Handicapping Biden's Big Plan (NYT Article)

[ctuser1]

This article arrived today morning in my mailbox:
https://www.nytimes.com/2021/03/23/briefing/boulder-colorado-biden-trillion-astrazeneca.html

I am bored out of my mind dealing with mind-numbing SOX paperwork this morning, and decided to take some break from that to do something I enjoy: speculate on economic policy, a topic I have precisely zero formal training on.

So what is in this plan? And what's to  like/dislike/hate about them?

Infrastructure:

The centerpiece of the package is a set of proposals to improve the country’s infrastructure, including money for roads, bridges, broadband access and energy-efficient houses and electric cars. Many of the infrastructure provisions are “directly related to the fight against climate change,” our colleague Jim Tankersley told us. “Administration officials essentially see those two goals — building out 21st century infrastructure and transitioning to a low-carbon future — as inseparable.”

This is a good goal. Expensive - but absolutely necessary. If you question this - someday take a trip across the Hudson river on a PATH train and peek out when it crosses the tunnel. 10% of US's GDP flows through all these well-past-design-life-and-held-together-by-duct-tape infrastructure around NYC. If you take into account infrastructure up and down the "old USA", it would be appropriate to say most of the US economy runs on expired infrastructure.

I would like Biden gang to be judicious in prioritizing these stuff based on real economic drivers and numbers thereof. If not, bad execution may kill a good idea.

Education

Biden wants to expand public education on both ends of the age spectrum. His plan is likely to make pre-K universal for both 3- and 4-year-olds, through federal funding of local programs, and would increase funding for community colleges. The ultimate goal is to move the public-education system from its current K-12 system to something that starts at age 3 and extends through two years of college.

Again - a laudable goal. Pre-K to community college on taxpayer dime is a good goal. Education generally pays off for itself. As long as it is simply an expansion of the public school system + an expansion of the existing community college programs - not much to dislike. More convoluted mechanisms that for-profit private colleges can exploit to goose their profit will kill this good idea via bad execution.

Child payments and paid leave
This is a redistribution to the bottom 90% - after this group has been badly shafted for 40+ years since Regan's war on America. Hence this is good.

On the execution side - I would want Biden gang to work with CBO and spend the money with an aim to get the biggest long term economic "stimulus effect" rather than have lobbyists add pork everywhere. Probably a wishful thinking - I know. But a man can dream.

Health care
More important than what is rumored to be in it is what is NOT.
No public option. Can't find any references to mandated price transparency measures beyond a bit of a wishy washy "a measure to limit how much pharmaceutical companies can charge Medicare for prescription drugs, which could lead to lower prices for private insurance plans".

But then, I guess a bigger healthcare debate can become all-consuming. So if they are simply trying to achieve some quick wins for the time being then I am fine with that.

Paying for it
Huh - the fun part.
Not too concerned that this will be implemented wrong. I just wouldn't want them to leave the bills in a "not paid" state. Increase revenue from the freeloading groups. Bonus points if they can do wealth tax and tie revenue generation counter-cyclically with the economic froth that seems very likely after the post-pandemic boom.

And then this bit got my seriously depressed.

Biden’s advisers are leaning toward splitting the package into two different bills, partly in the hope of securing Republican support for some of them.

This leads me to question if everyone in the Biden gang are really acting in good faith. Are they procedurally setting it up to fail? On what planet would the said "advisors" assume 10 republican senators will want to do something that will benefit all Americans??

[Tigerpine]

I seem to remember reading that McConnell said that he wouldn't support an infrastructure bill that included funding for it?

If that's the case, your answer may at least in part be there.

[trollwithamustache]

I just hope the infrastructure work they do isn't like California's high speed rail that runs up a section of the Central Valley instead of SF to LA.

[CodingHare]

I seem to remember reading that McConnell said that he wouldn't support an infrastructure bill that included funding for it?

If that's the case, your answer may at least in part be there.

Perhaps the new Republican platform is that Mexico will pay for our interior infrastructure in addition to the wall?

[jrhampt]

I am optimistic that even though Biden would like to offer the chance for bipartisanship, he also understands the need for speed and that bipartisanship is basically a pipe dream right now.  So if they really want to do this, I think they'll do it (like they did the stimulus package).

[tooqk4u22]

I am optimistic that even though Biden would like to offer the chance for bipartisanship, he also understands the need for speed and that bipartisanship is basically a pipe dream right now.  So if they really want to do this, I think they'll do it (like they did the stimulus package).

I have no doubt it will get done.....one party control has always allowed things to get done but never very well and with complete disregard for reasonableness (such as latest covid bill or Trump tax cuts) .  The only good thing is that each party when they have such control typically goes to far and either house or senate turns over at mid-term election.  Usually it means things shut down instead of the more desirable work together approach.  But I guess that's how it has to be.....get control, do as much as you can, lose control, other party gets control, does as much as they can, lose control, and so on and so on.   

[ctuser1]

I am optimistic that even though Biden would like to offer the chance for bipartisanship, he also understands the need for speed and that bipartisanship is basically a pipe dream right now.  So if they really want to do this, I think they'll do it (like they did the stimulus package).

I have no doubt it will get done.....one party control has always allowed things to get done but never very well and with complete disregard for reasonableness (such as latest covid bill or Trump tax cuts) .  The only good thing is that each party when they have such control typically goes to far and either house or senate turns over at mid-term election.  Usually it means things shut down instead of the more desirable work together approach.  But I guess that's how it has to be.....get control, do as much as you can, lose control, other party gets control, does as much as they can, lose control, and so on and so on.

That's not how it worked for FDR and Regan.

They are basically two fulcrums on which two most recent US political super-cycles pivoted. It's about time there is another pivot to recover from Regan's effect on the US.

[dang1]

I just hope the infrastructure work they do isn't like California's high speed rail that runs up a section of the Central Valley instead of SF to LA.

Central Valley is in between SF and LA

[trollwithamustache]

I just hope the infrastructure work they do isn't like California's high speed rail that runs up a section of the Central Valley instead of SF to LA.

Central Valley is in between SF and LA

indeed it is. sometimes the truth is the problem though.

[gentmach]

This leads me to question if everyone in the Biden gang are really acting in good faith. Are they procedurally setting it up to fail? On what planet would the said "advisors" assume 10 republican senators will want to do something that will benefit all Americans??

Haha. No. They are not operating in good faith.

https://youtu.be/wPzualSePp8

15 dollar minimum wage failed when 8 Democrats voted against it. Why do you think the establishment is going to help?

[LennStar]

This article arrived today morning in my mailbox:
https://www.nytimes.com/2021/03/23/briefing/boulder-colorado-biden-trillion-astrazeneca.html

I am bored out of my mind dealing with mind-numbing SOX paperwork this morning, and decided to take some break from that to do something I enjoy: speculate on economic policy, a topic I have precisely zero formal training on.

So what is in this plan? And what's to  like/dislike/hate about them?

Infrastructure:

The centerpiece of the package is a set of proposals to improve the country’s infrastructure, including money for roads, bridges, broadband access and energy-efficient houses and electric cars. Many of the infrastructure provisions are “directly related to the fight against climate change,” our colleague Jim Tankersley told us. “Administration officials essentially see those two goals — building out 21st century infrastructure and transitioning to a low-carbon future — as inseparable.”

This is a good goal. Expensive - but absolutely necessary. If you question this - someday take a trip across the Hudson river on a PATH train and peek out when it crosses the tunnel. 10% of US's GDP flows through all these well-past-design-life-and-held-together-by-duct-tape infrastructure around NYC. If you take into account infrastructure up and down the "old USA", it would be appropriate to say most of the US economy runs on expired infrastructure.

recommened video: https://www.youtube.com/watch?v=7IsMeKl-Sv0

[ctuser1]

This leads me to question if everyone in the Biden gang are really acting in good faith. Are they procedurally setting it up to fail? On what planet would the said "advisors" assume 10 republican senators will want to do something that will benefit all Americans??

Haha. No. They are not operating in good faith.

https://youtu.be/wPzualSePp8

15 dollar minimum wage failed when 8 Democrats voted against it. Why do you think the establishment is going to help?

The "establishment" is a necessary feature of any functioning democracy.

That might sound like a striking statement given the "establishment" is almost always corrupt, bought over by the big money of the day (whichever type of big money there is at that time) etc. But it makes more sense once you consider the alternative(s).

To attempt to get rid of such pesky "corruption", you need ideology. That is what happened to the current day republican party. I don't think it is possible to recover from ideology - at least I am not aware of any historical examples of that. An ideological political entity - even when the ideology is not as obviously hypocritical, like libertarianism - is destined for destruction. The only open question is whether it will drag the entire country with it, or fails to do so. If it fails, that won't be for want of trying (cite: 1/6/2021).

----------------------------------

So, we are back to "establishment" acting in bad faith. You make somewhat incremental progress against them, in steps. FDR may have passed a lot of bills in his first 100 days. But almost all of them were vague, just putting the wireframes of the "new deal" vision in place. Specific "New Deal" policies were being signed into law as late as Nixon. That is the way to transform a society - in small packages of tiny "real world" bits and pieces spanning decades. How many lives do you think would be saved if US had not-totally-insane politics that allowed for Obamacare to be tinkered with based on real world feedback to constantly improve it?

Coming back to today, the "progressives" will surely get some of their priorities into law, and will fail to get some others. They may even get nothing of substance  That is expected when the democratic coalition is a <55% majority. If the American population wants more such progressive policies passed, then they will expand the majority (like they did with FDR). If they want Ideological bs and Kabuki Theatre, then they will elect Trump.

[gentmach]

This leads me to question if everyone in the Biden gang are really acting in good faith. Are they procedurally setting it up to fail? On what planet would the said "advisors" assume 10 republican senators will want to do something that will benefit all Americans??

Haha. No. They are not operating in good faith.

https://youtu.be/wPzualSePp8

15 dollar minimum wage failed when 8 Democrats voted against it. Why do you think the establishment is going to help?

The "establishment" is a necessary feature of any functioning democracy.

That might sound like a striking statement given the "establishment" is almost always corrupt, bought over by the big money of the day (whichever type of big money there is at that time) etc. But it makes more sense once you consider the alternative(s).

To attempt to get rid of such pesky "corruption", you need ideology. That is what happened to the current day republican party. I don't think it is possible to recover from ideology - at least I am not aware of any historical examples of that. An ideological political entity - even when the ideology is not as obviously hypocritical, like libertarianism - is destined for destruction. The only open question is whether it will drag the entire country with it, or fails to do so. If it fails, that won't be for want of trying (cite: 1/6/2021).

----------------------------------

So, we are back to "establishment" acting in bad faith. You make somewhat incremental progress against them, in steps. FDR may have passed a lot of bills in his first 100 days. But almost all of them were vague, just putting the wireframes of the "new deal" vision in place. Specific "New Deal" policies were being signed into law as late as Nixon. That is the way to transform a society - in small packages of tiny "real world" bits and pieces spanning decades. How many lives do you think would be saved if US had not-totally-insane politics that allowed for Obamacare to be tinkered with based on real world feedback to constantly improve it?

Coming back to today, the "progressives" will surely get some of their priorities into law, and will fail to get some others. They may even get nothing of substance  That is expected when the democratic coalition is a <55% majority. If the American population wants more such progressive policies passed, then they will expand the majority (like they did with FDR). If they want Ideological bs and Kabuki Theatre, then they will elect Trump.

I've watched "Progressives" bend over for Nancy Pelosi on forcing a medicare for all vote. And I watched them surrender on $15 dollar minimum wage.

As for electing an FDR, well, Bernie Sanders got stuffed in a locker twice by his own party.

So... No. I don't think those bode well for "Pulling Biden Left" as was the hope.

[Tigerpine]

As for electing an FDR, well, Bernie Sanders got stuffed in a locker twice by his own party.

Bernie Sanders is only a Democrat when he runs for president.  Otherwise he's an independent who caucuses with the Democrats, which is not the same thing.

[Abe]

I predict some of the infrastructure bill will pass. The rest will be chucked overboard to keep that from sinking.

Infrastructure: half of the amount that is proposed, mostly for highways and broadband. Definitely nothing for affordable housing or electric cars. For buildings, the construction industry lobby will knee-cap anything meaningful and replace it with some weak-sauce energy efficiency for new buildings.
Child payments and paid leave: payments will be tied to having a job, and paid leave will be ditched.
Education: Ha! Maybe the Pre-K and K expansion. I bet most R-held states will reject any community college funding just like they rejected Medicaid expansion.
Health care: subsidies to $100k income may pass, but after much gnashing of teeth for political show. Rx drug prices: no way.

Ultimate prediction: all of this will be repealed or de-fanged immediately once Republicans regain control of the Congress in a big sweep in 2022. The ensuing political pie-fight will hobble Biden's 2nd two years. Cruz or DeSantis wins in 2024 and the remainder of these projects that didn't corruptly enrich big companies will be thrown in the trash can and set on fire.

[Sid Hoffman]

Central Valley is in between SF and LA

People hate having to do multiple trains for the same reason they hate doing connecting and especially multiple connection flights: it introduces risk that when one ride is late, you miss the next one, or the middle one of a 3-segment trip is cancelled/broken down, and so on. Running from L.A. directly into S.F. would have gotten a lot more people excited about it because you could just get on the train once, get off the train once. Instead it's the same frustration as always with having to figure out what stop is your connection, then how do you run quickly over (or wait for 1.5 hours) for your connecting train, and potentially you're spending 5 hours hopping 4 busses, 3 trains, and walking a mile and a half and in that 6 hours you could have just driven it instead.

[Abe]

Central Valley is between LA and SF the same way that the appalachians is between NY and Miami: yeah if you’re not good with lines it may be.

Having lived in LA and having many friends in SF, there is almost no reason we would take a train between the two except for leisure. In which case, the Amtrak between the two suffices. The high speed train is nonsense and a giant waste of money. It’s almost a modern art exhibit of useless spending. Maybe if it was for freight that’d be another story and save everyone from the poorly maintained trucks that bring food in.

We have better things to do with infrastructure than carting around us rich people. And no one who works 2 jobs in SF but lives near Fresno is going to take a stupid train in and then figure out the SF bus system to get to work.they’d spend their entire lives commuting to serve use our dumb lattes. Better make useful infrastructure there (like wind and solar power stations) and pay the residents a dividend a la Alaska.

[trollwithamustache]

Having lived in LA and having many friends in SF, there is almost no reason we would take a train between the two except for leisure.

Pre covid how many flights a day went back and forth? A lot.  SF Fresno bako and LA have a lot of people and a lot of business, not all tech. There is a huge amount of ag related business in this state too, its just not cool.  People would actually use it. (I don't know if the original economics used in the ballot measure will payout, but it doesn't matter since it passed.) But it would have to actually be built all the way. 

It is not a rich/poor thing, half assed infrastructure doesn't help anyone.

[Abe]

Total estimated cost is $20 billion with projected ridership of 12m a year, and about $60 per ticket from Central Valley to Silicon Valley (not estimates of ticket from LA to SF) (this from hrs.ca.gov 2020 business plan). This generates a revenue of $2.5b per year. Replacement costs are harder to find in their business plan, but another document on their site noted that replacement for the track over a 50 year lifespan is about 10-50%, average seems around 30% depending on the components (so $20b*0.3/50=$120m per year), financing even at 1% is $0.2b a year and maintenance is estimated for high-speed rails to be $30,000-$60,000 per mile (source http://onlinepubs.trb.org/onlinepubs/trnews/trnews255rpo.pdf) , so $7-14m per year for the 117 mile Central Valley project alone. Total maintenance and financing costs (not cost of running the trains, which I can’t find an estimate anywhere) are thus $334m per year, or $28 per ride. Presumably this would make the train revenue positive. The additional distance between LA and SF is $80b, and the extra distance is 380 miles, so all those costs go up 4x. It’s unclear there’s a demand for $240 train tickets.

This is all obviously back of the envelope calculations but is primarily to illustrate that massive infrastructure projects have to either fill massive gaps in our infrastructure or generate massive growth, and it’s not clear this year project does. Freight doesn’t care how fast it gets anywhere, so high speed rail only serves impatient people and urgent deliveries. They estimate 2.5 hours from LA to SF (vs 1.5hours by plane). Are people willing to pay extra or the same for that slower speed?

[Just Joe]

Excellent estimations. FWIW I would prefer the train even if it cost me another hour. I would assume the boarding process for the train would be faster than the airport. I would also assume the seating to be more comfortable and quiet than a plane. Possibly safer as well. More environmentally conscious?

[bacchi]

Excellent estimations. FWIW I would prefer the train even if it cost me another hour. I would assume the boarding process for the train would be faster than the airport. I would also assume the seating to be more comfortable and quiet than a plane. Possibly safer as well. More environmentally conscious?

Yes to all of those things, especially the boarding time. No one shows up to SJC 15 minutes ahead of time and expects to board. Amtrak? No problem.

[roomtempmayo]

Excellent estimations. FWIW I would prefer the train even if it cost me another hour. I would assume the boarding process for the train would be faster than the airport. I would also assume the seating to be more comfortable and quiet than a plane. Possibly safer as well. More environmentally conscious?

Yes to all of those things, especially the boarding time. No one shows up to SJC 15 minutes ahead of time and expects to board. Amtrak? No problem.

If the time was even close, I would always take the train.  Lots of Amtrak allows you to park for free, roll a bike onboard, and have actual legroom with an empty seat next to you.  Compared to most domestic flights, Amtrak is downright luxurious.

[Just Joe]

I know it exists in some form somewhere but know none of the details but riding a coast to coast train and bringing my car along would be sweet. We'd get to see the landscape just like driving our car, and we'd have our car once we arrived at the coast. Add in bullet train speeds and it could only get better.

Sure, I know I can fly to the other side of the country and rent a car, but if I could ride the train to Alaska and drive back, or CA and drive back. Or ride the train both ways - that would be pretty great.

And riding the train with my bike along would be nice too. Visit the nearest city from our smallish town, pedal my ebike/pedal bike around - and then return home by train. Assuming good infrastructureto pedal around town.  That would be better than taking my car, parking it, relocating it around the city, driving home tired.

[Sid Hoffman]

I know it exists in some form somewhere but know none of the details but riding a coast to coast train and bringing my car along would be sweet. We'd get to see the landscape just like driving our car, and we'd have our car once we arrived at the coast. Add in bullet train speeds and it could only get better.

There is sorta such a thing:

https://www.amtrak.com/auto-train

Lorton, VA (Washington, DC) Sanford, FL (Orlando)
17 hours 29 minutes Daily Departure

The Auto Train transports you and your car (or van, motorcycle, SUV, small boat, jet-ski or other recreational vehicle) nonstop from the Washington, DC area to Florida, just outside of Orlando.

I've talked to guys on another forum who have done it and few recommend it. They all said it's easier to just fly or take a regular train and rent a car at the destination. But it does exist at least.

[tooqk4u22]

I know it exists in some form somewhere but know none of the details but riding a coast to coast train and bringing my car along would be sweet. We'd get to see the landscape just like driving our car, and we'd have our car once we arrived at the coast. Add in bullet train speeds and it could only get better.

There is sorta such a thing:

https://www.amtrak.com/auto-train

Lorton, VA (Washington, DC) Sanford, FL (Orlando)
17 hours 29 minutes Daily Departure

The Auto Train transports you and your car (or van, motorcycle, SUV, small boat, jet-ski or other recreational vehicle) nonstop from the Washington, DC area to Florida, just outside of Orlando.

I've talked to guys on another forum who have done it and few recommend it. They all said it's easier to just fly or take a regular train and rent a car at the destination. But it does exist at least.

I looked into once to go to Florida from NE - was not at all convenient, auto loading areas were poorly located and inefficient, may have taken even longer than driving, and it was as much as or more than flying and renting a car.   

But the concept is appealing but it would have to be somewhere in between cost and time of driving vs. flying - can't have all the negatives and no positives.

[roomtempmayo]

Education

Biden wants to expand public education on both ends of the age spectrum. His plan is likely to make pre-K universal for both 3- and 4-year-olds, through federal funding of local programs, and would increase funding for community colleges. The ultimate goal is to move the public-education system from its current K-12 system to something that starts at age 3 and extends through two years of college.

Again - a laudable goal. Pre-K to community college on taxpayer dime is a good goal. Education generally pays off for itself. As long as it is simply an expansion of the public school system + an expansion of the existing community college programs - not much to dislike. More convoluted mechanisms that for-profit private colleges can exploit to goose their profit will kill this good idea via bad execution.

Child payments and paid leave
This is a redistribution to the bottom 90% - after this group has been badly shafted for 40+ years since Regan's war on America. Hence this is good.

On the execution side - I would want Biden gang to work with CBO and spend the money with an aim to get the biggest long term economic "stimulus effect" rather than have lobbyists add pork everywhere. Probably a wishful thinking - I know. But a man can dream.

It appears that the plan is now to do infrastructure - where they can get at least some business support - and set up the people-oriented part of it (child payments, family leave, education) as a fight for the midterm campaign.

The perversity is that the most popular policies are being preserved as campaign issues rather than being addressed with legislation.

[Sid Hoffman]

The perversity is that the most popular policies are being preserved as campaign issues rather than being addressed with legislation.

So you think Medicare to age 60 isn't happening in this congress at all? That it will be a 2023/24 issue, supposing the Democrats even still have control then? I feel like this is a "strike while the iron's hot" deal. There's all this talk about how older votes lean Republican, so dropping Medicare 5 years could go a long way to winning over a lot of those older voters.

[jehovasfitness23]

The perversity is that the most popular policies are being preserved as campaign issues rather than being addressed with legislation.

So you think Medicare to age 60 isn't happening in this congress at all? That it will be a 2023/24 issue, supposing the Democrats even still have control then? I feel like this is a "strike while the iron's hot" deal. There's all this talk about how older votes lean Republican, so dropping Medicare 5 years could go a long way to winning over a lot of those older voters.

those older people are already 65+ ;)

I remember at work walking by a classroom full of senior citizens and the teacher was talking about M4A and i heard several say "that's socialism"  LOL amazing

[roomtempmayo]

The perversity is that the most popular policies are being preserved as campaign issues rather than being addressed with legislation.

So you think Medicare to age 60 isn't happening in this congress at all? That it will be a 2023/24 issue, supposing the Democrats even still have control then? I feel like this is a "strike while the iron's hot" deal. There's all this talk about how older votes lean Republican, so dropping Medicare 5 years could go a long way to winning over a lot of those older voters.

Like universal pre-K and free community college, lowering the age for Medicare eligibility is a big expenditure that benefits a narrow swath of voters.

Even people pretty far out on the left think there's a limit to deficit spending, and we're likely approaching it.  Corporate tax increases will partly cover the infrastructure plan.  I'm not sure how these programs get paid for in a way that doesn't piss off a bunch of people who vote. 

Raising the top income tax bracket hits the donor class, and doesn't raise all that much money unless it's cranked up in major way.  A financial transactions tax would hit everyone with money in the market.  A carbon tax would hit rural people especially.

I'm all for instituting all of the above, but I'm not trying to get re-elected. 

I think the expensive social programs all get punted because there's no real way to pay for them without going to war with banking and the oil industry, and everyone downstream of them, like investors and pickup truck drivers.

[LennStar]

Excellent estimations. FWIW I would prefer the train even if it cost me another hour. I would assume the boarding process for the train would be faster than the airport. I would also assume the seating to be more comfortable and quiet than a plane. Possibly safer as well. More environmentally conscious?

Yes to all of those things, especially the boarding time. No one shows up to SJC 15 minutes ahead of time and expects to board. Amtrak? No problem.

In Germany for long distance trains, people actually show up 15 minutes later and expect to board HARHAR!

A big shoutout to the Shinkansen trains! Fastas a bullet, punctual like an atomic clock and clean as a chip factory.

Like universal pre-K and free community college, lowering the age for Medicare eligibility is a big expenditure that benefits a narrow swath of voters.

I wouldn't call (tens of) millions of people a "narrow swatch". Not to mention that this swath changes with this time. basically everyone is included in it.

Anyway, this has never been an issue for other things. Just look at agricultural subventions. How many people benefit from them? 1% of the population?
Anf what about tax deductions for things like nannies or house cleaners in privte households? A gift to the upper 5% who could definitely pay for this on their instead of taking the money of nurses and cashiers for it.

[tooqk4u22]

Anyway, this has never been an issue for other things. Just look at agricultural subventions. How many people benefit from them? 1% of the population?
Anf what about tax deductions for things like nannies or house cleaners in privte households? A gift to the upper 5% who could definitely pay for this on their instead of taking the money of nurses and cashiers for it.

Those exams apply to everyone,  the many part falls under the childcare deductions and credit and are capped so it's not like you can have a live in nanny for 30k and deduct the whole thing.   The house cleaner example only applies to home offices and you can only deduct the pro-rata amount of sf /total.   

[ctuser1]

Apologies in advance for digressing....

Anyway, this has never been an issue for other things. Just look at agricultural subventions. How many people benefit from them? 1% of the population?
Anf what about tax deductions for things like nannies or house cleaners in privte households? A gift to the upper 5% who could definitely pay for this on their instead of taking the money of nurses and cashiers for it.

Those exams apply to everyone,  the many part falls under the childcare deductions and credit and are capped so it's not like you can have a live in nanny for 30k and deduct the whole thing.   The house cleaner example only applies to home offices and you can only deduct the pro-rata amount of sf /total.

I live in CT, home of many a trust fund babies.

I've been told third hand (i.e. no direct knowledge, and would be happy to be corrected) that you can apparently get around many/most of those IRS rules by having the house as a "business" owned by the Trust, that is rented out to the inhabitants, and then the Trust engages in business activities like cleaning/nanny service etc.

Of course, real estate business, especially a value added one, does not come anywhere close to meeting the 1% rule in CT and hence the trust loses money on the deal. But that is the idea - the inhabitants effectively get untaxed benefits and perks that subsidizes their living expenses.

The next class of wealth further augment their lifestyle using tax free money using the "charities" and PAC's that they chair.

Bottomline : Normal rules of taxation that we would intuitively think applies do not actually apply to the rich people, and they actually pay a lot less than their fair share.

Hence, anything that any tax plan that can remove any of those loopholes would be a net positive for the economy. The Republican donor class have gotten a free ride at everyone else's expense for way too long.

[tooqk4u22]

I have no doubt that the 1%benefit and exploit some of these loopholes,  it even as you describe its not a loophole in of itself, they just created a more complex system to maximize the tax code, which not everyone has the knowledge or means to pay the knowledge to do so and probably wouldn't be worthwhile in any event. 

I have had clients who have had had tax preparation fees (also deductible) in the hundreds of thousands of dollars for their personal returns.....obviously it's for more than filing a simple 1040. 

Besides, the 1% pays 40% of taxes (fair or not isn't the question) and top 10% pay 70% of taxes so obviously any "loopholes" will benefit them bx they are the ones paying taxes.   

[Sid Hoffman]

Like universal pre-K and free community college, lowering the age for Medicare eligibility is a big expenditure that benefits a narrow swath of voters.

The difference between healthcare and daycare or college is that you HAVE to have healthcare. Not everyone needs daycare for their kids and not everyone even goes to college at all. However everyone is supposed to have health insurance by law (the ACA mandates it with fines) and private health insurance for 60-64 year olds is wildly expensive already, typically up over $1000/month regardless if you're looking at individual coverage or that person's cost to an employer's group coverage plan. So they are *already* spending $1000/mo just for the insurance alone.

On the flip side, yes, Medicare costs money but the younger somebody is, the less they cost Medicare. Thus adding 60-64 year olds to Medicare would technically be adding the cheapest demographic. Or the other way of looking at it is that adding 60-64 year olds to Medicare would overall lower the per-person cost of Medicare for everyone, since that group is healthier and less costly than the 65+ year olds currently in Medicare.

The elephant in the room is that the US spends around 60% more per person on healthcare in total than any nation on Earth while having wildly different individual costs and coverage levels. It's not rocket science. Basically every developed nation on Earth is doing healthcare cheaper, more efficiently, and with comparable health outcomes across the total population to the USA. That means a massive portion of the US healthcare expenditures are being spent on overhead, not providing care. That needs to change.

[LennStar]

The elephant in the room is that the US spends around 60% more per person on healthcare in total than any nation on Earth while having wildly different individual costs and coverage levels. It's not rocket science. Basically every developed nation on Earth is doing healthcare cheaper, more efficiently, and with comparable health outcomes across the total population to the USA. That means a massive portion of the US healthcare expenditures are being spent on overhead, not providing care. That needs to change.

I am curious, do you have numbers?

I know that the German state health insurances (there are still dozens in our Socialist system) have administrave costs between 100 and 250 dollar (which is also influenced by factors like how many very sick people there are, so it's hard to compare - the ones for working white collars for example have lower costs than the one who have to catch the pensioneers on social security).

I could imagine that e.g. PR expenditures alone are higher for US health care providers than that.

[ctuser1]

Like universal pre-K and free community college, lowering the age for Medicare eligibility is a big expenditure that benefits a narrow swath of voters.

The difference between healthcare and daycare or college is that you HAVE to have healthcare. Not everyone needs daycare for their kids and not everyone even goes to college at all. However everyone is supposed to have health insurance by law (the ACA mandates it with fines) and private health insurance for 60-64 year olds is wildly expensive already, typically up over $1000/month regardless if you're looking at individual coverage or that person's cost to an employer's group coverage plan. So they are *already* spending $1000/mo just for the insurance alone.

On the flip side, yes, Medicare costs money but the younger somebody is, the less they cost Medicare. Thus adding 60-64 year olds to Medicare would technically be adding the cheapest demographic. Or the other way of looking at it is that adding 60-64 year olds to Medicare would overall lower the per-person cost of Medicare for everyone, since that group is healthier and less costly than the 65+ year olds currently in Medicare.

The elephant in the room is that the US spends around 60% more per person on healthcare in total than any nation on Earth while having wildly different individual costs and coverage levels. It's not rocket science. Basically every developed nation on Earth is doing healthcare cheaper, more efficiently, and with comparable health outcomes across the total population to the USA. That means a massive portion of the US healthcare expenditures are being spent on overhead, not providing care. That needs to change.

Your last sentence is probably a little simplistic.

Here is an article that was extremely influential during the ACA debates: https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum...

The widely held understanding is that US healthcare cost difference is diffused among many causes. Moving to a single payer will not immediately erase the full difference in cost, as e.g. the ratio of the # of specialists vs. the generalists will not reset to normal levels immediately.

There will be a reduction in cost as we move close to a socialist system. Even ACA bent the medical cost curve downwards. You no longer have the 6% or 8% increases in healthcare costs - like was normal during the Bush years. But I would not expect some magic law that will suddenly bring our costs 100% in-line with France or Japan for example (France and Japan being two of the best run socialist healthcare systems).

US generally does socialism better than most places when it puts it's mind to it. e.g. our socialist electric grid system is one of the best in the world in terms of cost/reliability. So, over time, I am hopeful we may even be able to beat France/Japan at our skills at socialism if we put our mind to it. This will, however, will take a long time - possibly 20+ years, after a proper socialist system is implemented.

However, even something like expanding medicare age down to 60 is almost certain to reduce the total healthcare costs paid by all entities (government + private). The few million people who have either private insurance, or are uninsured, cost the healthcare system far more than they would cost medicare if insured via it (many reasons, some of them complicated, maybe someday I will dig up the discussions from the ACA debates). So in my view any arguments about cost on this topic is not based in reality.

[Sid Hoffman]

I am curious, do you have numbers?

I know it's popular to hate on Wikipedia, but you can go to the source data or look up variety of sources. I like Wiki because it's the quick and easy way.

https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

#1 most expenditures per capita nation: USA, $11,072. The next closest is actually higher than it used to be, now Switzerland is up to $7,732 per person, so technically the US is "only" spending 43% more than the next highest spending country. I think it was 60% more back about a decade ago, but my point still stands. Work your way a little farther down the list and you find even very expensive countries like Denmark at $5,568 or Finland at just $4,578 per person. So the US is spending 241% as much as Finland and I guarantee you we're not getting 241% as good healthcare.

I'm not calling for the federal government to seize the means of production of healthcare, but we should be studying perhaps the top 20 healthiest, most cost-efficient nations of the world for healthcare and copy the best of all those 20 countries. Generally there is a mix of some minimum government coverage, some private insurance, and price controls of medicines and procedures going on in the well run nations. It's nothing really radical or honestly not even all that different from Medicare's multiple parts and optional supplemental coverage. Just nearly all other countries have such a system that covers all ages, not just 65+.

[LennStar]

I am curious, do you have numbers?

I know it's popular to hate on Wikipedia, but you can go to the source data or look up variety of sources. I like Wiki because it's the quick and easy way.

I was talking about overhead, as you can see from the rest of my post ;)

A lot of healthcare can be (depending on country) on circumstances. House visits in the australian outback take hours and are done by helicopter (I don't know how widespread, I just have seen one place where they do that). That is of course a lot more expensive than high density population health care.

That is why you pointing out overhead was so interesting for me. It is (relativly) simple for private companies - the overhead is at minimum their profit, which alone is more than five times higher than the state run system in Germany (or is what they hope at least). 
Where is Medicare?

[ctuser1]

That is why you pointing out overhead was so interesting for me. It is (relativly) simple for private companies - the overhead is at minimum their profit, which alone is more than five times higher than the state run system in Germany (or is what they hope at least).
Where is Medicare?

Medicare overhead is small. Like most other "socialist" systems US runs, it does so very efficiently when it puts it's mind to it.
https://www.politifact.com/factchecks/2017/sep/20/bernie-s/comparing-administrative-costs-private-insurance-a/

The scale of the country, of course, is a massive boon in reducing overhead in US Style socialism.

Please notice, however, that Medicare is not 100% single-payer, nor is is fully "socialist". I use that term as a reflection of how the political right abuses it - in a slightly funny way. The advantage portion of Medicare uses private insurers.

So why does US Healthcare cost double as much, you might ask, given medicare itself is so efficiently administering the insurance portion? Well, that is where the very long form article I posted above is a good start. It explains an insiders view of reactions of medical industry when presented the cost number comparisons. The author of this article - Atul Gawande - has done some very good journalistic works on this. My take - based on 10 year old research - is that the cost difference is diffused among many different headings. e.g. once you get everyone insured and there is no uninsured emergency care - then you will save a single-digit percent of cost. Drug prices is another thing - but still the savings would not be more than a single digit percentage.

So even if a "medicare for all" inspired system of primarily private providers, insurers regulated as lightly as possible to even out the negotiation power disadvantage between the providers and the consumers of medical care, the costs will not go in line with France or Japan immediately. But, if the system can be appropriately managed and tweaked based on real world feedback, then I will fully expect that kind of a system to use it's scale as advantage to innovate and tweak itself to become better than even Japan/France in time - a couple of decades or so. America tends to do that after it has tried out for itself every other bad alternative because it is too proud to learn from the mistakes and experiences of others.

[tooqk4u22]

Yes, all data says as a country the US spends more.

 Is it due to overhead, like 500 administration, middle managers, collectors, etc.?   Maybe

Is due to the fact that our Dr's and nurses are compensates better? Maybe.

Is it due to a mostly private system that has a profit motive to overdue services?  Maybe

Is it due to a large portion of the population that is uninsured or under insured with a high deductible plan that they have no way to pay for so these folks hold off from getting treatment until it's too late and the requires care is abundantly more extensive?  Maybe

Is it as a society, we are generally more unhealthy that requires significantly more spending on things like diabetes, heart disease, and cancer?  Maybe

Is it that as a society we have a significantly higher incidence of gun violence and auto accidents for which the trauma requires extensive care that typically has poor results?  Maybe.

All I am saying is that it may not be as simple as saying the costs are out of control because the US spends more than the next highest country.  There may be a single or variety of contributing factors, and I believe there are.  Some of it is directly addressable and some of it is societal.  Some of it is as easy as preventive or early identification health care.

[ctuser1]

All I am saying is that it may not be as simple as saying the costs are out of control because the US spends more than the next highest country.  There may be a single or variety of contributing factors, and I believe there are.  Some of it is directly addressable and some of it is societal.  Some of it is as easy as preventive or early identification health care.

FYI - there has been a massive amount of work done on this topic in the industry and in academic circles. I was a "consultant" with one of the big-name firms when Obamacare debate was going on, and we had a few entire floors dedicated to healthcare consultants occupying prime real estate in NYC churning out massive amounts of materials dissecting everything related to this topic.

I'm too lazy to look up some pertinent materials right now - there are so many and most deal with so detailed and narrow a scope - such that finding a more general one is a big job in itself.

TL;DR - the problem is well understood - it is just a matter of spending the enormous amount of time required to go through all the materials that exist on this.