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I'm not sure it needs to be like that. Most developed nations have a public health system. Akin to how the US has public schools and emergency services. The r

I'm not sure it needs to be like that. Most developed nations have a public health system. Akin to how the US has public schools and emergency services. The revolution could be the government bitting the bullet, and spending a fortune on bootstrapping a public health system that undermines insurance and private health. Yes, it will hurt that sector a lot, it won't happen overnight, it will cause huge deficits, and it will inevitably cause higher taxation. But it's ultimately what needs to be done. We just need to give up on the sunk cost fallacy and go with proven models.

saagarjha 7y ago
Any plan like that is going to have a portion where you convince the part of the country openly hostile to it that you're not bringing in socialism.
- jakeogh 7y ago
  Having the gov decide who gets what care is incompatible with a free society. Alfie Evans is a striking example.
  - lazyasciiart 7y ago
    A "free society" doesn't require that parents be given free reign to torture their children. You may wish to argue whether that's what was happening, but that's the reasoning the state gave for their actions. If you'd like to argue that a free society does require this, go ahead, but I don't think most people agree.
    - jakeogh 7y ago
      The "state says" excuse? That's free to you? There was absolutely nothing wrong with his parents. The state in that case forbid them from accepting help and decided to (frankly) murder the person.
      - onion2k 7y ago
        Alfie's doctors made the decision that taking him from hospital for an experimental treatment in a different country had a strong chance of killing him, and that he was better off dying peacefully and not in pain in the UK. Alfie's parents fought to try and save his life at any cost even if it meant he went through tortuous pain first. Frankly both sides of the argument are understandable. No one wants a child to suffer but no parent wants to give up on their baby. It's a tragic case. It's also an exception. Using it as the basis of how you decide 99.999% of other medical cases is idiotic, and using Alfie's memory as a tool to promote a particular system of healthcare payment is obscene and shameful. Just remember this - for every case like Alfie's where there genuinely are two sides to consider there are millions more where the doctors are simply right. Setting a precedent that parents wishes automatically overrule the doctors would cause so many children to suffer. This is why we let doctors and courts make decisions - to save children from stupid parents.
        jakeogh 7y ago
        "taking him from hospital for an experimental treatment in a different country had a strong chance of killing him" ...so they killed him. The excuse about "dying peacefully and not in pain" is junk. Clearly he can be sedated, and that isn't an argument for letting the state kill people without trial anyway. Parents already overrule doctors on end of life care, try telling an American parent that you are going to lethally inject their child against their wishes (setting aside the obvious that murder is still illegal here). You excuse it as an exception. How many exceptions would it take for you to have a problem with it?
        onion2k 7y ago
        Clearly he can be sedated, and that isn't an argument for letting the state kill people without trial anyway. Just to clarify, the state didn't kill him. He died of GABA-transaminase deficiency, which was only diagnosed after he died. The treatment that his parents wanted to try was a shot in the dark. No one knew what was wrong with Alfie. You are arguing that taking a child from hospital, causing him more pain and suffering, putting him through a frightening and scary procedure, that has no basis in medicinal science (as there's no way to know if it'll cure an undiagnosed problem) is better than letting him die peacefully, safely and surrounded with love. You can take a "life at any cost" point of view but the UK Court didn't. It took the view that a pain free and caring death was better than an agonising and highly unlikely long shot.
  - pjc50 7y ago
    The Alfie Evans case could well have had the same outcome with fully private care, since it was a case about the rights of the child rather than about funding for treatment. (Besides, we can probably find a lot more cases of dead children in the US where they were simply denied or unable to afford coverage ...)
    - jakeogh 7y ago
      I agree. Thanks. It was a mistake to use his case as an example of my concern.
  - DanBC 7y ago
    In the US the doctors would have done exactly the same thing: they would have proposed a treatment plan; the parents would have disagreed; the doctors would have gone to court and probably would have won. But in the US there would have been the additional funding step: the parents would have had to get insurance companies to pay for futile treatment, and no compnay would do so, or the parents would have had to crowd-fund this treatment. Here, for anyone interested, are some of the legal documents (in date order) around the Alfie Evans case. They clearly show that parents have a right to a family life and to care for their child as they see fit, but that this right isn't total because the child is also human and has his own human rights. The paramountcy principle mean that the rights of the child come before the rights of the parents. Please note that because of the involvement of the Christian Legal Centre in some of the court cases there's been a lot of misinformation spread about the case. I know that there's nothing I can say to change your mind: you have an ideological viewpoint, and that's okay. But I think you should at least acknowledge that your opinion is not based on fact. https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC/Fam/2018/308.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC... https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA/Civ/2018/550.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA... https://www.bailii.org/cgi-bin/format.cgi?doc=/eu/cases/ECHR/2018/297.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/eu/cases/ECHR... https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC/Fam/2018/818.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC... https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA/Civ/2018/805.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA... https://www.bailii.org/cgi-bin/format.cgi?doc=/eu/cases/ECHR/2018/357.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/eu/cases/ECHR... https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC/Fam/2018/953.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC... https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA/Civ/2018/984.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA... https://www.supremecourt.uk/docs/in-the-matter-of-alfie-evans-court-order.pdf https://www.supremecourt.uk/docs/in-the-matter-of-alfie-evan...
    - jakeogh 7y ago
- flyingpenguin 7y ago
  Or convince them there is nothing more wrong with socialism than capitalism and the world needs more balance and nuance.
- Tracist 7y ago
  seems like its an education or media-bias problem more than a healthcare problem. If a majority of the poor in America are not educated enough to understand how public healthcare will benefit them and the country, or are educated enough to understand but not educated enough to realise media outlets have a politcal agenda and might not be reporting accurately, then public healthcare is still not going to happen. (and they might not want socialism, but it seems like they dont understand that democracy has problems too. and healthcare is the living example. but again, it circles back around to being educated enough to understand that democracy is good, but it isnt perfect, and no system is)
  - brewdad 7y ago
    See, even someone who should know better gets the argument confused. Socialism is not opposing democracy. Much of Europe is more socialist than the US and have democracies as strong or stronger than the US.
    - Tracist 7y ago
      Too true! I'm college educated but (in my defence) not American, so I'm not surprised I got the details confused.
  - ajmurmann 7y ago
    > and they might not want socialism, but it seems like they dont understand that democracy has problems too Isn't the contrast between capitalism and socialism? It seems like I could have democracy with either. Of course it doesn't help the conversation that Americans use term socialism differently than Europeans or Marx himself did.
gizmo686 7y ago
At some point, you need to decide if you want a revolution or incrementalism. We already have a public healthcare system, it is called medicare. We can expand medicare so that private insurance takes up a smaller segment of the total market. I believe that approach will provide incremental improvement and give policy makers leverage for further incremental improvement, but it is not a revolution. While many of our politicians are talking about revolution, what they are all proposing is incrementalism. The reason for that is very simple; revolution is a bad idea and incrementalism has a proven track record of working. As an aside, medicare-for-all is still a long way away from a public healthcare system; it makes one area of the healthcare system public.
- jeswin 7y ago
  > The reason for that is very simple; revolution is a bad idea and incrementalism has a proven track record of working. Is there any empirical evidence to back this up? There are enough successful examples of revolution and incrementalism from around the world, but I can't find stats.
- ars 7y ago
  > We already have a public healthcare system, it is called medicare. We can expand medicare No we can't. Medicare pays below cost of care, and hospitals make it up from private payers. You can't just switch everyone to Medicare, you would have to reduce expenses somehow (which means firing people).
  - cheerlessbog 7y ago
    Perhaps it just pays realistic prices and "below cost of care" is the provider's way of saying "reduces the income I am accustomed to.". The regular pricing also builds in an assumption that some patients can't or won't pay. If they can more easily get Medicare, less padding is necessary.
    - ars 7y ago
      > is the provider's way of saying "reduces the income I am accustomed to.". The "provider" is not a single person. So to reduce the income of the organization, you have to fire people or reduce their salary. I think you are thinking you can reduce their profits, but you can't. Instead if you feel they are charging to much, that directly translates into lost jobs or lower pay. It might be necessary, but just as long as you know what you are advocating. Can you imagine a politician running on a platform of firing healthcare workers?
DoreenMichele 7y ago
and spending a fortune on bootstrapping a public health system that undermines insurance and private health. I think we could start by expanding military medical benefits. For example, give lifetime benefits to all honorably discharged service members, not just those who made it to retirement. We already have a government funded and run system. It has some excellent assets, such as Walter Reed, a research facility. We could just start quietly expanding that in a way that people could get on board with. (Changed "honorably discharged veterans" to "honorably discharged service members" for clarity.)
- koolba 7y ago
  I’d rather go the other direction and expand Medicaid by allowing anyone to “buy in” to it regardless of income level.
  - deleted 7y ago
    [deleted]
- sailfast 7y ago
  We already have a system for that called the VA. Their track record over the last ten years in providing care is pretty abysmal. I am not confident your suggestion would result in a different outcome but I’m open to ideas.
  - r00fus 7y ago
    That’s mostly because we started two wars without costing in the trillions it would cost to care for battle vets. Then we continued to underfund the VA. It’s only logical that it’s where it is. Some of us foretold this from before the wars.
    - TheBeardKing 7y ago
      And the VA is run by government employees, which are just not cost efficient. Source: I am one and work with thousands of them.
Spooky23 7y ago
It won’t happen. If you visit different cities in the US, not the big 5, look around at the buildings in the central business district. Usually you’ll see a couple of regional banks, the local big bank outpost, and insurance companies. That’s lots of money and lots of jobs, lots of votes. Unlike banking, the arcane processes actually created more middle class jobs while banks nuked jobs over the last 30 years. If Clinton couldn’t push universal care in the 90s, nobody is going to do it in the foreseeable future.
joe_the_user 7y ago
The revolution could be the government bitting the bullet, and spending a fortune on bootstrapping a public health system that undermines insurance and private health. Or, uh, "Medicare for all", since medicare is an existing, functional single payer system (not actual "public health system" but still, there, works already for a significant fraction of the population, is an existing proposal. We just need to give up on the sunk cost fallacy and go with proven models. This, definitely. It's worth saying "sunk cost" arguments often go more with entrenched interests than any actual benefit. Unfortunately, this doesn't make them easier to counter.
ArtDev 7y ago
High salaries are justified by the absurd cost of medical school. A solution would be to create new public medical schools where tiotion a fraction of the price. Publicly trained doctors can work at cheaper public hospitals. There is a lot of profit in medicine yet almost no competition around prices. The simplest fastest solution, for now, is to pass a law requiring transparent prices!

saagarjha 7y ago

Any plan like that is going to have a portion where you convince the part of the country openly hostile to it that you're not bringing in socialism.

jakeogh 7y ago
Having the gov decide who gets what care is incompatible with a free society. Alfie Evans is a striking example.
- lazyasciiart 7y ago
  A "free society" doesn't require that parents be given free reign to torture their children. You may wish to argue whether that's what was happening, but that's the reasoning the state gave for their actions. If you'd like to argue that a free society does require this, go ahead, but I don't think most people agree.
  - jakeogh 7y ago
    The "state says" excuse? That's free to you? There was absolutely nothing wrong with his parents. The state in that case forbid them from accepting help and decided to (frankly) murder the person.
    - onion2k 7y ago
      Alfie's doctors made the decision that taking him from hospital for an experimental treatment in a different country had a strong chance of killing him, and that he was better off dying peacefully and not in pain in the UK. Alfie's parents fought to try and save his life at any cost even if it meant he went through tortuous pain first. Frankly both sides of the argument are understandable. No one wants a child to suffer but no parent wants to give up on their baby. It's a tragic case. It's also an exception. Using it as the basis of how you decide 99.999% of other medical cases is idiotic, and using Alfie's memory as a tool to promote a particular system of healthcare payment is obscene and shameful. Just remember this - for every case like Alfie's where there genuinely are two sides to consider there are millions more where the doctors are simply right. Setting a precedent that parents wishes automatically overrule the doctors would cause so many children to suffer. This is why we let doctors and courts make decisions - to save children from stupid parents.
      - jakeogh 7y ago
        "taking him from hospital for an experimental treatment in a different country had a strong chance of killing him" ...so they killed him. The excuse about "dying peacefully and not in pain" is junk. Clearly he can be sedated, and that isn't an argument for letting the state kill people without trial anyway. Parents already overrule doctors on end of life care, try telling an American parent that you are going to lethally inject their child against their wishes (setting aside the obvious that murder is still illegal here). You excuse it as an exception. How many exceptions would it take for you to have a problem with it?
        onion2k 7y ago
        Clearly he can be sedated, and that isn't an argument for letting the state kill people without trial anyway. Just to clarify, the state didn't kill him. He died of GABA-transaminase deficiency, which was only diagnosed after he died. The treatment that his parents wanted to try was a shot in the dark. No one knew what was wrong with Alfie. You are arguing that taking a child from hospital, causing him more pain and suffering, putting him through a frightening and scary procedure, that has no basis in medicinal science (as there's no way to know if it'll cure an undiagnosed problem) is better than letting him die peacefully, safely and surrounded with love. You can take a "life at any cost" point of view but the UK Court didn't. It took the view that a pain free and caring death was better than an agonising and highly unlikely long shot.
- pjc50 7y ago
  The Alfie Evans case could well have had the same outcome with fully private care, since it was a case about the rights of the child rather than about funding for treatment. (Besides, we can probably find a lot more cases of dead children in the US where they were simply denied or unable to afford coverage ...)
  - jakeogh 7y ago
    I agree. Thanks. It was a mistake to use his case as an example of my concern.
- DanBC 7y ago
  In the US the doctors would have done exactly the same thing: they would have proposed a treatment plan; the parents would have disagreed; the doctors would have gone to court and probably would have won. But in the US there would have been the additional funding step: the parents would have had to get insurance companies to pay for futile treatment, and no compnay would do so, or the parents would have had to crowd-fund this treatment. Here, for anyone interested, are some of the legal documents (in date order) around the Alfie Evans case. They clearly show that parents have a right to a family life and to care for their child as they see fit, but that this right isn't total because the child is also human and has his own human rights. The paramountcy principle mean that the rights of the child come before the rights of the parents. Please note that because of the involvement of the Christian Legal Centre in some of the court cases there's been a lot of misinformation spread about the case. I know that there's nothing I can say to change your mind: you have an ideological viewpoint, and that's okay. But I think you should at least acknowledge that your opinion is not based on fact. https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC/Fam/2018/308.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC... https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA/Civ/2018/550.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA... https://www.bailii.org/cgi-bin/format.cgi?doc=/eu/cases/ECHR/2018/297.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/eu/cases/ECHR... https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC/Fam/2018/818.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC... https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA/Civ/2018/805.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA... https://www.bailii.org/cgi-bin/format.cgi?doc=/eu/cases/ECHR/2018/357.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/eu/cases/ECHR... https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC/Fam/2018/953.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWHC... https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA/Civ/2018/984.html&query=(alfi)+AND+(evans) https://www.bailii.org/cgi-bin/format.cgi?doc=/ew/cases/EWCA... https://www.supremecourt.uk/docs/in-the-matter-of-alfie-evans-court-order.pdf https://www.supremecourt.uk/docs/in-the-matter-of-alfie-evan...
  - jakeogh 7y ago
flyingpenguin 7y ago
Or convince them there is nothing more wrong with socialism than capitalism and the world needs more balance and nuance.
Tracist 7y ago
seems like its an education or media-bias problem more than a healthcare problem. If a majority of the poor in America are not educated enough to understand how public healthcare will benefit them and the country, or are educated enough to understand but not educated enough to realise media outlets have a politcal agenda and might not be reporting accurately, then public healthcare is still not going to happen. (and they might not want socialism, but it seems like they dont understand that democracy has problems too. and healthcare is the living example. but again, it circles back around to being educated enough to understand that democracy is good, but it isnt perfect, and no system is)
- brewdad 7y ago
  See, even someone who should know better gets the argument confused. Socialism is not opposing democracy. Much of Europe is more socialist than the US and have democracies as strong or stronger than the US.
  - Tracist 7y ago
    Too true! I'm college educated but (in my defence) not American, so I'm not surprised I got the details confused.
- ajmurmann 7y ago
  > and they might not want socialism, but it seems like they dont understand that democracy has problems too Isn't the contrast between capitalism and socialism? It seems like I could have democracy with either. Of course it doesn't help the conversation that Americans use term socialism differently than Europeans or Marx himself did.

gizmo686 7y ago

At some point, you need to decide if you want a revolution or incrementalism. We already have a public healthcare system, it is called medicare. We can expand medicare so that private insurance takes up a smaller segment of the total market. I believe that approach will provide incremental improvement and give policy makers leverage for further incremental improvement, but it is not a revolution. While many of our politicians are talking about revolution, what they are all proposing is incrementalism. The reason for that is very simple; revolution is a bad idea and incrementalism has a proven track record of working. As an aside, medicare-for-all is still a long way away from a public healthcare system; it makes one area of the healthcare system public.

jeswin 7y ago
> The reason for that is very simple; revolution is a bad idea and incrementalism has a proven track record of working. Is there any empirical evidence to back this up? There are enough successful examples of revolution and incrementalism from around the world, but I can't find stats.
ars 7y ago
> We already have a public healthcare system, it is called medicare. We can expand medicare No we can't. Medicare pays below cost of care, and hospitals make it up from private payers. You can't just switch everyone to Medicare, you would have to reduce expenses somehow (which means firing people).
- cheerlessbog 7y ago
  Perhaps it just pays realistic prices and "below cost of care" is the provider's way of saying "reduces the income I am accustomed to.". The regular pricing also builds in an assumption that some patients can't or won't pay. If they can more easily get Medicare, less padding is necessary.
  - ars 7y ago
    > is the provider's way of saying "reduces the income I am accustomed to.". The "provider" is not a single person. So to reduce the income of the organization, you have to fire people or reduce their salary. I think you are thinking you can reduce their profits, but you can't. Instead if you feel they are charging to much, that directly translates into lost jobs or lower pay. It might be necessary, but just as long as you know what you are advocating. Can you imagine a politician running on a platform of firing healthcare workers?

DoreenMichele 7y ago

and spending a fortune on bootstrapping a public health system that undermines insurance and private health. I think we could start by expanding military medical benefits. For example, give lifetime benefits to all honorably discharged service members, not just those who made it to retirement. We already have a government funded and run system. It has some excellent assets, such as Walter Reed, a research facility. We could just start quietly expanding that in a way that people could get on board with. (Changed "honorably discharged veterans" to "honorably discharged service members" for clarity.)

koolba 7y ago
I’d rather go the other direction and expand Medicaid by allowing anyone to “buy in” to it regardless of income level.
- deleted 7y ago
  [deleted]
sailfast 7y ago
We already have a system for that called the VA. Their track record over the last ten years in providing care is pretty abysmal. I am not confident your suggestion would result in a different outcome but I’m open to ideas.
- r00fus 7y ago
  That’s mostly because we started two wars without costing in the trillions it would cost to care for battle vets. Then we continued to underfund the VA. It’s only logical that it’s where it is. Some of us foretold this from before the wars.
  - TheBeardKing 7y ago
    And the VA is run by government employees, which are just not cost efficient. Source: I am one and work with thousands of them.

Spooky23 7y ago

It won’t happen. If you visit different cities in the US, not the big 5, look around at the buildings in the central business district. Usually you’ll see a couple of regional banks, the local big bank outpost, and insurance companies. That’s lots of money and lots of jobs, lots of votes. Unlike banking, the arcane processes actually created more middle class jobs while banks nuked jobs over the last 30 years. If Clinton couldn’t push universal care in the 90s, nobody is going to do it in the foreseeable future.

joe_the_user 7y ago

The revolution could be the government bitting the bullet, and spending a fortune on bootstrapping a public health system that undermines insurance and private health. Or, uh, "Medicare for all", since medicare is an existing, functional single payer system (not actual "public health system" but still, there, works already for a significant fraction of the population, is an existing proposal. We just need to give up on the sunk cost fallacy and go with proven models. This, definitely. It's worth saying "sunk cost" arguments often go more with entrenched interests than any actual benefit. Unfortunately, this doesn't make them easier to counter.

ArtDev 7y ago

High salaries are justified by the absurd cost of medical school. A solution would be to create new public medical schools where tiotion a fraction of the price. Publicly trained doctors can work at cheaper public hospitals. There is a lot of profit in medicine yet almost no competition around prices. The simplest fastest solution, for now, is to pass a law requiring transparent prices!