Cthulhu D

Japan benefits from extremely high population densities - as does Singapore for example. The more you can centralise things, the easier it is to cut costs. Singapore also screws poor people. Japanese people have very low rates of smoking and eat exceptionally healthy diets. By comparison, the US, UK, Australia and the Dutch are about as fat as each other. It's not a hugely helpful comparison so I don't go there. With Australia, we pay roughly $300 dollars more per person per year (~10%) on a PPP basis. The numbers are slightly distorted because the most recent UK numbers are more up to date than the Australian numbers and healthcare costs go up in real terms year on year - more in Australia than the UK because the UK has better cost containment measures, so it's probably a bit more than that. When we look at what we get for those dollars, the UK also has better coverage than the Australian system (because dentistry is partly included in the NHS), and we score worse on every dimension (quality of care, patient satisfaction etc) according to the WHO except being 'patient centric', and having better population health outcomes, though those outcomes are probably nothing to do with the healthcare system. That's the US health insurance industry, yup. One of the biggest problems with it - you guys have more administrative costs (both in raw terms and as a proportion of spend!) due to proliferation of administrative overhead in the 'efficent' private sector. The UK public sector healthcare system has a much better ratio of tail (administrative staff) to teeth (carers) than the US! If that's what you want, a single payer 'no cost' to patient approach where the doctor doesn't have to consider your insurance or who is paying and can just jump in with both boots is probably the most effective. I appreciate this may come as a surprise, but in the socialist state of Australia I can do all those things you can too, including choosing my own GP and specialists (a right I have exercised!). Just it costs 50% less than what you get, and we rate higher on 'quality of care' than the US according to the WHO. Hope that gives some perspective.

So you're literally okay with setting $650 billion dollars a year on fire to create the freedom to choose from a range of inferior products? I'll make an analogy You are hungry. You can either have a good quality apple that I select for 10 cents, or pay $10 and pick your own apple from a range of poor quality apples. How can the utility of the choice possibly outweigh the utility of the cost saving, especially given that you get a worse apple regardless of the freedom to choose! Really if choice mattered, why is the US (which has the most choice) so dissastified with its own health system? I'll give you a hint, its because real people as opposed to randian superheros find the 'here's our best treatment and the government is gonna cover the tab for you' message way more comforting than 'you can select from a range of medical professionals and treatment options that may or may not be covered by insurance, and you can only find out after treatment. Also we wan that copay in advance'

Is it? Why is choice important? Surely what we're shooting for in a healthcare system is these three things 1) Health outcomes (the most important bit) 2) Patient satisfaction 3) Lowest cost (Cost can be considered in public/government and private/individual costs) And when designing a system you want to have some sort of balance between the three. Now that we've all accepted that government intervention is required to correct a market failure, then the only question is what is the best model for that intervention. The question has been answered and someone has stepped up. Depending on how much you want to pay, and if you want to outsource operation of the actual delivery of healthcare, the four archtypical models are of: A) France (Expensive/Best, though still 2/3rds the cost of the what the US pays). Government provides a (high) base level of service to everyone, you may purchase supplemental insurance via your employer. B) Canada (Outsourced operation, somewhat expensive than the UK for the same quality of service). Government provides a base level of service, additional care may be purchased outside of the state system. System is operated by private providers. C) The UK (Cheapest, same quality of care as the other options, lower patient satisfaction than France). Government provides a base level of service, additional care may be purchased outside of the state system. System is operated by public providers. D) The US, with a free market purchasing model, outsourced provision and multiple payers. It's very expensive - over 3 times as expensive per capita than the UK system, delivers the lowest patient satisfaction and doesn't exceed the UK on healthcare outcomes. Finland, best overall model, may not scale as the population is smaller, so I've gone with larger arch-typical examples. Clearly, the US has the worst system currently. You're paying a huge amount more in private costs, and almost the same in public costs (OK a bit lower, but it's like $100 dollars per person per year, ask everyone in the US if they'd pay $100 dollar a year to go on medicare from birth!) and not getting scoring higher in any of our assessment categories (outcomes and satisfaction) over the UK, so we can safely discard the free market approach upfront - it just doesn't work. The UK literally delivers Medicare type coverage to it's entire population with pretty much what the US spends on over 65s and medicaid recipients due to the economies of scale and positive externalities of preventative and primary care that can be captured by the single provider. The US is paying all this extra cash to deliver the same outcomes and worst patient satisfaction. It truly is a joke - the direct cost savings from getting it to the NHS are something in excess of $650 billion that could be redirected to productive investments, thus spurring the US economy. Other 'free market' models like Australia have the same problems, but we have more of a single payer system so costs are controlled more - but we still pay more for no better patient satisfaction or healthcare outcomes, so it is a bum deal. Once we've ditched the free market model as non functional, we can hone in on how exactly the government should control healthcare - should it run public institutions, or should it outsource it? Outsourced care is more expensive, because it appears their are minimal competitive advantages to be gained, the publicly owned/operated models (UK, Finnland, etc) are cheaper than the privately owned models (canada, Australia) on a per capita basis. It doesn't seem to drive increased patient satisfaction either, so we're spending more money but not scoring better on our outcomes. OK so far we can see that we want a publically operated single pay model - this is the most efficent. The next question is, what's the tradeoff between patient satisfaction and price? Well, it appears from the French vs UK experience (and for example, the Estonians excellent but centralised system vs anyone else) that what drives patient satisfaction is decentralised service delivery and integrated ancillary services that don't have demonstrable clinical benefits, for example the french offer stuff like accupuncture and massage services. However, these things all cost dollars - the concentration of service delivery enables improved economies of scale, but there is a clear tradeoff - the more you provide localised services, the more $$$$ you are on the hook for. So at the end of the day, you're going with a single payer, publically operated system, and you can then select where you sit on the 'cost' slider by adjusting the 'centralisation' slider. If you want the 'assurance' of the private sector running things, you can click that box and add 20% to the cost to manage their profit margins and the increased cost of capital for private institutions vs the government. It's a solved problem really, the problem is you guys keep wanting to expand the free marketness, when that has been shown time and time again to increase healthcare costs for zero benefits. Single payer is what works, I honestly do not understand why it's even slightly controversial.

That assumes you can reliably ID the accident victim, and access his living will or whatever prior to commencing treatment. The reality is when you have an emergency situation you cannot wait around, you have to dive in and you have no practical way of IDing him prior to commencing treatment. The problems are insurmountable - even if you'd let your insurance company tattoo you with exactly what treatments you are eligible for, the tattoo may become disfigured during the accident, and what happens when your care plan is revised next year - do you get a new tattoo? I imagine after 10 years you might be running out of space to tattoo you. If the decisions are outsourced to a third party, do you really want the paramedics trying to get someone on the phone before they commence immediate life saving treatment when you have 30 seconds to live when they make the call. What happens if after 45 seconds your care is authorised? If you'd prefer being chipped with some sort of ID (this is a non starter, but whatever), what happens if the chip is damaged? Or they have an equipment malfunction? Do they just not treat you? This is a widely considered problem (it even has a name in the medical profession but I cannot remember what it is - the naked patient problem?) and there are no good solutions, that is why there is a hard legislative requirement that emergency treatment be given by medical professionals if you need it, regardless of your perceived capacity to pay.

The conditions for a free market are well known. By definition it includes the ability to make rational decisions to select between a range of competing products (you know.. some sort of market). How do you make rational decisions when you are unconscious? Please tell me how you propose to resolve this critical issue in free market delivery of healthcare - patient decision making while the patient is unconscious. I look forward to it. Then we can talk about how head injuries impair rational decision making! Why? It's dumb. Once you've accepted that government intervention is a necessity, we can discuss what the most effective form of intervention is. I submit it's the type of intervention that results in the highest quality of care delivered with the least number of public dollars. How do you do that? Well, you implement the NHS, which delivers coverage to the entirety of the UK population for roughly the same amount per capita the US pays for Medicare and Medicaid. All the single payer systems have the lowest costs, lowest cost born by the public sector and thus the taxpayer. The hybrid solutions - like Australia's Medicare and the US solution just result in additional public AND private expense and no benefits at all.

Part of it depends how you measure: You can do population health with control for socio economic status, you can do patient satisfaction, and you can do quality of care. Looking at the UK vs the US. Current evidence suggests that the quality of care in the NHS is of approximately equal quality to the care delivered by the US system (to people who present at GPs etc and have full medical records - so this is giving the US a 'free pass' on the uninsured who present at ERs). There are varying strengths and weaknesses, the NHS is vastly superior at managing chronic illnesses, US cancer treatment tends to be better, both are amazingly awful at treating alcoholism, but overall the quality is about the same. On patient satisfaction, of those that are admitted to hospital or have long term prescriptions the NHS vastly out scores the US (but, but, bizarrely, not with those who just go to the GP and don't have significant medication, though, imho, asking people who don't go to hospital how statisfied with the hospital system they are is dumb, I don't work for the WHO). Population health is less clear cut, and trying to draw conclusions there is difficult. They seem to indicate that the NHS is better, but honestly this is hard to tell. Of course, while these measures are close (except patient satisfaction where the UK is leaps and bounds ahead), the UK total healthcare spending per capita (including private health insurance and spending) is like a third of US healthcare spending. Which to me suggests the US is getting a bum deal. Was a recent new item about a guy who passed out in his bathroom. Ambulance took him to some hospital that didn't recognize his insurance. He woke up several days later and the hospital presented him with a bill for $150,000. "Dunces" and "ignoramuses" are pejorative. Ignorance, at least, is fixable. Stupid isn't, but that doesn't mean we should hold the stupid in contempt — they can't help being stupid. And 'there can be no free market in health care' does not lead to the conclusion that the President ought to run the health care system — he's already demonstrated he's not competent to do so. Amusingly this is something Adam Smith got wrong - he thought that could never happened because of basic human decency hahaha. Anyway, this is a market failure and the only solution in the case of market failures is government intervention. It has been shown time and time again that in the case of healthcare the most efficient and effective form is a single payer system ala the French, Canada or the NHS. Pick how much you want to pay and go with that.

I love that he cannot see that, infact, air to stop you from dying and an emergency blood transfusion to stop you from dying are, infact, exactly the same. People who think there is a free market for healthcare are, in a very real sense, idiots. We've known since Adam Smith that a free market requires several things: A) Fully informed consumers B) Who are able to make a rational choice C) Have a number of options available that are in perfect competition. Now, let me cite a real healthcare example. You are hit by a car and knocked unconscious in the accident. How are you a) Informed about anything, because you are unconscious b) able to make a rational choice from amongst the treatment options available to you because you are unconscious. This fundamental healthcare scenario fails Adam Smith's precepts. There is no free market for healthcare, nor can there ever be. Should people wait for you to come around before calling an ambulance? What if you die in the mean time? What about if you are literally dying in an ER, and will not survive being moved to another hospital. The provider realises this, and suddenly the cost of his services is 'All of your possessions'. How does that meet point C? People who do not understand this inability for there ever to be a free market for healthcare under any circumstances are quite literally one of two types of idiots - dunces (those incapable of learning) or ignoramuses (those who are uneducated or ignorant).

Yeah, that's what happening - insurers would normally just make changes to protect their margins, but the legacy provisions force them to cancel plans where they would otherwise crank up the rates or descope coverage. But this is purely the corporations fault. It's honestly baffling that the fact that people are surprised by the fact that corporations, which are by design sociopathic, and reward sociopaths disproportionately screw over their customers. Corporations are fine if the incentives are aligned with the interests of the public and consumers, but the problem with the health insurance industry in the US is that the health insurance corporations are rewarded for how much service they refuse to give you.

Your current plan meets ACA standards regardless of what your plan is, because it is protected by the grandfather clauses. That is the entire point. This is 100% about the insurance company screwing you under the pretext of regulation. You bolded point 2, but point 3 is the incorrect, unclear or misleading statement. The only standard is that they have health insurance of any form whatsoever. The only other requirement is that the health insurance company wishes to keep offering the same plan. Which they are allowed to, unfettered by government regulation or anything else. The misunderstanding, incorrect or misleanding component is what Zelandakh is responding to No policies at all are being invalidated. Not one.

Rik is wrong - specifically point three is wrong. ANY PLAN AT ALL that people were enrolled into prior to May 2010 does not need to meet the requirements of the Act and can be continued if the insurance company does not modify it 'significantly' where significant changes is basically deleting coverage areas and increasing fees, copays or other charges above the medical inflation index. It's worth noting that less than 20% of Americans are able to correctly answer yes/no questions about the actual provisions of the act (Standford conducted polling where 0% of participants were able to answer the questions correctly(!), and only 14% could get more than half the questions right) , so I strongly recommend checking primary sources rather than believing some guys understanding, because there are very good odds they are wrong. You shouldn't believe me either, but I will point you at the relevant section of the legislation: 29 CFR 2590.715-1251 - Preservation of right to maintain existing coverage. It's fascinating how misinformed Americans are about the provisions actually - and they are somewhere between 5 (republicans) and 15 (independent voters) times more likely to support the law when someone tells them what the actual provisions are.

100% of cancellations are from cause one, as every plan that existed as of 2010 has an exemption unless it is changed outside of indexation.

Using the dark magic of looking at the table of contents.. "29 CFR 2590.715-1251 - Preservation of right to maintain existing coverage" is where you want to go. It notes the specific conditions under which you can retain a plan, and the circumstances under which it would be ruled to be significantly changed (e.g. if the price increases by more than medical inflation, if copays increase by more than medical inflation etc). It's farcical to expect this to be more simply written, regulation is complex and needs similar treatment.

Corporations are things, not people, and yet can engage in deceptive practices. Corporate entities are accumulations of capital. You are being duped by corporations, and thus capital. Indeed, without capital, the US medical insurance business could not exist in it's current form, and would have to be restructured into some sort of cooperative or government based system. So in this instance it is very specifically accumulations of capital that are hoodwinking you. It's also amusing to me because it helps make it very clear as an outside observer that you, the working man (or, perhaps, labour), are being bent over a barrel by big business (or, perhaps, the capitalists) and are not even aware of how it's going down! So yes, I think it's very relevant to note that capital is doing it to you in this specific case. How do you tolerate being lied to like this for what are blatantly the profit motives of the companies involved at the expense of you the working consumer? Then blame someone else!

This is a lie. The law says that legacy plans can be preserved as-is even if they do not meet the requirements. The choice to cancel the plans is the insurance companies, they are not being forced to do so by legislation. What's happening is that the insurance companies are rolling out significant changes, losing the legacy protection (because it counts as a new plan and thus must meet the minimum standards), and are blaming everything on the government, and you, the people, are being duped by capital and concluding it's Obama's fault. If they just kept the existing plan as is and put the price up, every existing plan could be kept.

People don't seem to think opening 1H is good because of the horribleness of the suit, which I agree with. However, alternative scenario. If you were playing 5 card majors and 1D = 4+ diamonds, unbalanced hand, and the auction 1D-1S-1NT was an unbalanced hand with 4+ diamonds and 4 hearts, would anyone open the first hand 1D?

I don't, my team is one of the weakest in our club competitions. As a result I like relatively flat boards with the opportunity to stick in a systematic and aggressive overcall because that is where we do the best. Really, any hands where we have a clear systemic bid and the field doesn't are the most likely opportunities to get a good result, so weak hands with both majors, balanced 14 counts that we open 1NT etc.

The best moderated forum I'm part of is the somethingawful.com forums where it costs $10 bucks to register and the moderators put the hammer down for shitty, low content posts in serious threads. Honestly, just probate or ban all the offenders (e.g. 32519's terrible posting and the guys slamming him). People will eventually get the message.

What are you doing with 5/5s? Just bid them naturally? I'm hestitant to limit the amount you can make the two suited bit, having played these as 5/4 or better for a while now they are just so good when they come up that I want to maximise the frequency.

Any system that systematically opens balanced 8 counts with an aggressive preempting style has an inbuilt psychic control in that aggressive moves opposite a psyche in 3rd are extremely unlikely, hands that would make aggressive pre-emptive raises are overwhelmingly likely to have preempted to begin with (perhaps on an assumed fit basis). But drury is clearly a psychic control and is permitted, so who knows.

Why do you triple post so much? Can you just use the edit button? It's on the bottom right of your post and allows you to edit a post to add thoughts you had missed previously into the post by editing it. It's just poor form to triple post.

Kungsteen's scripting language makes it x1000000 times easier to write an FD card. I literally cut+paste'd our system notes in, fixed a few things and it was good to go. Addmittedly, that's because our notes were in excel to start with which made it very easy.

I have a system inference that unless partner is very weak he doesn't have 5 spades. Given that they almost certainly have a spade fit I feel the 1S psyche is more likely to bury their fit than the preempt or psyching 1NT.

Doesn't that show Bridge at Rochester is stronger?

Yeah, for sure - this is so easy to write compared to FD which is impossible to manage as a human being. I can quite quickly author openings + responses and that's about 85% of your disclosure burden right there.

Both. The problem is bridge laws prevent you from actually discussing this with your partner, but safe in the knowledge that he doesn't read these forums: There are clearly times when it's better to psyche and indeed you should probably psyche (like when you have nothing third in green vs red playing a system with light openings), and psyching sometimes gives you an advantage if opponents are concerned you are a 'psycher' This is something I do badly, but say I'm playing a ridiculous system like tangerine club where we open 8-9 counts in 1st/2nd, and it it is passed around to me third in NV vs V, I'm pretty sure I should bid 1S with S: x H: xxx D: xxx C: Txxxxx