Universal / National Health Care Insurance

Discussion in 'The Red Room' started by Chaos Descending, Jul 16, 2021.

  1. Order2Chaos

    Order2Chaos Ultimate... Immortal Administrator

    Joined:
    Apr 2, 2004
    Messages:
    23,071
    Location:
    here there be dragons
    Ratings:
    +15,819
    Because we also have the highest levels of consumption, of pretty much everything, including a lot of health-damaging things. And it's insurance companies that are required to cover preventive care, not doctors.

    There could be better incentive alignment. For-profit insurance company profits are capped, so the more they spend on care per unit time, the more they can charge and profit (though realistically, profit is very much the smaller part compared to even the rest of the non-medical expenses, averaging 2-4%, out of the 15% non-medical expenses allowed), but that doesn't explain the 60% of large insurers who are non-profits nor why Medicare and especially Medicaid will do so little in the way of encouraging preventive care. Medicaid has exactly the incentives a national program would have, and yet it does next to nothing to encourage its use early for preventive care.
  2. Tererun

    Tererun Troll princess and Magical Girl

    Joined:
    Jul 5, 2014
    Messages:
    28,061
    Location:
    Beyond the Silver Rainbow
    Ratings:
    +17,696
    I remember I think it was 5th grade when the teacher though she would be cute and blow our minds by introducing negative numbers for a question with negative numbers that we had not learned yet. Of course I was picked because the teacher wanted to show me I should pay attention more. She was not happy when I easily gave the right answer and started giving me harder algebra questions which I could logically solve until she quickly got to something I could not do.

    This is what you get when your teachers are in that career because they want their summers off, there is little to no actual requirement to perform, and they have great state paid benefits and maintain seniority through tenure. Teaching is a fucking joke profession, that does not mean that all teachers are a joke as many do a good job due to personal discipline rather than management (AKA administration because the overpaid dipshits need special words for their normal position) .

    When a person like Dayton Kitchens can even be a substitute or coach on your school you have a massive problem with qualified people. I have to say hearing teachers bitch knowing what a teacher does, often does not sit well with me. I can get class size needs to be smaller, or you need more assistants who know what they are doing with a larger class. I am on board with that. But teachers could be working all year round and students should be learning all year round. There is no reason for summers off anymore. That should not be a thing.
  3. spot261

    spot261 I don't want the game to end

    Joined:
    Sep 27, 2018
    Messages:
    9,970
    Ratings:
    +14,185
    OK, but you're making a circular point here, at least with the first paragraph.

    Why are you such large consumers of unhealthy products?

    I'd submit the suggestion that even if insurers are, in fact, required to engage in preventative measures those measures are still paltry next to those practised by a nation wide provider whose client base is literally the entire population.

    Moreso that provider has a degree of access to schools, local authorities, public service broadcasting which is in stark contrast to the pervasive private advertising of fast food seen in the US.

    Walking around the US, watching TV there, the sheer overwhelming volume of messages and sensory input imploring you to eat this burger, that candy, drink this soda, take that medication to fix the problems caused is, to an outsider, astonishing.

    Nothing your insurer can do can compete with that.
    • Agree Agree x 1
  4. Torpedo Vegas

    Torpedo Vegas Fresh Meat

    Joined:
    May 28, 2020
    Messages:
    1,559
    Ratings:
    +3,499
    If you want to brag, just brag. You don't have to add all that teachers should work summers shit.
  5. Uncle Albert

    Uncle Albert Beep/Bop/Boop

    Joined:
    Mar 29, 2004
    Messages:
    53,812
    Location:
    'twixt my nethers
    Ratings:
    +22,527
    After a certain point, you must either let free will run its course or forcibly override it.
  6. Tererun

    Tererun Troll princess and Magical Girl

    Joined:
    Jul 5, 2014
    Messages:
    28,061
    Location:
    Beyond the Silver Rainbow
    Ratings:
    +17,696
    No, they should work summers., Why the fuck do they need summers off? It is fucking lazy and a load of shit that teachers get off in the summer. It is not even good for the kids because they tend to lose some of that knowledge over the way too long break. We could fit in more education if we just had them go all year.
    • Disagree Disagree x 1
  7. spot261

    spot261 I don't want the game to end

    Joined:
    Sep 27, 2018
    Messages:
    9,970
    Ratings:
    +14,185
    There are less extreme options.

    I know this to be true because they exist in reality.
  8. Order2Chaos

    Order2Chaos Ultimate... Immortal Administrator

    Joined:
    Apr 2, 2004
    Messages:
    23,071
    Location:
    here there be dragons
    Ratings:
    +15,819
    The government can do that already. They don't. It's not like they don't have incentive to currently, what with 34%, over 100 million people (40 million more than your entire population), being covered by the government. No reason to think that would change just because they're covering 100% instead. They're sure as hell not going to do anything about the ubiquity of advertising.
    • popcorn popcorn x 1
  9. spot261

    spot261 I don't want the game to end

    Joined:
    Sep 27, 2018
    Messages:
    9,970
    Ratings:
    +14,185
    No they aren't, but nationalising changes the playing field. That jump from shouldering 34% (or whatever figure) to 100% has, in every comparable instance, led to a concurrent shouldering of the much more manageable burden of education.

    That makes sense when you consider the equation changes from "how far does our budget stretch as a safety net" to "this budget has to potentially cover every single medical intervention conducted on outr soil, period".

    That's a much greater onus and a much greater incentive to reduce the requirements stemming from preventable diseases, diseases which were previously covered mostly by for profit providers.

    The outcome is a real reason to counter balance that advertising with genuine health education.
  10. Order2Chaos

    Order2Chaos Ultimate... Immortal Administrator

    Joined:
    Apr 2, 2004
    Messages:
    23,071
    Location:
    here there be dragons
    Ratings:
    +15,819
    Evidence? And why don't universal-but-not-single-payer systems have the same lack of education problems leading to lower life expectancies? Or do they (please adjust for Actual Individual Consumption@PPP first) and you've found a correlation that the RCA link I posted earlier and its sources missed?

    The NHS cuts and rationing 1980-2005 look an awful lot like optimizing for "how far does our budget stretch as a safety net".

    Time out. I need you to define your terms here: "previously covered mostly by for profit providers". Do you mean "for-profit insurers" or actually for-profit providers (in the US that almost always means hospitals, clinics, and doctors & nurses)? It sounds like you're either suggesting that the US nationalize health care in addition to insurance, or that most insurance plans are for-profit. The former is a non-starter - I don't think you could find a dozen elected officials anywhere in the country who are in favor of that, and probably not more than 1 in Congress, if that. The latter just isn't true; most private health insurance plans are not-for-profit; even more in total once you add in the government plans.
    • popcorn popcorn x 1
  11. matthunter

    matthunter Ice Bear

    Joined:
    Apr 26, 2004
    Messages:
    21,183
    Location:
    Bottom of the bearstack, top of the world
    Ratings:
    +31,772
    Cuts prior to 1997 were the Tories trying to kill the NHS because they are ideologically opposed to it. Those 1997 on were because Blair thought you could outsource stuff (cleaning, admin) to private industries. In other words - both capitalism, nothing to do with "how far can we stretch". The NHS budget has always been an afterthought compared to defence or paying for government boondoggles.

    See recently, when they refused to increase NHS pay by 1% because "there's no cash", even though they wasted millions on their pals flogging cheap and ineffective PPE or track/trace apps (which they had the balls to slap the NHS logo on despite it being nothing to do with them).

    After public outrage, they've now "found" enough for a 3% pay rise. Still not nearly enough, but at least it shows these fuckers have a fight on their hands before they turn OUR healthcare system into YOURS.
    • Thank You! Thank You! x 1
    • Winner Winner x 1
  12. RickDeckard

    RickDeckard Socialist

    Joined:
    May 28, 2004
    Messages:
    36,237
    Location:
    Ireland
    Ratings:
    +28,880
    They say they 3% will come from existing budgets, which presumably plies service cuts. But yeah, they have plenty of cash when it comes to private sector white elephants.
    • Agree Agree x 1
  13. spot261

    spot261 I don't want the game to end

    Joined:
    Sep 27, 2018
    Messages:
    9,970
    Ratings:
    +14,185
    NHS cuts have been more often ideological rather than practical, as previously mentioned. There's been no secret about successive tory governments running a health policy with an eye to progressively undermining the NHS, yet it remains effective despite decades of stagnating wages, attempts at back door privatisation and austerity measures. There are other factors at play here, ones I'm sure would be familiar to an American used to the guerilla politics practised on both sides of the Atlantic.

    So yes I am advocating for a move towards nationalisating care and if that requires partial measures such as nationalising insurance to ease the ideological shock so be it.

    In either case the likely end result is absolutely a shifting of budgetary priorities where the provider answers to the electorate rather than the market.

    Your objection is that this is politically unfeasible. I accept that, but in no sense does that alter the point that there would in any scenario be a net move towards prioritisation of health education and clinical necessity should it come to pass. Maybe not the sweeping paradigm shift that a binary change would represent, but we'll into the ballpark which would be worthwhile even before the impact on societal inequalities were considered.

    That shift towards education isn't without significance in it's potential effects. There's a strong connection (with a good case for claiming causality) between educational standards and health choices:

    https://www.google.com/url?sa=t&sou...Vaw3ExsPKdstroA6HGcETu_dR&cshid=1627219749961

    With the impact of health specific education being volume dependent:

    https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1746-1561.1985.tb05656.x

    particularly where measures focused on reported behavioural shifts as compared to knowledge base.

    In other words giving public health programs a foothold in schools and other public platforms is a demonstratably effective pathway to improving health related behaviours using a pre existing infrastructure. Can a private insurer (or smaller not for profit) reliably and consistently replicate that pervasiveness?

    The data supporting the advantages of health education are far more widespread and established than I've presented here from a quick Google and apologies for the formatting limitations of caveman me using a smart phone but the point stands. Health education is a credible and proven method of offsetting later interventions.
    • Agree Agree x 1
  14. spot261

    spot261 I don't want the game to end

    Joined:
    Sep 27, 2018
    Messages:
    9,970
    Ratings:
    +14,185
    Still, it'll pay for my 40k addiction:)
  15. mburtonk

    mburtonk mburtonkulous

    Joined:
    Dec 6, 2004
    Messages:
    9,909
    Location:
    Minnesnowta
    Ratings:
    +6,607
    He used to be more fun, and his ex-wife was always super nice.
  16. mburtonk

    mburtonk mburtonkulous

    Joined:
    Dec 6, 2004
    Messages:
    9,909
    Location:
    Minnesnowta
    Ratings:
    +6,607
    Nice work, Anc. You got caps, bold, and italics!
    • Funny Funny x 2
    • Thank You! Thank You! x 1
  17. steve2^4

    steve2^4 Aged Meat

    Joined:
    Nov 11, 2004
    Messages:
    13,601
    Location:
    Dead and Loving It
    Ratings:
    +10,769
    "is"
    • Agree Agree x 1
    • Love Love x 1
  18. mburtonk

    mburtonk mburtonkulous

    Joined:
    Dec 6, 2004
    Messages:
    9,909
    Location:
    Minnesnowta
    Ratings:
    +6,607
    They "get summers off" because taxpayers are cheap and nobody will work 12 months for a nine-month salary.
    • popcorn popcorn x 1
  19. spot261

    spot261 I don't want the game to end

    Joined:
    Sep 27, 2018
    Messages:
    9,970
    Ratings:
    +14,185
    Taxpayers are cheap you say.

    How many would I get for ten pounds?
    • Funny Funny x 1
  20. mburtonk

    mburtonk mburtonkulous

    Joined:
    Dec 6, 2004
    Messages:
    9,909
    Location:
    Minnesnowta
    Ratings:
    +6,607
    I have a hard time with past/present and "ex-" terms.
  21. steve2^4

    steve2^4 Aged Meat

    Joined:
    Nov 11, 2004
    Messages:
    13,601
    Location:
    Dead and Loving It
    Ratings:
    +10,769
    yeah but this is simple, she still posts and is still nice.
    • teh baba teh baba x 1
  22. mburtonk

    mburtonk mburtonkulous

    Joined:
    Dec 6, 2004
    Messages:
    9,909
    Location:
    Minnesnowta
    Ratings:
    +6,607
    10 pounds is a little more than 5% of the average American taxpayer.
    • Thank You! Thank You! x 1
    • popcorn popcorn x 1
  23. spot261

    spot261 I don't want the game to end

    Joined:
    Sep 27, 2018
    Messages:
    9,970
    Ratings:
    +14,185
    Oh, OK.

    Do they come in partial portions?
  24. 14thDoctor

    14thDoctor You know what time it is

    Joined:
    Mar 25, 2007
    Messages:
    26,827
    Ratings:
    +34,953
    I find a big thing right now is when your doctor prescribes pills for your hypertension, they'll tell you exactly where to get your prescription filled, exactly when to take the pills, and any other instructions you might need. You know exactly what to do.

    But if they tell you to make lifestyle changes, you just get "exercise more and lose some weight. Good luck figuring out what that looks like for you."

    A friend of mine is a personal trainer with the lowest level of personal training education that most of the trainer's at big chain gyms have, but she's also a nerd with OCD, so when a new client shows up with injuries or pains that limit their abilities, she figures out exactly what exercises will help. You don't wanna come in today because your back hurts? Too bad, now you're coming in and specifically doing exercises that will make your back feel better. No more excuses.

    That productive sort of personal fitness training should be something doctors can prescribe to patients, instead of just vague platitudes about getting in shape.

    Same with diet. People don't know how to eat healthy? Send them to cooking classes. Prescribe meal subscription packages. Hold their hands until they can do it themselves.
    • Winner Winner x 1
  25. Tererun

    Tererun Troll princess and Magical Girl

    Joined:
    Jul 5, 2014
    Messages:
    28,061
    Location:
    Beyond the Silver Rainbow
    Ratings:
    +17,696
    Imagine if they had to go in the real world and get results. Teaching is one of those professions like police officers. There is a lot of bad apples in that bin.

    In the real world training is often something employees end up doing. When you have a teacher hired by a company to train employees they are often observed and critiqued on levels a grade school teacher cannot accomplish. I have had teaching lumped into my job description in the real world, and no one gave me the summer off. At the time I was not making big bucks either. I also did not have things like tenure to protect my ass if I could not perform. Maybe things are different outside the US, but teachers teach in the US often because real work is very hard, and things do not stop in the summer so you can go on vacation and relax.
    • TL;DR TL;DR x 1
  26. Lanzman

    Lanzman Vast, Cool and Unsympathetic Formerly Important

    Joined:
    Mar 27, 2004
    Messages:
    33,820
    Location:
    Someplace high and cold
    Ratings:
    +34,302
    Most teachers are not "on vacation" in the summer. Most of them are working temp jobs, attending mandatory training of one sort or another, pursuing their own education, stuff like that.
    That said, there are a lot of bad apples in that bin, at least partly because of the strength of the Teachers' Union.
    • Agree Agree x 2
  27. Tererun

    Tererun Troll princess and Magical Girl

    Joined:
    Jul 5, 2014
    Messages:
    28,061
    Location:
    Beyond the Silver Rainbow
    Ratings:
    +17,696
    I had a doctor who diagnosed me pre-diabetic way back. He did give me some instructions on exactly what to do. It was like having a bomb dropped on my pleasant little life. He is only seeing me once a month. It seemed like everything was just gone, and I knew how to cook pretty fucking good. Lots of pain helped inspire me to learn shit, but shit could have been presented in a way that would have helped me understand much better than that. Still, at an appointment a month where we were really discussing my reaction to hormones none of that was going to get through. This doctor was primarily a weight loss specialist.
    • TL;DR TL;DR x 1
  28. Jenee

    Jenee Ind. Jenee of Winterfell

    Joined:
    Jan 20, 2008
    Messages:
    19,791
    Location:
    Touring the Galaxy
    Ratings:
    +11,764
    OMFG Unions!!!11!!

    Tell us more about how individuals should petition for better employment contracts ....
    • Agree Agree x 3
    • Facepalm Facepalm x 1
  29. mburtonk

    mburtonk mburtonkulous

    Joined:
    Dec 6, 2004
    Messages:
    9,909
    Location:
    Minnesnowta
    Ratings:
    +6,607
    Our workplace insurance has cash incentives to do coursework and activity challenges. So there is a little bit of movement on getting the right information to people. Not from doctors, unfortunately.
    • Agree Agree x 1
  30. 14thDoctor

    14thDoctor You know what time it is

    Joined:
    Mar 25, 2007
    Messages:
    26,827
    Ratings:
    +34,953
    I've going to the gym half-assedly for years, until my friend asked exactly what hurts. She looked into it, advised me to start using the heavy rowing machine, two weeks later most of my chronic pain is gone and I can walk around all day without my lower back aching. From just one exercise I can in a few minutes at a time. It's ridiculous that people like that aren't part of the health care system.
    Last edited: Jul 26, 2021
    • Agree Agree x 3
    • Love Love x 1