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  1. #81
    I suppose I could hold my nose and vote for Bernie in the general, but I don’t think I could ever canvass, organize, or donate to him like I would for just about any other candidate.

    I also think he will lose the general to Trump.

    Sadly, I think the split between his primary opponents vs his hardcore rabid supporters will likely get him the nomination.
    Help control the population. Have your blood elf spayed or neutered.

  2. #82
    Quote Originally Posted by Connal View Post
    The Paradox of the Democratic “Stop Bernie” Campaign
    https://slate.com/news-and-politics/...aign-2020.html

    Bernie Sanders can’t beat Donald Trump in 2020: Obama campaign manager Jim Messina
    Jim Messina added that Sanders is a likely finalist in the Democratic primaries.
    https://abcnews.go.com/Politics/bern...ry?id=62455986
    Obama's centrist policies is what got us Trump, they are just terrified of a progressive because that would force the party to take a stand against President Bernie and expose their corporate shilling. At the moment they have Trump and the GOP to give them cover when they ram through things like this with a progressive president harder to get away with that.

  3. #83
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    Quote Originally Posted by BrerBear View Post
    I also think he will lose the general to Trump.
    I wouldn't necessarily write Sanders off.

    The reason I say this is his recent appearance on Fox. Ignore the context for a moment and process what it means when we say "one of the leading candidates for the Democratic party presidential nomination appeared on FOX and was well received by the audience" - that in itself is unusual. When you add in that said candidate is viscerally center left in a way no Democrat candidate has been since Carter...

    Ignoring Bernie's policies, from a PR standpoint he has a number of things going for him in a way a lot of other Democrats don't - probably the biggest is that in no way can it be claimed he is a pawn of the Clinton/Soros/MSM conspiracy by virtue of how things proceeded back in 2016 during the Democrat primaries. He's also an old white man, but still popular with a lot of young people. That might draw enough of the people who swung or stayed home in 2016.

    Of course, Bernie's track record with minority demographics might end up negating that draw unless he either manages to increase his popularity or picks a VP candidate like Stacy Abrams.
    "Buttigieg is a finger trap for every heterosexual where all they have to do is critique his bad policies without making some terrible comment about his sexuality and they keep coming back running with their fingers trapped inside." - Anthony Oliveira

  4. #84
    Quote Originally Posted by Connal View Post
    He can use that against Trump: "Is it crazy to think that corporations ought to pay their fair share of tax?" "Is it crazy to think that people should not go bankrupt if they get sick?"..."if so call me crazy!"

    Etc... own the name, and don't let it have power over you. Trump is a bully, fight back with what you will change, or do for the people, instead of calling his supporters deplorable, etc...
    As he should in my opinion. Bernie was too soft when he debated Hillary. Politics sadly is a cut throat enterprise. But on the other hand, Hillary's one big mistake was calling half of the Trump supporters deplorable. I knew the instant I heard her say that, it was a 43% comment by Romney all over again.
    The constitutions of most of our States assert that all power is inherent in the people; that… it is their right and duty to be at all times armed.” - Thomas Jefferson.

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  5. #85
    Merely a Setback Connal's Avatar
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    Quote Originally Posted by Ghostpanther View Post
    As he should in my opinion. Bernie was too soft when he debated Hillary. Politics sadly is a cut throat enterprise. But on the other hand, Hillary's one big mistake was calling half of the Trump supporters deplorable. I knew the instant I heard her say that, it was a 43% comment by Romney all over again.
    Agreed, instead of attacking Trump's character, or his supporters, focus on policy, how you will fix the economy, help people get affordable health care, help retirees not have to worry about going homeless, etc, etc...

    I do not know what Bernie will do, but if I were his advisor that is what I would suggest. Give hope to the middle class, and the working poor, the people that are out of the job because their factories closed and moved overseas, the meat and potatoes that matter.

    Not who has sex with who, or the oppression olympics that a growing minority now thinks is the most important thing in the country. Or Russian conspiracy theories that went nowhere.
    Vocatus atque non vocatus, deus aderit.

  6. #86
    Quote Originally Posted by Butter Emails View Post
    Medicare for all is pie in the sky delusions, it's not something we can currently fit in the national budget
    Nonsense.

    1) The rest of the developed world has achieved universal healthcare in some form. Every one of these countries achieves similar or better outcomes than we do while spending far less. The USA lacking universal care is not a matter of being unable to afford it, but a matter of political will and the power of interest groups/lobbies.

    2) All of the funding needed is already in the healthcare system: we spend about 18% of GDP on healthcare, which is far more than any other country. Single-payer wouldn’t require more than this- under a Sanders-style plan, money now paid to private insurance companies, along with most deductible and out-of-pocket payments would be transitioned to taxes. So while government spending would go up, total healthcare expenditures (which is what really matters) wouldn’t.

    3) In fact, every indication is that doing so would reduce total healthcare spending. A single-payer monopsony would maximize bargaining power, giving the government leverage to keep down the costs of healthcare products and services. Getting rid of profiteering middlemen would reduce overhead, as well as some of the rent seeking of companies taking advantage of a market failure. Honestly, how can we afford to not undergo major systemic changes in how we handle healthcare? Getting that 18% number down to what other developed countries spend could free up hundreds of billions of dollars for more productive uses.

    You can prefer a different kind of healthcare system. You can argue against a single-payer model. Or if you like single-payer as a goal, there are reasonable discussions to be had about the most fair or effective mechanisms for converting insurance premiums into taxes, or whether to manage payments through Medicare or through private non-profits, or whether or what the transitional steps should be, or whether or not it’s politically feasible/achievable, but the idea that we can’t afford it is a nonsense talking point that needs to die.
    Last edited by Gestopft; 2019-04-18 at 02:24 AM.
    "As democracy is perfected, the office represents, more and more closely, the inner soul of the people. We move toward a lofty ideal. On some great and glorious day the plain folks of the land will reach their heart's desire at last, and the White House will be adorned by a downright moron."
    -H.L. Mencken, 1920

  7. #87
    Quote Originally Posted by Gestopft View Post
    Nonsense.

    1) The rest of the developed world has achieved universal healthcare in some form. Every one of these countries achieves similar or better outcomes than we do while spending far less. The USA lacking universal care is not a matter of being unable to afford it, but a matter of political will and the power of interest groups/lobbies.

    2) All of the funding needed is already in the healthcare system: we spend about 18% of GDP on healthcare, which is far more than any other country. Single-payer wouldn’t require more than this- under a Sanders-style plan, money now paid to private insurance companies, along with most deductible and out-of-pocket payments would be transitioned to taxes. So while government spending would go up, total healthcare expenditures (which is what really matters) wouldn’t.

    3) In fact, every indication is that doing so would reduce total healthcare spending. A single-payer monopsony would maximize bargaining power, giving the government leverage to keep down the costs of healthcare products and services. Getting rid of profiteering middlemen would reduce overhead, as well as some of the rent seeking of companies taking advantage of a market failure. Honestly, how can we afford to not undergo major systemic changes in how we handle healthcare? Getting that 18% number down to what other developed countries spend could free up hundreds of billions of dollars for more productive uses.

    You can prefer a different kind of healthcare system. You can argue against a single-payer model. Or if you like single-payer as a goal, there are reasonable discussions to be had about the most fair or effective mechanisms for converting insurance premiums into taxes, or whether to manage payments through Medicare or through private non-profits, or whether or what the transitional steps should be, or whether or not it’s politically feasible/achievable, but the idea that we can’t afford it is a nonsense talking point that needs to die.
    The problem with medicare for all is that it is not universal healthcare. It is a continuation of the same problems that have made healthcare such a mess in the US in the first place. It wouldn't cover all of your costs and for most people it would be forcing higher taxes for little to no gain. How do you convince people they should spend five or ten percent more of their total income to "fix" healthcare in the US when the level of care they receive will be basically the same? That is the issue. Most people who agree that there is a problem with healthcare costs in the US won't even benefit overall from medicare for all. Unless they could legitimately find a way to get the 1 percent to pay more instead of just leave the country and take their money with them and not raise costs for the middle and working class that is. And in my opinion medicare for all is just chosen because medicare is such a popular name to "brand" the idea with that it will get more support politically. It is very dishonest and caclulated.

    A lot of this topic also misses the problem with healthcare in the US. It is not because of profit. Profit is necessary to fuel an industry. Who is going to go to school for several years and spend a ton of money to work a stressful job for only a bit over 100k a year? Not many americans are willing to do that which is why we have to hire so many foreigners to come here and be doctors since they can go to school for much cheaper in their country. Their profits are already kept down due to certain government manipulations to the extent that most only want to be specialists in certain high earning fields. Trying to eliminate profits only makes things like that worse.

    The only real issue single payer type systems could help with are administrative costs. And that is a big issue for sure. Single payer absolutely would reduce that element of healthcare costs in the US. However that is only one factor. There are several other factors like how the trend in the US is that we see more specialists than pretty much anywhere else. We generally have better care when we want it. The economy and costs associated with becoming a doctor are higher so it creates an imbalance in incentive for getting into the industry....Then you have other issues that can and should be solved without need for massive overhaul like regulating drug prices which currently isn't allowed in a lot of ways in the US as well as corrupt government financing of certain brands that allow them to make a ton of profit thanks to government contracts that make it so no cheap competitor is able to compete.

  8. #88
    Quote Originally Posted by CryotriX View Post
    Nice I love it when fake lefties that are into shilling for big corporations and/or playing identity politics agonize. Doesn't help that they are into Russia conspiracies and anti-Assange, also quite expansionist in nature. Despicable.
    My read, and I've been following the internal battles of attendant institutions of the Democratic Party, like the Center for American Progress, for a while is that the ideological disputes between the factions involved are largely incidental to the fundraising matters that are typically at the heart of these fights.

    One of the least publicly discussed functions of political parties and the patchwork of political organizations (think tanks, grassroots organizations, etc) that support them is that they, among other things, serve as patronage machines. In short, they turn ass-kissing into paychecks. Anyone who has worked at a large company or non-profit knows that one of the basic tenets of the internal politics of big, hierarchical organizations is that your salary depends on telling the boss - in this case, deep pocketed donors - what they want to hear. This creates incentives to promote the parochial interests of the boss above the health of the organization.

    And there are a lot of people in what is commonly called "The Establishment" of the party that operates along these lines: suck up to the donors and get the check. The extent to which this undermines the health of the organization is the extent to which "sucking up to the donors" undermines the democratic legitimacy of the organization.

    So to use the Center for American Progress (CAP) as an example, since its featured heaviliy in the article: CAP is a center-left think tank that was founded by John Podesta about 15 years ago to serve as a counterweight to organizations like AEI and the Heritage Foundation (i.e. right-wing think tanks). It exists to produce policy and issues analyses and develop media strategies - often through its "independent" blog ThinkProgress - to promote those analyses. For most of its history, when John Podesta ran it, the management of CAP took a hands-off approach to the projects its individual scholars and writers were working on. As long as you complied with its above-stated ideological mission you could do whatever kind of work you wanted.

    This changed in 2011, when Neera Tanden was promoted from Chief Operating Officer of CAP to its President, and by insider accounts ended Podesta's "hands off" approach and started prioritizing fundraising over the policy work. You'd have scholars like Matt Duss who were critical of dominant American foreign policy writing pieces critical of, for example, the Israeli occupation of the West Bank that got in the way of getting very wealthy pro-Israeli donors like Haim Saban to cut CAP checks every year. From 2011 on, people like Duss were pushed out. The most recent departure in this vein was Ken Gude, a foreign policy analyst who was fired late last year for criticizing CAP for taking money from the United Arab Emirates because of its role in Saudi's war in Yemen (a monetary arrangement that CAP has since cancelled) and who is now suing CAP for wrongful termination.

    The biggest name among those who left on less than amicable terms is probably Faiz Shakir, a fairly influential political adviser who worked with both Nancy Pelosi and Harry Reid, who went on to be an informal adviser to Sanders in 2016; a development that left Tanden and even Podesta a lot less than pleased, according to the emails between the two of them released in the "Podesta Leak." Shakir is now Sanders's campaign manager. Duss works for Sanders now, too, as his chief foreign policy adviser. I wouldn't be at all surprised if Gude joined the campaign as well.

    There's a publication put out every year by the Federal government, informally called "The Plum Book," that lists all of the ~7,000 positions in the government that require Presidential approval to fill. If Sanders wins the nomination and becomes President, a lot of people who have been shit on by apparatchiks like Tanden will fill those jobs and promote those who they like. According to some post-election investigative reporting by Axios, Tanden was on Clinton's shortlist, had she won, to become Secretary of Health and Human Services.

    And even before that, if Sanders wins the nomination, those in his camp will assume responsibilities at the upper echelons of the party instead of a lot of these donor-oriented careerists. That makes them nervous.

    Also Putin and Assange are trash independent of the fact that these people are also pretty trashy.

  9. #89
    Quote Originally Posted by dippinsawse View Post
    The problem with medicare for all is that it is not universal healthcare. It is a continuation of the same problems that have made healthcare such a mess in the US in the first place. It wouldn't cover all of your costs and for most people it would be forcing higher taxes for little to no gain.
    Have you not seen the Sanders bill? He put out a new one for 2019. It a) would expand Medicare to cover much more than it currently does, removing co-pays and deductibles (the only out-of pocket costs would be up to a limit for non-generic prescription drugs), and b) extends it to all residents of the USA.

    Quote Originally Posted by dippinsawse View Post
    A lot of this topic also misses the problem with healthcare in the US. It is not because of profit. Profit is necessary to fuel an industry.
    The problem, though, is that healthcare is a market failure. As a captive market with inelastic demand, it is very easy for rent-seekers to extract value from the system because the mechanisms that keep prices down in regular consumer markets don't work in healthcare. It's why every other developed nation uses much stricter price controls, and the ones that manage insurance privately require insurers to be non-profits. So yeah, profit is absolutely one of the biggest problems with costs. But doctors' salaries are only part of that.

    Quote Originally Posted by dippinsawse View Post
    Who is going to go to school for several years and spend a ton of money to work a stressful job for only a bit over 100k a year? Not many americans are willing to do that which is why we have to hire so many foreigners to come here and be doctors since they can go to school for much cheaper in their country.
    1) Actually, applications are up by 25%. We just don't have enough medical school slots or residencies available.
    2) Foreign doctors (except those from Canada) can't just come over and practice medicine. They need to have a US residency (except in Missouri I believe), and those residencies are tightly limited. US doctors are basically a legal cartel that gets to limit their competition- which is one of the reason they get paid more and that we generally have fewer doctors per capita than other developed nations.

    Quote Originally Posted by dippinsawse View Post
    There are several other factors like how the trend in the US is that we see more specialists than pretty much anywhere else.
    This is at least in part another consequence of the 'doctor cartel' dynamic. Most of our doctors are specialists, whereas in other countries most are general practitioners. Expanding the role of nurse practitioners and greatly increasing a) the medicare funding for residencies, and b) especially the number of GP residencies could help smooth this out.
    "As democracy is perfected, the office represents, more and more closely, the inner soul of the people. We move toward a lofty ideal. On some great and glorious day the plain folks of the land will reach their heart's desire at last, and the White House will be adorned by a downright moron."
    -H.L. Mencken, 1920

  10. #90
    I'm tired of boomers/silents running the show, but I can't imagine Trump winning against Sanders. Bernie would have won in 2016 and if it's those two for 2020 I don't think it will even be close. Not only will Sanders win by a larger margin than Clinton, but he'll handily take the EC too.

    The only voters Trump is going to get in 2020 is the die hard base that are willing to vote against their own self interests. Trump has made zero effort to win over any voters on the left. He's gone out of his way to attack them. He's done about as much to piss off and let down voters in the middle that decided to give him a shot instead of Clinton.

    Since Trump isn't getting anyone to the left and has only alienated people in the middle, who exactly would give him the win in 2020?

  11. #91
    Quote Originally Posted by Gestopft View Post
    1) Actually, applications are up by 25%. We just don't have enough medical school slots or residencies available.
    2) Foreign doctors (except those from Canada) can't just come over and practice medicine. They need to have a US residency (except in Missouri I believe), and those residencies are tightly limited. US doctors are basically a legal cartel that gets to limit their competition- which is one of the reason they get paid more and that we generally have fewer doctors per capita than other developed nations.
    Yeah. The per capita population of physicians in the US is 2.3 per 1000, which is in somewhere in the neighborhood of 50th in the world (we slightly beat out the UK, which also has chronic doctor shortages requiring foreign-born doctors). The disparity becomes more glaring when you account for the fact that the US has the largest per capita population of nurse practitioners in the world, and one that has been growing at a rate of about 10% every year. NPs do a lot of front line medicine and primary care, and are much more likely to serve Medicare and Medicaid patients than traditional primary care physicians.

  12. #92
    Quote Originally Posted by Gestopft View Post
    Have you not seen the Sanders bill? He put out a new one for 2019. It a) would expand Medicare to cover much more than it currently does, removing co-pays and deductibles (the only out-of pocket costs would be up to a limit for non-generic prescription drugs), and b) extends it to all residents of the USA.



    The problem, though, is that healthcare is a market failure. As a captive market with inelastic demand, it is very easy for rent-seekers to extract value from the system because the mechanisms that keep prices down in regular consumer markets don't work in healthcare. It's why every other developed nation uses much stricter price controls, and the ones that manage insurance privately require insurers to be non-profits. So yeah, profit is absolutely one of the biggest problems with costs. But doctors' salaries are only part of that.



    1) Actually, applications are up by 25%. We just don't have enough medical school slots or residencies available.
    2) Foreign doctors (except those from Canada) can't just come over and practice medicine. They need to have a US residency (except in Missouri I believe), and those residencies are tightly limited. US doctors are basically a legal cartel that gets to limit their competition- which is one of the reason they get paid more and that we generally have fewer doctors per capita than other developed nations.



    This is at least in part another consequence of the 'doctor cartel' dynamic. Most of our doctors are specialists, whereas in other countries most are general practitioners. Expanding the role of nurse practitioners and greatly increasing a) the medicare funding for residencies, and b) especially the number of GP residencies could help smooth this out.
    Yes but he isn't expanding medicare to cover other things it doesn't cover that would require more private healthcare and as you say that is still not single payer and still seems to directly avoid solving one of the problems with medicare which is that it can't negotiate drug prices. But I don't think that is a big issue one way or the other. It would reduce administrative costs that is true but it would also add on other socialized costs for the average person.

    Healthcare isn't a market failure. There is a reason a lot of medical investment occurs in the US and not say...Europe. The issue with our healthcare market is that it is not viable to try to get into the market and compete when the government has contracts with many of the top dogs in the industry. But to be fair the government has also partnered with some smaller companies because bigger brands refused to negotiate lower. That's just not the norm and in general either way it reduces competition and centralizes the market making it extremely successful for the "right" companies and difficult for everyone else.

    That is why it is not a profit issue but a government issue, they protect and enforce a lot of these monopolies without negotiating properly. It is still a private market but the government makes it so that competition isn't viable which makes it so that prices go up and can't be challenged naturally. And since it is still privatized the government lacks bargaining power to drive prices down. Basically it is a lose/lose situation. It takes the worst of both systems and combines them. We should either have a fully privatized system or completely remove the private market. If it was fully privatized, and to be clear I don't care what system we have as long as it works, profit still wouldn't be an issue because the market would have competition that would drive down prices to what people are willing to pay and what competitors are able to produce for.

    I didnt say demand for doctors or applications to become doctors were going down. Saying that applications increased in one year doesn't show a trend and either way it's irrelevant to my point. We DO have a lot of demand for doctors and we have relied heavily on foreign doctors coming in to fill that need. And I don't think you know how many foreign doctors are working in the US. There are a LOT. It isn't tightly restricted at all. There are about a million licensed doctors in the US and about 250k of them are foreign-trained. A quarter of your entire doctor work force being from another country is massive.

    I wouldn't call it a cartel at all and if it was one it's failing at its job.

    But my main point is that we need to more directly solve the problems we have and not just jump on whatever sounds nice. I think we do need to move more in one direction or another but the transition is the main problem. We're stuck in a situation where going either direction will hurt people. You either cause people to lose their healthcare or you increase costs for everyone while lying to them and saying it will get cheaper. I'm not opposed to single payer or medicare for all, I just think we need to be more honest and thorough in pointing out to people what the issue is instead of trying to convince them that there is some magical solution (that just so happens to give someone political power to promise).
    Last edited by dippinsawse; 2019-04-18 at 06:34 AM.

  13. #93
    All of the problems you listed above is because of a failure of previous action. This is standard in just about every business or sector that makes up a decent portion of the overall economy. If say this was sorted out in the 50s it would not be in the tragic state it is in now or perhaps like it was with more state by state funds to subsidize peoples medical costs prior to the 1980s. I almost never see an actual Dr but a nurse practioner whom i have a great relationship with, she used to get a large amount of my dads Plums / Apples / Strawberries that he grew every year as a bonus thank you after she refused a gift card. The entire movement to a single payer system will be a massive shock mostly due to the job losses in the insurance industry more so then any other element and that is my one and only fear. The actual hospital staff will be more then fine even with a slight shock but nothing compared to the countless insurance agents, claims adjusters among other large amount of staff. I am sure this would happen over time but i think you would see layoffs or dismissals in the low millions over a 4-7 year period.

  14. #94
    Quote Originally Posted by jeezusisacasual View Post
    All of the problems you listed above is because of a failure of previous action. This is standard in just about every business or sector that makes up a decent portion of the overall economy. If say this was sorted out in the 50s it would not be in the tragic state it is in now or perhaps like it was with more state by state funds to subsidize peoples medical costs prior to the 1980s. I almost never see an actual Dr but a nurse practioner whom i have a great relationship with, she used to get a large amount of my dads Plums / Apples / Strawberries that he grew every year as a bonus thank you after she refused a gift card. The entire movement to a single payer system will be a massive shock mostly due to the job losses in the insurance industry more so then any other element and that is my one and only fear. The actual hospital staff will be more then fine even with a slight shock but nothing compared to the countless insurance agents, claims adjusters among other large amount of staff. I am sure this would happen over time but i think you would see layoffs or dismissals in the low millions over a 4-7 year period.
    In a way, yes, but technically no. What put us in this position WAS previous action. If everything was left privatized costs would be much lower. Adjusted for economy/cost of living we would have the cheapest and best healthcare in the world. Unfortunately no one stopped the government from causing this problem in the first place. People used to have the money to afford whatever doctors they needed so that wasn't even a problem then either. But now people have become so reliant on the state and it keeps giving them more and more that they don't have much of a way out of that situation. People used to take care of their own families and now we shove them into scam programs just to keep them out of our hair using our own money to accomplish the same thing in a more wasteful and detached way.

    But that is neither here nor there...what do we do about it now? How do you go to the working and middle class and say, "Hey want cheaper healthcare?" They will go, "Oh fuck yes I'm paying so much and it's such a pain in the ass. Please fix it." Then you tell them, "Ohhh well actually illegal immigrants, unhealthy people, and people who don't work are going to heavily offset whatever single payer healthcare might have saved you, is that still cool?" They will say, "What the fuck, you told me this would be cheaper. I am struggling enough as it is without having to give charity to people I don't even know!" And so they don't support it anymore because it isn't practical.

    This is why people like bernie have to lie to you to get you to think you're getting free shit when he's actually saying he wants to force you to give out charity while making it sound like he will improve your quality of life. And the thing that really pisses people off about that is if you are demanding people give out charity why are you not taking that out of the pocket of the people who can really afford it? The middle class is already evaporating and you expect them to be even more responsible for everyone else? Meanwhile they put on this show like they are going to somehow make the rich pay for it without ever explaining how they expect increasing marginal tax rates will work when those people can just leave the country with their money. Bernie knows he won't get the rich's money, he's not that stupid. He already pays a 13 percent tax rate himself despite being part of the one percent. He should be paying two to three times that amount under current tax rates but people like him always find a way around it. He's just a liar.

  15. #95
    The Undying Doctor Amadeus's Avatar
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    I was reading some of the feed about Bernie, and near as I can tell is he basically appealed to his base. Some are saying the town hall was filled with Sanders supporters, however my firm belief is that a lot of Fox News watchers are Bernie Supporters.

    Seriously, something that makes Fox News successful is that they are watched by people that love them and claim they hate them.
    "Intellect alone is useless in a fight...you can't even break a rule, how can you be expected to break bone" Khan Singh

  16. #96
    Quote Originally Posted by dippinsawse View Post
    Yes but he isn't expanding medicare to cover other things it doesn't cover that would require more private healthcare and as you say that is still not single payer and still seems to directly avoid solving one of the problems with medicare which is that it can't negotiate drug prices. But I don't think that is a big issue one way or the other. It would reduce administrative costs that is true but it would also add on other socialized costs for the average person.
    Both the Sanders and Jayapal versions of Medicare For All allow for the negotiation of drug prices through the monopsony ("single buyer") power of government.

    Healthcare isn't a market failure.
    ???

    Modern economic thinking on a specific kind of market failure - adverse selection - became part of the mainstream consensus because healthcare markets are rife with it. Ken Arrow's 1963 paper on how private healthcare markets are negatively distorted by factors endemic to those markets, which won him a Nobel Prize, is the foundational text on the subject of contemporary healthcare economics.

    Health insurance is the business of risk management. An insurance company makes a profit if it pays less out in claims than it collects in premiums. But neither the insurer nor the policy holder has a clue about how much money is going to be needed to cover actual medical costs, so the insurer instantiates all kinds of gimmicks to hedge their bet. The reason why the U.S. system has things like deductibles, co-pays, provider networks, and all the pre-ACA features like benefit caps and preexisting conditions, is because these are all the ways in which a private insurance company saves money. Its a way for them to navigate around the market failures inherent in medical care. Public health programs only face this problem to the extent that they're not adequately funded to cover the benefit costs.
    Last edited by Slybak; 2019-04-18 at 07:39 AM.

  17. #97
    Quote Originally Posted by dippinsawse View Post
    Yes but he isn't expanding medicare to cover other things it doesn't cover that would require more private healthcare and as you say that is still not single payer and still seems to directly avoid solving one of the problems with medicare which is that it can't negotiate drug prices.
    Literally all of this is completely wrong. Seriously. Read the bill. Note that every developed country still maintains some sort of private healthcare option, however small. Generally about 3/4-ish of healthcare spending is done by the governments in the OECD.

    Quote Originally Posted by dippinsawse View Post
    Healthcare isn't a market failure.
    I think you're misunderstanding that there is a technical definition of "market failure," which I'm referring to and which fits healthcare neatly. Markets require that consumers are able to make informed choices in order to function efficiently, and there is much in the healthcare sector that involves a lack information, a lack of choice, or both. It's why it's so easy for pharmaceutical companies, PBMs, insurance companies, hospitals, etc to extract value from the system. It's why we have the most expensive healthcare and the fewest cost controls.

    Quote Originally Posted by dippinsawse View Post
    There is a reason a lot of medical investment occurs in the US and not say...Europe.
    Thanks research universities and NIH funding. (This also has nothing to do with healthcare being a market failure.)

    Quote Originally Posted by dippinsawse View Post
    That is why it is not a profit issue but a government issue, they protect and enforce a lot of these monopolies without negotiating properly. It is still a private market but the government makes it so that competition isn't viable which makes it so that prices go up and can't be challenged naturally.
    There are many different ways that other developed nations run their healthcare. The biggest difference between us and the rest of the developed world is that we let for-profit companies run the show. Because healthcare is a captive market, and because the demand is inelastic, prices can be pushed upwards. Competition is only the answer when consumers have information and choice. But it's not just that the system lacks transparency (and has large-scale consolidation)- it's that people don't know what their healthcare needs are going to be, and they can't choose them. You don't know when you're going to get sick or with what ailment. You can't choose an illness that's within your budget. You aren't going to wait until the labor day sale on appendectomies for the price to go down. You don't pick what or where you receive your healthcare when you're having a heart attack. Healthcare needs are unknown, unplanned, and often urgent. This prevents consumers from making informed decisions. And actors within the healthcare system know this. That's what makes it so easy for them to rent seek. And then there's all the inefficiencies of the middlemen...

    The rest of the developed world doesn't rely on competition to keep healthcare costs down. Competition isn't going to fix it here, either, for reasons that are endemic to healthcare.

    Quote Originally Posted by dippinsawse View Post
    If it was fully privatized, and to be clear I don't care what system we have as long as it works, profit still wouldn't be an issue because the market would have competition that would drive down prices to what people are willing to pay and what competitors are able to produce for.
    See above. Competition is already not working, even where it can be found. When the choice is pay through your ass for pills or die, you don't have much of a choice. One of the fundamental choices market actors can make is to not participate in the market. This isn't an option in healthcare. They've got us by the balls. Also- look up hospital consolidation and sticky pricing.

    Quote Originally Posted by dippinsawse View Post
    I didnt say demand for doctors or applications to become doctors were going down. Saying that applications increased in one year doesn't show a trend and either way it's irrelevant to my point.
    The 25% was over ten years, not one. I failed to mention that in my post, so my bad.

    Quote Originally Posted by dippinsawse View Post
    We DO have a lot of demand for doctors and we have relied heavily on foreign doctors coming in to fill that need. And I don't think you know how many foreign doctors are working in the US. There are a LOT. It isn't tightly restricted at all. There are about a million licensed doctors in the US and about 250k of them are foreign-trained. A quarter of your entire doctor work force being from another country is massive.
    Partially a function of not enough medical schools. A quarter is about double the share of foreign born residents (over 13%). You can find it in other occupations too.

    Quote Originally Posted by dippinsawse View Post
    I wouldn't call it a cartel at all and if it was one it's failing at its job.
    It's not just me; it's economists and policy analysts. And it is doing its job: doctors in the US make at least twice what they do in other developed countries. They do this by limiting their own supply.

    Quote Originally Posted by dippinsawse View Post
    But my main point is that we need to more directly solve the problems we have and not just jump on whatever sounds nice.
    Man, if only there were other countries that had figured out how to achieve good quality universal healthcare at reasonable costs.
    "As democracy is perfected, the office represents, more and more closely, the inner soul of the people. We move toward a lofty ideal. On some great and glorious day the plain folks of the land will reach their heart's desire at last, and the White House will be adorned by a downright moron."
    -H.L. Mencken, 1920

  18. #98
    Quote Originally Posted by Slybak View Post
    Both the Sanders and Jayapal versions of Medicare For All allow for the negotiation of drug prices through the monopsony ("single buyer") power of government.


    ???

    Modern economic thinking on a specific kind of market failure - adverse selection - became part of the mainstream consensus because healthcare markets are rife with it. Ken Arrow's 1963 paper on how private healthcare markets are negatively distorted by factors endemic to those markets, which won him a Nobel Prize, is the foundational text on the subject of contemporary healthcare economics.

    Health insurance is the business of risk management. An insurance company makes a profit if it pays less out in claims than it collects in premiums. But neither the insurer nor the policy holder has a clue about how much money is going to be needed to cover actual medical costs, so the insurer instantiates all kinds of gimmicks to hedge their bet. The reason why the U.S. system has things like deductibles, co-pays, provider networks, and all the pre-ACA features like benefit caps and preexisting conditions, is because these are all the ways in which a private insurance company saves money. Its a way for them to navigate around the market failures inherent in medical care. Public health programs only face this problem to the extent that they're not adequately funded to cover the benefit costs.
    Medicare is specifically disallowed by law to negotiate drug prices like that. Laws were passed to directly prevent that. That is one of the reasons drug prices are so high because they are effectively guaranteed by programs and can't even have the prices reduced to a reasonable degree by medicare. What his plan says is that the administrator will negotiate with drug companies to try to lower prices but in order to try to get around those laws without having to repeal them those negotiative powers are made essentially worthless. If a deal isn't reached between the administrator and the drug company they still have to reimburse the drug company at a rate determined by previous laws. So...not great. Not to mention those drug companies are not legally bound to even provide that drug in partnership with the medicare bill and they will still be able to sell it to people in the private sector and charge what they want to which will almost certainly mean HIGHER prices than what people pay now.

    Bernie's universal medicare plan also specifically says that drugs and bio products are THE exception to what cost sharing is allowed saying that healthcare companies can still make you pay out of pocket up to $200 a year and after that it doesn't even require those providers to keep giving you the pills unless you absolutely will die if you don't get them, and even then that is still only within partnered provider parameters. He's still bending straight the fuck over for drug companies. Because of that, it says it will try to discourage brand name drugs and drugs that aren't considered "necessary" in typical socialist fashion (Oh you don't need that thing, it's not completely necessary and most people dont get that so you shouldn't have it either...if you want it then it will be much more expensive than before. But dont worry we'll force you to pay for everyone's abortion even though it wasn't a life threatening pregnancy and providers are now legally not allowed to reject abortion patients).

    I know what market failure is. I'm saying that it doesn't naturally or automatically exist in the healthcare industry without certain factors introduced by government to cause it.

    What you are talking about is not the healthcare industry but the insurance industry (not blaming you for the misunderstanding, dont worry). And those problems exist with all forms of insurance which is why they all find ways to cheat you and not pay. Yet why do people still choose to get insurance? Because it's still better for you in an absolute sense. It's better to pay some excess than to literally die with no way out of it if you get unlucky. So the industry still has a purpose. Socializing insurance and healthcare doesn't eliminate that fact, it just spreads that assurance and cost to everyone and accepts that there will be a loss no matter what and expects everyone to pay for that loss rather than involving any risk or speculation.

    Either way this bill is a dream of nonsense. It requires spending without guarantee of services which means either they will spend money they don't have, they will barely be able to cover any health care services, and/or they will necessitate the need for drastically increasing taxes without even allocating for that. All it does is say that every single dime added to the treasury that is not otherwise budgeted from here on out is automatically put into the healthcare fund but we already don't have excess money so it is only going to cause more ghost spending without actually increasing revenue.

    Not to mention it has a ton of provisions that would increase spending above what we already do spend just to ensure certain criteria it sets forth are met. It would reduce administrative costs but then it would also create a ton of additional bureaucracy like how it says they will track everyone's health across race and then determine "further measures" required to equalize health which would then mean even more spending. Or how it literally says they will require the budget every year to pay for the education necessary to meet the "need" of doctors and healthcare professionals...Or how it forces us to pay for the development of capital facilities. Or how about the fact that it includes forcing the budget to make us pay for all of the administration professionals who would be put out of work because of this bill--hey, sick of how administrative costs make healthcare so expensive, well dont worry we'll fire those people and then make sure you have to pay for them to do nothing. Brilliant! Surprise, surprise, another dipshit socialist bill that tries to sneak in extra shit they want right under your nose as they lie right to your face saying it is free and will make things cheaper while actually making it much more expensive.

    - - - Updated - - -

    Quote Originally Posted by Gestopft View Post
    Literally all of this is completely wrong. Seriously. Read the bill. Note that every developed country still maintains some sort of private healthcare option, however small. Generally about 3/4-ish of healthcare spending is done by the governments in the OECD.



    I think you're misunderstanding that there is a technical definition of "market failure," which I'm referring to and which fits healthcare neatly. Markets require that consumers are able to make informed choices in order to function efficiently, and there is much in the healthcare sector that involves a lack information, a lack of choice, or both. It's why it's so easy for pharmaceutical companies, PBMs, insurance companies, hospitals, etc to extract value from the system. It's why we have the most expensive healthcare and the fewest cost controls.



    Thanks research universities and NIH funding. (This also has nothing to do with healthcare being a market failure.)



    There are many different ways that other developed nations run their healthcare. The biggest difference between us and the rest of the developed world is that we let for-profit companies run the show. Because healthcare is a captive market, and because the demand is inelastic, prices can be pushed upwards. Competition is only the answer when consumers have information and choice. But it's not just that the system lacks transparency (and has large-scale consolidation)- it's that people don't know what their healthcare needs are going to be, and they can't choose them. You don't know when you're going to get sick or with what ailment. You can't choose an illness that's within your budget. You aren't going to wait until the labor day sale on appendectomies for the price to go down. You don't pick what or where you receive your healthcare when you're having a heart attack. Healthcare needs are unknown, unplanned, and often urgent. This prevents consumers from making informed decisions. And actors within the healthcare system know this. That's what makes it so easy for them to rent seek. And then there's all the inefficiencies of the middlemen...

    The rest of the developed world doesn't rely on competition to keep healthcare costs down. Competition isn't going to fix it here, either, for reasons that are endemic to healthcare.



    See above. Competition is already not working, even where it can be found. When the choice is pay through your ass for pills or die, you don't have much of a choice. One of the fundamental choices market actors can make is to not participate in the market. This isn't an option in healthcare. They've got us by the balls. Also- look up hospital consolidation and sticky pricing.



    The 25% was over ten years, not one. I failed to mention that in my post, so my bad.



    Partially a function of not enough medical schools. A quarter is about double the share of foreign born residents (over 13%). You can find it in other occupations too.



    It's not just me; it's economists and policy analysts. And it is doing its job: doctors in the US make at least twice what they do in other developed countries. They do this by limiting their own supply.



    Man, if only there were other countries that had figured out how to achieve good quality universal healthcare at reasonable costs.
    I have read the whole thing actually and yes he is allowing private healthcare to still exist. That doesn't mean he didn't also set parameters for what type of care is guaranteed. He absolutey did. See my other reply above, he also is making it so a lot of things that are expensive would specifically be discouraged in their medical plan partnerships like certain drugs which would then be mostly acquired and paid for in private healthcare which would be much more expensive as a result.

    About medical failure see my above reply.

    Competition wouldn't outright fix the issue. There are a lot of moving parts here. My point was that in theory a completely private system would absolutely work and therefore the issue is not profit. A private system built on competition does absolutely function because people can still buy insurance and costs are still driven down by free market factors. Again, that isn't to say that system is absolutely best but just to illustrate to you what the real issue is. Competition doesn't work now BECAUSE we have a mixed system that prevents competition.

    No haha that wasn't your bad about the ten year thing. That was actually my bad. I knew it was over ten years, what I was talking about was that it was a comparison between now and ten years ago and that doesn't mean those numbers have been steadily increasing over that time but that this year there is a difference of 25 percent compared to ten years ago. But either way that's not hugely important and admittedly I'm not sure what percent applicants grew each individual year so it could very well be that it steadily went up each year.

    Partially a function of lack of schools but also a lack of general applicants. Just because more have applied this past year doesn't mean ENOUGH are applying. There is a reason more schools haven't been created to take in more students. There wasn't enough demand. We are still at about half of the growth rate required to meet our needs for doctors.

    This assessment about the medical field being a cartel is silly. The quoted study by the economist explains the issue itself without realizing it. It lays out that for example the average US doctor makes about 7k more than a UK doctor when you subtract tuition fee differences. What it forgets to account for on top of that despite touching on it is the difference in opportunity cost. It even says that the biggest factor in getting an education to be a doctor is the opportunity cost. Since the economy in the US is the highest in the world the fact that you are spending all of that time not working is a much bigger hit for an american than in any other country. Add onto that the fact that it also notes that some countries here pay for tuition and even has preliminary medical schooling in public schools as well as the fact that at the end of the day the US has less healthy people, more money, and more competition for doctors and healthcare and it is easy to see that the difference is not really meaningful.

    And finally, those countries did not transition into universal healthcare systems from the same position the US would have to. As I pointed out, the transition is most of the problem. When you try to get public support for something that will directly hurt the vast majority of them it is a tough sell. You can't motivate people telling them that they have a right to want to fix something when the prescribed fix would cost them MORE money.

  19. #99
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    Straight up, whoever wins the Democrat nomination is getting my vote just so we don't move to dumping garbage into rivers because it helps some stock go up a quarter of a point. I am not so insane environmentalist or anything but the layers of environmental law that is being peeled away under Trump is just horrible. Its just being done purely for profit or spite. Most of the time both. I understand some things moved maybe to fast in the past and industries couldn't adapt but a full blown no rules at all just let the toxic waste flow into the Mississippi River to save a buck mentality is just insane to me.

  20. #100
    I think unless he says something very stupid in front of a camera he'll easily be the nominee.

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