Fisher: Ah okay, that makes more sense. Would you agree that education reform would be in order alongside this healthcare reform bill to make it truly work?
Fisher: Ah okay, that makes more sense. Would you agree that education reform would be in order alongside this healthcare reform bill to make it truly work?
There was a debate on the subject of administrative costs in the blogosphere a few years back due to a study by conservative "think tank" Heritage Institute. The summary of the argument is that comparing administrative costs as a percentage is misleading. Medicare is a program for the elderly, so they spend far more on healthcare than the average person, but administrative costs are fixed costs. Since per capita spending on healthcare is higher for Medicaid patients, looking at administrative costs as a percentage of total spending is not a good measure of relative efficiency.
Here are some links:
Book's Original Study.
Paul Krugman responds, twice
Book responds to Krugman.
This dude summarizes, and points out a statistical flaw in Book's approach.
Make of that what you will. But here's two points I'd make that go in opposite directions:
1. Discriminate programs have higher administrative costs than indiscriminate ones. All that's really required to gain Medicaid benefits is that you're past a certain age and have worked a long time in the US. The administrative costs of getting an insurance plan involve checking for pre-existing conditions and other investigative procedures to make sure you are eligible. All those investigative procedures add to the administrative burden of private insurance, which makes public provision of healthcare cheaper in this aspect.
2. Money spent on marketing and other overheads to keep private insurance companies running are considered administrative costs, but the deadweight loss of taxation isn't. The question I'd pose is, if you factor in the cost of taxation itself, is it really true that a single player healthcare system is more efficient? Calculating deadweight loss isn't simple, so my question is more of an open ended question than anything else.
So if you want to make the point that indiscriminate programs have a smaller administrative burden than discriminate ones, that's absolutely valid. It is not however proof that the public sector is more efficient at performing the same task. It's proof that the public sector can be more effective when it doesn't discriminate at providing a particular service. Subtle, but important distinction.
It's massively ironic that denying coverage for pre existing conditions increases the costs of administration, offsetting [to a degree] the gains to avoiding adverse selection.
Last edited by roflmao; 30th Jun 12 at 2:20 PM.
Debt and GDP have nothing to do with this though starfisher, their irrelevant.
The point is that what you draw out in state benefits should already have been paid in by you years ago when you where working. In practice of course we actually take money from the currently working to give to the old. But the theory still works because it's built on the following, (generally true), assumptions:
1. An OAP is not going to be bringing money in for a family. They've no dependents and thus their "minimum living standard", involves a much lower values.
2. An OAP will have paid of all their debts, they don't need to bring in further money to cover that.
Points one and two mean that to meet minimum needs a working age person is going to need to bring in that much more money than will be required by an OAP, just to meet minimum breadline. And it is an expected fact of the system that the vast majority will in fact be above the breadline. Since whatever money they get from their employer to meet needs is going to be after taxes. If the base tax rate is high enough, they'll pay more in taxes each year than a single OAP is drawing out.
Let me try a worked example. I'm gonna use C-Bills as the example currency as I want to stick to a made up currency and MWO is a big discussion point for people round here so it was a convenient place to grab such a currency.
Let us assume that the breadline income for a childless, debtless couple per year is 10,000 C-Bills. Someone on that can live right on the bread line. Let us then assume each Child in the family adds a further 2,500 C-Bills to the breadline on a per year basis. Lets assume average debt drains a further 10,000 C-Bills per year. That means a 2 child family, (if this was average population growth would be zero assuming no deaths of any individuals prior to having their 2 children), has an average required yearly income to sit on the breadline of 25,000 C-Bills. Lets assume the only tax is Income Tax, (makes it far easier to calculate). If the tax rate is 30%, (pretty dammed low compared to where i'd expect it to be), that means that the family is actually earning 35,700 C-Bills a year and Paying some 10,700 C-Bills a year in taxes. That means in theory they can support 1 OAP on their taxes. But wait, that’s not all. Let us say that in this made up society you start work at 25 average and work till your 65. Average life expectancy is 90. That works out at you paying into the system twice as much as you'll be taking out. Which not only leaves tax money free for other things, but provides some degree of saftey net in case of a surge in OAP numbers.
Now I’ll address each of my own points plus your baby boomer point.
Baby Boomers first. Simply put their irrelevant on the most basic level. Yes our horrifically shortsighted politicians of yesteryear have screwed things up for us. But the big point about the baby boomers is that they too will die someday. The only way the OAP vs Working age imbalance they represent is going to continue is if we slip into sharp and increasingly sharp negative population growth. That not likely as we'd wipe ourselves out in a matter of generations if that happened. You can't sustain ever increasing negative population growth for many generations and still have a species left at the end of it. This is where having a nice clean debt sheet would have been handy. We just go into debt for a generation or two, the baby boomers die off, the population growth rate hits a nice median points, OAP to working age returns to a more balanced ratio and then we pay our debt off. Problem solved. Of course given our current debt mountains it IS an issue, but not because there's something inherent about the system that creates it. It’s mismanagement that’s causing it.
People living beyond retirement age by greater amounts basically screws up the ratios of input to output, if the system is robust enough it can handle some varying. But eventually it starts to put excessive strain on things. The bigger underlying issue is that whilst medical care is doing a great job of allowing people to live longer, it's not doing such a great job of keeping them fit healthy, and otherwise in good shape to handle the rigors of work. This makes raising the retirement age very tricky as it means putting people who are starting to show and feel their age in jobs, which is not a good way to get either a productive or willing workforce. The latter helping reinforce the former. We basically need to put more money into medical research aimed at keeping peoples bodies functioning at that "youngster" level.
High unemployment amongst young people has obvious implications on their ability to contribute into the system. But it's being driven by a few different things that come back to the governments and their short sightedness, (again). Western manufacturing industries collapsed some year back when the third world finally became able to supply most of that stuff, and, (because of a variety of factors), produce it more cheaply. We suddenly saw a lot of the non-breadline jobs disappear overnight. Now I’m not going to claim that there hasn't been some new jobs created that are non-breadline that take advantage of the one thing first world countries do have that the third world doesn’t, (namely a highly educated workforce). But I think, (for the U at least), all the statistics about the number of university graduates unable to find jobs in their fields and the number of people on the breadline clearly show it's not enough. Fundamentally this come down to how expensive many such things are to start up. And because of our anti-monopoly laws and the like, companies aren't willing to take that big a risk without help, (typically governments being the only people they can turn to, who are non-too cooperative for various reasons). Of course you could go on and point out that the companies are being equally short sighted and protecting their own bottom line at the expense of society at large. But then that’s how capitalism today works. It's got it's downsides as well as upsides, same as anything else.
The final issue is the aforementioned high incidence of breadline jobs, these produce only very minimal tax returns, (I sometimes think the plethora of taxes that are on things besides the basic wage are there just to eek more out of these people to cover mismanagement), so exacerbate the issues. The cause though is the same as high unemployment. When you don't have many of those "special" jobs, all you have left is the basic bare essentials any country has to provide for itself. Food, Water, Heating, Lightning, and the maintenances and transport elements of all of the above. But you can only support so many people in those kinds of jobs and a great many tend to be very lowly paid as they're mostly unskilled jobs.
The fact is governments should have seen the issues the loss of the traditional industries would cause, and the reasons why they weren’t going to self replace as they did i the past, and stepped in to fill the gap and get things moving again. Even before that they should have seen the baby boomer issue coming and have cleared as much debt as possible while putting money by to try and stave off a debt rise. And by now they should have already figured out what they're going to do when, (inevitably), the third world starts to catch up to us and suddenly cheap manufacturing via cheap labor goes south. But they're so caught up in getting elected next time they don't care about what happens 20 or 30 or 50 years from now. Polition’s are inherently more interested in themselves and their power than in doing their job. Namely making sure the system that is their country operates today and will continue to operate for the foreseeable future.
That isn’t meant as an anti-democracy or anti-government rant BTW. Every system has it’s upsides and downsides, but the current failings of the system are glaring and very annoying for me personally.
I don't know what i'm talking about, ignore me.
Thousands of years ago, Egyptians worshipped what would become our ordinary housecat. The cats have never forgotten this.
I hate to say this to you after such a long post, but your entire thesis rests on a situation which has never occurred in history - some magically well run government that doesn't go into debt. History shows that every 80-100 years (often more frequently) there's a major credit and debt crisis that blows everything up. This suggest that there IS something "inherent in the system" at work here. Game theory/rational agent modeling of government spending makes just about anything sound good. Throw in real people and all the sudden just about everything fucks itself.
So, yes, if we had magic government that never borrowed from the future, you could make it work. That would be the "balanced life cycle" Moe was talking about. Problem is, we're not there. We're not anywhere NEAR there. Right now, we're already hip deep in a debt crunch endgame.
And Debt + GDP are absolutely essential to understanding why we have the crisis we have. In your magical scenario, debt would never grow faster than GDP or even not exist at all. Reality, unfortunately, is not so rosy, and the key to understanding why is debt versus GDP.
rofl: I don't think it's reasonable to expect health insurance to be a for-profit industry in the long run, unless you start leaving people out. That to me is antithetical to the whole notion of private insurance companies prospering left and right. I'm well aware of the other side of the argument, and it's not like their ideas are bad - minimize waste, offer choice, minimize fraud and all that - but I just don't see how you can realistically achieve that in a free market scenario without pissing all over the social contract.
There is nothing to force a private insurance company to use its profits to reduce deductibles and premiums, to offer more preventative care, or even to build a rainy day fund in case healthcare costs spike. That to me is the biggest problem. Healthcare should be like national defense IMO - it's something that we need and we accept that it won't be profitable in an immediate monetary sense, but it's required to safeguard our whole society.
roflmao: I'm not sure to what degree this counts as anecdotal evidence, but both my parents work in Public Health and it's apparently accepted as a given there that private health insurance is more wasteful than government, due to some specifics to do with the health insurance industry (admin costs relative to population possibly).
Care to source that claim that we get a major debt problem every 80-100 years becuase to my (admittedly limited) knowlage this ios the first tme goverments have gone into this kind of debt outside of a major war or similar economic drain. What i was describing dosen't need zero debt, it just needs enough room between current and peak possibble levels to allow for an emergancy situation like the baby boomers.
I'm also not remotly sure what that actually has to do with my point. The economics of OAP pensions aren't dictated soely by debt. That's creating a current problem yes, but it's a short term problem that in a few decades will not exist. Once where over that molehill, (i.e. the baby boomers die off and pop growh finds it's new range), our level of debt becomes completly irrelevent to our ability to provide OAP's with their penshions. It's only a factor now because of how recent sharp changes in average birth rate have created an imbalance in terms of old vs young numbers.
Our long term ability, (i.e. outside of a crisis), to do it is determined by our ability to keep the young
A) in work
B) earning enough that we can tax them enough
I've allready shown how even with a pretty high average life expectancy, (current is somwhere in the 70's AFAIK), and a very low average level of tax, (based on one common claim i've heard the total for uk taxes is equivelent to a roughly 75% income tax), we can make the economics work with quiet a lot left over.
That 'very low average level of tax' is wicked high in the US - it's only a few percentage points lower than the maximum marginal tax rate for individuals.
Carl, I don't think you understand government financing. To argue that debt is "irrelevant" ignores the basic reality of how modern governments get money to spend. Your point appears to be "If everything worked perfectly, we'd be fine." I do not contest that point. Instead, I offer a counter-point: "Yes, but things never work perfectly".
As for a source for my claim, read This Time Is Different, Devil Take the Hindmost and related books. In the history of modern capitalism, there has never been a time like what you describe. Barring some radical developments, there will never be.
Starfisher it might be worth explaining how dept and GDP result in the current pension system being flawed/broken, I'm pretty sure I understand why but you seem to better versed in it and I may be wrong. I also cant imagine Carls going to read that book before coming back to this thread in all honesty either.
(Formerly "The Herald")
"The bible is like an EULA. People just scroll past everything and click "I agree" without reading it."
@Moe: I get where you are coming from. A healthcare system that denies coverage to those who most need it isn't a genuine healthcare system. I get that. I guess the main difference stems from the fact that I do think a private-based solution is workable if subject to certain regulations accompanied by reform, and you're more of the mindset that healthcare is a human right that should be guaranteed and provided by the government just like national defense.
Oh I didn't respond to your post.
The systems are similar in that:
- It is insurance based, not a socialized means of distribution like most UHC programs.
- There is a minimum benefit package defined that insurance companies must comply to.
- Pre-existing conditions must be covered.
- Individual Mandate forces everyone to buy insurance.
- Means-tested government welfare system to give money to those who can't afford insurance.
The systems vary in that:
- Insurance must be bought by individuals, it isn't provided by employers (this is huge).
- No Medicare or Medicaid, it's all through the (highly regulated) insurance system.
Most of what I've been saying so far is just me parroting a lot of the talking points Avik Roy throws around. In fact, most of what I've said in this thread is neatly summarized here in case you are interested.
So, for me, what's so nice about the Swiss system is that it seems like it's actually something that could be achievable (hopefully). And it works fairly well! You're never going to convince any libertarian or conservative to adopt a UHC program that's entirely government operated, ever. And similarly no left-wing person will ever adopt a system that doesn't insulate consumers from costs. After all, one of the major pillars of UHC programs is that preventative care is the best type of care.
Personally, I'd be more in favor of a system that doesn't insulate consumers from costs, as I believe that insulation is by far and large the main driver in high healthcare costs, far beyond administration. Singapore, consequently, has one of the lowest per capita spending rates for healthcare of all major economies. It works through a two-tier system where they offer universal catastrophic health insurance through Medishield, just like Medicaid, but all other expenses come out of a savings account called Medisave, which is basically a voucher system. Medisave is a substantial but not infinite savings account that theoretically covers all your needs. But, if your Medisave money runs out, it's out. By not insulating consumers from costs, the costs of healthcare go dramatically down.
Insulation drives people to over consume, and I think that's a bad thing. People who support UHC programs however think that it is a massively good thing, which is why a Singapore model of healthcare would never be adopted in the States.
Last edited by roflmao; 1st Jul 12 at 11:51 AM.
I could probably whine and wax philosophical, but my objection to this legislation is the same as every other showboat piece of legislation- I do not want the government to do things for me. I don't want them to take my money, I don't want them to provide me a service, I don't want them to hold my hand, and I don't want their involvement in my life whenever it can be avoided.
Yes, you can go into the libertarian anarchy disaster counterargument, but my point/position is simply that everything the government meddles in turns to crap through red tape, bureaucracy, and legal inertia. I've just come back from the midwest to New York State for holiday, to visit my mother, and it's a striking dichotomy from small-government nonintrusive states (I've been living in Kansas), to the juggernaut of regulation that is New York. That kind of drag on the function of commerce, which is what creates jobs, prosperity, and low prices through competition, is simply an anchor against progress, and yet the solution I always hear touted when it's failing to work is to try again even harder.
I realize it's political suicide to say "we can't fix that" or "we shouldn't fix that" or even "we can't live up to campaign promises", but this sort of behaviour is maddening, and yet the entitlement systems continue to "mission creep" into every aspect of life like arterial plaque.
And rather than actually work on dieting the government, politicians tell us to just take a blue pill.
I'm seriously, though not in a crazy way, anticipating a Wiemar-level reboot to the economy at some point. It's simply an untenable pattern of growth versus resources from where I see it.
And as a young person who has been struggling with the job market despite readily saleable skills BECAUSE of government meddling, it's doubly stressful, because it's inescapable- I'm not working because the job market is crushed by the burdens imposed, and if I do work it paints a target on me that I'm a donor to whatever redistributive plan is presently in vogue.
The hungry, ignorant man immediately grasps that he is handed a fish, but is bewildered when handed a net. The man who shivers in the cold thinks happily of the man who invites him to sit by his fire, and somewhat poorly of the man who loans him an axe, flint and steel.
Debt to GDP simply shows the sustainability of the course you're on. If debt growth year over year is higher than GDP growth year over year, you are on an unsustainable path. I'm talking about total debt here, incidentally, not just government debt, because while government debt is a problem the broader economy suffers mightily after a debt bubble pops (also lowering tax receipts and making people less capable of paying into the pyramid scheme). Debt growth in excess of GDP growth must inevitably collapse, and the whole economy will suffer as bad debt is wound down. You can have a nice neat and tidy pension system that gets annihilated because all the sudden the people paying in are unemployed and the money promised gets used for "emergency" funding elsewhere in the government.
Carl appears to be arguing that if your government was careful and well run, it would never allow debt to grow faster than real prosperity, essentially guaranteeing that the system is always fully solvent. My point is that such a situation has never existed, so it's of the same practical value of saying that communism works in theory. Sure, maybe, but we live in real life. The books I reference chronicle example after example of governments and private enterprises engaging in excessive lending, showing that there's no evidence to suggest that any system predicated on "well, if everyone behaves" can work in practice. Pension systems are not divorced from the wider world and in fact are often the victim/perpetrator of debt bubbles and extremely poor planning. For example, in the US, many public worker pension funds are predicated on 8%+ growth in the stock market. If that doesn't happen, they become underfunded. Why should I believe that the next people to plan a pension fund are going to do a better job and use more realistic expectations?
I think that's a fair summary. However I will acknowledge that it is not that easy in that healthcare is expensive, in that there is an important private component to it (pharmaceutical, medical technology industries) and that this makes it problematic. This situation is quite similar to national defense by the way; here you have Lockheed and Boeing building planes rather than Novartis and GlaxoSmithCline building surgical tools, but the private/public mishmash is the same. I'm ok with a hybrid system and with private enterprises entering this system provided that they are subject to strict regulations. Ideally I would like to see something similar to the postal system, where you have a government program (USPS) alongside private companies such as FedEx or UPS.I guess the main difference stems from the fact that I do think a private-based solution is workable if subject to certain regulations accompanied by reform, and you're more of the mindset that healthcare is a human right that should be guaranteed and provided by the government just like national defense.
Got it, thanks. While I'm still not sold on it, I think I get it a bit better now.Oh I didn't respond to your post.
My Interceptor is better than your Interceptor.
Starfisher. This has nothing to do with a perfect scenario. It has everything to dfo with the FACTS, (that I’ve shown), that outside of their being a serious imbalance in the young vs old population you CAN easily and cheaply finance pensions directly out of taxes with plenty to spare. Debt only even enters into the equation when their is a very sharp difference between young and old as that is the only time the pensions system needs to borrow money to pay the OAP's. At any other time it does not.
Now if you want to argue that the debt repayments are going to make the system unsustainable, that’s fair enough. Except it's not just pensions this applies to. Under that theory any aspect of government spending that is non-zero is unsustainable, any economy we can possibly have is unsustainable so under that theory when this all goes south we won’t have any government spending or any economy at all,. And that is ludicrous.
Also ewoks has a point, I’m not inclined to track down 2 copies of books and read through what is probably several hundred pages just for the sake of an internet argument. It also doesn’t really address my point vis a vis why those occurred. As I said, my knowledge of this stuff is limited, but to my knowledge previous debt spikes have always been associated with was and their post war recovery periods. This graph i dug up, (i haven't had chance to read the attached text), seems to support this. Debt first spikes with WW1, then it levels off before rising slightly coinciding with the great depression, (which by your claim would be a result of the high post WW1 debt), then dropping again till the start of WW2 where it climbs sharply against, stays high for a period thereafter, and then drops shapely thereafter.
I'm not saying we won’t see debt spikes. But the idea that where guaranteed to see them on fixed timescales with fixed magnitudes strikes me as a bad assumption because that ignores the varying reasons these debt spikes happened. Based on the evidence of the last 100 years their strictly associated with wars. So unless where guaranteed to have a war every X number of decades there is no guarantee that we'll see an equivalent debt spike, or that said spike will go as high with as disastrous a set of consequences. Doesn’t mean it won’t be painful, but that doesn’t mean it will be on the scale your assuming either.
Carl: Your analysis was basically that 100% of the taxes of the top marginal tax bracket in the US would be able to fund two retirees. That's not 'affordable' - it means both that massive tax hikes would be required and you'd need to eliminate every single other method of government spending, such as roads, police, or the military.
It also completely ignores health care, which is what this thread is about.
@Langly: I assmed a base tax rate of 30%, as i allready explained, that about 40% of the actual rate here in the UK. We could afford 5 retierees per working adult with that tax rate. In adittion assumign a loosely stable population growth their would be 2 workers for every retieree. So that raises it to 10 per working person. That leaves oodels for other things. I've also added over 15 years to average life expectancy there...
Now if somone wants to shows that the living cost differnace between an OAP and a worker isn't as great as shown, then thats a valid counter. I didn;t have any data to base numbers on so i was fairly conservative with it.
40% is the income tax rate.
The real tax rate of the average UK worker is up around 70%+ when all forms of direct and indirect taxation on the income and purchasing sides are taken into account.
You're talking about first world nations which tend to have very low growth rate. The growth rate of many western nations is barely above zero, or in the case of Japan and Germany actually negative. You say "oodles" are left over for other things, which I assume means building roads or national defense. How much exactly is "oodles", and how does that compare to what we spend on those things now?In adittion assumign a loosely stable population growth their would be 2 workers for every retieree.
That base of 30% is the highest marginal tax rate in the US.@Langly: I assmed a base tax rate of 30%, as i allready explained, that about 40% of the actual rate here in the UK. We could afford 5 retierees per working adult with that tax rate. In adittion assumign a loosely stable population growth their would be 2 workers for every retieree. So that raises it to 10 per working person. That leaves oodels for other things. I've also added over 15 years to average life expectancy there...
Your assumption about stable population growth is also off (hint - it isn't stable), as is the assumption that every working-age person will be able to find work.
Also: In the US, about 50% of all workers pay no federal taxes after taking into account all the benefits they receive.
If you bothered to read those two books, you'd discover why your argument sounds hopelessly naive vis-a-vis good governance. But, let's ignore that for now and look at some more facts.
Right now, the US spends ~50%+ of its yearly budget on welfare, healthcare and pensions. 35% of the budget this year was funded with debt (ie the deficit). You claim that there's "oodles" left over after one pays for social programs, but let's take a look at reality. Here's a handy pie chart to help visualize things, and here's the wiki so you can verify the 35% deficit figure (enacted deficit/enacted expenditure).
If we immediately ceased deficit spending, we would have to cut the budget by 35%. We're granting that social programs stay, which means that ~50% of the budget is locked in, so another way to look at this is that we can add 15% more of the existing budget back into our fantasy budget. We can't not pay the interest on the national debt without causing a debt crisis (irrelevant, I know), so that's needs to stay, leaving us with 9% to go. Everyone hates the military, so let's just cut that entirely (let's ignore the gigantic recession and resulting drop in tax receipts that would cause). Everyone loves education, so I guess we should keep that in there, so now we have 5% to play with. Let's see. Other spending? But then we have to cut transportation and shut down all the prisons. Let's keep the prisons and transportation and 2% of "other spending".
So in our new reality, 76% of the government is devoted towards retirement benefits and health care. We have no military at all and have eliminated funding for the basic functions of the government ("General Government" getting the axe means that now a ton of federal salaries aren't going to be paid). We've dramatically reduced federally funded research, there's no more federal fire fighters (sorry Colorado) and the EPA is a memory. Oodles of stuff?
I'm taking this from the ground up, the way the government has been pulling money from education shows a large and clear intent.
From the 1980s through the today we have had an odd and very disturbing trend. Educate in general for the public has been cut, trimmed and then planned for more cuts. This is not fat that it is cutting out, but thought.
These days schools are being closed, those kids are then shuffled into another school which is provided a lower budged to handle the kids they have and the new inflow if kids. Schools then have to cut more educational days (fun for the kids in the short run but in the long run going to cost them). We are not talking about a couple days, we are talking a months off the system. As well cutting after school stuff off nearly all together. Football, Baseball, Soccer, Band? Most of these have been cut or trimmed to none existent.
What I see in my humble eyes is that the government, or more to the point the government has been sold to the corporations which don't want thinking, educated masses. They want drones, lower class fodder who knows no better and who's education was so short and split down they have no way of even comprehending how much less they had been given.
Who will fill those lower class jobs, who will fill the position of solder (with promise of education and money?), who will be now the middle to lower class? In truth Middle class is as much a lower class now that the divide is high enough. They need bodies, they need drones and they need them uneducated, uninspired and obedient. Turn on your TV, watch your news and soak your half truths with a straw.
The public universal healthcare/private insurer split works reasonably well here in Australia. Yeah, Medicare here costs a truckload of money, and Australians pay relatively high income taxes to support things like Medicare, and mostly-free tertiary education. The Boomers are a bit of a problem in that sense here in Australia too - but a forward-thinking Labor government in the 1980s introduced compulsory superannuation - which will easy the burden of pensions and the like on future generations as the Boomers retire. It also means that Australia has artificially high private savings - which means our debt-GDP ratio is (moderately) healthy. Wealthier Australians tend to invest in private health insurance despite the presence of the free public system. In the private system, particularly for elective procedures, you will be seen faster, and be back on your feet more quickly. Hence, if you've got the money, the private system is still appealing.
@ Vaarok - I would argue that one of the primary reasons for the GFC was insufficient regulation and oversight of financial institutions. I hate to bang on about Australia, because we aren't the paradigm case that everyone should emulate, but we regulate the absolute bejeesus out of our banks. Predatory lending of the sort which arguably precipitated the GFC (Sub-prime mortgages. Remember those?) is actually illegal here, and the regulators (mostly) enforce these rules. Result - Australian banks had limited exposure to the sub-prime crisis, and mostly emerged still functioning. Regulation need not and should not be about stopping people form doing stuff generally - it should be about preventing them from doing catastrophically stupid and irresponsible stuff.
All we want to do,
Is eat your brains.
We're not unreasonable,
Nobody's gonna eat your eyes.
I like the future view, mostly because their linear extrapolation for 2016 shows how absurd the budget plans being put forth by both parties are when it comes to "reducing the debt".
I can't imagine the backlash a President would get if they introduce something like a Carbon Tax, considering the backlash Obama got for wanting to give out free health care.
@Akranadas: There is no such thing as free health care.
edit: "free" doesn't exist. The closest you get to free is sunlight and even that isn't free. Somebody owns the land that sunlight is falling on and that somebody has to pay for that land in some way. Even the air you breath has a cost. Because it costs to prevent other people from making the air unbreathable in your area.
Most people think of free like "free T-shirts" in that something is handed to me and I don't have to hand money to that person in exchange. Except that "free T-shirt" isn't free. It might be available to you at no cost to your self but whoever is handing them out had to either pay for them or get them from someone who did. Somewhere along that line somebody paid the "cost" of that shirt. Just because that cost isn't passed on to you doesn't mean it doesn't exist. Someone had to absorb that cost.
When it comes to the government is is absolutely impossible for it to do ANYTHING without passing that cost onto it's citizens. The government cannot give you something without first taking that something away from someone else.
Every penny any government spends it takes from it's citizens under threat of violence. Democracies are supposed to ease this issue by having the citizens agree ahead of time what they will part with to maintain society. But you should never forget that your vote is a vote to force others to do as you say under penalty of violence.
Want a to feed the poor? A noble goal. Want to chip in with a lot of people to obtain that goal easier? A smart way to do it. Want to make a tax to support your project? You have just held anyone who otherwise wouldn't have contributed (for whatever reason) at gunpoint and taken their choice (and money) from them.
I am not saying that such a government project would be inherently bad or some such. I am saying that you have to understand that anything done through the government needs to be weighed against the damage it will cause. The good can outweigh the bad. The needs of the many often do outweigh needs or wants of the few. But it is incredibly easy for the wants of the many to oppress the few.
The healthcare bill's good may or may not outweighs it's evil. That can be debated and discussed at great length. It is not "free" though.
Last edited by TDATL; 24th Jul 12 at 4:53 PM.
You must be the change you want to see in the world.
Yes, I know that; you pay for the health care in taxes, or in our case a Medicare levy you pay at Tax time. But the notion of if I break my leg, I can turn up to any public hospital and be treated for it regardless of my level of insurance is, in essence free. As I am not required to pay upfront costs or pay after my leg is placed into a cast or after a doctor has seen me.
I never see the bills, I never have to fork over my paycheck to get healthcare; I can turn up and I know I'll be looked after - Free Healthcare. I can go private healthcare if I want extra coverage for things that my free health care doesn't cover if I want, or if I want other guarantees when I get sick. But I will not be turned away from any hospital for simply not having the cash to be treated.
You are simply wrong. If you break your leg and go to a hospital they will NOT treat you at no cost to yourself. You will be "stabilized" and be given a bill for it. If you want more then you have to be able to pay and either way they WILL give you a bill for stabilizing you.Originally Posted by Akranadas
There are charity run hospitals who will help you at no cost to yourself. That isn't paid for by with taxes though. That is payed for by the willing donations of other people.
I'm sorry, but you are not understanding me. I'm talking about the country I currently live in which has free health care. In which I can turn up to the hospital after having a tooth extracted and it breaching into my sinus cavity, then having a dental surgeon see me, patch me up with stitches and send me on my way and not have to see a single bill, ever.
How is that not free health care? How could you not want that?
Because it isn't "free." It is health care payed for by the government which means the government has to take more from it's people in order to sustain such behavior. That is not "free." The money to pay for that didn't pop out of thin air. Right now the US and most of the world is in a bit of a budget crisis. Tieing even more things into the government's budget is a spectacularly bad thing to do. If we had a surplus of money or the economy was up then it wouldn't be such a big deal.Originally Posted by Akranadas
You want to push the paperwork for handling paying your doctor onto someone else. Fine, hire somebody. You wanting to force everybody else to hire accountants and force them to then pay for someone to enforce that law so you don't have to see any bills is insanely selfish.
That is all you will be doing. If you aren't contributing enough to pay for your own expenses then you are stealing from someone else in addition to everything else. If you are contributing enough then all you are doing is forcing every one to pay the government to handle your medical finances for you.
edit: also you are forgetting that the US isn't getting government health care. We are getting government mandated health insurance. They are two totally different animals.
I'm not a fucking moron TDATL, I understand that the government pays for it, and that we pay for it through taxes and levies. But that is money I never see because it comes out of my paycheck before I even get a cent of it; so I never actually have to physically pay for the health care I receive through medicare.
My taxes go to a lot of things that help other people besides me, Pensions, Unemployment benefits, disability services but you know what, I don't care; I know that when/if I get into a position where I need assistance from my government in terms of money if I get unemployed or I retire that the government will assist me with that because others are paying their taxes. It's not selfish at all, I helped pay for others to live so that I in tern can get paid to keep living in my golden years or if I lose my job.
I'm not forcing my government to pay for my medical finances, but I damn well am glad I have a safety net in place so if I injure myself or get so sick I require hospitalisation that my government will step up to the plate in order to make sure I don't die. After all, governments are suppose to protect and help its citizens and what more basic way to do that then to make sure you citizens don't drop dead because they can't afford to go to the hospital. The best way a government can invest in itself is to invest in the well being of the population that provides it with the capital to continue.
From my understand, the only reason the US is getting that government mandated health insurance over universal health care is due to the constant changes made to the health care build that left it a shell of what it was going to be.
TDATL: Your analogy is completely and utterly wrong. Akranadas's example is not in any way, shape, or form similar to forcing everyone to hire accountants and force them to pay healthcare bills.
Instead, his situation is basically 'government-provided health insurance with no co-pay or deductible'. Sure, it's not 'free healthcare' (somebody is paying those bills, after all), but you know that's not what Akranadas was talking about, so your harping on the semantics is just bullshittery at its finest.
That said, I do believe teh 'no co-pay or deductible' bit is a bad idea, for the most part - institute a reasonable deductible or co-pay. Make it so the government-provided insurance is catastrophic-coverage only, perhaps (since hospitals are legally obligated to service those cases even if the patient can't pay), etc.
TDATL please explain to me why people buy insurance in the first place
@Langy & Akranadas: It isn't semantics and it doesn't matter if you understand that your "free healthcare" isn't actually free. Saying it is a free is misrepresenting it. There are people who will believe it is actually free and don't understand who is paying for it.
Calling it "free" is lazy at best and gross misrepresentation at worst.
@Langy: It is exactly the same. If you never have to see a bill then someone is being paid to handle that for you. If that someone is a government employee then you are forcing other taxpayers to pay for someone to handle your bills for you. Handling those bills costs something. Some people hire accountants so they don't have to handle their bills. Some people handle their own bills so they don't have to hire someone else to do it for them. Removing your choice to handle your own medical finances prevents you from saving money by doing it yourself if you so desired.
Yes the cost of that accountant is going to be spread over a lot of people but the same system could easily be setup in an opt-in fashion. As it stands it is needlessly limiting personal freedoms with reguards to how people choose to handle their finances.
@Mac_Bug: The reasons vary but the two main ones are as follows.
1. People want a safety net. They worry they won't have enough money on hand (for whatever reason) to handle the finance issues of an emergency. So they pay someone else to handle said finance issues. People generally don't word it that way but that is what they are doing.
2. (In regards to medical insurance specifically) Due to several factors medical costs are artificially inflated far above their actual market costs. Paying for your own treatment out of pocket is exorbitantly expensive. This ties in with #1 and people go with the more financially safer method. This is in large part caused by the between government provided insurances and various healthcare providers. Both sides assume the other is corrupt and misrepresent their own costs and data in an attempt to keep ahead of where they think the other is going to be. This is a huge issue that I will elaborate on at a later date if you wish.
Really because people just looooove going to the doctor and if they don't have to pay for it they'll just go all the time.That said, I do believe teh 'no co-pay or deductible' bit is a bad idea, for the most part - institute a reasonable deductible or co-pay. Make it so the government-provided insurance is catastrophic-coverage only, perhaps (since hospitals are legally obligated to service those cases even if the patient can't pay), etc.
Name one?Saying it is a free is misrepresenting it because there are lots of people who actually believe that it is actually free and don't understand who is paying for it.
Remember: you're a blogger. Pretense is your co-pilot.
@TheDeadlyShoe: You can't be serious. Name one? Fine. Bill Smith, I know him. I also just made him up. Unless you want me to point out a public figure, there is no possible way for you to tell if I am completely lying to you or not. Thus making me name someone absolutely useless. Restricting this to public figures who have publicly stated their beliefs on such a specific matter (and in a manner that is verifiable through the internet) is narrowing the pool of possible people down to at best a thousand people in the world.
The amount of work I would have to do to prove to you that such people exist far FAR exceeds the amount I am willing to put into a debate on an internet forum over something of relatively trivial importance to me (that something being if you believe that such people exist.)
No, I'm fairly sure everyone in Australia knows they and the government are paying for healthcare because it says so on their tax return, under the thing call Medicare levy. I'm sure most Australian's don't care that they are paying for this health care even if they only use it a few times in their life because they like the idea of having a safety net around them in case something bad happens.@Langy & Akranadas: It isn't semantics and it doesn't matter if you understand that your "free healthcare" isn't actually free. Saying it is a free is misrepresenting it. There are people who will believe it is actually free and don't understand who is paying for it.
Again, I'm talking from experience of using and paying for my countries Universal Healthcare system, which we all call Free healhcare.
I've got a Mental Floss article about this somewhere that I can dig up some specific names from if you'd like, but there was an American think tank which looked at this question back in the 60's, and in order to answer it they actually ran a health insurance company for 2,000 people. 1,000 had no deductibles or copays, the other group had payments in line with the industry at the time. What they found at the end of the study was that both groups were equally healthy, but the group without payments went to the doctor significantly more often for sniffles and the like. Without some kind of financial incentive to take care of minor matters themselves, they just had the doctor check them out no matter what.Really because people just looooove going to the doctor and if they don't have to pay for it they'll just go all the time.
Yeah, going to need some kind of link for that.
It takes a lot of argument
to convince most people
that they are lying.
Found it. I'm glad they published this on their website as well, I couldn't find it in my back issues of the magazine. Scroll down to the "Healthy Choices" section. Looks like I got the numbers wrong on the sample size though, it was 5,000 instead of 2,000.
@ TDATL. You'd either have to be a drooling, shambling moron or so divorced from reality as to be certifiably insane to believe that 'free' public healthcare (such as we have in Australia) is actually completely free. What 'free' means in this particular instance is that you are not billed directly and immediately for your treatment. In other words, I don't have to cough up 'x' dollars for the doctors to treat the compound fracture of my leg, or, as has happened to me numerous times, have my damn kneecaps put back on after a dislocation. Your argument that forcing people to pay taxes for this is wrong is a different matter. In Australia, we pretty clearly believe that paying our taxes for Medicare is a good thing. We like our publicly-funded health care, and our publicly-funded (tertiary-inclusive) education and our elections continue to prove that we are willing to pay for them. Is it socialist? Probably. Is it a good thing? In my opinion, yes.
Take a single instance of Australia's vast public health system, the Pharmaceutical Benefit Scheme (PBS). In essence, this is a scheme by which the Australian Federal Government subsidises medication (any medication approved by the scheme) to any Australian who is prescribed it by a doctor. At various different levels in the scheme, prices are capped, and the Government pays the difference. This essentially has the effect of turning the entire Australian public into one enormous consumer bloc, resulting in huge bargaining leverage with pharmaceutical companies. This is why, periodically, the US government attempts to get the Australian govt. to scrap the PBS - the US pharmaceutical lobby *really* hate it. Australians (sometimes) are willing to accept that they live in a society, and to act in the best interests of that society. Occasionally this might not benefit me personally, but we, on the whole, like the kind of country that behavior creates.
Massive disclaimer: Australians aren't perfect, and nor is our country. I wouldn't say that, and nor am I attempting to imply it. Public health care is something we do pretty well though, IMO.
In any case, it sounds like you just don't like insurance of any kind. If you can hold onto that sort of opinion, it's impossible to debate anything with you - our points of view are way, way too far apart.
Maktaka: Unless you have a more detailed source, I'm going to say that you saying:
Is massively misrepresenting their findings.What they found at the end of the study was that both groups were equally healthy, but the group without payments went to the doctor significantly more often for sniffles and the like. Without some kind of financial incentive to take care of minor matters themselves, they just had the doctor check them out no matter what.
There was a documentary about tax on the BBC last year, one of the interesting things in it (UK based obviously) was that unless you're a top rate tax payer you are a beneficiary of government spending. The amount of money you take in a lifetime for medical care, schooling, transport infrastructure, defence, emergency services, sanitation, benefits, pensions etc. greatly outstrips the money that you put into the country via taxation, even if you work your entire life.That is all you will be doing. If you aren't contributing enough to pay for your own expenses then you are stealing from someone else in addition to everything else. If you are contributing enough then all you are doing is forcing every one to pay the government to handle your medical finances for you.
I'm guessing that it works similarly in the US, as although you've got less of a social safety net you've also got lower taxes, so unless you're in the top 10% or so of earners then you cannot afford to directly pay for the services you benefit from and are therefore "stealing" from everyone else. If you pay for your own medical insurance and actually need to use it for something major, then it's likely the amount you've paid in won't begin to cover it, so you are "stealing" from those who've paid their fees and never used it. It's exactly the same as a national health care paid for by taxation.
@LoCo Or misremembering the details. This was an article I read from almost three years ago, but I remembered the ideas (as best I could anyway) because it ran contrary to what my idea of superior health care practices was at the time.
The point is the same though: without a personal financial investment in the remedies for their own ill health, people were worse at taking care of themselves, instead leaving it up to their health care plan to make up the difference. The question is what level of personal financial burden does the patient carry to keep them looking after themselves without bringing about undue hardship on those who have a hard enough time affording health care as it is.
So in other words people purchase insurance because they get more out of it than they pay into it. "If you aren't contributing enough to pay for your own expenses then you are stealing from someone else in addition to everything else"@Mac_Bug: The reasons vary but the two main ones are as follows.
1. People want a safety net. They worry they won't have enough money on hand (for whatever reason) to handle the finance issues of an emergency. So they pay someone else to handle said finance issues. People generally don't word it that way but that is what they are doing.
"If you aren't contributing enough to pay for your own expenses then you are stealing from someone else in addition to everything else"2. (In regards to medical insurance specifically) Due to several factors medical costs are artificially inflated far above their actual market costs. Paying for your own treatment out of pocket is exorbitantly expensive. This ties in with #1 and people go with the more financially safer method. This is in large part caused by the between government provided insurances and various healthcare providers. Both sides assume the other is corrupt and misrepresent their own costs and data in an attempt to keep ahead of where they think the other is going to be. This is a huge issue that I will elaborate on at a later date if you wish.
Given the amount of people in the US of A currently purchasing health insurance (we don't care about the poor, the kids and the illegal aliens anyway), it would appear that your nation is full of thieves.
The problem with a "reasonable" co-pay, is that "reasonable" isn't the same number for all economic classes. An upper-middle class person in southern california might think nothing of having to pay $20 for a doctor's visit, but a poverty line factory worker in Detroit may very well end up dying or having some sort of serious consequence of not having symptoms attended to because for them, $20 could represent a week's food money.That said, I do believe teh 'no co-pay or deductible' bit is a bad idea, for the most part - institute a reasonable deductible or co-pay. Make it so the government-provided insurance is catastrophic-coverage only, perhaps (since hospitals are legally obligated to service those cases even if the patient can't pay), etc.
Additionally, catastrophic coverage would be another horrible idea, because the poor, and even the lower end of the middle classes will end up only going to the doctor when they have a catastrophic issue, which ends up costing the system more than if we'd simply paid for proper preventative care and low or no-cost doctor visits.
"Fear nothing except in the certainty that you are your enemy's begetter and its only hope of healing. For everything that does evil is in pain."
-The Maestro Sartori, Imajica by Clive Barker
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