Vermont Single Payer System (legal, health care system, borders, Obama)

[MrRational]

Originally Posted by mufc1878

single payer works in manageable and homogeneous populations.
something vermont has.
single payer's challenge is the scalability for a vast and diverse populous like the US.

+1 This is exactly correct.

Another factor is the absurdity of any analogy that uses a UHC that has had 60 post war (mostly) boom years to develop into something...

[Grim Reader]

Originally Posted by MrRational

+1 This is exactly correct.

Another factor is the absurdity of any analogy that uses a UHC that has had 60 post war (mostly) boom years to develop into something...

It is true that the existing UHC systems ahve mostly had 60+ years to work out the kinks. I seem to vaguely remember that that was an explicit argument when Taiwan set up their system, and cherrypicked the best bits from other developed systems.

However, it seems to work equally well in Iceland with 300 000 homogenous people as it does in germany, with 80 million highly mixed. Or Japan 125 million homogenous, or Switzerland 8 million mixed.

There does in short seem to be no observable link ever demonstrated between size or mixed population and system functionality.

[padcrasher]

[quote=momonkey;19268072]No, you're wrong.

Vermont is the whitest state in the union.

Moderator cut: link removed, linking to competitor sites is not allowed/QUOTE]

No. You just can't read in context. Of course Vermont is a mostly white State, but not nearly has bigoted as mostly white Red States.

[MrRational]

Originally Posted by Grim Reader

There does in short seem to be no observable link ever demonstrated between size or mixed population and system functionality.

And then there is the geographical and internecine political aspects of having 50 separate sovereign states to impose that upon.

The issue isn't whether the US could make it work or even whether the US should make it work... the issue (in my view) is about what can actually get through Congress and how close that might be to what we actually need and be accepted by the largest majority and in fact be better than what we have now and before these latest changes.

IOW... the realpolitik as opposed to the pipe dream.
---

But this continuing argument over the notion that the problem can somehow be resolved as an either/or proposition is a large part of why this problem hasn't been resolved.

The US needs a mixture of the several approaches to PAYING FOR care.
It's also a fair statement that the UHS countries need a mixture of approaches as well.

FIRST: A tax supported plan for the catastrophic and traumatic care, major disease, and other universal underlying systems that individuals can't ever afford on their own but which they also can't ever afford to even insure against.

Just getting the worry and expense of this entire range of care and expenses off the backs of individuals will completely change the dynamic. Even as an incremental step toward eventual UHC this concept will have the most general appeal and likely needs to be done regardless of whatever else we might do beyond this.

SECOND: A whole lot more personal responsibility for the day to day care we may use... the costs of which are most affected by the other day to day choices we make... and will be most impacted by competition and market forces.

With the big worries off our shoulders and no more need for that 'OH MY GOD!" insurance policy... most people will be quite happy to do everything else on their own tyvm.

THIRD: And some small degree of private insurance on an individual basis for the services and costs that will occasionally come up that lie between those two ends.

But what we DON'T need are the Humongous Private Insurance Companies in every corner of our lives to do any of this..
nor do we (the largest majority of us) need an overly large government program to replace that model.

So far, the policies that have the most traction in DC are the ones that work against changing anything at all...
policies designed to actually support those big HI Companies.

THIS is the largest problem we have. That political influence of the HI companies.
--------
The middle ground approach:

I believe in keeping our employers and employment status out of the discussion entirely.

I believe in a tax supported network that keeps 911 and ER's and Trauma Centers operating.
This is the best part of Medicine in the US and we do it VERY well.

I believe in tax supported basic medicine for the poor, the elderly and for children.
I believe in tax supported advanced medicine (Cancer, Traumatic Injury, etc) for EVERYONE.

I believe in NOT distinguishing the peripheral services (dental, optical etc) from "medicine".

I believe in everything else that we might need of a medical nature on a year to year basis being a personal responsibility;
one that we can plan for and budget for and should pay for privately.

I believe we have NO NEED for Big Insurance as a part of that scheme in any way whatsoever
or for those companies to be even remotely involved in the servicer choices we may make.

I believe everyone should have a basic insurance policy to backstop us for the occasional hiccup in those year to year expenses
we otherwise pay for privately and that it should function very simply... very much like how a homeowner or auto policy functions.
(Some, with more involved medical conditions or other claim patterns will necessarily pay more for this than others)

I believe this covers it all.

[HurricaneDC]

Originally Posted by Randysavage69

...Where do people get this absurd reasoning that national healthcare can ONLY work in homogenous populations? WHAT? Healthcare is HEALTHCARE, no matter what the racial and ethnic makeup is! What the hell do you mean?

He's just race-baiting.

[EinsteinsGhost]

Originally Posted by MrRational

And then there is the geographical and internecine political aspects of having 50 separate sovereign states to impose that upon.

How does the "geographical" aspect come into play? Fifty "sovereign states"? What have you been smoking? Besides, Vermont is one of the fifty.

[HurricaneDC]

No, I think I get what he's saying. The structure of the system if it works in Vermont may not work in Missouri for example (due to the difference in the tax base, possibly?).

[Grim Reader]

Originally Posted by MrRational

I believe this covers it all.

I agree on the influence of the HI companies being the biggest challenge.

What you are describing otherwise suggests a hybrid between the French and Scandinavian systems. Both high performers.

The Scandinavian systems are similar to the NHS model, but broken down to a lower level of government to administer. In the US, it would be equivalent to taking all the money that make up medicare, medicaid, VA, IA etc, apportioning them out between the states based on population and density, and requiring each state to deliver state-run UHC for the money.

The French system, as I understand it, is basically high-quality basic medicine, preventive care and catastrophic coverage for everyone, with top-up private insurance for other stuff.

You seem to be arguing for a cross between the two.

[MrRational]

Fifty "sovereign states"? (the states rights arguments)

What I'm saying (perhaps too obliquely) is that just like with the civil union/marriage squabbles over the legal standing the push back will be too great. Not only collectively... but also that it will be shaped differently in each of those 50 separate fights. And there will be fights.

Anyway... the real point is about the all or nothing approach to the issue.
That sort of thing never really works.

The most it might do... is like the several packages of illegal immigrant legislation being passed i the several states is FORCE the issue up the line. Want to take any bets on how that might turn out?

[MrRational]

Originally Posted by Grim Reader

I agree on the influence of the HI companies being the biggest challenge.

What you are describing otherwise suggests like a hybrid between the French and Scandinavian systems. Both high performers.

You seem to be arguing for a cross between the two.

Yes. I said as much:
The US needs a mixture of the several approaches to PAYING FOR care.
It's also a fair statement that the UHS countries need a mixture of approaches as well.