What comes after the ACA?

[Schaefer Light]

Surely people on these forums wouldn't approve of spending more than their income year after year.

Please don't tell me you've made the obvious mistake of equating a household's budget with the US government's budget. 

Those two situations are only similar if the household can manufacture unlimited amounts of money, which they can not only spend but also sell to other households at a premium.

I wish the same were true of the government.  Taking away its ability to print as many dollars as it wants/needs would be a huge step in the right direction.

Major mistake to do that - deficit spending prevents a recession from getting worse.

Sometimes recessions should be allowed to get worse.  Just like big companies should be allowed to fail.  That's how free markets are supposed to operate.

[Schaefer Light]

Major mistake to do that - deficit spending prevents a recession from getting worse.

Don't expect that argument to get any traction with Shaefer Light.  People who espouse those kinds of naive beliefs have usually swallowed the whole package, and have thus rejected all forms of Keynesian economics.  They believe the US government must always collect more in taxes than it spends (like a household budget!), but they hate taxes in all forms (taxes are theft!) and so they want to deconstruct the American government (drown it in a bathtub!) by returning to the gold standard (abolish the fed!).

These folks are completely blind to the ways in which American capitalism has created the most successfully prosperous nation in history by doing the exact opposite of all of these things they like to chant about at rallies.  In part, I think it's motivated by a desire to return to the "good old days" when a poorly educated white man could comfortably raise four kids by working on the factory floor while his wife stayed home cooking and cleaning.  Black and brown people weren't economic competition, gays were tolerated but only if they were discrete about it, and if your girl talked back you could always pop her one right in the kisser.  To the moon, Alice! 

But even that bigoted nostalgia is misplaced.  Even then, the government pushed huge deficits in the name of military action, levied 90% tax rates on the upper tax bracket, and exerted authoritarian influence over popular media and culture.  Technology was in the process of rapidly replacing "women's work" around the home with machines, sowing the seeds of gender normalization that started with Rosy the Riverter, blew right through Gloria Steinem, and will someday give us a female President.  Capitalism ran wild with the support of debt-backed currency.   This combination of high taxes, strong central government, a newly empowered work force, and barely-constrained wall street chicanery is exactly what created the America we all know and love, and which has drawn aspirational immigrants from around the world for generations.

Why mess with a good thing, folks?  Come on in and play this awesome game with us, or don't.  America values your freedom!  But if you do, maybe dial back a little on that whole "I hate everything about America's ascendant rise to global economic superiority" rhetoric that we hear about so often on these forums from people like Shaefer Light.

Now if only we could figure out SOME way to use all of this success to also provide medical care to our least fortunate citizens...  Hmmm, what has worked really well for us before?

Yeah.  I believe in free markets so I must be a nut.  What the fuck ever.

[PiobStache]

Well, let's examine this.

Medicare tax 1.45% of employee income levees against all.
Medicare sur tax 3.8% of income leveed against income over $200,000-$250,000.

So we have two flat taxes.  QED.

Edit: it took 3 seconds to find an example of "foreign progressive taxation" that pays for healthcare.  Canada. At least partly funded by Canadian income tax which is definitively a progressive form of taxation. So just stop. You started an argument with me about something that I wasn't arguing and still failed.

Straw man.  You said the only way to fund it was through progressive taxation.  That's false as other countries use regressive taxation too.  I never said progressive taxation could not be part of the funding, merely pointed out your assertion was demonstrably false.

I think we know who is failing here and in multiple domains...

[PiobStache]

Regarding how to make health care cheaper:
The ACA/Obamacare law has been providing research into finding out what standards of care are the most effective for a given medical condition. This is vital research that will help us win the battle against cost.

So to the thought that ACA has been helping lower costs through research...memories are so short.  Does anyone else remember what happened when an ACA Blue Ribbon Panel presented new data on mammography and how to save money?  For those that need a reminder I'll just say a bus was involved and people were tossed under it by Obama.

[boarder42]

So you're saying people with DUII shouldn't pay more for car insurance and everyone should subsidize that behavior and the subsequent costs?

You don't think that telling people don't worry about saving money for healthcare when you reach 65 has any impact on their current and future lifestyles? Even obamacare recognizes this with higher prices for smokers.

False equivalence. You can choose not to drink and drive. You can't choose not to age.

so then you're ok with making obese pay more b/c you can choose to not be fat.  do the people who smoke pay more... i think you have to have some incentive program for the healthy/those trying to be healthier.  Obviously this cant be sold as a tax on the fat smokers.  So it would have to be a higher rate for the general population which you could offset like the workplace healthcare plans by getting annual physicals and being healthy or participating in things designed to help you get healthier to get a tax credit back. 

but then people would claim this is an invasion of privacy.  but the tax credit is optional so you wouldnt have to get it.

also defining obese is harder and would likely require we do body fat scans which are expensive b/c i think most can agree BMI is a bad metric. (works great for my tall lanky build bad for short stocky builds)

you have to create incentives to be healthy b/c it lowers the overall burden on society.  and those that create a larger burden should pay more. (after typing this part i think studies have shown healthy people actually cost more b/c they live longer but on a per year basis i think they cost less)

Now since everyone ages should we just blanket that out and say well you're likely going to get older so since we assume everyone will live to X age on average there is no charge for age difference.  I think that could be fair. 

[PiobStache]

BMI is a good, but not perfect metric, and fairly robust in predictive powers, just not 1:1.  For something that costs zero to measure it's rather awesome.  People that don't think it's a good metric are either uneducated about how a linear regression and a goodness of fit line works or...they're obese and don't want to believe.  Again, it's not perfect, there are outliers, but not everyone is an outlier...no matter how much they want to believe they are!

[nereo]

BMI is a good, but not perfect metric, and fairly robust in predictive powers, just not 1:1.  For something that costs zero to measure it's rather awesome.  People that don't think it's a good metric are either uneducated about how a linear regression and a goodness of fit line works or...they're obese and don't want to believe.  Again, it's not perfect, there are outliers, but not everyone is an outlier...no matter how much they want to believe they are!

Mostly playing devil's advocate here, but shouldn't those outliers matter?  In particular the BMI have less predictive power for very tall people, and unfairly punish people who have a great deal of muscle.  Is it fair to punish these healthy people because, for them, BMI is a poor indicator?

[Fireball]

Major mistake to do that - deficit spending prevents a recession from getting worse.

Don't expect that argument to get any traction with Shaefer Light.  People who espouse those kinds of naive beliefs have usually swallowed the whole package, and have thus rejected all forms of Keynesian economics.  They believe the US government must always collect more in taxes than it spends (like a household budget!), but they hate taxes in all forms (taxes are theft!) and so they want to deconstruct the American government (drown it in a bathtub!) by returning to the gold standard (abolish the fed!).

These folks are completely blind to the ways in which American capitalism has created the most successfully prosperous nation in history by doing the exact opposite of all of these things they like to chant about at rallies.  In part, I think it's motivated by a desire to return to the "good old days" when a poorly educated white man could comfortably raise four kids by working on the factory floor while his wife stayed home cooking and cleaning.  Black and brown people weren't economic competition, gays were tolerated but only if they were discrete about it, and if your girl talked back you could always pop her one right in the kisser.  To the moon, Alice! 

But even that bigoted nostalgia is misplaced.  Even then, the government pushed huge deficits in the name of military action, levied 90% tax rates on the upper tax bracket, and exerted authoritarian influence over popular media and culture.  Technology was in the process of rapidly replacing "women's work" around the home with machines, sowing the seeds of gender normalization that started with Rosy the Riverter, blew right through Gloria Steinem, and will someday give us a female President.  Capitalism ran wild with the support of debt-backed currency.   This combination of high taxes, strong central government, a newly empowered work force, and barely-constrained wall street chicanery is exactly what created the America we all know and love, and which has drawn aspirational immigrants from around the world for generations.

Why mess with a good thing, folks?  Come on in and play this awesome game with us, or don't.  America values your freedom!  But if you do, maybe dial back a little on that whole "I hate everything about America's ascendant rise to global economic superiority" rhetoric that we hear about so often on these forums from people like Shaefer Light.

Now if only we could figure out SOME way to use all of this success to also provide medical care to our least fortunate citizens...  Hmmm, what has worked really well for us before?

Yeah.  I believe in free markets so I must be a nut.  What the fuck ever.

Maybe not a nut, but certainly in the minority on this planet.

[PiobStache]

BMI is a good, but not perfect metric, and fairly robust in predictive powers, just not 1:1.  For something that costs zero to measure it's rather awesome.  People that don't think it's a good metric are either uneducated about how a linear regression and a goodness of fit line works or...they're obese and don't want to believe.  Again, it's not perfect, there are outliers, but not everyone is an outlier...no matter how much they want to believe they are!

Mostly playing devil's advocate here, but shouldn't those outliers matter?  In particular the BMI have less predictive power for very tall people, and unfairly punish people who have a great deal of muscle.  Is it fair to punish these healthy people because, for them, BMI is a poor indicator?

Um, where did I talk about punishing individuals that are statistical outliers merely for being statistical outliers?  This is just weird...

[nereo]

BMI is a good, but not perfect metric, and fairly robust in predictive powers, just not 1:1.  For something that costs zero to measure it's rather awesome.  People that don't think it's a good metric are either uneducated about how a linear regression and a goodness of fit line works or...they're obese and don't want to believe.  Again, it's not perfect, there are outliers, but not everyone is an outlier...no matter how much they want to believe they are!

Mostly playing devil's advocate here, but shouldn't those outliers matter?  In particular the BMI have less predictive power for very tall people, and unfairly punish people who have a great deal of muscle.  Is it fair to punish these healthy people because, for them, BMI is a poor indicator?

Um, where did I talk about punishing individuals that are statistical outliers merely for being statistical outliers?  This is just weird...

perhaps I've fallen off the train, but as I was understanding the argument it went as follows:  the thread was talking about whether individuals who are less healthy should be charged more.  boarder42 pointed out that defining obesity is difficult due to the problems associated with BMI, but that people that create a larger burden should pay more.
your argument was that BMI was a fine metric even if it wasn't 1:1 and had outliers.
So - if we are going to use BMI to define the 'healthiness' of an individual, and if that metric has outliers, they would be punished under this system.  Hence my question - is this fair?

[sol]

Yeah.  I believe in free markets so I must be a nut.  What the fuck ever.

Nah, man.  Free markets are great!  But what you're asking for is TOO free, and has historically resulted in worse outcomes for people.  Markets need rules, like "no stealing" and "no blackmail" and "no monopolies".  People need to have the protections required to participate in a market, which includes the power to have their contracts honored, their disputes resolved by a higher authority, and their means of payment protected. 

The US economy has been so wildly successful precisely because it has been able to thread that narrow path between too much regulation and too much anarchy.  Markets where strongmen and criminals rule the roost do not generate huge profits for everyone.  Markets where the government takes all profits also fail.  You (we) need to find that middle ground, to seek out the path that helps everyone succeed.

Lots of countries don't have fiat currency, or a court system, or police to deter crime.  Lots of countries don't have any taxes or market regulations at all, and as a result they rapidly have no widespread profits to protect because they have no capital to invest, no companies to generate revenue, and no shareholders to turn those profits back into the demand that drives more sales, more revenue, and more capital.

American Capitalism, despite it's flaws, is hugely profitable!  That's because the US government collects taxes from the most successful market participants and uses those funds to protect and expand the marketplace for everyone.  If we took away the source of capital (debt) or tried to curtail regulations (the bathtub) or starved the taxes (theft!) the system would fall apart.  By advocating for these archaic policies, you are actively undermining the very things that have made America so successful.  Why do you hate America so much?

So no, you're not a nut for liking free markets.  You might be a nut if you want markets to be so "free" that they can become dysfunctional, in which case you're not really a "free market" kind of guy so much as you are an "anti-market" kind of guy.

Healthcare can work the same way, because healthy citizens participate in markets.  Sick people, injured people, hospitalized people, addicted people, depressed people, these folks don't work.  They don't generate profits for their corporate overlords, they turn from a national asset to a national liability.  Good healthcare, just like good education, can turn those liabilities into productive taxpaying worker citizens.  As long as they generate more value for the economy as an aggregate population, than they cost in healthcare, then it absolutely makes sense for the government to raise taxes to provide that care.   From a macro-perspective, it's just capitalism protecting itself.   This is a case where we apparently need more taxes and more regulation, not less.

[PiobStache]

perhaps I've fallen off the train, but as I was understanding the argument it went as follows:  the thread was talking about whether individuals who are less healthy should be charged more.  boarder42 pointed out that defining obesity is difficult due to the problems associated with BMI, but that people that create a larger burden should pay more.
your argument was that BMI was a fine metric even if it wasn't 1:1 and had outliers.
So - if we are going to use BMI to define the 'healthiness' of an individual, and if that metric has outliers, they would be punished under this system.  Hence my question - is this fair?

I did not talk policy in the least but just gave a little primer on how a linear regression and goodness of fit line work.  I did present an "argument," as that implies there's two sides to this.  Math is just...math. 

[PiobStache]

I endorse this post.

Nah, man.  Free markets are great!  But what you're asking for is TOO free, and has historically resulted in worse outcomes for people.  Markets need rules, like "no stealing" and "no blackmail" and "no monopolies".  People need to have the protections required to participate in a market, which includes the power to have their contracts honored, their disputes resolved by a higher authority, and their means of payment protected. 

The US economy has been so wildly successful precisely because it has been able to thread that narrow path between too much regulation and too much anarchy.  Markets where strongmen and criminals rule the roost do not generate huge profits for everyone.  Markets where the government takes all profits also fail.  You (we) need to find that middle ground, to seek out the path that helps everyone succeed.

Lots of countries don't have fiat currency, or a court system, or police to deter crime.  Lots of countries don't have any taxes or market regulations at all, and as a result they rapidly have no widespread profits to protect because they have no capital to invest, no companies to generate revenue, and no shareholders to turn those profits back into the demand that drives more sales, more revenue, and more capital.

American Capitalism, despite it's flaws, is hugely profitable!  That's because the US government collects taxes from the most successful market participants and uses those funds to protect and expand the marketplace for everyone.  If we took away the source of capital (debt) or tried to curtail regulations (the bathtub) or starved the taxes (theft!) the system would fall apart.  By advocating for these archaic policies, you are actively undermining the very things that have made America so successful.  Why do you hate America so much?

So no, you're not a nut for liking free markets.  You might be a nut if you want markets to be so "free" that they can become dysfunctional, in which case you're not really a "free market" kind of guy so much as you are an "anti-market" kind of guy.

Healthcare can work the same way, because healthy citizens participate in markets.  Sick people, injured people, hospitalized people, addicted people, depressed people, these folks don't work.  They don't generate profits for their corporate overlords, they turn from a national asset to a national liability.  Good healthcare, just like good education, can turn those liabilities into productive taxpaying worker citizens.  As long as they generate more value for the economy as an aggregate population, than they cost in healthcare, then it absolutely makes sense for the government to raise taxes to provide that care.   From a macro-perspective, it's just capitalism protecting itself.   This is a case where we apparently need more taxes and more regulation, not less.

[rpr]

Yeah.  I believe in free markets so I must be a nut.  What the fuck ever.

Nah, man.  Free markets are great!  But what you're asking for is TOO free, and has historically resulted in worse outcomes for people.  Markets need rules, like "no stealing" and "no blackmail" and "no monopolies".  People need to have the protections required to participate in a market, which includes the power to have their contracts honored, their disputes resolved by a higher authority, and their means of payment protected. 

The US economy has been so wildly successful precisely because it has been able to thread that narrow path between too much regulation and too much anarchy.  Markets where strongmen and criminals rule the roost do not generate huge profits for everyone.  Markets where the government takes all profits also fail.  You (we) need to find that middle ground, to seek out the path that helps everyone succeed.

Lots of countries don't have fiat currency, or a court system, or police to deter crime.  Lots of countries don't have any taxes or market regulations at all, and as a result they rapidly have no widespread profits to protect because they have no capital to invest, no companies to generate revenue, and no shareholders to turn those profits back into the demand that drives more sales, more revenue, and more capital.

American Capitalism, despite it's flaws, is hugely profitable!  That's because the US government collects taxes from the most successful market participants and uses those funds to protect and expand the marketplace for everyone.  If we took away the source of capital (debt) or tried to curtail regulations (the bathtub) or starved the taxes (theft!) the system would fall apart.  By advocating for these archaic policies, you are actively undermining the very things that have made America so successful.  Why do you hate America so much?

So no, you're not a nut for liking free markets.  You might be a nut if you want markets to be so "free" that they can become dysfunctional, in which case you're not really a "free market" kind of guy so much as you are an "anti-market" kind of guy.

Healthcare can work the same way, because healthy citizens participate in markets.  Sick people, injured people, hospitalized people, addicted people, depressed people, these folks don't work.  They don't generate profits for their corporate overlords, they turn from a national asset to a national liability.  Good healthcare, just like good education, can turn those liabilities into productive taxpaying worker citizens.  As long as they generate more value for the economy as an aggregate population, than they cost in healthcare, then it absolutely makes sense for the government to raise taxes to provide that care.   From a macro-perspective, it's just capitalism protecting itself.   This is a case where we apparently need more taxes and more regulation, not less.

I concur. Indeed, before the 1920s we had a situation where regulation was fairly minimal and the situation was very chaotic with lots of boom and bust cycles. A case could be made that the Great Depression was a result of inadequate regulation of the economy. Since then, while there have been various cycles, on the whole the economy has been protected. 

[Bucksandreds]

Well, let's examine this.

Medicare tax 1.45% of employee income levees against all.
Medicare sur tax 3.8% of income leveed against income over $200,000-$250,000.

So we have two flat taxes.  QED.

Edit: it took 3 seconds to find an example of "foreign progressive taxation" that pays for healthcare.  Canada. At least partly funded by Canadian income tax which is definitively a progressive form of taxation. So just stop. You started an argument with me about something that I wasn't arguing and still failed.

Straw man.  You said the only way to fund it was through progressive taxation.  That's false as other countries use regressive taxation too.  I never said progressive taxation could not be part of the funding, merely pointed out your assertion was demonstrably false.

I think we know who is failing here and in multiple domains...

-Definition of Progressive taxation. " A progressive tax is a tax that takes a larger percentage from high-income earners than it does from low-income individuals. "  For Medicare we tax income below $200,000- $250,000 at 1.45%  and income above that number at 3.8%.

-Show me where I insinuated or said that progressive taxation was the "only way." If you confused OUR only solution (high inequality with low overall taxes) with THE only solution then you have a reading comprehension problem.

-You  argued with me about something I wasn't arguing and failed miserably with your argument. Our Medicare funding is by definition progressive taxation and I showed you another country that progressively taxes for health care when you asked for "real world example."


Edited due to ranting.

[Bucksandreds]

Yeah.  I believe in free markets so I must be a nut.  What the fuck ever.

Nah, man.  Free markets are great!  But what you're asking for is TOO free, and has historically resulted in worse outcomes for people.  Markets need rules, like "no stealing" and "no blackmail" and "no monopolies".  People need to have the protections required to participate in a market, which includes the power to have their contracts honored, their disputes resolved by a higher authority, and their means of payment protected. 

The US economy has been so wildly successful precisely because it has been able to thread that narrow path between too much regulation and too much anarchy.  Markets where strongmen and criminals rule the roost do not generate huge profits for everyone.  Markets where the government takes all profits also fail.  You (we) need to find that middle ground, to seek out the path that helps everyone succeed.

Lots of countries don't have fiat currency, or a court system, or police to deter crime.  Lots of countries don't have any taxes or market regulations at all, and as a result they rapidly have no widespread profits to protect because they have no capital to invest, no companies to generate revenue, and no shareholders to turn those profits back into the demand that drives more sales, more revenue, and more capital.

American Capitalism, despite it's flaws, is hugely profitable!  That's because the US government collects taxes from the most successful market participants and uses those funds to protect and expand the marketplace for everyone.  If we took away the source of capital (debt) or tried to curtail regulations (the bathtub) or starved the taxes (theft!) the system would fall apart.  By advocating for these archaic policies, you are actively undermining the very things that have made America so successful.  Why do you hate America so much?

So no, you're not a nut for liking free markets.  You might be a nut if you want markets to be so "free" that they can become dysfunctional, in which case you're not really a "free market" kind of guy so much as you are an "anti-market" kind of guy.

Healthcare can work the same way, because healthy citizens participate in markets.  Sick people, injured people, hospitalized people, addicted people, depressed people, these folks don't work.  They don't generate profits for their corporate overlords, they turn from a national asset to a national liability.  Good healthcare, just like good education, can turn those liabilities into productive taxpaying worker citizens.  As long as they generate more value for the economy as an aggregate population, than they cost in healthcare, then it absolutely makes sense for the government to raise taxes to provide that care.   From a macro-perspective, it's just capitalism protecting itself.   This is a case where we apparently need more taxes and more regulation, not less.

You need to start your own blog about policy and politics. You may be the most well thought and well written person on this board.

[EnjoyIt]

Who is arguing with you about need to lower costs? You said that we were a high tax country but effectively we are in the bottom 10-15% in terms of effective taxation for OECD countries. We are a first world very low tax country. Health care costs are lowered through universal care that is rationed with negotiated prescription prices and the government setting the rates for each procedure. No one is arguing that prices are too high. You have just been informed that we are a low tax country for the first world. PERIOD. Argue with the air, now.

You are not the only person on this forum and I am having a discussion with everyone else. The question asked is what comes after the ACA? The answer is higher cost. Period.

You on the other hand are very rude human being. Feel free to respond, but there is no reason for me to ever respond back to you.

[Bucksandreds]

Who is arguing with you about need to lower costs? You said that we were a high tax country but effectively we are in the bottom 10-15% in terms of effective taxation for OECD countries. We are a first world very low tax country. Health care costs are lowered through universal care that is rationed with negotiated prescription prices and the government setting the rates for each procedure. No one is arguing that prices are too high. You have just been informed that we are a low tax country for the first world. PERIOD. Argue with the air, now.

You are not the only person on this forum and I am having a discussion with everyone else. The question asked is what comes after the ACA? The answer is higher cost. Period.

You on the other hand are very rude human being. Feel free to respond, but there is no reason for me to ever respond back to you.

Sorry. I was rude. You are correct. I see intent based off of what I perceive as flawed logic when maybe mal intent isn't the driving force. Apologies.

[EnjoyIt]

Nah, man.  Free markets are great!  But what you're asking for is TOO free, and has historically resulted in worse outcomes for people.  Markets need rules, like "no stealing" and "no blackmail" and "no monopolies".  People need to have the protections required to participate in a market, which includes the power to have their contracts honored, their disputes resolved by a higher authority, and their means of payment protected. 

The US economy has been so wildly successful precisely because it has been able to thread that narrow path between too much regulation and too much anarchy.  Markets where strongmen and criminals rule the roost do not generate huge profits for everyone.  Markets where the government takes all profits also fail.  You (we) need to find that middle ground, to seek out the path that helps everyone succeed.

Lots of countries don't have fiat currency, or a court system, or police to deter crime.  Lots of countries don't have any taxes or market regulations at all, and as a result they rapidly have no widespread profits to protect because they have no capital to invest, no companies to generate revenue, and no shareholders to turn those profits back into the demand that drives more sales, more revenue, and more capital.

American Capitalism, despite it's flaws, is hugely profitable!  That's because the US government collects taxes from the most successful market participants and uses those funds to protect and expand the marketplace for everyone.  If we took away the source of capital (debt) or tried to curtail regulations (the bathtub) or starved the taxes (theft!) the system would fall apart.  By advocating for these archaic policies, you are actively undermining the very things that have made America so successful.  Why do you hate America so much?

So no, you're not a nut for liking free markets.  You might be a nut if you want markets to be so "free" that they can become dysfunctional, in which case you're not really a "free market" kind of guy so much as you are an "anti-market" kind of guy.

Healthcare can work the same way, because healthy citizens participate in markets.  Sick people, injured people, hospitalized people, addicted people, depressed people, these folks don't work.  They don't generate profits for their corporate overlords, they turn from a national asset to a national liability.  Good healthcare, just like good education, can turn those liabilities into productive taxpaying worker citizens.  As long as they generate more value for the economy as an aggregate population, than they cost in healthcare, then it absolutely makes sense for the government to raise taxes to provide that care.   From a macro-perspective, it's just capitalism protecting itself.   This is a case where we apparently need more taxes and more regulation, not less.

I agree with so much of what you say regarding free markets. I strongly disagree that more regulations are the answer.  Currently I see all this added regulation actually increasing the cost of healthcare. Regulation that forces providers, hospitals, out patient facilities to comply with cost money and lots of it. I look at the hospitals and see how many added personnel are required to comply with these laws and just can't imagine adding more is really the answer.  Some of these regulations are actually harming patients and directly increasing costs. Two examples of this has been tying pain control with reimbursement and tying patient satisfaction with reimbursement.  Both of these measures have created a narcotic epidemic in this country. Current regulations are forcing our nursing staff to spend most of their day clicking boxes in a computer instead of actual patient care.  They have since become task oriented and unfortunately many of todays nurses just don't think about the results of their actions. Many of these regulations I feel were written by people who have no clue about practicing medicine because some of them make absolutely no sense at all but add extra work to everyone.  BTW, extra work means less efficiency and added cost.

Sol, can you please elaborate what regulations are you thinking of and how do you want to implement them so that they help as opposed to harm the system further?

Your comment about raising taxes is correct in a sense.  Obviously increasing revenue will help, but I fear that it is a short lived solution to a much more pressing problem.  I honestly believe that we can not tax ourselves out of this situation.  Saying "increase taxes is easy."  The US spends more on healthcare than any other country in the world and by a wide margin.  Maybe the answer should be spending less money and using the extra cash to help those who have a difficult time accessing healthcare.

Don't expect that argument to get any traction with Shaefer Light.  People who espouse those kinds of naive beliefs have usually swallowed the whole package, and have thus rejected all forms of Keynesian economics.  They believe the US government must always collect more in taxes than it spends (like a household budget!), but they hate taxes in all forms (taxes are theft!) and so they want to deconstruct the American government (drown it in a bathtub!) by returning to the gold standard (abolish the fed!).

Just curious, but do you think we can run on a deficit forever and allow our debt to keep rising forever, or is there a point where our debt is so high that the system must respond by defaulting on that debt?

[Well Respected Man]

The debt can increase forever, as long as GDP is increasing. With long term rates so low, it makes a lot of sense to borrow now and pay back with inflated dollars 10 or 30 years from now. Borrow and invest in the economy; reap the rewards, and pay back with inflated dollars.

If debt as a percentage of GDP keeps increasing, it might not be so good, as the inflation rate would have to increase to cover the debt. However, the last time the debt was this high as a percentage of GDP was just before a 25-year boom (plus or minus a few minor recessions). At its low point, in 1974, we were mired in recession, inflation, and energy shocks.

[rpr]

The debt can increase forever, as long as GDP is increasing. With long term rates so low, it makes a lot of sense to borrow now and pay back with inflated dollars 10 or 30 years from now. Borrow and invest in the economy; reap the rewards, and pay back with inflated dollars.

If debt as a percentage of GDP keeps increasing, it might not be so good, as the inflation rate would have to increase to cover the debt. However, the last time the debt was this high as a percentage of GDP was just before a 25-year boom (plus or minus a few minor recessions). At its low point, in 1974, we were mired in recession, inflation, and energy shocks.

Interesting. From the plots at http://www.tradingeconomics.com/united-states/government-debt-to-gdp



we can see that there had been a secular decline from 1946 to 1980 where it reached a low of about 30. Then during the 1980s it doubled to 60. It remained roughly constant till about 2003-04. There was another 50% increase till 2010.

[jim555]

So what is the free market solution to those who can't afford health insurance?  Go Fund Me simply is not enough.  So they should just hope they never get sick?  Is that what is being advocated?  Shouldn't the law that requires treatment in the ER be repealed if you want a free market?

[obstinate]

So what is the free market solution to those who can't afford health insurance?  Go Fund Me simply is not enough.  So they should just hope they never get sick?  Is that what is being advocated? 

No, that's impossible. Don't talk nonsense. :) They should die. That's the Republican policy.

[NoStacheOhio]

So you're saying people with DUII shouldn't pay more for car insurance and everyone should subsidize that behavior and the subsequent costs?

You don't think that telling people don't worry about saving money for healthcare when you reach 65 has any impact on their current and future lifestyles? Even obamacare recognizes this with higher prices for smokers.

False equivalence. You can choose not to drink and drive. You can't choose not to age.

so then you're ok with making obese pay more b/c you can choose to not be fat.  do the people who smoke pay more... i think you have to have some incentive program for the healthy/those trying to be healthier.  Obviously this cant be sold as a tax on the fat smokers.  So it would have to be a higher rate for the general population which you could offset like the workplace healthcare plans by getting annual physicals and being healthy or participating in things designed to help you get healthier to get a tax credit back. 

This is literally how my health insurance plan operates. It's also not really the point I was making.

We can only penalize people so much for lifestyle choices before we start making it impossible for them to afford care. I would argue that pricing people out of healthcare because of lifestyle factors is inhumane, at least at the micro level. Over the long term, yeah, we want to encourage people to be healthier, but that's not always going to save you either.

I'm fucking glad I have gold-plated health insurance through my hospital employer right now, because my never-smoker, 21 BMI, 30-year-old wife was just diagnosed with cancer. In the last week they've billed about $10,000, and this is for not very aggressive, very early cancer. Shit like this is the reason we need to have reasonable health insurance and health screening policies in America.

[DavidAnnArbor]

I'm fucking glad I have gold-plated health insurance through my hospital employer right now, because my never-smoker, 21 BMI, 30-year-old wife was just diagnosed with cancer. In the last week they've billed about $10,000, and this is for not very aggressive, very early cancer. Shit like this is the reason we need to have reasonable health insurance and health screening policies in America.

I'm so sorry to hear that, I hope she recovers and so glad you have good health insurance coverage.

[DavidAnnArbor]

Yeah.  I believe in free markets so I must be a nut.  What the fuck ever.

Nah, man.  Free markets are great!  But what you're asking for is TOO free, and has historically resulted in worse outcomes for people.  Markets need rules, like "no stealing" and "no blackmail" and "no monopolies".  People need to have the protections required to participate in a market, which includes the power to have their contracts honored, their disputes resolved by a higher authority, and their means of payment protected. 

The US economy has been so wildly successful precisely because it has been able to thread that narrow path between too much regulation and too much anarchy.  Markets where strongmen and criminals rule the roost do not generate huge profits for everyone.  Markets where the government takes all profits also fail.  You (we) need to find that middle ground, to seek out the path that helps everyone succeed.

Lots of countries don't have fiat currency, or a court system, or police to deter crime.  Lots of countries don't have any taxes or market regulations at all, and as a result they rapidly have no widespread profits to protect because they have no capital to invest, no companies to generate revenue, and no shareholders to turn those profits back into the demand that drives more sales, more revenue, and more capital.

American Capitalism, despite it's flaws, is hugely profitable!  That's because the US government collects taxes from the most successful market participants and uses those funds to protect and expand the marketplace for everyone.  If we took away the source of capital (debt) or tried to curtail regulations (the bathtub) or starved the taxes (theft!) the system would fall apart.  By advocating for these archaic policies, you are actively undermining the very things that have made America so successful.  Why do you hate America so much?

So no, you're not a nut for liking free markets.  You might be a nut if you want markets to be so "free" that they can become dysfunctional, in which case you're not really a "free market" kind of guy so much as you are an "anti-market" kind of guy.

Healthcare can work the same way, because healthy citizens participate in markets.  Sick people, injured people, hospitalized people, addicted people, depressed people, these folks don't work.  They don't generate profits for their corporate overlords, they turn from a national asset to a national liability.  Good healthcare, just like good education, can turn those liabilities into productive taxpaying worker citizens.  As long as they generate more value for the economy as an aggregate population, than they cost in healthcare, then it absolutely makes sense for the government to raise taxes to provide that care.   From a macro-perspective, it's just capitalism protecting itself.   This is a case where we apparently need more taxes and more regulation, not less.

+1

[protostache]

I'm fucking glad I have gold-plated health insurance through my hospital employer right now, because my never-smoker, 21 BMI, 30-year-old wife was just diagnosed with cancer. In the last week they've billed about $10,000, and this is for not very aggressive, very early cancer. Shit like this is the reason we need to have reasonable health insurance and health screening policies in America.

I'm sorry to hear your wife is sick but glad to know it's very early. I hope she gets better soon.

[boarder42]

anybody have an analysis of the latest plan the GOP just put out. or at least a good summary of whats different from the current plan.

[nereo]

anybody have an analysis of the latest plan the GOP just put out. or at least a good summary of whats different from the current plan.

Short version:  It allows states to set up a waiver to get out from the ACA's prohibition for charging more to high risk individuals.  It restores essential health benefits (EHBs) but also allows states to 'opt out' if they choose to.
The worry as I understand it is that any states that opt out from the prohibition for cahrging more will see premiums for those individuals increase substantially - effectively pricing them out of the market.  "Available" coverage but not "affordable coverage".
The flip side is that premiums may go down for healthy people because they aren't subsidizing the cost of sick people and without EHBs they will have less benefits overall.

[NESailor]

anybody have an analysis of the latest plan the GOP just put out. or at least a good summary of whats different from the current plan.

Short version:  It allows states to set up a waiver to get out from the ACA's prohibition for charging more to high risk individuals.  It restores essential health benefits (EHBs) but also allows states to 'opt out' if they choose to.
The worry as I understand it is that any states that opt out from the prohibition for cahrging more will see premiums for those individuals increase substantially - effectively pricing them out of the market.  "Available" coverage but not "affordable coverage".
The flip side is that premiums may go down for healthy people because they aren't subsidizing the cost of sick people and without EHBs they will have less benefits overall.

My understanding as well.  It should create a de-facto "two state solution" with regards to healthcare in the United States.  Obamacare on the coasts and pre-ACA situation in the center/south. 

What I'm genuinely interested in is whether attitudes towards Obamacare or in general more government involvement in healthcare will change in the red states that choose to go "full opt out".  The elected officials there will be touting this as the equivalent of full repeal and probably pick up a lot of support from those who vigorously oppose Obamacare.  I'm under the impression, however, that much of this opposition is rooted in cognitive dissonance.  People have been conditioned to hate everything Obamacare but still rate many of the core provisions positively.  A full opt-out would make popular pieces either unavailable or completely unaffordable.  What then?

EDIT:  Before I get accused of being smug, arrogant, and calling people stupid - yes, that is exactly what I'm doing.  And no, it does not apply to people in this thread or even on this forum.  Many on here hold well reasoned and supported opinions on healthcare that I disagree with on various grounds.  I do not believe this to be the case out in the wild.  The stunningly low ratings of repeal bill 1.0 are a testament to this - once people realized what repeal meant to them they became vocal opponents of the effort.  This analysis was obviously missing before since Obamacare has had a net negative rating for pretty much the entirety of its existence - and a lot of it on fabricated grounds. 

[DavidAnnArbor]

Here's an excellent article from the NY Times reviewing the new health care reform efforts by the Republicans.
Bottom line is it would bring us back to what we had before, dozens of pages of filling out medical history on the application.  Rejecting you if you have anything wrong, or charging you more, or claiming that you lied on your application when you do get sick so that they can then pull the rug from underneath you when you actually need your health insurance.

https://www.nytimes.com/2017/04/20/upshot/new-republican-health-proposal-evokes-the-old-days.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news

[OurTown]

Simple solution:  don't get sick.  Or old, don't get old either. 

[MMMarbleheader]

Isnt this two state solution the same thing Susan Collins proposed months ago?

https://www.nytimes.com/2017/01/23/us/politics/senate-affordable-care-act-bill-cassidy-susan-collins-trump.html?_r=0

[jim555]

Trumpcare 2.0 is a re-heated turd sandwich.

[NESailor]

Isnt this two state solution the same thing Susan Collins proposed months ago?

https://www.nytimes.com/2017/01/23/us/politics/senate-affordable-care-act-bill-cassidy-susan-collins-trump.html?_r=0

I'll admit I'm not up to speed on the details of both to really say yay or nay.  I'm not sure what Cassidy-Collins wanted to do with Medicaid expansion etc.

Even if it is the same thing - they needed to fail miserably first so that they could consider failing less miserably "an achievement".  My question stands, however - what will the Anti-Obamacare crowd do when they realize that a full repeal will not solve the issues they have today?  I know there probably will be winners.  Young healthy people or folks who want catastrophic plans without essential coverage (and who get lucky in not getting sick) will see their OOP costs go down... they may celebrate at least temporarily.  I also wonder what the critical mass of terrible stories will look like and whether it actually will affect how we talk about healthcare once big changes are pushed through.

Interesting times.

[protostache]

Here's an excellent article from the NY Times reviewing the new health care reform efforts by the Republicans.
Bottom line is it would bring us back to what we had before, dozens of pages of filling out medical history on the application.  Rejecting you if you have anything wrong, or charging you more, or claiming that you lied on your application when you do get sick so that they can then pull the rug from underneath you when you actually need your health insurance.

https://www.nytimes.com/2017/04/20/upshot/new-republican-health-proposal-evokes-the-old-days.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news

Washington Post has an article up about the actual impact of eliminating community rating.

My wife delivered our daughter with only minor complications, so her health insurance will be $17,000 per year.

Seventeen thousand dollars per year.

I survived metastatic cancer, so my health insurance will go to $142,000 per year.

One hundred and forty two thousand dollars per year.

How is this good? Who actually wins here?

[NESailor]

How is this good? Who actually wins here?

In order:

• Insurance companies by eliminating sick people from risk pools = profit goes up
• Rich folks who own those insurance companies...to a much lesser extent
• Politicians who will claim they've slain the beast (that they fabricated for the fools to believe in)
• People who are healthy and never get sick (this is only temporary in my opinion)

This is what I keep going back to - there will be short term winners - but the country as a whole will be worse off because a system like this is not sustainable (I guess we could claim it is...but it is definitely a drag on the growth of the country as a whole).

[OurTown]

https://www.americanprogress.org/issues/healthcare/news/2017/04/20/430858/latest-aca-repeal-plan-explode-premiums-people-pre-existing-conditions/

I don't get it.  This cuts across the political spectrum, so a lot of the "losers" will be Republican voters.

[OurTown]

"Completed pregnancy with no or minor complications" gets a 425% surcharge.  Wait a minute, that covers all moms! 

[Glenstache]

https://www.americanprogress.org/issues/healthcare/news/2017/04/20/430858/latest-aca-repeal-plan-explode-premiums-people-pre-existing-conditions/

I don't get it.  This cuts across the political spectrum, so a lot of the "losers" will be Republican voters.

... but not the well to do ones with alternate access to health insurance. Like the ones in congress, or sitting behind the desk at Koch Industries (who opposed the last effort because it did not go far enough).

[OurTown]

I have considered switching parties so that I could try to reform the Republican party from within.  Surely we could all benefit from a rational conservative point of view.  There might be rational conservatives out there who actually want good policy.  Yes?  No?  Hello?

[Glenstache]

I have considered switching parties so that I could try to reform the Republican party from within.  Surely we could all benefit from a rational conservative point of view.  There might be rational conservatives out there who actually want good policy.  Yes?  No?  Hello?

Unfortunately the two-party winner take all primary system has the unintended effect of biasing election results towards the fringes and away from the center. I don't think that you will have much effect as a single voter, but pushing for things like impartial redistricting to reduce gerrymandering and ranked voting would likely shift the needle closer to the majority of the populace. In principle, those should be non-partisan, though in practice they are not.

[NESailor]

I have considered switching parties so that I could try to reform the Republican party from within.  Surely we could all benefit from a rational conservative point of view.  There might be rational conservatives out there who actually want good policy.  Yes?  No?  Hello?

Good one!  Starbucks apparently offers a unicorn frappuccino so I'm assuming there must be unicorns out there.  Kind of like rational politicians (of both leanings) as far as I'm concerned.

[OurTown]

I have considered switching parties so that I could try to reform the Republican party from within.  Surely we could all benefit from a rational conservative point of view.  There might be rational conservatives out there who actually want good policy.  Yes?  No?  Hello?

Good one!  Starbucks apparently offers a unicorn frappuccino so I'm assuming there must be unicorns out there.  Kind of like rational politicians (of both leanings) as far as I'm concerned.

Maybe when the Cylons take over they will implement rational policies.

[dividendman]

Maybe when the Cylons take over they will implement rational policies.

Frak!

[DavidAnnArbor]

Paul Krugman's column:  A primer on the sorry situation:

https://www.nytimes.com/2017/04/21/opinion/the-balloon-the-box-and-health-care.html?_r=0

[Monkey Uncle]

Paul Krugman's column:  A primer on the sorry situation:

https://www.nytimes.com/2017/04/21/opinion/the-balloon-the-box-and-health-care.html?_r=0

Good read.  He basically points out what a lot of folks on here have been saying: that Republicans had no intention of actually replacing the ACA; they just want to go back to the good old days when only the wealthy, healthy, and young could afford health care.  But now they're running up against a public that has come to expect that the less fortunate among us should also have access to health care.

[Monkey Uncle]

A couple of opinion pieces from opposite ends of the political spectrum, both of which argue that the US is headed inexorably toward universal government funded health care:

https://www.washingtonpost.com/opinions/sorry-republicans-but-most-people-support-single-payer-health-care/2017/04/17/f0919bb6-23a6-11e7-bb9d-8cd6118e1409_story.html?utm_term=.35d4fa602baa

https://www.washingtonpost.com/opinions/the-road-to-single-payer-health-care/2017/03/30/bb7421d0-156c-11e7-ada0-1489b735b3a3_story.html?utm_term=.fbe04d2c66f7

I think they're right in the very long run, but I don't see a political path that would take us there any time soon.  I disagree with Krauthammer that Trump is likely to flip and go single payer.  Even if he did, Democrats would need to control both houses of Congress for it to pass. 

My prediction (for today, at least) is that the Republican repeal/replace chatter will gradually die down, and we will keep limping along with the current version of the ACA until the Democrats are able to regain full control of the federal government.  As I've expressed in a previous post in this thread, I don't see a real chance of that happening before 2023, due to the need to first re-take all the statehouses and governorships that they've lost over the last decade, so that they can then un-do all the Republican-gerrymandered house districts during the round of re-districting that comes after the 2020 census.

[EnjoyIt]

I learned something today about the infamous healthcare of Germany and its single payer system. All employees pay an equivalent to medicare tax which is taxed at about 15%.  7% is paid by the employer and another 8% is paid by employee. This is capped at about $5500/yr which means that everyone who works pays for their own healthcare and pays taxes in Germany. Someone making $30K/yr will be paying their share of their medical costs.  in 2011 91% of Germany's population partook in the government funded healthcare.  Only 9% solely had private insurance and another 33% had both. Another interesting fact is that in 2011 about 1/3 of the hospitals in Germany were losing money. 

Although Germany is able to cover their entire population not only are the poor paying a large portion of their income for their healthcare, the system is struggling to stay solvent.

[DavidAnnArbor]

Great news analysis about how much bloat there is in health care spending

What jumps out at me is that the US spends 8% of health spending on the administration of it, versus 3% globally. Administration is the paperwork and medical coders and claims administrators.

https://www.nytimes.com/2017/04/22/opinion/sunday/our-costly-addiction-to-health-care-jobs.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-top-region&region=opinion-c-col-top-region&WT.nav=opinion-c-col-top-region&_r=0