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Old 11-09-2017, 09:50 PM   #1
bimmerfan08
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Why single payer health care is a terrible option

Great article even being an opinion piece. Links to some of the supporting documentation below. Would enjoy hearing Rhumb and Stankia refute this.

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The Affordable Care Act (ACA) is failing. Without regard for consequences, the law expanded government insurance programs and imposed considerable federal authority over US health care via new mandates, regulations and taxes. Insurance premiums skyrocketed even as deductibles rose; consumer choices of insurance on state marketplaces have rapidly vanished; and for those with ACA coverage, doctor and hospital choices have narrowed dramatically. Meanwhile, consolidation across the health care sector has accelerated at a record pace, portending further harm to consumers, including higher prices of medical care.

Almost inexplicably, even more top-down control -- single-payer health care, a system in which the government provides nationalized health insurance, sets all fees for medical care and pays those fees to doctors and hospitals -- has found new support from the left. And this despite its decades of documented failures in other countries to provide timely, quality medical care, and in the face of similar problems in our own single-payer Veterans Affairs system.

Clearly, this moment cries out for the truth about single-payer health care -- conclusions from historical evidence and data.

Single-payer health care is proven to be consistently plagued by these characteristics:

Massive waiting lists and dangerous delays for medical appointments

In those countries with the longest experience of single-payer government insurance, published data demonstrates massive waiting lists and unconscionable delays that are unheard of in the United States. In England alone, approximately 3.9 million patients are on NHS waiting lists; over 362,000 patients waited longer than 18 weeks for hospital treatment in March 2017, an increase of almost 64,000 on the previous year; and 95,252 have been waiting more than six months for treatment -- all after already waiting for and receiving initial diagnosis and referral.

In Canada's single-payer system, the 2016 median wait for a referral from a general practitioner appointment to the specialist appointment was 9.4 weeks; when added to the median wait of 10.6 weeks from specialist to first treatment, the median wait after seeing a doctor to start treatment was 20 weeks, or about 4.5 months.

Ironically, US media outrage was widespread when pre-ACA 2009 data showed that time-to-appointment for Americans averaged 20.5 days for five common specialties. That selective reporting failed to note that those waits were for healthy check-ups in almost all cases, by definition the lowest medical priority.
Even for simple physical exams and purely elective, routine appointments, US wait times before ACA were shorter than for seriously ill patients in countries with nationalized, single-payer insurance.

Life-threatening delays for treatment, even for patients requiring urgent cancer treatment or critical brain surgery

Those same insured patients in single-payer systems are dying while waiting for the most critical care, including those referred by doctors for "urgent treatment" for already diagnosed cancer (almost 19% wait more than two months) and brain surgery (17% wait more than four months). In Canada's single-payer system, the median wait for neurosurgery after already seeing the doctor was a shocking 46.9 weeks -- about 10 months. And in Canada, if you needed life-changing orthopedic surgery, like hip or knee replacement, you would wait a startling 38 weeks -- about the same time it takes from fertilization to a full-term human life.

Delayed availability of life-saving drugs

Americans enjoy the world's quickest access to the newest prescription drugs, in stark contrast to patients in single-payer systems. In Joshua Cohen's 2006 study of patient access to 71 drugs, between 1999 and 2005 the UK government's guidelines board, NICE, had been slower than the United States to authorize 64 of these. Before the ACA, the United States was by far the most frequent country where new cancer drugs were first launched -- by a factor of at least four -- compared to any country studied in the previous decade, including Germany, Japan, Switzerland, France, Canada, Italy and the UK, according to the Annals of Oncology in 2007.

In a 2011 Health Affairs study, of 35 new cancer drugs submitted from 2000-2011, the US Food and Drug Administration (FDA) had approved 32 while the European Medicines Agency (EMA) approved only 26. Median time to approval in the United States was about half of that in Europe. All 23 drugs approved by both were available to US patients first. Even in the most recent data, two-thirds of the novel drugs approved in 2015 (29 of 45, 64%) were approved in the United States before any other country. And yet, only months ago, NHS in England introduced a new "Budget Impact Test" to cap drug prices, a measure that is specifically designed to further restrict drug access even though the delays will break their own NHS Constitution pledges to its citizens.

Worse availability of screening tests

Despite what some might suppose about a likely strength of a government-centralized system, the facts show that single-payer systems cannot even outperform our system in something as scheduled and routine as cancer screening tests. Confirming numerous prior OECD studies, a Health Affairs study reported in 2009, before any Affordable Care Act screening requirements, that the United States had superior screening rates to all 10 European countries with nationalized systems for all cancers. Likewise, the single payer system of Canada fails to deliver screening tests for the most common cancers as broadly as the US system, including PAP smears and colonoscopies. And Americans are more likely to be screened younger for cancer than in Europe, when the expected benefit is greatest. Not surprisingly, US patients have had less advanced disease at diagnosis than in Europe for almost all cancers.

Significantly worse outcomes from serious diseases

It might be said that the bottom line about a health care system is the data on outcomes from treatable illnesses. To no one's surprise, the consequences of delayed access to medications, diagnosis and treatment are significantly worse outcomes from virtually all serious diseases, including cancer, heart disease, stroke, high blood pressure and diabetes compared to Americans.
And while some studies have noted that Canadians and Germans, for example, have longer life expectancies and lower infant mortality rates than Americans do, they are misleading. Those statistics are extremely coarse and depend on a wide array of complex inputs having little to do with health care, including differences in lifestyle (smoking, obesity, hygiene, safe sex), population heterogeneity, environmental conditions, incidence of suicide and homicide and even differences in what counts as a live birth.

The truth is that the UK, Canada and other European countries for decades have used wait lists for surgery, diagnostic procedures and doctor appointments specifically as a means of rationing care. And long waits for needed care are not simply inconvenient. Research (for example, here) has consistently shown that waiting for medical care has serious consequences, including pain and suffering, worse medical outcomes and significant costs to individuals in foregone wages and to the overall economy. In contrast to countries with single-payer health systems, it is broadly acknowledged that "waiting lists are not a feature in the United States" for medical care, as stated by Dr. Sharon Wilcox in her study comparing strategies to measure and reduce this important failure of centralized health systems.

Instead of judging health system reforms by the number of people classified as "insured," reforms should focus on making excellent medical care more broadly available and affordable without restricting its use or creating obstacles to future innovation. Reducing the cost of medical care requires creating conditions long proven to bring down prices while improving quality: increasing the supply of medical care, stimulating competition among providers and incentivizing empowered consumers to consider price.

Single-payer systems in countries with decades of experience have been proven in numerous peer-reviewed scientific journals to be inferior to the US system in terms of both access and quality. Americans enjoy superior access to health care -- whether defined by access to screening; wait-times for diagnosis, treatment, or specialists; timeliness of surgery; or availability of technology and drugs. As those countries turn to privatization to solve their systems' failures, progressives here illogically pursue that failed model.
And make no mistake about it -- America's most vulnerable, the poor, as well as the middle class, will undoubtedly suffer the most if the system turns to single-payer health care, because they will be unable to circumvent that system.

What has been the response to the public outcry about unacceptable waits for care in single-payer systems? First, a growing list of European governments have issued dozens of "guarantees" with intentionally lax targets, and even those targets continue to be missed. Second, many single-payer systems now funnel taxpayer money to private care to solve their systems' inadequacies, just as we now do in our own Veteran Affairs system, and even use taxpayer money for care in other countries.
http://www.cnn.com/2017/09/25/opinio...las/index.html

NHS areas planning to cancel or delay spending due to financial pressures

Waiting Your Turn: Wait Times for Health Care in Canada, 2016 Report

2009 Survey of Physician Appointment Wait Times

Novel Drugs 2015 Summary FDA
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If you want to make a statement that we all ought to get on board to fight poverty, I'm with you. If you want to say that we ought to fight income inequality I'm not with you at all. Because I don't think that the rich guy stole from the poor guy. In fact rich people don't get rich by stealing from poor people because it turns out poor people don't have money.
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Old 11-10-2017, 07:04 AM   #2
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Old 11-11-2017, 04:57 PM   #3
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That popcorn's getting cold. Let me replenish that for you.
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If you want to make a statement that we all ought to get on board to fight poverty, I'm with you. If you want to say that we ought to fight income inequality I'm not with you at all. Because I don't think that the rich guy stole from the poor guy. In fact rich people don't get rich by stealing from poor people because it turns out poor people don't have money.
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Old 11-11-2017, 07:36 PM   #4
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Better to have to wait a bit for treatment and pay substantially less, than for millions of your fellow citizens having no access at all....
And all while lining the pockets of the massive beurocratic health care Juggernaut who ultimately don't have your best interest in heart.

As someone in Canada who is currently on a wait list and whose wife works in the system (so I hear 1st hand) this article is a little misleading.
I have to wait because my condition is not that serious. Believe me that if you are in critical need (ie cancer surgery), you jump the line
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Old 11-11-2017, 08:57 PM   #5
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Believe me that if you are in critical need (ie cancer surgery), you jump the line
Even if the person is 78 years old?
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Old 11-12-2017, 10:35 AM   #6
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Originally Posted by TheNorm View Post
Better to have to wait a bit for treatment and pay substantially less, than for millions of your fellow citizens having no access at all....
And all while lining the pockets of the massive beurocratic health care Juggernaut who ultimately don't have your best interest in heart.

As someone in Canada who is currently on a wait list and whose wife works in the system (so I hear 1st hand) this article is a little misleading.
I have to wait because my condition is not that serious. Believe me that if you are in critical need (ie cancer surgery), you jump the line
Waiting can have implications on one's health I would imagine.
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If you want to make a statement that we all ought to get on board to fight poverty, I'm with you. If you want to say that we ought to fight income inequality I'm not with you at all. Because I don't think that the rich guy stole from the poor guy. In fact rich people don't get rich by stealing from poor people because it turns out poor people don't have money.
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Old 11-12-2017, 12:25 PM   #7
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Waiting can have implications on one's health I would imagine.
Amazing that you have to point that out, isn't it? Also anazing that anyone actually thinks the government would have your interests at heart.
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Old 11-12-2017, 01:08 PM   #8
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Amazing that you have to point that out, isn't it? Also anazing that anyone actually thinks the government would have your interests at heart.
Amazing that you missed the part where procedures which are critical or where a delay will have an impact are bumped to the front. You're not going to die if your knee replacement takes an extra week of waiting.

And organizations with profit as their sole motive has your well-being at heart? If anything they are more motivated to keep sucking you for cash.

I really don't understand why there is so much resistance to the single payer concept... besides that of the existing buissness model.

I want your people to live long healthy lives and do so as economically as possible.

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Old 11-12-2017, 01:40 PM   #9
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Amazing that you have to point that out, isn't it? Also anazing that anyone actually thinks the government would have your interests at heart.
Even more amazing that anyone actually thinks private insurance companies would have your interests at heart, rather than their primary interest in maximizing profits for shareholders. Inherently, the former interest is obviously subordinate to the latter, as anyone who has battled insurance companies not to ration (read: deny) coverage could readily attest.

Is it "bad" that a private, for-profit corporation would/should/must prioritize profit when all is said and done? Absolutely not, but that might also mean that they are not the appropriate vehicle for a society to pay for its citizens' healthcare, where those interests go far beyond profit.
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Old 11-12-2017, 05:37 PM   #10
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Hurt myself playing volleyball, got MRI the next day, no regrets. Enjoy waiting lists ******s
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Old 11-12-2017, 06:53 PM   #11
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Hurt myself playing volleyball, got MRI the next day, no regrets. Enjoy waiting lists ******s
Turned my finger into hamburger with an angle grinder. In, out, xray and stitches in under an hour... and no bill.
Blew out ACL, saw orthopedic surgeon next day. Surgery a week later. Also.. no bill.

Suck it.

You really are dense.

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Old 11-12-2017, 06:56 PM   #12
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Even more amazing that anyone actually thinks private insurance companies would have your interests at heart, rather than their primary interest in maximizing profits for shareholders. Inherently, the former interest is obviously subordinate to the latter, as anyone who has battled insurance companies not to ration (read: deny) coverage could readily attest.

Is it "bad" that a private, for-profit corporation would/should/must prioritize profit when all is said and done? Absolutely not, but that might also mean that they are not the appropriate vehicle for a society to pay for its citizens' healthcare, where those interests go far beyond profit.
I have no delusions that private companies are altruistic, but what is baffling is that citizens of voting age like you actually believe government is. If a private company fails to serve it's customers, the customers have direct and immediate options. Tell me, when the government fails to serve its subjects, what options do they have?

And when you give your predictable and insufficient answer, remember who the two major party presidential candidates were last year.
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Old 11-12-2017, 07:07 PM   #13
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Hurt myself playing volleyball, got MRI the next day, no regrets. Enjoy waiting lists ******s
How would you feel about a system that offers both public and private. In Austria (with my admittedly limited knowledge) everyone gets universal health care for "free" (paid for through taxes paid by everyone), while people with means can still purchase private insurance for better/faster/etc care if they want.

I think one of the main benefits under Obamacare is that EVERYONE* pays. Which should be required, unless hospitals can stop treating people without insurance. Before ACA and even now people without insurance still get treatment. Who pays for it? Anyone that has insurance. Hospitals and insurance companies aren't in the business of losing money. If 3 out of 10 people treated don't have insurance, the 7 people pay for the treatment of 10 people.

*I know a lot of people get free health care. But if people get regular access to doctors they won't wait until they don't have a choice. Example: someone getting a cut treated, cleaned, and a few stitches vs gangrene and amputation. It provides a cheaper option to society. Unless we make the decision that letting people without cash/insurance remain untreated is an option, I'm for the cheapest way to treat these people.
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Old 11-12-2017, 07:52 PM   #14
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My son fractured his right wrist last Monday. He will get a cast on tomorrow exactly one week later, because:

1. The healthcare in the US is the worst in the world.

Edit: I was going to go into details, but decided (1) would pretty much sum it up.
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Old 11-12-2017, 10:01 PM   #15
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Yeah a lot of the US healthcare system leaves a lot to be desired too. It takes weeks for me just to see my family doctor just so I could get referral to a specialist and then wait weeks again to get an appointment with the specialist. Then there are the various insurance and hospital "networks". One insurance company covers a particular hospital while another does not, because... reasons. If you get sick and want to switch to a different hospital which specializes in your illness you have to wait till the end of the year to change insurance plans, it's very frustrating.
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Old 11-13-2017, 11:07 AM   #16
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Not surprised this thread delved into anecdotes.

I'll respond more later.
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If you want to make a statement that we all ought to get on board to fight poverty, I'm with you. If you want to say that we ought to fight income inequality I'm not with you at all. Because I don't think that the rich guy stole from the poor guy. In fact rich people don't get rich by stealing from poor people because it turns out poor people don't have money.
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Old 11-13-2017, 11:13 AM   #17
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Not surprised this thread delved into anecdotes.

I'll respond more later.
And that's funny how?
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Old 11-13-2017, 11:26 AM   #18
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How would you feel about a system that offers both public and private. In Austria (with my admittedly limited knowledge) everyone gets universal health care for "free" (paid for through taxes paid by everyone), while people with means can still purchase private insurance for better/faster/etc care if they want.

I think one of the main benefits under Obamacare is that EVERYONE* pays. Which should be required, unless hospitals can stop treating people without insurance. Before ACA and even now people without insurance still get treatment. Who pays for it? Anyone that has insurance. Hospitals and insurance companies aren't in the business of losing money. If 3 out of 10 people treated don't have insurance, the 7 people pay for the treatment of 10 people.

*I know a lot of people get free health care. But if people get regular access to doctors they won't wait until they don't have a choice. Example: someone getting a cut treated, cleaned, and a few stitches vs gangrene and amputation. It provides a cheaper option to society. Unless we make the decision that letting people without cash/insurance remain untreated is an option, I'm for the cheapest way to treat these people.
Here's a good excerpt of the different health care systems worldwide.

Quote:
The Beveridge Model

Named after William Beveridge, the daring social reformer who designed Britain’s National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.

Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.

Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world’s purest example of total government control.

The Bismarck Model

Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system — the insurers are called “sickness funds” — usually financed jointly by employers and employees through payroll deduction.

Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don’t make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model — Germany has about 240 different funds — tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.

The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

The National Health Insurance Model

This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there’s no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.

The single payer tends to have considerable market power to negotiate for lower prices; Canada’s system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.

The Out-of-Pocket Model

Only the developed, industrialized countries — perhaps 40 of the world’s 200 countries — have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.

In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease.

In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat’s milk or child care or whatever else they may have to give. If they have nothing, they don’t get medical care.

These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we’re Britain or Cuba. For Americans over the age of 65 on Medicare, we’re Canada. For working Americans who get insurance on the job, we’re Germany.

For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you’re sick enough to be admitted to the emergency ward at the public hospital.

The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it’s fairer and cheaper, too.
http://www.pnhp.org/single_payer_res...sic_models.php
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If you want to make a statement that we all ought to get on board to fight poverty, I'm with you. If you want to say that we ought to fight income inequality I'm not with you at all. Because I don't think that the rich guy stole from the poor guy. In fact rich people don't get rich by stealing from poor people because it turns out poor people don't have money.
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Old 11-13-2017, 11:38 AM   #19
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I have no delusions that private companies are altruistic, but what is baffling is that citizens of voting age like you actually believe government is.
I don't believe neither private companies nor government are altruistic.

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Originally Posted by Cabrio330 View Post
If a private company fails to serve it's customers, the customers have direct and immediate options.
Which is far truer in the abstract than in reality. May I remind you of the terms "pre-existing conditions" and "job-lock" to start.

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Tell me, when the government fails to serve its subjects, what options do they have?
Contact your Representatives/Senators. Vote differently. Campaign for a different policies/candidates. Run for office yourself.

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And when you give your predictable and insufficient answer, remember who the two major party presidential candidates were last year.
One was capable, experienced and even-tempered, (too?) well versed on policy. The other was a bloviating, bullying narcissist who had no idea what he was getting into. The latter became president despite the significant majority of voters (3 million) clearly preferring the former. Perhaps your disdain for our representative democratic government does have some substance after all.
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Old 11-13-2017, 11:48 AM   #20
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National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.
Sounds a lot like our pre-ACA insurance companies who effectively rationed coverage and services in a wide range of ways (pre-existing conditions, raising rates, yearly/life-time limits, restrictions to in-plan services and physicians (that can result in wait times), denials of coverage, etc., etc...).
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