Socialist nightmare - "Thousands of suicidal children turned away by over-stretched NHS clinics"

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I think PCPs would be far less inclined to refer simple cases of htn, diabetes, etc to specialists if they weren't expected to assembly line patients q10-15 minutes.

When you're treading water and trying not to drown, sometimes it's just easier to refer out.


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Most economic theories work great in a vacuum, as long as you don't include the one ingredient which usually screws up any equation, people. But, once you throw them in, all of them show their inadequacy. Whether it be capitalism, socialism, communism, etc; they are all utter failures in actual practice.
 
To be fair Communism is a great idea and concept until man intervenes and redefines the original concept.

Communism wasn't even being used in communist countries. North Korea? It ain't even communist. Real communism wouldn't let the leader live in luxury while his subjects are starving. The Soviets weren't communist either though they were closer to it but still far from.

Communism only works in societies where EVERY SINGLE PERSON is willing to do their fair share and will actively fight to keep it that way. This is as we all know not close to the norm. Such is possible only in very limited groups of only a few people where the resources aren't stretched to the point where it becomes every person for themselves. Also even if you did reach this very difficult and highly unlikely balance the desire for profit does create inspiration for many and this is a fountain that would be unexploited. Yes I do know what real communism is.

As mentioned socialism does work in some situations and capitalism works in others. It's the way the human mind works. We like Windows/Mac better than DOS. Some things, because of the way we're hard-wired we work better depending on. For politicians to dogmatically state less government is always better is a farce and most of them saying this even know this but know the voters respond to code words like "less government."

Next time you hear someone claiming to be on the Right and claiming to espouse capitalism while at the same time trying to stop all regulations, that isn't real capitalism. Real capitalism still has the government intervening with preventing rat droppings in your meat. The fact of the matter is people can only keep 7 things in their mind at a time. When you go buy your meat you do not factor the 1000 things needed to factor if the market was completely unregulated. It's those 7 things that should be left to competition such as the taste, freshness, appearance, price of the meat.
 
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Communism wasn't even being used in communist countries. North Korea? It ain't even communist. Real communism wouldn't let the leader live in luxury while his subjects are starving. The Soviets weren't communist either though they were closer to it but still far from.
I'd agree with this. People refer to authoritarian red countries as communist, but they aren't. The Soviets would have been considered truly communist only when the workers tore down the Politiburo and the people governed each other without the need for an authority state. There has not been an example of actual communism on a national scale in world history. Which is probably telling (/editorializing).
 
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Capitalism can be introduced into the healthcare system but it cannot be done by being entirely free-market. Healthcare is not like other services or products like hot dogs or window washing where the free market works well. It also isn't being used in a manner where it would benefit the system.
Healthcare is the farthest thing from a free market in this country.

Healthcare is just like law and car mechanics. It's a knowledge asymmetry that capitalizes on a good that is very important, but with the exception of immediately life-threatening emergencies, is not particularly more important than housing, food, water, transportation, or security. A market being imperfect doesn't mean that it can't function well as a free market.
 
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I've worked in both systems. Each have their problems. E.g. a guy with diabetes in the US that cannot get treatment for it, this rarely happens in the UK to the point where it is hardly ever to be seen if at all.

Compare that to the US. Guy works more than a full-time job, still cannot afford health insurance and cannot see a doctor despite having diabetes.
A problem with healthcare and this is in any system is that the free-market doesn't work well in it and while it does have some benefits, those benefits aren't being exploited.
From a pure money model in the US this doesn't make sense because the guy's lack of diabetes treatment will in the long run end up costing society a heck of a lot more when he eventually gets DKA and now will be entitled to government assistance. Had he got treatment in the first place it would've been cheaper and he could've continued working and thus pay taxes.

Capitalism can be introduced into the healthcare system but it cannot be done by being entirely free-market. Healthcare is not like other services or products like hot dogs or window washing where the free market works well. It also isn't being used in a manner where it would benefit the system.

E.g. if the free market were to prevail psychiatrists would make more money and there likely would not be a shortage of them cause the money would be so good. Our pay hasn't gone up because the free-market forces are being locked up by the insurance companies.

Capitalism isn't he removal government interference and the Right and Libertarians often times misleadingly state. Capitalism is an economy based on competing forces fighting by offering the better product/service at better prices. Government IS SUPPOSED TO INTERVENE if this is not happening hence it is supposed to break up monopolies and prevent "Too Big to Fail." Adam Smith, the founder of capitalism,wrote chapters in his book The Wealth of Nations where he specifically stated it is supposed to intervene at times.

Specifically it should intervene if one business is sabotaging another business (E.g. one restaurant vandalizes another to reduce the other's business). It's supposed to regulate things that the consumer is unaware such as feces in meat, etc.

The very definition of capitalism has been lost among the masses who now believe it simply means no government interference whatsoever.

In short capitalism can work but it won't work the way the pundits are spinning it and it would only work in very limited methods. Socialism would also be needed in public health issues such as vaccination because the benefits of it are increased when everyone gets it. Neither model is perfect for healthcare. IMHO the best strategy is to specify what works best in each situation and rebuild the system from there but that ain't going to happen.

you can't blame to cost of govt intervention in the health care system on capitalism.....capitalism is quite literally, if not enough people can afford the $50k/yr treatment then they don't get it....the market responds by either increasing supply or lowering price to compete for the smaller amount of buyers. Capitalism can work just fine if you don't define working as everyone can afford everything...
 
E.g. if the free market were to prevail psychiatrists would make more money and there likely would not be a shortage of them cause the money would be so good. Our pay hasn't gone up because the free-market forces are being locked up by the insurance companies.
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This isn't true. Physicians would earn a lot less if there were truly a free market in healthcare. Psychiatrists even less. If there was a true free market then you would be able to get all drugs over the counter, and anyone would be able to hang up a shingle offering mental health services regardless of training or qualifications. Psychologists and other mental health clinicians would offer psychopharm services too. The whole point (in theory) of a free market is to drive competition which is supposed to improve quality and reduce costs for consumers. Not that it always works that way but free marketers like the Adam Smith Institute believe that we are all overpaid because of the cartel like behavior of organized medicine.
 
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Communism wasn't even being used in communist countries. North Korea? It ain't even communist. Real communism wouldn't let the leader live in luxury while his subjects are starving. The Soviets weren't communist either though they were closer to it but still far from.
I'd agree with this. People refer to authoritarian red countries as communist, but they aren't. The Soviets would have been considered truly communist only when the workers tore down the Politiburo and the people governed each other without the need for an authority state. There has not been an example of actual communism on a national scale in world history. Which is probably telling (/editorializing).
 
There is a tendency to throw big words like 'communism' and 'socialism', when it's totally unwarranted to do so. It's intellectually lazy and a lot of it is probably due to media propaganda. Most capitalistic developed countries are finding a way to combine a market system with a certain amount of state welfare that guarantees some similar level of playing field as well as a stake for the middle and lower classes. At the end of the day, universal healthcare, quality public transportation and public education, parental leave and other guarantees against abuse in the workplace do make for a safer, healthier, closer community and are not opposed to success. It's a choice we have to make, to what degree shall we privilege markets over people.
 
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This isn't true. Physicians would earn a lot less if there were truly a free market in healthcare. Psychiatrists even less. If there was a true free market then you would be able to get all drugs over the counter, and anyone would be able to hang up a shingle offering mental health services regardless of training or qualifications. Psychologists and other mental health clinicians would offer psychopharm services too. The whole point (in theory) of a free market is to drive competition which is supposed to improve quality and reduce costs for consumers. Not that it always works that way but free marketers like the Adam Smith Institute believe that we are all overpaid because of the cartel like behavior of organized medicine.
True, but things can be cheaper than they are now with a little bit more free market.
 
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You, not a lot of good data supporting increase of free market forces leading to better health outcomes or life expectancy rates. True single payer also probably not the answer, most likely the right mix would be the case.
 
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There is a tendency to throw big words like 'communism' and 'socialism', when it's totally unwarranted to do so. It's intellectually lazy and a lot of it is probably due to media propaganda. Most capitalistic developed countries are finding a way to combine a market system with a certain amount of state welfare that guarantees some similar level of playing field as well as a stake for the middle and lower classes. At the end of the day, universal healthcare, quality public transportation and public education, parental leave and other guarantees against abuse in the workplace do make for a safer, healthier, closer community and are not opposed to success. It's a choice we have to make, to what degree shall we privilege markets over people.
This guy gets it.
 
You, not a lot of good data supporting increase of free market forces leading to better health outcomes or life expectancy rates. True single payer also probably not the answer, most likely the right mix would be the case.
Ah. Well I don't have quality data yet, but I absolutely have proof that free-market principles can lower prices.

In my practice I negotiated with several lab companies to get the best prices for my patients. Consequently, I can offer things like a $4 CBC (going rate otherwise around $20), $7 lipid profile (usual rate $40), $11 PSA (usual $60). To get these rates I essentially pitted Quest, LabCorp, and my local hospital lab against each other and they kept coming back with better rates until we got to where I'm at now.

I did the same thing with prescription drugs and consequently my prices are 50-75% lower than the wal-mart $4 list. I can do a shot of rocephin for under $3 or a z-pack for $1.50. I have adorable purple dragon nebulizers for $23 with a month of albuterol for an additional $3.
 
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I don't know where I am politically these days. I've always leaned socialist and voted Green. I felt the Bern. I gave money to PNHP.

After half a year of working at a CMHC ... Well, I've gotten myself some essays from the Cato Institute and I'm going to read them and see if they resonate.

All I know is that a lot of my day to day frustrations are due to government regulation. And that on the way out today I was verbally accosted and threatened with malpractice by a patient who isn't even mine. She missed her appointment with her regular doc by hours and he was no longer there. She was demanding her meds and recognizing me in the hallway as a doctor, said I must fill them for her. I declined. "Well, you know whose fault it will be if I have a seizure!"

And I'm like (but didn't say), "Not yours for missing your appointment?"

Some personal responsibility would be nice. And I do wonder how much people respect the things they don't personally pay for.

Lots of thinky thoughts.


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I wish that anecdote generalized to the system as a whole, like in the case of oncology pharmaceuticals, which have exploded in price, despite a great increase in competition, among various other areas.
It can in some areas. Look, we can never make everything in medicine cheap. But if we play it smart, we can save in some areas to make up for the expensive ones.

A local ENT group in my area owns their own surgery center. Getting ear tubes placed there, including surgeon fee, is $1500. The exact same operation at the local hospital ambulatory surgery center costs 10 grand.
 
The problem everyone is skirting around is that there isn't a system which places accountability upon a person for their health care outcome, rather we're reduced to badgering a person to adopt "healthy lifestyles".

How is a person incentivized into adopting changes towards self improvement - weight loss, no substance abuse, management of emotional dysregulation, tight glycemic control, etc.

I know I'm late to the party but this always drove me nuts- how does one give patients external motivation (i.e. "incentivize) to not kill themselves through wanton hedonism?
 
It can in some areas. Look, we can never make everything in medicine cheap. But if we play it smart, we can save in some areas to make up for the expensive ones.

A local ENT group in my area owns their own surgery center. Getting ear tubes placed there, including surgeon fee, is $1500. The exact same operation at the local hospital ambulatory surgery center costs 10 grand.

Of course it can in some areas, not many would argue that. But, the same thing can be said of more socialized types of systems for certain services. Which, is why a mix is likely the bets bet.
 
I wish that anecdote generalized to the system as a whole, like in the case of oncology pharmaceuticals, which have exploded in price, despite a great increase in competition, among various other areas.
those drugs only get to be as expensive as they are because of the group sourcing of funds via govt intervention....if people had to buy their own meds there wouldn't be enough customers at those price points. Either the drugs would get cheaper or they wouldn't get made, but they wouldn't be that expensive
 
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I'm going to have to disagree with you on this one.

https://www.bma.org.uk/advice/employment/pay/general-practitioners-pay

Salaried GP salary range in England 2016-2017

Minimum £ Maximum £
55,965 84,453

That maximum ends up being $122,325.10 based on today's exchange rate.

I don't know a single US full-time family doctor making so little.


Yes, but those values are before bonuses for meeting "QOFs" (Quality and Outcomes Framework). http://www.hscic.gov.uk/qof

QOFs not only an incentive for GPs (ie, ensuring HbA1c is checked, and keeping it below 6.5, etc), but is also better for the patient. And allows for prevention.

http://www.telegraph.co.uk/news/ukn...-below-100000-for-first-time-in-a-decade.html

GP on average earn 100k pounds. AVERAGE. And the exchange value is historically low, around 1.4-1.5. 10 years ago 1 GBP = 2 USD. So on average GP in UK make around 180K USD. And of course, free health care. I don't know FM salaries too well, but I'm gonna guess the average in the U.S is around 160k?

Compare this with specialists: https://www.healthcareers.nhs.uk/about/careers-medicine/pay-doctors

The maximum they make is 102k pounds. Now of course, you can do private work on the side to boost your income. But the private system in the UK is not very developed (far less than Australia, and obviously not like the U.S). So there are GPs in UK earning more than Spinal Surgeons...I don't think in the U.S you'll find too many GPs earning >>> Spinal surgeons.
 
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Then it begs the question - what is 'fair share'?

Tax percentage paid based on earnings. In other words every one pays what they can afford based on their income bracket.
 
those drugs only get to be as expensive as they are because of the group sourcing of funds via govt intervention....if people had to buy their own meds there wouldn't be enough customers at those price points. Either the drugs would get cheaper or they wouldn't get made, but they wouldn't be that expensive

Plus oncology seems to be headed more and more toward the monoclonal antibodies for treatment. I can't imagine that those are cheap to produce compared to some of the older alternatives.
 
Here's an alternate headline to the one the OP has quoted:

Capitalist Nightmare: Friends and relatives grieve as anorexic patient dies despite doctors desperate pleas with insurance company for help.

Patient had a co-morbid diagnosis of chronic AN and MDD, patient also had insurance coverage. Owing to concerns regarding worsening symptoms of depression, the patient's treatment team had deemed it necessary that she be admitted to an inpatient program as a matter or urgency, and that continuing outpatient treatment was no longer a viable, or safe option. Insurance company refused coverage. Members of the patient's treatment team, including her Psychiatrist, sent letters to the insurance company outlining not only the plan for inpatient treatment, but the necessity. Insurance company still refused coverage. Patient's treatment team were still trying to make a case for coverage to be granted when the patient took their own life.
 
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Yes, but those values are before bonuses for meeting "QOFs" (Quality and Outcomes Framework). http://www.hscic.gov.uk/qof

QOFs not only an incentive for GPs (ie, ensuring HbA1c is checked, and keeping it below 6.5, etc), but is also better for the patient. And allows for prevention.

http://www.telegraph.co.uk/news/ukn...-below-100000-for-first-time-in-a-decade.html

GP on average earn 100k pounds. AVERAGE. And the exchange value is historically low, around 1.4-1.5. 10 years ago 1 GBP = 2 USD. So on average GP in UK make around 180K USD. And of course, free health care. I don't know FM salaries too well, but I'm gonna guess the average in the U.S is around 160k?

Compare this with specialists: https://www.healthcareers.nhs.uk/about/careers-medicine/pay-doctors

The maximum they make is 102k pounds. Now of course, you can do private work on the side to boost your income. But the private system in the UK is not very developed (far less than Australia, and obviously not like the U.S). So there are GPs in UK earning more than Spinal Surgeons...I don't think in the U.S you'll find too many GPs earning >>> Spinal surgeons.

Don't forget: little or no medical school debt, NHS Pension Scheme, kids go to uni for free, decent renumeration during training, etc... on balance, it seems to work out well.

I know I'm arguing for a two-tier system, but the sheer size and diversity of America is vastly underrated. Australia has less people than California and much more homogeneity. Ditto Canada. And the NHS got its start over 70 years ago. America just has so much damn inertia. Think about all the trouble with getting health-insurance exchanges set up, and those were simply conduits of information. So, yes for the two-tier system, but I think we can only get there in an incremental way.

However you feel about it, I think Obamacare will one day be seen as a marvel of conservative (in the sense of Burke, not Trump) political engineering. Just nudging the key stakeholders away from the idea of "pre-existing conditions" has been a tremendous step forward.
 
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Welcome to the team. Johnson/Weld '15!

#FeelTheJohnson?
So I was already 95% likely voting libertarian this election but you kind sir have now solidified my vote.

#FeelTheJohnson

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Don't forget: little or no medical school debt, NHS Pension Scheme, kids go to uni for free, decent renumeration during training, etc... on balance, it seems to work out well.

I know I'm arguing for a two-tier system, but the sheer size and diversity of America is vastly underrated. Australia has less people than California and much more homogeneity. Ditto Canada. And the NHS got its start over 70 years ago. America just has so much damn inertia. Think about all the trouble with getting health-insurance exchanges set up, and those were simply conduits of information. So, yes for the two-tier system, but I think we can only get there in an incremental way.

However you feel about it, I think Obamacare will one day be seen as a marvel of conservative (the sense of Burke, not Trump) political engineering. Just nudging the key stakeholders away from the idea of "pre-existing conditions" has been a tremendous step forward.
Agreed. I hate almost everything about ACA except for the fact that it started the process of change in our system. Even the dumb Pelosi statement about passing it to find out what's in it has a bit of truth. Best management skill I ever learned was that if you don't roll out a new policy until the staff are satisfied with it, then you will never roll out a new policy.
 
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those drugs only get to be as expensive as they are because of the group sourcing of funds via govt intervention....if people had to buy their own meds there wouldn't be enough customers at those price points. Either the drugs would get cheaper or they wouldn't get made, but they wouldn't be that expensive

Oh, there'd be plenty of patients at those price points. People have shown that they are willing to go into bankruptcy for a chance not to die.
 
I imagine this is very location dependent.
Perhaps, but it might not be. The local hospital here in South Carolina came to me with a similar pricing structure trying to get my business. If LA and SC are that similar, it does make one think it might be more widespread.
 
Don't forget: little or no medical school debt, NHS Pension Scheme, kids go to uni for free, decent renumeration during training, etc... on balance, it seems to work out well.

I know I'm arguing for a two-tier system, but the sheer size and diversity of America is vastly underrated. Australia has less people than California and much more homogeneity. Ditto Canada. And the NHS got its start over 70 years ago. America just has so much damn inertia. Think about all the trouble with getting health-insurance exchanges set up, and those were simply conduits of information. So, yes for the two-tier system, but I think we can only get there in an incremental way.

However you feel about it, I think Obamacare will one day be seen as a marvel of conservative (in the sense of Burke, not Trump) political engineering. Just nudging the key stakeholders away from the idea of "pre-existing conditions" has been a tremendous step forward.


Well, with regards to your first part. Yes, that is all true. But the counter argument is that Cost of Living in UK is >>> USA, and taxes are much higher. So I don't know. University in the UK is now 9k/year. So its still cheap medical school (9k x 5 = 45 k), but its not free like it was 10 years ago. My argument is purely looking at reimbursement/salary, where British GP do better than American.

I agree with what you say about US being so large and diverse. This is the main qualm I have with Bernie Sanders. I like his ideas, but I don't know how fiscally possible they are. He keeps comparing the U.S with Denmark. Well the U.S has 330 million people, and very 'capitalist'. Scandinavian countries are all below 10 million. I'm not convinced he can (yes, yes, I know he is not going to win primary, but for argument sake) turn America into a Sweden in just 4 years.

So specifically for healthcare, why don't we allow each state to run their own medicare for everyone. Universal Health Care, but keep it at a state level? Much more feasible I think than the boys and girls in Washington running the show for 50 states.
 
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So specifically for healthcare, why don't we allow each state to run their own medicare for everyone. Universal Health Care, but keep it at a state level? Much more feasible I think than the boys and girls in Washington running the show for 50 states.
There are many states that I have no doubt would have people dying on the streets if we left medicare decisions to states.

There are states that we can't even count on to give their residents of color equal access to VOTE for crying out loud.
 
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Communism wasn't even being used in communist countries. North Korea? It ain't even communist. Real communism wouldn't let the leader live in luxury while his subjects are starving. The Soviets weren't communist either though they were closer to it but still far from.

Communism only works in societies where EVERY SINGLE PERSON is willing to do their fair share and will actively fight to keep it that way. This is as we all know not close to the norm. Such is possible only in very limited groups of only a few people where the resources aren't stretched to the point where it becomes every person for themselves. Also even if you did reach this very difficult and highly unlikely balance the desire for profit does create inspiration for many and this is a fountain that would be unexploited. Yes I do know what real communism is.

As mentioned socialism does work in some situations and capitalism works in others. It's the way the human mind works. We like Windows/Mac better than DOS. Some things, because of the way we're hard-wired we work better depending on. For politicians to dogmatically state less government is always better is a farce and most of them saying this even know this but know the voters respond to code words like "less government."

Next time you hear someone claiming to be on the Right and claiming to espouse capitalism while at the same time trying to stop all regulations, that isn't real capitalism. Real capitalism still has the government intervening with preventing rat droppings in your meat. The fact of the matter is people can only keep 7 things in their mind at a time. When you go buy your meat you do not factor the 1000 things needed to factor if the market was completely unregulated. It's those 7 things that should be left to competition such as the taste, freshness, appearance, price of the meat.

Refreshing to see a view like this from an American. Unfortunately, I see a lot of Americans despite "socialism in healthcare".

I'm relatively active in the Pain Forum, and just today there is a thread denouncing "socialized healthcare"

http://forums.studentdoctor.net/threads/yikes-socialized-medicine-in-colorado.1204450/
 
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There are many states that I have no doubt would have people dying on the streets if we left medicare decisions to states.

There are states that we can't even count on to give their residents of color equal access to VOTE for crying out loud.

Your points are well taken.

But I assumed that the 'world's richest/greatest country' as my friends in the U.S consistently tell me, would be able to overlook something that is so essential for its citizens, healthcare.....
 
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Your points are well taken.

But I assumed that the 'world's richest/greatest country' as my friends in the U.S consistently tell me, would be able to overlook something that is so essential for its citizens, healthcare.....
We don't "overlook" anything, we just all have different ideas as to how it should be done.
 
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We don't "overlook" anything, we just all have different ideas as to how it should be done.

When I said "overlook" , I meant in the context of my hypothetical scenario of states individually running universal healthcare, overlooking/controlling/running...
 
Oh, there'd be plenty of patients at those price points. People have shown that they are willing to go into bankruptcy for a chance not to die.
100k/yr chemo drugs? Not for long. People making $50k/yr can only get so much credit before they default
 
Well then, it's a good thing that people will continue to be newly diagnosed with cancer.
That and the vast majority of the new super expensive chemo drugs don't actually work all that well. The 20k/month ones that extend life maybe 4 months really shouldn't be a readily available option, to my mind.
 
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It's not just the new ones, they've greatly increased the pricing on the drugs that have already been on the market for a while. The problem with the extreme economic theories, on both sides, is that they assume rational actors, which has NEVER been the case.
 
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It's not just the new ones, they've greatly increased the pricing on the drugs that have already been on the market for a while. The problem with the extreme economic theories, on both sides, is that they assume rational actors, which has NEVER been the case.
Ain't that the truth. They also tend to rule out short-sighted self-interest at the expense of others. They tend to assume a well-run government or a well-run company or a well-informed populace. I'm like Diogenes with his lamp still looking for those.
 
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It's fun to think about how healthcare could have evolved if the government hadn't instituted wage restrictions during WWII, ultimately creating the "insurance" (paid group bargaining/nonwage benefits) system we have today.
 
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So specifically for healthcare, why don't we allow each state to run their own medicare for everyone. Universal Health Care, but keep it at a state level? Much more feasible I think than the boys and girls in Washington running the show for 50 states.

Have have you ever been to the States? I wouldn't let some of them run chalk.

But seriously, that's almost what we're experimenting with now with Medicaid expansion. Still, no state has managed to pull off true universal care. Even Bernie Sanders' small, homogenous, and politically motivated state of Vermont gave up on their attempt called Green Mountain Care: https://en.m.wikipedia.org/wiki/Vermont_health_care_reform.

We already have the infrastructure. Medicare for all. Give it teeth to negotiate. Anyone can choose to buy better insurance.
 
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So specifically for healthcare, why don't we allow each state to run their own medicare for everyone. Universal Health Care, but keep it at a state level? Much more feasible I think than the boys and girls in Washington running the show for 50 states.
clearly you don't understand anything about how medicare is run. it's already adminstered at a regional level (thank god its not done on a state basis or people in the south would be even more screwed). For example in my neck of the woods medicare is administered by noridian jf. There are regional differences in what medicare covers as a result. For instance, in some parts of the country medicare covers TMS for depression but doesn't in others.
 
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clearly you don't understand anything about how medicare is run. it's already adminstered at a regional level (thank god its not done on a state basis or people in the south would be even more screwed). For example in my neck of the woods medicare is administered by noridian jf. There are regional differences in what medicare covers as a result. For instance, in some parts of the country medicare covers TMS for depression but doesn't in others.

Yeah, I got confused with Medicaid, which is combined effort of state and federal.

But my main point was, to have medicare for EVERYONE (18-65 age bracket) at a state level.
 
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