What do you think about Trump's proposed budget cuts or the American First Policy choices?

None of us like taxes, but are we willing to accept the decreased benefits that associate with those cuts?

The government is terrible at spending money efficiently to give me those "benefits" that I may or may not even use. The money is far better off in our pockets, for the most part. It's incredible how local government can manage to bankrupt themselves when they only have to do the simplest things, like maintain roads, volunteer firefighters, police, the abysmal public schools...

@Invisible: Oh, the government has never been good at spending money. There are too many hands too many steps. There are some things the government has to do though. And things like welfare and unemployment are optional things that cost us a lot.

I agree with you that the money, for the most part, is better of with the citizens. Though I think it is important to remember that it is hard to know from our limited view what it would cost us.

@MarsSword: It's easy to know what anything would cost us: less. It would cost us less.

@Invisible: Like you I prefer smaller government and more privatization. I think the government is pretty inefficient but necessary for things like roads, security, and law.

@Invisible: While it's true that the government isn't always the most cost efficient, neither is any other entity. States run their education systems at incredible inefficiency, and individuals make poor money decisions all the time. And medically speaking, healthcare prices all around are abysmal. You know how much one epipen costs? It's over $300. You know how much the medicine inside costs? About $1.80. That's a $298.20 markup for a plastic, spring loaded syringe. Someone has to flex some muscle and end this ridiculousness, but it hasn't been consumers (because they'd like to live), it hasn't been insurance companies, and it hasn't been the government either (big pharma lobby). Who's going to say enough is enough?

@Xuan12: It can't be consumers because you can't get the benefits of the free market if the government socializes insurance and insurance companies are massively for-profit (insurance companies used to be capped at 11% profit) and people end up unable to force competition among hospitals, among healthcare plans, and among healthcare products.

@Invisible: So basically no one can do it? Yet if you cross the border you can buy the same medicines for a fraction of the price. Canadian Epipen, $80.

@Xuan12: No, that's not what I'm saying. I'm saying that consumers [i]can[/i] do it, but not until the government cracks down on insurance companies like they used to, stops socializing insurance, and at least shortens the amount of time that healthcare product manufacturers can gouge consumers on prices. The deck is stacked against the consumer right now, so it's no wonder things cost a fortune in healthcare.

@Invisible: @Xuan12: If you believe that everyone should have access to the health care that you need then it needs to be socialized like Canada. That is an expensive system without a doubt. I don't think the government needs to be inefficient. Bring in a couple of mathematicians to figure out how best to organize and distribute medical care and the system could be made more efficient.

@MarsSword: 🤦 That's not how it works, you can't just optimize a system from the outside. You need to incentivized competition to bring down prices and to force companies to improve their products, which in this case would mean offering more practical healthcare plans that are actually suited to the amount of money that people will spend on healthcare. As our healthcare system is set up now, lots of poorer people are forced to pay a lot for coverage that has such a high deductible that they'll never actually get anything from it. It's ludicrous, and no mathematicians can fix all of these problems.

@Invisible: Actually you can optimize a system from the outside. The government doesn't have a good track record in the regard. But it certainly can be done.

I totally agree about the current broken state of the health care system in the US.

The problem with health care is that people cannot just not buy it if it is too expensive thus bringing the cost down...

@MarsSword: I agree with Marsword on this one. Medicare and Medicaid cover 1 out of 5 Americans, that gives the government a lot of bargaining power actually, they represent a large number of healthcare consumers in this regard. I believe the reason they haven't is because of the strength of the pharmaceutical lobby. I'm unconvinced that consumers can enact this change themselves, because healthcare isn't like a lot of other goods, without it your quality of life can drastically diminish, or you could even die. Kind of similar to food, you can put off buying it for a while, but eventually you have to do it or die. And shopping for alternative healthcare isn't feasible for a lot of people, because outside of major or medium sized cities, there usually aren't a great number of different doctors and hospitals available in the area. The district I live in has only 1 hospital for two hours in every direction, and only 5 doctors. Not enough consumers have the luxury of being able to discriminate about how they receive healthcare for this to be viable.

Consumers are over a barrel on this one, and need to rely on something other than their purchasing power. Insurance companies COULD theoretically do it, but they haven't, same with the government. I'm honestly quite skeptical any meaningful reform will be occurring this decade. Probably the thing that will actually get the ball rolling is a minor market crash for pharmaceuticals and medical suppliers, who will then agree to a restructuring on their terms, after they've extorted a satisfactory sum of money from the American people. Additional tidbit, rattlesnake antivenin, less than $100 to produce in Mexico, but have it administered to you in a US hospital, and you're probably looking at thousands of dollars.

@Xuan12: The government doesn't give citizens treatment, it just gives them healthcare insurance. That's what this discussion is about because obviously there are no government controls on hospitals or any such involvement.

The issue with people buying healthcare insurance through the government (and even being coerced to do so via Obamacare's uninsured tax plus its failure to give more than a single option in insurance provider to a third of the nation) is that competition is restricted and people can't even opt out of the system. It completely goes against voluntarism and free market principles. That's why it's so inefficient. No amount of mathematicians can fix this until these principles are established, and at that point the system will fix itself.

@Invisible: And what we've been trying to explain is why free market principles aren't coming to the rescue here. There just aren't options, and it's not really the law getting in the way. Insurance companies are allowed to operate in as many states as they want, they just have to meet the standards of each state they operate in. Now the ACA did introduce some new standards, but the principle is still the same, insurance companies can operate wherever they like if they meet the state's requirements. So why don't they? Some do, you can get insurance from some companies almost anywhere in the nation. UHG is available in all 50 states. Others just choose to operate in some areas for various reasons, mostly to keep costs down, and hence profits up.

Think about this. Insurance companies operating in each region typically form agreements with the healthcare providers in those regions. This is a way of simplifying coverage and pricing negotiations with preexisting contracts and agreements. Both sides do this because neither one likes lengthy, expensive negation processes. But how is this going to work if we just up and decided to trample on the states and say that any insurance plan from any state should be available anywhere? A consumer in Florida could by Insurance from Alaska if it suited them. Sounds like the free market, sure but it has none of the real benefits of the free market. The Alaskan insurance provider, now has to negotiate with healthcare facilities and providers in Florida, and in fact, they're going to have to do this with every HCP and facility that any consumer in the nation might go to. And that means they're going to have to sort through all the different state and local bureaucracy, and then the HCPs themselves to come to some sort of agreement. The amount of work it would take to form all those agreements, or negotiate all those charges is astronomical, and not cost efficient. The Alaskan insurance provider probably doesn't even want to do it because of that. It's able to provide less expensive insurance for people in the primary regions it operates in sure, but every new region it wants to sell insurance in means it has to enter another realm of negotiation and deal making, which just isn't worth it in most cases.

In addition to that is the very nature of insurance economics. To survive, an insurance company needs a robust pool of clients, that ultimately pays more than it consumes. Large numbers of healthy clients are therefore the most desirable. When these companies compete, the ones with larger bodies of proportionately healthier clients wins. They offer lower prices to win more clients over, and eventually their competition doesn't have a healthy enough pool of clients to continue existing, because in insurance economics having the wrong customer can actually lose you money. This is why regions with lower populations, and less healthy residents have fewer insurance companies competing in the area. It's less profitable, and there isn't room for many insurers to thrive there. They win monopolies. Any new insurer has to compete with the existing power, and any outside insurer moving in has to go through the expensive process of building a coverage network for itself in a new region, so it just doesn't happen that often.

Combine that with the increasing demand for medical care. People know that it can improve and lengthen their lives, so they really want it. Sadly people are also getting less and less healthy, due to increases in obesity and sedentary lifestyle mostly. So this strains the pool of healthy clients that insurers need, forcing them to do what they must, and raise prices. Of course that's not to say that there isn't a good deal of profiteering going on also, as I already mentioned.

So what's the government to do about it? Mandate the existence of more companies and prop them up with cash or force clients to buy their insurance? The individual mandate encourages buying insurance, but it doesn't tell you who you have to buy it from.

Oh, but then there's the healthcare providers themselves. They have almost no choice in anything. They cannot reject patients with critical needs based on their ability to pay, so they're going to need to recoup that somewhere. They go to the only entities they can in that arena, the insurers, who resist that tooth-and-nail. This isn't a typical sort of economic interaction. Patients who opt out risk life and limb, healthcare providers cannot reject patients, or choose which insurance companies they want to deal with, and insurers can actually lose money by having the wrong customers, and the only government interference in this dynamic is that HCPs can't turn away emergency patients, which is a rather non-contraversial ethical issue. And yes, there are some other government regulations, but not ones that are fundamentally changing this dynamic.

So what does the free market say about patients who risk life or limb by not buying (low freedom), providers who cannot refuse critical patients (low freedom), and a middle man trying to make a profit out from an increasingly high risk client pool? It tells you high prices. But insurance is basically a socialist concept anyway. A bunch of people pay into a general fund that provides for needy members at their time of need. We want the sick to get the treatment they need, and to keep costs manageable for all members by having enough healthy members, so the best insurance company would really cover everyone...but we could make it even more affordable by removing the profit motive. A nationwide, non-profit insurance system, a public insurance system.

Wow, what a giant wall of useless text. So, free market principles simply can't be implemented by the government because the government gets in the way? Yeah, that's an absolutely retarded argument, if you can even call it that.

If they got rid of compulsory coverage of preexisting conditions, got rid of state-level bureaucracy, got rid of the Obamacare tax on people who don't want to buy insurance through Obamacare, reimplemented profit limits on insurance companies, etc, then free market principles would work. It's no fucking wonder that they don't right now with the environment that has been set up.

Forcing insurance providers to cover preexisting conditions is literally forcing the rest of the population to pay for it, driving prices way up. Do you think that's fair? Because I fucking don't. God forbid people actually pay for what they can afford.

@Invisible: Do you even read anything or listen to yourself? [quote]I'm saying that consumers can do it, but not until the government cracks down on insurance companies[/quote]

So the free market will come to the rescue when the government cracks down on insurance companies by artificially capping their profits? Yeah, that must be how a "free" market works. By the way, that's already in place.

[quote]You need to incentivized competition to bring down prices and to force companies to improve their products[/quote]

So as explained, how do you incentives competition among insurance companies? They already have the freedom to operate where they want to, if they choose to and they don't. And also as mentioned, they like many companies in free markets, develop monopolies in their regions over time. That's a mechanism in a free market that naturally reduces choice over time.

As for not covering preexisting conditions, you know you're going to have one eventually, right? And then when you have it, and no other insurer wants to cover you without an extraordinarily high price tag for you, where has your "freedom" gone? You're now stuck with your present insurer, who is also likely going to raise your premiums as soon as the contract allows it. At least when that happens, you're more likely consider other options anyway, but you're still SOL in terms of price. The idea doesn't bother you, because you're young and healthy now, but that will change sooner or later.

Also, if you opposed to the idea of paying for others, why would you buy insurance at all? That's the entire point of what insurance is, it's a risk dispersal pool where you pay in and others who need it receive payment. You might be the beneficiary one day, but until then, you're paying for others. Heck, the fee for not having insurance no longer exists anyway, you should go ahead and opt out. Oh, sure one bad trip to the emergency room would bankrupt you, but you won't have to pay for others.

How much money do you make? Suppose you got a rattlesnake bite, the average hospital pays about $2,500 per vial of antivenom for that...so of course they're going to have to mark that up a bit to cover the cost of labor and such. Oh, and on average you're going to need 12 vials of antivenom. So 12X$2,500=$30,000...BEFORE the markup for labor. And this is assuming no insurance is involved at all, the cost of the medicine itself is $2,500 per vial...that's just materials. Oh, and forget about it if you need extra care or therapy to recover lost function due to the latent effect of the hemotoxins and neurotoxins.

So have fun. Just pray you don't get unlucky and go bankrupt, or you could take the other option, just don't take treatment you can afford and possibly die or lose limbs. Ah, the "freedom" to choose.

@Invisible: The point is a lot of people cannot afford the health care they need.

To reduce the cost of healthcare we need to encourage a healthier society on the whole, reduce obesity and other self inflicted medical conditions.

I wasn't talking about America's health care insurance problem. I said that if you think that everyone who needs health care should be able to get it then the US needs to move towards a centralized government run healthcare system like Canada. Where people pay for their medical care directly from taxes. This is a socialist concept but health care for everyone is a socialist concept in and of itself.

In terms of the concepts behind health insurances @Xuan12 outlined that well and I agree with him.

You can't just get something you can't nearly afford because you need it! Has everyone gone mad or is it just me? If you can't afford it, [b]you can't have it[/b], because if you got it, I would have to pay for it.

@Invisible: The idea is that there is the moral responsibility to provide such things as medical care to people who need it. If you don't hold on to that idea that people should not die from curable sickness then yes, people should only get what they can afford. Remember that when you or someone you know has been in a car accident that wasn't their fault and now need a $200,000 heart transplant and don't have health insurances because business has been bad.

@MarsSword: Hospitals always do emergency treatments before even discussing payment. People aren't dying because they can't afford care.

@Invisible: Emergency treatment is not the only treatment that saves lives. And somebody still has to pay for that emergency treatment.

@MarsSword: Yeah, the person who receives the treatment

@Invisible: My point is that often people cannot pay for such treatment. How long would it take you to come up with $300,000?

@MarsSword: I think I'd just be grateful for my life at that point. Oh, and very pissed at the insurance companies that drive up costs via the long negotiation process. I certainly wouldn't request that other people have their money taken by force in order to pay for it. Perhaps I'd get some degree of help from private charities, friends/family, my community.