The Obama Presidency - 2008 & 2012

[SteveMax58]

Originally Posted by Edward64

I know some say too much, others say too little on Libya. I think it was about right for a non-strategic war for US and in supporting our allies in "old Europe" in their fight. I remember the Balkan war when we were dis-proportionately involved considering it was in our allies backyard.

Who Did What in Libya - Real Time Brussels - WSJ

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.

[sterlingice]

I thought we played Libya pretty damn well

SI

[JPhillips]

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.

[SteveMax58]

Originally Posted by HiFiRevival

I'm still waiting to see a legitimate way to excuse military action without a declaration of war according to our constitution. If the Supreme Court actually bothered with the issues it's supposed to, the whole idea of Congress authorizing the President to use force thing would be tossed out as the unconstitutional tripe it is. We murdered random people in Libya that had zero to do with national security. It's evil, illegal, and without justification.

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.

[Edward64]

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

WASHINGTON — Among the very first foreign leaders President Obama called after entering the Oval Office on Jan. 21, 2009, was the president of the Palestinian Authority, Mahmoud Abbas. The last time the two men spoke was in February, when Mr. Obama failed, in an awkward, 55-minute phone conversation, to persuade Mr. Abbas not to go to the United Nations to condemn Israel for building Jewish settlements.

The 25 months between those calls demonstrate how Mr. Obama’s relationship with Mr. Abbas has withered — and along with it, Mr. Obama’s hopes to make Middle East peacemaking one of his signature achievements.

Later this month, the Palestinians seem determined to go to the United Nations again, this time to ask for recognition of a Palestinian state, a move the United States has vowed to oppose. But Mr. Obama has no plans to call Mr. Abbas, a senior administration official said, because it is clear that the president can say little to stop him. (The United States blocked the last Palestinian resolution as well.)

“The beginning of their relationship was good — auspicious, actually,” said Ziad J. Asali, the president of the American Task Force on Palestine. “But then decisions, mistakes and reality changed the relationship.”

American and Palestinian officials insist that there is no animosity between Mr. Obama and Mr. Abbas, unlike the often tense relationship between the president and Prime Minister Benjamin Netanyahu of Israel. But Mr. Abbas has lost faith in Mr. Obama, Palestinian officials said, and after four face-to-face meetings and many regular telephone calls, there is now little contact between them.

http://www.scoop.co.nz/stories/HL110...-palestine.htm

The documents reveal countless details of negotiations and offer a unique insight into the negotiations, the peace process and ultimately, its failure to-date.

The revelations cover a wide variety of deals and negotiations; one which has courted the most controversy was the willingness of Palestinian negotiators to accept Israel's annexation of all but one of the illegal settlements in occupied East Jerusalem - this would have created the 'biggest Jerusalem' in history had Israel not rejected the offer.

The Palestinian negotiators offered large concession on the right of return of Palestinian refugees, supposed to be a "final status" issue.

The Papers reveal Israel's request for the "transfer" of some of the Zionists state's own Arab citizens from Israel to a Palestinian state (though the state remains as yet undeclared).

The Papers also revealed the central role of the British Secret Intelligence Service (MI6) in a plan to orchestrate the complete destruction of Hamas within the Occupied Palestinian Territories.

The leaked documents exposed the PA's foreknowledge of Israel's offensive on the Gaza Strip in 2008-09 (Operation Cast Lead).

[gstelmack]

Originally Posted by RainMaker

Mark Cuban has actually talked a lot about this. His take is interesting. Bunch of rich funds buy in to a company. They bring a guy in, pay him huge bonuses for making short term moves to raise the stock (layoffs, etc). Then they cash out and leave the remains to others.

Companies and investors don't worry about long-term anymore. It's why we've seen so many large companies destroyed over the past decade.

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.

[SportsDino]

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.

[SportsDino]

Originally Posted by gstelmack

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.

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).

[Edward64]

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

WASHINGTON — As Congress opens a politically charged exploration of ways to pare the deficit, President Obama is expected to seek hundreds of billions of dollars in savings in Medicare and Medicaid, delighting Republicans and dismaying many Democrats who fear that his proposals will become a starting point for bigger cuts in the popular health programs.

The president made clear his intentions in his speech to a joint session of Congress last week when, setting forth a plan to create jobs and revive the economy, he said he disagreed with members of his party “who don’t think we should make any changes at all to Medicare and Medicaid.”

Few Democrats fit that description. But many say that if, as expected, Mr. Obama next week proposes $300 billion to $500 billion of savings over 10 years in entitlement programs, he will provide political cover for a new bipartisan Congressional committee to cut just as much or more.

The prospect of further cuts worries health care providers because it comes on top of the new health care law, which reduced payments to most providers to help offset the cost of extending coverage to millions of uninsured Americans

But Mr. Obama has said that “health care cuts” need to be part of any deal, and he has already given a preview of the cuts he is likely to propose next week. In April, he unveiled a framework for deficit reduction that he said would save $480 billion in Medicare and Medicaid by 2023.

In negotiations with Congressional Republicans in July, Mr. Obama went further. He indicated that he was willing to consider a gradual increase in the age of eligibility for Medicare and cuts in federal payments to states for Medicaid.

Medicare and Medicaid account for 23 percent of federal spending this year, and their costs are growing faster than the rest of the budget because of increasing enrollment and medical inflation.

Under current law, the Congressional Budget Office says, the two programs will account for 28 percent of federal spending in 2021.

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.

[RainMaker]

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

[SteveMax58]

Originally Posted by Edward64

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.

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.

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.

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.

[Marc Vaughan]

Originally Posted by RainMaker

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

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?

[stevew]

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

[SportsDino]

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

[Marc Vaughan]

Originally Posted by stevew

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

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.

[JPhillips]

Originally Posted by SteveMax58

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.

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.

[Edward64]

Originally Posted by SteveMax58

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...

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.

[SteveMax58]

Originally Posted by JPhillips

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.

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.

[JPhillips]

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.

[JonInMiddleGA]

Originally Posted by SteveMax58

This is why I believe you have to decouple employee/employer insurance as a "standard" practice

This.

[SteveMax58]

Originally Posted by Edward64

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".

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 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.

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.

[SteveMax58]

Originally Posted by JPhillips

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.

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 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.

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.

[JPhillips]

Originally Posted by SteveMax58

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.

[SteveMax58]

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).

[Warhammer]

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.

[SteveMax58]

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.

[Warhammer]

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!

[JPhillips]

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.

[SteveMax58]

Originally Posted by JPhillips

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.

[DaddyTorgo]

Originally Posted by SteveMax58

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.

[Mizzou B-ball fan]

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

[JPhillips]

Originally Posted by SteveMax58

I'm just arguing that you have to drive the cost to be more inline with the consumer's ability to pay.

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.

[SteveMax58]

Originally Posted by DaddyTorgo

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

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.

[SteveMax58]

Originally Posted by JPhillips

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.

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).

[DaddyTorgo]

Originally Posted by SteveMax58

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.

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?

[JPhillips]

Originally Posted by SteveMax58

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).

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?

[SteveMax58]

Originally Posted by DaddyTorgo

"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?

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.

[SteveMax58]

Originally Posted by JPhillips

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?

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.

[JPhillips]

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?

[BrianD]

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.

[DaddyTorgo]

Originally Posted by SteveMax58

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.

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.

[SteveMax58]

Originally Posted by BrianD

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.

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.

[SteveMax58]

Originally Posted by DaddyTorgo

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.

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

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.

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).

[DaddyTorgo]

Originally Posted by SteveMax58

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.

[SteveMax58]

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.

[SirFozzie]

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.

[SteveMax58]

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.

[BrianD]

Originally Posted by SteveMax58

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.

[SirFozzie]

Originally Posted by SteveMax58

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.

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?