The strange greatness of Donald Trump

[Sparko]

I'm not sure why that gave me a sudden thought but

Australia switched from a "free" medical system at doctors surgeries to a "co-payment" (where the patients pay part of the bill) system a few years ago. Hospitals still provide free care, and a scant few doctors continue with the underpaid government funding. Ramping suddenly became a problem here a couple of years ago: it ballooned suddenly from an almost unheard of event to nearly a daily event. Just did a check of national news for hospital ramping, same thing happened earlier in other states, which seem to have had a bit more of a problem with ramping before the change in health policy. Not that it is possible to draw a cause and effect conclusion - but it is food for thought.

what is "ramping?"

[carpedm9587]

I'm not sure why that gave me a sudden thought but

Australia switched from a "free" medical system at doctors surgeries to a "co-payment" (where the patients pay part of the bill) system a few years ago. Hospitals still provide free care, and a scant few doctors continue with the underpaid government funding. Ramping suddenly became a problem here a couple of years ago: it ballooned suddenly from an almost unheard of event to nearly a daily event. Just did a check of national news for hospital ramping, same thing happened earlier in other states, which seem to have had a bit more of a problem with ramping before the change in health policy. Not that it is possible to draw a cause and effect conclusion - but it is food for thought.

You're suggesting that people ramped up their use of medical services because now they had the privilege of paying for some of it?

[Cow Poke]

The ACA was a good first start, but had some significant flaws.....

Perhaps if Obama had kept his promise to publicize the healthcare debate

[carpedm9587]

Perhaps if Obama had kept his promise to publicize the healthcare debate

Yeah, well, two sides to every argument. The argument from the other side is that every attempt to open the discussion resulted in continuous attempts to thwart progress and kill the initiative. Given the "we can't let Obama succeed" POV of the Republicans in Congress, and the commitment to making him a "one term president," I find that a pretty credible claim.

Of course, now the Democrats are doing the same bloody thing with Trump, so

So long as we continue to elect unreasonable and intransigent people - we will get an unreasonable and intransigent government.

[Mountain Man]

Perhaps if Obama had kept his promise to publicize the healthcare debate

He also promised that all legislation would be publicly released 48- to 72-hours so that voters could see exactly what their representatives were up to.

[tabibito]

You're suggesting that people ramped up their use of medical services because now they had the privilege of paying for some of it?

No - doctors surgeries being no longer free, it seems a logical outcome that people on subsistence level incomes would avoid going to the doctors when they first got sick. Some would turn to hospital clinics (which are still "free") which will increase loading in emergency care rooms. Some will wait too long, and wind up being hospitalised - and using ambulance transport perhaps - for things that would have been no trouble with more timely and significantly cheaper treatment. All up - the load gets concentrated on hospitals instead of being distributed across the health care system. Again - chain of thought about possibilities, no data available - though it is perhaps something that should be given serious study.

[seer]

The ACA was a good first start, but had some significant flaws. Instead of setting out to fix those flaws, Trump and the Republicans have been exacerbating them, creating confusion in the healthcare market and skyrocketing costs. They are badly misreading their constituents. ACA popularity has been generally increasing since the end of 2013, moving from less than 37% at that time to over 53% at the end of last year, and that despite the ways it has been undermined. Imagine how much more popular it can be if we get someone in office that focus efforts on fixing its poorly structured parts!

Now "single payer" has become popular with anywhere from 50 to 70% of the electorate, with some polls showing even a majority of GOP constituents favoring it. We'll have to overcome the massive lobbying of the healthcare industry, and the steady drumbeat of the anti-government crowd, but the tide appears to be shifting.

So it is Trump's fault that it is failing, even though it was failing before he ever got into office...

[tabibito]

So it is Trump's fault that it is failing, even though it was failing before he ever got into office...

On this issue - there might be grounds for a qualified "yes."

[carpedm9587]

No - doctors surgeries being no longer free, it seems a logical outcome that people on subsistence level incomes would avoid going to the doctors when they first got sick. Some would turn to hospital clinics (which are still "free") which will increase loading in emergency care rooms. Some will wait too long, and wind up being hospitalised - and using ambulance transport perhaps - for things that would have been no trouble with more timely and significantly cheaper treatment. All up - the load gets concentrated on hospitals instead of being distributed across the health care system. Again - chain of thought about possibilities, no data available - though it is perhaps something that should be given serious study.

Agreed. TO every action there is an equal and opposite reaction. Sometimes, people don't think through the outcomes before they act.

[Mountain Man]

I don't have data for the country as a whole - so all I have is anecdotal from two companies I had direct experience with that did this...

And now we get to watch carpe argue with himself. From earlier in the thread:

I do know that a story is just that: a story. At best it is a single data point. So I typically go looking or some data to affirm or refute the observationsd.

The thing is, we do have the hard. objective data proving that government healthcare simply doesn't work and that it's not just one or two simple tweaks away from being efficient and effective (my favorite summary is that government healthcare operates with the efficiency of the DMV and the compassion of the IRS). I posted this information earlier in the thread, but you ignored it and chose instead to focus on my brief remark at the end.

And why don't we just accept that "everyone should have access to healthcare" is already in place. No doctor or hospital I know of will turn away a person in need of critical medical help. If a poor person is having a heart attack and is taken to the emergency room, they will do the surgery and care for them. Then we will pay for their bill in our inflated premiums. It's an ad hoc system with no real controls. Putting a system in place that acknowledges the universal coverage that exists (for some things) and then creates a structure to actually pay for it is something I would welcome. Healthcare costs are ballooning and out of control.

You've identified the problem, but we also have the data proving that government control of the system is not the solution and quite often makes things worse -- cost controls necessarily result in fewer people covered and/or reduced quality of care. The reality is that healthcare is a limited resource, and the notion that we can offer high quality care to everyone at a low cost is a pipe dream.

[carpedm9587]

So it is Trump's fault that it is failing, even though it was failing before he ever got into office...

I have not seen evidence that "it was failing" before he came in office. How much it was succeeding varied from location to location based on a wide variety of factors. States that did not accept the medicare expansion, for example, saw some pretty bad numbers - and they tended to be Republican states. Here in VT, the picture was pretty good. Premium increases were lower, until Trump took office and threw the market into turmoil. Then we saw premium increases beyond what they were BEFORE the ACA.

As with any such initiative, things were better for some and worse for others. The right tended to highlight the "worse" stories, the left tended to highlight the "best" stories. In general, AFAICT, there was initial resistance and then increasing acceptance. Even today it is not "failing" and it is now more popular than it was unpopular. It still needs attention - and that is not likely until there is a Democrat in the White House. It might even require that there be a trifecta at the Federal level, as there was when Obama first took office. I hate them, but Republicans are so rabid about destroying this act, it might mean needing such a trifecta until it can get fixed.

[carpedm9587]

And now we get to watch carpe argue with himself. From earlier in the thread:

No - we get what I said (which you conveniently deleted - so yet another example of your tendency to cherry pick). For those not reading back, what I said was:

I realize that's just anecdotal - so it doesn't provide a national view. It's possible the behavior differs by region or vertical, and both my examples were from the northeast.

When all we have is anecdotes - that's all we have. Relaying them is not a problem. Making a suggestion (or insisting) that the anecdote indicates what the larger reality is like is the problem - which I explicitly did not do.

The thing is, we do have the hard. objective data proving that government healthcare simply doesn't work and that it's not just one or two simple tweaks away from being efficient and effective (my favorite summary is that government healthcare operates with the efficiency of the DMV and the compassion of the IRS). I posted this information earlier in the thread, but you ignored it and chose instead to focus on my brief remark at the end.

Actually - what you have is cherry-picked data to try to hold to your position. The preponderance of the evidence says just the opposite. Internationally, the countries most satisfied with their healthcare system are generally those with universal coverage. Generally, they are some form of single-payer system. And we have one of the highest per capita cost structures.

And your data does not make the argument you think it does. What it tells us is that the NHS is losing popularity, and has made some moves that the population of the UK does not like/want. Since it is government run, the populace will likely respond to that by voting others into office who will make other decisions - but we will have to see.

From this one-country portrait you are attempting to extrapolate to the rest of the world and all "socialized healthcare systems." Like I said - cherry picking.

You've identified the problem, but we also have the data proving that government control of the system is not the solution and quite often makes things worse -- cost controls necessarily result in fewer people covered and/or reduced quality of care. The reality is that healthcare is a limited resource, and the notion that we can offer high quality care to everyone at a low cost is a pipe dream.

You actually have presented no such data, and at no point did I say we could provide high-quality care to everyone at a low cost, so you're also erecting strawmen.

[Mountain Man]

And your data does not make the argument you think it does. What it tells us is that the NHS is losing popularity, and has made some moves that the population of the UK does not like/want.

The data says a lot more than that. Did you really read the sources, or did you do your own "cherry picking" to only see what you want to see?

And the reason I picked the NHS is because that was the system being discussed. But I've seen similar data throughout Europe, Canada, Cuba, and other countries with government run health systems.

[carpedm9587]

The data says a lot more than that. Did you really read the sources, or did you do your own "cherry picking" to only see what you want to see?

I did, though it is always possible I missed something. What I saw was about the NHS.

And the reason I picked the NHS is because that was the system being discussed. But I've seen similar data throughout Europe, Canada, Cuba, and other countries with government run health systems.

You provided data about the NHS, I responded to data about the NHS. You made sweeping claims about socialized medicine - and the only defense you provided was the NHS. Ergo - your provided data does not make the case you are trying to make. Meanwhile, the data on comparative cost, ratio to GDP, and international rankings of satisfaction with healthcare systems makes exactly the point I've been making: in general there is higher satisfaction with healthcare systems in countries that have socialized their medicine and provided universal coverage. Our system provides for the highest cost per capita (almost twice the next highest), which is even higher when you realize that not all of that "capita" is actually covered.

[guacamole]

It sounds to me like you are arguing that reduced approval of the NHS specifically does not necessarily equate to reduced approval of socialized medicine in general?