Single-Payer Health Care: As Goes Canada, So Goes Vermont

The Something Awful Forums > Discussion > Debate & Discussion > Single-Payer Health Care: As Goes Canada, So Goes Vermont

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Fat Ogre posted:

Good luck with that.

Right to travel according to SCOTUS trumps that poo poo.
http://en.m.wikipedia.org/wiki/Shapiro_v._Thompson

Well go file an amicus curae brief with the Vermont Republican Party then, I'm sure you'd be rewarded handsomely.

I suspect they have taken this into account in some manner.

# ¿ Apr 26, 2014 21:21

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# ¿ May 22, 2024 15:22

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Bicyclops posted:

For example: when you're suffering from a difficult illness, quitting your job for a few months to move to Vermont is not, in fact, a realistic solution. Additionally, plenty of chronic illnesses (ulcerative colitis, rheumatoid arthritis, etc.) do not actually "go away" and require monthly treatments and constant medication, meaning you'd have to move to Vermont forever.

This is the "If they don't like the bigoted homophobia of their state, why don't they just move?" argument transported to healthcare, with the bizarre twist that this time it's posited as a bad thing.

I believe Fat Ogre's inquiry is, what keeps someone from moving there briefly and applying for welfare, which they may not be lawfully denied based on their status of residency? Because if it's a general 'what's going to stop everyone from flooding to Vermont for medical care' well you're kind of summarizing the issue there.

# ¿ Apr 26, 2014 21:33

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Fat Ogre posted:

2000 is crippling now? Where do you live that 2000 is crippling but you don't qualify for state aid etc for being poor as gently caress?

America, presumably.

# ¿ May 4, 2014 22:13

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anonumos posted:

Isn't it also a little insulting to say "You silly proles shouldn't be doing something as high brow and expensive as skiing. Go back to your hovels before ~~I hurt you~~ you get hurt."

Well you have to assert your power and station somehow, or what's the point of having it?

# ¿ May 5, 2014 03:46

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

AYC posted:

http://www.vnews.com/opinion/11801131-95/column-heres-why-a-single-payer-system-wont-save-us-health-caresw

Column in opposition to single-payer. Thoughts?

An unpersuasive argument trading heavily on "blooooo govmint bad" in my opinion, though I suppose she raises a point that even if we instituted ~~full communism~~ single payer tomorrow we would likely not instantly snap down to Canadian expenditure levels. That said, she's also claiming that the cost growth problem is... solved? And was solved in the 80s?

# ¿ May 5, 2014 03:58

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

What the gently caress hospitals are these that are mostly private rooms? Has that been where all the new stuff has been? Every time I've been in a hospital to visit or for treatment it's been semi-private, except when I was in the ICU for a few days.

I mean anecdote is not the plural of data, but there are clearly non-single hospital rooms out there.

# ¿ May 5, 2014 04:42

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

EvanSchenck posted:

Hospitals tend to hold people for observation because head injuries can result in complications that are difficult to immediately detect, but can rapidly worsen and cause permanent brain damage and/or death unless timely intervention is forthcoming. The death of Natasha Richardson was a famous recent example of this, and I'd actually guess that the Canadian friend was thinking of that exact case, because there was a lot of discussion of it among skiers.

A small risk of permanent brain damage or death is merely the price of freedom; the tree of liberty must be watered with the blood of massive stroke-outs from the uninsured.

# ¿ May 5, 2014 19:49

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Fat Ogre posted:

Why do you want to work here, "uh I need a job." Yeah.....

It isn't luck finding a job. There are poo poo tons of them out there. By saying it all comes down to luck basically implies no one has any skill whatsoever and everyone is equally qualified for every job. That the people in HR are just pulling resumes out of a hat and are looking at how well a person's attitude, relevant skills and qualifications fit them to that job

I'm curious, what is the correct answer to "Why do you want to work here?"

I mean for some kind of scientist or whatever it could well be "passion" but for Office Assistant II (p/t) is it really somehow enlightening if the answer is "Because I want to help people in this office!" rather than "I need money for goods and services?" Is it an effort to see if someone is either stupid enough to believe it, or smart enough to know to lie?

# ¿ May 8, 2014 22:29

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Fat Ogre posted:

Yeah because all medical services are emergency related

I have a wife and three kids and have had to call an ambulance ZERO times in my life. Yet interestingly enough have utilized and paid for a wide range of services that were I able to comparison shop would have been useful.

Then may I be the first to wish to you that none of your four loved ones, nor yourself, should ever have to have an emergency or a condition which will require such treatment methods. May your fiscal prudence be matched, forever, by the blessings of good fortune - so that you never are tested.

# ¿ May 10, 2014 20:25

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

VitalSigns posted:

Exactly. Medicine is a highly specialized professional industry, and comparison shopping is asking laymen to make medical decisions.

There was one really good post from a goon in a previous health-care thread (that I wish I had saved) telling a story where he took his wife to the ER in the middle of the night. She was in excruciating pain, and the doctor told him that to know if she required surgery she needed an MRI, but if it turned out to be nothing then his insurance would likely refuse to pay. He ended up doing it and it turned out she her fallopian tube was wrapped around an ovary or something (I forget what), but she needed surgery right then because every minute risked some kind of internal rupture and hemorrhage.

Here he was, a layman with no medical training, being asked to wager a huge sum against the life of his wife with no way to know beforehand what the outcome would be. In a sensible world, that decision would be up to the doctor's medical judgment, not the poker hand of some dude.

But hey, free markets. What does that rube expect for trying to get an MRI in the middle of the night? A savvy consumer like me would have told his wife to shut the gently caress up about her stomach for the rest of the night so in the morning I can use my finely-honed bargain-hunting skills to shop around for MRI's during normal business hours and let the hospitals compete for my business!

Well, clearly the free market was just stating to him: Hey, maybe you shouldn't have children - as in, maybe your wife shouldn't be able to have children, because her ovary ruptured and maybe she died while you were comparison shopping! That's the sort of freedom we need more of here in America - the kind of that kills and mutilates people.

I was once in a conversation with a Canadian who said "It's not all roses and sunshine up here, you know; if I needed an MRI but it wasn't urgent I might have to wait for a month." When the three Americans involved informed him that if they needed an MRI they would go bankrupt, beg from family, or not even consider getting one, his response was along the lines of "hrm."

# ¿ May 10, 2014 20:28

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

^^^ Oh, are these places that are guaranteed to give you antibiotics? That will end wonderfully.

Ditocoaf posted:

Wouldn't you prefer to go to the hospital that publicized its prices, if you had a choice? Why would they have to be forced to post, the free market should incentivize them to post. Y'know, if the free market was a thing that was relevant.

For that matter, what if you aren't in an area where you can easily reach multiple hospitals? Where I live, there's a pretty big hospital complex...

One of them. How do I comparison shop there?

To address Fat Ogre's pedantic point, it would not be a bad thing, though it might not be a useful thing, considering that even in a civilized society, medical treatment involves a poo poo ton of moving parts and the possibility that you will have an emergency crisis in the course of treatment - perhaps you should be able to declare "Well I'll take the basic course of treatment, but if it looks like it'll cost more, just let me die to spare my heirs!" and this will mysteriously and suddenly be completely OK with all the medical personnel, your family, etc.

The reason why people are not warmly embracing solutions such as that or "let me give you some pro career advice (become a coder)" etc. is, I think, a lot more because these are general discussion threads. If this was a medical discussion on the virology of the common cold, someone popping in to say "Just have some chicken soup! OK, some veggie broth if you're a vegetarian. What's wrong with that? Everyone can get chicken soup, what harm does it do? It's quick and easy so what's wrong with bringing it up?" etc. etc. would get told "gently caress off."

# ¿ May 10, 2014 20:42

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Fat Ogre posted:

They don't have to compete at all. So how on earth does competition work on them?

I'm saying for hospitals to compete. Force insurance companies to compete against out of state companies. Unless you think that is a bad thing when it comes to home owners insurance, car insurance etc?

As to your idea of the cheaper one being booked for 2 months that means the other places aren't being used. Have fun explaining to the board of directors why you let the other place steal your MRI business.

Do you have an answer for what would keep every insurance company from immediately moving its headquarters to Delaware or whatever other state has the laxest possible requirements? If they all do it, we don't get much of a choice, now do we?

Do you think hospital directors get quizzed by a board of directors on why they let another hospital steal their MRI business, or have we completely converted the medical system into the wonders that are quarterly-profits driven business operation in this example?

# ¿ May 10, 2014 20:56

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Oh yeah, all that federal government regulation we're likely to get in the next few years. That seems pretty likely. Maybe in 2020 or something.

VitalSigns posted:

What? How can you be against chicken soup? Good nutrition helps your immune system and it sure wouldn't hurt! Stop telling people not to eat chicken soup, that's insane. You just hate chicken soup because gently caress people with colds, right?

Obviously.

Why I remember on this very forum back in the before-times, someone said something to the effect of "Well because I don't live in COMMUNIST CANADA I'm going to go to the urgent care clinic tomorrow and get a Z-pack for this cold, because I can't afford to miss A SINGLE WORK DAY."

To which I was like "So you're going to get antibiotics to treat your cold?"

Someone half-heartedly chimed in, "well maybe he has an underlying infection--" and it was just like, come on, man.

# ¿ May 10, 2014 21:04

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VitalSigns posted:

And of course, you ignore that many, many procedures are unaffordable regardless. Let's take my friend Chad who now owes the cost of a cheap house in medical bills. Hooray, as he writhed in pain on the floor, his boyfriend applied his savvy bargain-hunting skills and was able to find a hospital in the next town that would treat him for $40k all-inclusive. Luckily, Chad didn't get septic and die during a few hours of shopping and another couple-hour drive, and he now owes a $40k bill he can never repay rather than an $80k bill he can never repay. Progress!

Or maybe as a savvy consumer he realized his credit score was too important to blow on some silly infection, told the hospital to come back when they had a better offer, and died at home while waiting for them to crumble.

Alternative title thread: Market-Based Health Care: Death Is Certain

# ¿ May 10, 2014 21:16

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Fat Ogre posted:

Sorry to suggest that maybe self improvement or entrepreneurial spirit could help those currently mired in the lovely system we have in place. Instead they can use your solutions which are *crickets chirping*. Apparently blaming everything and being annoyed at anyone trying to work in the current rigged system to help others is the solution to crippling student loans and ruinous medical bills.

God drat. Why should anyone want to fix anything if they get yelled at for suggesting baby steps towards resolving something?

Like I said, you're walking into a discussion on the epidemiology of the common cold and saying "Why not have some chicken soup?" You can get down off the cross.

# ¿ May 11, 2014 01:52

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Slobjob Zizek posted:

Everyone here is getting caught up in the minutiae of the configuration of insurance companies, but you are all tacitly agreeing that you LOVE DEATH AND ILLNESS. That is the system that we have -- one that dumps money into treating chronic disease and old age without considering the value of such treatments to the patients and to everybody else.

What?

Granted that perhaps we waste money on heroic measures in some cases. Are you just advocating Logan's Run or something? It sounds like you're specifically advocating cutting expensive treatments and things in favor of much cheaper (and good!) things like "gym memberships" and "bikes." You also seem to be introducing this whiff of "life unworthy of life" which has, uh, poor historical connotations.

# ¿ May 12, 2014 00:01

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Slobjob Zizek posted:

Toning down the weird, eugenicist overtones, here's the crux of my argument: we spend most of our healthcare dollars on the chronically ill and the elderly. These people are not flukes, they do not suffer from freak genetic diseases or barely survive horrible car accidents.

The quadriplegics and those with cystic fibrosis are who traditional insurance is meant for. They, randomly, suffered bad luck and now, we as a society provided for them (via insurance of some sort, public or private), because we, too, could suffer from bad luck.

Those with non-severe mental illnesses, chronic cardiovascular diseases, diabetes, cancer (in some cases), or old age do not suffer from bad luck, but from social diseases. People are overworked, overfed, overexposed to carcinogens, or simply too old. If we could absolutely cure the aforementioned conditions, great, I'm all for it. We solved the problem we created. Hopefully we came out even.

However, we usually can only merely treat the aforementioned social diseases, instead of cure them. So, more and more people develop chronic conditions and get older as social conditions are not addressed, and we keep dumping money into the medical-industrial complex. It's practitioners are all too happy to take it. And patients are "happy" that they can take a pill instead of change their life or think about the reality of death.

This would all be fine if people had to pay for their own healthcare when really sick. They don't, though (and couldn't afford it anyway). So, if we give carte blanche to every chronically ill/elderly person for their treatment, and stick the tab to those paying insurance premiums (private) or the taxpayer (public), we are essentially making a social decision. And instead of providing universal daycare, subsidizing college tuition, or raising the wages of younger workers, we are dumping ever-increasing amounts of money into healthcare. Is this really the future of the welfare state? Everyone holding on so desperately to life that it isn't actually lived? That's depressing.

You didn't really get rid of the overtones I was talking about.

There are two criticisms I have of this argument of yours.

The first is: Where, exactly, are you going to decide someone has a 'social disease' and is therefore implicitly unworthy of treatment? At what point does my unforeseen disease become something that was not due to a deficiency of bootstraps, but rather an honest accident? As an ancillary question, how are you defining "old age" - is there some point at which you just stop receiving medical care? What is that age threshold, how did you arrive at it, and is it subject to amendment in light of later improvements? I would also point out you are basically saying that someone who has a mental illness outside of a certain threshold needs to just deal with it, and society isn't interested in assisting them (which, in that case, is basically the current situation - but now you've made it explicit!)

The second is the question: Do you believe that the savings from cutting the former, would be applied to the latter? For that matter, do you think that they are mutually exclusive? The resources are there, just not the political will, at least in America.

# ¿ May 12, 2014 03:40

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

on the left posted:

You don't need to nationalize the entire health system to open medicare for all. Just enroll everyone in medicare, say "Our budget goal is ~$4000 per person per year", and negotiate prices and covered procedures until you hit that number. Obviously cuts will need to be made, but just start with expensive treatments and work your way down.

I saw a handy dandy "how much the average household pays for X in taxes," and I saw the medicare entry was (for this household of about 50k in earnings) about $600. I imagine doubling that would be more than sufficient to pay for everyone, given that most people on Medicare now are old and sick and busted.

# ¿ May 13, 2014 16:05

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

Slobjob Zizek posted:

First, I'm just going to share this chart from a famous study on the opinions of end-of-life care by physicians:

From here: http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2389.2003.51309.x/abstract

Second, I'm going to say that we implicitly medicalize all poor states of health in our society (Foucault talks about this for all you leftists), and that instead of imposing responsibility on patients or asking them to examine their values, we tell them we can fix them (or will at least try). Patients are treated like children instead of being responsible for their own health and health choices. Why? Because it's easier and because there are less complaints. Change your life? No, have a SSRI. Stop eating so much and start exercising? No, have some statins and insulin. Face your own mortality? No, try every treatment, no matter how effective.

What a grotesque rhetorical point. Not every mental illness can be addressed by "changing your life," especially in the modern world where it is unfortunately necessary to do things like "engage in some manner of productive work, however limited." What the hell "changing your life" is a person with a severe mental illness supposed to do instead of receiving pharmaceutical treatment? Granting there are probably many cases where medication is unnecessary or overly used, is it somehow better if we replace medication with the "tough titties" treatment?

quote:

You can debate whether or not this line of thinking is moral, but it is certainly not cost-effective. If we don't get the outcomes we want, and we spend tons of money on treatment, we are wasting money as society.

You're conflating psychiatric treatment with seeking out exercise with end of life care. These are three very different things. You're also saying that "society" is wasting money on caring for these... these PEOPLE, who just can't DEAL... How is this not social Darwinism, merely with its target changed from the poor (explicitly) to the mentally ill and the sedentary/obese (who are merely OFTEN poor)? It is not that I object to your specific interventions, though I would say you are in turn projecting an artificial construction of your own - that being that these things are all things which can be handled if you'll just fix up your attitude, pull up your own bootstraps, and go run some laps/accept that you will die because nobody wants to pay for your chemotherapy.

quote:

Third, no I can't say that savings from healthcare will be spent on something socially useful, but I can say that it might be. It's ridiculous to claim that we must spend money on socially useless endeavors because the alternative is too hard to consider.

What if it is next determined that devotees of Foucault aren't "socially useful"? The alternative would be too hard to consider, after all.

quote:

Last, you ask about the brightline between diseases we should treat and diseases we shouldn't. This is not an easy question, and will require a societal discussion, and changes in cultural norms. But the reality is that we already have a brightline between spending money on healthcare and not spending other socially useful endeavors. We just never consciously made the choice.

Leaving aside mental illness and obesity, can you list a few diseases that should not be treated? Can you establish a criteria by which one becomes life unworthy of life, perhaps?

e: To editorialize a bit on that final graph, it seems to be reflecting being put in a persistent vegetative state by severe brain injury, like Terry Schaivo. You seem to be implicitly discussing the treatment of heart disease or cancer; could you perhaps post the graph where physicians were polled on what treatments they would like in the face of suffering a severe heart attack? Or was one not taken?

There would seem to me to be a major difference between "in the face of something I know to be essentially unsurvivable, I would pursue palliative care, and perhaps we should encourage that as an option as well" and "we should actually just stop giving medical treatment to those who are undeserving, based upon obscure metrics."

Nessus fucked around with this message at 19:07 on May 13, 2014

# ¿ May 13, 2014 19:02

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# ¿ May 22, 2024 15:22

Nessus: Dec 22, 2003; After a Speaker vote, you may be entitled to a valuable coupon or voucher!

rscott posted:

haha all you depressed people you don't need pills! You just need to change your life, for the better, while feeling totally awful about yourself and possibly suicidal. Sage advice there Kimosabe.

I seriously doubt the treatment of depression is bankrupting the nation, too. In fact I imagine DepressObamacare which provided subsidies for outpatient therapy and medication for even the poorest would probably pay for itself in improving the function of many members of society, to say nothing of the less tangible benefits.

# ¿ May 13, 2014 19:08

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