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Why capitalism won’t fix healthcare

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I am a recently retired pharmacist. What has happened in the pharmaceutical manufacturing community over the past two decades makes me sick to my stomach. Drugs that cost very little are marketed at up to 5000 times their cost. Why? Because they can. In order for a human to survive, after the big 3 (breathing, drinking, and eating) comes health care. And don’t think these unscrupulous companies don’t understand this. You don’t need a Mercedes, a new computer, a fancy home, video games, or season’s tickets to your favorite team to keep you alive; but you do need health care. This is where capitalism has you by the balls and these immoral CEO’s will squeeze until they get their price. This is the ugliest offspring of capitalism. It’s not “Why Capitalism Can’t Fix Healthcare”, it’s “Why Capitalism Won’t Fix Healthcare”. And yet, even like some of my fellow pharmacists who think it’s OK to make the bucks off some ill human being, there are many reading this thinking I’m a bleeding heart liberal. Well fuck you and your self-centered capitalism. As in every ideal, there’s a line that can be crossed which shouldn’t be crossed. Shame on the health care capitalists of the world – you’ve crossed it.

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Posted by troll
Posted on 03/25/2017 10:16 PM
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The Insurance companies in the US have done an amazing job getting people to conflate “health care” with “health insurance”. They are not the same thing.

At the same time, the actual health care industry has done an amazing job at moving the blame for their runaway US costs away from themselves and onto the insurance industry.

Both of these businesses are causing problems that need to be addressed, but our political system hasn’t even begun to scratch the surface of the issues.

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Posted by Steve Schuller
Answered on 03/26/2017 11:08 AM
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    My health plan is to either never get sick or hopefully die instantly. I doubt this problem will be realistically addressed in my lifetime, much less solved.

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    Posted by Scott Nicholson
    Answered on 03/26/2017 2:05 PM
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      Nice read and I agree though I think you may have over complicated it? Here’s perhaps an over-simplified perspective.

      Our medical industry sells two products and services – life and quality of life. Most consumers want these products and services really in a bad way. Because of the nature of the product and services our healthcare system provides they have most of the capitalist pricing power and will likely always have it. Therefore, we consumers will either pay the asking price or suffer and/or die.

      Yes, capitalism is not an equitable match for life and quality of life.

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      Posted by Digital Ghost
      Answered on 03/26/2017 3:29 PM
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        Good read. Tough problem. Not really any easy solution, but agree government needs to be involved here.

        So some personal background… I’m a 27 year old with health insurance. I work in finance and make a good amount of money. I was diagnosed with cancer last year and they billed my insurance about $300k-ish give or take for all my treatment. I have a lot of millennial friends who complain about how much they pay for insurance. None of my friends (as we are pretty young) have any remote idea what it’s like to have such a serious disease or the costs that come with it. No matter how much any of them (or I) pay in health care premiums, it would never cover the cost of care. It’s something I point out as younger people tend to be healthier and don’t have to deal with these issues yet. Even with my job, I would never be able to pay that much money, ever.

        Yes, the hospital definitely overcharged but I guess that comes down to the economics of the issue – how much is a service really worth? Because healthcare (insurance, drugs, whatever) are pretty inelastic when it comes to cost.

        Insurance itself is built on people essentially paying for something they will never use, but it requires a lot of people to do it. Any insurance is like this – you have to have car insurance if you own a car, so you pay X a year. Likely, you won’t use it but you *might*. It’s one of the more interesting/complicated products out there from an economics point of view.

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        Posted by Kristin Ng
        Answered on 03/26/2017 3:44 PM
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          Really disagree with the idea that capitalism can’t fix healthcare. If we allow importation of prescription drugs from canada, health care becomes less expensive. Healthcare sharing is growing in popularity, see libertyhealthshare.org for an example. They are VERY inexpensive, they may also not be very good, I don’t know. Innovations like healthcare sharing, and allowing free trade and competition are market based solutions that absolutely improve our health care system. Maybe the federal government could stop subsidizing really unhealthy foods like sugar and high fructose corn syrup, another free market solution. Maybe capitalism can’t fix health care, but it sure can improve it, if we let it.

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          Posted by laskerfan12
          Answered on 03/26/2017 4:34 PM
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            Laskerfan12, read Kristin’s very good comment. There is not a market based solution for giving everyone a Ferrari. No matter how much competition there is Ferraris will always be unaffordable to most people. Same thing goes for Cancer treatment or any other millions of life saving operations that people need.

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            Cullen Roche Posted by Cullen Roche
            Answered on 03/26/2017 5:55 PM
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              Since everyone’s spending is someone else’s income, whose income is going to be reduced when we talk about reduced health care spending? Whose income *ought* to be reduced?

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              Posted by JGF
              Answered on 03/26/2017 9:34 PM
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                Capitalism may not be able to deal with the “Whale at a Buffet” problem, but single payer seems even less equipped to deal with it. I suspect single payer will turn a large segment of the population into whales. I know someone on Medicare who visits a doctor weekly. Is he very sick? No, basically, it gets him out of the house and gives him something to do. After all, it’s cheaper than going to a movie.

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                Posted by Jon L
                Answered on 03/27/2017 10:39 AM
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                  @ Jon,

                  Yes, a single payer system won’t fix all the problems here. I don’t think anyone is saying that the govt should rule over healthcare with an iron fist. All I am saying is that there’s a very legitimate argument for govt involvement here.

                  It seems to me that part of the problem with our political discourse these days is that one side (Liberals) argue for govt to work with the private sector on certain things while the other side (Conservatives) says that govt needs to get its hands out of everything. Both are legitimate positions in certain circumstances so we have to be really careful about how we generalize our thoughts here. Defaulting to one position or the other is not going to be the right stance all the time.

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                  Cullen Roche Posted by Cullen Roche
                  Answered on 03/27/2017 12:26 PM
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                    To my Libertarian “free-markets can fix health insurance and health care” friends, I say that when in comes to health insurance (not the same as health care), the free market can help, but it falls short for the reasons Cullen has illustrated.

                    For insurance, there must be a certain level of regulation because health insurance companies really don’t want to sell policies to people that will be (or will likely be, in the companies’ opinion) unprofitable.

                    Employer-provided health insurance, which has been a dominant piece of our health insurance system, has largely covered those employees with pre-existing conditions for quite some time, but in the individual insurance market, many of those workers would have hard time obtaining policies. Much of the discussion about how to best deal with those with pre-existing conditions wrongly gives the impression that we’re talking only about people with cancer, type 1 diabetes, or some other expensive to treat chronic health issues. As a former insurance agent, and as somebody who has had trouble getting insurance for my spouse – I can say that impression is inaccurate.

                    Our health insurance system is a multi-tiered, inefficient, and unfair mess – and was long before the ACA. Free-market forces have been greatly muted by employer-provided health insurance for decades. Employers get a tax deduction for the cost of the insurance while employees have no tax liability for that part of their compensation. Employees also have little or no say about the policies provided -and for many years (at large companies), they enjoyed very low deductibles and low co-pays. There’s not much in the way of free-market incentives when it comes to consuming health care when you have so little skin in the game.

                    Then there’s the other dominant piece of our health insurance system: Medicare – which is essentially a single-payer hybrid. We all know that Medicare is facing financing challenges, but in areas like Florida, the providers (doctors and hospitals) have figured out how to operate profitably with Medicare’s price controls. I suspect a modest payroll tax adjustment will keep Medicare going.

                    For all the problems our health insurance system has had for so long, we must acknowledge that our country has led the world in healthcare breakthroughs for decades.

                    To those that are so critical of single-payer systems like Canada, or individual mandate systems like Switzerland, I will say that all systems ration health care – ours just does it differently.

                    Would moving to a single-payer hybrid system completely end up seriously harming future innovations for health care procedures, treatments, and related technologies? I don’t know – but I don’t think it would necessarily mean killing off such innovations. What I do know is that we spend 25-40% more per capita on health care than any other developed nation – and we’re have arguably little to show for it on health care quality, life expectancy, or access to health care. (Cancer survival rates are the one metric we have a substantial lead in.)

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                    Posted by Steve W
                    Answered on 03/27/2017 12:31 PM
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                      Capitalism fixed this part of healthcare:
                      https://www.yourchoicedirectcare.com/pricing-fees/
                      Just look at those out of pocket affordable services. That’s in Michigan.

                      Dr. Jeffrey Davenport has something similar in Oklahoma:
                      https://jeffreydavenportmd.com/

                      Direct care where you remove the insurance middle man can go a long way to letting the free market help lower cost.

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                      Posted by Cowpoke
                      Answered on 03/27/2017 12:52 PM
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                        Now show us how competition is driving down the costs of life threatening treatments, ie, the Ferraris of the healthcare markets.

                        This is where the root of the problem is. As with any type of insurance pool the real risks come from the high risk part of the pool. When there are too many claims at the high risk part of the pool the entire pool becomes unaffordable. Competition isn’t fixing the part of the pool that actually needs fixing. And I suspect it can’t because it can’t make its users earn higher incomes.

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                        Cullen Roche Posted by Cullen Roche
                        Answered on 03/27/2017 1:56 PM
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                          I think health insurance and healthcare in the US has not been a capitalist market for a long time. To complete your analogy,

                          Consumers are paying for everything on the menu when they arrive at the restaurant. There is only a few simple prices on the menu, $ Bronze, $$ Silver, $$$ Gold. They have no idea how much a simple cheese burger and fries cost. Mcdonalds and and Healthy Mchealth do not publish rates for fries, nor do their partner restaurants (hospitals) and supply service (drugs and medical supplies). They only trust that Mcdonalds is making the best choice for them and their eating habits. There is no negotiating and there is no price breaks. Mcdonalds can set the price at $3000 for a Hamburger even though the actual dollar cost to produce hamburger is less than $3.00. Consumers have no price awareness, nor do they care.

                          I personally do not expect this system to reverse its course due to the special interest lobbying and the undeniable HUGE fact that it controls 18% of GDP. So what can be done rationally that will help consumers save vs. control?

                          The only pragmatic solution (your words not mine) is a fee for service model for “high risk” pools and a block funding model with price controls that exist in the medicare market for all other “healthy” pools. Insurance carriers will function much like our medicare market with plan type C administration. The key point is hospitals, RX and providers are no longer in control of setting pricing. High Risk individuals will always absorb the market capital and unfortunately, states have already shown a poor record of controlling cost and administration of high risk individuals. So this responsibility needs to pass to federal management and allow the state and local carriers only to manage the healthy pools.

                          Now the detail comes in as how do we pay for this.

                          Its not the solution I want, but arguably the only solution that will work long term in our political and social environment. Sorry, not sorry.

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                          Answered on 03/27/2017 3:51 PM
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                            In reading Kristen’s & Troll’s posts an alarm bell went off in my head.

                            I mean, this has all the sound of college tuition inflation (I don’t recognize the 2 universities from which I graduated – they look like they have transitioned into the real estate business!).

                            One common theme for the inflation has been all the government-sponsored loan money chasing a limited supply. The universities charge whatever they can get away with. Ad nauseum.

                            I see Kristen’s description of the costs in the vicinity of $300K. But wait a sec, we are talking cancer right? So, a combination of radiation and chemo treatments along with hospital bed time. The radiation treatment is some MRI-like machine, right? Chemo is taking drugs. Bed time is bed time (think hotel + nursing assistance).

                            Where is the vetted cost? I am not saying that Kristen is spoofing us, I am quite sure she isn’t. But how do you get to $300K? My takeaway is that the services and products are far out of scope to qualify as being at a ‘fair’ cost.

                            Just like tuition.

                            Just like the :20 doctor appt.

                            So at least one issue has to be an answer to the cost question. Why so much? Where is the vetting? At least with an after-market car part or a McDonald’s Big Mac, you have some visibility into the final cost and the paper-thin profit numbers.

                            The other thing that bothers me is the over-use of the system. The bad actors are actually on both sides with patients overdoing it with appointments, and doctors overdoing it with follow-ups and referrals to other specialists.

                            The other thing that bothers me is that typical medical ‘health’ isn’t. Heftily over-subscribed statins? Do you know what those things do to your body? The lipid hypothesis of heart disease (and why about the last thing you care about is your total cholesterol count!)(https://www.amazon.com/Human-Heart-Cosmic-Understand-Cardiovascular/dp/1603586199/ref=sr_1_1?s=books&ie=UTF8&qid=1490645291&sr=1-1&keywords=thomas+cowan+heart)? Low fat diets? Taking the next new chemo therapy when your quality of life will fall to the ground when you do (https://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/1250081246)?

                            I’d love to hear some solutions to these problems, because I am rapidly losing count of all the things to shake a stick at.

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                            Posted by Poseidons Bear
                            Answered on 03/27/2017 4:12 PM
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                              Medical Tourism is the Capitalistic answer for larger “High Risk” pools.
                              For a fraction the cost for things like Heart Surgery you can fly a whole Family of 4 to India put them in a 4/5 star hotel for a month while thier loved one recovers and then fly them home and still save 70-80 Grand
                              Heart Surgery in India for $1,583 Costs $106,385 in U.S.
                              https://www.bloomberg.com/news/articles/2013-07-28/heart-surgery-in-india-for-1-583-costs-106-385-in-u-s-

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                              Posted by Cowpoke
                              Answered on 03/27/2017 6:46 PM
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                                Healthcare is cheaper almost everywhere else in the world for many reasons. This isn’t necessarily a function of capitalism. In fact, if anything, this proves that capitalism has failed to drive the costs down in the world’s most capitalist country.

                                No to mention the minor detail that when someone has a heart attack they don’t exactly have time to get on a plane to India. The locality of healthcare is part of why the US system has a problem with bilateral monopolies….

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                                Cullen Roche Posted by Cullen Roche
                                Answered on 03/27/2017 7:34 PM
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                                  Are there any other countries that have an insurance-based system like we have? If so, how are they functioning?

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                                  Posted by Jon L
                                  Answered on 03/27/2017 8:06 PM
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                                    Sooo My brotha Cullen based on your reasoning, My cheap 50″ flat screen TV or computer or any other gadget is NOT a product of capitalism because they are made in China, Japan or somewhere other than the US.
                                    Not to mention the Call Center Tech I just got off the phone with who works for Square Trade Insurance Company (In India Call Center) that just cut me a check for $650 fiddy for a broken laptop screen… Nothing Capitalistic to see there hugh?? LOL

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                                    Posted by Cowpoke
                                    Answered on 03/27/2017 9:22 PM
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                                      Adding to the previous post: 2 thought streams:

                                      1) I mostly see an alternative medicine doctor (nurse actually) – straight fee for service (for their services only), once a year nominally. I get a blood/urine panel that is about 9 pages long (not the stuff from the regular medicos). I saw the bill from the last panel – about $2,500. I nearly had a heart attack. WTFO???? Then I saw the NEGOTIATED price in the bill after the health insurance claim was processed. Final bill? Somewhere between $173 – $250. Is it just me, or does it seem like the billings for raw-knuckled raw-cost services are way beyond normality? Thank gosh that we have a high-deductible catastrophic health plan in place to negotiate this insanity down to realism. But why is that way? Does your takeaway jive with mine? Do you get the feeling that health care costs are a complete and utter contrivance? Where did they pull that cost from anyway? My suspicion? Their a$$…

                                      2) Why is it that we treat Health Insurance SOOOOO differently than we do other insurance???? I have a work colleague who pointed out the fallacy of my thinking. We nominally get health insurance with the expectation that we go to the (damn) doctor and we pay a co-pay of about $20 or so. We don’t pay fee for service. But we don’t do that with car insurance! Do you actually use your car insurance to get an oil change? Do you use your home owners insurance to paint a room in your house???? Or to fix a window? We suffer from a fallacy of thought here, and this may be contributor to the problem. For health care, buck up and pay up for the nominal stuff – straight fee for service. Save the health insurance for the big boy bills, like when you really need a heart bypass operation. With the current insurance plan, we run super high deductibles ($3,000) and pay for all services and medications at the NEGOTIATED price – no co-pay. Mebbe, we are getting close?

                                      3) Extra credit: I had an appointment with a regular doctor this past year after ~21 years of not seeing a regular doctor. The only motivation was to get some sort of price break on our insurance costs which I never saw. That experience was so bad, that I am thinking of just opting out of regular medical care. These guys are num nuts! Their health ‘care’ is totally cookie-cutter and completely non-informed. It isn’t that I haven’t had serious issues with my alternative medicine doctor – I have. I had to take him and his nurse to the water on a problem I was having and run the tests. But these regular doctors? They are apparently so constrained by their working situation that to attend an appointment, you get to listen to a bullshit monologue. Oh? At the end of the :20 appointment, they MIGHT say ‘any questions’? I think I have come to a decision here! End of the regular doctors! See you mebbe in 20 years! Done.

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                                      Posted by Poseidons Bear
                                      Answered on 03/27/2017 9:29 PM
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                                        Addendum: Hey Cullen? Can we stop making this a criticism of capitalism, and instead think about fixing the system instead? Use capitalistic strategies where they make sense and when they don’t employ safeguards. Just sayin’…

                                        Arguing about the former issue doesn’t solve the latter issue – ’cause that’s where the rubber hits the road – hoss.

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                                        Posted by Poseidons Bear
                                        Answered on 03/27/2017 9:33 PM
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                                          CP, sigh. This is a false equivalency. If that doctor imported his services to the USA they’d be marked up at US prices just like your TV is.

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                                          Cullen Roche Posted by Cullen Roche
                                          Answered on 03/27/2017 9:40 PM
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                                            PB, you think I have solutions to this problem. You, good friend, have too much faith in me. ?

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                                            Cullen Roche Posted by Cullen Roche
                                            Answered on 03/27/2017 9:43 PM
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                                              Then Cullen, can you please get to work on this issue? We don’t understand the issues that Congress deliberates on health care. Citing the ‘failure’ of capitalism in health care is an easy out. We already get how capitalism fails us from the ‘robber barons’ in the 1920’s. Yes, we get that. But economics is about social issues – o/w there wouldn’t be a husband & wife pair of economists who recently reported on the alarming death rate increase of white females in the central US due to alcohol, ~drug abuse, and basically despair due to their lack of options of a reasonable living situation. Cf. the long diatribe by the Washington Post (I think it is a 6-part series). Google ‘white death rates alarming increase’ and I think you’ll hit it.

                                              People are dying here. And yeh, back in the 20th century they died as well. But now, we have the tools in place where we can do something. And it does not necessarily require a socialistic response of mongo wealth transfer from the healthy – at least, I am not sure it does – subject to a vetted debate.

                                              Does anybody remember St. Jude’s Hospital? Wasn’t there a hospital system that provided health care for the indigent (i.e., the poor) at one time? How in the world did that system work?

                                              I may be thinking that health insurance is too rich for my blood. I may just opt out completely. Take my chances – roll the die. Take whatever life (& death) gives me. Tant Pis. But I am just about convinced that health care is now my sole responsibility. Take it from there – stage right.

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                                              Posted by Poseidons Bear
                                              Answered on 03/27/2017 10:07 PM
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                                                Cullen, the topic you presented is “Why capitalism won’t fix healthcare” and I am presenting an ati-thesis to your original postulation. Where is the “false equivalency” in my summation that using the open and free WORLD WIDE market place via Capitalism Healthcare needs of people CAN be accomplished CHEAPER.
                                                On A MACRO Scale….

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                                                Posted by Cowpoke
                                                Answered on 03/27/2017 10:12 PM
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                                                  CP,

                                                  Fine, let’s look more closely at your example of India. This is a country where it’s estimated that 17% of people have access to healthcare. Is that your definition of solving the problem?

                                                  And let’s get real. Your average joe retired on an annual household income of 39K isn’t flying to New York for surgery let alone India. Telling people to go to the other side of the world for an emergency surgery isn’t a solution or an example of how great the system works.

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                                                  Cullen Roche Posted by Cullen Roche
                                                  Answered on 03/27/2017 10:29 PM
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                                                    Cullen, you are pontificating. You are not trying to engage in a discussions that seeks to solve problems but rather drone on about why we CANT solve a health care problems vias “Capitalism” .. Fine, be a stick in the mud naysayer. I however think the American Can Do Spirit CAN Prevail in this healthcare endeavor. AND IF I choose to utilize foreign nationals that were WESTERN EDUCATED, TRAINED ect..Why Not? Heck REMEMBER, the US Govt is spending BAZZILIONS on health care. So WHY does it matter whether the AVG Joe is and actual; “AVG Joe” OR a BAZILLIONAIRER… ? It shouldn’t ALL THAT SHOULD Is that they receive equal treatment @ a Reasonable price.

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                                                    Posted by Cowpoke
                                                    Answered on 03/27/2017 11:38 PM
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                                                      The 2 snakes on the caduceus (that’s the medical symbol with the 2 snakes wrapped around a staff) can represent health-care and health insurance. I couldn’t think of anything more representative of our modern health situation from a capitalistic viewpoint. One is feeding off the other and getting away with exorbitant costs because they are both HUGE contributors to both major parties. As I said, I can only speak from a pharmaceutical background; but I know when people are getting screwed by the corporate greed of drug companies – and it’s happening on a regular basis. If it’s happening in my field, I’m sure it’s happening in others. Capitalism is failing in pharmaceutical care because of corporate greed. I have a hunch that this sad state of affairs is across the board and am afraid that in the case of health-care, capitalism was a good idea gone bad.

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                                                      Posted by troll
                                                      Answered on 03/27/2017 11:51 PM
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                                                        CP,

                                                        I am not being a naysayer. I presented a sound reasoning for the govt to be involved in this discussion. The reason I did this is because there’s a big group of people out there who think that the govt shouldn’t be involved at all. You are one of these people. And you fail to understand the basic facts around the debate which is a big reason why this whole system is such a mess.

                                                        You have to get over this faith in “can do spirit” and recognize that some things just aren’t ideal for a competitive market based system. Until then we’ll continue to have these ridiculous debates and prices will continue their one way trajectory because we’re leaving the negotiating power in the hands of a group of bilateral monopolists motivated by increasing shareholder value.

                                                        Look – I have faith in capitalists to compete for general goods and services that improve our living standards. But when it comes to monopolists who have to increase earnings per share while also trying to do what’s in the best interest of a dying patient I don’t trust that capitalist for one fucking second to pick the customer over his shareholders…. If you can't understand the most basics realities of this discussion then we can't even begin to think about solutions and sadly a whole big group of people in this country can't understand the basics realities at work here and keep ranting against the govt for no sensible reason.

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                                                        Cullen Roche Posted by Cullen Roche
                                                        Answered on 03/28/2017 12:00 AM
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                                                          Hi Cullen,

                                                          I read your piece and have a couple questions for you:

                                                          1) You criticize capitalism for the high prices in medicine yet there is heavy government subsidy in healthcare, and basic capitalist strategies like opening competition beyond state lines for insurance companies hasn’t been tried. So how can you make the sweeping conclusion that capitalism cannot work for this industry? You conclusion seems ideological rather than empirical.

                                                          2) The system you are describing (everyone buying insurance, and the healthy subsidizing the sick) is the basic idea behind Obamacare. Premiums for this year alone have gone up an average of 25% and health insurance companies have been dropping out of the marketplaces. What is wrong with this system? Why do you say that this is an effective alternative to market based healthcare?

                                                          Thanks for writing and I look forward to your response.

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                                                          Posted by Dmitry
                                                          Answered on 03/28/2017 11:55 AM
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                                                            It seems like we’re headed for a two-tier system where it’s Medicare for the elderly, Medicaid for the poor, wherein most people get their health care via their employer, and the rest operate on the exchanges. The problem today are the cost of premiums on the exchanges. We need to bring those premiums down. If we can do that, we’ve basically fixed our health care problem.

                                                            With respect to pharma and drug prices, that’s a very easy problem to solve. We can either have the government negotiate drug prices or we can strike down drug (re)importation laws. If we do either/or/both, drug costs will come down very quickly.

                                                            Also, single-payer sucks. In Canada, it can take months to get an MRI on a knee. Here, I can get one by tomorrow and all I need to do is to pay ~$350-400 tomorrow (without insurance). Note that MRIs are diagnostic. In Canada, it can take over 6 months and even years to get an knee reconstructed after a torn ACL. The UK has been privatizing the NHS since Blair through Cameron and now into May. What’s happening? Tories keep gaining power.

                                                            So please no single-payer. I know everyone who’s far-left talks about it as great, but single-payer sucks. It’s really quite bad.

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                                                            Posted by Suvy Boyina
                                                            Answered on 03/28/2017 11:55 AM
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                                                              It seems like we’re headed for a two-tier system where it’s Medicare for the elderly, Medicaid for the poor, wherein most people get their health care via their employer, and the rest operate on the exchanges. The problem today are the cost of premiums on the exchanges. We need to bring those premiums down. If we can do that, we’ve basically fixed our health care problem.

                                                              With respect to pharma and drug prices, that’s a very easy problem to solve. We can either have the government negotiate drug prices or we can strike down drug (re)importation laws. If we do either/or/both, drug costs will come down very quickly.

                                                              Also, single-payer sucks. In Canada, it can take months to get an MRI on a knee. Here, I can get one by tomorrow and all I need to do is to pay ~$350-400 tomorrow (without insurance). Note that MRIs are diagnostic. In Canada, it can take over 6 months and even years to get an knee reconstructed after a torn ACL. The UK has been privatizing the NHS since Blair through Cameron and now into May. What’s happening? Tories keep gaining power.

                                                              So please no single-payer. I know everyone who’s far-left talks about it as great, but single-payer sucks. It’s really quite bad.

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                                                              Posted by Suvy Boyina
                                                              Answered on 03/28/2017 11:55 AM
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                                                                Cullen,
                                                                I feel your pain, but not from your view point. I’m one that has to live with the fact that I couldn’t do anything about it. [i.e. I was told by my supervisors that I couldn’t charge cost plus a dispensing fee to people who didn’t have insurance because we charged a different price to those who were insured (a price set by the insurance companies!) So, as an example, I would have to charge an uninsured person, say, $65 instead of $12 for a prescription. And this doesn’t begin to touch the markups I mentioned in my first post]. The fix is in and I’m glad I’m out of it.
                                                                If this is how capitalism works, then it’s immoral for me to support it. If on the other hand (and I hope this is true) an industry wide oversight committee by fellow capitalists (or, less desirably, a governmental body) could put an end to the health-care/insurance shenanigans that are presently going on, I’m all for it. There are literal scumbags in charge of certain health-care/insurance organizations who only see the dollar sign. I hope this debate you’ve started can do something about this mess.

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                                                                Posted by troll
                                                                Answered on 03/28/2017 4:01 PM
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                                                                  Hi Cullen?

                                                                  Question for you? You make a reference above to “bilateral monopolists”. When you get a moment, can you define what you mean by that? It isn’t referenced in your original post.(is it health care providers (doctors, pharma companies, and hospitals and then health insurance companies (Aetna, etc.)) I am too stupid on the issues of health care/insurance to get the reference.

                                                                  In the parenthetical, it seems more like monopsonies rather than pure monopolies. Both are bad situations in capitalism however. Just like oligopolies and ologopsonies.

                                                                  Another reader raised the point and I think it was a good one. The statement you make is that capitalism has failed in this regard. But hasn’t health care/health insurance been a mixed bag of government involvement and capitalism since about the 1980’s?

                                                                  While I can’t speak about the failure of capitalism because of the heterogeneity of the industry, I can sure state that the industry gives all the appearance of being a failure. I can sure agree with the latter.

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                                                                  Posted by Poseidons Bear
                                                                  Answered on 03/28/2017 4:07 PM
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                                                                    The nasty complexity of healthcare in the US is research. The US dominates global medical research, and a lot of that cost is baked into the 18% spending number. The implication is that socialization would have far different effects in the US versus other countries that play a smaller role in medical research. In other words, we spend more on research than they do, if we were to spend half as much, that would necessary reduce how much research gets done here. That’s not to say it’s perfect, I’m sure we spend too much on ED pills and not enough on hard diseases. Certainly there are structural reasons for the high cost that don’t benefit anyone as well.

                                                                    All that being said, Other countries have been able to piggyback on our innovations, which isn’t inherently wrong, but does have implications on global health outcomes if we no longer lead the way. The point being that we cant snap our fingers, socialize the system, and expect American (and global) health outcomes to improve while spending 8% less of GDP.

                                                                    Cowpoke & PB, please understand that much of the developed world has done just fine while paying roughly half what we spend. Some of that has to do with American research, but not all of it. At a minimum, health outcomes are not significantly worse in those countries, which really begs the question of why we often see those systems as vastly worse? Statistically they aren’t. Some issues are handled slower, like cancer, but other problems are handled better because 100% of the population has access. Certainly we cant discount those outcomes as irrelevant if we are so fast to point out the weaknesses.

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                                                                    Posted by advt
                                                                    Answered on 03/28/2017 6:15 PM
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                                                                      advt, That research part irks me. Because us tax dollars have spent a heck of a lot of dough on research that Big Pharma reaps the bennies and then pay BACK to shareholders instead of the the US taxpayers:
                                                                      “The taxpayer not only shells out at the pharmacy but often plays a critical role in funding these drugs in the first place. In other words, the public pays twice.”
                                                                      https://www.latimes.com/opinion/op-ed/la-oe-1027-mazzucato-big-pharma-prices-20151027-story.html

                                                                      Noty to mention all the cheap to free research done for these companies at US Universities. I worked with a guy who’s daughter was paid $12 bucks and hour doing graduate research for cancer for a major pharma. REALLY REALLY SAD..

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                                                                      Posted by Cowpoke
                                                                      Answered on 03/28/2017 6:45 PM
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                                                                        Aloha Hillary Clinton, Bill Gates and Warren Buffet, We need a new nationwide health care insurance company “Uncle Sam’s Health Insurance Company” that will (1) function profitably under the Obamacare mandate, (2) that will compete with the currently existing companies. There is no need to “repeal” Obamacare when the solution is so simple. Please figure this out.

                                                                        We need capitalists that are willing to open a non-profit health insurance company to service our already non-profit hospitals. As for drugs, we need negotiation, negotiation, and serious negotiation– not capitulation. Believe it or not, the reason that Canada’s drugs are cheaper, you guessed it– nationwide negotiation!

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                                                                        Posted by Dennis
                                                                        Answered on 03/28/2017 7:36 PM
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                                                                          Dennis Somthing should be done about drug prices, is it negotiation? I dunno, but I am now on the hunt as I am getting stung for one of my daughter’s asthma inhaler meds. She needs 2 of them at a cost of $1400.00 every 3 months. WTF…. The wife just said that a lady she works with Husband buys his Inhalers From India and saves a ton. Now I gota research this route.

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                                                                          Posted by Cowpoke
                                                                          Answered on 03/28/2017 7:46 PM
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                                                                            CP That company (Mylan), and several others are notorious for buying up other companies or their products so that you no longer have a choice of supplier, all the RX retailers have only one choice. Mylan, for example, spent yuuuge sums to get the exclusive rights from Pfizer and then sell that same EpiPen product at astronomical prices. In this case, the inhaler isn’t even made by them, Pfizer still makes it. They bought the inhaler gadget rights, the medicine costs nothing! They moved their company out of the USA and sell the same exact product to other countries for way-way less, where they have nationwide price negotiations, but also sell into the USA at whatever the market will pay. They are not under any USA “regulations” about monopolies because the company is NOT in the USA. https://en.wikipedia.org/wiki/Mylan

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                                                                            Posted by Dennis
                                                                            Answered on 03/28/2017 8:37 PM
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                                                                              CP Our FDA is prohibited from even talking about the price of the drugs and medicines they are urged to approve. The companies want the “label” or “package insert” to reveal data that this new drug is better than any existing drug so it will get a bigger market share. The FDA knows that if they agree with the label and its claims the drug can be sold for LOTS of moolah. So the FDA takes their time to study this drug and hold up approval so all the “eyes” are dotted and “tees” are crossed. That adds to the costs and we get to pay for it. Once approved it takes a law case to remove the claims on the label. Recently the FDA has the ability to add warnings to the label if when sold problems are later found.

                                                                              I would like to see quicker approvals along with the power to remove the medicine from the market if problems are found. But no dice. If a problem is found later then the FDA is blamed and the company is deemed a great marketer of medicines that make you sick, in the true capitalist fashion. Trump wants to cut the FDA staff and make them approve faster so that the pharma industry can make even more moolah than they are now, and cut regulations of course that could be used for getting bad drugs off the market.

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                                                                              Posted by Dennis
                                                                              Answered on 03/28/2017 8:52 PM
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                                                                                Roche is making broad strokes about capitalism “not working” when it is really all about an adverse selection problem. That’s easily dealt with by a law requiring all insurers to belong to a single national risk pool and a law requiring all consumers have insurance. Is that “government intervention”? Maybe, but then when government gets out of the way of managing, overregulating and/or providing sickcare and allows free market competition to do its magic, you’ll get the most efficiency and the highest innovation at the lowest cost due to the profit motive. We’re not too concerned about high risk individuals because that is what insurance is for and it works splendidly at that. That it doesn’t work at present in sickcare is a failure of government intervention arising from ideological socialists and Progressives, not capitalism.

                                                                                Also, claiming that capitalism “isn’t working” when there is no capitalism at the consumer level is just silly. Capitalism involves a mutually beneficial voluntary exchange between supply and demand… it can’t work if only the supply side is capitalist (or socialist) and not the demand side. It takes two to tango.

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                                                                                Posted by MachineGhost
                                                                                Answered on 03/28/2017 9:53 PM
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                                                                                  CP Our FDA is prohibited from even talking about the price of the drugs and medicines they are urged to approve.
                                                                                  Dennis, I have seen that before but have not researched it. However, now that I am getting stung for my kids meds.. I am starting to turn over rocks..

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                                                                                  Posted by Cowpoke
                                                                                  Answered on 03/28/2017 9:59 PM
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                                                                                    “Also, claiming that capitalism “isn’t working” when there is no capitalism at the consumer level is just silly. “

                                                                                    Well MG isn’t that what I myself is doing when I am using the world market place to buy my kids inhaler at a cheaper price?
                                                                                    heck if I can get it shipped from an Amazon.com store out of Canada, India or where ever at a substantial price decrease.. That’s aBoon for ME and capitalism… I think..

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                                                                                    Posted by Cowpoke
                                                                                    Answered on 03/28/2017 10:03 PM
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                                                                                      > I’d love to hear some solutions to these problems, because I am rapidly losing count of all the
                                                                                      > things to shake a stick at.

                                                                                      Increased competition. We need consumers and other demand-side agents to make rational pricing and purchasing decisions about sickcare, not economically-ignorant bureaucrats and politicians via scribbles known as “laws” and “regulations”. We have way too much of the latter and look at the result over the last 60 years. We’re even having this debate because of that.

                                                                                      > We need to bring those premiums down. If we can do that, we’ve basically fixed our health care
                                                                                      > problem.

                                                                                      The health care problem is only solved at the roots by motivating people to lead and practice healthier lifestyles. Getting premiums down would just involve cost shifting the costs to other groups, whether that is taxpayer or risk pool participants. Since there’s no cost or quality check on taxpayers due to career politicians beating their chests over the next preventable crisis, I prefer it be on risk pool participants via the profit seeking private market.

                                                                                      > With respect to pharma and drug prices, that’s a very easy problem to solve. We can either have the
                                                                                      > government negotiate drug prices or we can strike down drug (re)importation laws. If we do
                                                                                      > either/or/both, drug costs will come down very quickly.

                                                                                      That’s not the root problem. It’s the FDA, i.e. overregulation and regulatory capture. We have to look at fundamentals here, not symptoms. High prices/costs are always symptoms — artificial scarcity, genuine lack of supply and/or excess demand vs supply. Worse, virtually all other countries get a free ride off of the USA because they use price controls to keep down drug and technology costs, while they don’t have to pay for all of the research and approval… we do.

                                                                                      There is no real capitalism going on in the sickcare market. I don’t hold out any hope that it will be reformed with any common sense until anti-corruption legislation and term limits are passed at the local, state and federal levels. More realistically, technology will just circumvent this gigantic government boondoogle and give consumers the power to diagnose, treat and cure (beyond what is available out of the sandbox already).

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                                                                                      Posted by MachineGhost
                                                                                      Answered on 03/28/2017 10:38 PM
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                                                                                        To Cow & ADVT (& of course, Troll):

                                                                                        In advance of Cullen’s potential response, I thought about this on the way home from work today.

                                                                                        Thanks, CP for pointing out alternative get-arounds for this messy system. ADVT? I am barely understanding your explanation – my key takeaway is drug & health care research. Let me try and work with that expecting that, I, as a numb-skull, am probably am getting this woefully wrong.

                                                                                        Let’s first tackle the key reference to CowPoke by Cullen re:”bilateral monopolies”. I am not sure what his definition of that is and so I am second guessing here. I think he is talking not bilaterally – but more a dual situation of a monopolistic (or really a monopsony of) providers of both health care & health insurance. I am following Troll’s lead here on this thought line.

                                                                                        OK. So let’s think about this for a bit. We know for a fact that ‘capitalism’ fails under certain economic situations. What are those situations? Well, to move forward we need to define what we really mean by ‘capitalism’. So let’s first do that before we start shooting our arrows?

                                                                                        Capitalism requires an ‘infinite’ (aka, a really big) number of suppliers to a market place. As well, it also requires an ‘infinite’ (ditto above) number of demanders IN the market place in order for PRICE CONTROL to exist. I think I learned that about 41 years ago in ECON 101 as a freshman in college. I am surprised I actually remember that since I can’t remember what I did at work last week. By the same token, I am surprised that I even remember the term monopsony from that course. Oh well.

                                                                                        But, you see? When these conditions do not apply, ‘capitalism’ disavows itself! What we got here is a whole new ball game here fellas. It is not a ‘failure’ of capitalism when the dang rules don’t apply!

                                                                                        But is that our situation in the health care industry? I don’t think so. I don’t think we have an infinite supplier case, while it is certainly clear that we have an infinite number of demanders. Big Pharma is big pharma. Doctors are dang near semi-infinite but it will take you 6 months to get in to get a first appointment – which suggests to me that they are in limited supply. Hospitals – they are around. So pharma and doctors seem to be the limiting point. Health insurers? I think you could count them all on 2 hands – limited supply.

                                                                                        So, in my humble brain, it seems to me that the situation of ‘capitalism’ does NOT apply here in this specific case. It already dis-avowed itself.

                                                                                        When the conditions of ‘capitalism’ (as defined above) no longer apply – guess what? PRICING CONTROL is lost as well. I am going to fixate on that just a bit.

                                                                                        When I control the market as a supplier of goods or services – I get to name my price. Who is going to challenge my price? Nobody.

                                                                                        Until the Federal Government steps in and bitch slaps you.

                                                                                        Or until an independent body authorized to do that does that to you.

                                                                                        Ya’ know? The health care industry isn’t the only malfeasance on the block fellas. We gots lot more of this. Here is a specific example.

                                                                                        Look at cable/Fios. That, for sure, is a monopsony. Yeh, sure, we can get our TV from Verizon or Comcast or Dish TV. But you know what? Their prices are all about the same. And the value of your product given the service? Paying $125 per month or more for 500 channels you don’t even want to watch? These guys must be giving each other a BIG wink when they soak you for those outrageous monthly costs. The competition therein is a really big joke. Ask for a pricing where you only get the 3-4 channels you really want? Hasn’t happened until recently and it is still through the roof. That’s why we dropped all service completely and installed over-the-air broadcast antennas and HDTV receivers in our house. We have a non-recurrent cost of about $100 or so and we’re done! But we be spartans here. Funny thing? The kids adjusted to it in a heart beat since they only watched 2-3 channels out of the 500 offered. We watch DVDs instead. And that is TOTALLY ON DEMAND! But we still can watch the NCAA Final Four on TV! And it is FREE! Boo-ya. And oh, btw, you’re gonna rent me that damn box for forever? And I have to pay extra for the rental? That’s truly rentier style!

                                                                                        I understand that both Verizon/Comcast made some big investments in infrastructure burying their lines throughout the neighborhood. But their recouping the cost is on testosterone. I just don’t see the justification. I want to see their books!

                                                                                        The same goes with cell phones. That’s why I don’t own one. There seems to be no reasonable price control there either. Your data plan? WTF? You want to be ‘digitally distracted’ (your hands dude) for the rest of your life? I have much better ways to spend my time.

                                                                                        But now, let’s take a look at power providers (power companies). Their costs are under quite a bit of scrutiny – and regulation. Why not? ‘Capitalism’ certainly does not apply in the situation of a monopoly provider. There is no PRICE CONTROL in this situation absent of either state or federal regulation. Period. They can name their price – you can’t do diddly-divided-by-squat about that in the absence of regulation. And yes, we are now entertaining situations where we can buy our energy from different suppliers and that’s great. But? Who is the transmitter of the energy? The same old power company that is now sitting back and recouping his profits on the transmission line of that power – forever! Ya wannna know what a rentier is? That’s a rentier! God-damned parasite is a much better word. Until competing power companies lay their lines, we really don’t have true competition. It is a total contrivance.

                                                                                        Now let’s take a look at an industry which is composed of BOTH a monopsony as well as an oligopsony. That would be the defense industry. In a heart-beat. You can only do business with a very finite number of defense agencies, and you can only get your products from a pretty limited number of suppliers (the big boys you can name on almost 1 hand).

                                                                                        So how do they do business with the Department of Defense (the DoD)? Oh, they are regulated by something called the ‘FAR’ (Federal Acquisition Regulation). You can’t bid a contract w/o adherence to the FAR. That controls your profit on any job regardless of the contract type (Firm Fixed Price (FFP), Cost + (CFFP), or T & M, or Award Fee). And you can get burned. Suppose you enter into a contract to build 1,000 units of your product wherein you program your profit to start occurring after unit # 500. After that, you get 7% for the job when you finish unit #1,000. But then, the DoD cancels your contract b/c of budget shortfalls. You take the loss and take a hit on your sheet and possibly lay off people. But, at least there a PRICE CONTROLS in place.

                                                                                        Let’s address R&D. For pete’s sakes, just about anybody in the industries suffers these burden costs. And yes, they might be higher in the Big Pharma industry. But that high? At what unit of product were you pricing a reasonable profit? For those Big Pharma companies that have a lock on a single drug that could save people’s lives? I don’t think there is a sensible limit for the recouped profit. After all, they have a lock on this. And a 7-year patent guarantee as well – before they have sensible competition. Where is the scrutiny?

                                                                                        This is not about a failure of capitalism. This an abject failure on 2 sides of the fence. The first is not having an environment of capitalism to begin with, and the other is a complete and utter lack of having an independent authority (Fed Gov OOOOORRRR otherwise!) to provide PRICE CONTROL.

                                                                                        Sorry folks, got a little bit of fire on the belly…

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                                                                                        Posted by Poseidons Bear
                                                                                        Answered on 03/28/2017 10:42 PM
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                                                                                          > Well MG isn’t that what I myself is doing when I am using the world market place to buy my kids
                                                                                          > inhaler at a cheaper price? heck if I can get it shipped from an Amazon.com store out of Canada,
                                                                                          > India or where ever at a substantial price decrease.. That’s aBoon for ME and capitalism… I think..

                                                                                          That’s like smoking pot before it is legalized in your state. What net effect will that have? None until you agitate for legislative change to change the terms. Legal scribbles rule people’s worldviews, most especially those employed by government. The FDA and Customs will consider importing any overseas drugs as illegal and seize it if found even if you’re legally allowed by Congress to import a 3-month supply of medicine for personal use. Same way you can smoke a joint so long as you don’t cross a state line.

                                                                                          Has overseas medical tourism lead to prices dropping here? No. Has importing overseas medicine lead to prices dropping here? No. We don’t have a free market in sickcare so personal activist capitalism will do relatively little in the grand scheme of things. There’s just no place for the market feedback to go (or anyone to care).

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                                                                                          Posted by MachineGhost
                                                                                          Answered on 03/29/2017 12:55 AM
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                                                                                            The thing about health care is that the premiums and services costs are minimized when the risk pool is maximized. That means universal coverage.

                                                                                            I also think we should examine what takeaways there are from the Japanese system. https://yosida.com/forms/nationalins.pdf

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                                                                                            Posted by Lucas
                                                                                            Answered on 03/29/2017 3:41 PM
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                                                                                              Lucas – thanks for the link to the piece on Japan’s system, I’ll read it later. I found another stat about the Japanese system that I found somewhat amusing: they have far more MRI machines per 1 million of population than any other developed nation including the USA.

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                                                                                              Posted by Steve W
                                                                                              Answered on 03/29/2017 5:09 PM
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                                                                                                To fix a problem you have to know what you are trying to fix. Are we trying to fix health care and/or health insurance? Then there is the difference between the macro problem and the micro problem. The macro problem is having enough health care services to meet the demands of society. Are there enough doctors, nurses, facilities, equipment, etc. and are these resources being utilized to their most efficient possibility? On the micro side, the problem is how does each individual pay for their health care services especially when some of the cost can be prohibitively expensive.
                                                                                                On the macro side, I think the present insurance system is a mega waste of resources. Health care providers spend way to much time dealing with the payment system when they could be using that time providing health care. All those people working in the insurance industry could be doing something more productive for society (such as providing health CARE). An because insurance pays most of the cost, individuals have no incentive to control their health care cost; such as living a healthier lifestyle or seeking the most cost effective treatment.
                                                                                                I think we can learn from two successful systems already in place. First,Social Security. Everyone is given an account funded by the govt with X dollars to cover the cost of routine health care. The account can build over time and maybe allow healthy individuals to make withdrawals for non health care expenses. This eliminate all the waste in dealing with insurance companies and is an incentive for individuals to be cost/health conscious. Second, auto/home owner insurance. We have those insurances to cover large losses, not routine expenses. The cost of the insurance is somewhat contained because of competition between providers and what the insurance covers.
                                                                                                Anyway, I don’t think those idiots in Washington will fix the problem because I don’t think they know what problem they are trying to fix.

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                                                                                                Posted by Mark Groom
                                                                                                Answered on 03/30/2017 12:48 AM
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                                                                                                  Mark “On the macro side, I think the present insurance system is a mega waste of resources. Health care providers spend way to much time dealing with the payment system when they could be using that time providing health care.”

                                                                                                  Exactly, that is the number one reason we need “Uncle Sam’s health Insurance Co”, a competitor for the existing “waste”.

                                                                                                  “Aloha Hillary Clinton, Bill Gates and Warren Buffet, We need a new nationwide health care insurance company “Uncle Sam’s Health Insurance Company” that will (1) function profitably under the Obamacare mandate, (2) that will compete with the currently existing companies. There is no need to “repeal” Obamacare when the solution is so simple. Please figure this out.”

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                                                                                                  Posted by Dennis
                                                                                                  Answered on 03/30/2017 5:41 AM
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                                                                                                    @Mark: It’s not just dealing with various private insurance that is a mega-waste of resources and rations higher quality providers (they accept none to few insurance networks and almost always never HMO’s), it’s also dealing with the various government agencies. Competition involves having more than one insurance company — that seems unavoidable. Even under Medicare Advantage, you have your own proprietary Medicare card from each private insurance company. However, in my observation, doing medical billing is not that big of a deal. Providers either fill in manual forms, use proprietary software inhouse or use third parties to submit billing claims. It’s like filing taxes… generally a waste of time, but not prohibitively expensive to the point you could say that is the biggest reason for out of control sickcare costs. If anything, providers are rapt about getting their reimbursement compared to consumers with no direct payment responsibility. The biggest dearth of competition in sickcare is actually in the supply side over the demand side. I don’t know if consumer-driven sickcare *alone* has enough market power to force lower prices and increased transparency. Certainly, if you’re not getting a significant cash discount off the completely made up retail prices to be competitive with the negotiated rates of contracted insurance networks, you’re literally subsidizing all of the insured. Been there, done that.

                                                                                                    @Dennis If we allow a public option in Obamacare, it will essentially put all private insurance out of the Obamacare business even faster than Obamacare’s price controls are doing already. Insurance companies already piggyback their reimbursement rates off of Medicaid & Medicare’s price controls, so if the “fat” is eliminated, they may no longer be solvent and there may no longer be a check on the waste, fraud and abuse inherent in a public option. As a wealthy person already, are you prepared to pay higher taxes for another lesser quality public sickcare provider? How about a yearly wealth tax? Just sayin’.

                                                                                                    @Lucas: I like Japan’s approach but they’re also 200% GDP in debt and rising. Doesn’t seem like such a great success to me with the national government backstopping it anymore than the USA. Since they use price control in place of supply-side competition to keep costs down, aren’t they having supply issues similar to Medicaid/Medicare?

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                                                                                                    Posted by MachineGhost
                                                                                                    Answered on 04/01/2017 5:03 PM
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                                                                                                      Because the profit interest of health insurance companies is at odds with the health care interests of the customers paying the premiums,perhaps “insurance” is the wrong model. Or find a away to align the competing and contradictory interests. Maybe health insurance as usually conceived needs to go out of business. Problem is right now we do not have anything to replace insurance, and Trumpcare certainly was not a decent replacement for anything.

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                                                                                                      Posted by Lucas
                                                                                                      Answered on 04/01/2017 7:38 PM
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                                                                                                        Employers used to provide 100% of all premium and sickcare costs for their employees, including their wives and children.

                                                                                                        Household spending on sickcare has risen 25% from 2007 to 2014.

                                                                                                        Deductibles have risen 67% since 2010 — seven times more than earnings growth.

                                                                                                        Patient “cost sharing” has skyrocketed 256% since 2004.

                                                                                                        Generic drugs now cost thousands of dollars with some new medications costing $100K.

                                                                                                        Deductibles are now as high as $4K-$6K. So that’s effctively paying 100% out of pocket while also paying higher insurance premiums to boot.

                                                                                                        And copays are now 10%-40% after the above deductible.

                                                                                                        Premiums are also skyrocketing, especially under Obamacare.

                                                                                                        Low income and/or low resources people get Medicaid which pays 100% of all medical costs after a zero to small copayment, even for the above most expensive drugs. They don’t have to pay large premiums or deductibles only to be rejected by their insurance. Naw, the taxpayers fund it all, including the middle income ones paying for all of the above.

                                                                                                        In 2003, it cost less than $1 million file a generic drug application. Today it costs $5+ million for approval for a generic drug. Even for an identical drug. The whole situation is an order of magnitude worse for non-generic drugs. A true nightmare there where what costs pennies on the dollar to produce sells for several hundreds of dollars.

                                                                                                        The above costs and excessive regulatory burdens result in many generic drugs facing no competition and years of delays for new generics.

                                                                                                        There’s also sometimes collusion between generic drug makers where one ceases manufacturing while being paid by the competitor to do so.

                                                                                                        There is no competition in the generic drug marketplace allowed in the Food Drug and Cosmetics Act. Hence, price gouging.

                                                                                                        Again, none of the above problems implicates capitalism per se, but rather way too much political interference and over-regulation into a free market that prevents optimal and efficient solutions from being implemented based on feedback… by force of law. If the Republican’s ongoing attempt with their pathetic “ObamaCare Lite” is any indication, fixing the whole situation is a hopeless as the Titanic was. They’re just putting lipstick on a pig that’s been festering for at least half a century.

                                                                                                        There’s only two effective ways to deal with the Big Insurance/Pharma Lobbyists/Terrorists protecting to the death their lucrative monopoly empire of crony capitalism and regulatory capture. The middle class is eventually going to rise up and revolt and… a) demand free market competition be politically interjected anywhere and everywhere into the entire rotten sickcare corpse; b) drastically lower quality and innovation in a race to the bottom by forcing everyone into a “free” government-mandated, over-regulatory, Orwellian hell of a monopoly Medicare-For-All (and then face its eventual insolvency/bankruptcy shortly down the road). My hunch is on the latter due to decades of widespread ignorance and stupidity of the general public and politicians.

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                                                                                                        Posted by MachineGhost
                                                                                                        Answered on 04/18/2017 12:37 AM
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                                                                                                          Well if the govt banned/outlawed any form of medical “benefits” from employers forcing people to buy their own plans, that would go a long way to fixing the problem.

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                                                                                                          Posted by Cowpoke
                                                                                                          Answered on 04/18/2017 11:50 AM
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                                                                                                            It is not that employers used to provide 100% of all premiums and sickcare costs for employees and their families. That was really never a norm. You are overstating the “good old days.” Whatever part of premiums employers paid was part of the employees compensation package. It was not “free.” However, a major problem happened when employers not only reduced their compensation packages but also stopped raising wages. We have had wage stagnation for a couple decades.

                                                                                                            Most of your other “symptoms” are overstated. I will address just a couple. Premiums did not skyrocket under Obamacare. Premiums always increase. Under ACA, they have increased at a slower rate than before ACA. The main problem is the way to minimize costs of both premiums and healthcare costs is to maximize the risk pool. That means universal coverage.

                                                                                                            As someone who had a foster child who was on Medicaid, it is not a great system. Health care providers consider Medicaid patients their lowest priority.

                                                                                                            Over-regulation is a favorite bogeyman, but the reality is most regulations are promulgated because of bad actors. Over hundreds even thousands of years, the free market has proven itself incapable of disciplining itself. People tend to forget the history of the Triangle shirtwaist factory, tainted meat, child labor, worker safety, etc when they clamor for deregulation. Wherever deregulation has occurred, the results have been predictably disastrous.

                                                                                                            Here is an example from my own community. A real estate developer sought to escape the city’s regulation so they proposed putting 40 mobile homes on a plot of land. Thus they fell under the state’s jurisdiction. The city says homes have to be a certain distance from the freeway because of exhaust fumes and raised high enough to avoid flooding from the creek. The developer, unhampered by the city’s regulation has a whole role of units abutting the freeway on land 1/2 inch below the flood plain. Even worse, the “mobile homes” have no wheels. Corporations who clamor for deregulation do not have good intentions.

                                                                                                            Lower quality is not correlated with universal coverage or single payer https://www.ncbi.nlm.nih.gov/books/NBK53923/. In fact, just the opposite https://www.bloomberg.com/news/articles/2016-09-29/u-s-health-care-system-ranks-as-one-of-the-least-efficient AND https://time.com/2888403/u-s/.

                                                                                                            Insolvency and bankruptcy is not a given eventuality of universal single payer. I agree there is no free market in health care. The consumer cannot price shop. You have to be able to ask, “What is your charge for[type of service], CPT service code XXXXX?” https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/Downloads/2017-DHS-Addendum.zip For example, if you want to know the charge for urinalysis, you ask, “What is the charge for urinalysis, CPT code 81003?”

                                                                                                            Very likely the consumer does not know the CPT the provider is planning to use for the service requested. That’s okay. You can ask what CPT code the service provider expects to use. They will hem and haw. The paperwork you sign basically gives health care providers a blank check, and they like it that way. Heaven help you if you need emergency care. That’s a negotiation you cannot walk away from.

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                                                                                                              Posted by Lucas
                                                                                                              Answered on 04/18/2017 12:12 PM
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                                                                                                                The psuedo-token “competition” we have for consumers to have the “freedom” to choose which Mafia outfit to get their mandatory protection racket from is not even remotely what free market competition would look like. It won’t solve shit and certainly hasn’t to date. The real rotten jauggernaut is in the supply side. It won’t matter if we have a public option or private insurance or both at once — the same dirty rotten stinkin’ crony corpse is supplying both avenues. Only real free market competition will ever drive prices and costs down but that looks to be politically untenable even by the usual hypocritical Republicans. I am very discouraged and see no hope until we get term limits and ranked choice voting widespread. The politician-careerist impetus and the incestuous cronyism with Big Pharma/Insurance is just too much to overcome with a dose of common sense and economic justice right now. We have to force politics to stop pandering to the lowest common denominator of stupidity and ignorance because that is also the exact outcome we get.

                                                                                                                A universal risk pool is not going to be the same as free market competition in lowering prices maximally across the board. It just does not do that — it just delays the inevitable and buys you time. Same with a public option. All you’re doing is either case is just cost-shifting the upfront expenses onto taxpayers and backloading the mounting liabilities. Just look at Switzerland. They’ve got over 100 free market insurance companies all competing for premium dollars, but they still have the same problems with drug and sickcare costs increasing because there is no competition in the supply side. Insurance is not supply side… it is just a third-party middleman interjected between a voluntary negotiated transaction of two people which mutes and distorts the incentives for both to come to an economically efficient arrangement.

                                                                                                                Re: the “free market is bad” and “deregulation bogeyman”… There’s a HUGE difference between needing regulatory oversight and command and control socialism. I’m a post-libertarian, which means I believe that we need a coercive statist authority in the form of promulgating principles-based regulations because you simply cannot trust the bad actors in the government OR the free market. There always will be people that want to steal instead of produce because its far easier. Yet, in the meantime we suffer from an over-regulation in the form of anarchronistic top-down command & control socialism instead of modern bottoms-up principle-based regulation that would provide stable rules and structure to a free market to let it do its magical thing… with the emphasis on policing and enforcement instead of micro-management. The more command and control there is, the higher the prices and costs, the worse the supply will be and the more overall dysfunctional an industry becomes. Sickcare is a prime example of that.

                                                                                                                What works better than government regulation alone? Free market competition, of course. But what works better than free market competition alone? Principles-based regulation and free market competition. Yet, what is the worst form of all? Command and control socialism and crony capitalism. Guess which one we have in over-abundance of in sickcare? So the answer isn’t to restrict free market competition further because of a bunch of bad apples — it’s to be smarter and more common sense about regulation.

                                                                                                                Re: lower quality, its all B.S. where apples aren’t compared to apples just to make the US look bad…. every country has a different standard for what they do and do not include in the statistics that are ranked. It just serves the mainstream media, pro-progressive ideology for a universal government-funded sickcare boondoggle. If you really delve into the dirty details, you would not accept the “poor rating” of the USA at face value because its false. True, we have a gigantic amount of waste, fraud and abuse in out command & control system that relentlessly drives up costs. Yet we’re still subsidizing the rest of the world’s government-funded “free” sickcare systems with new drugs and medical innovation in that wee bit of capitalism that does manage to exist. So the ranks is not a convincing argument for going to the lowest common denominator in providing sickcare (hint: that is what socialism always does… drags down everyone so they are truly equal at a low level vs free market capitalism). And, boy, take a look at the mounting debt liabities of those government funded sickkcare systems… just WTF do they think they’re going to do in the future about all that??? The USA is not gonna bail them out or anything by buying their bonds when they have little productive capacity to service the outstanding debt and unfunded liabilities.

                                                                                                                I don’t believe the consumer can’t price shop; its just not ingrained into the system to do that because its based on third payer interfence/irresponsibility. CPT is for insurance billing, not point-of-sale cash payment. BTW, CPT is also another monopoly and owned by the AMA that profits from it (you have to pay to use it). No CPT billing code, no insurance reimbursement. No competition other than CPT allowed, so more common sense/inexpensive procedures do not get offered by providers. It’s all about “standard of care” robot-driven sickcare now. No freedom anymore for the physician, not just the patient.

                                                                                                                Look, I’ve been on (in order) a discount medical card, discount for upfront cash payment, Medicaid and Medicare basis. I’ve opted out of Original Medicare Part B and Part D because a) what is skimpily covered is determined by illogical and irrational Politburo bureaucrat decrees (I’m into prevention not fixing disease symptoms after they occur); b) the monthly premiums are completely overpriced for my age and health with no ongoing sickcare needs; c) the whole Medicare risk pool is fiscally insolvent because it relies on continual Congressional expropriations and there is no free market competition to control the gargantuan waste, fraud and abuse; d) I’m not sending token amounts of my hard-earned $ back to the government when taxpayers subsidize the other 75% of the risk pool’s expenses anyway — its not as if these token amounts to ration usage are any real free market competition, so just cover it 100% already — its already a boggy cesspool; e) I resent having to fund sick & old people that were too ignorant or stupid to take care of themselves when they were able to; f) there is no cap on out of pocket costs in Original Medicare so what the hell is the point?; g) I resent and hate HMO’s that Medicare Advantage overwhelmingly offers, although that is really the best of the extremely limited choices the consumer is “allowed” to have; h) I don’t believe Medicare is going to exist in the next few decades and I’m just not pissing away untold amounts of $$$ in the biggest government boondoggle there ever was. Basically, Medicare is a very bad value for me given the cost — only sick and old people think its a great deal because they’re being subsidized by the government who has also banned private insurance for retired people (other than spousal)… they don’t pay their fair share for the consequences of their earlier inaction or actions. If we want to continue to do that for risk pooling purposes, that’s fine, but don’t wrap it up in command and control socialism because you’re going to get the worst of everything and the best of nothing. All one has to do is read the horror stories from the UK (true socialism) or Canada (Medicare-For-All) to get an idea of how much better off we really are or could be doing as a system. Either way, I have to pay out of pocket to get the best of anything because a Politburo making coverage decisions for me (or the private insurance piggybacking off of it) is just too crony and/or ignorant. What can I do other than literally vote with my dollars? And yet, we don’t have a system that does anything with that most critical of market feedback.

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                                                                                                                Posted by MachineGhost
                                                                                                                Answered on 04/18/2017 2:46 PM
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                                                                                                                  So, I simply refuse to participate in this completely dysfunctional B.S.. I’d be out of Part A too but some stupid judge decided the illegal tying of Part A to SS benefits is valid and which means you can’t opt out of Part A without first paying back all of your SS benefits ever received and disavowing all future SS benefits. Part A is hospital insurance and get this, it qualifies as Minimum Essential Coverage and trust me, it doesn’t offer what ACA mandates other insurance has to offer. Part A is a monopoly and you can’t get any other insurance anyway.

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                                                                                                                  Posted by MachineGhost
                                                                                                                  Answered on 04/18/2017 2:58 PM
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                                                                                                                    You have a lot of strongly-held beliefs. We need to look at and follow facts and data wherever they lead, especially from ALL the other countries. Tallying up horror story anecdotes doesn’t work because it is just as easy to collect positive anecdotes as negative ones. That is why the plural of anecdotes is not data. Nobody seems to to want to look at Asian health care systems seriously.

                                                                                                                    I agree that health insurance companies have gamed the system to make it more of a racket than anything else. However, that does not invalidate insurance as pooled risk. Well-designed, it is the modern equivalent of all the neighbors getting together to help build the burned-down barn of one neighbor. They did not resent the expenditure of labor any more than we resent the expenditure of funds because we all know one day we might be the ones in need of our neighbor’s help. One of the worst things that happened to health care is when insurance companies persuaded patients (with the willing help of doctors) to assign the insurance check to the doctor. It used to be the insurance check came to the patient and the patient paid the doctor. It was a healthier system then because the patient was still part of the loop and could at least shop around for elective care.

                                                                                                                    The CPT codes are used whether there is an insurance claim or not. It used to be that doctors (actually their staff) filled out insurance claim forms themselves with a written description of services rendered. Claims examiners read the description and assigned a CPT code. So-called “superbills” with preprinted codes were acclaimed by one and all as a great convenience, but they are actually part of the problem. In fact, I have become convinced that consumers should give a wary look to anything billed as adding convenience. Convenience often provides cover for shady practice. CPT codes are not just for insurance claims. If you want to shop around, comparing apples to apples, CPT codes are indispensable. You seem to have an inaccurate idea of how CPT codes work. There is a CPT code for every procedure you can possibly imagine. When new procedures are invented, that procedure gets a unique CPT code.

                                                                                                                    You characterization of any old people who are sick only because they did not take care of themselves is false. It is definitely true there are any number of people who engage is self-destructive health habits like smoking, drinking and obesity. On the other hand, there are plenty of people who may have lead perfectly healthy lives, and they get sick anyway if only Alzheimers, or there is some sort of terrible accident. Christopher Reeve comes to mind.

                                                                                                                    Actually, if you have universal coverage, it is possible that the insurance model may not be necessary. We really need to start thinking more creatively. However, there is no indication that the free market will work because of the very nature of health care. The ultimate BATNA, walking away, does not exist for health care. If we accept all your premises, then you have come quite close to recommending a kind of Darwinism. Is that really the society we want? What about the person who has lived a healthy lifestyle all their life and ends up with Alzheimers or something. Your free-market self-pay plan implies that when that person runs out of money, then what? Euthansia? Then what about kids who are born with expensive health problems? Euthansia? There was a time just a couple hundred years ago when if you ran out of money, you just died. Our society has decided that such a situation was unacceptable, and thus we have shared risk. I completely agree that the profit motive has corrupted the health insurance companies. Any legislation purporting to be health care reform needs to severely restrain the health insurance companies (and I once worked for a health insurance company.

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                                                                                                                    Posted by Lucas
                                                                                                                    Answered on 04/18/2017 6:28 PM
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                                                                                                                      “I agree that health insurance companies have gamed the system to make it more of a racket than anything else.”

                                                                                                                      Yep, and I worked for United Health Care and saw first hand how it’s rigged.
                                                                                                                      Example:
                                                                                                                      I had Eye Care “coverage”. Like most “benefit” packages. Except, the company that was supposed to “negotiate” the best price for me in fact did NOT.
                                                                                                                      You folks may be able to see this one for yourselves. Go get your eye exam and then go pick out your frames and then your eyewear.
                                                                                                                      Add in the no line bifocals, tinted lenses, Anti-reflective stuff from computer screens etc… and wallah you have a 200-500 dollar deductible.
                                                                                                                      But WAIT, they have a half off frame sale or some other sale and you say I want that deal.. Nope Sorry they say that you have a special”negotiate” price and can’t use the in store discount.
                                                                                                                      WTF?(WHAT The Frick).
                                                                                                                      Yep, Nope you can’t just pay cash because your insurance is on file and we can get you the discount, you have to pay FULL PRICE through the system based on “Negotiated” rates.
                                                                                                                      IOW, In Other Words, the “Negotiated” rate was NOT negotiated with YOU the buy/owner of said policy in mind but rather the Insurance Company selling said policy.

                                                                                                                      bottom Line is your Company looks/feels good that they offered you eyecare. Insurance company looks feels good that they cover your eye care needs but in reality, you would be far better off with out any company sponsored eyecare and just paid cash removing the insurance middle man.

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                                                                                                                      Posted by Cowpoke
                                                                                                                      Answered on 04/18/2017 7:08 PM
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                                                                                                                        CP Here is a recent article about drug pricing in the USA vs other countries. It’s the law passed by numb skulls drafted by crooks. Welcome to crony capitalism.
                                                                                                                        “Why Did That Drug Price Increase 6,000%? It’s The Law”

                                                                                                                        https://www.forbes.com/sites/matthewherper/2017/02/10/a-6000-price-hike-should-give-drug-companies-a-disgusting-sense-of-deja-vu/#70ed015571f5

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                                                                                                                        Posted by Dennis
                                                                                                                        Answered on 04/18/2017 8:22 PM
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                                                                                                                          One thing about glasses and dental is that you still can price shop. I have never seen an eyecare or dental plan that beats cash pay.

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                                                                                                                          Posted by Lucas
                                                                                                                          Answered on 04/18/2017 11:29 PM
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                                                                                                                            Lucas,

                                                                                                                            First your brooking instutute bar graph and study by Adler and Ginberg is highly inaccurate and has been all but thrown into the garbage by most other Healthcare studies due to the fact they only took into account the subsidized dollar cost and not the true dollar cost before federal tax credits. They also did not take into account the medical cost claims and they ruined everything by pushing a 2009 baseline average of 9% and comparing to a 2013 after tax credit average ( that is bad because it does not take into account the overwhelming True cost and the unweighted average offset by high tax credits to lower income vs high age demographic). I wont go into why this is pseudo math but… im sure you get the picture. If not, google is your friend.

                                                                                                                            You are correct that the avg. premium increase for 2014 and 2015 were lower than previous 7 years. BUT that is only because of risk corridor programs that insurance carriers where expecting and ultimately denied. If unfamiliar with risk corridors, again google. After 2015, carrier markets readjusted and removed all the savings and increased the annual average to 14.9% since implementation. That is more than the 9.2% average for the previous 7 years (prior 2014). This includes the 23.6% 2017 plan year average.

                                                                                                                            If premium increases where lower, the markets would have reacted more favorably. Instead we see exactly the problem we have. Lower insurance participation, carrier exits, and much higher insurance premiums.

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                                                                                                                            Answered on 04/20/2017 1:08 PM
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                                                                                                                              So according to you, the bar graph understates the high cost of health care in the US relative to other countries. The line graph starts at 2009 to compare with ACA. Premiums were increasing faster before ACA than after. I agree that insurers underpriced the premiums and now want to play catch up. That never goes over well with consumers. Insurers having less profit is not really a problem. The fact that the profit interest of insurers opposes the health care interests of the customers is the real problem. The fact that insurers can exit the market because ACA tries to bring competing interests more into alignment is a real problem. The fact that so-called young healthy consumers are too foolish to understand what insurance really is,and that an accident could happen to them anytime is a problem. A young healthy uninsured guy I know just recently went to the doctor because of a bad cold. Turns out he had developed a sinus infection. During treatment,Hodgkin’s Lymphoma was found. He is in chemo now. To minimize both insurance and health care services costs, the risk pool needs to be maximized. Universal coverage needs to be mandated.

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                                                                                                                              Posted by Lucas
                                                                                                                              Answered on 04/21/2017 1:30 PM
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                                                                                                                                I don’t want to mess up this thread with politics, but that is what this is about.

                                                                                                                                When it comes to drug pricing, we have a problem: It’s our POTUS.
                                                                                                                                https://www.vox.com/policy-and-politics/2017/1/31/14453740/trump-medicare-prescription-drugs

                                                                                                                                When it comes to making affordable health care for all possible, we have a problem: It’s our POTUS
                                                                                                                                https://www.fiercehealthcare.com/aca/payer-provider-groups-press-trump-aca-subsidy-funding

                                                                                                                                When it comes down to it, the POTUS cares nothing about people. We are here to serve the king.

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                                                                                                                                Posted by Dennis
                                                                                                                                Answered on 04/21/2017 9:59 PM
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                                                                                                                                  Lucas

                                                                                                                                  No, the bar graph by the EOCD is fairly correct, we can throw around discussions regarding the Federal Employees Trust Health Cost but I would guesstimate it would not effect +-3%. What is not correct is the assumption that health premiums for ACA plans are lower post 2014 than they would have been with pre 2009 plans. This is by simple math, entirely false. The paper for the Brookings institute used incorrect numbers and to be blunt, categorically inaccurate to mislead the estimated average cost. It does not take a genius to see the problem with their calculation of health insurance cost.

                                                                                                                                  I know it is easy to blame Insurance Providers as the ultimate immoral boogey man but, the ACA mandated that insurance carriers limit administration fees to 20%. That means that $.80 of every dollar in premium must go to providers (Doctors and Hospitals). Again, this is not profit, but total administration fees for billing, network management, customer service… the list goes on.. Set aside the fact that the national average for insurance carriers is $.12 per dollar administration cost and 63% of all individual market insurance carriers lost money in FY 2014, 2015, 2016. This is not because of parity or ill aligned interest, but that the sheer fact that more benefits where added in ACA plans and the risk aversion model was woefully under priced. Even if you got rid of insurance carriers 12% cost, you would still be higher than pre 2009 plans.

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                                                                                                                                  Answered on 04/25/2017 10:24 PM
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                                                                                                                                    Christopher, You throw around numbers but provide no sources. You do not have to depend on the Brookings study. The extrapolated slope of premium increases was steeper before ACA.

                                                                                                                                    It is not actually a problem if carriers lost money. Their entire business model is based on NOT paying claims. Nearly every doctor’s office has a person whose primary job is to fight with the insurance companies. I used to be that person. IF carriers are losing money, it is not a bad thing. But they are not losing money. I checked the financials for the carriers that threatened to quit the market because they were losing money. All of the them except United health were doing just fine.

                                                                                                                                    You are correct that at the beginning of ACA they underpriced the premiums. Now in 2017 they are trying to play catch-up. Sudden big compensatory increases never go over well with consumers. There is definitely a problem with the risk corridor stunt that Rubio pulled. I am not sure what your main point is. The way to minimize the cost of both insurance and service is to maximize the risk pool participation, in other words, universal health care.

                                                                                                                                    ACA needs to do more, not less. Even with ACA, there are too many little rules about this, that and another thing. I favor the Japanese model. There is no network, so every provider is in the network. You choose whatever provider you want. The transaction is simple. Pretty much everything and everybody is covered. There are no little details that will surprise consumers with denied coverage of services that should logically be covered. It cost about 4% of your salary subject to a cap, with a 30% out-of-pocket “copay.” Even that 30% might be a lot less depending on certain factors. The Japanese greatly emphasize preventative care.

                                                                                                                                    Instead of quibbling over US numbers, the US should think about a comprehensive program that both reduces costs and has better outcomes. Perhaps the first step is to decide whether health care is a discretionary expense like buying a book or an expense in the public interest like education. Today some people argue no one has a right to health care. There was a time when Americans did not have a right to education either. Funny thing is a lot of those people who think we should all be on our own for health care suddenly change their tune when something happens to them. If they happen to be seniors, then they scream, “Don’t touch my Medicare.”

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                                                                                                                                    Posted by Lucas
                                                                                                                                    Answered on 04/26/2017 1:45 PM
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                                                                                                                                      @Lucas: Yes, I have strongly held beliefs that I feel are crafted based on real world empirical data, but I admit that some are likely to be slanted because rarely anyone presents a complete picture of pros and cons unless they’re being intellectual honest.

                                                                                                                                      “When new procedures are invented, that procedure gets a unique CPT code.” That’s not how it works. CPT is a AMA monopoly. Alternative medicine or other challenges to the crony capitalist status quo does not have CPT codes and are denied when applying. Medicare contracts to the AMA for the CPT codes so it is at mercy of what the AMA dictates coverage for. No CPT code, no insurance reimbursement. There are third-party CPT codes that do include alternative medicine, but you can imagine how little traction they have made against a monopoly.

                                                                                                                                      I don’t have a problem with socialization of losses per se, especially those that are sick that is not of their own doing. But a majority of sickcare is currently focused on palliating diseases brought about from poor lifestyle choices due to ignorance (both patient and physician), whether intentional or not. That’s another symptom of crony capitalism, but we’re not going to outlaw Big Pharma just for responding to market demand. So those people should not be subject to “commmunity rating”, etc. price controls that seems to make private insurance ultimately unworkable. They should pay more for their actions or inactions so they are economically-motivated to take self-responsibility. Don’t ask me how to draw the line in a top-down manner — if it’s really impractical to do so, then fine, stop having separate risk pools for every insurance company, plan, network, state, etc.. Mandate one national risk pool and be done with it to get the premium costs as low as possible!

                                                                                                                                      Well, if the adverse selection problem is endemic to the profit motive in insurance (or the opposite for supply-side sickcare), the only way private insurance is going to work is if we have strict regulations and enforcement so that the insurance companies cannot wiggle or loophole their way out of taking on expenses (i.e. sick patients, pre-existing conditions, etc.). Would that require a public-private partnership that Roche fancies? 🙂 Already we see that Obamacare is in a race to the bottom in terms of quality because the various price controls are forcing insurance companies to cut networks, benefits, etc. to the most expensive [sick] patients, while that degrades quality overall for everyone, including the healthy. That is just so very typical of what happens under socialism and government-intervention interfering with the price setting and market feedback mechanism. So, it would seem to be a natural response that to maximize a profit you would want to lower expenses as much as possible. If a way cannot be found to put a check on adverse selection in a free market environment due to the nature of our system being hopelessly corrupt and crony, then I guess we really are doomed to have a government-run single payer system for lack of a better choice. There will still be crony corruption in that, of course, just less bad that now. It’s just far from ideal and not the best that could be done.

                                                                                                                                      And BTW, the East is completely different compared to the West in rhetorical logic. It goes beyond just extreme homogenity that makes places like Norway work. The East is just not full of rugged individualists like the West is. Maybe Western rhetoric is part of the problem for effectively socializing losses as we’re the least like the East, but on the other hand, we’re not globally evolving to go back to viewing individuals as just an appendix to be cut out with no consequence.

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                                                                                                                                      Posted by MachineGhost
                                                                                                                                      Answered on 04/29/2017 7:37 PM
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                                                                                                                                        @Denis: That jacking up of drug prices on generics thing is a relatively new phonomenom, but its the end stage of a frenzy crony capitalism feeding for sure! Drug prices cost a lot in general because the FDA makes it cost a lot… $1 billion for invention to approval last I remember. That may not be so bad if the FDA wasn’t acting as protection racket monopoly for Big Pharma. The FDA is also funded by Big Pharma to the tune of 40% (I think) via user fees. Drug prices are “cheaper” in other countries because they use price controls to cap and then don’t have to live with the negative consequences of reduced or nonexistent supply because we just jack up the prices here in the land of origin to compensate, hence that’s how we subsidize the world. As a note of interest India doesn’t allow patents on drug molecules, etc. but they do allow patents on manufacturing processes, so the vast majority of drugs and copycats are legally made in India for pennies on the dollar, including Big Pharma’s. So if you want to source cheap drugs to take advantage of price controls (???) or free market competition, India is the place to go.

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                                                                                                                                        Posted by MachineGhost
                                                                                                                                        Answered on 04/29/2017 7:49 PM
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                                                                                                                                          Not sure if the below paper is what I had in mind at the time about how the WHO rankings are junx, but it’s all I could find via a quick search:

                                                                                                                                          “The World Health Report 2000, prepared by the World Health Organization, presented performance rankings of 191 nations’ health care systems. These rankings have been widely cited in public debates about health care, particularly by those interested in reforming the U.S. health care system to resemble more closely those of other countries. Michael Moore, for instance, famously stated in his film SiCKO that the United States placed only 37th in the WHO report. CNN.com, in verifying Moore’s claim, noted that France and Canada both placed in the top 10.

                                                                                                                                          Those who cite the WHO rankings typically present them as an objective measure of the relative performance of national health care systems. They are not. The WHO rankings depend crucially on a number of underlying assumptions — some of them logically incoherent, some characterized by substantial uncertainty, and some rooted in ideological beliefs and values that not everyone shares.

                                                                                                                                          The analysts behind the WHO rankings express the hope that their framework ‘will lay the basis for a shift from ideological discourse on health policy to a more empirical one.’ Yet the WHO rankings themselves have a strong ideological component. They include factors that are arguably unrelated to actual health performance, some of which could even improve in response to worse health performance. Even setting those concerns aside, the rankings are still highly sensitive to both measurement error and assumptions about the relative importance of the components.

                                                                                                                                          And finally, the WHO rankings reflect implicit value judgments and lifestyle preferences that differ
                                                                                                                                          among individuals and across countries.”

                                                                                                                                          https://object.cato.org/sites/cato.org/files/pubs/pdf/bp101.pdf

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                                                                                                                                          Posted by MachineGhost
                                                                                                                                          Answered on 04/29/2017 8:00 PM
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                                                                                                                                            @Lucas: A right does not have to be provided by government. That is where it all goes wrong. Just look at what a joke etucasion is and finally the school choice movement is hitting victory after victory with 58 programs in 28 states and DC now serving over 80,000 disadvantaged children (with the ACLU and teacher’s union fuckheads fighting it every step of the way). Do we want the same thing to happen to sickcare? Oh wait… 🙂

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                                                                                                                                            Posted by MachineGhost
                                                                                                                                            Answered on 04/29/2017 8:56 PM
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                                                                                                                                              I agree that a right does not have to be provided by government. However, rights that are not enforced by government tend to be alienated in some discriminatory way. If people actually behaved according to the Golden Rule, a lot of government would be rendered superfluous.

                                                                                                                                              Our health care system needs a serious overhaul. ACA made too many compromises especially in hopes of garnering bipartisan support. 160 of the 210 amendments proposed by Republicans were accepted. It is pretty clear that Ryan’s entire purpose with Trumpcare is a cynical attempt to free up money to pay for the tax cut proposal.

                                                                                                                                              I remember a statistic from many years ago that 80% of all health care costs were due to smoking, drinking and obesity. Actually, the health care attributed to those lifestyle choices has been reduced significantly, so all the public education on healthy lifestyle seems to be having a positive effect.

                                                                                                                                              There is no evidence that “socialism” necessarily degrades quality of health care for everyone. You can quibble about the WHO report if you want, but so-called socialist countries are experiencing better outcomes for a lot less cost. A big reason for this is the universal coverage aspect.

                                                                                                                                              We still need a world class health care system. It does not look like the Republicans have any desire to give it to us.

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                                                                                                                                              Posted by Lucas
                                                                                                                                              Answered on 04/30/2017 12:02 PM
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                                                                                                                                                “Quality” like GDP is one of those ephemeral metrics unless it is standardized upon overall, so whatever areas that “quality” suffers due normal run-of-the-mill sickcare business of any country rather than scary outliers is not likely to be included by biased proponents of “universal care” (which is almost always government-controlled and funded, too).

                                                                                                                                                I know some details of how the socialist NHS in the UK works and it is not always providing a great outcome compared to the USA. If sickcare costs are capped to a lowest common denominator through socialization, then some variable(s) along the supply-side chain will undoubtedly have to suffer and that typically seems to be choice and competition. Of course, you don’t know what you don’t know so people stuck in such a system may not realize there’s better outcomes and choices available, and it may even be illegal to do so. So if you’re not happy with your assigned physician’s or specialist’s competency as dictated by the district you live in, you’re shit out of luck (unless you can afford to pay out of pocket, which implies you’re opting out of the “awesome” socialization and how is that not an oxymoron?). So I don’t think we want to import that kind of socialist sickcare system here — that’s just too ass-backwards. Another example… if you had PSA cancer and didn’t want to fuck up your remaining lifespan’s quality with the current politically-proscribed “standard of care”, you are not gonna be allowed to access vanguard, state-of-the-art, proton therapy. No siree, Bob, you’re stuck with the mediocre hack and slash choices or you pay out of pocket — if you even know about it.

                                                                                                                                                I actually find Japan’s system way too complex for the average citizen…. pages after pages to explain everything. Since it doesn’t work without price controls, I still question how much medical innovation can be accomplished without competition and a profit motive. AFAIK, Japan excels at coming up with new dietary supplement ingredients that are regulated as pharmaceuticals over there but are lightly regulated here. Without the USA, they would not have a strong incentive to innovate in those areas. So once again, the USA is subsidizing another country. In this case its actually a good thing as opposed to treating lifestyle diseases.

                                                                                                                                                Anyway, I don’t have all the answers, but it is obvious Republicans have no fucking clue about anyhting.

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                                                                                                                                                Posted by MachineGhost
                                                                                                                                                Answered on 05/02/2017 6:04 PM
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                                                                                                                                                  Just a brief touch up here. A lot of this discourse is ‘inside the box’.

                                                                                                                                                  But in my view, the box is broken.

                                                                                                                                                  A lot of this discussion is also beyond my ken. I hate health ‘insurance’ and I hate ‘health care’ as it stands now. Period.

                                                                                                                                                  I don’t come at this from a point of view of Democrat or Republican. Hell, I don’t even know what those dudes stand for anymore (other than increasing Federal power at the expense of the citizenry). Certainly, not a Libertarian. I failed the 1st theorem of Libertarianism – that property rights proved all other subsequent rights of personal freedom. OK, I get that.

                                                                                                                                                  I think that the progressive socialism of our country from FDR has our brains skewed. Socialism is ALWAYS about wealth transfer. It levels the field. It runs counter to the following phrase: “To secure your liberties and allow for the pursuit of prosperity”. I mean why bother? You can always get your stuff from someone else, No?

                                                                                                                                                  But I think the first point of confusion arises to what are “rights”. I certainly do not feel that I have a fundamental “right” to health care. And I find it utterly laughable when I heard that Belgium (Netherlands??) declared that a two week vacation was a fundamental human “right”. I mean that is so over the top, that I didn’t walk to the bathroom – I sprinted.

                                                                                                                                                  And by the same token, you realize that a certain segment of our population has lost the fundamental right of the writ of habeas corpus?? This was signed into law by both Bush & Obama via the NDAA. Wow! These suckers totally rock! A fundamental right established in England in 1215 along with the Magna Carta, and we just lost it????

                                                                                                                                                  Is this shiite totally upside down or not?? Get where I’m coming from?

                                                                                                                                                  I don’t have the “right” to health care. I don’t have the “right” to car insurance or home owners insurance either. As a matter of fact, the whole business model of health insurance I find incredibly unsound. Unlike life, car, rental, & homeowner insurance, health insurance is a sure thing. There is no actuarial calculations in play here – the probabilities are pegged to unity! WTFO?

                                                                                                                                                  I do have the right to obtain car insurance, but only if I can afford it. If I can’t, then I can’t afford to have a car either@!

                                                                                                                                                  Last time I looked, our country hasn’t taken the step to declare that car ownership was a fundamental “right”. Thank god.

                                                                                                                                                  Same holds for “health insurance” (whatever abominable mastication this species of smegma is). I do have the right to pursue medical care however, but only if I can afford it.

                                                                                                                                                  That was what was meant by “the pursuit of prosperity”. It AIN’T a damned guarantee!

                                                                                                                                                  If I am prosperous enough, by virtue of my labors, then, OK, yes, I will pursue health care. I’ll think twice about ‘health insurance’ however.

                                                                                                                                                  And this is the 1st point. The extreme damage contributed by Obama was the conveyance that somehow, somewhere, health care was a fundamental right.

                                                                                                                                                  We may never recover from this distortion and perversion.

                                                                                                                                                  The 2nd point has to do with health care itself.

                                                                                                                                                  Doctor’s care and drugs cost way toooooooooooo much. Really.

                                                                                                                                                  The AMA makes sure that doctors are in short supply.

                                                                                                                                                  The FDA ensures that drugs cost a bundle, and they have a food pyramid that I would never, ever, eat. Lot of bullshit.

                                                                                                                                                  We have medical models which are just wrong (e.g., saturated fats, the cause of heart attacks, the “lipid” hypothesis, statins, opiods for pain) – and the ensuing regular doctor care follows suit. Seeing a regular doctor is painful. They ask if I am in pain all the time. One time, I said yes, my left calf is sore due to a total burnout track workout. I got drug prescriptions for pain killers! What is it that we don’t realize about the critical opiod addiction running through the Appalachian belt??

                                                                                                                                                  The regular medicos, in fact, are killing us (albeit, slowly). They follow a script. That’s where we’re at.

                                                                                                                                                  There is perhaps no time other than now when it becomes of the utmost pertinence to take care of one’s own health. O/w, go to a regular doctor and be killed! Go for it dude!

                                                                                                                                                  It turns out that this is not totally so difficult. Eat good shit, drink good shit, sleep good shit, and exercise a little (take a walk), stop sitting at the computer the whole damn day. Maybe see an alternative doctor and have him run the extensive panels that they run that you will never, ever see from a regular medico. At least get a gene panel done.

                                                                                                                                                  And that is how I sorta have opted out. I see an alternative medicine nurse (the doc requires appointments 1 year in advance). Run the panels and talk. Not perfect, but I learned a lot more about my health than from a normal medico. They aren’t perfect – had to call out them out on some problems I had, but we got it done. Nothing changed – my health was my responsibility.

                                                                                                                                                  Oh yeah? I forgot to mention that there was no medical insurance involve. Straight fee for service. Anyone remember that?

                                                                                                                                                  Did I have a “right” to that? No. It was because I could afford it.

                                                                                                                                                  And the shiite gets worse for elder care. I have a certain amount of experience in this with my mother. After 3-4 strokes (we lost count), and finally heart failure, she died last December. Her care was bloody awful. And it was actually pretty good comparing! There is no way I want to die that way. Not happening.

                                                                                                                                                  And the strokes? Turns out we have a gene defect and we are heterozygous MTHFR C677T (from my gene panel). That means we can only uptake 50% of folate and methylate it. When you fail to complete that 4th metabolic cycle, homocysteine builds up, which is a marker for making your blood ‘sticky’ (which means it is totally amp’ed up to preferentially clot). For years, my mom was on prescribed and mongo expensive blood thinners (e.g., Warfarin).

                                                                                                                                                  And the medicos put those band aids on right & left. They never corrected the problem. That’s the thing about our medical community.

                                                                                                                                                  The LAST thing these saviors are about is ROOT CAUSE. They do band aids. That’s it.

                                                                                                                                                  I find something rather intolerable about this.

                                                                                                                                                  So why bother with this?

                                                                                                                                                  Why bother with elder care in the state that it is now?

                                                                                                                                                  https://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp/1250081246

                                                                                                                                                  So I guess there are 2 points here:
                                                                                                                                                  1) I don’t have a “right” to health care,
                                                                                                                                                  2) I remain unconvinced that regular medical care is helpful

                                                                                                                                                  It didn’t always used to be this way. Rich people got access to medical doctors. Poor people got access to free hospitals when they were injured or sick.

                                                                                                                                                  Fixing this means an economy where all can pursue their prosperity to a point that they can afford the health care they can pay for.

                                                                                                                                                  Getting insurance companies and the Fed Gov involved just adds to the nauseating distortions we already had.

                                                                                                                                                  Finally, I feel that the ongoing diatribe will resolve nothing since these are arguments that are “inside the box”. We need to break the box. Autrement, you will accomplish nothing other than the turning of your intestines into knots.

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                                                                                                                                                  Posted by Poseidons Bear
                                                                                                                                                  Answered on 05/02/2017 11:50 PM
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                                                                                                                                                    To Poseidons Bear – Thanks for sharing your thoughts. I agree that we don’t have a “right” to health care, but I submit that we don’t need to think of it in those terms. Rather than a “right” – how about a responsibility – one for the common good of our society and citizens?

                                                                                                                                                    I’ve done a fair amount of reading about the various approaches to health insurance by other developed nations. One that stands out is Switzerland. Let me be clear, we are not Switzerland – that country is very small, culturally cohesive, highly educated, and very wealthy. They rank higher in per capita income and per capita accumulated wealth than the USA. Switzerland does not have “socialized” medicine – they have an individual mandate for a basic insurance plan. Low income citizens received help (if needed) with the premiums for the basic plan. Dozens of insurance companies compete for those customers – and all applicants must be accepted, regardless of health history. The companies don’t make profits (per regulation) from the basic plan – they make their profits from the optional supplemental plans. Doctors are in private practice. Citizens buy their own policies – they don’t depend on employer-provided health insurance. Their health care is among the most expensive – and best – in the world – but they still spend about 20% less per capita than the USA.

                                                                                                                                                    Capitalism is alive and well in Switzerland. Their citizens tend to view the health insurance mandate as a responsibility that benefits the whole country. The USA is a world leader in so many ways – productivity, military power, higher education, economic power, innovation, etc. — but we seem uninterested in notion of collective responsibility for health insurance.

                                                                                                                                                    Our system is a multi-tiered, inefficient mess – and has been for decades. We subsidize health insurance and health care via the tax code for employer provided health insurance. Incidentally, employer provided plans cover pre-existing conditions. Medicare is essentially a single-payer hybrid (that covers pre-existing conditions).

                                                                                                                                                    Your healthy lifestyle choices will certainly improve the odds of avoiding the need for expensive health care – but there’s no guarantee you’ll succeed. As you get older, the odds will most certainly begin going the other way.

                                                                                                                                                    As to what happened to your mother – I understand why you hope that will never happen to you. The thing is – you might have a stroke or some other incident that hits you without warning – and you might end up unable to make the decisions you now envision to avoid enduring the long, agonizing slope to dying like your mother did.

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                                                                                                                                                    Posted by Steve W
                                                                                                                                                    Answered on 05/03/2017 10:13 AM
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                                                                                                                                                      Machine Ghost,

                                                                                                                                                      So you are saying that the UK system assigns a doctor to you that you must use. sounds just like HMOs in America. If there is a feature of some other system we do not like, it does not mean we have to incorporate that feature in our system.

                                                                                                                                                      As someone who lived in Japan for many years and used their national health care system the whole time, I have no idea what you mean by too complex for the average citizen. It is an extremely simple system. You go to any provider you want. You pay your copay which is a maximum of 30% of cost of service subject to an out-of-pocket cap. Many people have smaller copays. It costs about 4% of your salary also subject to a cap.The costs of health care services is on average about one-third of what it is here in the US so that 30% copay is not usually a burden at all.

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                                                                                                                                                      Posted by Lucas
                                                                                                                                                      Answered on 05/03/2017 2:33 PM
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                                                                                                                                                        Machine Ghost,

                                                                                                                                                        You do not have to wonder about “how much medical innovation can be accomplished without competition and a profit motive.” You can look it up.

                                                                                                                                                        https://fsi.stanford.edu/sites/default/files/20151112stanfordlecturemedicalinnovation.pdf

                                                                                                                                                        https://factsanddetails.com/japan/cat23/sub151/item836.html

                                                                                                                                                        The Japanese seem pretty optimistic about their medical innovation.

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                                                                                                                                                        Posted by Lucas
                                                                                                                                                        Answered on 05/03/2017 2:45 PM
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                                                                                                                                                          Steve W,

                                                                                                                                                          Thanks for sharing your perspective – there were some valuable talking points.

                                                                                                                                                          1) Let’s take your example with Switzerland. Highest per capita income. Sounds like the ‘pursuit of prosperity’ is a success there (no doubt aided by avoiding 2 World Wars). Indeed, it appears they lack starving people, and that most of the them (the majority, perhaps?) are higher up the scale of Maslow’s hierarchy of needs? When a certain society reaches a certain level, is it then that one can undertake additional ‘responsibilities’? Such ‘responsibilities’ not necessarily falling under something like Article 1, Section 8 ‘the powers of the Legislative branch’? It wasn’t just that I viewed ObamaCare as just another illegal law passed by Congress, the thing that really got me steamed was that we were undertaking this new ‘responsibility’ during the GFC (is embarking on a fabulous journey a better phrase?). With so many people out of work in a global economic environment where unemployment has all the appearance of being structural (i.e., coal is not coming back), the timing seemed to be highly inappropriate. Our economy and our society in general just isn’t ready for prime time. I believe our economy needs to be a lot stronger than it is now for us to be taking on additional things. There are just too many people in our country who aren’t doing well. The death rates of rural white women between 25-56 are spiraling out of control due to, well basically, a loss of hope. Death rates for opiod addiction are also spiraling. This new ‘responsibility’ is almost as far out of reach as the notion of world peace, a world without borders. When people can’t eat or lack shelter, they have no thoughts of a peaceful border-less world.

                                                                                                                                                          2) Yes, trying to eat real food only delays the inevitable. We all die. I can’t tell you what was worse. The past 4 years of my mother’s life, or talking to her in French about how much her mother missed her and was waiting for her the night before she died. The kind hospice nurse told me that the auditory system is the last thing to go; so I was comforted by the fact that I knew she could hear me. I read “On Being Mortal” and felt I was prepared for her death. I wasn’t. I realistically don’t think you can prepare for this. But I also remember after her 3rd stroke (4th?), wheeling her through rehab. I saw an elderly patient lying perpendicular on his bed, with his head and feet hanging off the bed. We immediately arranged for a 24-hour nursing situation and removed her from there as fast as possible. I was struck by that – hard.

                                                                                                                                                          The kind hospice folks also left us with some materials after she died. It is called VITAS Healthcare “Five Wishes”. It is a good start towards the plan I want to assemble for myself. You basically delineate the treatment you want for a certain age range and condition. Past 75, all I want is palliative care.

                                                                                                                                                          The one fundamental aspect that is missing here, is the right to call my own death. I mean, if we believe in property rights, then don’t I have rights to my own body? Apparently not.

                                                                                                                                                          I am not without compassion. But something is dreadfully wrong here.

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                                                                                                                                                          Posted by Poseidons Bear
                                                                                                                                                          Answered on 05/03/2017 2:52 PM
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                                                                                                                                                            @Lucas: The PDF you originally linked to about Japan’s system was ridiculous in the number of pages it took to explain every POS aspect of the public health system, but if its simple to use at the POS then that may ultimately matter more. So this is how it rolls… patients pay 1/3rd, the insurance funds pay 1/3rd and the national debt pays 1/3rd (which is growing faster than revenues). Yet, it seems like a much better situation than paying 75%-100% of poor/sick/disabled/old. If technology can get the increasing costs under control, it seems more feasible than relying on political reform to allow more market competition.

                                                                                                                                                            So Japan “gets it” but it took them 20-years of going nowhere to get a cause for it. Meanwhile, the USA is falling further and further behind because of stupid politics and crony capitalism. Something has got to give.

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                                                                                                                                                            Posted by MachineGhost
                                                                                                                                                            Answered on 05/03/2017 3:43 PM
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                                                                                                                                                              @Poseidon: The “right” to sickckare is considered to fall under “promote the general welfare” in the Constitution.

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                                                                                                                                                              Posted by MachineGhost
                                                                                                                                                              Answered on 05/03/2017 4:22 PM
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                                                                                                                                                                Poseidon,

                                                                                                                                                                You wrote, “Our economy and our society in general just isn’t ready for prime time. I believe our economy needs to be a lot stronger than it is now for us to be taking on additional things. There are just too many people in our country who aren’t doing well. The death rates of rural white women between 25-56 are spiraling out of control due to, well basically, a loss of hope. Death rates for opiod addiction are also spiraling. This new ‘responsibility’ is almost as far out of reach as the notion of world peace, a world without borders. When people can’t eat or lack shelter…” It strikes me that you have made a case for the government to take more, not less responsibility. Meanwhile, the GOP wants to eliminate the programs that address the very issues you mention.

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                                                                                                                                                                Posted by Lucas
                                                                                                                                                                Answered on 05/04/2017 12:32 PM
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                                                                                                                                                                  MG,
                                                                                                                                                                  Yes, exactly! Thank-you. Article I, Section 8, Clause 1 (my favorite part) fragment:

                                                                                                                                                                  “and provide for the common Defence and general Welfare of the United States” (this is about why they collect taxes)

                                                                                                                                                                  And this is exactly what opens the flood gates. What does “provide” mean in “provide for the general welfare”?

                                                                                                                                                                  As a citizen (after paying my taxes) do I get a free car? A free house? It provides for the general welfare, right? I know I can now get a free lunch. I think it is called SNAP, right?

                                                                                                                                                                  Where do you draw the line?
                                                                                                                                                                  This is why I hate the oh-so pompous language of Clause I. Just say what you what you mean and move on – don’t make aspirations of hoi-paloi. “We have the right to collect taxes.” Done. Period.

                                                                                                                                                                  I prefer to take a narrower interpretation of that Clause, because I lack the wisdom to draw the line and I don’t feel I have the right to a free car or house. I have to earn the ‘privilege’. Just like health care (damn insurance).

                                                                                                                                                                  O/w, the flood gates are opened, and you are quickly overwhelmed by what you let in and what you keep out.

                                                                                                                                                                  Don’t worry, 99% of our society does not get this. We aren’t our forefathers. At all.

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                                                                                                                                                                  Posted by Poseidons Bear
                                                                                                                                                                  Answered on 05/04/2017 2:35 PM
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                                                                                                                                                                    Lucas,
                                                                                                                                                                    Your last sentence? I feel I would be morally bereft aspiring to defend the GOP or Democrats. Let us just say I can’t (nicely) speak to either of their actions.

                                                                                                                                                                    But your other sentence gives me pause. I don’t believe I was trying to make the case for/against more/less government, but a quote popped into my head. I can’t find out who said it (not Hayek or Menckin apparently), and I paraphrase it only: “You know a society is becoming tolerant to a tyranny or socialism when a big problem crops up and the 1st thing that the citizen asks is: ‘what’s government going to do about it?'”. I am not sure I have total buy-in to this since I sure hope the government is there to provide for the common defense of our borders. But I also think that we are too quick to ask the government to solve too many problems. We don’t strike a very good balance.

                                                                                                                                                                    I guess I was more about making a plea of our situation during the GFC. The HH sector has just been hammered due to falling housing prices, markets have plunged, unemployment is going through the roof and we want to saddle the taxpayers with another heavier burden? That isn’t wisdom to me. There are so many other things that need getting done to put our house in order that expanding the Fed GOV role in health care shouldn’t have been our highest priority. Oh BTW, those things still need to get done. The structural effects of a global economy concomitant with the GFC still hamper us greatly.

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                                                                                                                                                                    Posted by Poseidons Bear
                                                                                                                                                                    Answered on 05/04/2017 2:52 PM
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                                                                                                                                                                      Where you draw the line is at the bottom of Maslow’s hierarchy of needs. In the richest country in the world, it is government policies that ensure there are huge numbers of people still unable on their own to provide for their own basic needs. Trumpcare 3.0 is exhibit A. Its main purpose is to carve out “savings” from other programs that benefit the bottom 90% in order to fund unnecessary tax cuts for the upper 10% (including me). Government policy is partly (by some lights, wholly) responsible for the widest income inequality gap since the Roaring Twenties.

                                                                                                                                                                      To address you other concerns in order:
                                                                                                                                                                      House prices: 2006 houses prices were not normal. They were a bubble. That means they were inflated relative to fundamental value. That is like a sick fever. Recovery from a fever means the fever must come down to a healthy level. In many localities, house prices never recovered to that healthy fundamental value, and instead are rising, that is, relapsing to the sick fever. For some odd reason the media and the housing pundits call a relapse “recovery.” Look at your own community and ask yourself, is a median local house price no more than about 3 times a median local wage? If the answer is no, then house prices in your community are probably still too high.

                                                                                                                                                                      Plunging markets: Markets have NOT plunged. Just the opposite. On February 2009, the DOW was 7063. Today it is 20914 a RISE of nearly 200% for an annualized average increase of 25% per year. Today’s DOW is only 1% down from its 52-week high of 21169. That is not a plunge.

                                                                                                                                                                      Unemployment: Unemployment is NOT “going through the roof.” Again,just the opposite. Here is a chart that shows the unemployment rate for every year since 1948 https://www.multpl.com/unemployment/table. You might be talking about the labor participation rate https://www.multpl.com/us-labor-force-participation-rate. The labor participation rate is dropping, but keep in mind the largest segment of the population, the baby boomers, has been retiring during most of the drop.

                                                                                                                                                                      The additional taxpayer burden that we did not need to be saddled with is war. The reason that the government takes on burdens is because it is in the public interest to do so. A good example is education. It used to be that you could get an education only if you could afford one. Education used to be a “privilege.” Society decided that it was in the public interest for everyone to be educated, hence public school. There is a good argument to be made that universal basic health care is also in the public interest, and not a privilege only for those who can afford it. Tax cuts for the rich are NOT in the public interest. Previous experiments with tax cuts for the rich did NOT produce the promised societal benefits. There was no trickle down prosperity. Instead, tax cuts for the rich amount to a massive redistribution of wealth from the 90% to the top 10%.

                                                                                                                                                                      I am glad you have found your way to Pragcap. Your other sources of information seem to be leading you astray. If I were you, I would abandon those other sources, and seek sources that give you accurate information.

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                                                                                                                                                                      Posted by Lucas
                                                                                                                                                                      Answered on 05/05/2017 11:08 AM
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                                                                                                                                                                        “‘Make no mistake: This is a repeal and replace of Obamacare,’ President Trump said in the Rose Garden after the House passed the American Health Care Act by a slim margin of 217 to 213.”

                                                                                                                                                                        There we have it… stupid is as stupid does. Turning off the channel.

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                                                                                                                                                                        Posted by MachineGhost
                                                                                                                                                                        Answered on 05/05/2017 1:09 PM
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                                                                                                                                                                          @Lucas: Sometimes you sound like you repeat a lot of Democrat talking points that aren’t based on historical facts or are based on rewriting history. I’m not sure what “previous experiments” you’re referring to, but tax cuts worked splendidly in the 1920’s, 1960’s and 1980’s in the USA to contribute towards economic growth as well in a tons of other countries. So when you make a blanket statement that they did not, that only the rich benefited or that Republicans only care about tax giveaways to the rich, or other partisan nonsense, it impugns on your credibility as that is not (or was not) the at larger reality or motivation at all. I’m well familiar with the warped, self-serving, biased, tunnel vision ideology of both sides, so it is very easy for me to smell a rat. Ideology always triumphs facts.

                                                                                                                                                                          Hmm, do you even realize the Democrat party is super majority funded and stays afloat only due to a super minority of the “rich” that you claim to detest: the celebrities, the millionaires, the billionaires, the ambulance-chasing trial lawyers? After all, how can you expect the brain-dead rank and file Democrat to financially support such a massive party organization when they’re anti-capitalist and make very little income? At least the Republicans are not oxymorons in that respect.

                                                                                                                                                                          So are you ultimately more interested in intellectual honesty or just pushing ideology? If its the former, then be very careful about repeating talking points from either side. If you want to make the claim that historical reality was more nuanced in terms of facts, then state that instead of relying on false generalizations. I’ll leave you with this to point out how absurd your claims are:

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                                                                                                                                                                            Posted by MachineGhost
                                                                                                                                                                            Answered on 05/05/2017 1:34 PM
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                                                                                                                                                                              I have no interest in ideology beyond the idea that the richest country in the world should have policies that benefit the largest possible number of its citizens. I am not against all inequalities. I oppose the perpetuation of systemic barriers to opportunity. I am not a Dem, and I do not detest the rich. What I said is tax cuts for the rich did not produce the promised trickle-down prosperity. Instead, tax cuts for the rich correlate with widening of the income inequality gap and the hallowing-out of the middle class. Taxcuts for the rich are funded by increasing the debt or raising taxes on the non-rich. An excellent example of the latter was the 2010 elimination of the estate tax. This tax cut benefited a mere 5000 uber-rich people. I can tell you that millions of less rich people were astounded to find out upon the death of a loved one that stepped-up basis had also been eliminated to pay for the lost revenue the estate tax usually provides. As usual, the rich ended up benefited at the expense of everyone else.

                                                                                                                                                                              The result of tax-cuts for corporations has been that corporations hoard the money, or buy back their own stock. They do not use the tax savings to hire more people as the supply-side people wishfully hope in spite of all evidence to the contrary. And why would they hire? The decision to hire is driven by consumer demand, not extra money laying around.

                                                                                                                                                                              Here is a ton of raw data https://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/98xx/doc9884/12-23-effectivetaxrates_letter.pdf. And here: https://milescorak.files.wordpress.com/2013/05/atkinson-et-al-top-shares-19642-w19075.pdf

                                                                                                                                                                              I do not understand why you put up the Clinton attachment. It does not actually have any information to support whether the policies labeled pro-growth or anti-growth actually resulted in that pro-growth or anti-growth.

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                                                                                                                                                                                Posted by Lucas
                                                                                                                                                                                Answered on 05/05/2017 3:54 PM
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                                                                                                                                                                                  Hi Lucas,

                                                                                                                                                                                  1. I am sure I am not quite understanding your ‘draw the line at bottom of the hierarchy’, but I will agree that when one has a segment of its society that fails to meet need #1, then one is living in a country that isn’t doing so well.

                                                                                                                                                                                  The remainder of these items refer to the period 2008 – 2010 when the ACA was passed by Congress, except when made clear the time reference is otherwise:
                                                                                                                                                                                  2. House prices indeed had fallen. In some areas tremendously. While the housing market did indeed experience a bubble, the bubble also popped. And a large segment of the HH sector got hit very hard by that. Many were underwater in their mortgages. Many people had to default on their loans. That’s not a sign of good times. It is certainly not an opportunity to expand the Fed Gov even more, with a concomitant burden on the middle class. And yes, the relapse is also occurring now. It isn’t the outrageous real estate taxes that I have to pay semi-annually that makes me angry, it is the fact that my 3 children will NEVER be able to buy a 4-bedroom single family home. There is no off-setting wage inflation that they are experiencing to offset the home values here.

                                                                                                                                                                                  3. In the period referenced, markets did plunge. Bank stocks in particular hit rock bottom. Certain commodities plunged, while others (precious metals) soared. I know this b/c a colleague made a 50% profit timing his gold trade. Since that time, stocks are on one super bull run. No disagreement there either.

                                                                                                                                                                                  4. I don’t put a whole lot of stock into the BLS’s ‘birth-death rate’ models for estimating the unemployment rate. During the period referenced, even the BLS’s figures were pretty darn bad. If you take a look at the NIPA/FOFA data during that period the GOV sector’s transfer payments were enormous as well. And the labor participation rate has been in the toilet from 2008 to now. I find it difficult to blame that on demographics solely. People have been structurally removed from the work force by global economics, dying industries, collapsed manufacturing, etc.

                                                                                                                                                                                  5. I agree with war comment. I wish we didn’t have to be the world’s policeman. That job sucks.

                                                                                                                                                                                  6. I disagree slightly with your comment that GOV takes on burdens in the public interest. This has no time reference. The Fed GOV is only authorized to enact legislation in accordance with Article I, Section 8. At least, that is what is supposed to happen. If you don’t have constraints on what the Fed GOV can do, then the Fed GOV can expand its powers infinitely. That concept scared our forefathers to death. Furthermore, what is in the public interest or what is the public interest does not necessarily make it right. That is exactly why we are not a democracy. We are a republic. Was it not Ben Franklin who quipped “Democracy is 3 wolves and a lamb discussing the dinner arrangements”? As for education, that’s fine but there is nothing specific to Article I, Section 8 entitling the Fed GOV to enact legislation regarding education. That should mean it goes down to the states. And the states make that decision, IF they are legally entitled to do so. If not, it goes down to the local levels. And if I am not mistaken, education is still a privilege. With 3 children in college, they are sure not attending for free. If down at the state level or local level it is determined that there be free EL-HI public education then you also agree to pay taxes to support it. Fine. That works. If you disagree, you move to another state (vote your feet). You see? At the end of the day, public education is not free, and instead of it just costing you since your kids are in elementary school, it costs everyone regardless if they have children or not. We call that a wealth transfer.

                                                                                                                                                                                  7. I made no prior statements for the remainder of your post so I won’t take any issue with them either.

                                                                                                                                                                                  8. This marks my 9th year reading this website. Time was, you replied to Cullen as TPC.

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                                                                                                                                                                                  Posted by Poseidons Bear
                                                                                                                                                                                  Answered on 05/05/2017 4:35 PM
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                                                                                                                                                                                    So all ObamaCare Lite did was basically replace the below anti-growth taxes. Here’s hoping the Senate Republicans will get a clue and fix things fundamentally. Not holding my breath.

                                                                                                                                                                                    -Abolishes the Obamacare Individual Mandate Tax which hits 8 million Americans each year.

                                                                                                                                                                                    -Abolishes the Obamacare Employer Mandate Tax. Together with repeal of the Individual Mandate Tax repeal this is a $270 billion tax cut.

                                                                                                                                                                                    -Abolishes Obamacare’s Medicine Cabinet Tax which hits 20 million Americans with Health Savings Accounts and 30 million Americans with Flexible Spending Accounts. This is a $6 billion tax cut.

                                                                                                                                                                                    -Abolishes Obamacare’s Flexible Spending Account tax on 30 million Americans. This is a $20 billion tax cut.

                                                                                                                                                                                    -Abolishes Obamacare’s Chronic Care Tax on 10 million Americans with high out of pocket medical expenses. This is a $126 billion tax cut.

                                                                                                                                                                                    -Abolishes Obamacare’s HSA withdrawal tax. This is a $100 million tax cut.

                                                                                                                                                                                    -Abolishes Obamacare’s 10% excise tax on small businesses with indoor tanning services. This is a $600 million tax cut.

                                                                                                                                                                                    -Abolishes the Obamacare health insurance tax. This is a $145 billion tax cut.

                                                                                                                                                                                    -Abolishes the Obamacare 3.8% surtax on investment income. This is a $172 billion tax cut.

                                                                                                                                                                                    -Abolishes the Obamacare medical device tax. This is a $20 billion tax cut.

                                                                                                                                                                                    -Abolishes the Obamacare tax on prescription medicine. This is a $28 billion tax cut.

                                                                                                                                                                                    -Abolishes the Obamacare tax on retiree prescription drug coverage. This is a $2 billion tax cut.

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                                                                                                                                                                                    Posted by MachineGhost
                                                                                                                                                                                    Answered on 05/05/2017 5:16 PM
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                                                                                                                                                                                      @Lucas: I put it up because it shows the *results* of his policies but most all Democrats think that Clinton “saved” the economy and Federal government because of the marginal income tax increase (and not due to the Internet bubble). Of course in the real world its not as simple as just marginal income rates being increasing or decreasing. They don’t play a huge role compared to freedom, rule of law, minimal regulation, lack of corruption, and other historical pro-growth factors that typically go along with low marginal income tax rates. You can have high marginal income tax rates on top of a fundamentally sound economy & politics in all other areas and it won’t be deflationary, but an increasing proportion will be wasted on tax avoidance and shelters instead of improviing productivity. But most Democrats believe in what I call “Reverse Laffer Curvism” in assuming that raising marginal income tax rates magically fixes everything just as most Republicans believe in the opposite. Both are laughably simple world-views but the onerous should be on those promoting anti-growth policies based on the historical evidence.

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                                                                                                                                                                                      Posted by MachineGhost
                                                                                                                                                                                      Answered on 05/05/2017 5:26 PM
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                                                                                                                                                                                        A little off topic, but this article about France is good and why you can’t take talking points or sound bites at face value: https://images.realclear.com/files/2016/09/357_france.pdf

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                                                                                                                                                                                        Posted by MachineGhost
                                                                                                                                                                                        Answered on 05/05/2017 5:47 PM
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                                                                                                                                                                                          PB,

                                                                                                                                                                                          First, your implication that any of this was caused by the ACA is false.

                                                                                                                                                                                          Your points in order.
                                                                                                                                                                                          The housing bubble indeed popped, and that was a good thing. House prices needed to fall. Everybody blames the banks for the bubble, but I blame real estate agents. They advertise that when you are making the largest purchase you are likely to make in a lifetime, you need their expertise and you should rely on their expertise. Yet they used their expertise to sell houses at prices they KNEW very well were too high just to pocket the big commission and walk away. If you relied on your agent, pundits called you stupid for relying on the people you are supposed to be able to rely on. No one is holding agents accountable or even talking about their role in the problem. If you buy a house for more than it is worth, there is a risk that you will be underwater. There are some good reasons to use an ARM, but if you buy a house using an ARM because that is the only way you can afford the monthly payments, you are at great risk of default. The experts used their expertise AGAINST their clients. Remember that even with a conventional mortgage, the payments for the first seven years or so are mostly interest. The agents and the lenders knew exactly what they were doing.

                                                                                                                                                                                          You said “the markets have plunged.” That is present tense. You also do not have to “know” about gold because of a friend’s anecdote. The data is readily available online.

                                                                                                                                                                                          There is nothing wrong with the BLS data. It seems you take issue with BLS models because somebody told you to. Republicans are loving the models now. See how that works. It is probably true that “global economics, dying industries, collapsed manufacturing, etc,” have contributed to the labor participation rate. However, if you look at the data I provided, it puts the labor participation rate in historical context with a time when those factors were presumably not a problem. Furthermore, those factors are all way beyond the control of the people affected.

                                                                                                                                                                                          The comments on public interest are all over the map and too mixed up with ideological preconceptions, instead of letting data and logic lead. What do you think “public interest” means? It cost everyone whether they have children in K-12 or not because society determined that everyone benefits when everyone is educated, even those without children currently in the system. Here is just one benefit: even people who are not your children will help fund your social Security and Medicare payments after they grow up. The “wealth transfer” that should really gall you is not property taxes, but the wealth transfer that lines the pockets of the upper 10%, and especially the 1%, at the expense of rest of the people, who lose twice, not only from the wealth transfer but only because, as you mentioned, wages have been stagnant.

                                                                                                                                                                                          What on earth does “Time was, you replied to Cullen as TPC” mean?

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                                                                                                                                                                                          Posted by Lucas
                                                                                                                                                                                          Answered on 05/06/2017 12:30 PM
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                                                                                                                                                                                            MG,

                                                                                                                                                                                            You chart only showed category names and policies sorted into theoretical categories. It has zero data about whether any of those policies actually correlated with their categories.

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                                                                                                                                                                                            Posted by Lucas
                                                                                                                                                                                            Answered on 05/06/2017 12:43 PM
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                                                                                                                                                                                              @Lucas: That wasn’t the point — only to show the effects of the policies that Clinton presided over. It’s a major tenant of current Democrat ideology that the Clinton tax raise alone was KUMBAYA (even though the so-called budget surplus was all projected not actual) and now to the point that Limousine Liberals (i.e. Rattner) are denying and rewriting history about the pro-growth effects of Reaganism which is just getting downright silly.

                                                                                                                                                                                              Anyway, here’s “The inside story of how Trump and the Republicans got Obamacare repeal through the House (Hint: It wasn’t pretty.)”: https://www.politico.com/story/2017/05/05/donald-trump-obamacare-repeal-timeline-238016

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                                                                                                                                                                                              Posted by MachineGhost
                                                                                                                                                                                              Answered on 05/06/2017 6:05 PM
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                                                                                                                                                                                                Regarding your list of “anti-growth taxes,” please cite sources that characterize each item as a tax and the amounts. For example, “Abolishes Obamacare’s HSA withdrawal tax. This is a $100 million tax cut.” ??? “Funds set aside in a health savings account (HSA) can be double tax-free. Contributions are tax-deductible when going into the HSA. And distributions can be tax-free when coming out the HSA.” https://www.thebalance.com/the-key-benefits-of-health-savings-accounts-3192991
                                                                                                                                                                                                “Earnings, such as interest and dividends, in the health savings account, are tax-exempt at the federal level. Withdrawals from a health savings account are tax-free as long as the funds are used to pay for qualified medical expenses.” the very act of contributing to an HSA and using the HSA to cover medical bills is already a “tax cut.” If you withdraw money from the HSA for non-medical expenses, then all you really did was DEFER the tax while the money is in the HSA. After you take it out of the HSA, of course you should pay the tax. In what way, does AHCA abolish the tax? Does it say you can use money set aside in HSAs for any purpose now?

                                                                                                                                                                                                That was just one example. I have similar questions about the other eleven items on your list regarding both your characterization and the amounts.

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                                                                                                                                                                                                Posted by Lucas
                                                                                                                                                                                                Answered on 05/08/2017 2:43 PM
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                                                                                                                                                                                                  @Lucas: I think I tracked it down… hold you nose, but it’s from Americans for Tax Reform which I think is Norquist’s shop: https://www.atr.org/list-obamacare-taxes-repealed

                                                                                                                                                                                                  Recently, Hatch and Rubio introduced S. 403, the Health Savings Act of 2017. Of most interest is this section which would be an encouraging step in the right direction (in terms of increased competition and preventive care): https://www.congress.gov/bill/115th-congress/senate-bill/403/text#toc-IDacc7969cb585404ba4c482155cc17ed7
                                                                                                                                                                                                  It also would allow Part A-only Medicare beneficiaries like myself to finally have a HSA. $1K a year is awful tiny though (I easily spend more than that per month).

                                                                                                                                                                                                  Also, here’s a study from 2012 from RAND on how consumer-directed insurance (i.e. high deductible with HSA/FSA/MSA) affects sickcare use: https://www.rand.org/content/dam/rand/pubs/research_briefs/2012/RAND_RB9672.pdf
                                                                                                                                                                                                  So consumers spend less as they’re gaming the system less but also being more irresponsible. Doh!

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                                                                                                                                                                                                  Posted by MachineGhost
                                                                                                                                                                                                  Answered on 05/09/2017 9:42 PM
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                                                                                                                                                                                                    Okay, I wouldn’t post that list of so-called Obamacare taxes repealed anyway. The figures are outsourced, and the creator tries to construe every little thing as a tax whether it actually is or isn’t. The main purpose of the list is not to inform, but to create an impression. In short, it is more like propaganda than anything else.

                                                                                                                                                                                                    S 403: I really do not like anything that depends so heavily on HSAs or other tax-advantaged accounts because the tax advantages generally are useless to people who cannot exceed their standard deduction anyway. The other problem is that many of those same people are in no position to be able to save that kind of money no matter how frugal they are. A third problem is that HSAs, MSAs et al must be paired with a high deductible insurance plan. The same people cannot afford the deductible.

                                                                                                                                                                                                    “Consumer-directed” is a false frame. The reason sickcare use decreases is for the same reason uninsured people forgo sick care use altogeher until it become unfavorable (and more costly)—the deductible is simply unaffordable. Indeed, the study concludes as much when it says:

                                                                                                                                                                                                    It must be emphasized, however, that these studies examined only effects in the first year after families switched to a high-deductible plan. The cost effects in later years of enrollment remain uncertain and
                                                                                                                                                                                                    will require further study. If high-deductible plans stimulate more prudent purchasing over time, they could be an important part of the answer to rising health care costs. If, however, patients skimp on highly valuable services that can prevent more costly problems later, the savings may be short-lived.

                                                                                                                                                                                                    Many people are already playing roulette with their health care because they signed up for one of those high-deductible plans in order to get the premiums down to something they could manage, but when push comes to shove they essentially have no insurance except for the most catastrophic of occurrences, but they cannot afford the deductible anyway. A young man in my church fell into this trap. He has a high deductible plan, and right now he is in chemotherapy. His total out-of-pocket is $7000, which he has no hope of being able to pay. However, the church is pitching in and paying for it at an average of $25 per member. He is fortunate. A lot of people are not so fortunate.

                                                                                                                                                                                                    Do you see that this is how health care is supposed to work? The cost should be spread over the widest possible number of “members” so that the burden on any one member is light. The “church” should be the entire country, in other words, universal coverage. True, the healthy pay for the sick (and eventually we all get sick or have an accident), but when any of those healthy become sick, the other healthy will pay for them in turn. The bigger the shared pool, the cheaper both insurance premiums and service costs can be.

                                                                                                                                                                                                    “Insurance” is really the wrong paradigm for health care. Insurance assumes that many pay premiums, but few file claims. For example, in decades of driving, I have had two parking tickets, a few broken windshields, some damage well-within my very low deductible, and no accidents. I am probably an outlier, but you get the point. Drivers have well-defined “incidents,” not chronic or long-term conditions. Insurance is not really a suitable paradigm because sooner or later everyone needs substantial health care even if only for a final illness.

                                                                                                                                                                                                    Samaritan Ministries runs a “share the bills” program. For about $500/month/family, the amount of “shares” available is roughly equally to the amount of medical bills submitted each month. 1/12 (about 8%) of the the annual revenue is reserved for administration and salary. All the rest pays medical bills. The organization guarantees the admin/medical costs ratio of 8/92 because each family sends their share directly to another member who has submitted a bill for payment eleven months of the year. The twelfth month only (actually the first month) is sent to the administration office.

                                                                                                                                                                                                    You see Samaritan Ministries has made sure they align their procedures to the interests of the members. The profit motive of health insurance companies results in a misalignment of interests. The customers want the insurance company to pay the claims but the insurance companies major source of profit comes from denying as many claims as possible. It is a fundamental mismatch that results in premiums that are far higher than they need to be. Every medical provider has a staff person who job it is to fight with insurance companies all day. Patients pay that cost which could be eliminated if there were no mismatch. Neither ACA nor anything the GOP has proposed even comes close to dealing with this misalignment of interests. Health care reform must address this misalignment to be anything more than a stupid, deeply-flawed band-aid.

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                                                                                                                                                                                                    Posted by Lucas
                                                                                                                                                                                                    Answered on 05/10/2017 12:48 PM
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                                                                                                                                                                                                      Lucas –

                                                                                                                                                                                                      I tend to agree that “insurance” isn’t the best approach to health care. I find that comparisons to auto and home insurance are often misleading. A person can choose to live in a wooden house out in the country, far away from fire hydrants – and they’ll pay more for home insurance. In this instance, insurance is obviously a risk management tool. Health care is often quite different. It’s true that some people have certain health issues due to poor lifestyle choices, but in many other cases, their need for health care is genetic, due to an accident, or perhaps some other bad luck. Eventually, even the healthiest people making the best lifestyle choices (for health) often need health care – and it can be quite expensive.

                                                                                                                                                                                                      Critics of universal coverage often say that our country has the very best health care in the world. That’s mostly true for those with the resources, which generally is a combination of insurance and lots of their own money. Given that the USA spends 20-40% more per capita on health care than any other developed nation – we should have the best health care. The thing is – those other nations have figured out how to cover all their citizens – even those with pre-existing conditions – while spending less overall. Every system rations care – ours just does it differently.

                                                                                                                                                                                                      I think we should approach the problem as how to best finance health care. We live in the world’s most productive, dynamic economy – we are the most powerful militarily, our living standards are among the best in the world – and yet we cannot seem to move away from our current multi-tiered, inefficient, and unfair mess of a system. Some in the GOP talk about more “free market” forces for health care – but they really don’t mean it to any significant degree. As long our system remains dominated by tax-subsidized employer-provided health insurance along with Medicare (which is essentially a single-payer hybrid) – then “free market” forces on health care will remain weak.

                                                                                                                                                                                                      Having said all that – I believe the free market falls short when in comes to health insurance. The guy who buys an $75,000 Corvette and gets speeding tickets is going to pay lots of money for his auto insurance – and rightly so. He can also choose to get rid of the Corvette, buy a basic sedan, clean up his driving record by not speeding for a few years – and the insurance industry will happily provide him with policies priced appropriately along the way. He may never get in a car accident his whole life. I’ve been driving for 40 years and have never had an accident. On the other hand, the odds of him never needing health care his whole life, then dying peacefully in his sleep at age 90 are very, very low.

                                                                                                                                                                                                      As an interesting aside – universal coverage does not have to mean single-payer. Switzerland has arguably the best overall health care in the world – and they have an individual mandate for basic insurance (they are not dependent on employer provided group health insurance). Low income citizens receive help with the basic policy premiums. Citizens are free to buy optional policy upgrades – which is how the insurance companies make their profits. Very interesting – and consumers have more skin in the game compared to our system. Of course, we’re not Switzerland.

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                                                                                                                                                                                                      Posted by Steve W
                                                                                                                                                                                                      Answered on 05/10/2017 1:51 PM
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                                                                                                                                                                                                        @Lucas

                                                                                                                                                                                                        Did you really compare a medical sharing program to ACA QHP and then say that the medical share program is more in line with consumers interest…. I just hit my head on my desk.

                                                                                                                                                                                                        Oh, Medical share is great because it holds admin cost ratio to 8 and insurance carriers hold at 12 (again, national average, please see previous comments), but you forget all the other cost that goes along with bonifide “Insurance.” Lets start with the simple stuff like the 2.5% state guarantee fund that every insurance carrier pays, the 3.1% Exchange Policy Tax. Again, this is calculated in the admin cost that Medical Sharing Programs do not pay because 1- they are not insurance and are not liable if claims exceed forcasted share (the only remedy they have is to ask enrolled members to pay more immediately), 2-have a religious exemption and do not have to adhere to ACA mandates or state and federal taxes.

                                                                                                                                                                                                        Well.. Golly Gee, you fixed it. We should all just go to a medical sharing program and our problems will be fixed. Oh wait… they do have preexisting exclusions, there are no regulations controlling capital reserves, and they can deny anything that does not fit into “religious values.” Oh wait, there is a class action lawsuit from members who were diagnosed with hepatitis C and medishare would not cover the lifesaving drug cost…. hmmm.. Yep Misalignment or whatever the hell you rambled on about.

                                                                                                                                                                                                        Anecdotal evidence of your friend getting Cancer with a HSA plan and being screwed by high health cost is lacking. First let me explain to you the most basic concept of insurance. Its a transferred measure of risk. It is not anyones fault but your friends for choosing a high deductible health plan and then being diagnosed with cancer. Thank baby Jesus that his OOPM is only $7,000 or less. Chemo and radiation runs in the $1,500-$3,000 per treatment. I guess he can kiss his lucky stars he had some insurance. Grab a calculator and sit down for this one. Add the cost of a Gold or Platinum plan of your choosing (Premium + OOPM). Now add the HSA plan (Premium + OOPM). You are not going to like your answer of which one is more affordable.

                                                                                                                                                                                                        Oh I see, you were just complaining about health insurance as a whole. Those greedy bastards always denying benefits. Well, again you are not going to like the answer but do you know that most countries that have universal healthcare ALSO have private insurance or supplemental insurance tied to NHP. Oh no… Those greedy bastards will continue screwing us forever… How dare they stay in business by charging consumers money to transfer risk and liability while maintaining adverse claims but denying benefits that are not reasonable, negotiated or medically necessary. How dare they, misalignment… yada yada…yada!!

                                                                                                                                                                                                        I don’t see how any of what you complain about will change with a universal health plan. No they will not pay for your sex change operation in the UK, nor will they pay for preliminary study cancer treatment in Canada… Just a hint, these countries have National Health Plans.

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                                                                                                                                                                                                        Answered on 05/10/2017 2:40 PM
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                                                                                                                                                                                                          @Lucas

                                                                                                                                                                                                          Did you really compare a medical sharing program to ACA QHP and then say that the medical share program is more in line with consumers interest…. I just hit my head on my desk.

                                                                                                                                                                                                          Oh, Medical share is great because it holds admin cost ratio to 8 and insurance carriers hold at 12 (again, national average, please see previous comments), but you forget all the other cost that goes along with bonifide “Insurance.” Lets start with the simple stuff like the 2.5% state guarantee fund that every insurance carrier pays, the 3.1% Exchange Policy Tax. Again, this is calculated in the admin cost that Medical Sharing Programs do not pay because 1- they are not insurance and are not liable if claims exceed forcasted share (the only remedy they have is to ask enrolled members to pay more immediately), 2-have a religious exemption and do not have to adhere to ACA mandates or state and federal taxes.

                                                                                                                                                                                                          Well.. Golly Gee, you fixed it. We should all just go to a medical sharing program and our problems will be fixed. Oh wait… they do have preexisting exclusions, there are no regulations controlling capital reserves, and they can deny anything that does not fit into “religious values.” Oh wait, there is a class action lawsuit from members who were diagnosed with hepatitis C and medishare would not cover the lifesaving drug cost…. hmmm.. Yep Misalignment or whatever the hell you rambled on about.

                                                                                                                                                                                                          Anecdotal evidence of your friend getting Cancer with a HSA plan and being screwed by high health cost is lacking. First let me explain to you the most basic concept of insurance. Its a transferred measure of risk. It is not anyones fault but your friends for choosing a high deductible health plan and then being diagnosed with cancer. Thank baby Jesus that his OOPM is only $7,000 or less. Chemo and radiation runs in the $1,500-$3,000 per treatment. I guess he can kiss his lucky stars he had some insurance. Grab a calculator and sit down for this one. Add the cost of a Gold or Platinum plan of your choosing (Premium + OOPM). Now add the HSA plan (Premium + OOPM). You are not going to like your answer of which one is more affordable.

                                                                                                                                                                                                          Oh I see, you were just complaining about health insurance as a whole. Those greedy bastards always denying benefits. Well, again you are not going to like the answer but do you know that most countries that have universal healthcare ALSO have private insurance or supplemental insurance tied to NHP. Oh no… Those greedy bastards will continue screwing us forever… How dare they stay in business by charging consumers money to transfer risk and liability while maintaining adverse claims but denying benefits that are not reasonable, negotiated or medically necessary. How dare they, misalignment… yada yada…yada!!

                                                                                                                                                                                                          I don’t see how any of what you complain about will change with a universal health plan. No they will not pay for your sex change operation in the UK, nor will they pay for preliminary study cancer treatment in Canada… Just a hint, these countries have National Health Plans.

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                                                                                                                                                                                                          Answered on 05/10/2017 2:41 PM
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                                                                                                                                                                                                            I think its clear we need a comprehensive reform solution not some overpriced bandage that Obamacare and Obamacare Lite are. But since Congress is addressing the individual market instead of sickcare overall, there’s no impending crisis to get them to act. They never act without a crisis anyway and very rarely does their solutions make things better long-term.

                                                                                                                                                                                                            As mentioned before, I favor the Switzerland and Australian sickcare model but it’s purely superficial at the insurance level and not introducing any real market competition into the supply side (i.e. to lower costs long-term without sacrificing service and quality). There’s too much crony capitalism that would have to be rolled back, careers ended, interests threatened, money flows driedup, etc.. It will never happen. Just resign yourself to Medicare-For-All after Obamacare Lite implodes.

                                                                                                                                                                                                            Frankly, if more people would stop being lazy and relying on the conflation of sickcare with healthcare as security theatre, they would be more self-responsible and that alone would reduce the costly burdens of palliating. Ignorant people that believe hack, slash and burn is the “best option” rather than just a “standard of care to make the most money possible for the hospitals, surgeons, oncologists and Big Pharma, et al.” don’t live too long.

                                                                                                                                                                                                            I think changed my mind and agree with Roche now. Capitalism won’t fix sickcare. The core problem is how do you preserve the power of the profit motive and the pricing feedback mechanism for efficiently allocating society’s resources without it?

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                                                                                                                                                                                                            Posted by MachineGhost
                                                                                                                                                                                                            Answered on 05/10/2017 8:29 PM
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                                                                                                                                                                                                              MG- “Did you really compare a medical sharing program to ACA QHP and then say that the medical share program is more in line with consumers interest?” NO, I didn’t. I was merely pointing out the cost share aspect of the medical sharing program. You are correct that it is not insurance, and perhaps insurance is the wrong model for health care anyway. At no point was I recommending a wholesale adoption of a medical share program (as an aside, I certainly would not look at Medi-share at all. Any comparisons should be made with Samaritan Ministries, and then with a number of caveats)

                                                                                                                                                                                                              “It is not anyones fault but your friends for choosing a high deductible health plan and then being diagnosed with cancer.” This is an extremely cold statement,and not at all relevant. Lots of people have zero choice as to their plan. They have to take the one offered by their employer, no matter how bad it is or go without. They are forced to roll the roulette wheel. In fact, many employees were blindsided after ACA passed by their employers unilaterally downgrading the quality of their health plan, but without a reduction in premiums. You also missed the point of my anecdote.

                                                                                                                                                                                                              You know what, a lot of countries have better plans than we do. Citing something you don’t like from the Canadian plan or the UK plan does not invalidate my basic point. Nevertheless, Canada’s plan enjoys high consumer satisfaction compared to the plans of ten other countries https://content.healthaffairs.org/content/9/2/185.full.pdf. This recent (2015) survey found Japanese levels of satisfaction comparable to Canada https://www.omicsgroup.org/journals/what-makes-patients-satisfied-with-their-healthcare-nationwide-patient-experience-surveys-in-japan-2167-1168-1000294.php?aid=61003. See also https://www.med.or.jp/english/journal/pdf/2013_04/267_274.pdf On the other hand, this report on Japan considered those satisfaction levels quite low when compared to more countries https://www.nhk.or.jp/bunken/english/reports/pdf/report_15070801.pdf. How about looking carefully at every country’s health plan, and NOT adopting one wholesale for the US, but thinking carefully about what we want our world-calls plan to look like. Again, the Japanese model has much to commend it. The 30% copay motivates people to price shop. I know I did. I have heard good things about Switzerland and Australia as well. We can pick and choose the features we want.

                                                                                                                                                                                                              I used to be that person who fought with insurance companies all day. Before a surgery, I had to play games like call three separate times for a preauthorization, taking care to record date and time of call, name and ID # of rep and pre-auth number each time. We learned the hard way if we called only once, somehow after I filed the claim on behalf of the patient, we would learn the claim is denied because no pre-auth. Our data meant nothing, but our data times three was indisputable. The doctor ended up doing some surgeries for free because we had assured the patient before surgery that his insurance would cover it. Many doctors do not have that kind of integrity.

                                                                                                                                                                                                              You have mischaracterized what I have said. I have also been a Medicare claims examiner. There is a ton of fraud there, and providers who misuse the system deserve to have their claims denied. However, the insurance companies are not merely “staying in business.” They are doing so well, they have millions of extra dollars to overpay their executives and lobby politicians to preserve their cash cows. The so-called “power of the profit motive and pricing feedback mechanism” are not necessarily givens except if you are ideologically wed to them. We need to figure out what works with everything on the table and no pre-assumptions.

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                                                                                                                                                                                                              Posted by Lucas
                                                                                                                                                                                                              Answered on 05/11/2017 1:42 PM
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                                                                                                                                                                                                                We have centuries of empirical history that laws, taxes and regulations are simply relatively ineffective compared to the profit motive and price feedback mechanism for enforcing ethical behavior and positive social outcomes. That is why we’re all capitalists now. I’m not ideologically wedded to those ideals, but I’m a realist and a pragmatist. We wouldn’t be having this whole political debate if the sickcare industry was not already a government-run and incompetently-managed boondoggle. The insurance companies are just flies feeding on top of the rotten wedding cake, not the core problem that everyone gets obsessed with. Do we need to go non-profit to preserve the pricing feedback mechanism and drop the profit motive? Fine. Just keep the economically and real world ignorant bureaucrats and politicians out of it.

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                                                                                                                                                                                                                Posted by MachineGhost
                                                                                                                                                                                                                Answered on 05/11/2017 2:28 PM
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                                                                                                                                                                                                                  P.S. And please stop using insurance company executives as a scapegoat. Where do you think all the money the insurance companies pay out goes? It goes to their crony ilk in the public supply side who are just as overpaid and corrupt but unfortunately are immune from consumer feedback, directors or shareholders unlike insurance company executives. On the one hand you can’t say that a government solution will work better when it is already ineffective and corruptible now, but on the other blame capitalism unless you’re gonna just reduce every single problem down to “greed”. Liberals love to conflate capitalism with greed as if there was never, ever a voluntary and mutually beneficiary outcome possible. That is just pure B.S..

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                                                                                                                                                                                                                  Posted by MachineGhost
                                                                                                                                                                                                                  Answered on 05/11/2017 2:39 PM
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                                                                                                                                                                                                                    “We have centuries of empirical history that laws, taxes and regulations are simply relatively ineffective compared to the profit motive and price feedback mechanism for enforcing ethical behavior and positive social outcomes. ” You’re kidding, right? Centuries of empirical history show just the opposite. Profit motive and price feedback mechanism did not prevent the Triangle Shirtwaist Factory fire, protect our food safety,keep workers safe on the job. Oppressing the poor for personal gain is as old as dirt. Even the Bible records instances of exploitation in the absence of laws.

                                                                                                                                                                                                                    Proverbs 14:31
                                                                                                                                                                                                                    Whoever oppresses a poor man insults his Maker, but he who is generous to the needy honors him.
                                                                                                                                                                                                                    Isaiah 1:17
                                                                                                                                                                                                                    Learn to do good; seek justice, correct oppression; bring justice to the fatherless, plead the widow’s cause.
                                                                                                                                                                                                                    Psalm 72:4
                                                                                                                                                                                                                    May he defend the cause of the poor of the people, give deliverance to the children of the needy, and crush the oppressor!
                                                                                                                                                                                                                    Psalm 34:18
                                                                                                                                                                                                                    The Lord is near to the brokenhearted and saves the crushed in spirit.
                                                                                                                                                                                                                    Zechariah 7:10
                                                                                                                                                                                                                    Do not oppress the widow, the fatherless, the sojourner, or the poor, and let none of you devise evil against another in your heart.”
                                                                                                                                                                                                                    Proverbs 22:16
                                                                                                                                                                                                                    Whoever oppresses the poor to increase his own wealth, or gives to the rich, will only come to poverty.
                                                                                                                                                                                                                    Jeremiah 22:13
                                                                                                                                                                                                                    “Woe to him who builds his house by unrighteousness, and his upper rooms by injustice, who makes his neighbor serve him for nothing and does not give him his wages,

                                                                                                                                                                                                                    Whenever there are laws and regulations, people look for loopholes. Without laws and regulation, the profit motive and price feedback mechanism encourage exploitation and monopolies. See J.D. Rockefeller. Adam Smith himself said that for capitalism to work, it would need to be “highly regulated.” He knew that without tight regulations, workers would get abused, and that price collusion, monopolistic tendencies, environmental abuses of the commons would all game the system over toward those with the capital.

                                                                                                                                                                                                                    Please do not put words in my mouth or presume to know what I think about greed. Greed is abundantly present in any and all economic or social systems, and has been since the beginning of time. Regulation arose precisely because the profit motive and price feedback mechanisms have proven insufficient.

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                                                                                                                                                                                                                    Posted by Lucas
                                                                                                                                                                                                                    Answered on 05/12/2017 10:40 AM
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                                                                                                                                                                                                                      How to know when a discussion is over… someone starts quoting Bible Verses. Next on Pragcap… lets discuss the economics of loss PP with the passing of Roe vs Wade. Good work, way to keep it pragmatic.

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                                                                                                                                                                                                                      Answered on 05/18/2017 1:33 PM
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                                                                                                                                                                                                                        You missed the point. The purpose of the Bible verses is to show that centuries, even millennia, of history show us that the profit motive and price feedback mechanisms are insufficient and ineffective at ensuring ethical behavior. The Bible is an extremely relevant window on 6000 thousand years of human nature.

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                                                                                                                                                                                                                        Posted by Lucas
                                                                                                                                                                                                                        Answered on 05/18/2017 9:50 PM
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                                                                                                                                                                                                                          @Lucas: I wasn’t kidding. I’m overly concerned about fair competition, innovation, cost lowering and better risk socialization, none of which economically-ignorant parasitical politicians passing interventionist “laws” and “regulations” know squat about and haven’t managed to successfully bring about despite centuries of trying (rare exceptions nonwithstanding). Bad actors are a given fact of life; nothing novel or new about that.

                                                                                                                                                                                                                          All you can point to is that coercive risk socialization on taxpayer backs in other countries kicks the can down the road as a crutch. It’s not a permanent fix nor a primary solution to my concerns.

                                                                                                                                                                                                                          At some point, liberals are going to put the final plank into their ever-growing anti-discrimination obsession: wealth. What will we do then when its no longer fair or just to steal?

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                                                                                                                                                                                                                          Posted by MachineGhost
                                                                                                                                                                                                                          Answered on 05/18/2017 10:32 PM
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                                                                                                                                                                                                                            You are correct. Bad actors are a fact of life. They must be managed and deterred. Capitalism and free market forces have proven insufficient. Bringing up “liberals” at the end has nothing to so with anything. In fact, the entire sentence makes no sense, and the last sentence is a real head-scratcher. When has it ever been fair or just to steal?

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                                                                                                                                                                                                                            Posted by Lucas
                                                                                                                                                                                                                            Answered on 05/19/2017 10:52 AM
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