TROLLIN' TROLLIN' TROLLIN'

Since Simon Kuznets developed the useful concept of Gross National Product in the 1930s, many critics have pointed out one of this major flaws: by aggregating the dollar value of all goods and services exchanged in an economy, it can "reward" some horribly inefficient behaviors in the form of higher GNP. With the assumption that a higher GNP/GDP is a sign of a stronger and better economy, the most valuable citizen is not an entrepreneur, a laborer, or an inventor. It's a terminal cancer patient who just wrecked his Lamborghini and is going through an expensive divorce. Think of the billable hours he generates for the legal profession. Think of what his hospital bill will be when all is said and done. Look at all the Economy he's generating.

The point of the morbid example is simply that not every form of economic activity is inherently "good." The American economy could hugely benefit, for example, from bombing several major cities (what a boon for the building trades!) or infecting half the population with some long-lasting and expensively treated disease. Most of us would prefer that economic growth result from something less dismal.

Similarly, single-payer is beginning to attract support from more than just the far left lately. Don't misunderstand – I don't believe SP is coming soon or that huge majorities of Americans suddenly support it. But it is transitioning into the mainstream of the health care debate, which eventually will have a positive effect on policy. You can tell it's being taken more seriously because the campaign of concern trolling against it has intensified noticeably during this session of Congress.

The LA Times has a decent piece on three prominent types of SP concern trolls – "We need more details," "It's too expensive," and "It'll never happen" – but I believe another important kind is absent: the "Think of all the middlemen of the health care industry who will lose their jobs!" troll. The Chamber of Commerce, reliable organ of Business writ large, is most aggressively pushing this narrative. You know they must be worried if they're willing to pretend they care about The Working Man's job.

Conceptually, it isn't difficult to imagine a switch to single payer eliminating some jobs. The administrative bloat in our healthcare system is beyond most people's comprehension – I've had the misfortune of seeing it from the inside earlier in my career. People whose days consist of filing and refiling and appealing and refiling various insurance claim forms and managing the labyrinthine network of medical records are two tasks that involve more person-hours than you can imagine. A single payer system would de-complicate those issues at least somewhat if not entirely, and the paper pushing jobs our current system creates so readily would decline.

Other generally pro-SP estimates argue that a changeover would create jobs in the long run. It's a very difficult thing to forecast and there's no way to resolve the different predictions at this point. What is undeniable, though, is that "It employs a lot of people" is a very bad reason to keep a healthcare system as it is. The ability to access basic medical care without risking long term financial ruin should be a fundamental compoonent of any society that considers itself civilized. And for an issue on which costs and inefficiencies are brought up constantly, sticking with the current system because it creates a ton of jobs for middlemen, rentiers, and layers of superfluous bureaucracy is a very bad argument. The system's inefficiencies bloat costs and need to be eliminated, but they also create jobs so should be kept? C'mon guys. Pick one.

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64 Responses to “TROLLIN' TROLLIN' TROLLIN'”

  1. Leo Artunian Says:

    As Al Capp (of all people) pointed out long ago in his Li'l Abner stories about the Smoos, if everyone is happy, healthy, and well-fed, it pretty much destroys the parts of the economy driven by greed, vice, and the need to knock heads together. I wouldn't mind giving a happy, healthy, and well-fed world a try, however.

  2. land_planarian Says:

    Both Sander's bill and the California state bill (not sure about the others) contain 'just transition' clauses to let people laid off in the first few years of implementation get extra unemployment and/or scholarship money to go back to school.

    It won't make getting laid off a walk in that park, but if a few thousand hospital desk workers scattered across the country have to become a phlebotomists or go get another office job for the rest of us to get insurance that covers everything, lets you chose pretty much any doctor in the country and can't be lost when you change jobs…they can deal.

  3. Safety Man! Says:

    Always, always point out that we already spend an exorbitant amount of public money on healthcare, might as well structure it more efficiently.

  4. Ten Bears Says:

    Yes, let's think of all the middlemen, the faceless Little Eichmanns between you and your health care.

  5. Katydid Says:

    Something to consider; veterinary care for our pets has traditionally been single-payer (as in, the owner pays). The veterinary system is so much more sensible than our current system. You can call any vet's office and get a straight answer as to what the office visit will cost, what the rabies shot will cost, how much a spay or neuter surgery will cost.

    Whenever I try to contact my doctor's office, it's always an exercise in frustration and aggravation, and forget trying to get them to call back because they invariably call my work number at 7 pm or my home number at 10 am and then get mad at me, or they'll call back 11 weeks after I called in for an alarming situation (this just happened).

    Single-payer allows the veterinary office to streamline their billing process and allow high school students to manage the check in/check out procedure.

  6. Aaron Says:

    As part of the ACA, the FFELP system of federal student loans (private lender originates loan, feds pay for guarantee by a 3rd party guaranty agency, 3rd-party billing and collections) was replaced by Direct Loans (Department of education originates and guarantees loan, only the billing and collection service are outsourced).

    Oh man, the people who complained about a government takeover of the Federal Family Education Loan Program. And the concern trolling like you're pointing out. Oh yes sir. Lots of that.

    The lost jobs in the private sector loan origination service centers and guaranty agencies are real but I have a feeling that the people who did most of the complaining and editorializing did not actually care about those people. They cared about their stake in the rent-seeking.

    Today almost nobody actually thinks FFELP was a good system and there is no serious proposal to revive it.

    With any luck, we'll see the same thing happen for healthcare — once a somewhat-saner system is in place, we'll forget that anyone ever pretended to be concerned about the damage caused by the transition.

  7. jon Says:

    I want details because I want to be able to talk down the negatives of what is going to be a massive change. Also, if the Congress of 2009-10 passed single-payer, what would the subsequent Congresses have done with coverage, availability, costs, services, etc? Would you rather have a pencil-pushing bureaucrat or Paul Ryan in charge of your policy? Obama or Trump?
    These things matter.

    I want to know costs because I want to be able to use figures that mean something and to include the hidden costs in the present system (where most people get insurance from their employers and don't even have a clue what their employers pay compared to what they do.) And people want assurance that maybe some of that money their employers pay might come to their paycheck, especially as they're worried this new system might not be as good. A dollar-for-dollar argument can work better than a series of charts, but to get there we need someone to figure out those series of charts and figure out how this thing will work. It matters.

    The never argument I don't understand. I want single-payer quite a bit. I also want it to be solid. Building on the ACA can work. Maybe making Medicaid available for all children would be a good middle step toward taking away the program stigmas that are largely based on "Oh noes! I am not poor!" that motivate too many voters. Single-payer can happen. It should happen. But it's not concern-trolling to want it to be done right, effectively, with long-term support and buy-in from those most affected from the status quo. It's never going to happen if skeptics are given the pshaw treatment rather than some details.

  8. BruceJ Says:

    @Katydid:

    Something to consider; veterinary care for our pets has traditionally been single-payer (as in, the owner pays).

    "Sorry Grandma, it costs too much for your gall bladder operation, we're just going to put you to sleep".

    The corollary of that 'simple single payer' is that animals owned by poor people don't get treated, are abandoned, or euthanized. No one who has ever volunteered at a shelter would think this was the way to treat humans.

  9. mothra Says:

    "Sorry Grandma, it costs too much for your gall bladder operation, we're just going to put you to sleep"

    Well, that's where we are heading if Graham/Cassidy passes.

  10. HoosierPoli Says:

    One man's waste is another man's paycheck.

  11. HoosierPoli Says:

    By the way, I won't pretend to have a handle on the numbers but I've seen the case made that GDP figures for the US economy make the country appear richer than it is because of the way economist book private versus public healthcare spending.

  12. Katydid Says:

    Hey, Bruce J; we're there already. Here's a secret you might be privy to; even middle-class Americans are forgoing needed medical treatment because they simply can't afford it. For example; my employer-provided healthcare has a $10k deductible. You read that right; $10k/year before insurance kicks in. I've got a frozen shoulder that I simply can't afford to have treated; the physical therapy alone would come to $9k/year, and the surgery with post-surgery PT is $20k. Just this past summer, I got a tick bite that turned into a bullseye rash within 8 hours; the after-hours doc-inna-box and follow up with my own doctor, plus the 3 weeks of antibiotics to combat the Lyme, cost $500 that came right out of my pocket because I haven't hit my yearly $10k deductible.

    Also, you might not have been around for this, but just this past spring, I lost a dear friend who simply couldn't afford to treat her congestive heart failure and it killed her.

    None of us are the poors that the rightwing hates so much. But the current for-profit insurance bankrupts anyone who needs more than routine medical care.

  13. Davis X. Machina Says:

    Insurance companies at least represent a countervailing force to the medical profession, medical equiment manufacturers, and pharmaceutical companies. There are things they won't pay for, and should, to be sure, but some of the things they won't pay for, shouldn't be paid for, at least at the asking price.

    Given the history of regulatory capture by industry in this country — we already have a stellar example in the legislation prohibiting Medicare from negotiating drug prices — single payer represents an opportunity for regulatory capture on an epic scale, across the spectrum of things-that-get-bought in health care.

    Unless your regulators have nerves of steel, and the legislature never reverts tp the GOP — because a Democratic legislature will have passed it — single-payer could be an unmixed blessing.

  14. Davis X. Machina Says:

    For "could be an unmixed blessing" read "could be other than an unmixed blessing."

  15. Bernard Says:

    getting single payer will be despite those who own America and like things just the way they are now.

    Human lives matter to us,the little people who pay taxes. Not so much for the rich and prostituting America, for fun and profit.

    Single payer will be last thing Congress approves, by Profit loving Republican and their Vichy Democrats

    Why stop the Scam in Healthcare? Piss of Pharma, Hospital.

    who'll bribe Congress for Single Payer? we'll get Single Payer after millions die. 'As Alan Greyson said, the Republican Health Plan is "Hurry up and Die.!!

  16. templar Says:

    David, I have had the same thoughts along the lines of Maggie Thatcher's attempted gutting of the NHS.

  17. OtherAndrew Says:

    Except the insurance industry has captured the government already and does not, in fact, represent anything resembling a countervailing force.

  18. Haggis Says:

    Single payer is prevalent in every other modern western economy. No citizen would ever go without it and any politician trying to reduce or remove that safety net would be drummed out of town.

    I've been fortunate health wise, but my experience of national health care has included Canada, the EU/UK and Asia. Is it always perfect – No. Is it good – Yes!

    I can't believe the US are still debating this. Go out and cherry pick the best ideas and just get on with it.

    Seriously, if you want to gin up the economy with useless jobs just make the tax returns way more complicated (a very stupid idea). As is the notion that employing a bloated "for profit" bureaucracy to manage your healthcare system.

    Good luck!

    PS – Even Hong Kong, "the worlds freest economy", provides social housing to a huge percentage of the population and heavily subsidised health care. An E&R visit costs roughly US $12., including ambulance, x-rays, scans, doctor, and medication. And it is all first world quality care. I know because I've had to take 2 elderly relatives through the experience – one of whom was visiting from the US!

  19. Dave Bearse Says:

    "It employs a lot of people" by itself isn't bad or good. Pushing papers isn't productive. Health aids assisting seniors staying in their own homes or the disabled being more productive is.

  20. Dave Bearse Says:

    There's an established pattern of having it both ways. Pols for example claimed that the government's stimulus spending is a waste. Mention that the Pentagon doesn't want to waste money on a local military installation that the Pentagon no longer needs, and the first thing out of pols mouths is the importance of government spending to the local economy.

  21. Katydid Says:

    @Haggis; I've seen how single-payer works in the UK and Holland. It's cheaper than for-profit and the wait times are actually less than for many things in the USA. It's a no-brainer.

  22. democommie Says:

    @ Dave Bears:

    ANY gummint spendin' outside MAH DISTRICT, is Pork Barrel waste and extravagance which this wounded but indomitable nation cannot afford! Ah said, bo'ah, ANY gummint…

    @ Bernard:

    "Single payer will be last thing Congress approves, by Profit loving Republican and their Vichy Democrats."

    Thanks to those "vichy" democrats you still have some semblance of healthcare, unions and teh gay mawwiage–among other things that the Teabagvangelicals would have shitcanned by 3/01/17. Unless I missed something and they were all replaced by leftprogs since last November.

  23. Jestbill Says:

    That's a neat idea; that our GDP is higher than it should be because our healthcare system is too messed up to properly account for.

    So when they say that other countries spend half what we do, they're saying "half a real number" instead of "half an inflated number"? Great!

    We'll get something. We'll call it SP and most of the South will call it Socialism. It will be neither.

  24. quixote Says:

    Just seconding the other commenters pointing out that it's good to avoid plunging the lower-level flunkies of the current system into poverty.

    Concern trolls: single payer can't be done because people are feeding off the InsureCos.

    People making a good point: let's get to single payer, but not by raising the misery quotient.

    (And also seconding Katydid that we already have the no-care-plus-dysthanasia system. The irony being that people who want euthanasia can't get it.)

  25. MS Says:

    The billing department at a US hospital consists of another office building full of people, comparable in size to the hospital itself. They're talking to a dozen OTHER office buildings full of people at various insurers.

    The billing department at a Canadian hospital consists of a couple employees total. Their hours open to the public are like 9-11AM, 1-3PM, five days a week. When you go in, they're surprised to see anyone. 99.9% of billing is handled automatically – the hospital sees people, charges the provincial health insurer electronically, the provincial health insurer pays. The end. There aren't any disputes because there's only one set of rules and everyone knows them. When there are disputes, it's a couple of staffers from the hospital and insurer having "meetings" and talking about "implementations of a new standard of care" and crap like that, it's not individual disputes. No individual is ever affected.

    I don't think Americans have ANY idea.

    Imagine getting major surgery, walking out of the hospital, and that's it. You never hear from the hospital again, except maybe a doctor or nurse calling you to follow up with your medical problem. Not a single bill of any sort is ever seen by the patient. That is the reality for every single resident of Canada, today, and has been for decades. When Americans say they have the best system in the world, I laugh and laugh and laugh and laugh.

  26. Leo Artunian Says:

    MS: Their health system is another way that Canadians implicitly, perhaps inadvertently, and ever so politely, make it clear to everyone that Americans as a nation are jerks.

  27. Ten Bears Says:

    Thak you for that, MS, we really needed to hear that.

  28. E* Says:

    @Katydid

    I'm so sorry. I came to the comments section specifically to ask about your friend, but you already answered. I guess all of my positive thoughts for her were no match for our fucked up medical system. Which is exactly why we need to get our collective acts together over this.

  29. Katydid Says:

    Thank you, E*! It was a quite a blow to all of us who were our friends. We had no idea her heart problems were so severe or we would have held a fundraiser (which obviously she didn't want because she didn't tell us). It's a travesty that people in Murikkkuh have to beg strangers on the internet to help us if we're ill…that's for-profit insurance for you.

    Anecdata about the British system; I went over to work in England right after college. I knew I needed all 4 wisdom teeth out but had zero way to afford it, and my employer didn't offer dental, hearing aid, or vision coverage (because teeth, hearing, and seeing are all optional in Murikkkuh).

    I rented a little hovel in the village near my job, and at some point must have said something to my British neighbors about my teeth, because they urged me to go see the dentist a couple of streets over. I'm not British–wasn't even *pretending* to be British, but they urged me to go anyway and "see what the dentist can do for you." So, I called, identified myself as an American (because the American accent didn't give me away, hahaha), and asked if I could pay to be seen. The receptionist told me to just come in, so I did. The dentist took x-rays, said, "Yup, they all need to come out" and asked if I was free the following week. Pay? "The NHS pays me." Got my teeth pulled, was handed a bottle of pain pills by the receptionist, and told to call if I had any problems.

  30. Katydid Says:

    @Quixote; regarding euthanasia–our pets have such better care than we do. In my life I've had to bring in a number of elderly/sick pets for the final visit, and nobody tried to make a difficult thing even harder by trying to talk me out of it or claiming it's a crime to cease a being's suffering when there's nothing left but the suffering.

    So, not only are vet visits more rational and the fees readily available, but when the end comes, there are no legal battles over it.

    In contrast; the $500 tick bite? I was paying bills for months and had to make several calls disputing bills and reminding them I'd already paid what they were re-billing me for, for the third time in a row. My insurance paid zero because I hadn't reached my deductible.

    And while we're on the topic; the standard of care for early-catch Lyme is Doxycycline. Those of us over 30 who grew up with fish tanks remember buying liquid doxy to clean out the fishtank…and it costing pennies. This past summer, 3 weeks' worth of doxy cost me $280-some. Also not covered by insurance.

  31. Katydid Says:

    MS, you wrote, "Imagine getting major surgery, walking out of the hospital, and that's it. "

    Yeah….now *you* imagine going to your primary care for a routine 5-minute visit, and spending the next three months endlessly calling your insurance company and the doctor's office to try to reconcile the absolutely bizarre billing. Try not to be too jealous of us, okay?

  32. mainmata Says:

    I think we need to distinguish between a basic health insurance plan that covers the "minimum essential requirements" laid out in the PPACA, which covers the vast majority of health insurance needs and the current system that covers everything (essential and non-essential). IOW, that still leaves space for private insurance to cover non-essential surgeries such as elective plastic surgery and other beauty surgery plus other stuff that is non-essential. This is what most of the European systems have. So, some of those paper-pushing jobs could remain in the reformed private market, some would go to Medicare-for-All (since its expansion will require some new employees) and some can go into the innovation sector that will come with a new, non-feudal health insurance system.

  33. Haggis Says:

    I remember seeing an American stand up comic at Second City in Canada back in the day.

    "Gotta love Canada! Smokes are five bucks a pack. Heart transplants are free…."

    That just sort of stuck in my mind. And at the time smokes were a buck a pack in the US.

  34. Kaleberg Says:

    How many people here actually think the folks in the executive suites at those health insurance companies give a hemi-demi-semi-hoot about whether they lay off 122,000 people or not? If we pass single payer, we can just buy these people. It might cost a billion a year to co-opt all of them. They have expensive tastes, but they are in it for the money, and they can be bought. The overall savings will more than pay for the multi-millionaire welfare.

    The only downside is that whoever passes the legislation that makes health care accessible but lays off hundreds of thousands of drones while rewarding their goon CEOs is going to be vulnerable in the next election.

  35. Well paid socialist Says:

    The Economist once described the US health care system as a game of musical chairs where there were insurance companies, patients, and providers, all playing a game of musical chairs trying not to be stuck with the bill when the music stops. It seems like the attempt to play hot potato with costs just doesn't exist to the same degree in any other system in the developed world.

    I knew somebody who worked at one of the better known animal shelters in the US, who once said "we have principles like animals should get essential medical care, enough to eat, and human interaction" (pause) "imagine what it would be like if we applied those same principles to the homeless people on the street?"

  36. vegymper Says:

    …and la(w)yers of superfluous bureaucracy…

  37. democommie Says:

    @ mainmata:

    "So, some of those paper-pushing jobs could remain in the reformed private market, some would go to Medicare-for-All (since its expansion will require some new employees)"

    Yeah, steep learning curve, there. Little people who have spent years FUCKING OVER other little people will have a hard time making the adjustment. Anyone above the level of case worker will prolly have to be out on paid disability with full medical benefits, for quite a while.

  38. Engineer Says:

    Don't forget the trolls who worry about "people being unable to get the best procedures".

  39. Katydid Says:

    Hey, Demo, I think you might be pleasantly surprised by some of the "little people" in the insurance companies. I had an experience with an HMO where the care manager was actively working for me–I suspect she may have been breaking rules, but she had a heart and wanted to do good. For example, under the HMO rules, I only quaified to have X, but she made sure I got Y because it would improve my quality of life.

    I like mainmata's example of universal insurance for the routine stuff (broke your leg? It's covered) and private insurance for non-essentials (want butt cheek filler? Go see someone else). They'd just have to be watched carefully–for example, IMO breast reconstruction following cancer = necessary, vs breat reconstruction of perfectly healthy issue for a more aesthetic look = optional.

  40. Tim H. Says:

    What makes those paper shufflers more worthy of sympathy then those who used to make things back in the day? At least they'd be out job hunting for a more meaningful reason then "Ethical standards are too much of a pain in the ass."

  41. Katydid Says:

    Tim H., are you referring to my "not every worker bee is a heartless villian" comment?

    As to you "make things back in the day" comment, I come back with, "What makes the coal miners more worthy than the countless retail workers who far outnumber the coal miners?" Also, how far back in the day are you talking about? Are you crying over the whip-makers who lost their jobs when the automobile came out? How about the sail makers who lost their jobs when the coal-fed engines came inot production?

  42. Tim H. Says:

    No, referring to jobs that are still done, but elsewhere for greater profit, or to evade regulations.

  43. Katydid Says:

    Still confused as to your meaning, Tim. Are you saying there are enclaves of rogue dwarves, building "things"?

  44. Leading Edge Boomer Says:

    Sometimes people confuse "single payer" (SP) with "universal coverage" (UC), although not at this forum. SP is one way to get to UC, but there are alternatives. All decent countries have UC, but not all have SP. Those countries without SP all have heavy controls on the drug and insurance companies that may be involved.

    It is tempting to go for SP because it maximizes the pain for insurance company payment deniers and bureaucrats, and hospital business office ghouls, and they richly deserve it. But the world is full of a variety of forms of UC, and we should know as much as possible about all of them before formulating the version best for us.

    In the nearest term, we must make fixes to ACA to get rid of unintended consequences that are hurting people. Then we'll have time to do better. Social Security and Medicare/Medicaid all needed

  45. Bill Says:

    I chime in rarely, and don't understand much about healthcare policy. I feel fairly strongly that there are too many people in too small a space, and that population growth is not sustainable at anything like the current level. This does not mean that I want people to die, or that I wish people to be unhappily childless, or anything similar. I just wonder how we're going to feed and water everyone. I understand that people smarter than myself are working on this. Is it possible that the (largely or entirely) Republican war on healthcare is no accident? Are the Koch brothers et al trying to stave off overpopulation by denying the lower and middle classes healthcare? I think I understand the general gist of trading Obamacare for massive tax cuts for the ultra-rich, but is there something further, something more evil?

  46. Tim H. Says:

    Katydid, that sounds so conservative.

  47. democommie Says:

    "Don't forget the trolls who worry about "people being unable to get the best procedures"."

    It has never been unpossible to get the best care IF you haz dollaz. It's just the poors who have to wait (and, hopefull, die while they're waiting).

  48. Katydid Says:

    Tim H, you were caught concern-trolling. Own it.

  49. Katydid Says:

    @Demo; are you familiar with the concierge model of health care? In essence, if you're willing to shell out big bucks, it buys you doctors who actually return your calls and see you. It's becoming a big deal in my area. For $10k/year, you get a doctor's office that doesn't take insurance but you'll be able to see the doctor when you need to, often the same day you call.

    I'm considering this because it cuts out the insurance company and offers pretty much the same level of care that I'm paying $1200/month (plus the $10k deductible) for now with my company-provided insurance.

    Of course, this model only works if people have money. As you said, the best care in the world as long as you haz dollaz.

  50. democommie Says:

    @ Katydid:

    Yes, I'm familiar with concierge healthcare, it's been around in oligarchic and banana republic sortacountries forever.

    One of the things that annoys the living shit out of me is when people say that it's only right that in the country with the best medical care (and one of the shittiest healthcare systems) in the world, it's only right that thems as gotz the dollaz are able to PAY for their wonderful healthcare.

    Thing is, we ALL pay for their wonderful healthcare. Not just in the sense that they fuck the help, cheat the public, despoil nature and avoid taxes to become obscenely wealthy–but in the sense that we ALL pay taxes to enable them.

    The CDC and other organs of the gummint spend billions on research in their own right and help to fund teaching hospitals and various programs for studying health/medical problems across the country. Without all of the tax payers money those fucking leeches would be forced to pay or die. Assholes.

    Can we say it, all together?

    "I don't wanna pay for those TAKERZ gettin' shit that I PAID FOR!".

  51. greatlaurel Says:

    @democommie, you are spot on. Every doctor, who goes through residency training in the USA, is funded by Medicare. Medicare pays for the training and the resident's stipend. If the GOP destroys Medicare, how do they plan on funding the Residency part of the medical doctors training in the future?

    Any doctor who did their residency in the US who refuses to accept Medicare or support Medicare is a greedy creep who is pulling the ladder up behind them. Cassidy is beyond vile.

  52. Major Kong Says:

    To be fair, the GOP does have a plan for single payer.

    The single payer will be YOU.

  53. Katydid Says:

    One of my college roommates became a doctor, and we've had many a long talk about her field. There's a move to reduce the hours resident doctors work from all the hours, every week, to a slightly-less-punishing schedule that would allow them to occasionally sleep and hopefully make fewer mistakes out of sheer exhaustion. There's so much opposition from the older doctors who feel they had it rough, so therefore everyone else coming after them should have to suffer, too. But when they suffer, so do their patients. When I was in the ICU, it was at a teaching hospital and the amount of times I had to save myself from exhausted young doctors making terrible decisions was horrifying.

  54. jcastarz Says:

    Major Kong says: "To be fair, the GOP does have a plan for single payer. The single payer will be YOU."

    Well put, and I agree.

  55. Dave Dell Says:

    What Bill said. Are they playing the long population control game?

  56. democommie Says:

    @ Dave Dell:

    I don't know about the 1%ers and their domestic Congressgrifters but it appears that Trumpligulamygdala is only interested in quarter-over-quarter population reductions.

  57. TakomaMark Says:

    I still think the most potent argument they will trot out some example from Canada about some dude there got some esoteric form of cancer that like 100 people have ever had diagnosed in the history of disease and the system didn't give him $100,000 worth of drugs that probably wouldn't have been effective anyway therefore socialized medicine sucks just look at Canada. That's always the argument – that you can't get whatever health care you want when you want it…like you can do that in America if your means are limited. 10 people will die because under socialized medicine they couldn't get some experimental drug. Meanwhile, in the USA thousands of people a year die because their type II diabetes is undertreated because widely prescribed effective treatments are beyond their financial and insurance means.

  58. democommie Says:

    " Meanwhile, in the USA thousands of people a year die because their type II diabetes is undertreated because widely prescribed effective treatments are beyond their financial and insurance means."

    Is feature, not bug.

  59. Scott Says:

    @ Katydid:
    So here's MY single-payer anecdote:
    Some years ago I was vacationing in Ontario and passed a kidney stone.
    (Not exactly what happened, but the details aren't important.)
    Worst pain I have ever experienced, and I've been shot, several times.
    Went to a lovely little hospital, (the kind that have now disappeared from the U.S.) complete with an emergency room.
    Waited about 20 minutes, which only seemed like 4 hours.
    Got an x-ray, exam, correct diagnosis, and instructions to go home and see my doc ASAP, along with a big load of morphine. (Don't know why they wouldn't let me drive myself home. I was FINE.)
    As we were leaving, the ER doc told us that he was really sorry, but since we weren't Canadian citizens, we would have to pay.
    Perfectly reasonable, I thought, expecting a $2500 bill.
    "Sorry it's so much, he said, "but I have to charge you 75 dollars."

  60. Scott Says:

    Oh.
    Also, what Leading Edge Boomer said.
    Single Payer is not the only kind of universal coverage.
    We tend to conflate one with the other.
    Lots of countries, including Switzerland, and even Taiwan, have UC without SP.

    (Sorry that makes the discussion more complex.)

  61. democommie Says:

    @Scott:

    I've never (fortunately) had to experience a kidney stone, several of my friends have, some more than once.

    I have had tootaches and sciatica that made me wish I could die or at least get unconcious for a long time.

    I talked to a friend's wife once and she asked me why I was using a cane. I explained that I had had an attack of sciatica that flattened me for most of 2 weeks and a couple of weeks out from that was still not comfy.

    She said, "Oh, yeah, I know what you mean. I've had sciatica–when I was in labor.". I think my penis shrank a little…

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  64. Ron Warrick Says:

    When I see claims that single payer is going to save 25% or whatever on health care costs, I ask them how many employees of the health care system do they think would have to be let go to achieve that? Might it be something like 25% of them? And there is like 20 million of them? Not going to happen.