Defining the problem so broadly makes it less likely that it will be solved. We already have high inflation in part because of high government transfers during the pandemic, and handing out money to 100M people with medical debt or student loan debt would aggravate this.
Two wildly different issues. Medical debt is still generally owed to payers, student loan debt (as considered in debt relief) is largely federal. The impacts of forgiveness of either would seem radically different.
I find it odd that when talking about inflation or moral hazard people bring up money spent given to individuals but not about the trillions spent given to businesses. I think it is immoral for a country as wealthy as the United States to have so many people with medical debt. There should be universal, almost free healthcare. The moral imperative is far more important to me than considerations about inflation.
I dislike adding morals into this discussion. However, there is a real question of whether society in its current state can, in fact, function well. I personally would argue that right now society is very dysfunctional and that dysfunction is primarily benefiting those at the top. And the usual issue with dysfunctional societies is that they tend to fall apart. Now, reasonable person would argue that would not be a good thing even for those on the top of the pile, but clearly no one is scared enough yet.
All I want is balance. That societal balance does not exist now. Hence the tension that seems to be increasing.
I very much agree overall with your observations and points. I do think though that one should always consider moral aspects to policies and decision making since peoples’ lives are affected. Making policy based on economic theory without considering moral aspects seems like a bad idea in general.
Reminds me of my joke policy that meets many people's stated goals yet would be universally unpopular: the government should fight inflation by confiscating money from billionaires and then destroying it.
Milton Friedman famously said: “Inflation is always and everywhere a monetary phenomenon, in the sense that it is and can be produced only by a more rapid increase in the quantity of money than in output.”
We have a housing crisis and an energy crisis. There's absolutely no need to drag monetary theory in when the outcome is due to failed industrial policy.
Why can't it be all three? I understand that it is easier to sell it as a specific political problem, but I am genuinely tired of arguing partial inflation problem, because discussing it as a whole undermines some political angle.
Well, he's wrong, given that output has been knocked about by a large number of non-monetary factors such as COVID, supply chain issues, the war with Russia, and (yet again) oil and gas.
The way I see it, even if there’s a war or Covid or whatever, if people don’t have more money to spend, they can’t pay higher prices. Then you get a recession.
If they do have the money (because you printed more) they pay the higher prices. Then you get inflation.
There are 48 Democrat Sentors and 2 Independents who caucus with the Democrats, one of whom has sought the Democratic nomination for President. That’s 50 votes, plus the Democratic VP to break any tie. While it might be correct to say the Democrats do not have a majority in the Senate, its not incorrect to say they do control the Senate.
In the context of voting for taxpayer funded healthcare, or any other broad population wide benefit program / tax increase, it would be inaccurate to label Manchin and Sinema as Democrats.
Same as when Affordable Care Act was being molded, a couple of “Democrat” senators like Leiberman sank any chance a taxpayer funded option. Just like Manchin and Sinema sank Biden’s universal preschool/daycare and paid parental leave proposal last year.
Eh, both Manchin and Sinema self-identify as democracts, which some argue is all you really need these days. More importantly to me, however, if we rely on actions and not words, they consciously elect to remain members of Democractic party ( as opposed to say.. being Republican, Independent, Green or whatever ).
For all practical reporting purposes, they are Democracts. The moment you apply 'but they voted for X', you can cast McConnel as a democract, because he greenlighted new gun deal.
Context matters. The original post I replied to was admonishing Democrats as a bloc for not trying to reform healthcare, specifically with a taxpayer funded option.
The reality is that Democrats, as a bloc, are the only ones to have even attempted taxpayer funded healthcare, and somewhat succeeded. Just because a couple people who label themselves Democrats, but do not vote with them does not make sense to blame Democrats as a whole for holding back progress in taxpayer funded healthcare, and ignore the 50 Republicans voting against it.
This is all ignoring the fact that in the context of taxpayer funded healthcare, you need 60 votes to do anything, so the measure for “control” of the Senate would be 60 votes.
It is my bad. I did not read down-voted comment closely enough. I do have a problem with casting senate control as 60 votes, but your rationale makes sense now.
I think, because, in theory at least[1], simple majority in Senate is all that you should need to pass a bill. To the best of my understanding, 60 is just for being filibuster-proof.
Your question is qualified enough to relate specifically to the bill listed by OP, but, again in theory, if the bill wasn't so off-putting that senators decided to filibuster, maybe it would pass.
In other words, 60 is not control; 60 is safety. 50+1 is control albeit minimal.
I agree with your characterization. I supposed we will see more support of getting rid of filibusters via “nuclear option” as the bipartisanship gets less and less likely.
Democrats would not be able to bring a vote without 60 votes, or without using the nuclear option to rid the filibuster.
Which would burn a lot of political good will for no reason, considering the likelihood of how Sinema and Manchin would vote.
The point being that evidence points to Democrats by and large supporting taxpayer funded healthcare options. It specifically was removed in 2009 from ACA because of 1 senator from Connecticut.
Let's get a vote in the House to see where everyone actually stands. My point is that the Democrat majority seems to be against Medicare for All, and I want to see it in a vote.
It's not really fair to pin Lieberman's opposition to the public option or expanding Medicare as some personal opinion, he had previously supported expanding Medicare until he abruptly... got new orders? Seems like the the $930,000 in bribes he accepted from the health industry could have played a role:
The problem is, the democrats have done a lot of these symbolic votes, on issues that majorities (55% or more) of the public support. They take down the vote, and the public doesn't notice.
Even with public support for their ideas, they are losing the messaging war against the other party. Most voters don't pay attention to candidates' voting records, and barring the unforseen the Republicans appear poised for a major victory in the House, with the senate in play as well. We are in for some bad times ahead.
Blame Democrats for the college educated urban-dominated coalition they’ve deliberately chosen. I recall some activist types talking a few years ago about whether pro life Dems like Manchin should be kicked out of the party. Though it’s the House not the Senate, Dems just lost a longtime majority-Hispanic seat in south Texas: https://www.texastribune.org/2022/06/14/texas-special-electi.... To give you an idea of the temperature of that room, the Dem candidate had run as “a ‘conservative Democrat’ and ‘pro-life’ Catholic.” National Dems are making a deliberate choice to abandon those Dem voters, just as they did with working class white people in the Midwest. Remember when Dems had 60 Senate seats, including in states like South Dakota? It wasn’t ancient history it was 2008.
The Dems might have had 60 seats in name only, but even that was for a few months (Jul 2009 to Jan 2010). More importantly, a couple Democrats like Lieberman do not tow the party line, and frequently vote like Repubs, so I would not say Democrats ever had 60 seats.
> Democrats held at least 57 seats as a result of the election. When the new senators were first sworn in, the balance was 58–41 in favor of the Democrats, with the unresolved election in Minnesota causing that seat to remain vacant. The April 2009 party switch of Pennsylvania senator Arlen Specter from Republican to Democrat and the July 2009 resolution of the Minnesota election in favor of Democrat Al Franken increased the Democratic majority to 60–40 (providing the Democrats, including the two Independent senators who caucus with them, a supermajority and thus able to hypothetically over-ride any filibusters). Republicans gained a seat in a January 2010 special election in Massachusetts, thereby making the balance 59–41 before the start of the next election cycle.
They had 60 votes to get Obamacare enacted, which was a historic achievement. Obviously your coalition won’t agree on everything and you have to keep the marginal votes on board. That’s just how politics works. My point is that there is a more potent democratic coalition out there even within the framework of the Senate system. To the contrary, the Senate system long benefited Democrats because it favors working class rural areas over moneyed industries (finance, tech, etc.) concentrated on the coasts.
The country and politics of the nation have shifted. The divide is rural/urban now. The cities have the vast majority of the wealth but not the accompanying representation. The rural areas of the country are overwhelmingly conservative and increasingly white nationalist in sentiment. What the state of things 50 years ago was is no longer relevant.
The election of Donald Trump was clearly a white nationalist backlash. This is obvious and it was an enabling event for more extreme elements of white nationalism. One only needs to look at the rhetoric used to see this. Don’t confuse “white nationalist” with “white supremecist” (though the latter is a subset of the former).
The underpinnings of white nationalism have been around for a while but really came to the fore in 2016. The desire to keep “our America” and other catch phrases are indicative.
EDIT: Having white, nationalist sentiments or leanings is not necessarily bad or wrong. It’s quite natural for a majority population to have such sentiments when their status as a majority gets threatened. The demographics and gender power structure of the nation is noticeably changing and having a backlash against that change is common.
Republicans abandoned people who are in favor of abortion. Republicans abandoned liberal Republicans like Bill Weld. Every party abandons people. Democrats consistently hold majority views on a wide range of policy issues and consistently have more votes in national elections. Gerrymandering so that urban centers lose their voting power and other election rigging techniques is what is holding back Democratic policies. The Democratic Party should not abandon its highly popular core principles to cater to the deranged apportionment that the U.S. has.
> Republicans abandoned people who are in favor of abortion. Republicans abandoned liberal Republicans like Bill Weld. Every party abandons people.
Sure. My point is that the party made this choice deliberately. Trying to pin the blame on Joe Manchin, who is doing yeoman’s work holding onto a key part of the old FDR coalition, is disingenuous.
> Democrats consistently hold majority views on a wide range of policy issues and consistently have more votes in national elections.
The views of the party leadership and donor base and closely affiliated NGOs do not have consistent majority support. For example, Dems have basically allowed NARAL, etc., to be the voice of the party on abortion. But a strong majority of Americans oppose second trimester abortions, which are guaranteed by Roe, and a quarter of democrats identify as “pro life.” That’s more than ones who identify as “very liberal.” The party used to get that, carving out a space for folks like Manchin in WV and Tom Daschle in SD.
> Gerrymandering so that urban centers lose their voting power and other election rigging techniques is what is holding back Democratic policies.
Republicans have won the Congressional popular vote slightly more than half of the time since 1990. They’re about to do it again. Gerrymandering doesn’t affect that.
Even in the electoral college, it benefitted Democrats not only throughout the 1960s-1980s, but as recently as 2012. Obama would have been able to win a second term even if he lost the popular vote.
> The Democratic Party should not abandon its highly popular core principles to cater to the deranged apportionment that the U.S. has.
Democratic leaders and donors are deeply confused about what those “core principles” are, and who is in their coalition. The coalition is one of urban liberals who vote democrat for ideological reasons, and minorities and immigrants who vote Democrat out of self interest. My parents are the type of immigrant who turned Virginia blue. They care about Obamacare. They’ll accommodate some things the urban liberals want to get that. But that doesn’t mean they agree with college educated urban white people about what kids should learn in schools.
The fact is that a big chunk of the Democratic coalition has social values closer to Republicans than to liberal Democrats. Moreover, those are the party’s marginal votes in states like Arizona and Nevada and Georgia. Urban Democrats should live in that reality.
You are absolutely wrong in thinking Gerrymandering does not affect Congressional popular vote. It absolutely does. Especially in non-Presidential years. There are secondary effects you are ignoring with this incorrect belief. In recent years, since SCOTUS abandoned voting rights, the closure of polling stations also affects voting numbers.
We do not have proportional representation in the House, and the person with the most votes for President lost in 2000 and in 2016. The way Congressional districts are made and the weirdness of the Senate representation is such that we will soon be governed by a minoritist party. Who cares how things were in the 60s and 70s when the topic at hand is about the present day?
EDIT: The Republican Party has overtly attempted to subvert the political norms of the country and continues to do so. Arguing about this or that policy is meaningless unless the messed up way the Senate and House seats are allocated is fixed. That won’t be addressed anytime soon so the situation is essentially hopeless. Oh, and Manchin sabotaged voting rights legislation.
> You are absolutely wrong in thinking Gerrymandering does not affect Congressional popular vote.
Gerrymandering does not even consistently hurt democrats in the number of House seats. Dems in 2020 won the same number of seats as their share of the Congressional popular vote.
> There are secondary effects you are ignoring with this incorrect belief. In recent years, since SCOTUS abandoned voting rights, the closure of polling stations also affects voting numbers.
This is the Democrat equivalent of believing the Big Lie.
> The way Congressional districts are made and the weirdness of the Senate representation is such that we will soon be governed by a minoritist party.
What’s Biden’s approval rating again?
> Who cares how things were in the 60s and 70s when the topic at hand is about the present day?
Because Democrats still claim to be the party of FDR, who stitched together a winning coalition. The electoral system benefited that coalition—when Biden became a Senator, Democrats had 10 percentage points more House seats than their share of the Congressional popular vote. That coalition is still viable. Obamacare was enacted on that coalition. Urban Dems have chosen deliberately to prioritize other things instead.
You are very much wrong in your assessments. Closing hundreds of polling locations absolutely affects voting outcomes and number of voters. That isn’t a big lie. It is a provable fact. There is no point in discussing this topic with someone who refuses to acknowledge indisputable facts.
You are completely wrong on your assessment regarding Gerrymandering. You clearly don’t understand how total national vote total has nothing to do with whether or not Gerrymandering causes one party to have more seats than they otherwise ought to have. Here’s a hint: A Representative from California res presents far more people than the one from North Dakota. Here’s another hint: Heavily Democratic distinct overwhelmingly votes Democrat while three districts with slight majority Republican vote elect Republicans and the overall vote totals are mostly even. Both hints must be used to see why overall vote total means nothing when it comes to determining if Congressional representation is skewed.
> You clearly don’t understand how total national vote total has nothing to do with whether or not Gerrymandering causes one party to have more seats than they otherwise ought to have.
You're mixing up completely different things. The Congressional popular vote represents the total number of people that voted for each party in House elections. It's an absolute number of votes, irrespective of number of seats. Republicans have won this absolute count more often than not since 1990. For example, in 2016, Republicans won 63,182,073 votes (49.1%) and Democrats won 61,765,832 votes. Also, you can cross check it against the generic Congressional ballot, which is based on polling and isn’t affected by gerrymandering: https://projects.fivethirtyeight.com/polls. Republicans are ahead right now. That’s not a “minority party.”
> Here’s a hint: A Representative from California res presents far more people than the one from North Dakota.
It's actually the opposite, though it's a rounding error. California has 53 representatives and 39 million people, or 736,000 people per rep. North Dakota has 1 representative and 760,000 people.
These sites are peddlers of election falsehoods, just like Breitbart or Newsmax.
The irony of all this is that progressive election lies are used to disenfranchise minorities within the Democratic Party. Disproportionately white progressives invoke the notion that Democrats have overwhelming popular support but elections are close because of dirty tricks, to boost their own power within the party. That happens at the expense of disproportionately conservative and moderate democrats, who are disproportionately minorities.
Political parties aren’t one big happy family. The truth is that there’s trade offs between the interests of different factions and we should be honest about those. If Obama hadn’t run to the right on social issues in 2008, we wouldn’t have Obamacare today (which cut the number of uninsured Black people by half). That’s the reality of the trade offs between different factions of the party.
Manchin is not doing yeoman's work when he throws hissy fits over his name on a WH press release about something he'd already done (negotiated with Biden)
> Gerrymandering so that urban centers lose their voting power and other election rigging techniques is what is holding back Democratic policies.
I mean gerrymandering doesn't help but the Democrats aren't one cohesive unit otherwise they'd have no issue doing stuff right now. Sure people claim they only have 50+1 in the senate so they can be filibustered but they can just remove the filibuster with 50+1 and then do w/e they want. Democrats don't achieve their "party position's" because they're not the position that each member of the party has.
The same is true for Republicans. Look at Trump's campaign promises [1] which were often parroted by Republicans in congress but they only major thing they achieved was the Tax Cuts and Jobs Act [2]. ACA was not repealed because some Republicans voted no. One thing news orgs commonly bring up with Trump is he appointed a bunch of judges but that's just because Republicans changed the filibuster so they could; if RBG retired when Obama told her too or Democrats made the same changes, Obama would have appointed a bunch more judges.
Republicans were never going to get rid of ACA; it’s their plan after all. Republicans were never going to build a wall. These were just talking points. What Republican lawmakers are great at is being united in thwarting Democratic policies and doing what it takes to enhance their own power. Republican lawmakers are much more united when it comes to core principles:
1. This is kind of vague but Republicans do vote on Democrat-lead bills [1] which is a pretty poor way of thwarting them.
2. I did forget about mentioning that one. Republicans could have easily restricted it in 2016 if they as a cohesive unit wanted to. They do not. It's much more useful to leave it in the current state where it can constantly be brought up every election cycle as a way to drum up supporters who have no object permanence.
3. You got me here but that's also the thing I listed as their only accomplishment.
4. This one is very bi-partisan. The military has no issue with losing funding and especially wants to optimize funding by doing things such as closing low-utilized bases and moving those staff to other under-utilized bases. However doing so affects congressional districts and their congress representative have no interest in losing jobs (money) for their region. The lack of awareness of defense spending as a jobs program is a big pet peeve of mine :/
> What Republican lawmakers are great at is being united in thwarting Democratic policies and doing what it takes to enhance their own power.
5. Sure but Democrats have this issue as well. There have long been calls for things such as Ranked Choice Voting, Approval Voting, etc and Democrats and Republicans have long tried to even overturn those efforts even when decided by voters as a ballot measure. Both of them know that allowing this will degrade the "both sides" situation going on as other parties will gain a foothold. However it also leads to situations where voting for your first choice (a 3rd party) in close elections (i.e 2016 [2] vs 2020 [3] and 2000 [4]) can allow your second favorite candidate to lose but Democrats collectively are ok with losing every 3rd presidency (~1/10yr) as long as it doesn't eat into their powerhold (every other elected position).
There really is no reason to argue about the Republicans here. We have a bunch of states such as North AND South Dakota strictly to increase the number of republican senators [5]. Or more recently, in 2000 when Republicans in US Supreme Court overruled Florida's Supreme Court about if a recount should occur [6] (so much for states rights!). SO yes, it's a moot point that Republicans are power hungry and don't care about consistency only power.
did they put the Medicare for all on vote? if not, you can't just assume that if they didn't want more reckless government spending(thank God they stpped at that, the damage is already immense) they also don't want medicare for all.
But NPR tried their damnedest to hide it from me. A while ago you could reject tracking and get the text only version of the article. Today I only saw "agree" and "see how we use cookies". No official pointer to the text site.
And 70m of the population is 18 and under. So apparently the percentage of people with medical debt who are over 18 is quite substantial. Didn't realize it was so significant myself.
It's an entire industry based on fraud and deception. My wife recently had surgery and we got hit with a $1500 surprise facility fee. It likely won't be covered by insurance due to some fuckery around not reimbursing the fee if the in plan physician owns the facility.
We knew enough to ask about the anesthesiologist and any surgery assistants. But they came up with some new bullshit and got us. When the world gets wise to this nonsense they'll come up with something else. It's a business deeply rooted and based on scamming their customers.
I don't see why this is a bad number. It is easy to get on a 0% payment plan for medical procedures, or to contest a medical bill that is "a debt" that will get paid eventually.
Well, no. You certainly could be someone who *could* pay it off but chooses not to for a variety of reasons. Many otherwise financially people I know carry some credit card debt.
Now is that a large portion of people? I have no clue, and my anecdotal evidence certainly isn’t qualified to answer the question.
Please just read the article if you want to argue about it, it's not that long.
> And about 1 in 5 with any amount of debt said they don't expect to ever pay it off.
That's 20 million people.
> About 1 in 7 people with debt said they've been denied access to a hospital, doctor, or other provider because of unpaid bills, according to the poll.
That's 14 million people.
> An even greater share ― about two-thirds ― have put off care they or a family member need because of cost.
That's 66 million people.
> Half of U.S. adults don't have the cash to cover an unexpected $500 health care bill
That's 129 million people.
Again, please read the whole thing, whether or not you want to comment more. This is important information for US residents.
> Half of U.S. adults don't have the cash to cover an unexpected $500 health care bill
I recognize that this is an important discussion to have to improve US healthcare, so I’m not outright disagreeing with you.
But I think this is a bit editorialized. Paying with cash is so rare in society. I don’t even have the cash to pay for my lunch - I just use a credit card. It shouldn’t be surprising.
Half of U.S. adults said they would pay it immediately.(30% using savings,20% using a credit card they pay off that month)
A further 21% said they would pay with a credit card and pay it off over time. (Anyone who is already in other forms of debt will probably take this option as they, by definition, don’t have the cash for other things.)
Another 5% said they would make a payment plan with a provider / pay overtime.
That’s 76% of the country that is knowledgeable about reasonable ways to pay for the services. Now, 24% using worse off options or not knowing - that’s not good at all. But it’s a far cry from the implication that “half of people can’t pay”
But still this isn’t really a metric on the U.S. healthcare system directly - that would be asking why we have unexpected $500 bills, not which payment method people are using. And alternatively, or even in tandem, why people are not saving and planning ahead.
Note that this data is from a poll, not actual investigations of medical account balances. It includes the following, very broad, categories in the original polling methodology:
“c. Any debt you owe to a bank, collection agency, or other lender that includes debt or loans used to pay medical or dental bills.
d. Any medical or dental bills that you have put on a credit card, and are paying off over time.”
Thus, by one interpretation, if you’re already in over $5,000 of credit card debt, and you charge a $10 prescription fill or $25 copay to that credit card, their methodology will now include you in the medical debt and medical debt amount statistics as having medical debt over $5,000. The specific wording of the “amount” question seemingly tries to prevent this, but considering the above was classified as medical debt prior in the polling, it’s not hard at all to imagine people answering in the affirmative.
Is this really true? I don’t know, that’s a complicated discussion. There are certainly people who are paying medical costs with credit cards. They deserve to be included. But it does seem possibly a bit too broad.
Edit: By "that assumption", I mean that the portion of the number made up of people who only owe a few bucks and only briefly is significant enough to call for a dismissive attitude.
Anyone interested in this topic who wishes to explore it in depth should read Marty Markary's 2019 book "The Price We Pay".
While slightly out-of-date due to legislation that has passed since then, the book does an excellent job of explaining a lot of the perverse incentives at all levels throughout the medical industry that contribute to the outrageously high cost of healthcare in the US. Worth a read.
I have issues with how they did their analysis. They count anyone who paid for medical services on a credit card and then is carrying that on their credit card balance month to month. Folks… that’s how many Americans pay for all goods and services and run their finances. The last time I checked, 60% of Americans carry a credit card balance from month to month. The findings in their report seem aligned to that.
I think people are reading too much into a poor analysis, created and reported on by institutions with an obvious agenda.
Drs and other high earners in the states that introduce socialized health care will leave immediately as the state institutes price controls. There is a reason so many Drs trained in Canada immigrate to the US.
It is always the same poor journalism tactic of obscuring the distribution of data to make a “plausible” controversial claim. Similar to the oft quoted “Americans cannot afford a $500 emergency”.
Go ask any law enforcement officer, fire fighter, or EMT how many times a week they hear "please don't call an ambulance, I can't afford it" and the answer will be so depressing that you may change your tone about this.
Fun fact about the US's system too - even when ambulances are called for things like heart attacks -- they take much longer to show up in poor areas compared to wealthier ones;
There are some common agreed upon thresholds that strongly correlate with positive outcomes, e.g. 15 minute response time after a heart attack. In wealthy areas, this outcome was achieved 97% of the time vs. only 93% of the time in poorer ones. That doesn't sound too bad, but that means you were something like 230% more likely to miss that cutoff if you were in a poor neighborhood. But at least it's not "socialist".
My friend who lives in the USA had to deliver her own baby in a hospital hallway because all the rooms were full and the doctors were too busy to tend to her.
The hospital still sent her a $30k bill for the delivery.
Is having 41% of adults in America in debt really worth "innovation" for the rest of the world?
And what exactly is "rationing" - I bet almost every adult in America knows someone (or is that someone) who has delayed going to the doctor/for a procedure (or just never got it entirely) because of how much it is going to cost? Doesn't the inability to even get the required care due to the cost really count as "rationing" in the system we already have?
If you think our current system doesn't have rationing, I'm not sure what to tell you. "Long wait times" are one way to ration care -- but equally effective is just denying 30 million people the ability to get any care at all due to unaffordable insurance and ruinous costs for any 'touch' with the system. Another effective way to ration care is to make routine things so expensive that people self-select out of receiving care or filling prescriptions even when they are insured.
Literally the entire point of copays and other forms of cost sharing is to 'ration' healthcare by reducing demand. There might be health insurance out there without cost sharing, but I've never seen it and it's certainly not the norm in the US.
can you elaborate on the "rationing" part?
I'm guessing you tied "socialist" and "rationing" together, but did you do it in the context of other developed economies (i.e most of Europe?)
Is this just sarcasm? Rage bait? Are you out of touch? Poor people already ration care. I experienced it first hand working in a grocery store. God forbid you got hurt or sick because you'd be losing work days aka income. Then you'd be eating less or borrowing money or skipping a few medications. But, sure, socialism in healthcare * like every other developed economy* will stifle innovation.
U.S. healthcare underperforms in most verticals. High cost is the primary reason that prevents Americans from accessing health care services. Americans with below-average incomes are much more affected, since visiting a physician when sick, getting a recommended test, or follow-up care has become unaffordable.
https://www.commonwealthfund.org/publications/issue-briefs/2...
I'm no socialist, but you can actually have a system of government health insurance but keep private healthcare. Or basic free healthcare (government run hospitals/clinics) and if you want better, pay out of pocket for private.
For example, in my wife's home country, she give birth in an awesome private maternity hospital for about $2k out of pocket for everything. I mean everything. But if we wanted, she could have done it in the government run hospital for $0.
> you can actually have a system of government health insurance but keep private healthcare.
This is what we currently have in the US. In fact, the US government is the largest healthcare insurer in the US (through Medicare and Medicaid) [1].
Interestingly, economists have found the US government becoming a healthcare insurer substantially increased US healthcare prices. For example: "Finkelstein estimates that the introduction of Medicare was associated with a 23 percent increase in total hospital expenditures (for all ages) between 1965 and 1970" [2].
It turns out making healthcare "free" to certain people caused them to demand more healthcare. Higher demand caused higher prices. Congress "didn't consider the effect of the increased demand that Medicare set off." [3] Now healthcare prices are high AND Medicare/Medicaid is being paid through deficit spending.
If we want to solve the problem of unreasonably high prices for healthcare, and the debt that causes, we can't keep doing the same thing and expecting different results. We need to fix what we've broken with the healthcare market so it can operate like markets do and find a fair price.
idk. Most innovation in the field of medicine comes from research in universities, which are pretty socialized for the most part. The workers that are doing the innovation are also educated in a mostly socialized learning system. And there are plenty of economies with mostly socialized medicine that do plenty of innovation (including the USA). So I think your fears of collective funding of important institutions are unfounded.
The commonly accepted definition of innovation is the practical implementation of ideas that result in the introduction of new goods and services. So while the ideas may come from research in universities, I struggle to think of examples of practical implementations resulting in new goods and services. Do you have any examples?
I also intentionally go in to debt for any of my expenses subject to deductible, because my hospital offers zero-interest payment plans. I then pay their payment plan with a credit card, get 2% back, and pay it off at the end of the month.
This also ties into that commonly statistic that 60+% of bankruptcies are caused by medical bills. The study is more complicated than that, and it's not the best summary:
This is exactly the kind of thing I'm getting at - absolutely 100% of bankruptcies are caused by debt; perhaps 60% of them also have medical debt somewhere in there, but that may be a distraction (after all, once you're on the path to bankruptcy why bother trying to make medical payments, they're not going to repossess your lung but they very well may repossess your house).
The US has a major debt problem and the solution at some point is going to be curtailing just how much debt you can accumulate with just a signature.
A lot of people read that statistic as "medical debt is crippling" but there are also correlations with lot of other life circumstances going on in that figure too.
Most of the people who file something like chapter 7 have little to no income, don't have big bank accounts, luxury cars, second homes, etc. This often correlates with people who have medical issues and rack up big bills, and can't work a job. These people can file "no-asset" chapter 7 cases, in which case, they lose absolutely nothing. This is what happens in the majority of chapter 7 cases filed. So, for a lot of the people who do choose to file, this is because it is a good option, not because it is a life crippling choice forced upon them.
I'm very surprised they do not charge the credit card processing fee here. But I guess since you are actually paying they are making such high margin they don't even care.
This is 100% the case, the billing side is completely and absolutely disconnected from the care side it's not even funny. As long as the inflows from customers and insurances companies roughly equal the outflows in expenses, they really don't care much how everything is billed.
Which is why you can often do better paying cash at a "expensive" hospital that is overflowing with money than at a "budget" one that is having difficulty making the numbers balance. The latter is more likely to hard-line.
Yeah I was going to say, I would be 0% surprised if I had old outstanding medical bills somewhere just because of the general chaos of the process. I have plenty of cash to pay whatever I owe, it's just a low-visibility clusterfuck.
Yep. I'm dealing with a situation where speech therapy as rehab from a surgery is covered by by plan. But the hospital just submitted the claim with some general code. The insurance says they need the therapist to change the billing code. They won't allow us or the surgeon to submit anything to prove it should be covered. We have to wait for the inept therapist to change the code. All the while thousands in bills hang over our heads and we wonder if insurance will pay out.
And rarely, if ever, can you get the insurance company to admit what the secret billing code is before you have the procedure done. You have to hear it in whispered conversations from those in the know.
2/3 childbirths we missed one (tiny, in both cases) medical bill and it ended up in collections.
We were getting like 3-5 letters per provider per visit, and many visits resulted in bills from multiple providers.
"NOT A BILL" (so why the fuck are you sending it to me?) same thing again from insurance for some reason, incorrect bills we had to fight, insurance refusing to pay on things they should so that drags out for months and you're getting "FINAL BILL" in the meantime but the hospital billing people are telling you not to pay them until insurance is sorted out.
Many providers sending a bill exactly once and it goes to collections if you don't pay in 30 days, no calls or follow-ups (that's how both of ours ended up there—again, they were tiny, we'd have paid them instantly if we'd known about them).
Bills showing up two months after a visit and you've had 30 medical appointments in the last year so you can't remember WTF it was for. I think in one case we were still sorting crap out from the birth and prenatal care when the kid was 6 months old.
Hospital requiring full payment months in advance for the births. And getting it very wrong in one case (on the high side, of course—every billing error is in the hospital's favor, super weird how that works, bet it's just an accident and not them being actual no-bullshit criminals, though eyeroll) because they refused to use our version of what insurance would pay (which was correct) and basically just made up a number.
Total fucking mess. Horrible experience every time. Can't wait to get to deal with this horseshit when one of us is actually, seriously sick. I've added hospital billing departments to the list of medical-related folks I truly, sincerely wish the worst on, and I mean the worst—show me the headline, I'll open the champagne. They're either shockingly incompetent in ways that mess up people's lives, or they're malicious. Maybe both.
My wife and I have good insurance (like $200 out of pocket for surgery good) and I still hate going to the doctor because I know I'm going to get stuck with an involuntary side hustle as a medical billing clerk if I want the benefits we're entitled to to actually be honored. Our insurance paid maybe ~6k in charges one time, then 6 months later retroactively denied the claims and billed us for them. There's just no repose ever at any time, and you have to deal with a system that is always stacked against you.
No joke. If we'd been compensated at any kind of reasonable rate (not even our day-job rates) for time spent dealing with billing and insurance crap, it would've covered a good chunk of our (substantial) bills.
I truly don't think everyone involved could be making so many mistakes in their own favor if it weren't the result of policies tuned to ensure that happens.
The policies are designed to find errors in the client's favor, that's manifestly clear.
Penalties need to be attached to misbilling; it needs to be made effectively illegal and allow others to help collect the penalties, then an industry of scummy lawyers will appear to help customers reduce their bills at the expense of the hospitals.
We've encountered similar situations (especially the "NOT A BILL" fuckery) and the "oh don't pay it when it arrives because insurance is always slow" shit - but luckily none of our three births have been that bad cost/handling wise, even though we used three different hospitals (same insurance).
The smaller hospitals in general have been better but it's so obviously a giant clusterfuck.
I can't even imagine how someone without partner support (who the hell wants to deal with hospital fuckery post-partum) does it.
At worst they'd put you as one of the 37% of people who haven't had to cut spending on food, clothing, or other basics.
Of course, 63% of the people with health care debt have (according to study).
So while your case is interesting from a technical point of view, it isn't really practically or morally interesting, and can only serve to detract from the important points of the study.
These studies are always self-reporting and taken at much more than they actually say. Checking the methodology is important and should be done more often, especially on surveys based on self-reporting and not on large amounts of data.
You are right. I tried to caveat my analysis with "(according to study)". My prior is not that the study is completely accurate, but that it is accurate enough to make the broader points described. I may be wrong, and you're right that everyone should be more cautious.
But I think there is a difference between cautioning neutrally (the comment I'm replying to now) versus obliquely cautioning in a way that casts doubt with negative consequences (the comment I replied to previously).
$1000 is $2 / day for les than 2 years (if you can do math unlike commenter below, that's including nearly 20% APR). I'm sorry but even the poor in america can come up with some way to make $14 in a week, if nothing else by picking up some cans.
I live in a city where a segment of impoverished people come up with ways to spend $20+ a day in fentanyl, and they don't seem to have much trouble coming up with that even while living in a tent.
Yes, if you are living in a tent and are addicted to opiates, I doubt that "medical debt" would be anything that even registers on your radar. You'll get emergency medical care as needed at the nearest public ER, and since you don't have an address they probably won't even bother to try to send you a bill.
If you're not eating it follows you're eating $0 worth of food. So it is what you said, unless you're implying someone is spending money on food without eating any of it.
I'm interested in the meals you suggest that you think are "eating ok" while maintaining the nutrition to work, $2 all in per day (food cost + transport to buy the food + cost to cook the food + depreciation on any utinsils / cookware).
Also keep in mind many poor people live in a food desert so if you're counting on discount food you're gonna need a bus ticket or a hell of a long walk once in awhile.
As an aside, it's worth noting if your suggestion is true and one can truly eat ok on $2 a day, then the median medical debt holder who spends say $4 a day on food can easily pay off their loans in a few years following your cooking advice. You just came up with a way for them to produce $2 / day without any additional income.
There are multiple meals per day if one has to skip some of them to make ends meat then they are "not eating" those meals.
It's a bit more complicated than you are making it out to be, it would not hurt to remember you are talking about fellow human beings and not just numbers in a spreadsheet.
Got it, the typical person can browse reddit, come up with an "ok" diet for $2 day, saving them $3+ a day vs what even the typical working class person spends on food. And simultaneously you believe it is achievable to save this $3+ per day eating following your reddit suggestion while somehow not being able to use $2 of those $3+ to pay your medical bills?
Do you find that being this uncharitable is an effective way to communicate with others?
You haven't actually been poor like that in the US. That isn't a question, it is a statement. I have as have others I know so yes even a few dollars per day can make/break the budget.
>You haven't actually been poor like that in the US. That isn't a question, it is a statement. I have as have others I know so yes even a few dollars per day can make/break the budget.
I don't know how poor you have been or are. And you don't know how poor I have been either. I'm not going to play oppression olympics with you. I have been homeless, sleeping in ditches and parks before, living off of minimum wage day labor. Even back then, if I needed $2 I simply worked an extra 15 minutes moving drywall at construction sites or whatever. Those who can't work may end up buying snacks with their foodstamp card and hawking them to high schoolers walking to school or something (as I see many homeless do near my house). There are very few people who aren't already covered by medicaid/medicare who are incapable of coming up with $2 / day somehow, and if they are they are the extreme case. Again even _drug addicts_ in my neighborhood, while high out of their minds, somehow manage to come up with $20/day for their fentanyl habit and that doesn't even cover the rest of their necessities.
And as an aside, I'm not buying the argument that being broke somehow makes you more of an expert on how to budget. The poor in this country are notoriously victims of sub-par education which sadly leaves many of them poorly situated to navigate managing their own economic future. If I want budgeting advice I'd much rather ask say a guy who started his own restaurant vs some random broke person on the street.
> I'm not going to play oppression olympics with you.
That wasn't my point. Honestly please take a look at your interaction with me and reflect on it, it isn't necessary to engage in such a hostile fashion. You have read a lot into what I have written that simply isn't there.
You have read a lot into what I have written that simply isn't there. It's not a good look to clam up and play the victim when called out on your presumptuous and contradictory statements, including your assuming the economic background of someone based on a short dialogue. Remember just one post ago you found it completely valid to retort about how I "haven't actually been poor like that" and how you have.
Please take a look at your interaction with me and reflect on it, and think to yourself about how you can be less presumptuous.
You're taking one person's experience, who has mild medical expenses and applying their situation to loads of poor people as if their experience exemplifies the experiences of millions. Frankly, that's disgusting and while I don't wish you awful medical debt, it sounds like you could stand to be humbled by some.
Think of bigger medical expenses over the same period -- 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly costs (300-400/mo). Then rent, then food. Etc etc.
>You're taking one person's experience, who has mild medical
"You" being the parent OPs who I responded to who introduced the nation of $1000, which happens to be above the median for my state and most states shown in the article? Remember I'm RESPONDING to the $1000 comment, not introducing the figure. But maybe they said something about the $1000 you agreed about, so you went with the disingenuous approach of only impugning someone commenting on it and in bad faith accusing THAT person of introducing the figure.
The MAJORITY in my state and most states have less than $1000 in medical debt. Millions. This isn't some edge case. $1000 "exemplifies" the median medical debt in most states, according to the article.
>sounds like you could stand to be humbled by some
Yeah a subtle suggestion I ought to experience medical problems. Keep it classy. "Frankly, that's disgusting."
>Think of bigger medical expenses over the same period -- 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly costs (300-400/mo). Then rent, then food. Etc etc.
Yes I thought about it, and then decided my $2/day figure still holds as a possible approach for paying off median medical debt. Thanks for the thought exercise!
I'm not sure how throwing around a $100k figure is supposed to make your point any better. If it's worth considering the 100k case of the minority it's worth considering the half of person's in these states for whom the debt is under $1k.
My intention was never to show that someone with $100k of medical debt could get out of it as easily as the majority with far less.
I'm not assuming anything, I'm wondering about their methodology (and since it's a self-reporting survey, how people were answering the questions).
Medical debt is a huge problem but to craft solutions we need to fully understand that problem. Should, for example, insurance companies collect "deductibles" ahead of time and refund those not used, similar to how you could use an HSA? Should healthcare providers and insurance companies be required to offer 0% financing for 12 months for certain amounts or certain customers?
The vast takeaway is usually "this survey supports what I think should be done" which often results in not much of anything being done, or getting something worse than what was before.
No need to wonder. You can read the poll and results methodology yourself.
The answer is two clicks from the article, both links above the fold on their respective page. If you’re being genuine in your curiosity, it would improve the discussion here if you shared what answer you find.
> The survey was designed to reach adults who currently have health care debt or have had health care debt in the last five years. In order to do this, the probability panel sample included an oversample of panel members with annual household incomes less than $30,000, individuals with current or past health care debt (n=641) were included in the sample. In addition, 52 adults with past or current health care debt were reached by calling back respondents that had previously completed an interview on the SSRS Omnibus poll (and other RDD polls) and reported an annual household income of less than $25,000.
> The combined online and telephone samples, excluding oversamples, were weighted to match the sample’s demographics to the U.S. population using data from the Census Bureau’s 2021 Current Population Survey (CPS). On the basis of this weighted sample, parameters for the debt and no-debt populations were extracted. Weighting parameters for each group included sex, age, education, race/ethnicity, region, education, and income, as well as patterns of civic engagement from the September 2017 Volunteering and Civic Life Supplement data from the CPS. The sample was also weighted to match population density parameters from the Census Planning Database 2020. The weights take into account differences in the probability of selection for each sample type. This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.
So they intentionally targeted people with debt, so the "63% percent of respondents" is not able to be read as "63% percent of Americans".
The 100M in the title is extrapolated, and is likely correct, but people are not reading the percentages as they should be read.
The key takeaway from the study is that not all medical debt is reported as such, and poor people have difficulty paying bills, one type of which is medical bills.
I hate the way the health-care system works and how it's affected me and those close to me. I spent much of my adult life paying off medical debt exactly like they describe. Defrayed by parents somewhat, but still a significant burden for many years. On one hand, we have debt and bankruptcy as a tool to help individuals deal with costs that would be impossible to save up for. On the other hand, this quote from the article rings true:
> “We have a health care system almost perfectly designed to create debt.”
As implied in another comment, the real solution is one people don't want to consider - forbid people from taking debt on in certain circumstances.
But this immediately appears as "unfair" even if predatory lending is a huge problem.
Meanwhile those who already have some money wouldn't be affected by it much, for example, a law requiring all credit cards that charge interest on balances to be secured ones (where if you have a $1k credit line you must have $1k cash/cash equivalent in the bank).
Yes. Debt is the entire story of the American economy, from top to bottom, it's not inherently evil. It's useful for creating new wealth. But of course it gets misused also.
I don't think anyone is arguing that debt can't be another tool in the toolbox, but when you consider that the debt/equity ratio has risen considerably since the second half of the 20th century, you start to get the sense that this is somewhat "centrally" planned.
Also known as 100M people who may have died without medical care, but were provided it despite their inability to pay for it. If you remove the ability for medical workers to seek payment for their services, most medical workers are just gonna say fuck it and not work for free.
Medical care providers have families they have to feed too.
The US doesn't have universal healthcare, so there's not a great mechanism for health care workers to earn a living without charging client for it. Some charities excepted.
The money going into medicare is enough to extend coverage to all americans provided the system is run with the cost efficiency of the typical EU healthcare system.
Well I think that's the entire point of this article: to call attention to the overwhelming crisis of medical debt in the US, and the need for us to create a great mechanism to deal with it.
Just because we don't currently have a functioning healthcare system doesn't mean we can't have one ever. As more people are made aware of how pervasive the issue is, there will be more impetus for those in power to start doing something about it.
The alternative isn't denying care. It is providing the same care without having people get into debt, which every other developed country (and a lot of undeveloped countries) in the world manages to do.
except that you redistribute according to means, seeing as tax is correlated to income. so instead of having a random dice roll ("ah, you're working multiple low-hour jobs and you just got cancer? game over!"), you pay a bit more of your income as tax
Not everything is binary. 10k for an emergency X-ray and sitting on a bed for 3hs is very far from not getting paid. That gray area in between is what needs to be looked at.
The "why are people expecting doctors to work for free?" argument is such a bad faith take.
You know damn well that nobody is expecting doctors to work without pay. I refuse to believe someone could actually believe such an idiotic argument is being made. So why act like it is?
Ah I see, doctors aren't supposed to work for free, just other taxpayers (who most likely make far less than a doctor) working for free to pay the (much higher salary) to cover someone elses expenses. Got it.
I'm opposed to tax funded police, roads, and schools. If you want to create a roads charity, by all mean I'm fine with that.
Sometimes tax payers are funding their own expense, sometimes not. What I take issue with is being involuntarily compelled to pay someone else's expense at gunpoint.
Nobody is forcing you to pay at gunpoint, you are free to leave at any time and no longer pay. Paying taxes is no different than mortgage or rent, either pay it or get out. You don't fully own the property you live on even if it's paid off, it is the soil of the country you live in, if you want your own soil fight for your own sovereign territory and keep it through force without any help, good luck.
>Nobody is forcing you to pay at gunpoint, you are free to leave at any time and no longer pay.
OK so if a robber comes to my house and says pay up or leave, then that's not a forceful action at gunpoint?
>you are free to leave at any time and no longer pay.
That's not how it works -- allow me to inform you of tax law in the US. US Citizens are responsible for filing, and possibly paying taxes on income earned ANYWHERE IN THE WORLD. The US, and I believe Eritrea, are the only two nation's I'm aware of in the world like that. Now you could renounce citizenship, but even then that wouldn't satisfy your condition of "no longer pay" because you even have to pay over $2000 just to renounce citizenship, and that has to be done outside of the US. The US has been known to engage in "extraordinary rendition" which is to say they target/extract citizens even out of countries when there is no legal mechanism for them to do so.
In short your claim here is incredibly innacurate.
>Paying taxes is no different than mortgage or rent
When I pay rent/mortgage it's for my own use of property in a private contract, in a voluntary exchange. Tax is an involuntary transaction. A very different thing.
>, if you want your own soil fight for your own sovereign territory and keep it through force without any help, good luck.
You start off saying nobody is forcing this at gunpoint but then you go on to challenge me to "keep it through force." You're starting to look like a violent person. It's really comical how quickly the façade drops of persons such as yourself who turn out to be persons of great violence who are quick to challenge others to engage in such activity.
>OK so if a robber comes to my house and says pay up or leave, then that's not a forceful action at gunpoint?
They are not a robber they are a landlord, you are on their land, pay taxes or leave your choice. They are not forcing you to stay and work and pay taxes at gunpoint, you have the choice to leave. However while you are there you must fund the services they are currently providing to you, if you willfully evade that payment then you are committing a crime, but you have the option not to, you always have choice.
>That's not how it works -- allow me to inform you of tax law in the US. US Citizens are responsible for filing, and possibly paying taxes on income earned ANYWHERE IN THE WORLD.
Most standard income is covered under FEIE and FTC, that is you won't pay taxes twice if your paying taxes in another country utilizing their social service instead and if you have been truly living in working for almost a full year you pay no tax on the income.
Note since you are US citizen you still benefit from their social service while living abroad, the are many protections upheld to US citizens traveling abroad you would no longer have if you renounce.
>Now you could renounce citizenship, but even then that wouldn't satisfy your condition of "no longer pay" because you even have to pay over $2000 just to renounce citizenship, and that has to be done outside of the US.
Exactly, you must pay your final rent payment and get out, no one is forcing you to stay. If you don't have the money to pay then you are not making income to pay taxes either.
>When I pay rent/mortgage it's for my own use of property in a private contract, in a voluntary exchange. Tax is an involuntary transaction. A very different thing.
You have agreed to the social contract [1], you are voluntarily staying in the country and utilizing the social services and resources (military and police protection, roads, public spaces etc.) to make money and live safely and productively. No one is forcing you to stay, there are places in this world that do not tax you for police and schools.
>You start off saying nobody is forcing this at gunpoint but then you go on to challenge me to "keep it through force."
That's the point, the reason you don't have to defend your property and life through force on a daily basis is because you have voluntarily agreed to live in a country that has the monopoly on violence [2] and in exchange for the social service of military and police protection you must pay taxes if you profit from that protection.
People are social animals, they work together to solve problems no individual could on their own, money facilitates this and is needed to fund the large social framework you live under hence taxes. If government disappeared tomorrow, it's would be reformed quickly in not so pleasant ways. You may not like it but that doesn't matter because others will form large groups and impose it on you regardless and you will have no choice over its form.
I understand the 'notion' of social contract. However I choose not to accept the terms of the contract as envisioned by above. A key element of 'contract' is consent.
Then you must move out to someplace else that you wish to consent to or forge your own social contract which will require force unless you find un-inhabited unclaimed land.
By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.
How about you move. It's hilarious to suggest the contract is still intact when the government violates the contract itself, such as abridging 4th and 2nd amendment rights, rendering the contract void. Just a few months ago, I had a warrant served where a homeland security official lied and said a drug dog had "alerted on my buttocks" and I was forcefully strip-searched and dragged to a hospital to be "internally examined." Sorry the government themselves violated the contract.
And it's worth noting, even though the "contract" legitimize this, the last president didn't even have the assent of the majority of voters.
>By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.
I'm not too worried about whatever ad-hominem you'd like to label.
>Note since you are US citizen you still benefit from their social service while living abroad, the are many protections upheld to US citizens traveling abroad you would no longer have if you renounce.
This is so hilarious as to make me wonder if you've ever actually been to a US consulate abroad. I have, against my wishes due to riding in the same taxi with a 'friend.' We had both overstayed our visas, and the consular services basically said "lol get fucked, good luck!" I could have obtained the same services talking to a wall. I'm good on their services.
>Exactly, you must pay your final rent payment and get out, no one is forcing you to stay. I
If I've already "gotten out" including paying my taxes this rent analogy makes even less sense, not that it was a good one to begin with. I never signed a contract saying if I leave the non-existent contract I agree to pay $2000 to back out.
> you don't have to defend your property and life through force on a daily basis
I wonder if you've even been to the United States? It was not so long ago someone tried to rob me at gunpoint. I still have a scar from fighting back. On a daily basis, people are violently assaulted in my city. Nowadays I'm forced to have "protection" that I have daily in case someone tries to use lethal force against me again. The police have no legal duty to "defend" you per the supreme court. The type of protection police provide here, I wouldn't wish on my worst enemy.
As for military protection, I actually have fought as a self-funded volunteer in a foreign militia (YPG) against ISIS, so I'm willing to put my money where my mouth is about not using tax money to defend life.
>However while you are there you must fund the services they are currently providing to you
You don't get to just provide services for someone, who never agreed to it, and then demand payment. Payment for services is predicated on the parties consenting to the transaction. Providing service without the other party agreeing is charity at best, unwelcome intrusion at worst.
>no one is forcing you to stay
Except some people have had their passports revoked, and occasionally without even owing anyone anything ("for national security reasons.") In fact DHS has threatened to revoke my passport before, despite not breaking any law. It is a crime to leave the US without a passport. So the US does 'force' some people to stay.
>People are social animals, they work together to solve problems no individual could on their own, money facilitates this and is needed to fund the large social framework
People are capable of doing this in a consensual manner. In fact many businesses operate on this principle of consensual mutual benefit.
>You may not like it but that doesn't matter because others will form large groups and impose it on you regardless and you will have no choice over its form.
Back to your contradictory argument of "no one is forcing you at gunpoint" -- except you reneg and say a...
What's "excessively naive" is to act like you're not suggesting people work for free, when indeed you are. You're simply performing a sleight of hand: instead of framing it as the doctor working for free, you shift the free labor onto mostly people making a lesser income. You sir/mam, are both deceptive and disingenuous.
>The actual argument you wanted to make
And how incredibly good faith of you to bring up taxation of roads, school, and police and then have the gall to act like it's a waste to discuss the very subject YOU YOURSELF INTRODUCED. My brother, I did not mention anything about the taxation of roads/police/schools until you brought it up, it's beginning to look like that's the real argument YOU wanted to introduce.
Is there evidence that the high cost of healthcare is due to paying frontline medical workers?
This is an honest question I don’t know the answer to, but based on my analogous experience with academia and the high cost of tuition, I would guess the answer is “no”.
I think that's only a fraction. I agree we should eliminate licensing and regulations, which in part are responsible for burdensome administrative parasites.
Just watched John Q (2002) last night, and can't believe that despite all the attention it gets, nothing has changed at all. Can't say I'm surprised though.
Basically the way things work in the US is that even if you can get an overwhelming majority of people to agree that something is a problem, you will never get them to agree on a solution.
In this instance, the two proposed solutions are: make healthcare the government's responsibility like many countries that don't have this problem, or do nothing because that solution isn't perfect.
Further, neither side (seems to) accept incremental change and loves making the perfect the enemy of the good -- especially, imo, the left -- so they get nothing and complain about it.
You're going to have to elaborate on that one, considering that the ACA came from the Obama administration and was about the smallest incremental change possible. Not that republicans didn't try to repeal it several times anyway.
Sometimes incremental change happens, like the ACA, sometimes people go all accelerationist[0]/Bernie-or-bust on us and then someone vastly worse[1] gets elected. Seems like it's more the latter than the former these days considering how divided we are, politically.
I literally linked those two polls just yesterday, hah [0]. Did you see my comment, or did you just happen to do a similar search and get those results?
As I mention in my other comment, I speculate the possibility that people think "Single payer" and "Medicare For All" are different things [1] and so report a different opinion on each, similar to how the ACA was viewed MUCH more favorably than ObamaCare despite one being the nickname for the other.
[1] ACKSHUALLY, single-payer doesn't HAVE to be simply expanding Medicare to everyone. It could be done in some other way, but the core idea of the government paying for everyone's healthcare is still the same.
Yeah, but they're ridiculoisly overpriced, and regulatory capture around medical devices means new entrants' devices will never be approved by the FDA.
Before Michael Crichton wrote fiction, he was a doctor and his first book, "Five Patients", was actually an examination of different topics in healthcare in the 1960's. One topic was the massive cost increases even back then. It's a pretty interesting read too.
not that it honestly matters. the whole cabal of private healthcare has become such a teetering house of cards post covid that credit reporting agencies no longer count medical debt in your score.
My wife had a decent chunk of medical debt when we got married which was long before COVID. Even at that time medical debt didn't count terribly against her. Maybe a 10 pt drop in her score. And eventually the debt fell off her credit.
This is one of many reasons why hospitals charge so much. Medical debt is extremely difficult to actually collect because refusing to pay has basically no consequences. Hospitals have to eat those costs and make up for it by squeezing patients who do pay for as much as possible.
I did the same thing with an ER bill I couldn't afford a while back. I just never paid it and suffered virtually no consequences.
But they still have the debt, right? It's great if it's not counted against them, but to say "it doesn't matter" seems unfair - won't they still be hounded by collections agencies and potentially sued?
I don't know why people see this as a good thing. Healthcare is expensive for precisely the reason that people skip out on paying their debt. Now it's harder to collect so what's the result? Costs are going to go up to subsidize the increased cost of collection.
I will just chip in to point out the obvious: the US healthcare is the teetering house of cards etc etc etc. Many other countries managed this just fine, so the question is, why not also in the US? Follow the money: who gains out of this chaos?
This is the expected result of median deductibles being larger than median savings accounts. Small amounts of debt <$1000 are not necessarily problematic amounts of debt, especially considering that they can typically be paid off over time with no interest.
> Elizabeth Woodruff drained her retirement account and took on three jobs after she and her husband were sued for nearly $10,000 by the New York hospital where his infected leg was amputated.
I'm not sure what sort of retirement they had planned to have on less than 10k, but it looks like in this case the hospital knew they could afford to pay but preferred not to. When people use number of jobs rather than hours worked per week it's typically beacuse number of jobs is greater than one and hours is less than forty.
> Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills.
The emergency room was available to him. What was the total he was asked to pay? Why didn't he pay it?
> Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.
Average nurse practitioner salary 115k. Why are they putting medical debt on credit cards? The emergency room wasn't going to stop care to those kids if they didn't pay immediately. If they were poor the kids would get CHIP, so I think they probably had too high income and maybe decided to forgo health insurance and work as contractors for additional pay. What was the plan for the birth? Was the problem that they were early and they didn't have a chance to get insurance at the last second?
>Average nurse practitioner salary 115k. Why are they putting medical debt on credit cards?
Are you asking why they couldn't afford 70% of an average salary (which, there is a 50% chance this person made less than the average) in one shot?
Your entire post seems to be victim blaming based on a few sentences of context. You don't know what other debts and obligations these people had, nor what other avenues they tried to exercise.
Maybe what they are asking is how someone making an average of 115k, who is also in healthcare doesn’t have better health coverage and still decides to have a kid.
The American Dream. Must make 115k+ (what is that, 2x or 3x the average American?) and pay out the ass for coverage just so you can have the privilege of having a kid without being judged by random people on the internet.
I’ve made much less than 115k for most of my working life and I never had such shitty coverage. I don’t agree that having twins or whatever should be 80k, don’t get me wrong. But if you’re in healthcare and make enough to have a decent plan and choose not to, and on top of that you decide to have kid/s, you know what you’re getting into.
At 38k a year I had a max out of pocket of 7k. It can be done.
It’s as if I opened a web server in my home with all the ports open, a password that is “changeme” and then complained that someone else should’ve been protecting me.
She wouldn't of had any coverage at all. Obamacare puts the out of pocket max well below 80k. At that income level and field, that's a choice. Is the idea that I'm supposed to pick up the tab or feel sorry for her? I make less than she does and I pay for my health insurance.
That's not at all a normal cost of having a kid. It says she ended up with twins and they were born prematurely. That said, I have no idea why it wasn't covered or how she ended up getting stuck with the bill. I've had catastrophic occurrences like this, too, years worth of spine surgeries in which I racked up a few million dollars of expenses, but my out of pocket max was $4,000 and that was all I ever had to pay in a year. Any charges denied by the insurance were just dropped by the provider, not pushed to me.
So it raises the question of what kind of shitty coverage she had that was able to do this, or if she just had no coverage at all for some reason, which as far I understand, is supposed to be illegal after PPACA (you can always buy from the exchanges and they can't say no).
Sure, but it's not uncommon, either. If you ever find yourself in a fight with a chronic or long-term condition, check the statement of benefits your insurer sends you every month. They're denying massive amounts of things that you never get a bill for. I even asked my main surgeon's office manager about this once, and he explained to me that insurance companies don't have any sort of upfront published caps on what they're willing to pay and for what, so both sides are kind of winging it. The providers simply bill some very large number that they know is so ridiculous that it has to be larger than the max that will get reimbursed, figuring that by doing so they'll at least guarantee they get that max and not inadvertently sell themselves short.
So when you see things like a $14,000 charge for someone consulting over video for 10 minutes of work, or $800 for a bandaid, and you wonder how the hell a charge can possibly be that high, the answer is often that it isn't. That's just an artifact of this blind bidding thing going on between providers and insurers where providers send the largest conceivable bill they can to insurers knowing damn well they won't actually get that much.
This also feeds back into why insurance companies have such a horrible incentive to default deny everything. They know the providers are overcharging and charging for bullshit. Both sides are forced into taking equally extreme baseline negotiating positions by the total lack of pricing transparency.
It points at a very specific dysfunction of our system that goes well beyond the question of whether the government or private insurance purchasers should bear the bulk of the cost. This is a totally separate and orthogonal problem that both buyer and seller, no matter who they are, treat all transactions, no matter how mundane, like it's a blind silent auction for a rare Vermeer that hasn't seen a public market in 300 years.
Oh, I know the incentives. I strongly suspect there's even an additional one you don't list - tax writeoffs.
And you're going onto a tangent that I am very much in agreement with (that the whole system is massively broken and suffers all sorts of perverse incentives), but -my- point, if you'll recall, is that not everything gets written off. People still get unexpected medical bills -all the time-, for things their insurance didn't fully cover; this despite their deductible and/or max out of pocket.
Or, as I commented before, and which you're...agreeing to, in a whole lot of words, it's a provider choice, and not guaranteed. I.e., every time you go to the doc you're rolling the die; doubly so for emergency stuff that you can't get pre-authorized. "It doesn't happen -that- often" seems to maybe be your argument, but it happens enough, and the consequences of it happening at all are devastating.
Medical debt is very low recourse. If you don't pay your electric bill they shut the power off, they won't unamputate your leg if you fail to pay. If you don't have substantial assets, taking the credit hit is the better choice. I can't envision a situation where it makes sense to trade low recourse medical debt for high recourse credit card debt.
From both the context and the picture it's clear she's not actually, you know, retiring. The amount in someone's retirement account is meaningless unless you know their age and their income. Yeah, $10k isn't a lot if you're in your 60s and living a lifestyle that costs 6+ figures a year; it's a lot if you're making $30k a year and are in your 20s, and quite understandable if in your 30s at that income level. Three jobs are quoted because yeah, they probably are part time (and just saying "works 60 hours a week" or whatever doesn't carry the same punch), but -they may not be able to get a full time job-. Or else...you know, they might have healthcare.
The emergency room has ludicrously high costs, and none of his medical history. You're literally saying "don't expect to be able to see your primary care provider, go to the emergency room instead" -because of existing debt-.
You're making a lot of assumptions...all of which miss the point. Why is life shattering medical debt a common thing we tolerate in this country, given every other Western country has managed to make it a rarity? But, to your assumptions - maybe and she gave birth prematurely and ended up being seen by a hospital who were out of network and her insurance didn't cover it. Or even went to an in-network hospital, but was seen by doctors who were out of network, as frequently can happen, especially in emergencies when you can't personally vet the doctor is in network for you before you see them. Certainly, something unexpected happened (maybe even the pregnancy itself! Something to look forward to with the Supreme Court set to overturn Roe v Wade), and insurance wasn't there. Why is that acceptable in this country?
I work in healthcare and grew up poor in the US, and had medical debt of my own so I can read between the lines here. People absolutely get screwed over by medical debt, I'm just saying these are terrible examples of that happening.
> When people use number of jobs rather than hours worked per week it's typically beacuse number of jobs is greater than one and hours is less than forty.
It’s hard to imagine a person wanting to take on multiple jobs if instead they had the option to work one for the needed amount of hours and pay. Hours at one job != hours at three jobs, especially when you add in commuting time and lack of benefits because you’re not full time.
Urgent care had my girlfriend go to ER when she went in for Epinephrine shot. Because, apparently, they call an ambulance for anybody who shows up with something potentially dangerous (including EKG readings they can't read, according the the ambulance driver who took us).
We just sat on a chair for a couple hours for 'monitoring', and sure enough we got a $1700 bill from them, since she hadn't met her deductible yet.
Of course people are in debt if they get hit with bills like that.
I see any suggestion to the contrary of Socialized medicine being downvoted. Honest question. How do you propose to expand healthcare with 130% Debt to GDP and 8.9% inflation? It seems we are broke and there is a demand from the HN community to spend more? Feels like hitting the accelerator as one drives off a cliff and invokes memories of Thelma & Louise
We pay nearly double for our privatized monstrosity, compared to the most expensive socialized systems. Such savings! So cheap! Very efficient! Can the treasury possibly bear the expense of spending less than double?
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Yeah, a transition is going to be an expensive shitshow and now is not a good time, but just about any other time in the last decade was a good time and in a year or two it will be a decent time again. We'd better rip this bandaid before it soaks all our blood out.
Politics aside, money puts a cap on everything: wars, social services, etc.
The issue at hand is to take something the public spends nothing on, that the government gets for "free" and to put that on the public balance sheet - a huge cost. I guess we could balance that out with a tax, but who would like that? And even if we were to raise taxes - it wouldn't help our balance sheet since we already spend 30% more than we take in. Looking at the balance sheet as it stands today, we can't even afford what we currently spend. And inflation is on the rise.
I just don't see it ever happening. Save a collapse and total reset of the current monetary system.
You are obviously a very smart guy, jjoonathan. Why do you suppose the Democrats didn't even propose this when they had 60 Senate votes, the Presidency and the House? If its a 101 level problem why do you think that is?
We have a hybrid system here in Australia where there are tax benefits for having private health insurance but we also have a high quality public system. The public system actually comes out consistently as being more efficient than the private one, so the cost to society is less.
The rebates for private health insurance (to convince people to take out private insurance to “take pressure off the public system) have actually made things worse, for most people it’s subsidised by 30% by the Government (and you avoid an extra health levy), but over the last decade or two, the premiums have just gone up significantly and the amount of things covered has been dropping. It would have been better to just put that money into the public system (which is a bit overstretched due to underfunding). So mostly the subsidy has just gone into profits for insurers. It’s hard to get people to take out the private insurance without it and tax offset, but as I said before, since the public system is more efficient, the cost to society would be less without subsidising private insurance.
"Socialized" explicitly means government ownership of the means of production (1-3). Weaker definitions include ideas like regulation, administration, or control. But let's stick with ownership. Your word, so let's work with that.
If the government owns the system, the government can establish all sorts of controls (4). What do you think the margin is in these sectors (% is of $3.5T in 2017)
Hospital care (33%)
Physician and clinical services (20%)
Retail drugs (10%)
Other health, residential personal care services (5%)
I agree and have always felt all of this is the wrong debate. The focus should be on fixing the root cause of most medical issues. "An ounce of prevention...." yada yada... Just Type-2 diabetes alone will bankrupt the US by 2040 or sooner according to the CDC as reported in an interview on Joe Rogan. [1] There are a myriad of other CDC studies that show us going bankrupt sooner regardless of who pays for medical issues. I have no idea where all this money will come from short of conquering some other countries. For me personally, I will just focus on proactive measures. Here [2][3] are a couple of the reports.
As a side note I am about to go feed Thelma and Louise. Ill pet them and say hi for you.
If you're not incredibly rich, you're just temporarily holding all your savings & retirement accounts for the hospitals and nursing homes that'll eventually take all of it. And then some.
You can file bankruptcy which will protect your retirement accounts. There are other way to protect your assets and money as you get older and risk gets higher.
It should not be this way though because mostly the wealthy take advantage of protecting their assets as it requires some money.
Yep the entire end-of-life industry is incentivized to drain all the wealth from the old and terminally ill before they die. That is why my plan is to opt out. DNR, living will, I will not enter a care facility or hospital I'd rather die on my own terms and have my children inherit whatever I have managed to accumulate.
Was your uncle qualified for medicare? We recently had several members need end of life care and they didn't have to pay any of the hospital bills. Many bills we did receive, we called the charging company and they were waived immediately "oh I guess we made a $100K mistake" or "medicare already reimbursed us, that was just a courtesy notice."
Honestly, I am not sure. I wasn't well versed in personal finance/healthcare/money back then. He destroyed his family and his wife left him. His kids don't really want to discuss that period of their life at all, so we never talk about it.
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[ 3.3 ms ] story [ 320 ms ] threadAll I want is balance. That societal balance does not exist now. Hence the tension that seems to be increasing.
The government would like you to believe that, but a good chunk of the problem is supply-side, not demand-side.
If they do have the money (because you printed more) they pay the higher prices. Then you get inflation.
I don't understand that point of view. It seems pretty cold to me.
Same as when Affordable Care Act was being molded, a couple of “Democrat” senators like Leiberman sank any chance a taxpayer funded option. Just like Manchin and Sinema sank Biden’s universal preschool/daycare and paid parental leave proposal last year.
For all practical reporting purposes, they are Democracts. The moment you apply 'but they voted for X', you can cast McConnel as a democract, because he greenlighted new gun deal.
The reality is that Democrats, as a bloc, are the only ones to have even attempted taxpayer funded healthcare, and somewhat succeeded. Just because a couple people who label themselves Democrats, but do not vote with them does not make sense to blame Democrats as a whole for holding back progress in taxpayer funded healthcare, and ignore the 50 Republicans voting against it.
This is all ignoring the fact that in the context of taxpayer funded healthcare, you need 60 votes to do anything, so the measure for “control” of the Senate would be 60 votes.
Your question is qualified enough to relate specifically to the bill listed by OP, but, again in theory, if the bill wasn't so off-putting that senators decided to filibuster, maybe it would pass.
In other words, 60 is not control; 60 is safety. 50+1 is control albeit minimal.
[1]https://www.house.gov/the-house-explained/the-legislative-pr...
Incorrect. I was admonishing them for not putting it to a vote.
Which would burn a lot of political good will for no reason, considering the likelihood of how Sinema and Manchin would vote.
The point being that evidence points to Democrats by and large supporting taxpayer funded healthcare options. It specifically was removed in 2009 from ACA because of 1 senator from Connecticut.
It's not really fair to pin Lieberman's opposition to the public option or expanding Medicare as some personal opinion, he had previously supported expanding Medicare until he abruptly... got new orders? Seems like the the $930,000 in bribes he accepted from the health industry could have played a role:
https://www.opensecrets.org/members-of-congress/industries?c...
And the major force against universal healthcare, since FDR's Second Bill of Rights (right to health), has always been the AMA:
https://www.democracynow.org/2009/6/12/ama_opposition_to_oba...
When you speak with disdain and sarcasm, no one will listen to what you have to say even when you are right about everything.
If you want to change minds, show respect first, clarify the opponent's best argument, and then take it apart calmly piece by piece.
If, instead, you want to spread anger and frustration from yourself to those around you, by all means continue with the snide comments.
Even with public support for their ideas, they are losing the messaging war against the other party. Most voters don't pay attention to candidates' voting records, and barring the unforseen the Republicans appear poised for a major victory in the House, with the senate in play as well. We are in for some bad times ahead.
https://en.wikipedia.org/wiki/2008_United_States_Senate_elec...
> Democrats held at least 57 seats as a result of the election. When the new senators were first sworn in, the balance was 58–41 in favor of the Democrats, with the unresolved election in Minnesota causing that seat to remain vacant. The April 2009 party switch of Pennsylvania senator Arlen Specter from Republican to Democrat and the July 2009 resolution of the Minnesota election in favor of Democrat Al Franken increased the Democratic majority to 60–40 (providing the Democrats, including the two Independent senators who caucus with them, a supermajority and thus able to hypothetically over-ride any filibusters). Republicans gained a seat in a January 2010 special election in Massachusetts, thereby making the balance 59–41 before the start of the next election cycle.
The underpinnings of white nationalism have been around for a while but really came to the fore in 2016. The desire to keep “our America” and other catch phrases are indicative.
EDIT: Having white, nationalist sentiments or leanings is not necessarily bad or wrong. It’s quite natural for a majority population to have such sentiments when their status as a majority gets threatened. The demographics and gender power structure of the nation is noticeably changing and having a backlash against that change is common.
Sure. My point is that the party made this choice deliberately. Trying to pin the blame on Joe Manchin, who is doing yeoman’s work holding onto a key part of the old FDR coalition, is disingenuous.
> Democrats consistently hold majority views on a wide range of policy issues and consistently have more votes in national elections.
The views of the party leadership and donor base and closely affiliated NGOs do not have consistent majority support. For example, Dems have basically allowed NARAL, etc., to be the voice of the party on abortion. But a strong majority of Americans oppose second trimester abortions, which are guaranteed by Roe, and a quarter of democrats identify as “pro life.” That’s more than ones who identify as “very liberal.” The party used to get that, carving out a space for folks like Manchin in WV and Tom Daschle in SD.
> Gerrymandering so that urban centers lose their voting power and other election rigging techniques is what is holding back Democratic policies.
Republicans have won the Congressional popular vote slightly more than half of the time since 1990. They’re about to do it again. Gerrymandering doesn’t affect that.
Even in the electoral college, it benefitted Democrats not only throughout the 1960s-1980s, but as recently as 2012. Obama would have been able to win a second term even if he lost the popular vote.
> The Democratic Party should not abandon its highly popular core principles to cater to the deranged apportionment that the U.S. has.
Democratic leaders and donors are deeply confused about what those “core principles” are, and who is in their coalition. The coalition is one of urban liberals who vote democrat for ideological reasons, and minorities and immigrants who vote Democrat out of self interest. My parents are the type of immigrant who turned Virginia blue. They care about Obamacare. They’ll accommodate some things the urban liberals want to get that. But that doesn’t mean they agree with college educated urban white people about what kids should learn in schools.
The fact is that a big chunk of the Democratic coalition has social values closer to Republicans than to liberal Democrats. Moreover, those are the party’s marginal votes in states like Arizona and Nevada and Georgia. Urban Democrats should live in that reality.
We do not have proportional representation in the House, and the person with the most votes for President lost in 2000 and in 2016. The way Congressional districts are made and the weirdness of the Senate representation is such that we will soon be governed by a minoritist party. Who cares how things were in the 60s and 70s when the topic at hand is about the present day?
EDIT: The Republican Party has overtly attempted to subvert the political norms of the country and continues to do so. Arguing about this or that policy is meaningless unless the messed up way the Senate and House seats are allocated is fixed. That won’t be addressed anytime soon so the situation is essentially hopeless. Oh, and Manchin sabotaged voting rights legislation.
Gerrymandering does not even consistently hurt democrats in the number of House seats. Dems in 2020 won the same number of seats as their share of the Congressional popular vote.
> There are secondary effects you are ignoring with this incorrect belief. In recent years, since SCOTUS abandoned voting rights, the closure of polling stations also affects voting numbers.
This is the Democrat equivalent of believing the Big Lie.
> The way Congressional districts are made and the weirdness of the Senate representation is such that we will soon be governed by a minoritist party.
What’s Biden’s approval rating again?
> Who cares how things were in the 60s and 70s when the topic at hand is about the present day?
Because Democrats still claim to be the party of FDR, who stitched together a winning coalition. The electoral system benefited that coalition—when Biden became a Senator, Democrats had 10 percentage points more House seats than their share of the Congressional popular vote. That coalition is still viable. Obamacare was enacted on that coalition. Urban Dems have chosen deliberately to prioritize other things instead.
You are completely wrong on your assessment regarding Gerrymandering. You clearly don’t understand how total national vote total has nothing to do with whether or not Gerrymandering causes one party to have more seats than they otherwise ought to have. Here’s a hint: A Representative from California res presents far more people than the one from North Dakota. Here’s another hint: Heavily Democratic distinct overwhelmingly votes Democrat while three districts with slight majority Republican vote elect Republicans and the overall vote totals are mostly even. Both hints must be used to see why overall vote total means nothing when it comes to determining if Congressional representation is skewed.
You are wildly wrong in your views.
https://www.motherjones.com/politics/2019/09/report-more-tha...
https://www.theguardian.com/us-news/2020/mar/02/texas-pollin...
https://www.salon.com/2019/09/12/report-reveals-nearly-1700-...
It doesn't meaningfully affect turnout in the same way Voter ID doesn't affect turnout: https://www.vox.com/policy-and-politics/2019/2/21/18230009/v.... Both parties are lying about the impacts of voting rules on turnout.
> You clearly don’t understand how total national vote total has nothing to do with whether or not Gerrymandering causes one party to have more seats than they otherwise ought to have.
You're mixing up completely different things. The Congressional popular vote represents the total number of people that voted for each party in House elections. It's an absolute number of votes, irrespective of number of seats. Republicans have won this absolute count more often than not since 1990. For example, in 2016, Republicans won 63,182,073 votes (49.1%) and Democrats won 61,765,832 votes. Also, you can cross check it against the generic Congressional ballot, which is based on polling and isn’t affected by gerrymandering: https://projects.fivethirtyeight.com/polls. Republicans are ahead right now. That’s not a “minority party.”
> Here’s a hint: A Representative from California res presents far more people than the one from North Dakota.
It's actually the opposite, though it's a rounding error. California has 53 representatives and 39 million people, or 736,000 people per rep. North Dakota has 1 representative and 760,000 people.
> https://www.motherjones.com/politics/2019/09/report-more-tha... > https://www.theguardian.com/us-news/2020/mar/02/texas-pollin... > https://www.salon.com/2019/09/12/report-reveals-nearly-1700-...
These sites are peddlers of election falsehoods, just like Breitbart or Newsmax.
The irony of all this is that progressive election lies are used to disenfranchise minorities within the Democratic Party. Disproportionately white progressives invoke the notion that Democrats have overwhelming popular support but elections are close because of dirty tricks, to boost their own power within the party. That happens at the expense of disproportionately conservative and moderate democrats, who are disproportionately minorities.
Political parties aren’t one big happy family. The truth is that there’s trade offs between the interests of different factions and we should be honest about those. If Obama hadn’t run to the right on social issues in 2008, we wouldn’t have Obamacare today (which cut the number of uninsured Black people by half). That’s the reality of the trade offs between different factions of the party.
I mean gerrymandering doesn't help but the Democrats aren't one cohesive unit otherwise they'd have no issue doing stuff right now. Sure people claim they only have 50+1 in the senate so they can be filibustered but they can just remove the filibuster with 50+1 and then do w/e they want. Democrats don't achieve their "party position's" because they're not the position that each member of the party has.
The same is true for Republicans. Look at Trump's campaign promises [1] which were often parroted by Republicans in congress but they only major thing they achieved was the Tax Cuts and Jobs Act [2]. ACA was not repealed because some Republicans voted no. One thing news orgs commonly bring up with Trump is he appointed a bunch of judges but that's just because Republicans changed the filibuster so they could; if RBG retired when Obama told her too or Democrats made the same changes, Obama would have appointed a bunch more judges.
[1]: https://www.politifact.com/truth-o-meter/promises/list/?prom... [2]: https://en.wikipedia.org/wiki/Tax_Cuts_and_Jobs_Act_of_2017
1. Thwart Democrats
2. Oppose abortion
3. Tax cuts
4. Cut/freeze non defense spending
2. I did forget about mentioning that one. Republicans could have easily restricted it in 2016 if they as a cohesive unit wanted to. They do not. It's much more useful to leave it in the current state where it can constantly be brought up every election cycle as a way to drum up supporters who have no object permanence.
3. You got me here but that's also the thing I listed as their only accomplishment.
4. This one is very bi-partisan. The military has no issue with losing funding and especially wants to optimize funding by doing things such as closing low-utilized bases and moving those staff to other under-utilized bases. However doing so affects congressional districts and their congress representative have no interest in losing jobs (money) for their region. The lack of awareness of defense spending as a jobs program is a big pet peeve of mine :/
> What Republican lawmakers are great at is being united in thwarting Democratic policies and doing what it takes to enhance their own power.
5. Sure but Democrats have this issue as well. There have long been calls for things such as Ranked Choice Voting, Approval Voting, etc and Democrats and Republicans have long tried to even overturn those efforts even when decided by voters as a ballot measure. Both of them know that allowing this will degrade the "both sides" situation going on as other parties will gain a foothold. However it also leads to situations where voting for your first choice (a 3rd party) in close elections (i.e 2016 [2] vs 2020 [3] and 2000 [4]) can allow your second favorite candidate to lose but Democrats collectively are ok with losing every 3rd presidency (~1/10yr) as long as it doesn't eat into their powerhold (every other elected position).
There really is no reason to argue about the Republicans here. We have a bunch of states such as North AND South Dakota strictly to increase the number of republican senators [5]. Or more recently, in 2000 when Republicans in US Supreme Court overruled Florida's Supreme Court about if a recount should occur [6] (so much for states rights!). SO yes, it's a moot point that Republicans are power hungry and don't care about consistency only power.
[1]: https://www.govtrack.us/congress/members/report-cards/2016/s... [2]: https://en.wikipedia.org/wiki/2016_United_States_presidentia... [3]: https://en.wikipedia.org/wiki/2020_United_States_presidentia... [4]: https://en.wikipedia.org/wiki/2000_United_States_presidentia... [5]: https://en.wikipedia.org/wiki/Dakota_Territory#Statehood [6]: https://en.wikipedia.org/wiki/Bush_v._Gore
https://text.npr.org/1104679219
So no, they can keep their article.
We knew enough to ask about the anesthesiologist and any surgery assistants. But they came up with some new bullshit and got us. When the world gets wise to this nonsense they'll come up with something else. It's a business deeply rooted and based on scamming their customers.
"A quarter of adults with health care debt owe more than $5,000."
Not saying some people don’t have “bad” medical debt (they can’t repay) but to lump in all debt as “bad” is silly.
Edit: Oh, it's a poll. Similar to the poll that said "Households earnings more than $250,000 are stuggling financially".
I mean, it's a poll? Did you expect people to say "nah, I have medical debt but I can handle it no problem".
Now is that a large portion of people? I have no clue, and my anecdotal evidence certainly isn’t qualified to answer the question.
> And about 1 in 5 with any amount of debt said they don't expect to ever pay it off.
That's 20 million people.
> About 1 in 7 people with debt said they've been denied access to a hospital, doctor, or other provider because of unpaid bills, according to the poll.
That's 14 million people.
> An even greater share ― about two-thirds ― have put off care they or a family member need because of cost.
That's 66 million people.
> Half of U.S. adults don't have the cash to cover an unexpected $500 health care bill
That's 129 million people.
Again, please read the whole thing, whether or not you want to comment more. This is important information for US residents.
I recognize that this is an important discussion to have to improve US healthcare, so I’m not outright disagreeing with you.
But I think this is a bit editorialized. Paying with cash is so rare in society. I don’t even have the cash to pay for my lunch - I just use a credit card. It shouldn’t be surprising.
Half of U.S. adults said they would pay it immediately.(30% using savings,20% using a credit card they pay off that month)
A further 21% said they would pay with a credit card and pay it off over time. (Anyone who is already in other forms of debt will probably take this option as they, by definition, don’t have the cash for other things.)
Another 5% said they would make a payment plan with a provider / pay overtime.
That’s 76% of the country that is knowledgeable about reasonable ways to pay for the services. Now, 24% using worse off options or not knowing - that’s not good at all. But it’s a far cry from the implication that “half of people can’t pay”
But still this isn’t really a metric on the U.S. healthcare system directly - that would be asking why we have unexpected $500 bills, not which payment method people are using. And alternatively, or even in tandem, why people are not saving and planning ahead.
“c. Any debt you owe to a bank, collection agency, or other lender that includes debt or loans used to pay medical or dental bills.
d. Any medical or dental bills that you have put on a credit card, and are paying off over time.”
Thus, by one interpretation, if you’re already in over $5,000 of credit card debt, and you charge a $10 prescription fill or $25 copay to that credit card, their methodology will now include you in the medical debt and medical debt amount statistics as having medical debt over $5,000. The specific wording of the “amount” question seemingly tries to prevent this, but considering the above was classified as medical debt prior in the polling, it’s not hard at all to imagine people answering in the affirmative.
Is this really true? I don’t know, that’s a complicated discussion. There are certainly people who are paying medical costs with credit cards. They deserve to be included. But it does seem possibly a bit too broad.
Out of interest, could you elaborate on why you assume you are in the mode, rather than one end of the bell curve?
The stereotype of the US medical industry means that a lot of us would assume you are one of the lucky few.
Edit: By "that assumption", I mean that the portion of the number made up of people who only owe a few bucks and only briefly is significant enough to call for a dismissive attitude.
While slightly out-of-date due to legislation that has passed since then, the book does an excellent job of explaining a lot of the perverse incentives at all levels throughout the medical industry that contribute to the outrageously high cost of healthcare in the US. Worth a read.
I think people are reading too much into a poor analysis, created and reported on by institutions with an obvious agenda.
Either to save lives: https://www.scientificamerican.com/article/universal-health-...
Or to save money: https://www.pnas.org/doi/full/10.1073/pnas.2200536119
The aversion to it honestly baffles me.
Really? How about year-long debt or 30-60-90 day breakout chart by amount?
Downvote away though :p
https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
There are some common agreed upon thresholds that strongly correlate with positive outcomes, e.g. 15 minute response time after a heart attack. In wealthy areas, this outcome was achieved 97% of the time vs. only 93% of the time in poorer ones. That doesn't sound too bad, but that means you were something like 230% more likely to miss that cutoff if you were in a poor neighborhood. But at least it's not "socialist".
Comments talking about voting (including this one) are worthless, and deserve every down vote they get.
The hospital still sent her a $30k bill for the delivery.
And what exactly is "rationing" - I bet almost every adult in America knows someone (or is that someone) who has delayed going to the doctor/for a procedure (or just never got it entirely) because of how much it is going to cost? Doesn't the inability to even get the required care due to the cost really count as "rationing" in the system we already have?
Yes, technically I could pay the couple thousand dollars out of pocket, but in most socialized health care systems you can do that as well.
U.S. healthcare underperforms in most verticals. High cost is the primary reason that prevents Americans from accessing health care services. Americans with below-average incomes are much more affected, since visiting a physician when sick, getting a recommended test, or follow-up care has become unaffordable. https://www.commonwealthfund.org/publications/issue-briefs/2...
For example, in my wife's home country, she give birth in an awesome private maternity hospital for about $2k out of pocket for everything. I mean everything. But if we wanted, she could have done it in the government run hospital for $0.
This is what we currently have in the US. In fact, the US government is the largest healthcare insurer in the US (through Medicare and Medicaid) [1].
Interestingly, economists have found the US government becoming a healthcare insurer substantially increased US healthcare prices. For example: "Finkelstein estimates that the introduction of Medicare was associated with a 23 percent increase in total hospital expenditures (for all ages) between 1965 and 1970" [2].
It turns out making healthcare "free" to certain people caused them to demand more healthcare. Higher demand caused higher prices. Congress "didn't consider the effect of the increased demand that Medicare set off." [3] Now healthcare prices are high AND Medicare/Medicaid is being paid through deficit spending.
If we want to solve the problem of unreasonably high prices for healthcare, and the debt that causes, we can't keep doing the same thing and expecting different results. We need to fix what we've broken with the healthcare market so it can operate like markets do and find a fair price.
[1] https://www.trillianthealth.com/insights/the-compass/the-gov... [2] https://www.nber.org/digest/apr06/medicare-and-its-impact [3] https://reason.com/1993/01/01/the-medicare-monster/
Also, note that 63% of the people in debt are already literally rationing.
"Cut spending on food, clothing, and other basics" - 63%
> For many Americans, debt from medical or dental care may be relatively low. About a third owe less than $1,000, the KFF poll found.
I wonder how they'd count me, who puts all expenses on a credit card and pays it off each month, technically I'm going into debt ...
https://www.politifact.com/factchecks/2009/jun/11/chris-dodd...
The US has a major debt problem and the solution at some point is going to be curtailing just how much debt you can accumulate with just a signature.
Most of the people who file something like chapter 7 have little to no income, don't have big bank accounts, luxury cars, second homes, etc. This often correlates with people who have medical issues and rack up big bills, and can't work a job. These people can file "no-asset" chapter 7 cases, in which case, they lose absolutely nothing. This is what happens in the majority of chapter 7 cases filed. So, for a lot of the people who do choose to file, this is because it is a good option, not because it is a life crippling choice forced upon them.
If you call them up, they'll usually just say "what can you pay?" and agree to just about anything you propose.
Which is why you can often do better paying cash at a "expensive" hospital that is overflowing with money than at a "budget" one that is having difficulty making the numbers balance. The latter is more likely to hard-line.
We were getting like 3-5 letters per provider per visit, and many visits resulted in bills from multiple providers.
"NOT A BILL" (so why the fuck are you sending it to me?) same thing again from insurance for some reason, incorrect bills we had to fight, insurance refusing to pay on things they should so that drags out for months and you're getting "FINAL BILL" in the meantime but the hospital billing people are telling you not to pay them until insurance is sorted out.
Many providers sending a bill exactly once and it goes to collections if you don't pay in 30 days, no calls or follow-ups (that's how both of ours ended up there—again, they were tiny, we'd have paid them instantly if we'd known about them).
Bills showing up two months after a visit and you've had 30 medical appointments in the last year so you can't remember WTF it was for. I think in one case we were still sorting crap out from the birth and prenatal care when the kid was 6 months old.
Hospital requiring full payment months in advance for the births. And getting it very wrong in one case (on the high side, of course—every billing error is in the hospital's favor, super weird how that works, bet it's just an accident and not them being actual no-bullshit criminals, though eyeroll) because they refused to use our version of what insurance would pay (which was correct) and basically just made up a number.
Total fucking mess. Horrible experience every time. Can't wait to get to deal with this horseshit when one of us is actually, seriously sick. I've added hospital billing departments to the list of medical-related folks I truly, sincerely wish the worst on, and I mean the worst—show me the headline, I'll open the champagne. They're either shockingly incompetent in ways that mess up people's lives, or they're malicious. Maybe both.
Thou shalt never assume malice so sayeth lord Hanlon (brought to you by Carl's jr.)
Penalties need to be attached to misbilling; it needs to be made effectively illegal and allow others to help collect the penalties, then an industry of scummy lawyers will appear to help customers reduce their bills at the expense of the hospitals.
And they'd deserve it.
The smaller hospitals in general have been better but it's so obviously a giant clusterfuck.
I can't even imagine how someone without partner support (who the hell wants to deal with hospital fuckery post-partum) does it.
Of course, 63% of the people with health care debt have (according to study).
So while your case is interesting from a technical point of view, it isn't really practically or morally interesting, and can only serve to detract from the important points of the study.
But I think there is a difference between cautioning neutrally (the comment I'm replying to now) versus obliquely cautioning in a way that casts doubt with negative consequences (the comment I replied to previously).
I live in a city where a segment of impoverished people come up with ways to spend $20+ a day in fentanyl, and they don't seem to have much trouble coming up with that even while living in a tent.
They can’t make more money and save it, because their needs will always exceed their income short of massive windfalls
>difference
> eating ok
> not eating
If you're not eating it follows you're eating $0 worth of food. So it is what you said, unless you're implying someone is spending money on food without eating any of it.
I'm interested in the meals you suggest that you think are "eating ok" while maintaining the nutrition to work, $2 all in per day (food cost + transport to buy the food + cost to cook the food + depreciation on any utinsils / cookware).
Also keep in mind many poor people live in a food desert so if you're counting on discount food you're gonna need a bus ticket or a hell of a long walk once in awhile.
As an aside, it's worth noting if your suggestion is true and one can truly eat ok on $2 a day, then the median medical debt holder who spends say $4 a day on food can easily pay off their loans in a few years following your cooking advice. You just came up with a way for them to produce $2 / day without any additional income.
It's a bit more complicated than you are making it out to be, it would not hurt to remember you are talking about fellow human beings and not just numbers in a spreadsheet.
As for inexpensive ways to eat please see https://old.reddit.com/r/EatCheapAndHealthy/
You haven't actually been poor like that in the US. That isn't a question, it is a statement. I have as have others I know so yes even a few dollars per day can make/break the budget.
I don't know how poor you have been or are. And you don't know how poor I have been either. I'm not going to play oppression olympics with you. I have been homeless, sleeping in ditches and parks before, living off of minimum wage day labor. Even back then, if I needed $2 I simply worked an extra 15 minutes moving drywall at construction sites or whatever. Those who can't work may end up buying snacks with their foodstamp card and hawking them to high schoolers walking to school or something (as I see many homeless do near my house). There are very few people who aren't already covered by medicaid/medicare who are incapable of coming up with $2 / day somehow, and if they are they are the extreme case. Again even _drug addicts_ in my neighborhood, while high out of their minds, somehow manage to come up with $20/day for their fentanyl habit and that doesn't even cover the rest of their necessities.
And as an aside, I'm not buying the argument that being broke somehow makes you more of an expert on how to budget. The poor in this country are notoriously victims of sub-par education which sadly leaves many of them poorly situated to navigate managing their own economic future. If I want budgeting advice I'd much rather ask say a guy who started his own restaurant vs some random broke person on the street.
That wasn't my point. Honestly please take a look at your interaction with me and reflect on it, it isn't necessary to engage in such a hostile fashion. You have read a lot into what I have written that simply isn't there.
You have a pleasant rest of your day.
Please take a look at your interaction with me and reflect on it, and think to yourself about how you can be less presumptuous.
>You have a pleasant rest of your day.
Likewise!
Think of bigger medical expenses over the same period -- 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly costs (300-400/mo). Then rent, then food. Etc etc.
"You" being the parent OPs who I responded to who introduced the nation of $1000, which happens to be above the median for my state and most states shown in the article? Remember I'm RESPONDING to the $1000 comment, not introducing the figure. But maybe they said something about the $1000 you agreed about, so you went with the disingenuous approach of only impugning someone commenting on it and in bad faith accusing THAT person of introducing the figure.
The MAJORITY in my state and most states have less than $1000 in medical debt. Millions. This isn't some edge case. $1000 "exemplifies" the median medical debt in most states, according to the article.
>sounds like you could stand to be humbled by some
Yeah a subtle suggestion I ought to experience medical problems. Keep it classy. "Frankly, that's disgusting."
>Think of bigger medical expenses over the same period -- 10k. That's 20/day. 100k -- 200/day. Now add ACA monthly costs (300-400/mo). Then rent, then food. Etc etc.
Yes I thought about it, and then decided my $2/day figure still holds as a possible approach for paying off median medical debt. Thanks for the thought exercise!
My intention was never to show that someone with $100k of medical debt could get out of it as easily as the majority with far less.
Medical debt is a huge problem but to craft solutions we need to fully understand that problem. Should, for example, insurance companies collect "deductibles" ahead of time and refund those not used, similar to how you could use an HSA? Should healthcare providers and insurance companies be required to offer 0% financing for 12 months for certain amounts or certain customers?
The vast takeaway is usually "this survey supports what I think should be done" which often results in not much of anything being done, or getting something worse than what was before.
The answer is two clicks from the article, both links above the fold on their respective page. If you’re being genuine in your curiosity, it would improve the discussion here if you shared what answer you find.
> The combined online and telephone samples, excluding oversamples, were weighted to match the sample’s demographics to the U.S. population using data from the Census Bureau’s 2021 Current Population Survey (CPS). On the basis of this weighted sample, parameters for the debt and no-debt populations were extracted. Weighting parameters for each group included sex, age, education, race/ethnicity, region, education, and income, as well as patterns of civic engagement from the September 2017 Volunteering and Civic Life Supplement data from the CPS. The sample was also weighted to match population density parameters from the Census Planning Database 2020. The weights take into account differences in the probability of selection for each sample type. This includes adjustment for the sample design and geographic stratification of the cell phone sample, within household probability of selection, and the design of the panel-recruitment procedure.
So they intentionally targeted people with debt, so the "63% percent of respondents" is not able to be read as "63% percent of Americans".
The 100M in the title is extrapolated, and is likely correct, but people are not reading the percentages as they should be read.
The key takeaway from the study is that not all medical debt is reported as such, and poor people have difficulty paying bills, one type of which is medical bills.
No, that's not how it works. You oversample a group you are interested in and then weight it.
To be honest, you don't know enough about statistics to evaluate this. You should either learn more or accept the conclusions of those who know more.
> The 100M in the title is extrapolated, and is likely correct,
What's the problem with their comment, exactly?
> “We have a health care system almost perfectly designed to create debt.”
This was true before the ACA – and is still true.
But this immediately appears as "unfair" even if predatory lending is a huge problem.
Meanwhile those who already have some money wouldn't be affected by it much, for example, a law requiring all credit cards that charge interest on balances to be secured ones (where if you have a $1k credit line you must have $1k cash/cash equivalent in the bank).
Medical care providers have families they have to feed too.
Just because we don't currently have a functioning healthcare system doesn't mean we can't have one ever. As more people are made aware of how pervasive the issue is, there will be more impetus for those in power to start doing something about it.
Where doctors also make much more modest salaries
I would say that they are "less high", but not "modest", given that the cost of life is also lower.
Also you have to factor in that they don't have to sell their house if they get cancer.
You know damn well that nobody is expecting doctors to work without pay. I refuse to believe someone could actually believe such an idiotic argument is being made. So why act like it is?
My tax money goes to building roads that I won't drive on.
My tax money goes to police dealing with crimes I'm not a victim of.
Do you consider EVERYTHING funded by tax payers to be the result of people "work for free to cover someone else's expenses"?
Sometimes tax payers are funding their own expense, sometimes not. What I take issue with is being involuntarily compelled to pay someone else's expense at gunpoint.
OK so if a robber comes to my house and says pay up or leave, then that's not a forceful action at gunpoint?
>you are free to leave at any time and no longer pay.
That's not how it works -- allow me to inform you of tax law in the US. US Citizens are responsible for filing, and possibly paying taxes on income earned ANYWHERE IN THE WORLD. The US, and I believe Eritrea, are the only two nation's I'm aware of in the world like that. Now you could renounce citizenship, but even then that wouldn't satisfy your condition of "no longer pay" because you even have to pay over $2000 just to renounce citizenship, and that has to be done outside of the US. The US has been known to engage in "extraordinary rendition" which is to say they target/extract citizens even out of countries when there is no legal mechanism for them to do so.
In short your claim here is incredibly innacurate.
>Paying taxes is no different than mortgage or rent
When I pay rent/mortgage it's for my own use of property in a private contract, in a voluntary exchange. Tax is an involuntary transaction. A very different thing.
>, if you want your own soil fight for your own sovereign territory and keep it through force without any help, good luck.
You start off saying nobody is forcing this at gunpoint but then you go on to challenge me to "keep it through force." You're starting to look like a violent person. It's really comical how quickly the façade drops of persons such as yourself who turn out to be persons of great violence who are quick to challenge others to engage in such activity.
They are not a robber they are a landlord, you are on their land, pay taxes or leave your choice. They are not forcing you to stay and work and pay taxes at gunpoint, you have the choice to leave. However while you are there you must fund the services they are currently providing to you, if you willfully evade that payment then you are committing a crime, but you have the option not to, you always have choice.
>That's not how it works -- allow me to inform you of tax law in the US. US Citizens are responsible for filing, and possibly paying taxes on income earned ANYWHERE IN THE WORLD.
Most standard income is covered under FEIE and FTC, that is you won't pay taxes twice if your paying taxes in another country utilizing their social service instead and if you have been truly living in working for almost a full year you pay no tax on the income.
Note since you are US citizen you still benefit from their social service while living abroad, the are many protections upheld to US citizens traveling abroad you would no longer have if you renounce.
>Now you could renounce citizenship, but even then that wouldn't satisfy your condition of "no longer pay" because you even have to pay over $2000 just to renounce citizenship, and that has to be done outside of the US.
Exactly, you must pay your final rent payment and get out, no one is forcing you to stay. If you don't have the money to pay then you are not making income to pay taxes either.
>When I pay rent/mortgage it's for my own use of property in a private contract, in a voluntary exchange. Tax is an involuntary transaction. A very different thing.
You have agreed to the social contract [1], you are voluntarily staying in the country and utilizing the social services and resources (military and police protection, roads, public spaces etc.) to make money and live safely and productively. No one is forcing you to stay, there are places in this world that do not tax you for police and schools.
>You start off saying nobody is forcing this at gunpoint but then you go on to challenge me to "keep it through force."
That's the point, the reason you don't have to defend your property and life through force on a daily basis is because you have voluntarily agreed to live in a country that has the monopoly on violence [2] and in exchange for the social service of military and police protection you must pay taxes if you profit from that protection.
People are social animals, they work together to solve problems no individual could on their own, money facilitates this and is needed to fund the large social framework you live under hence taxes. If government disappeared tomorrow, it's would be reformed quickly in not so pleasant ways. You may not like it but that doesn't matter because others will form large groups and impose it on you regardless and you will have no choice over its form.
[1] https://en.wikipedia.org/wiki/Social_contract
[2] https://en.wikipedia.org/wiki/Monopoly_on_violence
People like the GP reject the notion of social contract.
By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.
How about you move. It's hilarious to suggest the contract is still intact when the government violates the contract itself, such as abridging 4th and 2nd amendment rights, rendering the contract void. Just a few months ago, I had a warrant served where a homeland security official lied and said a drug dog had "alerted on my buttocks" and I was forcefully strip-searched and dragged to a hospital to be "internally examined." Sorry the government themselves violated the contract.
And it's worth noting, even though the "contract" legitimize this, the last president didn't even have the assent of the majority of voters.
>By staying within the bounds of a country you are consenting to its laws or are considered a criminal or foreign aggressor.
I'm not too worried about whatever ad-hominem you'd like to label.
>Note since you are US citizen you still benefit from their social service while living abroad, the are many protections upheld to US citizens traveling abroad you would no longer have if you renounce.
This is so hilarious as to make me wonder if you've ever actually been to a US consulate abroad. I have, against my wishes due to riding in the same taxi with a 'friend.' We had both overstayed our visas, and the consular services basically said "lol get fucked, good luck!" I could have obtained the same services talking to a wall. I'm good on their services.
>Exactly, you must pay your final rent payment and get out, no one is forcing you to stay. I
If I've already "gotten out" including paying my taxes this rent analogy makes even less sense, not that it was a good one to begin with. I never signed a contract saying if I leave the non-existent contract I agree to pay $2000 to back out.
> you don't have to defend your property and life through force on a daily basis
I wonder if you've even been to the United States? It was not so long ago someone tried to rob me at gunpoint. I still have a scar from fighting back. On a daily basis, people are violently assaulted in my city. Nowadays I'm forced to have "protection" that I have daily in case someone tries to use lethal force against me again. The police have no legal duty to "defend" you per the supreme court. The type of protection police provide here, I wouldn't wish on my worst enemy.
As for military protection, I actually have fought as a self-funded volunteer in a foreign militia (YPG) against ISIS, so I'm willing to put my money where my mouth is about not using tax money to defend life.
>However while you are there you must fund the services they are currently providing to you
You don't get to just provide services for someone, who never agreed to it, and then demand payment. Payment for services is predicated on the parties consenting to the transaction. Providing service without the other party agreeing is charity at best, unwelcome intrusion at worst.
>no one is forcing you to stay
Except some people have had their passports revoked, and occasionally without even owing anyone anything ("for national security reasons.") In fact DHS has threatened to revoke my passport before, despite not breaking any law. It is a crime to leave the US without a passport. So the US does 'force' some people to stay.
>People are social animals, they work together to solve problems no individual could on their own, money facilitates this and is needed to fund the large social framework
People are capable of doing this in a consensual manner. In fact many businesses operate on this principle of consensual mutual benefit.
>You may not like it but that doesn't matter because others will form large groups and impose it on you regardless and you will have no choice over its form.
Back to your contradictory argument of "no one is forcing you at gunpoint" -- except you reneg and say a...
I don't waste my time talking to people with that excessively naive viewpoint. Have a good day.
>The actual argument you wanted to make
And how incredibly good faith of you to bring up taxation of roads, school, and police and then have the gall to act like it's a waste to discuss the very subject YOU YOURSELF INTRODUCED. My brother, I did not mention anything about the taxation of roads/police/schools until you brought it up, it's beginning to look like that's the real argument YOU wanted to introduce.
This is an honest question I don’t know the answer to, but based on my analogous experience with academia and the high cost of tuition, I would guess the answer is “no”.
In this instance, the two proposed solutions are: make healthcare the government's responsibility like many countries that don't have this problem, or do nothing because that solution isn't perfect.
0: https://en.wikipedia.org/wiki/Accelerationism
1: edited to add: imo. And probably in their o as well.
When Obamacare was passed, 70% of the population wanted Medicare for all instead:
https://thehill.com/hilltv/what-americas-thinking/412545-70-...
In 2020, 54% supported single payer health care:
https://www.pewresearch.org/fact-tank/2020/09/29/increasing-... overage/
I can't find any post-covid polls, but states are currently trying to step in and implement it locally. Don't hold your breath.
Edit: the medicare for all poll was under trump
As I mention in my other comment, I speculate the possibility that people think "Single payer" and "Medicare For All" are different things [1] and so report a different opinion on each, similar to how the ACA was viewed MUCH more favorably than ObamaCare despite one being the nickname for the other.
[0] https://news.ycombinator.com/item?id=31755822
[1] ACKSHUALLY, single-payer doesn't HAVE to be simply expanding Medicare to everyone. It could be done in some other way, but the core idea of the government paying for everyone's healthcare is still the same.
Medicare is generally understood to work with supplemental insurance. Single Payer is often marketed as a prohibiting supplemental insurance.
The whole topic is disgusting, particularly the rejection of opt-in Medicare at cost by both sides.
This rejection is hypocritical to everything either party claims to stand for.
Yet.
https://www.forbes.com/advisor/personal-finance/medical-debt...
Simply walking away from medical debt if there is only a minor impact on credit score seems like a decent option if not.
I did the same thing with an ER bill I couldn't afford a while back. I just never paid it and suffered virtually no consequences.
I'm not sure what sort of retirement they had planned to have on less than 10k, but it looks like in this case the hospital knew they could afford to pay but preferred not to. When people use number of jobs rather than hours worked per week it's typically beacuse number of jobs is greater than one and hours is less than forty.
> Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills.
The emergency room was available to him. What was the total he was asked to pay? Why didn't he pay it?
> Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.
Average nurse practitioner salary 115k. Why are they putting medical debt on credit cards? The emergency room wasn't going to stop care to those kids if they didn't pay immediately. If they were poor the kids would get CHIP, so I think they probably had too high income and maybe decided to forgo health insurance and work as contractors for additional pay. What was the plan for the birth? Was the problem that they were early and they didn't have a chance to get insurance at the last second?
I'm pretty sure that's on purpose.
It could also be the companies aren't willing to have someone on full-time, because then they'd have to pay for medical and other benefits.
Are you asking why they couldn't afford 70% of an average salary (which, there is a 50% chance this person made less than the average) in one shot?
Your entire post seems to be victim blaming based on a few sentences of context. You don't know what other debts and obligations these people had, nor what other avenues they tried to exercise.
At 38k a year I had a max out of pocket of 7k. It can be done.
It’s as if I opened a web server in my home with all the ports open, a password that is “changeme” and then complained that someone else should’ve been protecting me.
So it raises the question of what kind of shitty coverage she had that was able to do this, or if she just had no coverage at all for some reason, which as far I understand, is supposed to be illegal after PPACA (you can always buy from the exchanges and they can't say no).
That's a provider choice, and not guaranteed.
So when you see things like a $14,000 charge for someone consulting over video for 10 minutes of work, or $800 for a bandaid, and you wonder how the hell a charge can possibly be that high, the answer is often that it isn't. That's just an artifact of this blind bidding thing going on between providers and insurers where providers send the largest conceivable bill they can to insurers knowing damn well they won't actually get that much.
This also feeds back into why insurance companies have such a horrible incentive to default deny everything. They know the providers are overcharging and charging for bullshit. Both sides are forced into taking equally extreme baseline negotiating positions by the total lack of pricing transparency.
It points at a very specific dysfunction of our system that goes well beyond the question of whether the government or private insurance purchasers should bear the bulk of the cost. This is a totally separate and orthogonal problem that both buyer and seller, no matter who they are, treat all transactions, no matter how mundane, like it's a blind silent auction for a rare Vermeer that hasn't seen a public market in 300 years.
And you're going onto a tangent that I am very much in agreement with (that the whole system is massively broken and suffers all sorts of perverse incentives), but -my- point, if you'll recall, is that not everything gets written off. People still get unexpected medical bills -all the time-, for things their insurance didn't fully cover; this despite their deductible and/or max out of pocket.
Or, as I commented before, and which you're...agreeing to, in a whole lot of words, it's a provider choice, and not guaranteed. I.e., every time you go to the doc you're rolling the die; doubly so for emergency stuff that you can't get pre-authorized. "It doesn't happen -that- often" seems to maybe be your argument, but it happens enough, and the consequences of it happening at all are devastating.
> Why are they putting medical debt on credit cards?
Doesn't say they did - reads to me like they built up debt on the credit card with regular living expenses while servicing the medical debt.
The emergency room has ludicrously high costs, and none of his medical history. You're literally saying "don't expect to be able to see your primary care provider, go to the emergency room instead" -because of existing debt-.
You're making a lot of assumptions...all of which miss the point. Why is life shattering medical debt a common thing we tolerate in this country, given every other Western country has managed to make it a rarity? But, to your assumptions - maybe and she gave birth prematurely and ended up being seen by a hospital who were out of network and her insurance didn't cover it. Or even went to an in-network hospital, but was seen by doctors who were out of network, as frequently can happen, especially in emergencies when you can't personally vet the doctor is in network for you before you see them. Certainly, something unexpected happened (maybe even the pregnancy itself! Something to look forward to with the Supreme Court set to overturn Roe v Wade), and insurance wasn't there. Why is that acceptable in this country?
It’s hard to imagine a person wanting to take on multiple jobs if instead they had the option to work one for the needed amount of hours and pay. Hours at one job != hours at three jobs, especially when you add in commuting time and lack of benefits because you’re not full time.
We just sat on a chair for a couple hours for 'monitoring', and sure enough we got a $1700 bill from them, since she hadn't met her deductible yet.
Of course people are in debt if they get hit with bills like that.
------
Yeah, a transition is going to be an expensive shitshow and now is not a good time, but just about any other time in the last decade was a good time and in a year or two it will be a decent time again. We'd better rip this bandaid before it soaks all our blood out.
The issue at hand is to take something the public spends nothing on, that the government gets for "free" and to put that on the public balance sheet - a huge cost. I guess we could balance that out with a tax, but who would like that? And even if we were to raise taxes - it wouldn't help our balance sheet since we already spend 30% more than we take in. Looking at the balance sheet as it stands today, we can't even afford what we currently spend. And inflation is on the rise.
I just don't see it ever happening. Save a collapse and total reset of the current monetary system.
What part of "we pay nearly double" didn't make it through?
We can't afford the enormous premium we are paying for privatized care.
> I guess we could balance that out with a tax
Payroll tax. In the vacancy left by private insurance. Scribble off one memo line, write in another. Come on, this is a 101 level objection.
You are obviously a very smart guy, jjoonathan. Why do you suppose the Democrats didn't even propose this when they had 60 Senate votes, the Presidency and the House? If its a 101 level problem why do you think that is?
The rebates for private health insurance (to convince people to take out private insurance to “take pressure off the public system) have actually made things worse, for most people it’s subsidised by 30% by the Government (and you avoid an extra health levy), but over the last decade or two, the premiums have just gone up significantly and the amount of things covered has been dropping. It would have been better to just put that money into the public system (which is a bit overstretched due to underfunding). So mostly the subsidy has just gone into profits for insurers. It’s hard to get people to take out the private insurance without it and tax offset, but as I said before, since the public system is more efficient, the cost to society would be less without subsidising private insurance.
If the government owns the system, the government can establish all sorts of controls (4). What do you think the margin is in these sectors (% is of $3.5T in 2017)
Hospital care (33%)
Physician and clinical services (20%)
Retail drugs (10%)
Other health, residential personal care services (5%)
Nursing care facilities (5%)
Dental (4%)
Home health (3%)
Other professional services (3%)
Other non-durable medical products (2%)
Durable medical equipment (2%)
(1) https://www.britannica.com/topic/socialism
(2) https://www.merriam-webster.com/dictionary/socialism
(3) https://en.wikipedia.org/wiki/Socialism
(4) https://www.cms.gov/research-statistics-data-and-systems/sta...
As a side note I am about to go feed Thelma and Louise. Ill pet them and say hi for you.
[1] - https://www.youtube.com/watch?v=5LTWJOi3bCo [video] [joes t-shirt nsfw, minimize browser]
[2] - https://www.cdc.gov/media/releases/2017/p0718-diabetes-repor...
[3] - https://diabetesjournals.org/care/article/41/5/917/36518
It should not be this way though because mostly the wealthy take advantage of protecting their assets as it requires some money.
Basically the hospital took the house he worked his whole life for.
They just don't understand the FREEDOM that high health care costs provide! /s