I actually think the limited role we played was about right. I think any time you can get broad consensus (or the consensus of our key allies) to take action and dethrone a really bad guy who's sheer presence oppresses millions (and as a result, causes misdirected outrage)...it is better for the world, and better for the US as a result.

We clearly arent in any position to lead such an effort...but some minor support? Sure...I think it was the right thing to do.

I thought we played Libya pretty damn well

SI

I'm very concerned with the way congress has abdicated it's responsibility, but I don't understand your issue with the Supreme Court. They can only rule on cases that come before them. Until someone with standing takes the issue to court there isn't anything the Supreme Court can do. There is no constitutional process for the Supreme Court to issue opinions prior to a case.

Well, I'm not sure we share the same definition of murder, which I'd define as a crime identified by the collective population where the unauthorized killing of a person occurs. Whereas in military action (or even "war" if you define all military action as war) it is an authorized killing of people. And the authorization is the government, which in theory, represents the collective will & interest of the population it serves.

I understand if you believe ALL killing of people should be looked at as murder, but I personally think that's taking things a bit too far. Only killing people in "self-defense"? That's also a little gray but probably less variables to it.

Having established that as a baseline as my definition (which you may or may not agree with)...I'm not sure what murders you are referencing. Specific soldiers doing their own thing (which I'm not aware of any even being on the ground in Libya)? Or do you mean casualties that result from bombs lobbed in from 100 miles away? Or just backing other country's troops who may have done some unauthorized things? Or just simply using military action is always "murder" in your mind? I'm just curious what you are referring to.

To be honest, the Palestine question is probably at most 4th or 5th in list of his priorities (if that high) but am disappointed that Obama/Hillary hasn't delivered ... George Mitchell is gone.

I think Abbas has shown he can deliver on his "side" and making me more sympathetic to their cause (vs when they go crazy and start killing innocents randomly).

Obama and Abbas - From Speed Dial to Not Talking - NYTimes.com
http://www.scoop.co.nz/stories/HL110...-palestine.htm

Can't forget shareholder lawsuits whenever stock prices dip at all, so yes corporations are all about whatever it takes to raise stock prices.

Plus don't forget on CEO compensation that the people deciding the pay of one are often CEOs themselves, so by driving up average CEO compensation they drive up their own compensation.

In stock prices it is all about the short term, particularly when they have a backstop of 401k money to play against (rebalancing funds is probably where a lot of those computer arbitrage games make a lot of sense).

As for getting rid of the bad CEOs, you need shares with voting rights, you need to win a proxy fight (there are numerous articles of extremely rich people trying this and failing epicly... in many different ways), and to get all of that to happen you also need to break the boardroom cartel with the multi-company mutual brown-nosers (why else do terrible failing CEOs keep getting hired, because they have proven they play along with 'consolidation' as Jon puts it, which is not really much of a skill).

The best answer is blow away as many barriers to entry as possible (that is get government out of being the corporate brute enforcer) and hope smaller firms with fresher leadership gain market share. In some segments this is easier than others (software/tech), but it is hard to fight market share, particularly in a complacent society like ours that will eat shit sandwiches as long as it has a brand name sticker slapped on it somewhere.

You would think enough disasters would lead to a bit of a rebellion amongst these boards, but the amount of grabass keeps the advantage in the hands of the agents for the forseeable future. The biggest trends of successful leaders these days are private companies or those cashing in a big IPO payday before their say(shares) gets diluted to the point of nothing by the banks.

Shareholder lawsuits shouldn't be given much weight... they go no where in court and I think they are pretty rare unless there is some massive bunch of them out there I haven't heard of (pissed off investors would be a variable to account for in pricing psychology after all).

Obama’s Expected Plan for Entitlement Savings Worries Democrats - NYTimes.com



Just a data point. I went to see an eye specialist and had an hour consult. Happy with the information etc. She said it would be taken care of by BCBS and not by regular eye vision insurance.

In rough numbers ...

Got a $200 bill on what BCBS did not pay. I thought that was pretty reasonable and willing to pay it. The entire bill was for about $800 and BCBS paid $600 of it.

Which got me thinking that the problem is lack of transparency. Somehow, they are allowed to bill $800 for an hour visit. No operation, no special pill, just the standard tests etc. and an hour of good Q&A, medical opinion etc.

There is alot of fat, corruption etc. in the current system.

With that said, I really don't know if Obamacare is the right solution (but it is better than McCain's alternate of $4-5K tax credit). Something needs to change, system needs to be turned upside down to fix it.

A quick cut would be allowing Medicare to negotiate drug prices. But we all know that will never happen.

You're right...no transparency and nobody cares what the costs are. Thats why I think you see such exorbitant bills like that. Because nobody is keeping the costs down to a reasonable level. Now...one can argue this has a side effect of allowing for improved test equipment & easier access but I think the problem is that the consumer of such services isn't really demanding it...or at least in a reasonable position to determine the demand of it.

This is why I have said all along...the way to control health care costs is to put people in charge of footing the majority of the bill. You'll see a real sharp drop in demand and some degree of pain in the industry initially, but just like other bloated industries, you'll also see a more sustainable model as well moving forward.

I don't honestly think the bill known as Obamacare is actually better than McCain's plan. A single payer system...sure, perhaps it "could" be (though not convinced we'd run it that effectively at the Fed level).

To be honest, if you were able to decouple employment with insurance, then I believe consumers will be more inclined to select plans that are cheaper but cover them in catastrophic cases, and perhaps cost more for a normal visit, or minor outpatient procedures. This would lead to more transparency as consumers would be more attentive to the bill itself...and would question Doctors on their pricing upfront before even deciding whether they should go.

It all comes down to this in my mind...who is looking at the legitimacy of the bill? Right now, insurance companies are in that role and while there are many legitimate issues with them...sometimes they are having to make decisions that consumers should be making themselves. Which is...sorry, I dont need the (non-cancerous) mole on my shoulder removed for $2200.

I really DONT get why this wasn't allowed in the first place - what is the logic in enforcing that the government has to pay artificially high prices for items?

So that wealth can continue to be concentrated, as well as rewards for years of campaign contributions?

Ya pretty much direct corruption, gotta rob them taxpayers... particularly once you can loophole yourself out of the taxes.

Thats pretty much all I could think of myself - but in that case why is there no huge out cry from the public (or heaven above the press) about this? ... especially as there is huge talk of cutting costs generally, I'd have thought this would be the first and most obvious thing to look into myself ...

Ok well, for me second thing - with the first being cutting down in the monstrous military budget.

But the costs aren't in regular doctor visits and elective care. The major healthcare costs are chronic disease management, prescription drugs and catastrophic/end of life care. Consumer choice doesn't matter in those cases unless the choice is to not get a treatment ordered by your physician because you can't afford it.

IMO the starting point is not the consumer to drive transaprency, there is already a "conspiracy" to prevent this. I don't remember the specific incident (think it concerned dental) but have asked for "how much will this cost" and got the reply "not sure, depends etc. but your insurance will take care of 80% of it etc".

I think the issue is the medical providers. They should be forced/mandated to reveal their pricing, publicize it etc. and put whatever context they want around it.

What other services do we purchase that we don't understand the approx cost/range prior to purchasing.

Of course it matters. All of those services/products would have different scales to them if they were consumer driven prices. Right now they are not, so it costs $100k for a year of outpatient care, which may be all or in part covered by an insurance company. That is completely out of line with what the average consumer of such services is capable of affording...and I believe the prices would come down if consumers had a more direct role in the selection AND the payment of such services.

Again...some consumers would select lower cost plans that cover the basics only (such as ER, life-threatening operational needs, etc.), while others may prefer to have an increased level of coverage. But in both cases, they still have insurance coverage with the exception that instead of their employer paying $800+ and them paying $200+ per month the consumer will buy insurance that is more in line with their budget desires, which could be more like $350/mo but gaining the net back (i.e. $650) from the employer in salary. This is why I believe you have to decouple employee/employer insurance as a "standard" practice and it needs to be affordable (read: not subsidized, but actually affordable) for people.

It doesn't always have to be about getting care or not getting care. Sorry...I didnt mean to spark a HCR debate again, but it just drives me nuts that we seem to think that there doesn't need to be accountability for cost. I guess that speaks to our ability to just print more money any time we want it. That may be so, but I don't think I like society becoming a nation of people who don't see themselves as the answer to problems...but some faceless/nameless entity that is "supposed" to look into such things.

I think healthcare is much different than most consumer goods and doesn't respond to the same types of pressure. When my doctor tells me I need test A and prescription B I go get it. I don't know enough to know whether I truly need them, but I trust my doctor to make those decisions. I have no interest in saving money, because if I die I don't give a shit if my bank account looks good.

I think a free market approach to healthcare can provide top quality care for some, but leaves a lot of people without proper access while costs explode year after year. I don't think there's any way to contain those costs in a free market system without people using fewer services. I just don't think the outcome will be providers lowering costs so that everyone maintains the same level of access.

That's why I think eventually the healthcare sector is going to need to be more regulated. It may be within a private insurance system or it may be through a single payer system, but if the country is going to manage healthcare costs the rate of growth is going to have to lower dramatically, to do that by limiting access isn't going to be politically viable IMO.

This.

Your experience is in line with most of my own as well. They don't tell you because they don't happen to know offhand because either (a) they have different prices for different insurers, or (b) because it is not in their interests to advertise their rates.



I don't think mandating medical providers to publish their rates would matter that much, honestly. Their "customer" (i.e. the person who will pay the vast majority of the bill) is the insurance company and they usually already know what the cost is.

When you throw a few hundred a month direct from your paycheck, and your employer funds the other half or so, you just become numb to it (and you never see the employer's share of it). So long as the co-pay is low, most people wont give a crap what the cost actually is because they dont see it as something they can impact significantly (not to mention...most people think short term, not long term). They will just continue to go to the "best" facilities their insurance will allow and disregard the cost (though certainly some will not). This also drives up the bargaining power of those noted "best" medical facilities that people flock to since the insurers can't NOT cover people in many of them (or they risk losing large pools of customers). I'm not crying for insurers in this, I'm just saying they can't affect the cost to the degree that consumers can.

So I think if you want more transparency, you can mandate it. But if you want costs to actually get inline with what consumers can actually afford...you need to have them determine the cost. And I think the transparency in cost will follow as the consumer demands it.

Why does it always have to be "I follow blindly those who are supposed to know more"...or "those who are supposed to know more are always wrong so I'll disagree". Its like we always think along those 2 trains of thought.

In a free(er) market system, you'd know your doctor's rates upfront, because you & every other consumer wouldn't do business with them if they didn't. You'd decide whether to get a 2nd opinion when faced with any problem. You'd purchase the meds yourself without fear of being on the "insured list" or your doctor being bribed to prescribe them by the pharm sales rep. And best of all...you'd be getting the level of care that is affordable without going into debt for the next 30 years...or artificially deflating your kids' trust fund/savings because you wanted to stick around a few years longer but couldn't be bothered to manage your own health costs.


I think a single payer system is the ONLY (potentially) viable alternative to a free market approach. But the idea that we can't be bothered to help control costs ourselves, individually, is disheartening to me.

There will always be people in a civilized society that get better services or treatment. Whether that be because of money, power/influence, affability, or some other reason is less important to the overall solution. You & I can't afford to get AIDS and live for 30 years...Magic Johnson can. And the sooner we stop worrying about getting his level of service, the better & more affordable our level of service can be.

There are plenty of people that will live for decades with HIV. In the U.S. it's becoming a chronic disease rather than a life threatening disease. Insurance is picking up a lot of the tab for most people and passing it on to those more healthy. It may not be exactly the level of care for Magic Johnson, but a lot of people with far less money are getting damn good care that they couldn't afford if they had to pick up a significantly greater portion of the expense.

Ok...I'm confused then. So our services are adequate then & you want to just keep taxing until everybody has the same level of services?

IMO, the problem is both access to services (which Obamacare essentially has subsidized for those with pre-existing conditions), and the cost of such services. If nobody cares what the cost is for them, or the people who DO care what the cost is cannot contain it, then how on earth would we ever actually contain the costs? More regulation?

Why not just regulate that insurers & medical providers cannot make profit? Or cannot make more than 5%,10% (pick your number) profit? Because that is essentially where you want to get to, without actually having to do anything beyond passing more bills (with of course, the accompanying pork/special interest projects).

The problem with that is there are still ways around it. Why did we get in the mortgage mess? Real Estate salesmen and home appraisers started saying your house was worth $X + 10%. That would raise the prices of the other homes in the area. Well if that house went for $X + 10%, yours is at least 10% more!

Last time my house was appraised, it appraised for $5k more than when I bought it, even though the homes in the neighborhood were selling for $15k less! Everything was fine until the ride stopped.

Thats my point WH...the more you obfuscate cost, the higher it tends to go up, artificially. We have a health services bubble ath this point, and we can regulate until we are blue in the face but you wont drive the cost to be more efficient without putting consumers in charge of determining the actual cost.

Agreed. I made a post a while back where I compared getting a car to medicine.

When we get a car, we brag about the deal we made. I paid $10k under invoice!

When we pay for medical, we brag about how much we spent. I paid $50k for this new treatment! My doctor always runs 5 tests even when I have a cold! My doctor cares because he always makes me have a follow up visit!

Well regulation and/or national negotiation are the only ways I think you can achieve a reduction in the growth of healthcare spending(which over time is good enough to save trillions) without reducing access to care.

In other markets how do consumers drive prices? Generally a manufacturer sets a price and consumers either pay that price or refuse to purchase the goods in question. The manufacturer then decides if they can thrive on current sales/prices or if they need to reduce prices to capture more sales. Over time that works and consumers are fine because none of the goods in question are necessary for continued life.

I don't think it will work that way in healthcare due to our limited knowledge of what is essential care and our general desire to spend whatever is necessary to get essential care. Those who can afford to pay will pay and those who can't will be denied access to care. It's possible that over time prices may come down to a point where access is equal to or greater than what it is today. I don't think that will happen, but I admit it is possible. However, over that period of time numerous people will be denied access to life saving healthcare. I think that's a morally dubious path for a society.

I'm not arguing whether there should be a base level of care for everybody. I'm just arguing that you have to drive the cost to be more inline with the consumer's ability to pay. Just because we decide to devalue our collective currency in order to provide access & equal services, does not mean everybody will take advantage of them and actually follow through. But regardless of whether they do, those who do use the newly found access will not be driving down the cost of services...which is a second problem.

But lets not pretend there are millions of people who want to go to their doctor...who will then follow their doctor's advice to exercise, eat healthier, stop smoking, take a pill daily, whatever...but they just can't get access to this wisdom so they will continue eating poorly, smoking, and not exercising in ignorance and show up at the ER in 20 years and cost us more money overall.

We need to stop pretending that everybody is as concerned with their health as others are. Its great that you want to live to be 100 but there are a good many people who aren't the least bit concerned with that.

Well look - either costs need to come down by a huge percetnage or employees have to pass on to employees the money that they're currently paying - otherwise you're talking a massive squeeze on the consumer's ability to pay for healthcare, let alone anything else.

And neither corporations nor insurance companies are likely to like that solution, so that's really not going to happen.

We had some discussion where several people talked about how they don't want any tax increases until the federal government demonstrates some level of competence in regards to spending. Stuff like this only reinforces my notion that we still have issues with how our money is spent.

Officials Raised Concerns Of Solar Project's Solvency Ahead Of Bankruptcy, Emails Show | Fox News

I agree with that, but how do you get there. I don't think consumers have the expertise or interest required to really drive down costs. It seems to me that you're relying too much on providers lowering their costs preemptively. Any consumer driven approach is only going to lower costs over time as people refuse to get treatments or see their doctors because of cost.

Nothing is always more likely to happen than something. You can continue to push for further obfuscation of cost in both private & government sectors but I don't see why that is necessary.

What is the motivation for corporations to continue being tied into health care? They compete for employees by providing some level of subsidization of the cost, but that cost is part of your employee costs which I assure you is what your CFO considers your "total compensation" amount. If that cost goes away, then it either goes into other areas of the business for investment, goes in the form of pricebreak capability to its clients, or it allows them to offer more competitive salaries to employees. Some will pass it on to employees, some will not and they will lose employees because of it.

They will stop getting treatments from inflated-cost providers in exchange for more reasonable cost facilities. Not much different than what happens today as not everybody accepts Medicare/Medicaid (i.e. reasonable costs).

Certainly it will depend on the service one needs as not every medical service is available at every provider facility. But the vast majority of treatments & costs can be driven down by the consumer choosing to pay the more reasonable price providers, which encourages the others to adjust accordingly unless they can sustain a market share that will pay it (which is what they do now).

This wouldn't happen preemptively or in a week/month, etc. But it would happen over the course of many months and a couple of years & ultimately lead to a model which doesn't need new loopholes fixed and can be sustained with modest tweaks to coverage, association, & transparency (and likely a couple of other things that will come up over time).

It can be done with some balance between individual rights & responsibility. I don't care if you call it a free market solution, a consumer-driven cost model, or a popping of the health services bubble. But at some point, we have to fix the problem, and its got a lot of intertwined parts to it which all need to have their solutions addressed (like the cost of med school, and higher ed in general).

I'm not pushing for obfuscation. I'm pushing for single-payer.

Yeah - I gaurentee you if they don't have to pay employees healthcare that money is going into CEO bonuses or stock buyback plans to raise the share price so they can cash out - I bet in an extremely miniscule number of cases only will it go back to the employees. You're clearly uninformed about how capitalism works if you think otherwise.

"Some will not and they will lose employees because of it" -- great, more unemployed people. Don't we have enough of a problem with that already? :banghead:

Here we're saying the same thing. My concern is in that interim costs overall only get reduced as people refuse to pay and that refusal will come,to some degree, because people don't get the treatments they are prescribed due to cost. How do you provide access for those people or do you just write them off as a necessary cost of change?

Don't be a knucklehead dude. You seem to get pretty worked up when people don't agree with what you watched on MSNBC, Bill Maher, or the Huff and decided to believe without questioning. I guess because they are snarky and appear "smart".

They wouldn't be unemployed, they will go where the employer is offering the better salary. Netflix runs their company this way already...its actually a progressive concept.

Nothing ever gets implemented overnight. A change in simple access (when Obamacare was written into law) was going to take 2 years. BTW...I'm calling it Obamacare for brevity's sake.

If you actually decoupled health care from employment, gave people the ability to realize those cost savings and get their own insurance...which they could then pick & choose the liability level but have a lower premium in exchange for a higher out of pocket or upfront cost for treatments....there would be more downward pressure on the providers to lower their costs as consumers wont opt to get their treatments from_those_providers that inflate their costs. Businesses would be evaluating their models well in advance to adjust their pricing, compensation models, and their service offerings to be more attractive to the consumer market when the time comes to serve them directly (meaning cost). If there is concern over limitation of services, then you can add requirements of a health services provider in order to ensure competitiveness in the market.

Point being, not every concern need be a roadblock to implementing a more sustainable model.

I don't think it will work that well, but even if it does, you still don't address what happens to people in the interim before a new price equilibrium is established. Do you have means for access or are these people written off as the cost of change?

And what do you do about the 40 million without insurance and Medicare recipients?

Letting people shop independently for their insurance and healthcare providers would probably lead to more competition and better pricing, but it will also lead to a lot of "discount" insurers who will prey on the old and the uninformed with low prices and practices which will make it harder to get necessary care in a hurry. We will need some form of regulations to keep these in line. Healthcare and insurance are way too complicated and prone to abuse.

FYI I don't watch any of the political punditry shows, and I NEVER believe without questioning. I'm a history major by training - I ALWAYS evaluate the biases of whatever I'm reading/viewing. So *BLEEP* you very much for assuming I'm some brainless cretin who gets all my opinions from talking heads.

They would be unemployed right now, because businesses aren't hiring because there's no growth in consumer demand! Taking more money out of people's pockets to pay for healthcare would only drive down that demand even further. And I still maintain you would see the vast majority of companies either funneling that money back into corporate coffers or into CEO bonuses/stock buybacks. You wouldn't see an appreciable rise in employee wages on a mass scale (although of course there would be the outlier companies who would). I think the pressure on publicly-owned companies to funnel the money back into the company (by Wall Street) would be huge, and that most likely it'd be the "edgier" and/or privately-owned companies that would increase employee compensation.

You're setting up a mechanism where neither side has an incentive to act: employers keep money and assume healthcare companies will blink and lower rates, healthcare companies keep rates high and assume employers will blink. Meanwhile the man in the middle gets fucked.

Agreed. I'm not necessarily saying to eliminate Medicare/Medicaid in the process, although you could look to do that at such time that it made sense, I'm just advocating for less obfuscation of cost and allowing the people who use the service, to determine its cost/worth.

I understand the argument that people may opt to do less treatments if thats left to them, but honestly there are 2 things here.

(1) If people value their health less than you or I (figuratively), then why should we force them to take preventative care to the extent we might. Because on the same token, that would mean we now have to concern ourselves with their weight, diet, habits, etc. which to me is not the type of society I want to be a part of where we sit in constant judgement of each other and calculate how much that "fat SOB next door is costing me".

(2) With that additional obfuscation of cost reduced (or removed in some cases), the cost will go down and become more transparent and reduce the corruption at play between big pharma, large medical providers, and insurers. Hopefully it reduces the corruption level with government as well, but this is likely only because the industry will not have as much cash to throw around more than any fundamental solution to that.

My apologies then DT. You must truly be simpatico with their mindset then without knowing it then.


You're arguing that decoupling health insurance from employers/employees would result in mass layoffs? Why?

I think you are conflating 2 different topics.

Yes, people who own & run companies can be greedy but you are missing the motivating factors. If we've been diligent in creating an atmosphere of competition, then that also means competition for employees. Those employers who decide "Oh goody! I can stop paying for insurance and loot that money!" will be sorely punished by that attitude because 1 of their competitors WILL pass that savings onto employees, lower costs to clients, or some combination of the 2. They may also see higher demand in the short term as not everybody will immediately spend their new salary bump on insurance..so this may lead to short term demand increase (though I wouldnt see that as a reason to justify, just an observation).

I must be. Because honestly I don't watch them.

I'm not saying it would create mass layoffs. You were saying that if employers didn't pass the money on to employees that employees would leave. I'm saying there's not jobs for them to leave to, so the only alternative would be to leave and be unemployed (I didn't make that really clear, my bad).

You have a lot of faith in the free market. My faith in the free market to do the "right" thing is pretty much shot at this point.

No, I don't put faith into the free market or anything else really, without having checks & balances established. My contention is that the only way to drive down health care costs is to put that into the consumers' hands to determine as nobody else should care more about your health, than you.

So if you value your health above all else, you can get access to services & help drive the price of affordability. At the same time, you aren't forcing everybody else to go along with you on an extended life at all "costs" model. Where "costs" can be financial or lifestyle choices that impact how one chooses to live their life.

Except what you seem to be claiming is the free market value and just like the free market in other things (cell phones, etcetera) the trend is towards consolidation so they can charge more while giving less.

Consolidation/competition, while related, is not the same topic as having a consumer that is able to drive the price of a product or a service. Lack of competition as a result of consolidation is its own separate topic which can have its own set of rules around it.

And besides...you'll have the same issues with consolidation no matter what solution you go with. As a matter of fact, I'd venture to say under a single payer system you would see a lot of consolidation in an effort to force government to play ball with the pricing they want to get from them, as well as elimination of redundant jobs in order to invest that into lobbying & finding tax loopholes.

I guess I'm just saying that bigger centralized government with more mandates, laws, and regulations to follow will (and does) lead to bigger consolidation of companies, their lobbying efforts, and their influence on such larger government.

And both of these need to be reduced in a big way. A completely free market will lead to consolidation and consumers getting raped by the conglomerates. A completely socialzed market will have its own problems. We need the mostly free market with true anti-monopoly regulations enforced to maintain true competition.

I find that greatly counter intuitive. If we restrict companies from consolidating and controling the market (with mandates, laws and regulations)... it'll.. lead to bigger consolidations?

Just randomly vouching for how easily this kind of thing can be true.

If I watch 5 hours of all the TV talking heads combined a year it'd be an unusually high number. Likewise, at this point I read maybe a hundred print/online national political columns a year max, and even that number is inflated by "batch reading" a few writers maybe once a quarter or so ... but I do end up on some of the same "talking points" from time to time.

As much as anything perhaps, it's probably a sign that me & DT could have taken over the old Hannity & Colmes timeslot with hardly anyone missing a beat ;)

No, the point is that we don't really restrict consolidation all that much but in the industries that we amass more regulation onto (banking, insurance,etc.) they tend to consolidate more than they do otherwise, and that consolidation leads to increased levels of corruption (of government).

You could have this issue in any solution, I'm saying the likelihood is higher to see consolidation in a single payer system. That doesn't stop us from trying to prevent consolidation, but it isn't usually done until an industry is already way out of control (which it is of course, but it will take a few years before consolidation would be blamed or looked at).

Looking forward to how this plays out.

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"Morally dubious path for a society"? What moral standards are you implying? What is your or society's goal in achieving some level (or additional level) of morality - to get more brownie points with God or to earn more point for heaven? We will not be judged as a "society" or as a "nation" or as a government. It is our personal responsibility to love and to care for one another, physicall and spiritually. But to apply some sort of moral standard as (or to) a society is only important in the worldy view.

I think you're just playing semantics. A society's decisions are made by individuals. Certainly you'd agree that a society can do immoral actions based on the decisions of the people in charge?

It wasn't as dramatic as the average given, but my wife made more in total compensation as a contractor for the SEC than those working directly for the SEC, and that didn't include whatever fee the contracting company was given.

Did that study take into account future pension obligations?

That doesn't sound very far out of line with typical contract company vs employee comparisons in many industries.

I used to do the same thing. I was a (non-government) contractor and made probably 2-3x what I would make as an employee (at least where I lived).

But those rates are disposable. You don't have to pay that person until you can justify firing them. You don't have to compensate their 401k, pay for insurance for them, etc. And they are typically given their own liability indemnifications (depending on what they do) so that the government, or contracting business, does not have to be liable for problems that can occur.

Maybe solve one problem at a time, get pricing transparent before pulling for your preferred pattern of how healthcare should be administered. I've ranted about this in the past, start by regulating health care pricing not in the insurance industry but directly at the hospital supply. Require all common treatments (I'm not talking the million dollar experimental surgeries, but things that happen thousands of times a year if not millions) to be transparently priced on local exchanges, and force hospitals to publish a list price that anyone can get. If insurers can privately negotiate something under that, good for them, they are doing their job!

All publicly funded health runs at the published price or within some fixed margin below it (i.e. you want the Medicare market the government can leverage some percentage of savings due to bulk).

By fixing a lot of the supply uncertainty you can then attack one area we shouldn't have so much of in healthcare, obscene paperwork expenses. For common procedures things should be standardized and treated like a military logistics problem and make the supply chain as simplistic as possible.

Encourage competition between lower cost outlets for health care (smaller clinics, urgent care, family doctor) and with them muddying up the market with their specialities and lower prices they will either shunt demand away from the hospitals or lower hospital pricing in the same areas.

Break out a classification of services that are price indexed by this government program and require insurers to create standardized packages with easily broken down coverage of the standard treatments (most already do some form of this, but direct comparisons are complicated without looking at ugly charts once you go across insurance companies with differeing policies per treatment). Label everything else as various classes of specialty treatment... if you want solid gold treatment in those areas expect to pay the premium associated with it.

The goal of all this is stopping the price inflation cycle that is clearly at action here and doesn't have to be as we can tell from simple observation of other countries. You might get single payer like pricing without a single payer system over time with this kind of transparency. With the way things are heading it is not a question of if but WHEN all the employers will start dropping their health packages and it moves to individual coverage systems for the vast majority of all employees. In such a scenario volume will start to be driven towards those publicly available prices and hospitals that got their agendas straight will find ways to capture that volume and make a profit at lower prices.

The public pricing also shames prices into falling, when people start seeing the bandaid application that costs 50 bucks, or the ankle sprain that can be wrapped for $30 at an urgent care or $300 at a hospital... it will be hard to justify the idiotic supply side prices we are seeing now (often a product more of bureacracy than actual hospital efficiencies).

The "people in charge" is no different than the people they alledgedly serve. Besides, when do people (whether in charge or not) not do immoral actions? Which was more moral (or immoral), the isolationist policy prior to WW2 or the declaring of war to enter into WW2? Which is more moral, the allowing of killing the unborns or the neglect of the newborns or perhaps just those involved in such actions (as oppose to the "people" or the "government"? To me, it's all about the individual not the collection of individuals (or their leaders or nations) nor the collection of souls.

Stat claims it is TOTAL compensation which would presumably include some allowance for 401K and insurance.

Contractors do make sense for some cases. Although there are a number of sweetheart contractors which are basically ways to pay cronies of particular interests huge sums of money for doing nothing (I'm thinking Pentagon and its people so important they need to be kept secret at all costs and they make hundreds of thousands for playing golf all day, when not expensing their hookers and holiday travel expenses). We could probably save a billion just in those and not lose a bit of work.

Then take it as a shorthand. It's going to take quite a long post to list everyone that supports a policy that I may or may not find immoral. I think there's a lot less in that nomenclature than you might want to believe.

I think the difference I perceive is that you are more concerned with leaders of the nation (or corporation or whatever) and the policies they make (or should make) than someone that focuses more on individual responsibilities and the condition of the heart in the actions that one take.

My wife did the exact same work as the other person in her office and her job was considered essential enough that they hired her during a freeze. Her salary was basically the same as the government employee but her insurance package was much better and her 401 was roughly equivalent. At least in her situation contracting her job seemed to be a way to "reduce" the number of government employees.

I wouldn't say that. When I say a society I include the populace as well.

Yeah, you see this with large private companies as well. I have a friend who has been contracting solidly for a major communications company (everybody knows them) for the past 5 years. In that time, they have laid off workers, eliminated contracts (with other companies), downsized or eliminated departments, and generally tried to cut costs. But he has remained in place and going for so long that he is basically considered the authority of a lot of things that would typically be employee-only items.

But on the whole, shareholders like seeing contracted better than employees as that is a disposable expense in theory. In practice, not so much.

At the end of the day, aren't these two of the big things that are coming from the Health Care bill?

First, there are the insurance exchanges to allow for a legit insurance marketplace (SteveMax's point). And, secondly, all those "onerous" regulations are basically setting a baseline of what you must cover (BrianD's point).

There is certainly a lot of stuff in the bill to hate, but those are two of the good things, right?

SI

Because the loudest voices are the partisians who are so far up their parties ass that they won't say a word against them. And since both parties sort of agree with it, you don't have anyone to bitch about it.

It's sad because it's a change that would effect absolutely no one on Medicare. You would still get the same drugs, the country would just be paying signifigantly less. The massive buying power of Medicare can strike some killer deals. It's pure unequivocal waste. It's propping up private businesses that bought Congressmen.

Veterans Affairs pays 58% less for their drugs. Now imagine the savings when you factor in Medicare is much larger. It's not a surprise that one of the bills sponsors and many aides ended up getting high paying jobs with the Pharmaceutical lobby afterwards.

Medicare doesn't even have to negotiate. Just taking a cue from the corporate world and saying we get your cheapest offered price would save a ton of money.

I think health care costs are going to skyrocket even more as the Boomers start aging and needing more and bigger care requirements.

Well, my understanding is that these exchanges are only available to people who cannot get coverage elsewhere (including Medicare/Medicaid, employment, etc.) and subsidizes it for people who can't afford it. So that doesn't really help to solve the first part (of my premise) which is to decouple the insurance from employment. It does help people get access but it doesn't really do anything for cost.

But the second premise that I have is that consumers MUST foot more of the bill (and in return, less premiums) as they are the only party with any interest in keeping costs down. Insurers have "some" level of interest in keeping costs down on an individual basis, but on the whole, it is still more beneficial to handle & markup 10-20% of $100B than $100M.

I don't know what the right ratio should be for the consumer. Obviously 100% would be ideal as this would eliminate insurance as a piece of the pie. But insurance plays a vital role in this so perhaps its 50% of visits/procedures & 90% on the vital care services. Or perhaps the ratio is 60% non-vital / 100% vital. IDK...but I do believe it needs to be more than 10-20% & $10 co-pays.

A showdown.
Netanyahu set for UN diplomatic showdown - FT.com

I'm not sure decoupling insurance from employment is a good idea. A large group can always negotiate a better rate than an individual. Furthermore, I don't see this approach doing anything about the problem with pre-existing conditions. No individual is ever going to be able to negotiate such a deal. Say what you want about Obamacare, but it completely erased that problem with one stroke of the pen.

The main problem with our system is that a majority of our costs revolve around reactive care (expensive procedures for things that got caught too late) instead of preventative care. With everyone covered and seeking preventative care, health care costs will go down long term because we shift the overall costs to cheaper procedures. That's why I also don't like the idea of the consumer footing more of the bill, as I believe that would result in people seeking less preventative care and instead waiting for something catastrophic before using their insurance.

I think you are seeing that "everybody does x, so if they just did y" and thinking people don't do "y" for the wrong reason (i.e. they aren't healthy because they don't get access to preventative care so a doctor can tell them to stop eating bad foods and sitting around on the couch).

Reactive care will always be the way things are handled by most. If ALL healthcare costs (100% of them) were subsidized for everybody starting tomorrow, I'm sure you'd see a lot of preventative care costs spike. You'd think that's a good thing, since its a cost that will prevent reactive care later (presumably when its too late or much further along and will cost more to treat).

What I'm submitting is that the preventative care might spike initially, but will taper off shortly after with the majority of people just continuing to do what they always did. So some people will certainly head off problems, while the vast majority will be showing up so that doctors can figure out a way for them to live longer without putting any effort into doing anything.

As a second point of contention, even if more preventative care truly means people living longer (which I dispute beyond a certain % of the population)...then that tells me the end of life costs will be further increased as people will live to the age where bodies breakdown regardless of how well you have taken care of it. And eventually, we all require reactive care.

So, again I go back to individual choice. Why do I have to help you (figuratively) live to 100 with problems that I don't really want for myself? I mean...is the tragedy that we don't all get to experience being very old so we have to strive to live long enough to not be capable of standing, sitting, using the bathroom alone, etc? I'm not at all making light, or diminishing what science may bring about...I'm just saying that it isn't a requirement or goal for me to live to 100 if it means I can't talk, walk, or shit on my own. And...I'll add...at a greater cost to everybody else.

I think Israel should say "we agree to Palestinian statehood if Jordan and Syria are willing to cede part of their land to that state as well". Highlight how poorly the Palestinians are treated by the rest of the Arab world as well...

There's no such thing as a "problem with pre-existing conditions".

It's insurance, not a fucking medical savings plan. It's based on the notion of managed risk & asking an insurance company to cover those is forcing them to take part in a sucker bet. That an unconscionable intrusion into a transaction that the government has no right to be in beyond the standards of contract law. The biggest part of the so-called "insurance crisis": the way the system has devolved bears little resemblance to how "insurance" is supposed to work in the first place, it shouldn't be part of every little sniffle.

Now I'll happily go along with the assertion that there's a cost-of-health-care crisis, just not with the pretense that insurance is where the solution lies. The further we can remove insurance from the average medical procedure the better the system becomes, going back basically to what SteveMax has been saying here.

Over the past few months people on the right side of the spectrum here have argued that the poor and middle class should pay more taxes, work for less and pay more for healthcare. How will that help?

It'll help get rid of the poor and middle class entirely and turn them back into wage-slaves or serfs, which is what the narrative driven by their corporate masters desires (which is ironic, since basically everyone on this board would fall into that category). The phenomenon of middle and lower-class people voting Republican (and against their own self-interest) continues to be mind-boggling to me.

Pretty broad statement and if you want to be that broad about it I think I would correct it to say that people on the right generally would want lower taxes for everyone.

Its more mind boggling to me that anyone votes for either party anymore but I guess your disbelief in people's collective stupidity stops only at Republican voters that vote against their own self interest. How exactly is endless war, corporate welfare, and absolute messes like the Patriot act in anyone's self interest? (Unless they work for Lockheed Martin or one of the Federal government's multiple spy agencies)

I'm just talking about people in this forum and I don't mean to imply that everyone on the right agrees with all three points. I have seen all three argued over the past few months, though, and I'm just curious if there's an argument on how these changes would lead to greater prosperity.

I don't think an absolutist stance gets anything accomplished. I'm deeply disappointed in the Democratic party, but I'd rather vote for a person that will have the possibility of accomplishing some of my preferred policy options than someone who I either disagree with completely or will have no chance of getting elected. It's often the best worst option for me given our system.

I'll speak for myself here since while I don't think I've seen anybody argue this, I know I have not argued this.

As a general principal, I think everybody should be taxed on a flat %. You (and others) would likely argue that this is regressive in nature since there are so many other loopholes available to the rich to take advantage of to the point that they never end up paying their fair %. Or perhaps additively, the rich are better educated and/or setup to continue producing more wealth because their parents/whatever created an empire for them to step into.

To that, I say its a different problem to solve. On the first point...close loopholes, end subsidies that are no longer necessary, and lets get the true cost of things more inline with what the consumer market can afford & demands. On the second point...individual access to education is available in this day & age (freely via the internet I'd add). You can argue that the internet, computers, etc. aren't free, so therefor the access to competing is uneven. To which I'd say common sense & work ethic can't be bought either...so at some point there has to be a cutoff. And motivation of the individual to improve their life circumstances is where that evenness needs to come from.

We can't solve all inequities with a bill. And not even most of them. But the key is to put the proper system in place which properly motivates the actors in it to the extent that they can change their role as they see motivation to do so.

Ultimately, yeah.

But I'll happily grant the point that was being made, I won't be satisfied until the tax rate - whatever it is - is completely flat across the board. While that's definitely not a majority position, it's also not as if I'm the Lone Ranger about that either.

Maybe I should clarify.

A lot of folks here think the 47% that didn't pay federal income taxes should have to pay something. That has to mean higher taxes for some doesn't it?

At least one poster actually said Americans should get used to working for less in a global economy. I think there's a fair amount of agreement among those on the right that union and government compensation packages are too high and that the majority of workers without high demand skills will have to settle for compensation more in line with Asian and South American competitors.

I think the recent insurance discussion would have to mean, at least initially, greater expenses for those that use healthcare. Would anyone argue that?

I'm just wondering how these ideas can lead to greater prosperity for anyone other than the wealthy.

This.

This is basically the point I thought you were making, and it's the one that I mentioned taking no exception to.


This I might quibble with a bit, it probably goes well beyond that. Then again, barely more than half (52%) of even Democrats are convinced that there's still a need for unions at all. 68% of Repubs & 54% of Indy's believe that unions have outlived their usefulness.

edit to add: At this point, anyone that "looks for the union label" is more likely to be checking so that they can find a different product to buy.

Yes, I agree with that sentiment. Though, there are a lot of other ways they are being taxed artificially that should go away. I don't see that the latter needs to change the principle of the former.


I think you are conflating 2 different concepts (at least if you are referring to anything I've said).

Having the global laborer's quality of life improve more quickly than the US laborer's quality of life does not mean the US laborer's quality of life is not improving. Throughout the past 30+ years that we've seen "income inequality" grow, we've also seen some of the biggest breakthroughs in quality of life for the average worker. Is it perfectly equal to somebody of higher income? Of course not...that's what the higher income can support & should be seen as motivation if one values such things that a higher income can afford.


Greater out of pocket expense in exchange for the increase in salary. Just like lowering taxes, when you put money into the consumer's hands, it gets spent where the consumer sees the most benefit.

Now, if you are arguing that the consumer isn't informed, or in some way capable, to make such determinations for themselves...then that is going to be a fundamental disconnect with us. We can inform & educate through our public school systems to the extent that we teach people how to learn & what it means to be educated on a subject.

But this "handholding until you see how right I am" approach is the road I just don't like people going down. I don't think (all) liberals see it that way...but I think its fundamentally wrong to force people into participation when there are alternative ways to allow for incentive...but not mandate.


As I noted above...I disagree that you & I have not had prosperity. You've had it...just not in the obvious wrapper you're looking for.

I wasn't talking about the past, just proposals for moving forward. I've seen people here argue that union compensation should be lower, government compensation should be lower, lower skilled people should be happy with whatever the company offers, Americans will just have to get used to their being fewer jobs, and as one poster stated people should get used to working for less. Almost all of those posts have come from people that are also argue at least one of the other points. I'm just curious what the theory is behind these policies. How would they lead to greater prosperity for the poor or middle class?

I can almost get behind this if insurance contracts are simplified to the point that you get out of college around 20-something you pay into a life insurance like plan that grows at a set scale as you age by contract that the insurer is not allowed to break or modify and illegal tactics like misuse of recissions, being bounced from coverage due to employers, and other factors that make the market inefficient are eliminated.

You could do this now, but it is a bitch and expensive, and any attempts to fight it are shouted down by the 'healthcare is so expensive' line. I agree though that in theory insurers should not be in the business of providing care to customers who come to them with bad conditions. I do think they should be in the business of selling a consistent long term insurance product and being held accountable for the debts they owe as part of those contracts.

To make the math work you need less movement between contracts and less employer involvement and more responsible consumers... all of those factors have been a mess and I don't think people in their 40's or 50's now should be punished by the fact the market was fucked throughout their adult lives and they are shopping when the natural price curve is insane and they are loaded with conditions. Maybe some sort of government backed subsidy combined with a planned transitionary period, expansion of government aid in the interim, and some sort of heavy club to create a productive (and profitable) insurance market that is more in tune with a marketplace and not the various negotiations between cartels we have today (employers, insurers, hospitals, all taking agency decision away from the people who need it most... and not passing on the security of group bargaining they should).

A flat tax is regressive, even conservative economists (those not spouting what their handlers want them to) have done micro and macro analysis of it and agree it is suboptimal for an economy. The basic concept is marginal return and incentives, and in a society with any sort of social/government spending at an appreciable scale (never mind the USA's massive spending) the notion of pushing thousands of people deeper down the wealth curver for every single rich man (with each of those thousands generating more circulation effect per marginal dollar than the billionth dollar of Bill Gates) is generally considered to be perverse cruelty, and for the math nerds like me who are sometimes heartless... it is bad for consumer spending (or for the frugal out there, it also highly destroys savings rate, and if you get rid of middle class savings you put a massive supply crunch in the financial system, even with all those billionaires out there, it is amazing what numbers still count for).

I do not want to live in a country with a 'fair tax' that takes my effective rate from 40% to 25% (or whatever rate the flat tax balances out to, it ain't no small number these days even with loophole reduction), but kills the economy so I can't sell millions of widgets and grow my wealth in the first place. Growing economies are good, and yes tax reduction is factor of growth, my ultimate ideal is all rates declining as wealth creation allows spending to be reduced... we should all aim for that, but you don't do that with a pointless top rate cut and a massive hike for 80%+ of the population. Spending drives growth, spending decreases when the ratio of budget of dollars you have over budget of dollars you need to spend decreases.

I sort of agree with this. But I only agree with this in the sense that the free market doesn't work completely for the health care industry. Sure it's fine if you're in your 20's and 30's and relatively healthy. You pay for insurance and if something goes wrong you get fixed up and save yourself an impending bankruptcy.

The problem lies in people who either can't get insured through pre-existing conditions, cost, or both. And these aren't people who are just lazy. There is no insurance company that would insure a 75 year old man with a history of cancer. The overwhelming majority of retirees could not afford their premiums. While I heavily support the free markets in other areas, health care is just not one it works with thanks to its unique issues.

I still think cost and preventative health is the single most important issues to tackle. It was kind of sad to see people attacking Michelle Obama for her childhood obesity campaign. That's the kind of stuff we should be pushing and will result in lower costs for everyone.

One of the most interesting discussions I had was with a doctor of mine who actually came from overseas and worked in the Middle East during the recent war (he has a unique perspective on things to say the least). He told me one of the issues with our system is that there is no stopping point for care. He gave an example of a kid who hit his head. Says that a good examination by a doctor and some observation is good enough. But there is that 1 in a million chance that it's something more severe so everyone wants a CAT scan done. Not just the parents but the doctors who don't want to get sued. So you've thrown on a few thousand for an unnecessary test. He also mentioned how we give out a ton of Meningitis vaccines which can cost billions yet it really doesn't effect a lot of young people.

Now he wasn't saying we shouldn't do that, but just saying there is no line. That if we want to run every test for a bump in the head or get a vaccine for every small possible illness that could strike, we are going to have to pay a lot for it.

I think I'm the only poster who routinely rants about spending reduction in government while at the same time the necessity of a massive jobs rebound. We should sponsor policies that get real work out there, but even i do not think we can recklessly spend ourselves there. We need to build some seriously useful shit, consider this a great time to borrow dollars at record low treasury rates, and clean house as part of our economic recovery.

Cutting spending is not going to save us by itself, spending shovel ready piles of money will just dig the hole deeper. You need real asset creation at the time where all the pundits will try and tell you that you do not deserve them, that you should prepare to live like a dirty ass Chinese peasant. We are not entitled, but we do got work to do if we want to maintain the security and standard of living that we spent most of the 20th century developing, and that is not bombing some dirt farmer half a world away, or sweetheart deals for billionaires who long ago stopped contributing ideas that created wealth and became our nations biggest welfare cases.

I still don't get why people get so upset with unions. I'll admit that the deals they get are way over market value. But fuck, it's a free market and they found a way to get paid that. I could give two shits what GM or Ford pay their union workers.

Now if we're talking government, then I'd be upset with the politicians who gave them those deals, not the union or people in it. It's like owning a sports team, sending your GM to cut a deal, he gets a horrible one and then blaming the player's agent.

If you are paying 40% effective rate right now, then you are not taking advantage of the types of loopholes that Google is, or the accounting practices that have driven us into lower effective rates on the wealthy. The problem is the regressive nature of the tax system.

So yes, when economists speak, they are speaking in a vacuum within today's tax structure. A flat tax rate would seem regressive in today's structure because of the effective tax rate that would be realized. But those are still 2 very different problems to solve in my view. I wouldn't advocate that you employ a flat tax without closing creative accounting breaks first...but I would prefer to see both happen (among other things) at the same time in order to stop the obfuscation of cost we have in government (and products). And the less dollars that circulate through a centralized government...the smaller its power, influence, and resultant impact from bribery becomes.

In other words...I want an effective rate equal to the taxed rate. No loopholes & no deductions because you washed your car with rainwater...flat. If we could get Google, GE, Warren Buffet, & Big Oil (including their CEOs) to just pay an effective rate close to what an average middle class worker pays...we'd be in much better shape. So advocating to keep the convoluted system in place because of the perceived inequality is, in my view, worse for middle- & lower- income workers than simply putting in a flat rate (but a TRULY flat rate without loopholes or deductions). IDK if that should be 25%, 20%, 40%, or 10% but when we unravel all of the tax breaks & loopholes...we'll have a better understanding of where we need to be. But you gotta take 1 issue at a time, and this is only the first.

Agreed. I'm not overly concerned with them either beyond the point of when/if it comes time that taxpayers have to bail them out. That suggests a broken system & I don't think its very useful to prop up such systems.

You're right. We aren't entitled to our way of life...we need to earn it.

My soapbox has (and will be) that we should set a goal to be 90% (or somewhere around there) energy independent by 2020. What do we use to do that? I don't give a crap what we use, so long as it is sourced from the US as a matter of national security. So if its Nuclear, some wind, some solar, some coal...fine. Just make it happen and the costs will justify themselves as the economic activity will stay within the US and the money leaving the US to countries that we don't really align with philosophically will end (or at the very least...the market for oil will have the biggest buyer out of it, which will lower the price of it thus lowering revenues for oil-producing nations).

That is exactly the point I have been trying to make & thats a good way to summarize it...there is no stopping point to care.

And as you mentioned, the doctor doesn't want to get sued...the parents are worried...and guess who is looking at the cost? Insurance companies...who aren't vested in your family financially or otherwise. But if that family had to foot say, 75-80% of the bill...then common sense is going to come into play.

I guess I'm still not clear on why a situation of a 75 yr old man with no insurance but has cancer even exists? Why can't this man get Medicaid today?

The economic analysis is done in the absence of loopholes... so everyone paying the exact same percentage has been shown to have many weaknesses and very little value other than some absolutist notion of fairness. Ultimately I want all taxes to be reduced (including the top rate) but unlike the supposed fiscal conservatives in the room I actually believe you pay your bills before you go shopping at the mall. To me the best way to clean up the mess is to tax the rich... to get their incentives aligned with killing the expensive corporate welfare that is ever more making up an increased share of spending.

Once the lobbying money is turned away from sweetheart deals and towards across the board tax reduction (because they don't have their loopholes anymore) I would be surprised to see spending, deficits, or high tax rates to stick around for too long. It might encourage them to be brutal about cuts to 'entitlements' in their lobbying (meaning the politicians are going to have to grow a spine, either confronting the lobby or confronting those big swaths of voters)... but either way the gravy train is going to get killed as far as social security or medicare is concerned if thinks stay on track, I'm suggesting what I think to be the path most probable to keep them around.

So I agree, take one issue at a time, start with loopholes, make use of the resulting surpluses to either build important things or flat out pay off debt.

Consider the regressive tax on the majority of people after you take at least a year or two of those tax returns to clean up the mess caused by decades of corp pork and low effective rates.

He can, I'm just using it as an example as to how free markets and medicine don't necessarily mix that well. There are people who literally argue that Medicare is bad.