While I agree with you in spirit, the health policy arena is considerably more complex and there are more evil players than simply the insurers. It is a misery-inducing ecosystem that includes government, pharma, device manufacturers, hospitals, universities, journals, the AMA and insurers.
If you saw the Jar-Jar is Supreme Leader thread, it’s like that.
I think we’re mostly on the same page, but did you watch the entire video?
I don’t think the corrupt insurance industry is alone in this. If you watch the entire interview with the whistelblower I posted above, he goes into other complicit entities involved such as government, etc. – I would never say nor imply that the insurance industry stands alone in guilt here.
That said, the insurance industry is vastly responsible for conditioning the American public as the former insurance exec explains in the interview. They are able to accomplish this with their massive windfalls in money (and power) they consume from the American public. Their power to manufacture consent (and fear) among the populace is a core problem that we’re contending with to this day.
The interview video goes into this in detail and shows examples of where the insurance industry manufactured and disseminated propaganda that’s repeated to this day. There’s actually news clips within the video showing politicians parroting the “talking points” word-for-word that were previously contained within secret insurance industry memos the whistleblower exposed.
Those propagated industry talking points are repeated like mantras among the American public to this day. These mantras based upon lies spread the fear, uncertainty and doubt that keep single payer at bay due to a poisoned public perception. We really shouldn’t underestimate how powerful that is.
They’re not real?
Define…“real”
Sorry, the only politics I incessantly discuss is my socialism but then I’ve been told here recently that I’m not a true socialist (nor is Bernie) in another thread.
This seems to suggest that you are working backwards from quite a few assumptions. This is what most people - even in a progressive forum like this - seem to get hung up upon. You start from how you do everything in your daily life now, and consider only those changes which leave it functioning more or less the same. This allows you to dismiss any deep, fundamental, structural changes as “not a real choice, because I’m not going to do it”. Starting from first principles shakes things up a bit, but can leave you with more control of your situation.
What should you eat? Can you grow it? Do you know anybody who does? What sort of shelter are you going to eat it in? What jobs need doing most? How will you negotiate your utilities? Who do you think is qualified to get them from? What are your surpluses and needs? What cultural capital do you produce these days?
There is not anything especially “intellectual” about it, it is merely basic social activity which most people seem to take for granted will be done by other people whom they don’t even know. If a person is going to get out of bed today, they presumably have some goals, personal, social, etc. If you are going to interact with other people, then you need some basis for negotiating what will be done, and by whom. Unlike wankery - a solo sport - this means that people need to interact with each other about what is actually significant. At least try to Instantiate the formal social structures needed for you, your friends, your neighbors, and your family first, before you settle for leaving it to some other sketchy randos to decide for you.
The amount of personal responsibility and close interactions required for non-imagined community seems to strongly polarize many people. Most of the responses I get are (for whatever reason) split between it sounding impossibly difficult, or magically easy.
I think that’s quite the opposite of what I am suggesting. Most people use hands-off social structures for which they have little or only symbolic input. Most people have dropped out already, since they don’t control the structure of their social interactions.
What I think people need to do is drop in, and create social structures to do what they need on a small scale amongst themselves. Instead of waiting for outsiders to do a poor job of it while disenfranchising everybody, as usual. Make it the social version of “thingiverse”, but instead of DIY plans for plastic crap, anybody can download sketches for new kinds of family units, improvised housing, school curricula, community agriculture, currencies, computer networks, business cooperatives, local governments, etc, etc, Try something actually fundamentally different to how you live now, instead of instantly resorting to complaining and begging for professional busibodies to fix it for you.
Well, yes, because I’m in my 40s, successful in my career, married, own a house, and have a kid in college. I’ve crafted, largely, a comfortable existence that supports my needs, those of my spouse, and what we want to do…
Hey now. I post stuff on that site!
Yes, I watched the whole thing about a month ago I think. Did you post it? I think you did, probably in a Bernie thread. I watch most of the videos you post because they tend to be interesting.
I think we mostly agree. At this point, it’s putting a finer point on it and describing it better. My career is in epidemiology, statistics and health research, with a hefty helping of health policy. No, I’m not going to totally claim the expert card on this, but I’ve had way more exposure to that world than most people, over the span of about the last 15 years.
Medicare reimbursement rates are calculated based on something called the RVU, which are relative value units that are agreed upon by a physicians’ group and the government. This means that a throat cancer is worth x while a triple bypass is worth y. Read the wiki entry, it’s pretty accurate:
For each service, a payment formula contains three RVUs, one for physician work, one for practice expense, and one for malpractice expense. On average, the proportion of costs for Medicare are 52%, 44% and 4%, respectively.[2] The three RVUs for a given service are each multiplied by a unique geographic practice cost index, referred to as the GPCI adjustment. The GPCI adjustment has been implemented to account for differences in wages and overhead costs across regions of the country.[1] The sum of the three geographically weighted RVU values is then multiplied by the Medicare conversion factor to obtain a final price.[1] Historically, a private group of 29 (mostly specialist) physicians—the American Medical Association’s Specialty Society Relative Value Scale Update Committee (RUC)—have largely determined Medicare’s RVU physician work values.[1]
A similar scheme is used in negotiating reimbursement rates between private payers and hospitals. It’s a massive, ongoing collusion between physicians, hospitals, the government and insurers to set the rates of reimbursement for services, devices, drugs and procedures. Imagine a big list of stuff that hospitals do: each of those thousands of line items is constantly being shifted around in negotiations with insurers so that the providers are extracting as much as they can, and insurers are competing to reimburse as little as possible while extracting the maximum they can from individual subscribers. It’s a huge price war, like what happens with all the stuff on the shelves in a grocery store: each thing’s price shifts around over time because everybody is competing for advantage.
I agree that insurers bear the lion’s share of the moral burden of this shit system that we have. No doubt about it. But they do also share that moral burden with these other groups. Drug companies set their own prices. Medical device manufacturers set their own prices. We have massive collusion for all the other prices for medical care. Physicians want to make more money. Hospitals want to make more money. Insurers want to make more money. Medicare wants to pay out less, to stay solvent. Nowhere in there is a single entity that represents the best interests of the consumers. Some people try to argue that this should be the government, but as we all know about how the ACA/Obamacare has played out, the states and republican-controlled Congress itself strongly resist that role of consumer protection advocate regarding health care.
If I had to boil it down, there is one word to describe why health care is so expensive in the USA: greed. All of these entities are competing to extract the most money from consumers who have no choice because they must get treatment. A close second would be “capitalism” since that’s the system that allows and supports this price warring. It could be a more socialist system with government paying for most things, but as long as there are greedy people who are allowed by law to get a bigger and bigger slice of the pie, costs will continue to increase and the system will remain chaotic.
Yes, it’s the insurance companies. But it really is all these other things too, simultaneously.
The only way to reprogram the system will be to legislate away the greed, as most other countries have done.
I’m sorry. I thought you wanted a summarization of P’s views. If you want an exegesis, you’ll have to go to the source.
The only exegesis I read is this:
Excellent choice!
I think capitalism is the big one, but not exactly for the reason you are saying. Insurance works on percentages. They’d rather sell me a policy on my $1M home than on my $500k home. Sure, if it burns down they have to pay out more, but they already hedge properly and know that on the whole they are going to come out ahead. Just like a casino wants their customers to place bigger bets, insurance companies want us to insure more expensive things.
The idea of a private system of insurance for something like health is that all the price warring will drive prices down. But like many things in capitalism, it doesn’t work the way it should. Insurance companies want to pay less for any given thing at any given time, but in the long run they want everything to cost more, just like they want to insure bigger houses. I’m not even sure if they want that, in the sense of executives sitting around saying “wow, wouldn’t it be nice if heart surgery cost twice as much”, but the insurance companies will be richer ten years from now if the cost of that surgery goes up 10% a year than if it stays the same.
Looking at the cost of a variety of procedures in Canada vs. the US you see this playing out. Some procedures are 5 to 10 times as expensive and I think they are almost universally twice as expensive.
Capitalism is supposed to keep prices down, but really accumulates money on top of money.
It can do this exponential accumulation when there is no force limiting demand. You don’t ever hear of people saying they do not want surgery or drugs to treat an illness. Since consumers must consume medical services, it is an unnatural marketplace, which really makes it unsuitable for existing in a capitalist system. Thus, greed is the main driver. Capitalism, as we are discussing it here, is just the enabler. Take away greed, problem solved. Take away capitalism, problem not necessarily solved. The greed is what has to be addressed.
IMPOSSIBLE! The market is rational, otherwise the economics theory makes no sense!
I know you’re being funny, but the market is behaving exactly as it should. When demand is unrestricted, these are the results. That’s why I said healthcare is an unnatural fit for a capitalist marketplace. But that the capitalist system is not really what’s at fault… it’s the human tendency towards greed driving the bus. It could be socialism or fascism or even communism, but if the greed is still allowed to play out on any level, we’ll get the same result.
We eventually will come to the realization that the greed in health care delivery has to be surgically removed and thrown in the garbage bin.
I tend to agree, but my comment wasn’t meant only as joke: Most of the economic theories are excluding the human factor, as if characteristics like greed or generosity are irrelevant for the models. It does not make sense, the market consists of human beings with human traits. imo economics is mostly a pseudoscience.
Economics in the absence of psychology is pseudoscience, yes. WITH psychology, it’s legit.
I don’t really understand this. Capitalism is the system that attempts to harness greed to produce wanted outcomes (doesn’t work, but the capitalists will freely admit this is the idea). The Market works based on everyone being greedy. It assumes greed. If greed is the problem then capitalism is the problem. Whereas a publicly owned single-payer system is a system that doesn’t interact much with greed, so it is a good system for this purpose.
That shit goes in a biohazard container.
