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What fortuitous timing!...

Didn’t King Con Don, Don Jr, Eric, Melania, and Barron recently launch a family crypto businesses?

Now low-information Americans can get scammed out of their retirement savings with fake money created by the oligarchs!

Chef's kiss!

https://www.cnbc.com/2025/08/07/trump-order-will-a...

This is as good a sign there is that crypto isn’t worth the paper it’s printed on.

Trumps will make some money.

Later on, you people ---- will fund the bailouts.


HaHa.

Later on, you people ---- will fund the bailouts.>/i>

That’s the thing, right there.

401(k)s are about YOUR retirement. If your risk tolerance is such that you want to pile into crypto and potentially go nuts with it, have at it.

But like with all investment vehicles you bear 100% of the risk and if it goes south…no bailout for you.

-dope, no position in crypto and no real desire to have any.

This is as good a sign there is that crypto isn’t worth the paper it’s printed on.

Great image, but cryptos aren’t even printed on paper.

Then again, currencies are increasingly not written on paper either.

Those old gold bugs may have a point. The metal itself. Not the pieces of paper that sharp lawyers construct that tell you you own gold, but really don’t.

Later on, you people ---- will fund the bailouts.

And you won’t be part of the “you people” funding the bailouts?

401(k)s are about YOUR retirement. If your risk tolerance is such that you want to pile into crypto and potentially go nuts with it, have at it.

But like with all investment vehicles you bear 100% of the risk and if it goes south…no bailout for you.

But that's not what happens. Which is why we don't let people do things that are self-destructive beyond certain limits. Because there are always externalities and consequences that aren't limited solely to the person who makes bad investment decisions.

Because when people are experiencing extreme poverty, it's makes life worse for everyone. It makes the society worse. When you have to pay more for shelters and food banks and for police to clean out parks and libraries filled with homeless people, when emergency rooms get clogged with folks who are unable to care for their basic needs, when families have to take in an elderly parent or relative because they blew their retirement funds on inappropriate investment vehicles....it never stays contained with the people who made the bad decision.

For better or worse, modern society is not a collection of atomized individuals who are separated by distance because we're primarily agrarian homesteaders and yeoman landowners. It's not like colonial days where you if you had a "work/save or starve" choice, it was only you that suffered if you ended up with "starve." That's not where we are any more. That's why we have these systems that impose some constraints on individual freedom - because we've lived through what happens when you don't, and the consequences are rarely limited just to the people who make the bad choices. So we don't let people make every bad choice they might possibly want to make.

I expect the edict to come down soon requiring the SS Trust Fund to being investing in crypto instead of Treasury Bonds.

For better or worse, modern society is not a collection of atomized individuals who are separated by distance because we're primarily agrarian homesteaders and yeoman landowners. It's not like colonial days where you if you had a "work/save or starve" choice, it was only you that suffered if you ended up with "starve." That's not where we are any more. That's why we have these systems that impose some constraints on individual freedom - because we've lived through what happens when you don't, and the consequences are rarely limited just to the people who make the bad choices. So we don't let people make every bad choice they might possibly want to make.

*Looks around*

Did somebody argue for zero social safety net? I must have missed that, because it wasn't in anything I typed.

As far as I know, if you put all of your 401(k) into risky startups and they all go bust, there is no bailout mechanism. Now, for this reason a lot of people use what are called "Target funds" in their 401(k)s and IRAs that "Target" a year to retire in. The risk level is adjusted depending on how many years away the person is. But even with those, the risk level is generally kinda moderate.

If somebody wants to park 100% of their retirement savings into crypto, are you willing to fund a bailout if it goes sideways on them? Because I'm not.

Did somebody argue for zero social safety net? I must have missed that, because it wasn't in anything I typed.

You said no bailout - and you've repeatedly in past conversations criticized the growth of existing social safety nets.

If you let people take high levels of risk in their 401K, you're allowing them to privatize the risk but socialize the losses. They get more money if they win, but if they lose they add an enrollee to those social safety nets that would otherwise have had enough resources to pay for their own stuff. That's generally a bad outcome for everyone else.

If somebody wants to park 100% of their retirement savings into crypto, are you willing to fund a bailout if it goes sideways on them? Because I'm not.

I'm not, either. Which is why I would prefer not to let people park 100% of their retirement savings into crypto. Because if it goes sideways on them and we don't bail them out, we're all going to have to pay more in taxes because they blew their retirement savings on a gamble.

If somebody wants to park 100% of their retirement savings into crypto, are you willing to fund a bailout if it goes sideways on them? Because I'm not.

The best way to avoid having to make that choice (with an economic gun to our head, as you and I both remember) is to maintain a strong regulatory oversight of such financial instruments. This was both the failure that led to the Great Recession of 2008, as well as what will lead to the likely collapse that will occur due to Trump’s rolling out the red carpet to Wall Streets creative construction of crypto derivatives.

Only this time, Trump and a few crypto bros will be major beneficiaries

You said no bailout - and you've repeatedly in past conversations criticized the growth of existing social safety nets.

I said no bailout for people who blow their 401(k)s on crypto.
The only "Bailouts" today for 401(k)s that I'm aware of is if the program administrators screw up and don't manage the money well (fiduciary breach). I'm pretty sure that does not cover losses realized in a plan under the control of the individual investor.

Now, if some institution were to say to its investors "Put your money into this awesome crypto fund!" and they take a bunch of risk then the 2008 Supreme Court decision opens them up to a lot of liability. Hence why you don't see uber-risky investment options in most modern 401(k) plans.

If you let people take high levels of risk in their 401K, you're allowing them to privatize the risk but socialize the losses. They get more money if they win, but if they lose they add an enrollee to those social safety nets that would otherwise have had enough resources to pay for their own stuff. That's generally a bad outcome for everyone else.

This argument is basically saying that there ARE mechanisms for bailouts in the event of crazed risk. My position is to NOT socialize the loss - if someone knowingly bets their retirement on the Roulette to hit Red 11 and only Red 11 then they shouldn't be allowed to complain when the next spin shows Black 33. (Red 11 doesn't even exist on some wheels, by the way).

I'm not, either. Which is why I would prefer not to let people park 100% of their retirement savings into crypto. Because if it goes sideways on them and we don't bail them out, we're all going to have to pay more in taxes because they blew their retirement savings on a gamble.

Given the implications of the above mentioned Supreme Court case and that fact that 401(k)s are generally managed baskets of securities, I doubt we see much in the way of uber risky crypto options. The more likely case is that firms start to offer baskets of dollar-backed crypto funds or ETFs like this one:

https://etfs.grayscale.com/btc

...which have risk profiles much less spicy than just trading in raw blockchain or something.

The best way to avoid having to make that choice (with an economic gun to our head, as you and I both remember) is to maintain a strong regulatory oversight of such financial instruments. This was both the failure that led to the Great Recession of 2008, as well as what will lead to the likely collapse that will occur due to Trump’s rolling out the red carpet to Wall Streets creative construction of crypto derivatives.

Only this time, Trump and a few crypto bros will be major beneficiaries

Not in 401(k)s. There's a reason why the most spicy investments aren't offered there: https://supreme.justia.com/cases/federal/us/552/24...

LaRue v. DeWolff, Boberg & Associates, Inc., 552 U.S. 248 (2008)
Docket No.
06-856
Granted:
June 18, 2007
Argued:
November 26, 2007
Decided:
February 20, 2008

SUPREME COURT OF THE UNITED STATES


No. 06–856. Argued November 26, 2007—Decided February 20, 2008

Petitioner, a participant in a defined contribution pension plan, alleged that the plan administrator’s failure to follow petitioner’s investment directions “depleted” his interest in the plan by approximately $150,000 and amounted to a breach of fiduciary duty under the Employee Retirement Income Security Act of 1974 (ERISA). The District Court granted respondents judgment on the pleadings, and the Fourth Circuit affirmed. Relying on Massachusetts Mutual Life Ins. Co. v. Russell, 473 U. S. 134, the Circuit held that ERISA §502(a)(2) provides remedies only for entire plans, not for individuals.

And the ruling was:
Held: Although §502(a)(2) does not provide a remedy for individual injuries distinct from plan injuries, it does authorize recovery for fiduciary breaches that impair the value of plan assets in a participant’s individual account. Section 502(a)(2) provides for suits to enforce the liability-creating provisions of §409, concerning breaches of fiduciary duties that harm plans. The principal statutory duties imposed by §409 relate to the proper management, administration, and investment of plan assets, with an eye toward ensuring that the benefits authorized by the plan are ultimately paid to plan participants. The misconduct that petitioner alleges falls squarely within that category, unlike the misconduct in Russell. There, the plaintiff received all of the benefits to which she was contractually entitled, but sought consequential damages arising from a delay in the processing of her claim. Russell’s emphasis on protecting the “entire plan” reflects the fact that the disability plan in Russell, as well as the typical pension plan at that time, promised participants a fixed benefit. Misconduct by such a plan’s administrators will not affect an individual’s entitlement to a defined benefit unless it creates or enhances the risk of default by the entire plan. For defined contribution plans, however, fiduciary misconduct need not threaten the entire plan’s solvency to reduce benefits below the amount that participants would otherwise receive. Whether a fiduciary breach diminishes plan assets payable to all participants or only to particular individuals, it creates the kind of harms that concerned §409’s draftsmen. Thus, Russell’s “entire plan” references, which accurately reflect §409’s operation in the defined benefit context, are beside the point in the defined contribution context. Pp. 4–8.

And it looks like it was 9-0, so it wasn't particularly close.

I said no bailout for people who blow their 401(k)s on crypto.

But you also intimated that you weren't suggesting getting rid of social safety net provisions. So while it's not a full bailout, it's still a bailout. If you blow all your retirement savings betting on Red 11, you're not going to be allowed to starve. We're still going to pick up all your costs of food and housing and clothing and shelter and a lot of other things that you would have been able to pay for yourself out of your own pocket if you hadn't been allowed to bet your retirement savings at the Crypto Casino.

That's why it's not a great idea to let people do this. It's not costless to you or me or society if they make a terrible choice. We will have to pay to support them if they make a truly bad choice. Which is one of the major reasons why even in a society that prizes liberty we restrain people's ability to make terrible choices - when it affects other people, not just themselves.

If you're going to have a social safety net (which you don't argue against), then people's individual self-harm will have externalized costs to the broader society. Usually, the correct response is to not let them take the risky actions that expose other people to the risk of externalized costs. No, you can't store dynamite in your living room; no, you're not allowed to build your house out of super-flammable materials; no, you have to wear a seat belt while driving.

Which is why we don't let people do things that are self-destructive beyond certain limits.

And, again, I have to ask...can he even do this?

The 401K was created by an act of Congress, with whatever rules govern it. Yes? So, can the Felon just rewrite the rules by edict? It seems to me, unlikely.

Agree with everything else you said. It makes it worse for everyone, not just the fools who put their money into a ponzi scheme.

The 401K was created by an act of Congress, with whatever rules govern it. Yes? So, can the Felon just rewrite the rules by edict? It seems to me, unlikely.

I am not a tax lawyer. But in the age of modern government, many rules - probably most rules - aren't written by Congress. They might be based on an act of Congress, but many of the rules and most of the details are written by governmental agencies in the form of regulations, not statutes. And Trump can definitely order his agencies to re-write those rules.

Now, the key thing here is the difference between writing an Executive Order saying that 401(k)'s should be allowed to invest in crypto and actually amending whatever provisions of the Code of Federal Regulations currently don't allow that. There's a lot of steps between changing your mind and changing the actual rule that's written down - and it takes a fair amount of time and usually a few lawsuits for that to happen.

But it's only Year 1 of his four-year term - so yeah, if this is just a change to the CFR and not the statute, he can probably do it.

But you also intimated that you weren't suggesting getting rid of social safety net provisions. So while it's not a full bailout, it's still a bailout. If you blow all your retirement savings betting on Red 11, you're not going to be allowed to starve. We're still going to pick up all your costs of food and housing and clothing and shelter and a lot of other things that you would have been able to pay for yourself out of your own pocket if you hadn't been allowed to bet your retirement savings at the Crypto Casino.

That's called "Social Security" and the welfare system. It's a bit of a stretch (as in, take your 1970's Stretch Armstrong action figure and tie him the to the bumpers of two cars headed in opposite directions) to equate the idea of "a dude blows all his retirement money on crypto and we're going to bail him out" to "401(k) companies have a fiduciary responsibility to look out for their clients' best interests".

If you're going to have a social safety net (which you don't argue against), then people's individual self-harm will have externalized costs to the broader society. Usually, the correct response is to not let them take the risky actions that expose other people to the risk of externalized costs. No, you can't store dynamite in your living room; no, you're not allowed to build your house out of super-flammable materials; no, you have to wear a seat belt while driving.

And, wonderfully enough, we already have such a system: It's called "incentivize the financial houses to make sure they don't give out stupid advice to their clients unless fully warned and prepared for losses". We don't need a bailout program; for once in American society we have...common sense...applied to a thing. There's zero need for a formal "Bail out 401(k) idiots" program from the government. The USSC ruling neatly creates just the right incentives into the system.

-dope, in the process of moving pre-tax IRA money into an insurance policy for guaranteed cash flow/future tax mitigation reasons.

Now, the key thing here is the difference between writing an Executive Order saying that 401(k)'s should be allowed to invest in crypto and actually amending whatever provisions of the Code of Federal Regulations currently don't allow that. There's a lot of steps between changing your mind and changing the actual rule that's written down - and it takes a fair amount of time and usually a few lawsuits for that to happen.

But it's only Year 1 of his four-year term - so yeah, if this is just a change to the CFR and not the statute, he can probably do it.

It is highly unlikely that crypto is mentioned *anywhere* in the legislation that created 401(k)s and the regs that drive them...because in 1978 crytocurrency didn't exist.

In general this is why we've allowed federal regulatory agencies considerable latitude in using legislation as regulatory frameworks that allow for the supervising government agency to issue "clarifications" in the form of rules and regs: this way the legislation doesn't have to be future proof/perfect right from Day 1 -or- doesn't require constant amendments. The US can, theoretically, chug along at the speed of innovation because we have a social contract that says "All parties will try to do the right thing, so we don't have to have Congress inadvertently lock us out of something we might want to do" (by writing an overly restrictive law).

Unfortunately, too many in government abused this contract - notably the EPA, but certainly including others like OSHA and the ATF - leading to the revocation of the Chevron doctrine last year.

But in the age of modern government, many rules - probably most rules - aren't written by Congress. They might be based on an act of Congress, but many of the rules and most of the details are written by governmental agencies in the form of regulations, not statutes. And Trump can definitely order his agencies to re-write those rules.

Is this still true since the SCOTUS overturned the Chevron doctrine last year?

The 401K was created by an act of Congress, with whatever rules govern it. Yes? So, can the Felon just rewrite the rules by edict? It seems to me, unlikely.


Well, look here: we have a fan of revoking the Chevron doctrine!
Funny how that works.

https://supreme.justia.com/cases/federal/us/603/22...

The Court granted certiorari in these cases limited to the question whether Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, should be overruled or clarified. Under the Chevron doctrine, courts have sometimes been required to defer to “permissible” agency interpretations of the statutes those agencies administer—even when a reviewing court reads the statute differently. Id., at 843. In each case below, the reviewing courts applied Chevron’s framework to resolve in favor of the Government challenges by petitioners to a rule promulgated by the National Marine Fisheries Service pursuant to the Magnuson-Stevens Act, 16 U. S. C. §1801 et seq., which incorporates the Administrative Procedure Act (APA), 5 U. S. C. §551 et seq.

Held: The Administrative Procedure Act requires courts to exercise their independent judgment in deciding whether an agency has acted within its statutory authority, and courts may not defer to an agency interpretation of the law simply because a statute is ambiguous; Chevron is overruled. Pp. 7–35.

That's called "Social Security" and the welfare system. It's a bit of a stretch (as in, take your 1970's Stretch Armstrong action figure and tie him the to the bumpers of two cars headed in opposite directions) to equate the idea of "a dude blows all his retirement money on crypto and we're going to bail him out" to "401(k) companies have a fiduciary responsibility to look out for their clients' best interests".

No one said we're going to "bail him out," in the sense of replacing all of his losses dollar per dollar. I'm simply pointing out that when if a person loses their retirement funds, some of that cost inevitably shifts to the broader society as long as social safety nets exist.

No one's arguing for a "bail out 401(k) idiots program." We're arguing for a "keep limits on what 401(k)'s can invest in so that it's less likely people will lose all their retirement savings." The same reason we require people to wear seatbelts when driving. We don't let them take the risk of being horribly injured in a crash, even if they're willing to take that risk, because we know that it will affect people other than just that one person if they get horribly injured.

Is this still true since the SCOTUS overturned the Chevron doctrine last year?

Yes. That didn't eliminate the existence of federal rulemaking - it simply removed the presumption in favor of the agency's interpretation of its own rules or rule-making power.

No one said we're going to "bail him out," in the sense of replacing all of his losses dollar per dollar. I'm simply pointing out that when if a person loses their retirement funds, some of that cost inevitably shifts to the broader society as long as social safety nets exist.

Sure. And this notion of "Socialized losses" is the general slippery slope from which lots of bad ideas are spawned, the general trending of which is to try and eliminate all manner of risk in a society. The bottom line is not only can you not do that, you shouldn't.

I can reduce traffic deaths to zero by reducing speed limits to 5MPH, installing governors on cars so they never exceed that speed and issuing Governmental Bubble Wrap to every bicyclist and pedestrian out on some road. But...should I drastically limit mobility like that? No, I shouldn't.

Society requires some amount of risk to move forward since there's never any such thing as Utopia.

We're arguing for a "keep limits on what 401(k)'s can invest in so that it's less likely people will lose all their retirement savings." The same reason we require people to wear seatbelts when driving. We don't let them take the risk of being horribly injured in a crash, even if they're willing to take that risk, because we know that it will affect people other than just that one person if they get horribly injured.

And, thankfully, we already have exactly what you're asking for in terms of a wonderful incentive placed on the financial houses to NOT allow for betting on Red 11 in 401(k) portfolios.

Bill brought up the financial crisis. I wrote extensively about that on the Fool: the major cause boiled down to all the incentives in the system were for all the players in that story to do exactly what they ended up doing.

Society requires some amount of risk to move forward since there's never any such thing as Utopia.

Sure. "Some risk," not "all risk." You're allowed to have 401(k)'s, which often give the investor the opportunity to allocate resources themselves (some risk) - but not all types of investments are allowed in 401(k)'s (not all risk).

And, thankfully, we already have exactly what you're asking for in terms of a wonderful incentive placed on the financial houses to NOT allow for betting on Red 11 in 401(k) portfolios.

Could you elaborate? Your case upthread didn't stand for that proposition. The financial houses are not allowed to themselves bet on Red 11 in a defined benefit plan (not a 401(k)) in a case where that would be inconsistent with the instructions that were given to the financial house (and thus a breach of fiduciary duty). Nothing in that would prohibit a financial house from allowing bets on Red 11 and executing them if the plan beneficiary asked to place that bet. Was there something else?

And Trump can definitely order his agencies to re-write those rules.

So his IRS could alter whatever rules are in place to allow it. I don't know the legislation that created 401Ks, but I had assumed (possibly incorrectly) that Congress laid out some very specific rules. I vaguely recall (again, possibly incorrectly) that the 401K creation wasn't a slam-dunk, and one side was demanding some pretty tight guardrails on it to allow it to pass. I would think that the IRS would have no discretion about those rules, only rules that they were allowed to impose after it was law.

I only ever worked for one company with a 401K, so I really have no idea what is out there. Ours was through Fido, and even then, only maybe a dozen options were available for fund choices. As opposed to an IRA, where you can declare pretty much anything an IRA. Within that, I'm sure one could trade crypto today. The 401K was a special creation.

And, thankfully, we already have exactly what you're asking for in terms of a wonderful incentive placed on the financial houses to NOT allow for betting on Red 11 in 401(k) portfolios.

Following up after my own post, in a piece of fortuitous timing the BusinessWeek columnist Matt Levine (whom I adore reading) led off today's column with a discussion about the changes that will allow for some more spicy investing in 401(k)'s. And which has some additional information about the specific mechanism by which the Administration is going to allow them to invest in crypto.

In a nutshell, you're both right and wrong about the above. We do have exactly what I'm asking for in the form of the incentive placed on the financial houses - and it's exactly that incentive that the Administration is going to remove. The specific change that the Administration is directing the Department of Labor to make is to revise the regulations that govern what constitute fiduciary responsibilities on alternative investments in 401(k)s. More specifically, it is currently the situation that if an employer's 401(k) allows you to be on Red 11 in the 401(k) that they will get sued - but the change that the Administration is proposing is to stop that and to make it so you won't be able to sue them for letting you bet on Red 11 in the future, which completely removes the "wonderful incentive" you were describing.

https://archive.ph/AxpDU

My position is to NOT socialize the loss

Do you support or oppose Universal Health Care?

Or should those who choose to not have health insurance AND can not afford the care they need, be allowed (or required?) to suffer the consequences of their own choice?

Justify your response.

...strong regulatory oversight...

Dream on. Not even weak regulatory oversight now. Pay the bribe to the Great Grifter and get 'regulatory relief'.

Or should those who choose to not have health insurance AND can not afford the care they need, be allowed (or required?) to suffer the consequences of their own choice?

One way or another, society will probably pick up the tab. We really need universal health care.

We really need universal health care.

We probably don't deserve it. Pretty much every 1st-world nation has figured it out in some form. They make it work. But we can't. What does that say about how "clever" we are?

We probably don't deserve it. Pretty much every 1st-world nation has figured it out in some form. They make it work. But we can't. What does that say about how "clever" we are?

I think it says the health insurance lobby is extremely powerful.

If crypto scam crashes, we need to tithe all 401K balances that are over the national average.....and redistribute it.

To make it fair.

What does that say about how "clever" we are?

Not much. The reason we don't have universal health care has little to do with us being clever or not. It's the result of path dependence and our political structure, which gives far more political power to medical service providers than in other countries.

I said no bailout for people who blow their 401(k)s on crypto.

Then you are admitting it is highly likely there will be people who blow there 401(k)s on crypto. Just before the GFC there was a move afoot to allow people to invest in entities dependent on RE submortgages. The name of them escapes me at the moment. I was dead set against it and was perturbed that the idea was being floated. Now look at how quickly this barrier fell for crypto. We are in very strange time if this can be done at the behest of your monster to line his pockets. F Trump and FU for backing this. You are a terrible mindless sightless person with no feeling.

The name of them escapes me at the moment.

Mortgage backed securities.

Soon we will have:

Crypto backed securities a l’Orange.

And guess who will be selling them? The same people who sold the mortgage backed securities in 2006-8, as well as Trump and a handful of his crypto buddies.

And when the scam blows up (as it will), guess who will be on the hook?

You and me.

F Trump and FU for backing this. You are a terrible mindless sightless person with no feeling.

Hahahahaha. <burrrrpppp>

Crypto backed securities a l’Orange.

Require Spankee's entire portfolio of investments be converted into crypto-backed securities--his own. He will own lots of SpankeeCoin. It IS a "market-based" security, so lots of buyers and sellers at high prices. What could go wrong? Problem solved.

Crypto, and now Private Equity, are chomping at the bit to scam billions from non-sophisticated investors. They are very high risk asset/investments that do not belong in everyday retirement accounts.

They are virtually unregulated and reporting is, at best, opaque.

IMNSHO, it is foolhardy to allow these asset/investments into programs designed to be in long term security and retirement accounts.

Sometimes it is wise to try and protect people from themselves and make sure some guardrails are put in place (we literally do that on certain roads). Retirement accounts is one of them. This protects individuals as well as society.

Allowing these products in IRAs is nothing more than a vehicle for a handful of individuals to pickpocket ordinary folks. It’s a scam.

It's the result of path dependence and our political structure, which gives far more political power to medical service providers than in other countries.

Sure. However, the voters still decide. And they elect people who are -for the most part- hostile to changing the insurance-paid medical system. Heck, Obama didn't really change it (i.e. it's still an insurance-based system), and it still barely passed (and was one senate vote away from being scrapped a few years ago).

Europeans, Japanese, and others, have all figured it out. But we haven't (mostly). In fact, some factions have been talking about ending Medicare (the one public health system we have). Medicare works, so it's gotta go!

Allowing these products in IRAs is nothing more than a vehicle for a handful of individuals to pickpocket ordinary folks. It’s a scam.

Of course it’s a scam. In fact, a double scam. In addition to the clueless investors it hurts, it will draw in the federal government in a bailout.

“Oh,”they say, “there will be no bailout for those stupid enought to buy these instruments!”

But there will be, because not only the big banks will be made whole, but Also Trump will profit.

Remember- he’s making the rules for the game he’s playing with our money.

Do any of you people actually know what’s in the EO?

"Do any of you people actually know what’s in the EO?" - Dumbass Dope

Yes, Albaby explained it upthread. I am pretty sure you could not comprehend it just like you couldn't comprehend his point about socializing the cost of supporting the people who lose all of their 401k in crypto.

Reading comprehension is not overrated. Try it sometime.

Yes, Albaby explained it upthread. I am pretty sure you could not comprehend it just like you couldn't comprehend his point about socializing the cost of supporting the people who lose all of their 401k in crypto.

It’s not simply individuals with retirement accounts that stand to lose. As in 2008, it’s pension funds and banks that also buy the crypto backed securities.

Trump didn’t publish his Executive Order on cryptos in isolation. He’s published a few more as well over the past several weeks, and taken steps to severely weaken regulatory oversight.

Give Wall Street a year or two to package and sell crypto poison with the same degree of “financial innovation” that they exhibited in 2008 with sub-prime mortgages.

Trump didn’t publish his Executive Order on cryptos in isolation.

So that’s a no, both you and whatever person I’m ignoring that you’re replying to.

Were any of you aware that government pensions had access to this already?

So that’s a no,

Not really. It’s more a “I don’t jump just because you whistle.”

Not really
Like I thought, a no. Perhaps if motivated I’ll post the actually thing but for now this is another therapy thread for you people.

Like I thought, a no.

You think a lot of things that are not necessarily true.

...it will draw in the federal government in a bailout.

Will it? I'm totally against crypto, and would never touch it, but that's beside the point. I know Fido has FDIC and SIPC coverage, which they have to pay for. Should they go belly-up, account holders are protected up to some threshold. If crypto is allowed in -for example- a Fido 401K, would that not then apply?

Just curious.

Who wil be President during the cryto crash?

It will be his or her fault.

"Give Wall Street a year or two to package and sell crypto poison with the same degree of “financial innovation” that they exhibited in 2008 with sub-prime mortgages."

That is how I see it, also. And the taxpayer will be left holding the bag when it blows up on everybody but the insiders. So non participating innocent bystanders gonna get boned to.

Freakin Trump, let's follow that psycho over the cliff.

"Give Wall Street a year or two to package and sell crypto poison with the same degree of “financial innovation” that they exhibited in 2008 with sub-prime mortgages."

Gonna be a LOT of shorts--just a matter of when.

Were any of you aware that government pensions had access to this already?

You are a terrible person for supporting this. There are enough people who end up paupers or desolate in their old age through no real fault of their own. And then we have those who were never working at a job where they could save. We don't need to create any more. Have you seen what that looks like? There isn't any life ahead for them. No one wants to have a talk with a destitute old person. In Japan there are many honorable suicides for people who don't want to be a burden. The Western States are the suicide belt. You want more people having bleak endings for their lives? And as Albaby pointed out, it affects us.

"So that’s a no, both you and whatever person I’m ignoring that you’re replying to." - Dumbass Dope.

Classic Dumbass Dope. You don't know what someone said because you are ignoring them, yet you assume they are wrong and you are right.

Willful ignorance is bliss eh?

You are a terrible person for supporting this.@

This board is getting.
Dumber.
By.
The.
Day.

Unlike reflexive posters who automatically assume things, I prefer to get the facts.

Sheesh.

You know who generally terrible people are? People who run around whining about other terrible people.

Sure. However, the voters still decide. And they elect people who are -for the most part- hostile to changing the insurance-paid medical system. Heck, Obama didn't really change it (i.e. it's still an insurance-based system), and it still barely passed (and was one senate vote away from being scrapped a few years ago).

But that's because they don't want to pay for it. It would be insanely expensive to provide universal single-payer health care at the current prevailing price for medical treatment. We don't pay more for health care than other Western developed countries because of insurance costs. We pay more for health care than other Western developed countries because we pay more for health care.

That's why no state has been able to do it, even very liberal ones where the voters strongly support single-payer systems in theory. You can't switch to single payer universal health care unless you slash what you pay providers for their services. And no one's willing to do that.

Europeans, Japanese, and others, have all figured it out.

No, they didn't. That's the "path dependence" part. They never had to do what we would need to do. They never had to make a switch. They never let their health care industries grow to be 10% or more of their economies - or have 10% or more of their workforce be in the health care sector - and they never let their medical service providers raise their rates to the kind of levels we have here in the first place. Once you've got a system where so many people would have to be economically hurt in order to balance the books in a switch, it becomes politically hard to make the switch.

We can't provide health care to all the people who currently don't have access to health care without either: i) paying a lot more for health care at current rates; or ii) cutting current rates. Both choices would be pretty unpopular. The ACA did the former - the federal government basically just paid for an extra 20 million people's health care costs at roughly going rates. That's why our health care costs haven't moved any closer to those of other countries, even though we have fewer uninsured than previously.

They never let their health care industries grow to be 10% or more of their economies - or have 10% or more of their workforce be in the health care sector - and they never let their medical service providers raise their rates to the kind of levels we have here in the first place. Once you've got a system where so many people would have to be economically hurt in order to balance the books in a switch, it becomes politically hard to make the switch.

All true, albaby, but that simply argues that the current way we do health care in this country is unsustainable. At some point, perhaps as a result of Trump’s chaotic approach to things, it’s going to crack. In fact, it may have already cracked.

This is not a problem to be viewed in isolation. Health care is only one element of a system being stressed.

All true, albaby, but that simply argues that the current way we do health care in this country is unsustainable.

Why is it unsustainable? Lots of things are suboptimal but can be sustained indefinitely. We might just always pay our medical service providers more than other countries do.

Other countries use the power of the single-payer purchaser to set prices well below ours. Their health systems are just monopolies (technically monopsonies) where health care providers basically have to just suck it up and accept less for their services than they could get in a different type of market. People face very different incentives in the two systems, both in terms of choosing to consume health care or become a provider in the health care marketplace. But there's no reason that either has to be unstainable.

To be fair, both Europe and Japan had the "advantage" of being almost completely destroyed before 1945. So they rebuilt pretty much everything from scratch. It is my understanding that this is the genesis of public healthcare for most/all of these countries. I get that we have an entrenched system, but that doesn't mean we can't un-trench it.

We already know that medical costs are made up. For example, just from my life, I had a surgery that was billed at over $150K. Insurance disallowed over $100K of that, paid something like $20K, and I had to pay about $5K (just flying from memory here...may be off by a couple of K). So the original charge was BS. The hospital (and doctors) got -at most- $30K for this. And the insurance company got the premiums, with which they paid the charge, plus CEO bonuses, and other overhead, plus a profit to report to shareholders. Government healthcare (like Medicare) skips all that nonsense because it is not-for-profit, and does not report to shareholders, or give executive bonuses.

I now have a script from all that. If I go the Walgreens with insurance route, I would pay about $140 for 90 days. Again, BS. CostPlus online charges me $35 for the same med, and that includes shipping.

If we cut out the BS, actual medical costs -based on my experience- is about 75% less than what they want to charge.

Also, note that people can still go to private practices in Europe...they have to pay out-of-pocket, but it is still available.

You can't switch to single payer universal health care unless you slash what you pay providers for their services.

The entire system--i.e. nationwide--has to be SP-UHC in order for it to work. No state or group of states can do it by themselves. The states NOT participating in SP-UHC system would simply send ALL their old and/or sickest patients to live in the SP-UHC area(s) long enough to obtain residency and thus be covered by SP-UHC. Then their cost shifts to the SP-UHC system. Worth the cost for the non-participating states to fund the temporary period while the relocated people wait for their new healthcare eligibility to begin. So, the SP-UHC system would need a system to deny non-participating states from shifting their health care costs to the SP-UHC.

Government healthcare (like Medicare) skips all that nonsense because it is not-for-profit, and does not report to shareholders, or give executive bonuses.

....and still pays double what other countries pay.

How we pay for healthcare isn't why we pay so much. We pay more because we pay more. If you look at per capita health care spending by age, we're paying just as much more in the age groups covered almost entirely by Medicare as we are in the age groups that aren't. In fact, just eyeballing the chart it's even worse in Medicare than other ages - the gap between our spending and that of other countries really widens when the population hits 65:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7411536/

Al:You can't switch to single payer universal health care unless you slash what you pay providers for their services.

Jerry: The entire system--i.e. nationwide--has to be SP-UHC in order for it to work. No state or group of states can do it by themselves. The states NOT participating in SP-UHC system would simply send ALL their old and/or sickest patients to live in the SP-UHC area(s) long enough to obtain residency and thus be covered by SP-UHC. Then their cost shifts to the SP-UHC system. Worth the cost for the non-participating states to fund the temporary period while the relocated people wait for their new healthcare eligibility to begin. So, the SP-UHC system would need a system to deny non-participating states from shifting their health care costs to the SP-UHC.

What is SP-UHC? AI may have it wrong. :)

This is why "You can't get there from here." When I was 15 listening to my Army Doctor father talk against socialized medicine, I didn't realize I was listening to drug and insurance corporations totally interested in market and profit. Would we have to have an amendment to try single payer?

What is SP-UHC?

Single Payer - Universal Health Care. He's pointing out (correctly) that there's some moral hazard if a state moved ahead with SP-UHC on its own, because you'll get some adverse selection as sick people might move to the state. But a lot of that can be controlled with eligibility and enrollment limits, and IIRC that didn't end up being much of a factor in killing the SP-UHC efforts in the states that tried it. It was just the plain old cost of treating all the existing un- and under-insured in the state.

Would we have to have an amendment to try single payer?

Nope. The federal government could tomorrow decide to offer a national health insurance program that covered everyone in the country.

The obstacle to doing so isn't federal power. It's that switching would significantly increase the amount we collectively pay for health care, and that's politically very difficult.

We’re not doing single payer health care. Nope.

For those who doubt that, I invite you to do the math.

And oh, yeah - if other taxpayers are paying for your health care then you better believe the rest of us get a say in how you manage your life.

And oh, yeah - if other taxpayers are paying for your health care then you better believe the rest of us get a say in how you manage your life.

Likewise, we grt a say in how you run yours

I love it.....each tribe taking the other's freedoms.

Oh man this is gonna get good.

Just gotta be patient---let the stock market nonsense get it's deseerts. And let some displacement due to AI happen.

In the meantime, they're dividing themselves....intro violent tribes.

Cruise control.

I'm winning.

Boom.

They'll be the only condo association that in addition to telling each other how to live, are actively shooting each other, and hteir muftis (politicians) are bombing each other.

Just as someone used to predict a decade before Trumpy came along.

And there's NO hope -- they won't fix this problem before it's too late ;)

Cmon, make Daddy proud.

The obstacle to doing so isn't federal power. It's that switching would significantly increase the amount we collectively pay for health care, and that's politically very difficult.

Yes, so we'd have to slash costs, and that would lead to a big section on the economy taking a nose dive now, not to mention the unemployment problem. Insurance companies would get cut out, CEOs out, consolidation, turmoil. Big mess. That's my understanding of why it can't be done. We're too far down the road.

And oh, yeah - if other taxpayers are paying for your health care then you better believe the rest of us get a say in how you manage your life.

The Gov can have a say, but not you, especially if you let crypto into 401(k)s.

We’re not doing single payer health care. Nope.

For those who doubt that, I invite you to do the math.

Every other developed country in the world has universal healthcare. Lower cost, better outcomes. But no, we're special. We get a kick out of watching people die because they can't afford health care.

It's that switching would significantly increase the amount we collectively pay for health care,...

But would it?

We already pay more. We cover those who can't get care, either through ACA tax credits, or ER visits (in which ERs can't ask if you can pay until you're ready for release from the ER). Granted, the ER isn't quite the same coverage that you and I expect. It's also a lot more expensive in the ER.

Cut out insurance, reduce trivial ER visits, give the government power to negotiate like insurance companies already do (ref: my $150K surgery that didn't cost anyone $150K), and -more difficult to quantify- make people healthier so they need to use less services in the first place, and I wouldn't be surprised if it's a wash. Or, at least, not catastrophically more than we're already paying. Plus, as an added bonus, medical bills won't drive people into poverty, which has numerous other costs associated with it (e.g. food stamps).

IMO, the big problem is the perception of "socialism", and the medical and pharm lobbies. Heck, the pharm lobbies really messed up Part D for the average citizen.

The ACA's big flaw is that it relies on private insurance. The government pays part (or all) of the premiums to for-profit insurance, and we (those of us on ACA) also pay private insurance for anything the tax credits don't cover. And then we have to worry about which doctors are on which networks. We can eliminate that entirely but making government the insurance provider, and encouraging all doctors to be "in-network". No more middle-men-insurance companies paying big bonuses to their CEOs (which comes from the premiums they receive, as well as the specious denials of claims), nor dividends to their shareholders (also from our premiums). Private insurance is a huge waste of money when we know government can do it, and do it better.

I just ran across this

https://www.facebook.com/reel/24691440103775951

The Gov can have a say, but not you, especially if you let crypto into 401(k)s.

Good.
Now drop and give me 20.

Every other developed country in the world has universal healthcare.

That’s not an argument.

Lower cost, better outcomes

Better outcomes. Do they?

How many weeks would I have to wait for cardiac bypass surgery, in day, the UK vs. here?

You guys don’t want socialized medicine.

Reading the article, the healthcare for US adults compared to other countries has a lower ratio than for younger adults. Still higher than other countries but proportionally not as much. So it's not worse on a proportional basis under Medicare.

Aussi

Dopey

How do you measure better outcomes. You mention heart bypass but you don't provide the numbers which is a bit suspicious. Let's look at life expectancy. The U.S. has a shorter life expectancy of 4 t 5 years than other developed countries. Research papers report that some of this is due to the health care system in the U.S. Other factors include higher car fatality rates and gun violence.

Aussi

To answer the question about wait time for bypass surgery, if the situation is not an emergency and the patient has no insurance or money, the wait time is until the situation becomes an emergency and the patient goes to the emergency room. So generally, a lot longer than in the UK.

In Australia it is 3 weeks unless an emergency.

Aussi

How do you measure better outcomes. You mention heart bypass but you don't provide the numbers which is a bit suspicious.

I only ask questions i know the answer to. I’m also not obligated to do your homework for you.

So. Let’s see if there are any logic skills here. If, Dope1, am asking about the wait time difference between the US (no socialized medicine) and the UK (has the NHS) in cardiac bypass surgery wait times…what might you deduce the answer is?

The U.S. has a shorter life expectancy of 4 t 5 years than other developed countries.

Americans don’t exercise as much as others, work very hard late in life and eat a lot of processed foods.

Gun violence doesn’t explain the rates of MI or other heart diseases in the US. That’s a red herring of an argument.

You can drop and give me 20 also.

So generally, a lot longer than in the UK.

You should have led with “Dope has a point about care wait times being sh1t in countries with socialized medicine”. You would have earned some points.

Here’s our next exercise for fans of socialized medicine. Who wants to guess - on a per capita basis - which country had more MRI machines, the US or Canada?

Come on, gang. This is another logic test.

But would it?

Yes. By definition, if you switch to universal health care, you're going to be doing more health care. More tests, more procedures, more medications, more medical equipment - more of everything. That's the point. That's why you do it. But that means you spend more.

Say you adopt universal health care for the coming year. Next year, you will perform all the medical treatments you perform for all the people who currently can afford/have insurance for treatments. And now you will be performing all the medical treatments for the people who wouldn't have gotten those treatments, either because they lacked insurance/money or were underinsured.

That's going to cost a lot. And no, it's not going to be made up in savings by eliminating private insurance costs. Those costs are large in the absolute sense (tens of billions) but miniscule compared to the cost of providing health care for another 10%+ of the population (hundreds of billions).

Could we cut prices if we give the government the power to do so? It's theoretically possible, but it's not going to happen. Government insurance doesn't spend less on health care than private insurance. Maybe even worse. We pay double the amount per capita for treating our seniors than any other country, just like we do for people who are not in Medicare. Government doesn't squeeze medical providers, because 10% of workers (and probably a larger percentage of actual voters) work in the health care industry. The "doc fix" will always get passed, the reimbursement rates will always stay high, and the medical industry (not just the nasty health insurance or pharmaceutical folks but the entire medical industry) will protect their rice bowl.

If, Dope1, am asking about the wait time difference between the US (no socialized medicine) and the UK (has the NHS) in cardiac bypass surgery wait times…what might you deduce the answer is?

You can't deduce an answer. With only two items in the comparison, there's a very good chance - indeed a likelihood - that the reason for the difference is not due to the general category of health care systems in the country, but instead may be due to the particulars of the UK specifically.

If you wanted to deduce an answer, you'd have to compare several single-payer systems around the globe to see if the increased cardiac bypass surgery wait times was caused by the type of health care system (single-payer vs. non). Also, you probably wouldn't limit your U.S. analysis just to the wait times experienced by a person who has adequate private-party insurance (or independent means) to pay for cardiac bypass surgery - because while that's a lot of people, it's not everyone. So if someone who has a good employer policy can get cardiac bypass surgery quickly, but people who are uninsured have to wait a very long time in order to solve for their funding problems, the average wait time for cardiac surgery will be different than just looking at the former person.

Etc. These are not questions whose answers can be deduced by a simple "anecdote to anecdote" comparison.

Gun violence doesn’t explain the rates of MI or other heart diseases in the US.

He was talking life expectancy. Lack of access to treatment is one major factor in increase MI.

What is SP-UHC? AI may have it wrong. :)

Single Payer-Universal Health Care.

Insurance companies would get cut out, CEOs out, consolidation, turmoil. Big mess.

They would suddenly be required to get REAL jobs. How fast are they at picking fruit and vegetables? FARMERS LOOKING FOR TEMP HELP AT "FAIR" WAGES--PER SPANKEE. Or NOT ??? LOL !!

Now drop and give me 20.

You will have to get your 20 pcs of Spankee feces direct from the source....

How many weeks would I have to wait for cardiac bypass surgery, in day, the UK vs. here?

Could be same day in the UK.

In the US, it would take MONTHS--or longer--especially if your insurance company said it was "experimental" or "unnecessary".

You would be dead before getting care in the US.

which country had more MRI machines, the US or Canada?

The US has more total MRI machines. However, they are used far more efficiently and effectively in Canada--resulting in a total lower cost per use than in the US.

"Every other developed country in the world has universal healthcare."

"That’s not an argument."

Sure it is. You just do not like the argument because you cannot respond to it so you just waive your hands and hope it disappears. Waving your hands is a poor form of debate.

"Better outcomes. Do they?

How many weeks would I have to wait for cardiac bypass surgery, in day, the UK vs. here?"

Yes, way better outcomes. To answer your second question, it would depend upon what type of insurance they have in the U.S. If they are uninsured, the wait time might be infinite. If they have great insurance, it might be very fast.

Heck, any clinic can purchase an MRI machine. It is a revenue producing addition to the bottom line. Never mind the temptation to order unnecessary or questionable tests. Those MRI payments don't pay themselves.

As to the inevitable increase in cost if we switch to single payor, have to disagree. We already have a system in place, Medicare, that runs a 3% overhead cost. Moreover, there are parallel systems for comparison in every other industrialized country in the world who deliver better care, (when adjusted for the total % of people covered, not just your concierge plans), at a lower cost.

The only reason we don't have single payor healthcare in this country is the number of pigs at the trough, and the politicians they purchase. Private equity siphons off money for middle men, executive salaries, and investor returns, which total ~ 30% of all health care premiums, that does not deliver any health care.

fd

As to the inevitable increase in cost if we switch to single payor, have to disagree. We already have a system in place, Medicare, that runs a 3% overhead cost. Moreover, there are parallel systems for comparison in every other industrialized country in the world who deliver better care, (when adjusted for the total % of people covered, not just your concierge plans), at a lower cost.

But neither of those things is relevant to the issue.

Switching to a universal single-payer system means providing health care to all the people who are currently uninsured and uninsured. That will dramatically increase the amount of health care services that get provided in the country, relative to the status quo. This is a good thing. Lots of people suffer adverse impacts because they aren't receiving medical treatment.

However, that's going to drive up how much we spend on health care services as a country. Insurance overhead is a trivial amount of health care expenditure. Other countries in the world provide health care at vastly lower costs because they pay providers less for health care, not because they don't have private insurance mechanisms. You don't save much money by taking private insurance out of the picture - you save money by imposing dramatic price controls on health care providers.

And we're not going to impose dramatic price controls on health care providers. If we switched to a universal single-payer system, we'd certainly see the same outcomes we have now in Medicare - where the U.S. pays pretty much double what every other country pays for their 65+ health care, per capita. Because the lower overhead cost doesn't matter a hill of beans if you're paying twice as much for health care services. And our political system is not going to impose dramatic economic hardship on an industry that constitutes about 10% of GDP and employs 10% of all workers. It's just not going to happen. Even progressives can't even talk about it - they only talk about going after pharmaceutical companies or health care insurers, because those industries are unpopular and have narrower employment bases and are more geographically concentrated. No one talks about wanting to cut the budget of the local hospital by 43% (or whatever number), because unlike those big bad health insurance companies the local hospital is one of the largest employers in the congressional district.

Albaby

Again, beg to differ. The point of universal health care is, wait for it...
to deliver health care. If we are not delivering it now, despite spending more as a % of GDP than anyone, why not?

You are right in your surmise only if you expect to leave the parasites in place, adding universal care on top of the money wasted on useless middle men and robber baron hospital CEO's, (who write their own pay packages), and let Pharma decide what they should be paid for their products, (often developed at tax payer expense).

But I assure you I am right, that we can easily afford care for everyone, ie universal, with the dollars already being spent. We just need to direct the torrent of funds in a more useful direction.

Or is that tooooo socialist for you.

fd

If we are not delivering it now, despite spending more as a % of GDP than anyone, why not?

Because we pay more to providers for services than anyone else. If they reimburse $300 for an MRI, we reimburse $1,000. If they pay $500 for a colonoscopy, we pay $1,200. Etc. We pay actual providers more than anyone else. Not the middle men, not the insurance companies, not the hospital CEOs, not just the people that we find it popular or pleasing to hate. The actual providers - the medical people who are providing the services get paid more.

You are right in your surmise only if you expect to leave the parasites in place, adding universal care on top of the money wasted on useless middle men and robber baron hospital CEO's, (who write their own pay packages), and let Pharma decide what they should be paid for their products, (often developed at tax payer expense).

No, that's wrong. Because it's not about the parasites. They don't take enough from the system for it to matter. They're the analogy to the "waste, fraud, and abuse" that right-wing conservatives like to point to as being available to allow tons of tax cuts without cutting service. But just like you can't cut federal spending meaningfully without actually cutting the stuff that federal spending actually provides, you can't cut health care spending without cutting the money you spend on actual services performed by medical providers. And if you're not going to reduce the amount of health care services you buy, it means you have to drastically cut the price you're willing to pay for those services.

But I assure you I am right, that we can easily afford care for everyone, ie universal, with the dollars already being spent.

I agree. It just requires giving everyone in the health care industry a substantial haircut. Not just the parasites or the people that it would be politically palatable to damage economically. Everyone.

Which is why it doesn't happen, and won't happen.

It has nothing to do with whether this is tooooo socialist or not. You can't substantially expand the amount of health care services that you provide without substantially increasing the amount you spend on health care unless you reduce health care reimbursements and prices to the whole system, and not just the "bad guys" in the system. That's unpalatable for progressives who want the world to be different than that, but that's what killed all of the state efforts. Even in the progressive states where there was plenty of political will to adopt single-payer. They couldn't make the dollars work.

Because we pay more to providers for services than anyone else.

Is that true? No. If the insurance company contract pays a flat amount for a procedure, that is the income--period. As the provider has already agreed to the haircut set by the insurance company(ies), prices can be reduced to that level from that provider.

Is that true? No. If the insurance company contract pays a flat amount for a procedure, that is the income--period. As the provider has already agreed to the haircut set by the insurance company(ies), prices can be reduced to that level from that provider.

I'm not sure what you're saying here. If the insurance company contract here in the U.S. provides a flat amount of $1,000 for a procedure here, and the single-payer system in an EU country provides a flat amount of $500 for a procedure there, then we're paying more money for the same quantity of health care services. It doesn't matter that the amount is set by the insurance company contract or Medicare or the EU country's Health Ministry. Since the amounts that are paid in the states are higher than those in all the other countries, we end up paying more for health care than they do. That's true in both the private insurance sector and the Medicare sector, since we pay about double the per capita expense than other countries for both people under 65 and over 65.

It doesn't matter that the amount is set by the insurance company contract or Medicare or the EU country's Health Ministry.

It does matter, for a very simple reason. The doctor (or the practice) agrees to perform a variety of specific procedures at a fixed price for each procedure. As these prices are not public information (IMO, they should be), this means the healthcare patient can not shop for treatment at real prices--only artificially HIGH prices. This is one of the reasons driving medical tourism--with the willing help of employers. Everyone saves money and the US healthcare system shows how inefficient it actually is. I posted this info years ago on TMF. It has only grown ever-faster due to the massive increase in US healthcare costs.

It does matter, for a very simple reason. The doctor (or the practice) agrees to perform a variety of specific procedures at a fixed price for each procedure. As these prices are not public information (IMO, they should be), this means the healthcare patient can not shop for treatment at real prices--only artificially HIGH prices.

Fair enough, but that doesn't really change the analysis. My point is that we pay a lot more for health care - the prices we pay for the actual health care - than in other countries. That very well may be because of lack of shopping, which gives the doctors a lot of pricing power over consumers. But regardless, it won't change if we switch to a single-payer system unless the federal government is willing to go to all those doctors and hospitals and whomever and tell them that they're now going to get paid a lot less. Which simply isn't going to happen.

we pay about double the per capita expense than other countries for both people under 65 and over 65.

As for the over 65 group, I have to wonder if that's partly because in the US those over 65 are generally in worse health than in other countries. There's likely a good number of folks who have been uninsured before 65 who - finally - qualify for Medicare and now have insurance. But because of the lack of health care while they were younger, they're now sicker than their counterparts in other countries.

Plus, even Medicare has co pays and deductibles, which give incentive to poorer folks to put off health care until they can't any longer.

I seem to recall that there is a life expectancy difference between the US and countries that have universal health care - and that difference doesn't favor the US.

In my opinion, the real solution isn't SP-UHC, it's going all in and hiring doctors and nurses and all the ancillary folks needed to run clinics and hospitals. What I'm thinking is not Medicare for all, its VA for all. Don't turn the government into a health insurer, let them be the health provider.

--Peter

Albaby1

When you say US prices are higher, are you quoting uninsured pricing, insured negotiated rates or rates outside of the hospital network, or perhaps a blended rate? When I do a bit of searching comparing Canada to the US, the US uninsured rates are much higher, negotiated rates a bit higher and non hospital rates cheaper. Of course, ChatGPT could be wrong.

Aussi

unless the federal government is willing to go to all those doctors and hospitals and whomever and tell them that they're now going to get paid a lot less. Which simply isn't going to happen.

You can't get there from here.

You can't deduce an answer. With only two items in the comparison, there's a very good chance - indeed a likelihood - that the reason for the difference is not due to the general category of health care systems in the country, but instead may be due to the particulars of the UK specifically.

I’m not the one positing that UHC is so great and every other civilized country has it (ergo, we suck for not having it).

Therefore…comparisons on critical services are 100% fair game.

albaby1,

Is there any incremental improvement you think could happen in our health care system, given the hard realities you describe? Any kind of legislation that might be helpful?

Albaby,

"Because we pay more to providers for services than anyone else."

Professional salaries to health care providers account for only 8% of total health care expenditures.

https://www.latimes.com/opinion/story/2021-09-14/d...

When you say US prices are higher,

If you aggregate the expenses, our expenses are much higher.


AI Overview

U.S. versus European healthcare costs: the data ...

https://epianalysis.wordpress.com/2012/07/18/usver...

Healthcare costs in the US are substantially higher than in most European countries. The US spends significantly more per person on healthcare, with costs often double or even triple those seen in comparable wealthy nations. This higher spending doesn't necessarily translate to better health outcomes for Americans.
Here's a more detailed comparison:
US Healthcare Costs:

High per capita spending:
In 2022, the US spent an estimated $12,742 per person on healthcare, which is the highest among comparable countries.

Disproportionate spending:
The US spends significantly more on healthcare than other wealthy nations, with costs often more than twice as high as in countries like Germany, France, or the UK.
Higher costs across the board:
This includes higher spending on inpatient and outpatient care, administrative costs, and pharmaceuticals.

European Healthcare Costs:

Lower per capita spending:
Most European countries have significantly lower healthcare costs per person compared to the US.

Varied approaches:
While some European countries, like Germany, have higher costs within Europe, they are still considerably lower than the US.
Focus on public systems:
Many European countries have strong public healthcare systems that aim for universal coverage and cost control.

Factors Contributing to Higher US Costs:

Privatized system:
.

The US healthcare system relies heavily on private insurance and market-based mechanisms, which can lead to higher costs and administrative overhead.
Administrative costs:
.
A large portion of US healthcare spending goes towards administrative tasks, such as billing and insurance processing, which are more streamlined in other countries.
Pharmaceutical costs:
.
Drug prices in the US are significantly higher than in Europe.
Defensive medicine:
.
Some argue that the threat of lawsuits leads doctors to order more tests and procedures, contributing to higher costs.

Health Outcomes:

Lower life expectancy:
.

Despite higher spending, the US has lower life expectancy and higher rates of infant mortality compared to many European countries.
Higher rates of chronic disease:
.
The US also experiences higher rates of chronic diseases, like diabetes and heart disease, which can be linked to healthcare access and lifestyle factors.

In summary, the US spends considerably more on healthcare than European countries, but this does not translate to better health outcomes. The structure of the US healthcare system, with its emphasis on private insurance and market-based solutions, is a major factor in the higher cost

Professional salaries to health care providers account for only 8% of total health care expenditure.

So what? When you pay for services - either here or in other countries - "professional" salaries aren't going to be the only component of cost for providing those services. If you're getting a medical procedure done, the reimbursement rate will cover the cost of the building and equipment, the medical supplies used in the procedure, utilities and power and heating and cooling, the costs of all the "non-professional" salaries like nurses and technicians and orderlies and janitorial staff everyone else (in the op-ed you cited, they're only talking about doctors), and everything else. It's hardly surprising that only a twelfth of that is going to the handful of people who hold an actual medical degree, and not the countless other people and equipment and materials. And it's not just health care services that are provided by doctors - it's physical therapy and home health care treatments and nursing home staff and the countless other things that are health care expenses covered by insurance (private or Medicare) that make up our annual health care expenditures.

We pay more for all of that. Twice what other countries pay. You can't reduce our overall health care spending in any material way unless you're willing to reduce what we pay for these services. The form of insurance structure doesn't matter - we pay twice what other countries pay both within Medicare and without.

Is there any incremental improvement you think could happen in our health care system, given the hard realities you describe? Any kind of legislation that might be helpful?

I mean, there's tons that "could" happen - but few of the politically possible measures involve reducing our health care expenditures to move us closer to what other countries do. It's politically difficult, but still possible, to increase what we spend on health care. That's what the ACA did. It expanded the amount of health care we provided, and increased the number of people receiving healthcare, primarily by the simple mechanism of having the government pay another $100B per year or so to pay for more people to get health care.

The simplest and easiest way to cut our spending a bit would be to have slight pressure on what government pays for health care services, such as Medicare and Medicaid reimbursement rates. Most of our health care spending, and the overwhelming majority of insured health care spending, is done in government programs. In 2023 (most recent data), total health care expenditures within insurance programs were about $3.6 trillion - of which about $2.1 trillion was government health insurance programs (including direct care like the VA), compared to only $1.4 trillion in private health insurance.

So if you wanted to reduce health care spending, start there. Just have the federal government decide that it's going to pay a little bit less to people to provide health care services under Medicare and Medicaid.

The problem, of course, is political. It's one thing to say in the abstract that you want the U.S. to pay less for health care than other countries do because it's unsustainable to pay 18% of GDP. But if you reduce the amount of money the government spends on health care, people will attack you for cutting health care spending.

I’m not the one positing that UHC is so great and every other civilized country has it (ergo, we suck for not having it).

Therefore…comparisons on critical services are 100% fair game.

They're fair game, but you can't make those comparisons against a single country's UHC program for a single procedure. Because it's entirely possible that UHC is generally superior to a private health care system, but that there will exist individual procedures in individual countries where the private system might excel.

To give you your own example, you observed that Canada has far fewer MRI machines than the U.S. per capita - and intimated that this was a problem in UHC. But Japan also has a UHC system, and yet they have more MRI machines per capita than the U.S. If you only look at a single country (and a single facet of that country's health care system), you won't get any useful information. And indeed, just like MRI machines, you can probably find at least one country on each "side" of the matter, so that you can reach contradictory conclusions. Which is why that "single-country single-procedure" approach is not at all useful for evaluating the relative merits of UHC vs. the U.S.' private system.

When you say US prices are higher, are you quoting uninsured pricing, insured negotiated rates or rates outside of the hospital network, or perhaps a blended rate?

None of the above - I was just taking jerryab's formulation of the issue. We pay more for actual healthcare than any other country regardless of the "price" that's quoted among market participants - the amount of money that actually goes from the payors to the medical providers is about double (per capita) than typical developed countries. That's often not reflected in "prices" - for example, we have a program where we pay a certain price for the medical services that hospitals provide to low-income populations, and we also pay many of those hospitals large lump-sump block payments to keep them from going out of business. So we're paying a pretty large component of the amount of money we spend on that population's health care needs outside of the price structure we have for those services.

The simplest and easiest way to cut our spending a bit would be to have slight pressure on what government pays for health care services, such as Medicare and Medicaid reimbursement rates. Most of our health care spending, and the overwhelming majority of insured health care spending, is done in government programs. In 2023 (most recent data), total health care expenditures within insurance programs were about $3.6 trillion - of which about $2.1 trillion was government health insurance programs (including direct care like the VA), compared to only $1.4 trillion in private health insurance.


That's one way, but would likely cause more problems that it would solve.

If you really want to cut medical spending, then there has to be a functioning market with 100% price transparency...forcing health care providers to compete for patients' business. What we have right now is the exact opposite of that.

I've been banging this drum for years. Finally it's getting some notice:

https://www.ajronline.org/doi/10.2214/AJR.22.27326

Price Transparency
Medical care in the United States is an opaque marketplace in which the price is often unknown to both the consumer (patient) and provider (physician or facility) at the time of service. In radiology, prices and reimbursement rates vary for the same examination, even in the same hospital, across payers [61, 62].

...which is ridiculous. The price for a service should be the price for a service. HOW someone pays is step #2.

In the first Trump administration, he issued guidelines on price transparency:
Since January 2021, CMS has required that hospitals make public—in an online single digital file in a machine-readable format—their gross and payer-specific negotiated rates, deidentified minimum and maximum negotiated rates, and discounted cash prices for all services [63]. The goals are to allow patients to shop for lower-cost care and to encourage high-cost systems to lower prices [64, 65].

The authors note some problems...
Even well-intentioned transparency tools may not be effective in altering patient behavior for numerous reasons, including low health care financial literacy, lack of quality measures, missing or variable Current Procedural Terminology codes for describing imaging services, a focus on charges and negotiated prices as opposed to patient-specific out-of-pocket costs, and a lack of financial incentives for patients [70, 75–77].

...but these are easily solved as the insurers themselves will provide incentives for patients to educate themselves on pricing. Just as they have for prescription drugs.

If you really want to cut medical spending, then there has to be a functioning market with 100% price transparency...forcing health care providers to compete for patients' business. What we have right now is the exact opposite of that.

There's no way that's ever going to work, though.

Health care can't function like a "normal" market. It has two key attributes that prevent that from happening, and ensure that the market can't function propely:

1) The choice of what to buy (and who to buy from) is primarily made by a different person than the one paying the bill.
2) The provider of the medical service has immeasurably different and better information than the person buying it.

That situation can't function like a normal market, and prices are pretty much useless in most contexts. If I (as the patient) am not paying the cost of the service, I am utterly indifferent to differences in price between provider. And I have no way of ever meaningfully determining whether a price is "fair" or not for most medical procedures, treatments, or even products: Doctor A might charge 20% less than Doctor B for the same service, but I as a lay person would never be able to know whether that reflected a real difference in the value of the service being provided or not.

Pricing can't, and won't, meaningfully affect medical spending either.

There's no way that's ever going to work, though.

I disagree vehemently.

1) The choice of what to buy (and who to buy from) is primarily made by a different person than the one paying the bill.
2) The provider of the medical service has immeasurably different and better information than the person buying it.

No and no.
Many, many medical procedures are elective and non-emergent. Patients have choices as to the provider and schedule. Many patients also educate themselves on what each procedure is and how it affects them.

Blew out my knee in 1999. As it happens, the guy that does knee surgeries for the Colts/Pacers/Purdue/Indiana University did a once a week trip up to West Lafayette to meet patients. Dude has his coterie of fellows and med students with him. Since I had wrecked my knee and nothing better to do than pull MedLine articles up and ask him questions about the papers he's written. I got an impromptu anatomy lesson and he went through the whole thing step by step.

Does every patient do that? I'll admit, I'm more detail oriented than a lot of folks but that just means there's a spectrum of folks who WILL take the time to understand every aspect of the care they're getting.

If I (as the patient) am not paying the cost of the service, I am utterly indifferent to differences in price between provider.

Because you have no incentive to. However, if your insurance company told you there'd be a discount on your next premium if you picked Hospital A or Provider B you would take notice.

All this is infinitely better than an unwieldly government driven solution that seizes partial control over a quarter of the nation's GDP (or more).

Since I had wrecked my knee and nothing better to do than pull MedLine articles up and ask him questions about the papers he's written. I got an impromptu anatomy lesson and he went through the whole thing step by step.

Does every patient do that?

No. And not enough will ever do so to ever matter. And even then, I notice that your description of the work and education and questions you put into him doesn't mention price!!! Even as you were educating yourself about him and his skills and the procedure, did you ever bother to research his pricing compared to those of other providers, and figure out whether the cheaper alternative might be a better fit for you.

Because you have no incentive to. However, if your insurance company told you there'd be a discount on your next premium if you picked Hospital A or Provider B you would take notice.

But they're not going to. Not enough people would ever take them up on it to make that worthwhile. The insurer has lots of information about the tradeoffs between price and medical outcome, both generally and for specific doctors - there's no benefit to having all their patients recreate that learning curve.

All this is infinitely better than an unwieldly government driven solution that seizes partial control over a quarter of the nation's GDP (or more).

How do you know? Obviously you have a philosophical belief about it, but there's absolutely no country on earth that has the type of pricing model you are wishing for, and we have no way of knowing at all whether it could work or whether it would have any better outcomes.

Pricing can't, and won't, meaningfully affect medical spending either.

It depends what is being given a price.

Big difference between drugs and personal professional services.

Drugs CAN be priced, and should have reasonable price controls. That is 30+% of US healthcare costs. The US pays far more for the same drugs, and it buys many of the highest volumes--which means the price/dose in the US should be near the lowest cost. Thus, the US govt is not using the tool it uses in many other purchasing decisions--requiring competitive bidding. That would not apply to newly-approved drugs for a set number of years, but that is normal with a new product under a recent patent. The federal govt already requires drug companies to sell to the VA at a "best price" (set by the company, I believe).

However, if your insurance company told you there'd be a discount on your next premium if you picked Hospital A or Provider B you would take notice.

There is no incentive for the insurer to make such a choice. They are under a different set of legal obligations than any patient. The insurance company has ONE objective--to maximize their profit by being AS CLOSE AS POSSIBLE to the minimum medical expense payout amount that allows them to keep the FULL PREMIUM COLLECTED. If the payout falls BELOW the federally required medical payout amount, the insurer has to REFUND A PORTION OF THE PREMIUMS COLLECTED TO THE INSURED CUSTOMERS.

Plus, you--AND the insurance company--have omitted a third option. Medical tourism. Some businesses are now offering it as an option in their self-insurance programs. The company saves a lot of money AND the employee gets needed covered medical care *plus* vacation in one reasonably priced package--mostly/wholly paid by the employer due to massive savings realized by avoiding the overly-expensive US healthcare system.

I have posted this info on TMF several times over the years.

It depends what is being given a price.

Big difference between drugs and personal professional services.

Sure, but when I said "pricing can't meaningfully affect medical spending" I was referring to changes in pricing systems. Pricing for medical services is very opaque (sometimes completely invisible) to patients at point of purchase decision, and patients don't have way of knowing what they're buying in advance. Pricing for drugs already isn't like that - today patients can get a very good sense for what a drug will cost (and what you get for the price).

The kind of price controls you're describing are exactly how other nations save money on health care expenditures. They impose price controls on health care, and tell providers (whether they be providing services or drugs or equipment) that they're going to have to eat smaller reimbursement rates.

Prescription drugs are "only" about 10% of total U.S. health care expenditures (about $485B). That's not nothing - certainly more than the amount that goes to insurance company profits - but it does mean that you're only looking at a few percentage points of health care expenditures that can be obtained by squeezing on drug prices. To actually get U.S. health care costs close to other western developed countries, you need to squeeze compensation/reimbursement on everything.

Even then, though, note that we haven't squeezed drug prices all that much. It's just really hard to do - our system is structured so that it is very difficult to impose large costs on a small discrete group in exchange for small benefits shared by a very large diffuse group.

No. And not enough will ever do so to ever matter.

Oh, I'd disagree with that as well, especially if the patient had more financial skin in the game.

I said: All this is infinitely better than an unwieldly government driven solution that seizes partial control over a quarter of the nation's GDP (or more).
You said:
How do you know? Obviously you have a philosophical belief about it, but there's absolutely no country on earth that has the type of pricing model you are wishing for, and we have no way of knowing at all whether it could work or whether it would have any better outcomes.

The "every other country has this so we should do it, too" or "No other country has this so we shouldn't do it"...again - aren't arguments. Every mom who's ever found weed in her son's sock drawer has heard a version of "All the other kids are doing it". In other words, just because all the other teenagers in town are hitting the bong doesn't mean it's the right thing to do.

There's zero way we're doing single payer health care here. Zero. Why? We can't afford it, and we already have the numbers in hand from the last time this came up.
Case in point. I ran Vermont's numbers back on the Fool, and they didn't jive: they were estimating $5 billion dollars per year (likely understated).
For those who incessantly demand links: https://mediad.publicbroadcasting.net/p/vpr/files/... (This presentation is their own post mortem)
Slide 21. The $5B number is from 2020.

Vermont has 648,000 residents. That's a cost of $7,700-ish per resident per year.
Vermont's entire state budget is $9 billion. So they'd have to increase their state budget by 80% for this.

Now let's extrapolate to the entire country. The US has 342M citizens. At $7700 per (and given that the Vermont thing was several years ago that number is likely FAR higher given medical cost inflation)...ouch...but let's be generous and say that through the miracle of government intervention we got the price down to about half or merely $4,000 per citizen. That would mean we're spending the equivalent of double the entire federal budget today.

As I said, not happening. (And the real number is probably north of $10k/citizen, anyhow).

And btw.
And even then, I notice that your description of the work and education and questions you put into him doesn't mention price!!! Even as you were educating yourself about him and his skills and the procedure, did you ever bother to research his pricing compared to those of other providers, and figure out whether the cheaper alternative might be a better fit for you.

How could I have? Nobody published pricing information back then.

But now...I could go here:

https://surgerycenterok.com/

I could look up ACL repair surgery. I'd find this: $7,931.

Guess what? This is LESS than what my insurance was charged 26 years ago!.

You're trying to argue that no patient would do this research because they have no incentive to. But you know who would? The insurance company, who has every incentive to. They'd do the research for the patients.

Over time pressure would be applied to the system such that prices would naturally somewhat equalize (allowing for differences in regions and demand just like with many other markets) to a FAR better degree that we have now. Costs would drop as insurers would demand improvements in efficiencies across the board.

For the record, I DID negotiate price with the surgeon and the anesthetist and got the entire thing done for $229 bucks out of pocket. All it took was a 10 minute phone call, btw. Maybe not even that long.

The kind of price controls you're describing are exactly how other nations save money on health care expenditures. They impose price controls on health care, and tell providers (whether they be providing services or drugs or equipment) that they're going to have to eat smaller reimbursement rates.

And price controls work really well, don't they? We don't have loads of examples of bad outcomes on things like rent control, do we? Things that are taught in every Econ 101 class?

The "every other country has this so we should do it, too" or "No other country has this so we shouldn't do it"...again - aren't arguments.

But you're just misunderstanding the argument I made.

This isn't a "should" statement. It's a fact statement. Since no other country has the pricing scheme you're talking about, you have no way of knowing whether it would or would not reduce costs. That's not an argument that "everyone else is doing it so we should do it." It's an argument that you have no information about how the market would actually behave under the scheme you're proposing.

I could look up ACL repair surgery. I'd find this: $7,931.

So what? That tells you the price at that one center (and certainly loaded with caveats). And if another center offered the procedure for $7,352, and a third offered the procedure for $8,371...how would you pick between them? How would you know which of the three is the right choice? One's the cheapest - but is that perhaps because their doctors aren't as good or they have worse outcomes, or have a contract that puts you on the hook for more "unexpected" events than the more expensive one? One's more expensive - but is that because the doctors are better or have better outcomes, or include more possible contingencies in the sticker price? Why would you even bother if this is covered by insurance? And why would the insurance company bother giving the patient incentives to pick between them and pick up the administrative costs (and legal jeopardy) that would accompany such a system?

You're trying to argue that no patient would do this research because they have no incentive to. But you know who would? The insurance company, who has every incentive to. They'd do the research for the patients.

They do do that. The insurance companies negotiate these rates. They employ their own medical professionals to help them in those negotiations. Which is why there's almost no real benefit to making prices transparent to patients (because the patients don't need to know them), and there's no opportunity to make prices more transparent insurers (because the insurers already know them). Which is why you won't have any material savings with any of these pricing transparency efforts.

Again, it's not a question of "everyone else is doing it so we should too." It's that there's little reason to think that consumers would be able to "solve" the problems of radical information asymmetry and third-party payment with more information, and the absence of any real-world systems demonstrating otherwise means there's no counterexamples to show otherwise.

And price controls work really well, don't they? We don't have loads of examples of bad outcomes on things like rent control, do we? Things that are taught in every Econ 101 class?

They can work really well - in response to market failures. Econ 101 doesn't tell us that price controls are good or bad, it just says that they generally have worse outcomes than a functioning free market alternative. But for goods that can't be provided in a free market (like, say, access to courts or national defense) or that suffer from significant free market failures (like, say, access to firefighting in urban environments), price controls can be a better alternative than the broken market system.

So rent control usually works poorly compared to the alternative. Fixed prices for filing a lawsuit works pretty well, because there literally is no free market alternative.

This isn't a "should" statement. It's a fact statement.

And if it was a "Fact" that every other teenager in town smokes weed that's the right way to go?

Since no other country has the pricing scheme you're talking about, you have no way of knowing whether it would or would not reduce costs.

You mean other than the 400 years or so of the history of human economics applied across the globe?

That tells you the price at that one center (and certainly loaded with caveats).

So? It's a starting point. If one place at one end of town offered $7500 and the other place offered $25,000 I'd at least be motivated to talk to the $7500 place so I could determine if the deal was right for me.

And if another center offered the procedure for $7,352, and a third offered the procedure for $8,371...how would you pick between them? How would you know which of the three is the right choice?

So you're saying...there is a potential market for a health consultant to explain to me the difference? And then charge me $1 less than $1,019 bucks (because I'd still be better off than if I chose the more expensive option blindly). You're making my case for me :)

And why would the insurance company bother giving the patient incentives to pick between them and pick up the administrative costs (and legal jeopardy) that would accompany such a system?

Huh? Insurance companies want to maximize efficiency across their systems, realize lower costs and have healthier outcomes for their patients. On that last point, why, you might ask? Simple: Because people with better outcomes are healthier and require less follow up care. And that means lower outlays for the insurance companies.

Which is why there's almost no real benefit to making prices transparent to patients (because the patients don't need to know them), and there's no opportunity to make prices more transparent insurers (because the insurers already know them). Which is why you won't have any material savings with any of these pricing transparency efforts.

And that's worked out so very well, hasn't it? There are more reasons for point pricing information. One, we can better track where dollars are going into the system and for two insurance companies can offer different tranches of products to meet market needs based on the open, transparent pricing.

Tranche 1: Here's a plan for X dollars per month and it gives you access to these Toyota hospitals, where they offer Camrys, Corollas and Rav4s.
Tranche 2: Here's a plan for Y dollars/month and it gives you access to these Lexus hospitals, where they offer LFAs, RZs and IS 500's.

It's that there's little reason to think that consumers would be able to "solve" the problems of radical information asymmetry and third-party payment with more information, and the absence of any real-world systems demonstrating otherwise means there's no counterexamples to show otherwise.

Other than the entire history of economics in literally every other market that's ever been a marketplace in the world. Other than that your point is a good one. But ever since Danish Tulips we've known about how markets work. Each is a little different, but all follow a few universal rules that help drive pricing to its optimum point. Or, at the minimum, put incentives in place to help get there.

We also have reams of data on socialized medicine. I'm taking it easy on you by not noting how the US has 3x more MRI machines per capita than the Canadians do, for example.

Insurance companies want to maximize efficiency across their systems, realize lower costs and have healthier outcomes for their patients.

Uh, NOPE. Insurance companies are NOT in that business. They ARE in the business of maximizing profit for themselves. Don't believe me? Mandate a significant reduction in pay of the highest-paid executives--in order to boost corporate profit. ROFLMAO on this one !!!

And if it was a "Fact" that every other teenager in town smokes weed that's the right way to go?

No. But if it was a fact that no other teenager in town smoked weed, then you'd lack data about what the impact of smoking weed on teens was.

Again, I'm not using the fact that no other country has the system you're describing as an argument that we should or should not have that system. I'm pointing out that because that system doesn't exist, we don't know whether it would have the real-world impacts you're assuming.

You mean other than the 400 years or so of the history of human economics applied across the globe?

Yep. Because the 400 years or so of the history of human economics applied across the globe have taught us that sometimes markets don't work. You keep reciting the lessons of Econ 101 about why markets are good. But in Econ 201, we learn that sometimes markets have characteristics that keep them from functioning properly - and that in such instances markets can be bad unless the government intervenes. I mean, the irony is that this is exactly what you're proposing. The independent actions of all the private market participants in health care have not produced the type of transparent and price-based market that we expect in the absence of market failure, and you're proposing some external policy be imposed on the market to change that.

I'm taking it easy on you by not noting how the US has 3x more MRI machines per capita than the Canadians do, for example.

And I'm taking it easy on you by not noting how Japan has more MRI machines per capita than the U.S. does, for example. Sometimes you can't learn much of import by looking at an isolated example in only one other country.

unless the federal government is willing to go to all those doctors and hospitals and whomever and tell them that they're now going to get paid a lot less. Which simply isn't going to happen.

You can't get there from here.

Yep. That's the pithier way of saying "path dependence," but it's where we are....

And I'm taking it easy on you by not noting how Japan has more MRI machines per capita than the U.S. does, for example. Sometimes you can't learn much of import by looking at an isolated example in only one other country.

Just to be clear, Japan has not-quite- double the number of MRI machines per capita that the US does.

Also slightly ahead of the US are Greece and South Korea. Barely behind the US are Germany, Italy, and Finland.

Only one of those countries has the kind of convoluted, upside down, so-called private health care market (ha! Auto type changed that to “racket”) that we do.

I'm pointing out that because that system doesn't exist, we don't know whether it would have the real-world impacts you're assuming.

Price equilibrium is far from an assumption. It's a proven reality backed by hundreds of years of economic outcomes across hundreds of millions of products.

But in Econ 201, we learn that sometimes markets have characteristics that keep them from functioning properly - and that in such instances markets can be bad unless the government intervenes. I mean, the irony is that this is exactly what you're proposing. The independent actions of all the private market participants in health care have not produced the type of transparent and price-based market that we expect in the absence of market failure, and you're proposing some external policy be imposed on the market to change that.

And is the medical market completely unregulated? Hardly.
The policy of price transparency has already been imposed. It happened in 2020 and took effect in 2021. After a slow start, hospitals are complying.
And now there are studies out about price disparities. They say some interesting things:

https://www.mckinsey.com/industries/healthcare/our...

After a slow start,2 payers and hospitals have made progress toward publishing negotiated rates.3 In the meantime, regulators are continuing to take actions to further advance price transparency. For example, the Centers for Medicare & Medicaid Services (CMS) has shortened the time hospitals have to respond to notices of noncompliance and has imposed automatic fines for noncompliance.4 The US House of Representatives recently advanced legislation that would impose more price transparency requirements on additional types of care delivery organizations.5 Moreover, state and local governments in Massachusetts, Minnesota, New York City, and Virginia have enacted their own price transparency requirements.

Wow, Massachusetts is a locale I wouldn't have expected there.

What sorts of things are we learning? The article actually covers what you and I have been talking about:

This article puts price transparency rules in context and explores their implications, including:

-the existence of price dispersion in US healthcare that is not explained by differences in quality of care

-how price transparency rules address some market inefficiencies driving this price dispersion but leave others unresolved

-that patients—if given proper incentives and information—would be interested in shopping for care that amounts to 20 to 25 percent of US healthcare claims spend, potentially unlocking gains in affordability for consumers

-the potential for price transparency rules, together with other innovations, such as advances in technology and analytics, to empower patients to shop for care more than ever, helping offset growth in healthcare costs

-implications for healthcare industry stakeholders, potential shifts in industry profit pools, and first-mover advantages for organizations that capitalize on this opportunity to improve healthcare for US consumers

Many benefits.

And let's enumerate some benefits:

US healthcare prices vary widely; on average, prices for the same healthcare services differ by 40 to 50 percent within a given US metropolitan statistical area (Exhibit 1). This means substantial economic value is at stake in commercial rate negotiations between care delivery organizations and payers. Given that annual spending for commercial healthcare claims is roughly $1.1 trillion, every increase or decrease of 1 percent in commercial reimbursement rates leads to an increase or decrease of about $11 billion in national healthcare claims spend.10

40-50% price differentials in the same metro area: that's the very textbook definition of inefficiency.

Much more in the article.

Will this fix US health care? Not by itself. Supply and demand needs to be addressed, and for that I would point interested readers here

https://www.amazon.com/dp/1259860868/?bestFormat=t...

Christensen, C., Grossman, J. and Hwang, M., 2010, The Innovator's Prescription: A Disruptive Solution for Health Care, McGraw-Hill.

Price equilibrium is far from an assumption. It's a proven reality backed by hundreds of years of economic outcomes across hundreds of millions of products.

And hundreds of years of economic outcomes across hundreds of millions products also show that price equilibrium doesn't always happen, and that many markets have failures that require interventions.

Efficient markets are an assumption of Econ 101, but it's an assumption that gets abandoned in more advanced economic analysis because it doesn't always hold true in the real world. Health care markets strongly exhibit characteristics that lead to failures in market mechanism, including:

1) Asymmetric access to information, coupled with high costs of acquiring information;
2) Non-fungible goods or services;
3) Third-party payors; and
4) High levels of externalities.

There is no reason at all to assume that a market for health care services would look like the market for, say, raw lumber or white cotton t-shirts.

And is the medical market completely unregulated? Hardly.

True, but the regulations aren't ones that we would normally expect to interfere with private parties' decisions to disclose or not disclose prices. Whether on the producer side (providers seeking customers by competing on price) or on the consumer side (patients demanding price information upfront). Indeed, that's exactly what we see with certain aspects of health care markets, such as Lasik or cosmetic surgery procedures - consumers and producers shape their behaviors based around pricing.

Why is that? Because those procedures are among the few that don't have the characteristics described above. They're elective procedures, fairly standardized, are not covered by insurance (and thus don't have third-party payor problems), and typically do not have any externalities associated with them.

So the reason we don't have a lot of transparent pricing in health care services markets is because they're affected by market failure, which market failure has to be remedied by government intervention if it would be changed. Which is (again ironically) exactly what you're claiming can't and shouldn't happen by your appeal to "hundreds of years of economic outcomes across hundreds of millions products."

And that's why this won't work, because lack of transparent and visible prices is a symptom of the factors I listed above. Mandating price disclosures isn't going to get consumers or producers to start competing on price, because consumers almost never actually pay the price for services covered by third-party payors (and thus have no incentive to take it into account), and even if they did lack the information necessary to evaluate whether pricing differentials are justified or not and face very high acquisition costs to obtain that information.

It's not likely to make any difference, Dope - despite the promises and expectations of people who advocate for it, like those in the article you linked to.

40-50% price differentials in the same metro area: that's the very textbook definition of inefficiency.

You must have a really bad textbook. There's vastly more than a 40-50% price differential in the cost of getting a dinner at an Italian restaurant in my metro area as well. Does that mean the restaurant market is inefficient? Or perhaps it's because the characteristics of an Italian dinner vary wildly across different restaurants.

Or heck, we don't even need to get into that. A quick google search reveals that the cheapest price of gasoline in Miami right now is about $2.72 per gallon, while the most expensive gasoline is $4.39 per gallon. By coincidence, pretty close to the same range you note in your excerpt. I guess the market for gasoline (a purely fungible good whose prices are perhaps the most visibly advertised of any product that exists on the market) is a textbook definition of inefficiency....

There is no reason at all to assume that a market for health care services would look like the market for, say, raw lumber or white cotton t-shirts.

That's great, since no one has.

So the reason we don't have a lot of transparent pricing in health care services markets is because they're affected by market failure, which market failure has to be remedied by government intervention if it would be changed. Which is (again ironically) exactly what you're claiming can't and shouldn't happen by your appeal to "hundreds of years of economic outcomes across hundreds of millions products."

There are a number of reasons why we don't have price transparency in medical markets. One reason is the entire negotiated price system, which acts as a contract between the hospital/provider and the insurance agency. Notice how the patient is left out if it.

Mandating price disclosures isn't going to get consumers or producers to start competing on price, because consumers almost never actually pay the price for services covered by third-party payors (and thus have no incentive to take it into account), and even if they did lack the information necessary to evaluate whether pricing differentials are justified or not and face very high acquisition costs to obtain that information.

It's not likely to make any difference, Dope - despite the promises and expectations of people who advocate for it, like those in the article you linked to.

It will make a difference by merely exposing misaligned value propositions and highlighting inefficiencies.

Momentum is building for more price transparency in medical markets.
Want an example of it working? Look no further than prescription drugs; there are more and more calls for it:

https://www.ama-assn.org/system/files/issue-brief-...

To empower patients and address health care
costs, the AMA encourages prescription drug
price and cost transparency among
pharmaceutical companies, pharmacy benefit
managers (PBMs), and health insurers.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11129567/
Parente used an upper bound analysis to estimate the impact of the price transparency rule for the commercial population by 2025 for income level, region, and state. 52 Using the 40% reduction in expenditures for “shoppable” services by shifting from negotiated commercial prices to cash prices suggested by the analysis from Lawrence Van Horn et al 54 —the same estimate used by the White House and HHS in 2019—Parente estimated the overall impact of price transparency for the commercial population in 2025 to be as high as $80.1 billion. 52 The analysis notably projected greater percent savings for low income beneficiaries at or below 137% of the Federal Poverty Line and variation across regions and states. It also projected that the growing use of high deductible health plans may reinforce potential savings from price transparency, because recent research has shown that price information leads to a shift to lower cost providers, in particular for those beneficiaries subject to high deductibles. 55 It should be noted that the growth in high deductible plans reinforce the broader, consumer-oriented changes in U.S. health care that we have been discussing.

And there's a growing pile of literature out there with studies galore...

There's vastly more than a 40-50% price differential in the cost of getting a dinner at an Italian restaurant in my metro area as well.

Uh, huh. For the same 12oz Diet Coke? Hardly.

Or perhaps it's because the characteristics of an Italian dinner vary wildly across different restaurants.

You're trying hard here to conflate all procedures in an analogy that compares the Michelin 5-star Italian restaurant with the $200 bottle of Pinot Gris with Luigi's pizza place, his checkered tablecloths and $5 dollar slices. And many procedures are like that.

But if I'm merely looking for something to drink I'm going to go for the $200 Pinot Gris I'm going to have a soda. Similarly if I have a sniffle or a turned ankle I'm not going to fly to the Mayo Clinic. It's not necessary.

Consumers’ lack of clarity on health care prices has long been recognized as a problem in U.S. health care because they have been vulnerable to price-setting behavior characteristic of monopolies, not free markets. In addition, high prices in U.S. health care have been recognized as a key driver of U.S. health care spending, and current research suggests that hospital prices are growing at a faster rate than physician prices. The modern era has seen a growing interest in empowering U.S. health care consumers to play a greater role in their health care spending. Price transparency is an important component of that shift, and recent federal and state policy changes are designed to bring more price transparency to U.S. health care, with the belief that it can ultimately lower prices and spending. As the Congressional Budget Office (CBO) writes, “If more consumers started using price information to choose lower-priced providers, then, over time, those changes in price sensitivity might pressure providers to accept negotiated prices that were much lower than they would be under current law.” 63

That's great, since no one has.

But hasn't that been your argument? Since markets are good and are capable of functioning for most goods, then surely they're good and capable of functioning for medical services? Rather than directly respond to my observations about health care markets, you keep pointing to things like hundreds of years of other markets or millions of other products. So if you're not claiming that medical services markets are functionally similar to typical markets, why do you keep doing that?

It will make a difference by merely exposing misaligned value propositions and highlighting inefficiencies.

Why? The people who actually pay for health care services - the insurers - are extremely aware of all of these cost differences and varying charges. That information is already extremely well known to all the people who actually make the purchasing/reimbursement decisions. It's already exposed to all the market participants who would act on it. So what difference would it make to additionally expose that information to patients, who are never going to act on it (they don't pay the prices) and are not going to invest any resources into learning about them?

And there's a growing pile of literature out there with studies galore...

Again, that study shows exactly what I'm telling you! Look at the passage you cite: they're talking about drugs (a fungible physical item whose characteristics and quality do not vary from provider to provider) among high-deductible plans (where consumers are directly paying their own costs rather than relying on third-party payment) where there is little to no information acquisition costs (patients know exactly what the service is and don't have to have any medical expertise to know whether there might be additional procedures or costs associated with getting it). And guess what? It's already very easy for consumers to obtain that information. If you have a scrip for a drug, you can call around to various pharmacies and they'll tell you exactly what they would charge you to buy it if you're paying for it yourself.

That's not where there's any existing problems with pricing transparency. The projections and estimations and speculations that are mentioned in the report you cited, trying to apply estimates of cost savings due to price availability in other markets to those for medical services, are not going to work for the types of medical services that make up the overwhelming majority of U.S. health expenditures. Because those services are paid for by insurance, and therefore will be almost entirely unaffected by pricing information given to the patient.

Uh, huh. For the same 12oz Diet Coke? Hardly.

Except getting medical treatment from different medical professionals is not at all equivalent to getting the same 12oz Diet Coke. Didn't you note upthread how much time and effort you spent on researching the bona fides and directly questioning the doctor that was going to do a procedure on your knee? You don't interrogate the quality of which specific 12oz Diet Coke you're going to buy that way. Because Diet Cokes are fungible, while medical services are not.

And even for fungible products, you can get significant variation in prices. Did you not see where I noted that there are also significant price disparities in the price of gasoline? It's 50% higher in some stations than others, even though a gallon of regular gas is pretty much fungible.

And guess what? It's already very easy for consumers to obtain that information. If you have a scrip for a drug, you can call around to various pharmacies and they'll tell you exactly what they would charge you to buy it if you're paying for it yourself.

And this hasn't always been the case. Only in the last few years have we had this kind of thing help improve the flow of information and empower people to make different decisions.

At any rate. We will see more movement towards disclosing to consumers what has not been disclosed in the past. More information equals better informed and more educated consumers which leads to more informed choices. Which leads to realizations of efficiencies. Which leads to more equalization of prices at similar levels of services. And so on.

Only in the last few years have we had this kind of thing help improve the flow of information and empower people to make different decisions.

What are you talking about? I've been taking various prescription medicines for about four decades. I've always been able to call up the local pharmacy and ask them how much it would cost to fill a prescription.

More information equals better informed and more educated consumers which leads to more informed choices. Which leads to realizations of efficiencies. Which leads to more equalization of prices at similar levels of services.

Only if the patient is paying the prices. If they're not, they're going to be largely indifferent to information about prices. The people who are paying for the services will be very responsive to price information....but they already have the price information. So it's pretty likely that informing patients of prices will do absolutely nothing, because they're not the market participant that's the "consumer" that the price information would have an effect on....

What are you talking about? I've been taking various prescription medicines for about four decades. I've always been able to call up the local pharmacy and ask them how much it would cost to fill a prescription.

So you've been able to compare name brands to generics across mail order and retail pharmacies plus Amazon over 40 years? Wow. I'm impressed.

Only if the patient is paying the prices. If they're not, they're going to be largely indifferent to information about prices.

And this is where insurers will start providing incentives to consumers, won't they?

So you've been able to compare name brands to generics across mail order and retail pharmacies plus Amazon over 40 years? Wow. I'm impressed.

No - I've been able to get price information for 40 years. There have been innovations in the way that I can compare prices across multiple retailers for any product, but those are general to retail and not limited to drugs. Forty years ago I couldn't compare name brands to generics across mail order and retail stores for clothes or canned soup or what have you, either - that was a limitation of the retail chain, not price transparency.

And this is where insurers will start providing incentives to consumers, won't they?

No. Because it's not worth it to them to add that layer of complication. Health care insurance customers are already overwhelmed and unhappy with how complicated things even without having to deal with the firehose of information you'd need to make an informed decision about pricing of most medical services, and health care insurance providers face enough administrative costs in dealing with the logistics of administering these plans. It's not going to be worth it to do that.

How do we know that? Because health insurers already have all that information. Remember, all these prices are very transparent to the insurance company. They're the ones who decide in advance whether to pay those prices for those services from those providers. Heck, in a lot of cases they're directly involved in the process of setting those prices, because they often negotiate rather than function as price-takers.

So it's already a trivial matter if a health insurer wanted to provide pricing to their enrollees and provide some discount if they were willing to go to the low cost provider. But we don't see health insurers doing this. At all. Why not? Well, when all the companies offering a product (like health insurance) uniformly decide not to do something, it's typically because it's not worth it to them to do it. If they could reduce their outlays (and thus increase their profits) by getting their customers to choose the $1,200 doctor instead of the $1,300 doctor, it would be quite surprising if they didn't. The most likely explanation is that it wouldn't save any money - that the costs of administering that kind of program (direct in administrative and transactional costs and the rebate to customers, indirect in the form of customer frustration and annoyance) outweigh the economic gains.

You want the real world illustration of millions and millions of products? Haggling. When you go into a supermarket, there is one price for any particular good. That 12oz can of Diet Coke has a price on the label, and that's what you pay. You don't get to negotiate, you don't get to buy products you would buy if the price were 10% cheaper (and the retailer loses a sale they might be willing to make). You get some loss of efficiency in pricing because you don't exactly match every point on the supply curve to every point on the demand curve, but instead just have "one price fits all." But the reason that millions of firms do that for millions of products is because the transaction costs of seeking out that perfect price efficiency are higher than the gains they would see from the perfect price efficiency. Heck, it's why Disney World went from a "per-ride" pricing model to a singe entrance fee, all-you-can-ride model - sometimes it's just a more efficient way to sell your product to not be constantly bargaining everything.

So too with health care. The business model is that you pay your premium, and it covers everything that's covered. You don't have to worry about the pricing, and the insurer doesn't choose to involve you with the pricing even though they could. Because the cost of doing that isn't worth the pennies that would be saved.

There have been innovations in the way that I can compare prices across multiple retailers for any product, but those are general to retail and not limited to drugs. Forty years ago I couldn't compare name brands to generics across mail order and retail stores

I have been buying prescriptions for myself for over 50 yrs. I was able to compare prices because I live in MN--which has a vigorous and highly competitive market. How competitive? Costco tried to set up their first Minnesota store near where I lived--in Minneapolis (late 70s or early 80s, I forget which). I checked it out because it was new. However, Costco was forced to close after a year or two because numerous competing retailers and grocery stores ran specials all the time--either meeting or beating Costco prices. That was not atypical for us because there are (or were) a LOT of companies in the various food markets and they ALL wanted a piece of the action. Sam's Club was in suburbia in the 1990s--but not in any city. Costco came back and was successful. The one Walmart in St Paul closed a few years ago. But they are successful in suburbia. I get deliveries from them.

Regarding drugs, the market used to be essentially two types of sellers. One was serving the relative short-term needs of most people--so Walgreens, CVS, and other traditional pharmacies. The other was serving primarily long-term customers who bought a variety of products based on price because that was their way to save money. I bought one drug from Walgreens because I bought a year-plus's supply at one time (400 tablets). Got it for $30. My doctor had no problems issuing such a prescription. In the late 1990s, the bulk resellers were acquired and shut down by various large pharmacies. The death knell for them was the 2003 Medicare reform under GWB. Bulk buying was essentially no longer available. Having drug purchases modestly subsidized by the govt eliminated the ability to buy from a "specialty" pharmacy because it would NOT be included in any network. They undercut the cost of other pharmacies, so they had to be OUT of the network. They closed. Both Amazon and Mark Cuban don't want to touch it unless they choose to only do it within the network. They will NOT challenge the market.

And now you will be performing all the medical treatments for the people who wouldn't have gotten those treatments, either because they lacked insurance/money or were underinsured.

That's going to cost a lot.

But, perhaps, not as much as treating those people in ERs. And there's two elements to that. First, people using ERs for general healthcare (expensive), and people using the ERs because they didn't get treatment when something was minor, and now it's very severe (and more expensive). That's ignoring the issue of ERs packed with non-urgent patients because they can't get care elsewhere.

During the original ACA debates, I recall both are major contributors to expensive healthcare. One example I recall was a guy who had some infection (I think it was an abscess), and he was given two scripts. He couldn't afford both, so he opted for the pain killer over the antibiotic. The infection got to the point that he was in the ICU, on the taxpayer dime, and ended up dying. That's so messed up on so many levels. And we, the taxpayers, paid for it. If he had UHC, and gotten regular care to catch conditions early, it never would have gotten to that point.

Like fixing your car...when the oil light illuminates, put some oil in it. Costs a few bucks. Or, wait until you throw a rod, and pay a couple of thousand to get that fixed (if you don't have to do a complete engine replacement).

Investing a few dollars now saves a fortune later. And patients like the one described will eventually get care. It's usually critical care, and very expensive. We, as a society, are not likely to "let them die". Well...depending on how prevalent MAGA is, maybe we are?

I don't have solid numbers, but I would not be the least bit surprised if it would be a wash in terms of spending. Either care for everyone routinely (relatively cheap), or only care for the people when they become critical and need ERs and ICUs (very expensive).

But, perhaps, not as much as treating those people in ERs.

No - it will be more. Treating people in ER's is pretty expensive for what you're treating - but giving people all the health care that normally gets covered under insurance ends up being a whole lot more. A ton more. Because an enormous amount of health care coverage doesn't qualify for ER coverage. And it's been a really long time since I looked at it, but my recollection was that studies found that ER usage was mostly unaffected by health care expansions to the uninsured.

Because the patients don't eventually get care. That's why it's bad for the people who are uninsured to be uninsured. To use your example, it's really expensive for the government to provide free oil changes to everyone. And they're not going to pay to fix the engine when it throws a rod, then the government doesn't save any money by paying for the oil changes. It's just really really bad for the people whose engines are no longer usable.

Very few preventative care interventions will end up reducing total long term health care costs. There are a few, but most have not been shown to do that:

Are there policies that can both improve health and reduce health care spending in the long run? Is it possible to improve health for free? The answer is occasionally yes, but only in a very limited set of interventions, such as colonoscopy for 60- to 64-year-old men or childhood vaccinations, where the downstream reduction in health care spending more than pays for the intervention itself.1

https://jamanetwork.com/journals/jama-health-forum...

Basic health care is the cheapest way of providing good health, but that is not the same thing as saying that the dollar cost of the preventative health care is lower than the downstream savings on medical interventions later.

Every other developed country in the world has universal healthcare.

That’s not an argument.

Says you. It's an excellent argument. If everyone in the room says you're drunk, believe them, you're drunk.

Lower cost, better outcomes

Better outcomes. Do they?

Yes. U.S. life expectancy is ranked 48th in the world, behind almost every other OECD country.

How many weeks would I have to wait for cardiac bypass surgery, in day, the UK vs. here?

How much does it matter? In the UK if it's critical they'll take you directly from the ER to surgery, without asking you to sign away your life savings. In the U.S. the death rate from heart disease is 73 per 100K. In the UK it's 43.
https://www.worldlifeexpectancy.com/cause-of-death...

You guys don’t want socialized medicine.

You bet we do.

Elan

Says you. It's an excellent argument. If everyone in the room says you're drunk, believe them, you're drunk.

So when every other teenager huffs Tide Pods and steals Hyundais because TikTok said so, that's what we'll do, I guess!

U.S. life expectancy is ranked 48th in the world, behind almost every other OECD country.


And this is single-sourced traced to the national health care system, is it? I'll answer for you: No, it's not.
Americans don't exercise enough and eat too much junky, processed crap. We have some of the highest rates of highly preventable diseases in the world:

https://www.heart.org/-/media/PHD-Files-2/Science-...

Physical Inactivity
• In 2020, the overall prevalence of meeting the 2018 Physical Activity Guidelines for
Americans for aerobic activity was 24.2% in US adults.
• Among US high school students in 2019, 44.1% were physically active for 60 minutes or
more on at least 5 days of the week.
Nutrition
• Using the AHA’s Life’s Essential 8 scoring metric, diet was among the 4 metrics with the
lowest scores; the range for diet across demographic groups was 23.8 to 47.7 out of
100.
Unless otherwise noted, all statistics in this document pertain to the United States. Please refer to the complete Statistics Update for
references and additional information for reported statistics.
©2024 American Heart Association, Inc. All rights reserved. Unauthorized use prohibited.
2024 Statistics Update – At-a-Glance Statistics
• Among children 2 to 5 years of age, a mean diet score of 61.1 out of 100 was observed.
The score for children 12 to 19 years of age was 28.5 out of 100.
• Using 2019 data, an estimated 7.9 million deaths and 188 million disability-adjusted life
years were attributable to dietary risks. The leading dietary risk factors were high
sodium intake, low whole grain intake, and low legume intake.

As they say in the fitness world, you can't outrun a bad diet. Give all these people all the free health care and watch them drive to McDonald's and eat chicken McNuggets from the couch.

You bet we do.

Then move some place that has it, 'cause you ain't getting it here.

BTW this socialized medicine stuff is eerily similar to what the housing-first and "harm reduction" people say with respect to homeless drug addicts: They just need free housing. Housing is a human right.

You know what you get when you take a drug addict off the street and give them a nice apartment? A drug addict who destroys a nice apartment and winds up either out on the streets again or dead.

Same thing with your socialized medicine. Take some guy that's never exercised a day in his life and eats donuts for dinner and give him free health care. He either strokes out or drops dead from an MI at the exact same rate than before he had single-payer insurance.


Neither thing the advocates advocate for address the root causes.

You guys don’t want socialized medicine.

I have heard versions of this statement many times. But the people when questioned do not want to get rid of medicare for seniors. One sixth of the population already has socialised medicine.

Instead of asking how long for a bypass surgery in the UK, the question should be how long in the US for a person over 65 compared to a person under 65. Of course the answer doesn't support their position so it's ignored.

Aussi

I have heard versions of this statement many times. But the people when questioned do not want to get rid of medicare for seniors. One sixth of the population already has socialised medicine.

Because it's too entrenched in the system and they've been paying for it their entire lives. Fans of socialized medicine point to this and try to claim victory while conveniently forgetting none of these people ever had a choice.

The bottom line on single payer is that we can't afford it. I realize this board tends to ignore facts it doesn't like and just repeats a desire for a thing, but the math here doesn't pencil out.

You bet we do.

Then move some place that has it, 'cause you ain't getting it here.

Nope. This is where I live, and I'm going to fight and vote for what I want. Eventually we'll get it here because it makes sense and it's what most people want, just like we got Medicare and Medicaid and Obamacare and everybody but you loves it. How about if you don't like it, you move to Zimbabwe or some other hellhole and live in your little house on the prairie.

The bottom line on single payer is that we can't afford it. I realize this board tends to ignore facts it doesn't like and just repeats a desire for a thing, but the math here doesn't pencil out.

Really? So every other developed country in the world can afford it but we can't? The richest country in the world can't. The country with the highest cost in the world for medical services can't find a way to reduce those costs. That's the math of someone living under a rock and refusing to look around.

Nope. This is where I live, and I'm going to fight and vote for what I want.

Great. You can pay for it then.

Eventually we'll get it here because it makes sense and it's what most people want, just like we got Medicare and Medicaid and Obamacare and everybody but you loves it.

Uh, huh. You go right ahead and double the federal budget and pray there aren't any other downstream consequences of the federal government seizing control of 20-something percent of GDP. Meanwhile, what's your plan to force people to exercise and eat right? Are you planning on banning Krispy Kremes and Pizza? Mandating fitness standards?

Just saying "I want my socialized medicine" doesn't solve anything.

Really? So every other developed country in the world can afford it but we can't?

Based on the math, yes. I refer you to the numbers earlier in the thread.

That's the math of someone living under a rock and refusing to look around.

Then go do the math. I gave you Vermont upthread. Or you can stand there and wave your hands around.

Uh, huh. You go right ahead and double the federal budget and pray there aren't any other downstream consequences of the federal government seizing control of 20-something percent of GDP.

That's easy. Stop being a welfare state for billionaires corporations and tax cheats. Have them pay their fair share of taxes. Have them pay fair wages so that their employees don't need food stamps. Everything else works out.

Really? So every other developed country in the world can afford it but we can't?

Based on the math, yes.

That's preposterous and you know it.

That's easy. Stop being a welfare state for billionaires corporations and tax cheats. Have them pay their fair share of taxes. Have them pay fair wages so that their employees don't need food stamps. Everything else works out.

Does it, now.
How much revenue does that raise?

That's preposterous and you know it.

The cost estimates are upthread.

They just need free housing. Housing is a human right.

You know what you get when you take a drug addict off the street and give them a nice apartment? A drug addict who destroys a nice apartment and winds up either out on the streets again or dead.

"Finland has significantly reduced homelessness through a "Housing First" approach, which prioritizes providing immediate, permanent housing to individuals experiencing homelessness, regardless of their circumstances. This contrasts with traditional models that require individuals to address personal issues like sobriety or mental health treatment before receiving housing. Finland's success is attributed to a national strategy that combines this housing-first principle with increased affordable housing and robust support services."

Same thing with your socialized medicine. Take some guy that's never exercised a day in his life and eats donuts for dinner and give him free health care. He either strokes out or drops dead from an MI at the exact same rate than before he had single-payer insurance.

"Socialized medicine, particularly universal healthcare, is associated with increased life expectancy, primarily by improving access to care, reducing healthcare costs, and promoting public health initiatives. This is often achieved by guaranteeing coverage, enabling access to preventive and early-intervention care, and potentially lowering costs for individuals."

You once lectured me on "the Nordic System" remember?

You once lectured me on "the Nordic System" remember?

Let's see if his memory is better than Spankee's....

You once lectured me on "the Nordic System" remember?

I did. Recall what I said?

You once lectured me on "the Nordic System" remember?

I did. Recall what I said?

You knew little about it, just used it as a springboard.

You knew more than you. That’s right.

I drop out for a few days, and come back to the Putin debate still raging (because Dope can't admit when he's wrong...or at least not so far as I've read). But this is a good topic!

It's an excellent argument. If everyone in the room says you're drunk, believe them, you're drunk.

Yep. Good analogy.

U.S. life expectancy is ranked 48th in the world, behind almost every other OECD country.

Haven't read all the replies, so maybe someone else covered this. But, to be fair, there are a lot of factors affecting life expectancy. I don't think we can ignore the sedentary lifestyle (I'm guilty too!), and bad diet of the typical USian. The Japanese diet, for example, is vastly different than ours, with a lot more seafood. And most aren't as reliant on the automobile, so people do a lot of walking in other countries. So, while your statement is perfectly accurate, there is a lot of stuff to unpack in that statistic. It's not just that we don't have UHC, even if that may be one factor in that statistic.

You guys don’t want socialized medicine.

You bet we do.

Yes, we do. I know someone who is on Medicare and Medicaid. When she goes to the doctor, she almost never gets a bill. Not even a copay. She couldn't afford to go to the doctor if it were any other way. I'll spare you her life story, but she was poor her whole life and had little savings. She had to have a surgery a few years ago, without which she would have died in agony. I believe it was covered with $0 out of pocket for her.

That's how medicine should be.

(because Dope can't admit when he's wrong...or at least not so far as I've read).

Wrong about what? Just because a collection of liberals says a thing...

Yes, we do.

No, you don't.
Health care isn't a thing that other people just pay for. If you believe that "Health Care is a human right" (as almost all leftists do) then you need to accept that with rights come responsibilities.

For the privilege of having everybody else pay for your health care, then that means they have skin in the game for your health care.

Are you people sure you want that?

Because if you do, then get ready for mandatory PE class...when you're 65.

Yes, we do. I know someone who is on Medicare and Medicaid. When she goes to the doctor, she almost never gets a bill. Not even a copay. She couldn't afford to go to the doctor if it were any other way. I'll spare you her life story, but she was poor her whole life and had little savings. She had to have a surgery a few years ago, without which she would have died in agony. I believe it was covered with $0 out of pocket for her.

That's how medicine should be.

And that's the truth. Even though I don't think we can get there from here - due to being to far down the road and it would be a hug unwanted shock to the economics and people's lives, I recognize we went the wrong direction. We made a mistake.

Wrong about what?

I'd say you're wrong about roughly 70% of it. Your view of the war in Ukraine is simplistic, emphasizing "dudes" a lot. Sure, it's a factor. But, as many have tried to show you, you're not seeing the entire picture. It's a lot more complex than "guns and dudes". I could go on for pages and pages about it, from corruption (which weakens your military) to incompetence (e.g. bad planning) to arrogance (yes, arrogance is actually a factor in many wars).

I do agree with you that the west needs to inflict more pain on Russia (without actually escalating, as that would cause more problems than it solves). Tariffs on allies, and inviting a pariah leader onto your soil for a face-to-face isn't inflicting more pain on Russia.

If you really want to go into deep dives, listen to Perun. He cites all his sources (including Oryx, a defense analysis organization), has contacts in various think tanks and military organizations, and actually gets invited to weapons shows (where they show off their latest tank, or missile, or whatever). It would take a long time for you to come up to speed, but if you really want to do it, he's a great source. His emphasis is defense economics, and since most wars are fought over economics, that's a really good perspective.

No, you don't.
Health care isn't a thing that other people just pay for. If you believe that "Health Care is a human right" (as almost all leftists do) then you need to accept that with rights come responsibilities.

For the privilege of having everybody else pay for your health care, then that means they have skin in the game for your health care.

Are you people sure you want that?

Because if you do, then get ready for mandatory PE class...when you're 65.

Yes, I do.

You bring up a good point about "skin in the game". However, there are some pretty easy solutions to most of that. For example, we already charge taxes on tobacco. Those taxes could be (should be!) directed to the UHC system (if we had one). Keep in mind, all those monies going to insurance companies would cease. I had to buy a benefit plan at work. Heavily discounted, but I had to pay. Plus the company had to pay. All that cash could go to a UHC system, and it would have been transparent to me. If I think only had to do a $20 copay for any visit, that would have been an obvious plus for me.

I go back and forth about healthcare (and also food) being a "human right". It's pretty much mandatory during every person's lifetime. Eventually, you will need it, just as much as food and water. It's a very basic need. Depending on how you define a "right", it could be. I think any coherent defintion of a "right" would include not being subjected to beatings and being killed, not being owned as chattel, etc. Beyond that, define what is a "right".

However, that's just semantics. No sane society should allow people to go into debt just because they have a medical condition, or are in an accident, or whatever else that requires medical attention. The person I mentioned before, one could argue that there should be some sort of copay. Maybe $20? Just enough so they think "yeah, it's worth $20 to find out what is going on with me". I'd be OK with that, and I think most people would. I'm sure she would have been. I'm not OK with people not being able to afford care early, and so they become acute before they seek attention (at which point it is a LOT more expensive, and they could die anyway). Or going broke to treat their child, often having to reach poverty levels before they "qualify" for any sort of assistance. That system is insane, but that's the one we have right now.

Maybe $20? Just enough so they think "yeah, it's worth $20 to find out what is going on with me". I'd be OK with that, and I think most people would. I'm sure she would have been. I'm not OK with people not being able to afford care early, and so they become acute before they seek attention (at which point it is a LOT more expensive, and they could die anyway). Or going broke to treat their child, often having to reach poverty levels before they "qualify" for any sort of assistance. That system is insane, but that's the one we have right now.

Yah, I think $20 now is reasonable - as long as there's ways for the destitute. I just think access to health care is a key, but when someone has a reversal of fortune, we need to be able to recognize that. I was talking with a clerical fellow at work and found out he'd dropped his health care due to a reversal of fortune. He had type 2 diabetes. People who knew him said he had been having troubles physically, surgeries, then dropped his health care as it was too expensive. He didn't want to talk to me about the details. He had really lowered his meds (possibly eliminated them). Wasn't measuring his blood sugar. He was dead 6-9 months later.

For the privilege of having everybody else pay for your health care, then that means they have skin in the game for your health care.

Are you people sure you want that?

Are you sure you do NOT want others to help pay your bills? Because that is exactly what PRIVATE INSURANCE DOES. It includes ALL INSURANCE, not just health insurance. One insurance that is mandatory is work compensation. We do NOT see you objecting to that *type of universal mandatory single-payer* insurance.

The definition of Universal Health Care is inclusive of everyone, not just a selected segment of the entire marketplace.

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