Miscellaneous And Off Topic Subjects

[CGVT]

I'm sure the US Treasury is paying, and I believe Trump should pay his own way. Golf Channel says Obama went golfing 333 times in his 8 years. You may be right, or not, but what do you say we just see how it plays out. Trump has had 1/3 of one year so far. Let's see what the numbers are when all is said and done.

Keep in mind that Trump saved billions by personally renegotiating the F-35 contract. I suspect you can think of things that Obama personally bargained down in price, but I can't think of one right now. If I had an employee who cost me millions but saved me billions, I try to hire another guy just exactly like him.

I'm glad Macron won. I think an independent millionaire who wants to reform France's silly labor laws and cut the federal budget is fine. IMO, LePen is a statist, and a bigot.

And Trump did not endorse her. What he said was that the terrorist attacks would help her in the election.

Haha

[Da Geezer]

So when the single payer system is approved in 4-5 yrs, should the govt tax based upon lifestyle choices? Should sugar be taxed? How about fast food? Or should people have the right to do what they want when the govt picks up the tab?

You hit the nail on the head. If you are giving away something of value, there will be unlimited demand. The only other option is some form of rationing. I went golfing once with two "medical ethicists" from Canada, and their "job" was to make this kind of decision. They said that one rationale for having to wait in line for treatments that are immediately available in the US is that it is a type of rationing. Has anyone here had to wait 14 months for a knee replacement? I have a friend in Scottland who just got her knee after that wait.

I personally think a dual system will evolve where the better off will buy private coverage, kind of like where the upper middle class sends their kids to private schools. But unlike the statists here, I think around 1/3 of the citizenry will opt for a private plan (and will agree to things like preventative care). Inevitably, those on the public plan will see their system collapse because of bureaucratic costs. Those on the private plan may well not continue to support the public plan, and the kind of acrimony we have now will get worse.

Honest question now: Can anyone name something that is done by government that is as efficient as the same thing done by the private sector? Why, then, do we expect health care to be provided more efficiently by government? The VA is an example of what will inevitably happen to a public option. Personally, I'm leaning toward restoring the status quo ante with a simple repeal, but the Rs will never do that; too much lost power.

But in answering that question, you will come up with goods that we hold in common, like roads, military, police, fire. I say again, IMO it is the redefinition of health care as a right (and deserving of treatment as a common good) that is the lasting legacy of the ACA.

And notice I'm using "health care" as a synonym for health insurance. No one is denied health care in the US, but I tire of drawing that distinction, and I suspect many here don't like me doing so.

[Jeff Buchanan]

Is this stuff done in other developed countries that have these systems? Or do we do it to the people already in single payer systems in the US. Mainly Medicare is what I am thinking of. The best way to attack it is find existing models and see what they do, the US wouldn't be trailblazing if they did implement single payer.

I think the point people are arguing about single payer is that it is cheaper than the current system. At least, that is my understanding as the US system is very expensive in comparison.

Your questions have merit, but I think they are seperate arguments.

Couple of points ....... The US has the most progressive federal income taxes in the developed countries. It is one of the reasons, among many, why tax increases are so hated by earners in the 28% and above (33, 35 and 39.6%) tax brackets and why it so hard to raise taxes to support federal spending needs - even legitimate ones.

By contrast, European income taxes are much less progressive. But government spending is, by and large, paid for by Value Added Taxes (VAT). This is especially true for social programs. They're taxing consumption to a much higher degree to support spending that they are taxing income.

With that having been said, the concept of taxing the consumption of foods and products that are deemed unhealthy would be, in my mind, perfectly justifiable and sensible.

If I'm not mistaken, a tax on sugared beverages in NYC, proposed by then Mayor Bloomberg, failed for lack of general support from the voters. So, there's an East Coast versus Left Coast culture battle there at play too.

But around the country, sugar tax is gaining support because it is unequivocally contributing to obesity which then produces secondary diseases that are costly to manage. There is a parallel forming between tobacco and sugars additives ..... and the food and beverage industry has long been warned about this and laughed it off. They are probably about to pay. Don't buy Coke stock.

So, as Froot points out, there are two arguments here but in the context of HC they are somewhat related. I believe a single payer system in the environment where health care costs in the US are as high as they are is not supportable by our current method of paying for stuff from a very progressive federal income tax system. Not politically feasible.

That brings us back to the article in the Harvard Business review I linked to a month ago. Our political culture is much more amenable to having costs controlled to some degree by market forces in a regulatory environment that fosters that. Big HC - and I use that term purposely here - is developing efficiency's that lower costs of care, pharmaceuticals and procedures. These are based on the value of outcomes approach pioneered by the Center For Medicare Services (CMS) and being implemented in most of the large HC entities US wide.

It's worth pointing out that even though critics of the ACA bemoan the administrative burdens of it, a good deal of this complaining comes from quarters that do not understand how this reporting and accountability are designed to shape the behaviors of big hospitals and drive costs down, at least conceptually. The point of that rejoinder is that this kind of stuff needs fine tuning not outright abandonment of it as the Trump and the R's would have it.

So, with HC costs controlled (and that is happening right now) and the insurance industries' profit driven motives somewhat regulated through the ACA's approach via mandates, a viable and affordable HC delivery system that is not a single payer system is entirely possible ...... save the idiocy of those that want to dismantle the ACA.

[Wild Hoss]

But around the country, sugar tax is gaining support because it is unequivocally contributing to obesity which then produces secondary diseases that are costly to manage. There is a parallel forming between tobacco and sugars additives ..... and the food and beverage industry has long been warned about this and laughed it off. They are probably about to pay. Don't buy Coke stock.

I caught a commercial the other day where Coke and Pepsi (Or Coke and whoever) were voluntarily reducing the sugar in their products. They made it seem like some altruistic move, which of course its not, but I didn?t give it any thought beyond wondering what the angle was. Reading the last few posts, I can see now they are prepping for increased sugar taxes.

[THE_WIZARD_]

Hoss:

"...pour some sugar on me..."

[Jeff Buchanan]

....... bottom line is single payers like the VA are really three separate heads often biting and feeding off each other in a frenzy to control the health care of this single payer.
its gotten to the point where the nursing and admin heads are choking off the providers and your seeing enrollment dwindle in medical schools because of to be filled by the Nurse practitioner--your minimum wage full time health provider

health care is a mess and a lot of it starts from within

The part of this I can agree with, Crash, is the last point.

I'm not sure about some of your generalizations above about the VA. I'm going to do some research. Some of it personal.

I live in ATL. There is a VA Medical Center about 30 minute from where I live. I've been in it for various reasons - one of my visits, a three week one, I did a clinical rotation in a Hepatology Clinic there. I've never received care.

My son is a dentist. He works in the VAMC in Ann Arbor Michigan and has been there for over 6y. He loves it. Now, given, dental services are a bit different than medical care services in the VA so, not going to use this as a measure of how good the VA is.

I'm looking for a new Primary Care Provider (PCP). I have a PA friend of mine who works in the Cardiology Clinic of the VAMC in Atlanta who urged me to apply for VA medical care for which I am eligible. She says the bad things we all hear about VA medical care are over-blown. We'll see.

A long time ago, I did a clinical rotation in a VA Hospital with an ED in Dublin GA. It was the best run ED I have experienced in the last 18y of working in private ones. Back in '98, the VA was the first hospital system to widely adopt Electronic Medical Records to assure continuity of care for beneficiaries obtaining care through the VA hospital system. It worked well even back then.

Unlike my current practice experience where, you have no idea what the medical history of a new patient coming to your practice for urgent or emergent care is, that is not the case in the VA. The entire beneficiaries medical record, the drugs he is on, the procedures he has had are all in one spot and at your finger tips. This is a huge benefit in dealing with urgent, emergent and even chronic non-urgent conditions.

So, there is that sort of advantage for the VA which is a single payer system but not sure it is a good example in the context of our discussion. Medicare and medicaid are examples and they do work....

.....and, BTW, another reason I'm seriously looking into the VA is this: I am a Medicare benficiary. I pay $102 a month for part A (Hospitilization) and part B (other medical services). There is a 20% co-pay for all medical services covered by Medicare parts A and B. There is no public pharmacy coverage under Medicare (there are exceptions known as part D). So, like most Medicare beneficiaries, I have a supplement that covers the 20% co-pay and pharmaceuticals. The difference is, I don't pay for it or for pharmaceuticals because I am covered by Tricare for life, a benefit extended to retired Military personnel.

Well, if the R's have their way before they get swept out of office in 2018, I will very likely lose that "free" Tricare for Life coverage and will have to pay upwards of $600/m for my wife and I who is also now covered under my insurance. I'll be prepared for that but will still have to pay for my wife's Tricare coverage should the loss of my coverage eventuate.

Admittedly, I have no real world experience with the three headed thing within the VA you are talking about Crash but I'll look into it and have a report as soon as I can do it.

[CGVT]

Hoss:

"...pour some sugar on me..."

I've never seen either one of you, regardless, that post brings a terrible visual.

[hack]

Honest question now: Can anyone name something that is done by government that is as efficient as the same thing done by the private sector? Why, then, do we expect health care to be provided more efficiently by government?

Because that bullshit is, increasingly, proven to be a myth. I already linked to that Bloomberg piece in which Medicare was shown doing a better job keeping costs down than Blue Care. Some other examples:

1. The Ambassador Bridge is privately owned, the the Detroit/Windsor Tunnel publicly owned. Both are roughly the same age, but the bridge is falling apart and the tunnel is not.

2. I would rather fly any number of state-run airlines than any US airline, including Turkish, Emirates, Singapore, and others.

3. Costs rose in Iraq when Halliburton won the right to provide services.

4. Prison operations - private ownership has introduced scandal and corruption into a service provision that had been uncontroversial before. Same goes for Chicago's parking meters.

There is a set of conditions under which private ownership can potentially deliver a better service or a cheaper service, or both. An examination of exactly what those conditions are and what incentives should or should not present is long overdue. It's time to stop subjecting people to these fictions, and it's time to stop allowing corporations to milk taxpayers based on these on-paper assertions that too often turn out to be untrue. Especially for activities where the capital cost is so high that there will be few competitors, inviting in the private sector courts corruption. The proper way to do these things might be a public-private partnership, in which the government retains enough of a measure of control and ownership of underlying assets, and a private-sector partner gets a concession to operate the asset for a determined period.

[Wild Hoss]

Hoss:

"...pour some sugar on me..."

homo erectus

[froot loops]

The Ambassador bridge is an excellent example.

[Wild Hoss]

I've never seen either one of you, regardless, that post brings a terrible visual.

As well it should.

[hack]

http://www.washingtonpost.com/wp-dyn/content/article/2007/09/30/AR2007093001352.html

According to data provided to the House panel, the average per-day pay to personnel Blackwater hired was $600. According to the schedule of rates, supplies and services attached to the contract, Blackwater charged Regency $1,075 a day for senior managers, $945 a day for middle managers and $815 a day for operators.

According to data provided to the House panel, Regency charged ESS an average of $1,100 a day for the same people. How the Blackwater and Regency security charges were passed on by ESS to Halliburton's KBR cannot easily be determined since the catering company was paid on a per-meal basis, with security being a percentage of that charge.

Halliburton's KBR blended its security costs into the blanket costs passed on to the Defense Department.

How much more these costs are compared with the pay of U.S. troops is easier to determine.

An unmarried sergeant given Iraq pay and relief from U.S. taxes makes about $83 to $85 a day, given time in service. A married sergeant with children makes about double that, $170 a day.

Army Gen. David H. Petraeus, the top U.S. commander in Baghdad overseeing more than 160,000 U.S. troops, makes roughly $180,000 a year, or about $493 a day. That comes out to less than half the fee charged by Blackwater for its senior manager of a 34-man security team.

[Mainevent]

Yeah, that's not surprising. A friend of mine's cousin was a mercenary that contracted out to places like Blackwater. But he made like $200-$300K a year depending upon how often he worked.

I mean, good for those guys to get paid for putting themselves in harm's way (well, except for the fact this guy was a warmongering, adrenaline junkie asshole apparently), but brutal when you think about how much US service men are paid.

[froot loops]

Yeah he's not golfing at his properties so he won't clog up some other properties. That's a hell of a spin though.

[THE_WIZARD_]

Do not dis single payer...it's Nirvana!

"...come...as you are...as you were..."