Philosophical Productive Discussion

[Eric Cartman]

Moving my semi-carepost reply to this thread where it belongs?

I think you're wrong on this one; Firstly, I don't believe that use of force is acceptable where alternative methods of change exist, and where use of force is required it should be both measured and proportional, and executing a dude in the street in a democratic nation is neither of those things.

But the scarcity argument is flawed. It creates inefficiency, not solves it.
There already exists mechanisms in healthcare to distribute limited resources to those that most need it - its called triage.
For-profit health insurance changes the criteria for triage from those in most need to care, to those best able to afford it, specifically those with the best insurance.
It removes the treatment assessment criteria away from the doctors performing the care to the actuaries looking at a spreadsheet, and, worse, it creates perverse disincentives; the trust fund kid who broke his arm snowboarding and has super double platinum insurance will get a barrage of tests they don't even need (utilising those self same scarce resources) while the guy whose insurance company decided his best treatment is experimental and won't pay for it gets to bankrupt himself before his long painful death from cancer.
That shit ain't right.

Except this isn't how triage or insurance works in any system anywhere. Every single system would, with no other information than what you provided, deny this hypothetical rather than fund it blindly for "triage" reasons. There are gobs of non-profit and state healthcare providers in the United States and every single one denies things. Every single "universal" system denies things. You're making the same mistake Hap did in thinking that insurance doesn't direct resources exactly the same as any funding system does. "For-profit" is an entirely irrelevant saying because all systems are for-profit, especially states. "Non-profit" doesn't mean they don't make profits, it means they do accounting tricks to hide the profits. Accounting methods don't change that systems always have limited resources, and funding, money, is a resource because it simply is the representative of all other resources.

Okay, so perhaps I should have clarified as 'actively profit seeking behaviours' rather than just 'can make money'.
Insurance as an industry is inherently a profitable endeavour, because in much the same way the house always wins when it comes to gambling, the insurance company always makes money longterm, because insurance rates are always calculated based on the probability of payout.
Like... most people with insurance are always putting in more than they take out, right?
Sure, in the event something happens that you need to make a claim, in the very short term the insurance company will take the hit, but in the longer term they are going to make that back and then some.

What seems particularly egregious about US healthcare insurance providers is the combination of;

1. reduced risks of casual fraud - average joe might be tempted to buy a load of expensive stuff, put it in storage, burn their place down, then claim everything on insurance and double dip by reselling everything they didn't actually lose in a fire. You can't really do that with healthcare?
   
2. Denying payouts on things people have already paid for, and often on fairly spurious loopholes, or by changing the terms after the fact and only disclosing that at the point that the money is needed. And they get away with it (and rely on) protracted legal action having the wronged parties just fucking die before wrongdoing is proven and a payment is forced.
   

A healthcare underwriter is still gonna make plenty of money from every month someone is paying them and not getting sick, right?
Even the crazy big unforeseen payouts are just going to come out of someone elses pool until they can top it back up.

We can look at an extremely important example in your country right now, where life saving care for trans people is going to be denied thanks to Joanne's massive spending rather than life-long "triage" taking priority. 

I snipped the stuff about justifiable homicides because I don't believe in justifiable homicide, so its irrelevant to my point that the way healthcare is run as an agressively for profit business generates bad feelings (avoiding the bad blood metaphor / pun) because of how those businesses conduct themselves and actively prevent alternative solutions.

Lets take for granted Kyunujis understanding of waiting lists as accurate; they can go get themselves their elective, non-essential, self-diagnosed treatments right now if they want; sure they might have to spend a bit of time diagnosis shopping to find the private doctor who will just sign off on a scrip no problem, but I am somewhat sure such physicians contact details are already widely circulated online amongst that community.
They'd have to pay for it themself though.
Or wait to get it free on the taxpayer.

I don't consider that as an aspect of denial, I consider that perfectly logical allocation of resources. I also don't deny the concept of resource scarcity.

I also reject your proposition that UHC represents a monopoly interest; if anything it represens a baseline standard to encourgae competition.
If the NHS hits the levels of shittiness certain political leanings would like, people can always get private insurance instead.
Conversely, if the levels of shitiness I'm sure private providers would like to be able to achieve if left unchecked gets reached, they lose business because that baseline level of care for free for all still exists.

If your belief is that healthcare is not a thing a government should pay for, I would ask what should a government pay for with taxes?
Keeping its own citizens alive by removing avoidable threats would seem to me pretty much the most important function of a government.

universal healthcare still involves someone picking and choosing who lives or dies

it might ultimately be a better system for many, but in the moment that doesn't mean much to the person who dies as a result of the bureaucracy, as a result of being forced to wait to get examined for something that needed immediate treatment, or any number of other silly reasons people continue to suffer under universal healthcare

all healthcare everywhere ultimately involves someone picking and choosing who lives or dies, the difference being whether its someone in the hospital making the judgement call at 'point of sale' based on medical grounds, or someone looking at a spreadsheet making that decision on profitability grounds.

I'm also not sure you understand how, well, most every other country in the first world actually operates, because waiting lists are generally for non essential treatment, not diagnoses.

You also can't really point to universal health care being worse than the US system on economic or efficacy grounds, because the US spends fairly significantly more than most other comparable countries on healthcare as a percentage of GDP, but also generally has a lower life expectancy than those same comparable countries.

I don't know what your specific criteria for success are, but 'costs the country less and has better results' seem like fairly good ones, no?