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Posted this in the comments last week, but was curious to get some more thoughts on a potential path forward on the healthcare front that isn't just single-payer across the board:
I do occasionally wonder if you could get to a decent place via:
That's going to create some winners and losers, hospitals will be upset that more high cost people are on Medicare, but shifting people from Medicaid to commercial reimbursement rates should help out with that. The amount of bureaucratic nonsense saved by getting rid of Medicaid should be huge.
All a bit of pie in the sky dreaming anyways...
It's not about the system, it's about the people.
Low income, high obesity, non-White or non-east-Asian will topple any system.
What evidence is there of this for income or race?
What kind of evidence are you looking for? That the largest brown population groups in America make less money than the Whites and East Asians? That low income people pay less, despite requiring the same treatment? That obesity is a cause for many medical issues? That doctors can spend up to 30 hours in a week servicing people who don't pay anything at all, ever?
Conceptually it's a simple proposition. The system is based on pooling resources together, and then that pool is used for those in need. People who pay more than they take out can maintain the system. People who pay less make it harder. Both ends of this equation matter.
The problem America has is that it wants to maintain a 'high' European or East Asian standard, but it's lacking the population to maintain it on both ends. Which leads to odd systemic 'errors'. The complexity of the system muddies the water as to why it is so expensive. But it makes sense when you operationalize the population differences.
If your logic is based solely on income, including race is very confusing.
It's not based solely on income. I said that it's based on people and the differences between them.
We can tease out some obvious differences using various proxies, such as the examples I gave before: Income, obesity, or 'race'. But the overarching point is that we have big natural experiments when comparing various different health care systems. Those experiments collapse a lot of the complexities, but they also help verify the proxies we used before and the limited but relevant insights they give into the health care systems.
What natural experiments show this for race, controlling for income? That's why this is confusing.
I want to say any majority black country, but I'm not sure we are on the same wavelength with regards to income.
To highlight what I'm getting at the most obvious example I can think of is the fact that the black population In the US can not functionally maintain the white/east asian standard. I.e. you have a population block that does not contribute to the pool of potential quality medical staff in a similar way that the white/east asian group does.
This disparity might not be pronounced in any relevant way so long as there are proportionally enough candidates for quality medical staff, but change the proportions enough and you will run into the aforementioned 'system errors'. This has similar cascading effects when looking at other professions that require high quality people.
To that extent income isn't as relevant a factor as one might think. There are a lot of wealthy people whose wealth is only made relevant by the existence of the quality people that enable that wealth to begin with. You might argue that to be the case with regards to any society in general, and I'd agree, but what I am getting it here is that the wealth generating avenues are not at all equal or equally predicting with regards to social outcomes. Which is exemplified by the fact that even when controlling for income, blacks commit more crime than poor whites.
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