2017 American Political Scene

[antimony]

I think you will find it is the American People that run the U.S. and that a U.S. President as powerful as he might be still is nothing in comparison to the will of the American people.

Trump might sound a bit crazy to some but he is going about things as a business man would as example.....for years and years many nations have benefited from massive American Military protection.

These nations especially the Europeans pay very little of their share for their own protection yet complain constantly about the massive U.S. Military presence in their own nations.

Trump went and said..."OK....you don't want us we will simply leave and your own your own but if you DO want us they YOU will have to start paying more for our protection!"

There was a LOT of European Leaders wgo said right at that point....."OH CRAP!! We can't protect ourselves without the U.S......Uhhhh.....so President Trump....how much more do we have to pay?"

LOL!!

A.M.

Could you go to the intro thread and tell us a bit about yourself?

[zraver]

Your metrics of choice (wait times and consumption of medical technology), ignore the fact that US lags in healthcare outcomes severely compared to OECD nations. Also, despite spending more on health care, Americans have fewer hospital and physician visits. Meanwhile, private spending on health care is highest in the U.S. Interestingly, U.S. public spending on health care is high, despite covering fewer residents. This is without including tax exclusion for employer-sponsored health insurance (amounting to about $250 billion each year).

And yet, the US lags behind in life expectancy, infant mortality, obesity, presence of chronic ailments. Here is what was depressingly interesting, the Institute of Medicine found that poorer health in the U.S. was not simply the result of economic, social, or racial and ethnic disadvantages—even well-off, nonsmoking, nonobese Americans appear in worse health than their counterparts abroad.

http://www.commonwealthfund.org/publ...al-perspective



Ah yes, the blacks and browns, because of whom we cannot have nice things like good Healthcare, as articulated so elegantly by Joe Walsh.

Apparently Canada and UK do not have diverse populations. Ali Velshi is actually too nice with this pathetic moron.

Tell me, do minority populations in Canada have the same rates of violence, genetic diseases like sickle cell anemia, rates of lead poisoning, poverty and substance abuse? The Ghosts of Jim Crow are still wreaking havoc on the African American community.

[tbm3fan]

what the GOP is promising is simultaneously more benefits (less costly premiums, lower deductibles), coverage to anyone whom wants it regardless of pre-existing conditions, and "freedom" from any mandate for anyone whom doesn't. all with less government intervention/cost.

Sign me up! I want some of what you have,.... or are smoking

[tbm3fan]

Obamacare has entered its death spiral. Trump was right when he said he should have let it fail and let the Dems take the fall. The only way to save private healthcare in the US is to make the pool healthier. Since you can't force healthy people to pay an extra 20% tax on their income=- move sicker people out of the pools. Chronic cases need to be in a separate pool.

Would you consider diabetes to be a chronic illness? I would as it is for life in case you weren't aware. Are you also aware that in the not to distant future it is expected 54% of the American population will be diagnosed with diabetes or have it and not know it? That is one hell of a separate pool. One that would cost gazillions given what diabetes does to you. While I am all for being healthy, and get on the case of diabetics doing their utmost best to control it and lose weight, people will be people. It is simply frustrating and our food system is complicit.

By the way the young and healthy of today who don't want to be forced to subsidized them will find that 54% of them will be diabetic one day in their middle - older years.

[tbm3fan]

Here is a question: Why do we need to save private healthcare? Why is the focus on that instead of better healthcare?

That would be great but it is so profit driven, by so many special interests in the United States, that it would take a miracle to overcome. Prescription drugs for one have gone through the roof. Some new ones no better than old ones other than cost so Pharma advertises for you to ask for it. Generics which used to be cheap have also gone through the roof. Trying to find an inexpensive generic drug for a patient, who doesn't have drug coverage, can be daunting. I managed to get bacterial conjunctivitis one month ago somehow. Beats me. Spent a day going over generic meds I knew and calling drug stores to find something reasonable. Got one at $25/5 ml bottle at 100 drops. Most just write out an Rx while a few others pay attention to these costs.

Another example/analogy. In the 80's a friend of mine had his own printing business. Not your basic business cards and letterhead but high color stuff for companies like Apple and Intel. That required a 5 color Heidelberg Press which is quite the monster and cost around $250,000 at the time if I am remembering correctly. He knew it had to be in operation 24 hours a day to make a profit at a certain price point. He would lease it out for overnight operations when he wasn't on it. Now every printer could have bought one and two things would have happened. Either they would have gone out of business for lack of volume or all raised their prices sky high. Instead three, they all didn't buy them but would refer jobs out.

An MRI is pretty much the same thing. It should be in use at least 18 hours per day. When there were few they were. Yet every hospital wants one and consequently they are abundant, sit idle at times, and so raise costs. The guys who make them love them. The hospitals all get to say they have one but the RTO isn't great unless you make up for it elsewhere. Next an OCT. Revolutionized retinal practices and most got them yet there aren't a lot of retinal practices. Soon glaucoma practices got them , then general OMD practices got them and now it is supposed to be standard of care and all OD practices want them. Top of the line Zeiss is $75,000 and doesn't decrease in price with more sales like other tech. These practices could easily refer out for a scan and get the results sent to them but decline to do so because of competition/poaching. The machine is reimbursed between $35-45 depending on code and only certain codes are covered. General practices don't see those codes as much as a retinal or glaucoma practice. So now I am seeing the push for these practices to use it for other conditions and bill it to the patient. Me, I refer out to a glaucoma specialist down the street who I have personally known a long time. I will not get caught up in that rat race but it is tempting as the results are so cool.

It is all about making bigger bucks.

[GVChamp]

Sorry but no. 'Australia-among-world-leaders-for-cancer-survival'

https://www.cancerinstitute.org.au/a...ancer-survival

And for a more general comparison of how our health care systems stack up in terms of costs and outcomes see below. The short answer by the way is basically summarized in the chart I posted above. Whatever the 'evils' of universal health care may be ours produces consistently better outcomes across a broad range of medical services. And yes there are long wait times for some surgical interventions (depending on specially) but those are prioritized on a needs basis i.e triaged.

As for 'limited choice of drugs' our health system requires that drug companies produce clinical evidence that a new drug produces superior clinical outcomes before it will be subsidized for public use. (FYI the Drug companies hate this) Beyond that there's no real issue.

http://www.nationmaster.com/country-...-States/Health

Re: the Bold.

I mean, you realize this will never fly in the United States, right? And you realize this is eventually going to destroy the socialized systems, as the various socialized populations realize that they are being restricted from US levels of utilization? You're looking at this from a politically-dead angle: "we're going to triage you" means you're denying cancer treatment to someone diagnosed. And you can say "but they are only stage 0 and the evidence suggests any care we do will do more harm than good," and you will be called racist/sexist/transgender-ist, whatever.

The various healthcare systems have done an absolute shit job of holding down costs, except for the UK NHS, which is by far the worst of all the socialized systems and will sink the UK government as more people realize it. All these nations are pretty much where we were when we first started debating this crap with Clinton Care.

US insurers can't even get away with treatment denials like you're talking about (and what the VA does), because the US population would probably lynch the executives. After all, all of our problems are because of capitalism and profit-seeking. Just look at Venezuela and the Soviet Union!

The effect of the ACA is so pitiful the US death rate is going up, and it's going up for things like heart disease, not just drugs. The US death rate was going DOWN 2000-2014 for heart disease, despite the fact we had a private system, despite the fact that we had soaring premiums: we STILL realized ALL of the easy gains for our WORST disease.

The idea the US is somehow going to get easy gains from nationalizing the system is as silly as the idea we would get easy gains from nationalizing any other system.



BTW, I understand the Swedish live quite a while. Here in the United States, we also have Swedes, and they also live a long time. Minnesota has an average life expectancy of 81, up there with the Dutch and the British and practically everyone else. What the fuck do I care if Mississippi is dragging down our life expectancy? That's not because of the US healthcare system, it's because Mississippi is an economic and social statistic shit-stain and has been since it was admitted to the Union. These macro-stats have no bearing to MY life. I certainly do not want more federal dollars spent in a naïve attempt to boost that state.

[antimony]

Tell me, do minority populations in Canada have the same rates of violence, genetic diseases like sickle cell anemia, rates of lead poisoning, poverty and substance abuse? The Ghosts of Jim Crow are still wreaking havoc on the African American community.

Z,

I don't know, feel free to share any data you have to show that he two populations are different and it is all because of Jim Crow. Even if I assume you are right in what you are trying to say, your approach basically means: "Yeah we screwed you and now we are unhappy that you are getting insurance". Please do think about that for a bit.

Also, have you been to the UK? The state of any of the African and South Asian communities there certainly ain't pretty. Bonus points, they are also disliked by the native British population. Yet their health system (regardless of your "wait times" metric)still beats the US.

[tbm3fan]

but those are prioritized on a needs basis i.e triaged.

[/URL]

and therein lies the problem. The guy with the minor broken finger is going to moan about the guy coming in after him with a compound fracture of the femur. The person who wants a lid lift is going to complain about waiting for someone to have a squamous cell carcinoma removed from their lid.

[Monash]

People will moan regardless of the type of healthcare system involved if only because 'but my suffering is worse than your suffering'. People here complain about their private health care providers as well. Yes medical services in the public sector are 'rationed' but the result is overall superior healthcare outcomes, if only because the private system tends to divert resources into those procedures and services that are most profitable as opposed to those that maybe the most needed or which have more positive health outcomes.

[Monash]

Re: the Bold.

I mean, you realize this will never fly in the United States, right? And you realize this is eventually going to destroy the socialized systems, as the various socialized populations realize that they are being restricted from US levels of utilization? You're looking at this from a politically-dead angle: "we're going to triage you" means you're denying cancer treatment to someone diagnosed. And you can say "but they are only stage 0 and the evidence suggests any care we do will do more harm than good," and you will be called racist/sexist/transgender-ist, whatever.

The various healthcare systems have done an absolute shit job of holding down costs, except for the UK NHS, which is by far the worst of all the socialized systems and will sink the UK government as more people realize it. All these nations are pretty much where we were when we first started debating this crap with Clinton Care.

US insurers can't even get away with treatment denials like you're talking about (and what the VA does), because the US population would probably lynch the executives. After all, all of our problems are because of capitalism and profit-seeking. Just look at Venezuela and the Soviet Union!

The effect of the ACA is so pitiful the US death rate is going up, and it's going up for things like heart disease, not just drugs. The US death rate was going DOWN 2000-2014 for heart disease, despite the fact we had a private system, despite the fact that we had soaring premiums: we STILL realized ALL of the easy gains for our WORST disease.

The idea the US is somehow going to get easy gains from nationalizing the system is as silly as the idea we would get easy gains from nationalizing any other system.



BTW, I understand the Swedish live quite a while. Here in the United States, we also have Swedes, and they also live a long time. Minnesota has an average life expectancy of 81, up there with the Dutch and the British and practically everyone else. What the fuck do I care if Mississippi is dragging down our life expectancy? That's not because of the US healthcare system, it's because Mississippi is an economic and social statistic shit-stain and has been since it was admitted to the Union. These macro-stats have no bearing to MY life. I certainly do not want more federal dollars spent in a naïve attempt to boost that state.

GV, to clarity in this context 'rationing' healthcare services does not mean denying access, it does mean that in the absence of private health cover the more serious medical issues take precedence. In short no-one here is denied access to health care, depending on the specialty there can be delays (more than anyone would like) but everyone gets treated.

As for drugs every new medicine that is released on the market is assessed by local authorities for efficacy v older drugs. Superior performers get a wave-through to discount prices. The remainder can still be released to the market - at market rates. Virtually all of the drugs you have access to in the US are available here albeit some can take longer to arrive. Nor is our system 'Nationalized' we have a mixed public/private healthcare system.

Likewise I don't know what Soviet Union or Venezuela have to do with this discussion. Notwithstanding the manifest flaws of their political or economic systems neither country was brought to the brink of collapse by their Healthcare spending! For that matter while the burden is significant Australia is doing fine thank you.

Lastly, pointing out certain benefits accrued under our and other public health systems is not the same thing as advocating a socialist economy. If anything it points to inherent, structural inefficiencies in the health care market. Like many physical utilities healthcare is a industry with significant barriers to entry and a systemic lack of consumer choice.

What you advocating is a fully privatized health care model that can best the outcomes achieved by the various public or mixed systems currently in place in other Western nations. And that by 'best' I mean beat them across the board on most if not all metrics, not just a few cherry picked examples. If you can come up with such a pure, free market healthcare system, one that allocates medical resources cheaply and effectively more power to you. So far however no-one else in the US has managed it.

[DOR]

I made this point way back when, but it seems to have been lost.

Healthcare, uniquely, has unlimited demand. Therefore, it must be rationed.
There are three options, or a mix of the three:

1. Ration by price: You get what you pay for.
2. Ration by time: Wait your turn.
3. Ration by quality: Who says crystals and new ageism don't work?

Mix and match to your heart's content.

[Monash]

Correct, it also suffers from a complete lack (or almost complete lack) of product substitution. With most other goods and services rationing by price leads to consumers selecting a product from the range offered based on their price point. Doesn't matter if it's food, clothing, transport or shelter this rule applies (except at the extreme margins). With healthcare it doesn't. If you or a family member requires an appendectomy you have to purchase an appendectomy no matter what the price - no substitution is possible.

These and related structural problems are precisely why 'free market' economics hits a brick wall when it comes to healthcare costs - medicine is simply NOT a free market as defined by economic theory. It would be great (and so much simpler) if it was but it isn't. Hence the impending train wreck heading strait towards the far right of the Republican party.

[GVChamp]

?????

A lot of this is separate from any economics I learned and is squarely in "gold standard" and "tax cuts pay for themselves" categories.

The actual anti-market case in healthcare is excerpted below:
https://krugman.blogs.nytimes.com/20...-page-34/?_r=0

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

....

The second thing about health care is that it’s complicated, and you can’t rely on experience or comparison shopping. (“I hear they’ve got a real deal on stents over at St. Mary’s!”) That’s why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.

You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people don’t trust them — they’re profit-making institutions, and your treatment is their cost.

These arguments aren't nearly as strong as they seem, they aren't actually the problems that make healthcare a growing problem, government intervention does not fix these problems, and left-leaning policy solutions clearly aren't trying to fix these problems.

The biggest problem with healthcare is that certain procedures remain extremely expensive and a political third-rail. It's easy to argue you "need" a certain healthcare procedure and hard to argue against it, but money is finite, so we try to find ways to mask the cost as much as possible. Some of this is Obama-care style community rating and mandates, some of it is payroll taxes to fund Medicare, most of it is the bipartisan-endorsed exemption on employer-provided coverage.

The second biggest problem with healthcare is the average American household's complete inability to save money, which causes all sorts of other problems.

There are other problems, but those are your biggest ones.

However, the US healthcare system still does a fine job, even if it's unquestionably over-priced. What metric you use can move the US up or down rankings (I've seen 1 to 20 pretty frequently). Here's a Forbes article about US LE excluding violent deaths: https://www.forbes.com/sites/theapot.../#731560fb2b98
Either way, for people like me in dual-income households that both have access to insurance, the US healthcare system is definitely world-class and probably best in the world, with a lot of intensive procedures covered which I probably won't want and don't really need. Expensive, but expensive in part because of the high incomes in the US.

And since Krugman talks about trust, no, I don't trust Democrats meddling in this, which will NOT result in more efficiencies, but WILL result in me having to pay more dollars, for inferior care, to win more votes. I can certainly live with it (won't be the end of the world), but definitely not my first choice.

[astralis]

GVChamp,

Expensive, but expensive in part because of the high incomes in the US.

not anywhere close to proportionally, though.

to put it another way: pharma-bro Shkreli's antics (and to be fair: his defense that everyone in the industry does it, he was just open about it is a correct statement) would certainly not change even if certain procedures WEREN'T a political third-rail, and US consumers saved money like they were Chinese.

[astralis]

taking a break from all the talk about healthcare:

https://www.bloomberg.com/view/artic...-trump-doesn-t

Washington Loves General McMaster, But Trump Doesn't

The national security adviser has lost sway. The White House says everything's fine.
by Eli Lake

May 8, 2017, 10:44 AM EDT

For the Washington establishment, President Donald Trump's decision to make General H.R. McMaster his national security adviser in February was a masterstroke. Here is a well-respected defense intellectual, praised by both parties, lending a steady hand to a chaotic White House. The grown-ups are back.

But inside the White House, the McMaster pick has not gone over well with the one man who matters most. White House officials tell me Trump himself has clashed with McMaster in front of his staff.

On policy, the faction of the White House loyal to senior strategist Steve Bannon is convinced McMaster is trying to trick the president into the kind of nation building that Trump campaigned against. Meanwhile the White House chief of staff, Reince Priebus, is blocking McMaster on a key appointment.

McMaster's allies and adversaries inside the White House tell me that Trump is disillusioned with him. This professional military officer has failed to read the president -- by not giving him a chance to ask questions during briefings, at times even lecturing Trump.

Presented with the evidence of this buyer's remorse, the White House on Sunday evening issued a statement from Trump: "I couldn't be happier with H.R. He's doing a terrific job."

Other White House officials however tell me this is not the sentiment the president has expressed recently in private. Trump was livid, according to three White House officials, after reading in the Wall Street Journal that McMaster had called his South Korean counterpart to assure him that the president's threat to make that country pay for a new missile defense system was not official policy. These officials say Trump screamed at McMaster on a phone call, accusing him of undercutting efforts to get South Korea to pay its fair share.

This was not an isolated incident. Trump has complained in front of McMaster in intelligence briefings about "the general undermining my policy," according to two White House officials. The president has given McMaster less face time. McMaster's requests to brief the president before some press interviews have been declined. Over the weekend, McMaster did not accompany Trump to meet with Australia's prime minister; the outgoing deputy national security adviser, K.T. McFarland, attended instead.

Even McMaster's critics acknowledge that he has professionalized the national security policy process and is a formidable strategist in his own right. Trump credits McMaster with coming up with the plan to strike a Syrian air base last month, which won bipartisan support in Washington.

At the same time, White House officials tell me that in recent weeks, Trump has privately expressed regret for choosing McMaster. Last Monday, former U.S. ambassador to the United Nations, John Bolton, who was a finalist for McMaster's job, met with Trump to discuss a range of issues with the National Security Council. White House officials tell me the two discussed the prospect of Bolton coming in as McMaster's deputy, but eventually agreed it was not a good fit.

The roots of the McMaster-Trump tensions begin in February, when the general was hired after his first meeting with the president. McMaster replaced another general, Michael Flynn. Both Vice President Mike Pence and Priebus supported getting rid of Flynn, after they alleged he misled his colleagues about conversations with the Russian ambassador.

Trump himself has defended Flynn publicly. The two shared a bond from the campaign trail, where they often discussed sports and movies during long evenings on the road. For a president who puts so much value in personal relationships and loyalty, Flynn's departure was a blow.

In this sense, McMaster came into the job with one strike against him. He has accumulated more. The first conflict between McMaster and Trump was about the major speech the president delivered at the end of February to a joint session of Congress. McMaster pleaded with the president not to use phrase "radical Islamic terrorism." He sent memos throughout the government complaining about a draft of that speech that included the phrase. But the phrase remained. When Trump delivered the speech, he echoed his campaign rhetoric by emphasizing each word: "Radical." "Islamic." "Terrorism."

Then Trump's inner circle began clashing with McMaster over personnel. This began with Ezra Cohen Watnick, who remains the senior director for intelligence at the National Security Council. McMaster initially sided with the CIA and wanted to remove this Flynn appointee from his position, but eventually McMaster changed his mind under pressure from Bannon and Trump's son-in-law, Jared Kushner.
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That dispute was followed by a bigger one. Bannon and Trump, according to White House officials, pressed McMaster to fire a list of Obama holdovers at the National Security Council who were suspected of leaking to the press. The list of names was compiled by Derek Harvey, a former Defense Intelligence Agency colonel who was initially hired by Flynn. McMaster balked. He refused to fire anyone on the list and asserted that he had the authority to fire and hire National Security Council staff. He also argued that many of these appointees would be ending their rotation at the White House soon enough.

And finally, the White House chief of staff himself blocked McMaster this month from hiring Brigadier General Ricky Waddell as his deputy, complaining that McMaster failed to seek approval for that pick. McMaster had asked his inherited deputy to leave by May 10; she is now expected to stay on for the time being.

For now the White House is saying the president and his national security adviser are in sync. Trump said in his statement to me that he couldn't be happier with the general. Of course, White House counselor Kellyanne Conway assured the public in February that Trump had full confidence in McMaster's predecessor. Only a few hours later, he was forced to resign.