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OT: American Politics

So Kansas is one of the states suffering under it's "Grand Conservative Experiment", led by governor Brownback and all GOP legislature, who have implemented crazy tax and spending cuts and ruined the state in the process. And of course, part of this experiment was resisting and sabotaging Obamacare in all ways, shapes, and forms - including refusing the offer to expand medicare.

But in light of the failed healthcare debacle last week, a few states, including Kansas, have looked at that medicare expansion again - and amazingly, both state houses passed the legislation to expande medicare already, just in the last 2 days. Because people are suffering, especailly under their idiotic economic policies of their great conservative experiment, and need help.

But of course Brownback is likely to veto that out of pure ideological spite - even though he specifically signed a bill a couple years back require both state legislatures to pass medicaid expansion bills.

Let this guy tweet sum it up:

Andy Slavitt
@ASlavitt
Two words stand between 150,000 people and full access to care. All Sam Brownbeck needs to do is write his name on a piece of paper. 1

Andy Slavitt @ASlavitt
15h
By a miracle the House and Senate passed Medicaid expansion. In 2014 Brownbeck signed a bill requiring both houses to pass legislation. 2

Andy Slavitt @ASlavitt
15h
He assumed it would never happen. But the last state I expected to did it. For their neighbors. But Brownbeck will likely move goalposts. 3

Andy Slavitt @ASlavitt
15h
It's a great deal for the state, 4 people & makes imminent sense 4 the economy. It would be cruel not to.

Cruelty. Brownbeck' specialty. 4

Andy Slavitt @ASlavitt
15h
There are so few times in life when you have a chance to impact 150,000 people by influencing 1 decision. 5

Andy Slavitt @ASlavitt
14h
Brownbeck's phone number is 785-368-8500.

I don't know how many calls he can take in the next few days. I don't have creative ideas. 7

Andy Slavitt @ASlavitt
14h
I'm picturing 150,000 people.

And 2 words on a page. And changed lives.

And 785-368-8500.

RT this thread & figure out if you can help.
 
leafman101 said:
Yeah health care innovation. The US didn't discover penicillin, or insulin, or vaccines. They are currently doing crazy shit in Germany with stem cells. They have become the leaders there.

There is first class medical innovation all over the world. And everyone can actually access the care.

Innovation doesn't stop under single payer health care systems.
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vaccines are evil
 
Leafovic said:
We need to change the behavior of the providers and the consumer.

In Ontario, physicians primarily get paid through cost per service (Family Docs on average around $62/per patient, and specialists something like $80-90 per patient). The issues that patients face (not being able to get an appointment, being rushed out of an appointment and not having health issues addressed, sometimes trying to rectify this by heading to a clinic or emergency room) are all connected to how doctors get paid. They are incentivized to book as many patients as possible to maximize their income. We could change this.
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Specifically how though? I've tried to wrap my head around the entire concept though and I don't see a method for it. What behaviours have better outcomes? How to we develop a system that rewards outcomes that doesn't unfairly reward or punish based on pure dumb luck or incorrect assumptions about personal health?

On the end of the consumer/patient... the idea itself is not important for the sake of this conversation, but we somehow need to change how consumers behave as well. Education (explaining of options) does not seem like an effective way of changing behavior.
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I disagree, I think the entire point of this conversation at it's root is that you're claiming that a better management system is not only available, but easily visible if viewed through a different paradigm. I think you're heavily misguided in this, and the devil is very much in the details.




I've never heard it explained quite like that, and I think that's a very good point. It's in the very least a good argument for subsidizing some groups or having an emergency pool of money. But like I said before, I agree that we should subsidize some groups. I like many aspects of the Canadian healthcare system.
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Here's the problem...economies of scale. This is one of the core problems of the American system....silos. Every silo looks after it's own management of risk and doesn't co operate with the rest of the money/risk silos. When you allow the economies of scale to do as much of the work for you as possible (spread monetary risk among larger populations, utilize the buying power of the entire system when negotiating to purchase access to drugs, equipment, etc), you do a much better job of keeping costs down. So as soon as you accept that we should subsidize some groups, it simply makes basic economic sense to subsidize all groups.


I would not blame anyone for getting sick, or blame someone for not being able to predict when they would get sick. I just think that any good system should drive people to be more likely to make a good decision, and less likely to make a bad one. That's good for all of us.
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The fault in this logic is simple....we're often not qualified to know, beyond the very basics. Are there basic decisions we can make that keep us generally healthier? Sure. But where do we draw the line at expecting people to make the best decisions for their health if we're often not sure about which mechanisms in the body lead to which disease? Why should I be punished for liking sugar in my coffee (I'm taking your philosophical point to it's extreme to emphasize the mechanism at work, I'm not saying that you're suggesting this severe a policy) if I have a genetic predisposition to be more or less functionally immune to diabetes? There's just way too much knowledge required to make informed choices, and the march to greater knowledge often leaves old knowledge gutted by the side of the road (the role fats play in the diet being an excellent example).




My first post was just a general disgust at people who sit on their ass and expect some doofus in government to get them a job and solve their issues. This might have been a valid excuse in the past, but in 2017, it's not imo.

It annoys me that people make important life decisions based on what the govt does. Oh, the govt is raising the child benefit amount..let's have 2 more kids then! Does their personal circumstance come into play here at all? Does it matter that they don't have jobs? an education?
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Who are these people though? I can't say that I've ever met anyone who had more children because the government was shelling out a bit more at tax time. This thinking kind of stinks of the "welfare queen" stuff from the 80's that of course turned out to be fictional.
 
leafman101 said:
Well yeah. American is where the money is.

But that has nothing to do with a single payer health care system. All that cuts out is these insurance companies, not innovation or capitalism. There is a middle man in their health care system taking a cut. And a pretty massive cut at that.
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huh?
 
leafman101 said:
Well yeah. American is where the money is.

But that has nothing to do with a single payer health care system. All that cuts out is these insurance companies, not innovation or capitalism. There is a middle man in their health care system taking a cut. And a pretty massive cut at that.
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Which is probably stifling innovation more than anything else.
 
Leafovic said:
So..what you're saying is that people around the world have a good incentive to take their skills to the US?
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Certain people who are elite in their fields. Absolutely.

I've never claimed that incentives don't work. I'm saying that they won't work in the space you think they should exist in. They're too complicated a function to try to build a health care system around.
 
Also the incentive isn't some legislated thing made up by a psych major to address people's human nature. Its an incentive developed by the state of the economy. Supply and demand.

There is a demand for manpower in the US. Particularly in healthcare.
 
The use of incentives are as old as the hills. Nudging provides benefits at the margins, but doesn't get around the overwhelming actuarial reality of health insurance pools and income distribution.
 
Re: OT: Canadian Politics

corksens said:
Such as?
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- Improved the access to information request process significantly
- Implemented a non partisan advisory board on Senate appointments
- In the process of creating a chief science officer position in the federal government
- Legal ganj by summer 2018
- New rules to limit government advertising
- Restored long form census and make StatsCan independent
- The whole Syrian thing went off without much of a hitch despite a lot of hand wringing at the time.
- Approved the Trans Mountain pipeline (when we were assured that he was an eco nazi who hated pipelines)
- Pretty big infrastructure package planned
- Big investments in public transit
- Student loan relief program where money isn't owed until they have found a job for 25K a year or more.
- More grants for students from low income families
- Cut the middle income tax brackets and created a new tax bracket for higher earners
- Restored a bunch of arts funding
 
lecoqsportif said:
The use of incentives are as old as the hills. Nudging provides benefits at the margins, but doesn't get around the overwhelming actuarial reality of health insurance pools and income distribution.
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Yup, coming at this from some ideological psychological bent, with little to no understanding of economics was always going to lead to a bat shit nuts argument.
 
lecoqsportif said:
The use of incentives are as old as the hills. Nudging provides benefits at the margins, but doesn't get around the overwhelming actuarial reality of health insurance pools and income distribution.
Click to expand...

It could easily work.

Get rid of public insurance. Lots of savings.

Get rid of some regulations which drive up provider costs. You already have multiple tier healthcare, anyways.

It will have pitfalls just like the universal system..but at least it will be more like real life is (ie some people are more valuable than others, and they produce more..so maybe they can get better care than someone else)

Innovation will be at its highest!
 
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