in a country with socialized medical care. Her and her husband depend on it. So she is not just giving examples, she is speaking from decades of experience. Expert testimony.

                      Comment


                      • #12
                        Originally posted by Starlight View Post
                        It always shocks me how expensive healthcare is in the US. I guess it's a result of having for-profit systems on every level, taking out the profit, pumping up prices, and needing hordes of lawyers and billing clerks etc. Oh, and paying full price for pharmaceutical drugs.
                        Tort reform would go a very long way in reducing costs but the Democrats (who receive a great deal of money from trial lawyers) continue to block it.

                        To give you just one example, in the state I live in the estate of a man was recently awarded $3 million after he had a heart attack and died. He had gone to a cardiologist complaining of chest pain radiating down into his arm so the doctor scheduled him for testing and told him that he was at "high risk" of having coronary disease and to avoid any "exertional activity." Then the man went out and engaged in a ménage à trois (threesome) during which he had a heart attack and died. The family sued claiming if the doctor had specifically told him to avoid such activities he would still be alive.

                        I'm always still in trouble again

                        "You're by far the worst poster on TWeb" and "TWeb's biggest liar" --starlight (the guy who says Stalin was a right-winger)
                        "Overall I would rate the withdrawal from Afghanistan as by far the best thing Biden's done" --Starlight
                        "Of course, human life begins at fertilization that’s not the argument." --Tassman

                        Comment


                        • #13
                          Originally posted by rogue06 View Post
                          Tort reform would go a very long way in reducing costs but the Democrats (who receive a great deal of money from trial lawyers) continue to block it.

                          To give you just one example, in the state I live in the estate of a man was recently awarded $3 million after he had a heart attack and died. He had gone to a cardiologist complaining of chest pain radiating down into his arm so the doctor scheduled him for testing and told him that he was at "high risk" of having coronary disease and to avoid any "exertional activity." Then the man went out and engaged in a ménage à trois (threesome) during which he had a heart attack and died. The family sued claiming if the doctor had specifically told him to avoid such activities he would still be alive.
                          They don't need tort reform, they just need to weed out the idiotic jurors who would accept such a lame argument.

                          Comment


                          • #14
                            Originally posted by Sparko View Post
                            They don't need tort reform, they just need to weed out the idiotic jurors who would accept such a lame argument.
                            IIRC the family sued for $5 million and the jury decided that both sides were culpable with the cardiologist being 60% at fault

                            I'm always still in trouble again

                            "You're by far the worst poster on TWeb" and "TWeb's biggest liar" --starlight (the guy who says Stalin was a right-winger)
                            "Overall I would rate the withdrawal from Afghanistan as by far the best thing Biden's done" --Starlight
                            "Of course, human life begins at fertilization that’s not the argument." --Tassman

                            Comment


                            • #15
                              I should note that many lawyers are absolute masters at playing on the emotions of jurors. They continue to point out how much the family lost and is suffering through no fault of their own and need help and then slip in how the doctor/hospital (or in other cases business) has "deep pockets" and insurance (though rarely enough to cover some of these multi-million judgments). The result often is massive awards for things such as this.

                              I'm always still in trouble again

                              "You're by far the worst poster on TWeb" and "TWeb's biggest liar" --starlight (the guy who says Stalin was a right-winger)
                              "Overall I would rate the withdrawal from Afghanistan as by far the best thing Biden's done" --Starlight
                              "Of course, human life begins at fertilization that’s not the argument." --Tassman

                              Comment

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