Get Sick and Die; The State of U.S. Healthcare

The Something Awful Forums > Discussion > Debate & Discussion > Get Sick and Die; The State of U.S. Healthcare

Ytlaya: Nov 13, 2005

Jaxyon posted:

Step 1: Keep a fascist in power
Step 2: ???
Step 3: Leftist agenda realized.

Step 2 is where folks seem to get hung up. While Trump certainly gets people upset, he also has largely unchecked political power and can actively make things worse in many areas, which he has. There's basically no world in which a continued Trump presidency makes a leftist agenda easier to implement. The whole thing hinges on the mushy part in the middle about how he'll somehow make people angry and the Revolution comes, which never gets any more detail than that.

While there's certainly room for disagreement, there are several easily understandable rationales for this. The biggest and most obvious are:
- Historically there's a much higher chances of parties switching after 2 term presidents, particularly if the economy is bad (which it definitely will be in 2024), and there's also an extremely low chance of somehow switching Democratic candidates after 4 years of Biden; either Biden (or more likely Harris) will be the nominee, or Trump will win. So Trump serving another term means that there will at least be an opportunity to elect a decent president in 2024, while there's an almost zero chance of it being possible if Biden is elected.
- The incumbent tends to result in downballot losses during midterms. This happened heavily under Obama, and there's no reason to think it won't be at least as bad under Biden. So there's good reason to believe that it's likely that electing Biden will result in a worse Congress from 2022 onward

These two things certainly aren't any sort of proof that electing Biden would be worse for the left, and there are pros and cons in both cases, but it's definitely plausible that electing Biden could end up worse overall.

I personally don't think there's an opportunity for the left in either of these situations. Both end in power being consolidated against the left.

# ¿ Aug 18, 2020 01:13

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# ¿ May 9, 2024 21:54

Ytlaya: Nov 13, 2005

KOTEX GOD OF BLOOD posted:

as far as i know, the american left's refusal to embrace basic patriotism - like, just mentioning the word "america" in a positive context - is unique among electoral movements. it's also self defeating. turns out, voters like to hear about america and how it can be great. despite losing constantly for decades this left is too petty to try winning by articulating a complete vision for the country. instead it's ceded basic tools of electoral politics to conservative capitalists. what other country in the world is there where a display of the flag in any way, at least in urban and semi urban areas, is presumptively a conservative statement?

Yes, clearly the reason the left isn't in power is because they did not mention America enough.

This is basically the political version of someone saying "maybe the reason you're poor is that you didn't dress correctly" or something, except even worse because it's describing large-scale political movements where choice of rhetoric is around #467 on the list of "things that matter."

# ¿ Aug 30, 2020 22:41

Ytlaya: Nov 13, 2005

KingNastidon posted:

It really has nothing to do with profit motives of insurance companies. Right now insurance companies may need to bring in $1.03 in revenue per $1.00 in expenditures to show profit or give dividend to stockholders or whatever. If they were non profit then the only thing that changes is they only need to bring in $1.00 in revenue.

So let's say we turn them into non profits and their baseline revenue is $1.00. You implement an cap on health expenditures for individuals at a certain income level. This causes revenue to drop to $0.90. You need to collect the incremental $0.10 somewhere else to break even. This will be captured via increasing premiums by ~11% on the pool of patients not subject to the cap. You can't selectively tax higher income individuals higher because the cost of employer provided insurance is not linked to the income of any given employee.

The root problem with US healthcare expenditures is our supply slide costs exceed other countries. Some portion of this is due to for profit insurance but larger portion due to hospitals and HCPs that work for them, unaffiliated support staff (e.g., paid caregivers), and other providers (e.g., pharma, med device, diagnostic/testing companies). The cost savings associated with single payer aren't realized simply through eliminating for profit insurance, but rather job cuts, lower salaries, and rationing on the other three sectors.

Any serious single payer advocate needs to full-throatedly acknowledge that reality and potential trade-offs because otherwise their opponents will. They also need to tell people what they'll actually pay rather than rely on some sort of moral argument or principle. People are very much aware of how much they pay for their family's healthcare each year because everyone deals with benefit changes around this time of year. One of the many reasons democrats do not talk about this is because their voter base are college educated urbanites. What are the demographics of anyone that touches healthcare provider system? Where in the country are these companies typically located?

Now that Bernie is out of the picture, the left has yet another 4 years to construct concrete plans and refine messaging rather than talk to an abstract framework.

This not how politics should work, though. The most important thing to talk about politically is "what result you want." The important specifics aren't the specifics of implementation, but the specifics of outcome. In the case of healthcare, it would be things like "needs to be free at point of service" and "covers everyone." For a country like the US with no practical limit to resources/wealth, such a goal can be made to work (and the details of how to make it as cost effective as possible and how to offset its costs are something for others to work out).

Your position is like if people were arguing for ending a war and you demanded that anti-war people provide a detailed plan for disengagement. That isn't important for the purposes of supporting/opposing the goal, and anyone who spends 99% of their time emphasizing the complexities/difficulties of disengagement (and literally never expresses direct support for ending the war unless it's accompanying doubts/concerns about doing so) is likely not on your side.

# ¿ Oct 21, 2020 02:51

Ytlaya: Nov 13, 2005

When it comes to all this talk about "innovation," I think it's necessary to actually translate that to lives saved (or other direct benefits to people). For example, there's a certain percentage (though I'm not sure how high that percentage is) of R&D that doesn't actually translate to anything meaningful for patients and is just intended to replace medications that might have patents ending soon.

At this point, benefits from medical "innovation" are likely experiencing significant diminishing returns relative to decades past, and the biggest actual determining factor in health outcomes is going to be simple access to care and resources available to provide care.

I'm pretty sure that the difference in the actual impacts of "innovation" would be pretty small under a single-payer or NHS-like system (and might even be better if you increased funding to the NIH/NIDA/etc at the same time, since a lot of very important research is forced to be stingy with resources currently), and would unquestionably be dramatically eclipsed by the benefits to simply making healthcare easily accessible to everyone.

# ¿ Oct 27, 2020 01:08

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