The Real Problems with American Healthcare

[TheHas]

Every other OECD country is different than ours for one. None of them take in as many immigrants, none of them are as large by population, none of them have as much diversity as the USA does.

So.…. we're blaming diversity and immigrants for America's problems?

You make a claim "there is virtually no evidence that the health system in the US would be better if there was less Government involvement." which is a quite ironic statement considering you are making a claim of no evidence while providing no evidence to support this position.

You're just proving my point. Like I said, there are zero developed countries that have anything like the US health system of private companies running the show on healthcare (and you're suggesting we need more of that). The US is an outlier. My proof that more Government involvement would be better for healthcare is literally EVERY other OECD nation. Yours for less is... what exactly? A feeling that the US health system is bad, and it must be the Government's fault? Some general ideological positions that you're trying to apply to the health system?

If you have any health literature to support your opinion, such as OECD data, studies, anything at all that shows why less Government involvement in the US system would be a net benefit, I'd love to read it.

The fact is there is plenty of evidence, just look at every government program ever. They always expand beyond their mandate, inflate prices because the customer doesn't care and its just "free money" to them that the public foots the bill for, then the prices get more and more bloated as the middle men like insurance agencies, banks, and lawyers start working their way in.

I'm not sure what OECD health system in the world you are applying this too. Also the US taxpayer is already spending the same amount as other countries. The taxes for healthcare are the same as other countries, but then also get smacked with high private fees.

And the 'middle men' you mention of insurance agencies, banks, and lawyers is the problem I agree. You cut them out of the equation or reduce their role substantially - like other countries already do that have a cheaper and better system.

The marketplace is cutthroat. That means if one organization is full of worms, people can go to the more efficient worm free version because it provides better service at a lower cost. Unfortunately with government regulations a system of protectionism and rent seeking is set up for these companies which literally prevents competition and protects their monopolistic profiteering stranglehold. Don't make the mistake of thinking governments and corporations are different entities. While technically they are, largely they exist to serve each other in practice. This is why they need to be kept separate at all cost. I am not against regulation necessarily depending on how it is constructed, but this whole concept of government subsidy is a failure from the word go.

This thinking is why US gets nowhere on healthcare. You're taking an issue that has common sense answers (based on the experience of, well, the rest of the world) and put some idealistic free market competition dream over the top of it because it feels right deep down inside. Again, no other developed country lets the 'free market' determine if you die from a health issue or if it will make you broke.

Just to bring it down to a practical level of how this free market consumer choice health system actually works in the US -

Pretend you're unexpectedly seriously sick and need surgery. You need to be operated on within 24 hours or your chance of dying within a couple of weeks will go from 10% to 40%.  

In the US after your overpriced insurance (if you have it), your doctor still says you'll need to pay $10k in additional fees, but it could go up to $30k depending on whatever reasons they have.  

Your doctor is the expert, and you have a life or death health emergency. You're stressed and you think you can only just pay the bill.

It's at this point you want the uninformed potentially dying patient (or 'consumer') to start shopping around to see if they can find a cheaper/better life saving procedure at another clinic? Its at this point you want the person to check that they can't get the $30k procedure for $27k a couple cities away? Its at this point you want the person to question their doctor (who has your life in their hands) whether that extra $1k payment on the bill isn't over the top?

This isn't buying a TV trying to get the best deal in the free market. You just want to not die. But no, the 'market is cutthroat' and we can trust the market, doctors and big pharma to be reasonable players in a fair market that acts in your interest? please. Social policy issues should not be bystanders to free markets.

Just for a reference point - you know what happens in my country in the above example? I get treated and pay nothing except my taxes for healthcare (which are the same as what taxes the US pays on healthcare).

Finally, most important of all, all of these other dithering excuses aside, IT IS NOT THE US GOVERNMENTS MANDATE to provide you with anything other than what is explicitly mandated in the constitution.

Here you are giving up. You are essentially saying that even if the health system would be better served by more Government involvement, it isn't directly permitted in the Constitution, so meh better not go there. I don't think you should see it like that as I'm pretty sure the founding fathers didn't have a concept of how the world would be today, and weren't thinking about the 21st century health care needs of the country. I would also find it unlikely they would support the current control of private companies over citizens.

You raised a few other points, which were mainly anti-government or establishment. I'm not trying to diminish those views and how they operate in other non-health (or social policy) fields, but for simplicity and to keep the points about healthcare, I'm looking at those as ideology pushing out evidence. Every other country does better than the US on healthcare. If the US wants to take the issue seriously, the bar is so low that they have plenty of nations to turn to for examples of what could work in the US.

[1713517357]

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[1713517357]

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[r1s2g3]

Ecuador anyone? https://internationalliving.com/countries/ecuador/health/

It is true for most of developing nation (not only equador). The ultrasound procedure that cost $900 in USA just cost less than $20 in developing nations. Even if you are covered by insurance and paying only 20% of cost , you still pay $180 (9 times more).

I understand there is difference in cost of living but $900 vs $20 does not justify that difference.

[o_e_l_e_o]

The ultrasound procedure that cost $900 in USA just cost less than $20 in developing nations.

And it costs $0 in most other developed countries.*

*Before anyone starts with the usual nonsense, yes I know it is paid for through general taxation, but we have already established that citizens of other developed nations pay less in taxes towards healthcare than US citizens do, and don't have to pay out of pocket expenses and insurance premiums on top of that.

[BitBustah]

American government would rather spend $700 billion on the military.............

[TECSHARE]

Every other OECD country is different than ours for one. None of them take in as many immigrants, none of them are as large by population, none of them have as much diversity as the USA does.

So.…. we're blaming diversity and immigrants for America's problems?

So we are pretending a huge load of people not paying into a system that subsidizes their healthcare doesn't have any detrimental effects? While we are at it lets pretend that conflicts arising from differences in culture do not directly result in issues such as more violence. Cultural homogeneity is known to have a stabilizing effect in many areas. The US has very little of this, Europe has quite a bit. Additionally you just totally ignored the point of the issue of scale. Not every system is scalable and there are diminishing returns when certain systems are scaled up, leaving you with less effective or ineffective results.

You make a claim "there is virtually no evidence that the health system in the US would be better if there was less Government involvement." which is a quite ironic statement considering you are making a claim of no evidence while providing no evidence to support this position.

You're just proving my point. Like I said, there are zero developed countries that have anything like the US health system of private companies running the show on healthcare (and you're suggesting we need more of that). The US is an outlier. My proof that more Government involvement would be better for healthcare is literally EVERY other OECD nation. Yours for less is... what exactly? A feeling that the US health system is bad, and it must be the Government's fault? Some general ideological positions that you're trying to apply to the health system?

If you have any health literature to support your opinion, such as OECD data, studies, anything at all that shows why less Government involvement in the US system would be a net benefit, I'd love to read it.

There are also zero nations that are exactly like the USA, the differences previously mentioned and well documented. You are comparing dissimilar countries and claiming the same system will work. This is proof of nothing. I am not suggesting we need more private industry, but less government involvement, and definitely not subsidies. Regulations need to be carefully considered, and nothing I have seen presented does this. The US healthcare system operates as a monopoly. Monopolies can not exist without them being protected by government regulation, furthermore they are illegal but only tolerated as they are perceived as a public good. Everything I have said has basis in logic, not "feelings" or "general ideological positions". I will leave that up to you making arguments from a moral position rather than a functional and logistic one.

The fact is there is plenty of evidence, just look at every government program ever. They always expand beyond their mandate, inflate prices because the customer doesn't care and its just "free money" to them that the public foots the bill for, then the prices get more and more bloated as the middle men like insurance agencies, banks, and lawyers start working their way in.

I'm not sure what OECD health system in the world you are applying this too. Also the US taxpayer is already spending the same amount as other countries. The taxes for healthcare are the same as other countries, but then also get smacked with high private fees.

And the 'middle men' you mention of insurance agencies, banks, and lawyers is the problem I agree. You cut them out of the equation or reduce their role substantially - like other countries already do that have a cheaper and better system.

All of them. They are all in varying stages of this process. Most importantly I am referring to the existing US system, which I had previously explained has already made the population the victim of this government mandate creep into entitlements and creating rent seeking systems as well as creating and protecting monopolies choosing winners and losers.

The marketplace is cutthroat. That means if one organization is full of worms, people can go to the more efficient worm free version because it provides better service at a lower cost. Unfortunately with government regulations a system of protectionism and rent seeking is set up for these companies which literally prevents competition and protects their monopolistic profiteering stranglehold. Don't make the mistake of thinking governments and corporations are different entities. While technically they are, largely they exist to serve each other in practice. This is why they need to be kept separate at all cost. I am not against regulation necessarily depending on how it is constructed, but this whole concept of government subsidy is a failure from the word go.

This thinking is why US gets nowhere on healthcare. You're taking an issue that has common sense answers (based on the experience of, well, the rest of the world) and put some idealistic free market competition dream over the top of it because it feels right deep down inside. Again, no other developed country lets the 'free market' determine if you die from a health issue or if it will make you broke.

Just to bring it down to a practical level of how this free market consumer choice health system actually works in the US -

Pretend you're unexpectedly seriously sick and need surgery. You need to be operated on within 24 hours or your chance of dying within a couple of weeks will go from 10% to 40%.  

In the US after your overpriced insurance (if you have it), your doctor still says you'll need to pay $10k in additional fees, but it could go up to $30k depending on whatever reasons they have.  

Your doctor is the expert, and you have a life or death health emergency. You're stressed and you think you can only just pay the bill.

It's at this point you want the uninformed potentially dying patient (or 'consumer') to start shopping around to see if they can find a cheaper/better life saving procedure at another clinic? Its at this point you want the person to check that they can't get the $30k procedure for $27k a couple cities away? Its at this point you want the person to question their doctor (who has your life in their hands) whether that extra $1k payment on the bill isn't over the top?

This isn't buying a TV trying to get the best deal in the free market. You just want to not die. But no, the 'market is cutthroat' and we can trust the market, doctors and big pharma to be reasonable players in a fair market that acts in your interest? please. Social policy issues should not be bystanders to free markets.

Just for a reference point - you know what happens in my country in the above example? I get treated and pay nothing except my taxes for healthcare (which are the same as what taxes the US pays on healthcare).

This is not a simple issue that "common sense" flippant "solutions" will solve, if it was that simple the issue wouldn't exist currently. Lots of really arrogant people like to think the answers are just so simple but the rest of the world is just too dumb to get it. I submit that the only thing common about your sense is that it is average.

Your little theoretical situation is meaningless for many reasons, primarily as a result of the fact all you are looking at is the individual and not the operation of the system as a whole. Again this comes from your position of arguing from a moral standpoint rather than a logistically functional one. What if they can get charitable assistance to cover the cost? What if they can get a payment plan? What if the person who is ill, is ill as a result of poor eating habits and drug abuse? Why should everyone pay for their bad choices, and who decides who gets that help?

Middlemen aside, the actual costs for these goods and services simply don't vaporize, they are passed on via taxes, or as is common in most nations with universal healthcare, increased waiting times, shortages of doctors and medicines, as well as other issues. Every choice has a cost, and you are only looking at the part you like while ignoring the parts you don't because you are operating from a basis of some undefined moral mandate.

Finally, most important of all, all of these other dithering excuses aside, IT IS NOT THE US GOVERNMENTS MANDATE to provide you with anything other than what is explicitly mandated in the constitution.

Here you are giving up. You are essentially saying that even if the health system would be better served by more Government involvement, it isn't directly permitted in the Constitution, so meh better not go there. I don't think you should see it like that as I'm pretty sure the founding fathers didn't have a concept of how the world would be today, and weren't thinking about the 21st century health care needs of the country. I would also find it unlikely they would support the current control of private companies over citizens.

You raised a few other points, which were mainly anti-government or establishment. I'm not trying to diminish those views and how they operate in other non-health (or social policy) fields, but for simplicity and to keep the points about healthcare, I'm looking at those as ideology pushing out evidence. Every other country does better than the US on healthcare. If the US wants to take the issue seriously, the bar is so low that they have plenty of nations to turn to for examples of what could work in the US.

I am sure your marginalization tactics work quite well on most people, but unfortunately you are the droid I am looking for no matter how much you tell me you are not. Don't speak for me please, I can do that for myself thanks. There is a reason the USA has grown so much and become so powerful, and a big part of it is our system of government. Being familiar with how and why it works, I understand that its writers were very intelligent men that realized government is like a liquid that will fill any crack or opening you allow it to enter in to, and then over time it will enter every facet of people's lives until the people become the servant of government, and not the government the servant of the people.

Again, you ignored my very logic based point that by creating dependence on the government for such a vital service, you are creating an imbalance between government and its people. With this powerful leverage, the people become the servant rather than the government serving the people. This alone is sufficient reason to limit the mandate of the government, not out of some lofty ideology, but as a knowledgeable human being that understands ANY CENTRALIZED SYSTEM can be subverted. Just plugging your ears and yelling "LALALALALA ITS MORAL THING TO DO LALALALALA" doesn't make this fact go away.

[o_e_l_e_o]

or as is common in most nations with universal healthcare, increased waiting times, shortages of doctors and medicines, as well as other issues.

Except none of that is true.

The US is decidedly middle-of-the-pack in terms of waiting times:
   

The US has a lower number of doctors per capita than the UK, France, Germany, Spain, Netherlands, Belgium, Italy, Switzerland, Canada, Australia, New Zealand, Russia, the OECD average, the EU average, the NATO average, and the G7 average: https://www.who.int/gho/health_workforce/physicians_density/en/

[Spendulus]

....
The US has a lower number of doctors ....

I am seriously unimpressed with your one sided use of biased propaganda statistics.

They seem to make the point opposite to what you may think they are making.

[o_e_l_e_o]

I am seriously unimpressed with your one sided use of biased propaganda statistics.

Feel free to present some actual data of your own then. If they are "biased propaganda" as you state, then refuting them should be an easy task.

[Spendulus]

I am seriously unimpressed with your one sided use of biased propaganda statistics.

Feel free to present some actual data of your own to refute them.

I have done so in one case, which you conveniently ignored. But that's okay because you would have read up on the criticism of the 4% number, clipped and pasted that, and then you would have expected me to argue similarly on the 65% number. Where you went wrong there was to assume your audience would believe a number by Senator Pocahantas....

Your responses really resemble the canned "ready to clip and paste"  responses by climate alarmists used commonly on the web. That's why they are not convincing. To me they look like stuff made up by big Pharma and big Med for yet another (or the last, given the age of the citations) takeover of income streams in the government sector.

Basically you are ignoring facts to the contrary while pushing a polemic. That's more in line with propaganda methods than any effort to actually figure a problem out.

And by the way, I've been in numerous countries with "socialized medicine" so I kind of know first hand home much of this is true and not true.

Let's take a different look at this. Instead of exporting your favorite Euro-progressive-half-commie paradise's health care to the USA, let's export our Washington DC lobbyist industry to them, and see how they do with their legislation.

[o_e_l_e_o]

I have done so in one case, which you conveniently ignored.

Except I didn't ignore it. I responded directly to it.

But that's okay because you would have read up on the criticism of the 4% number, clipped and pasted that

Go and find my source then if you think I copy and pasted (hint: I didn't. I read and critiqued the paper, like anyone who is actually interested in the facts.)

and then you would have expected me to argue similarly on the 65% number.

Well, yes. To disagree with the facts I have presented, you must have, at a minimum, read them and critiqued them. Otherwise you are simply writing them off based on your biases and preconceived notions.

Your responses really resemble the canned "ready to clip and paste"  responses by climate alarmists used commonly on the web.

What's this got to do with anything?

To me they look like stuff made up by big Pharma and big Med

If they are so clearly made up, then they should be easy for you to refute.

Basically you are ignoring facts to the contrary while pushing a polemic.

Again, please present your facts which refute mine.

And by the way, I've been in numerous countries with "socialized medicine" so I kind of know first hand home much of this is true and not true.

Personal experience and anecdotes are not on an equivalent level of evidence as methodologically sound studies.

You can continue to ignore the facts I have presented and talk about "Big Pharma" if you like - I will not be responding to these non-arguments any further. If you have any evidence to support your points, I'd be more than happy to discuss it.

[Quickseller]

The ultrasound procedure that cost $900 in USA just cost less than $20 in developing nations.

And it costs $0 in most other developed countries.*

*Before anyone starts with the usual nonsense, yes I know it is paid for through general taxation, but we have already established that citizens of other developed nations pay less in taxes towards healthcare than US citizens do, and don't have to pay out of pocket expenses and insurance premiums on top of that.

The procedure costs the same everywhere, it is just a matter of who pays for it.

The cost of an ultrasound can be broken down into 5 parts:
1 - The cost of the machine - For example, if an ultrasound machine costs $5,000, will last one year, has no downtime or maintenance costs, and can (and will) be used 10 times per day 365 days a year, the cost of the machine for one use is ~$1.37 (I have no idea what the specifics are, but the actual inputs can be put into this formula: (purchase price + maintenance costs over useful life) / # of times machine can be used)
2 - Cost of any disposable (single use) materials used to perform the procedure, such as the jelly, the cloth on the examination table, etc.
3 - Cost of the Nurse's or Doctor's, time, based on what the market is willing to pay.
4 - Administrative costs of the doctor's office, such as rent for the office, the salary of someone who handles billing/scheduling, the cost of malpractice insurance
5 - Profit for the doctor's office (or the entity who is performing the procedure).

If the machine is being purchased for $5,000, but the cost (including a reasonable profit to the manufacturer) is $50,000, then the manufacturer is paying a portion of the cost. If the free market value of a nurse's time is $50/hour, after accounting for benefits, breaks, PTO, and employer paid taxes, but the nurse is only earning $20/hour (after account for all of the above), she is (effectively) paying a portion of the cost.

The ultrasound procedure example is probably paid for mostly by taxpayers as a whole, however the above points bring me to a better example....
Costs of Drugs:

In general, the cost to produce an individual dose of a drug is very low, and will generally represent a small fraction of the amount received by the drug maker (for a drug sold in the US) for an individual dose. Most of the amount received by the manufacturer is the manufacturer recouping the cost of Research & Development of the drug. In general, it costs a lot to develop a drug, and there are many drugs that fail during the development phase. If a drug maker does not believe the R&D cost of a drug can be recouped, then it will not invest money into developing the drug.

There might be a particular drug that costs $0.90 to manufacturer and ship that is made in a plant in Nashville, TN. This same plant may ship the drug to New York City where it is sold by a pharmacy for $20/dose (plus the costs/profits of the various middlemen), but the same drug is sold for $1/dose in Norway due to price controls imposed by the government. The drug company makes a small profit off the manufacturing for drugs sold in Norway, however it would not recoup its R&D costs if the drug was sold for $1/dose everywhere. If Norway were willing to pay a "market" price (non-government controlled), the drug company might be able to lower the dose price of the drug to say $19.96 -- this is only a small decrease, but Norway is also a single small country, and if many  countries with large populations allowed a market price to be used, the price at which the drug company is confident it will recoup its R&D costs could be a lot less than $20/dose.

The US is, in effect subsidizing the costs of drugs overseas.

Trump has proposed a 'fix' for the above problem by limiting how much a drug company can sell a drug for in the US based on how much the drug is sold for in other countries. My belief is the goal of this is to force drug companies to stop selling drugs at government controlled prices overseas, which will make other countries with socialized medicine to decide to either pay a market price for a drug or not have access to the drug at all.

Malpractice Insurance/associated costs:

Unrelated to the above, the cost of Malpractice Insurance is very high. It was disputed above that some doctors will perform unnecessary procedures because a third party says to do so. I do not think it is common for doctors to perform unnecessary procedures, however it is more common for doctors to perform what could be described as unnecessary tests in order to avoid a potential malpractice lawsuit. This not only drives up the total cost of having an ailment, but also drives up the costs of these tests because of increased demand.

Malpractice lawsuits (the ultimate driver of malpractice insurance) can often lead to expensive settlements in favor of the patient that arguably are excessive. This is in part because these lawsuits are expensive to defend against even if frivolous (or not meeting the "frivolous" threshold, but not a case that would end in favor of the patient if it went to trial). Tort reform would be a step in the right direction to lowering these costs. It would be a huge step forward in reducing these costs if laws were passed giving medical professionals "safe harbor" against malpractice lawsuits if they meet certain criteria in their standard of care.

[TECSHARE]

or as is common in most nations with universal healthcare, increased waiting times, shortages of doctors and medicines, as well as other issues.

Except none of that is true.

The US is decidedly middle-of-the-pack in terms of waiting times:
 

The US has a lower number of doctors per capita than the UK, France, Germany, Spain, Netherlands, Belgium, Italy, Switzerland, Canada, Australia, New Zealand, Russia, the OECD average, the EU average, the NATO average, and the G7 average: https://www.who.int/gho/health_workforce/physicians_density/en/

First of all those are all based on surveys, the lowest form of data to be had, a type that is exceptionally easy to manipulate. Second, these are all from 10 years ago before the hordes of millions of illegal migrants started crossing over in to Europe and to the US, which is clearly having an effect on supply and demand. Again, as I explained people keep saying we need to be more like these countries, and I argue that this was already attempted and failed, resulting in the current conditions. It is rather convenient then, as people who support these kinds of policies usually do, to blame "free market" and "capitalism" for the failed results of government subsidized rent seeking monopolies resulting from attempting these entitlement policies from the past while using that failure as an example of the policy's own virtues.

[Spendulus]

I have done so in one case, which you conveniently ignored.

Except I didn't ignore it. I responded directly to it.

But that's okay because you would have read up on the criticism of the 4% number, clipped and pasted that

Go and find my source then if you think I copy and pasted (hint: I didn't. I read and critiqued the paper, like anyone who is actually interested in the facts.)

and then you would have expected me to argue similarly on the 65% number.

Well, yes. To disagree with the facts I have presented, you must have, at a minimum, read them and critiqued them. Otherwise you are simply writing them off based on your biases and preconceived notions.

Your responses really resemble the canned "ready to clip and paste"  responses by climate alarmists used commonly on the web.

What's this got to do with anything?

To me they look like stuff made up by big Pharma and big Med

If they are so clearly made up, then they should be easy for you to refute.

Basically you are ignoring facts to the contrary while pushing a polemic.

Again, please present your facts which refute mine.

And by the way, I've been in numerous countries with "socialized medicine" so I kind of know first hand home much of this is true and not true.

Personal experience and anecdotes are not on an equivalent level of evidence as methodologically sound studies.

You can continue to ignore the facts I have presented and talk about "Big Pharma" if you like - I will not be responding to these non-arguments any further. If you have any evidence to support your points, I'd be more than happy to discuss it.

Perhaps step back a second and look at the matter? The "facts" may not be what you think they are and may not have the effect of refuting argumentation as you think they may?

Personal experience is highly relevant. It gives us a feel of the vast gap between a UN chartered paid for set of propaganda and the reality on the ground, doesn't it?  Or it can verify the high quality of such data and the care that it represents. I have worked in survey design and statistical methods, so we don't need to try to impress each other with such things. Neither do you need to hold up your surveys as golden, which they certainly are not.

Advancing the state of understanding of a large and complex matter is not going to be found in politically biased polemics.

[BADecker]

The real problem with American anti-healthcare is what's in front of the "healthcare" part... kinda out of sight.

[r1s2g3]

Does it conclude about high cost of malpractice insurance?

High cost of health insuarance.
High cost of Malpractice insurance.
High cost of auto insurance.
+ other insurances.

I think tagline should change to "In insurance,we trust"  or "The people,we neglect".

Anyways lot of facts are shared here but my question is what can be quickest and cheapest way to fix this system?

[TECSHARE]

https://ijr.com/economist-claims-doubling-income-taxes-wouldnt-fund-medicare-for-all/

[Spendulus]

Medicare for all can be funded with any amount of money.

It's very simple.

First, scrape off the total received funds those that are to be kept by various corrupt people and operations in Washington DC. For this, the more funds brought in, the better and bigger the parties are.

Then take the remaining funds and divide them up by the institutions and doctors providing service.

Yes, it's really that simple.

Whatever care you get is that fraction of available resources.

[yeosaga]

Medicare for all can be funded with any amount of money.

It's very simple.

First, scrape off the total received funds those that are to be kept by various corrupt people and operations in Washington DC. For this, the more funds brought in, the better and bigger the parties are.

Then take the remaining funds and divide them up by the institutions and doctors providing service.

Yes, it's really that simple.

Whatever care you get is that fraction of available resources.

Are you trying to tell me that when they said you can pick your own doctor, they didn't mean from a tree?

[Spendulus]

Medicare for all can be funded with any amount of money.

It's very simple.

First, scrape off the total received funds those that are to be kept by various corrupt people and operations in Washington DC. For this, the more funds brought in, the better and bigger the parties are.

Then take the remaining funds and divide them up by the institutions and doctors providing service.

Yes, it's really that simple.

Whatever care you get is that fraction of available resources.

Are you trying to tell me that when they said you can pick your own doctor, they didn't mean from a tree?

I can see how you would be able to pick your own doctor.

When your pro-rata fraction of his time allotted by Big Gov Socialism was 15 minutes or 15 microseconds is the question.

[TECSHARE]

https://fee.org/articles/i-was-a-physician-at-a-federally-qualified-health-center-heres-why-i-no-longer-believe-government-health-care-can-work/