Luminous Landscape Forum
The Art of Photography => The Coffee Corner => Topic started by: Rob C on January 20, 2017, 04:42:14 pm
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I have to confess that I'd been a teeny bit concerned, but I shouldn't have been: Melania looked absolutely exquisite and regal in a fabulously understated shade of blue! At first I'd thought her shoes were white, but that was just my eyes: on going closer to the tv I realised she had not erred. I was transfixed by her face and expressions the entire early part of the swearing-in oath itself; unfortunately, the camera controller swung left and then cut to a distant group shot (why would he do that?), and I lost continuity. HC-B would not have blown that one; faces of the supporting cast can tell one so much!
However, another lady - no idea who she is - was doing a Carnaby Street Sergeant Pepper. Obviously, she must have been looking for sartorial inspiration in LuLa, and come across my shot of the Spanish lady in the market... other than that, it didn't tell me very much more at all. Maybe there was nothing more to tell.
Always claimed that women in their forties are at their best, and far more interesting than bathing beauties in their late teens and mid-twenties; there's so much more to it than just physics.
To conclude, I'm afraid that I must say that a part of the opposition didn't do itself any favours by staying away from the ceremony; if anything, it made itself look less worthy than the man it opposed. You can't knock somebody for not being 'presidential' enough, and then make an ass of yourself too by disowning protocol and good manners.
Rob
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+1
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For my American friends and family - I have a couple of rooms for rent cheap.
Come to Australia where the concept of living minimum wages, gun control and universal healthcare are not quite the disaster the neo-cons would have you believe. 8)
Sorry that cricket is so dead boring, and AFl makes no sense, but you can't have everything.. ;D
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I have to confess that I'd been a teeny bit concerned, but I shouldn't have been: Melania looked absolutely exquisite and regal in a fabulously understated shade of blue! At first I'd thought her shoes were white, but that was just my eyes: on going closer to the tv I realised she had not erred. I was transfixed by her face and expressions the entire early part of the swearing-in oath itself; unfortunately, the camera controller swung left and then cut to a distant group shot (why would he do that?), and I lost continuity. HC-B would not have blown that one; faces of the supporting cast can tell one so much!
I agree. Melania and her Ralph Lauren outfit saved the day.
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I agree. Melania and her Ralph Lauren outfit saved the day.
Yep, that will certainly be a big compensation for the folks who find themselves without medical insurance.
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Yep, that will certainly be a big compensation for the folks who find themselves without medical insurance.
Hardly Mrs T's fault now, is it? Why so bitter?
The so-called underclass is ever with us, always will be. It's a direct result of breeding where breeding was not the sensible economic choice to have made. You overfill schools, streets and neighbourhoods with kids with half a parental influence - at best - and what can you expect? There's no encouragement for study at home, if there is even a home, and so the snowball grows. People create their own mess in so many different and insidious ways, which every single one of us breathing can verify if we just look back at our own mistakes and see them for what they are: our own fault. Of course, we all feel so much better holding up placards and shifting the blame str¡dently onto other shoulders. But, deep down inside, we still know, don't we?
Frankly, I thought Mr T was not cut out for politics because of confrontational tendencies, but in today's world, where nothing seems to make political sense, perhaps he will turn out to be a breath of fresh air.
I can also say that watching the street demonstrations against him fills me with a sense of shame that I suspect many Americans must feel - and I'm not an American. Some people gather around simplistic slogans and question nothing. Just like some third world people, then: follow blindly and hate. Within the U.S. system, he won. Period.
Health insurance. Depends on the system in place in your country. I have experienced both: for years I paid private health insurance and, for a while (in Spain), when I was already eligible for state insurance, continued to pay for private and it seved us well; then in an emergency we discovered that the state version was just as effective with the only difference being that patients had to share a room with another person. Even the docs share their time between the two systems. However, there comes a time when you no longer work, that you can't keep up with inflation if the banks don't pay interest on your savings and so you can't do what you once could, and then everything changes in your life, and you have to depend on the state for emergencies that will always arrive to say hi!
Now, some think that the state's health system is free, that anyone using it is a scrounger; not so, you do contribute to the health system all your working life, just as if you were paying into a private scheme. Where the Brit one seems to go awry is that it's too broad in its application, and covers all sorts of items that are not essential to life or death, and so it becomes abused.
I think that one way of striking a better balance would be to have an earnings point where it became mandatory for the person to buy private insurance simply because he can then afford it. If social security help is supposed to be there in order to help those who need help, a lifeboat, if you will, then those who do not need financial help, but simply need medical attention for which they can afford to pay private insurance, that's what they should do. Still contributing to the national system - hardly a puntive sum of money - would guarantee that come the time they retire and may no longer be able afford private insurances, they will not be left to die on the street either, just because they did well for some years.
Rob
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There are many reasons that Trump is getting a very mixed reception and many are unrelated to healthcare. For instance, anyone with a notion that our shared environment needs any protecting would be extremely unhappy with all of his cabinet choices. They would also be unhappy with many of his statements, such as "The concept of global warming was created by and for the Chinese in order to make U.S. manufacturing non-competitive." Many are also unhappy about the large conflicts of interest sprinkled throughout his entire administration. Others are bitter about him publicly challenging the legitimacy of Obama's presidency and U.S. Citizenship for over 5 years and now expecting everyone to accept the legitimacy of his presidency. I would take a wild guess that today's events have more to do with many statements by him about women and the groping by him alleged by at least 13 different women. Frankly, one tends to get back what they give in life, and some people are reacting to Trump more or less as he has reacted to others. If I were more religious I might put some biblical quote here.
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Hardly Mrs T's fault now, is it? Why so bitter?
Not at all bitter, Rob. Just commenting that Mrs Trump's outfits are possibly of less importance than her husband's plans to prevent millions of Americans from obtaining health care.
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Not at all bitter, Rob. Just commenting that Mrs Trump's outfits are possibly of less importance than her husband's plans to prevent millions of Americans from obtaining health care.
I just penned you a full reply and then suffered a ten-second power cut and lost the lot. I simply have not the will left to rewrite. Nothing to do with your post, just with my tumbling dedication to online bullshit.
;-)
Rob
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Yes, Mrs. Trump (who ironically entered the country illegally some years back to do a modeling gig) did look radiant. I suspect that had not Trump won the election she would have left him as she appeared to be fed up with his antics. She will head back to Manhattan after this weekend and will only be seen sporadically in the White House. I don't know what type of pre-nuptial agreement she signed but she looks less than interested in being first lady. There were some comparisons with Jackie Kennedy in the papers today but she would have to go along way to enjoy the same popularity as Jackie O (hope she doesn't have to experience the tragedy). I worry about her son who looks as if he has some type of disaffection disorder.
Regarding health insurance, Obamacare has worked for each of my daughters who are independent contractors and do not have access to corporate insurance policies. They are not alone as many of their millenial colleagues are in the same position. Without Obamacare they would be paying much more for less coverage. I sometimes wonder whether Republican members of Congress realize this. Perhaps all their children are on the fast road to success in various corporations. I think there are probably a number of LuLa members in the US who are independent workers as well. Do they not enjoy the benefits of Obamacare?
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I agree. Melania and her Ralph Lauren outfit saved the day.
Yep, that will certainly be a big compensation for the folks who find themselves without medical insurance.
Jeremy,
thank you for elaborating this point. Just to let you know, it was meant with tongue in cheek. From Canada With Love!
I know some people need to see those funny yellow circles at the end of the sentence, but they were enough insults dished out on that day, so I didn't want to add any more.
True, the money for that gorgeous Melania's outfit could have been spent better for an open-heart surgery or two, but how did you like it?
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Regarding health insurance, Obamacare has worked for each of my daughters who are independent contractors and do not have access to corporate insurance policies. They are not alone as many of their millenial colleagues are in the same position. Without Obamacare they would be paying much more for less coverage. I sometimes wonder whether Republican members of Congress realize this. Perhaps all their children are on the fast road to success in various corporations. I think there are probably a number of LuLa members in the US who are independent workers as well. Do they not enjoy the benefits of Obamacare?
This argument for the ACA always annoys me.
Long before the ACA was even being dreamed up, I bought health insurance independently on the open market without any difficulties from a local health insurance agent I happened to meet while networking. I am an independent contractor and did not have access to group plans.
The plan did not have a life time limit and I only paid roughly $146 per month when I was 26 years old.
Now that plan did not have a drug prescription program, but then again I was young without any significant health problems and only got sick about once a year. Typically my prescriptions while I was sick cost roughly $12, so paying the additional $100+ dollars per month to add on the drug prescription did not make sense, a decision I came to.
I was also responsible to pay for the first $4000 per year in medical costs that went beyond doctor visits, such as operations. The rest was covered after that. Some may look at that $4000 figure and balk, but, personally, if you don't have a few grand in the bank, that is the result of your inadequate planning and saving. If I wanted to, I could have opted to have this out of pocket cost lowered, but that would add on an additional $100+ per month. However, in 3 years time, I would have paid $4000 extra for a service I most likely would not have used, so what was the point?
Additionally, it did not include screening for prostate cancer and other end of life ailments, but once again why pay for it if I don't need it at my age.
To say that it would be impossible for a young healthy individual to find adequate coverage without the ACA is just a cop out, and something I know to be very possible.
(Yes, I know the preexisting condition argument, but that could have been taken care in a much less invasive manner.)
Since the ACA has been put in place, I have seen my options go down significantly and I am now forced to pay for services which I will not use for at least another 15 years.
Additionally, it is growing more and more obvious that the program is going to fail regardless. The system was designed to rely on the most tragically unreliable group of people in the country, namely 20 years olds. Most don't think bad things can happen to them, so why pay for insurance? The rest (26 or younger) are covered by their parents' insurance (a requirement of the law), which means they will not be contributing to the system either. And the handful remaining who actually give a damn enough to fork over their money, well it is just not enough to offset the cost of the old and sick and prevent a death spiral from taking over, which has already started.
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I have preexisting chronic medical issues. My wife's COBRA is about to run out. ... Even with our current plan, a significant amount of our household income goes to healthcare.
I have no idea what to expect regarding the future of healthcare in the US. It's been broken for decades. Undoubtedly, many benefit from the ACA. If the current administration and congress are able to come up with something better, that'll be fine.
I like LuLa. It brings people together. It's an international community of photographers. I hope politics will not spoil the fun.
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Yes, Mrs. Trump (who ironically entered the country illegally some years back to do a modeling gig) did look radiant. I suspect that had not Trump won the election she would have left him as she appeared to be fed up with his antics. She will head back to Manhattan after this weekend and will only be seen sporadically in the White House. I don't know what type of pre-nuptial agreement she signed but she looks less than interested in being first lady. There were some comparisons with Jackie Kennedy in the papers today but she would have to go along way to enjoy the same popularity as Jackie O (hope she doesn't have to experience the tragedy). I worry about her son who looks as if he has some type of disaffection disorder.
Regarding health insurance, Obamacare has worked for each of my daughters who are independent contractors and do not have access to corporate insurance policies. They are not alone as many of their millenial colleagues are in the same position. Without Obamacare they would be paying much more for less coverage. I sometimes wonder whether Republican members of Congress realize this. Perhaps all their children are on the fast road to success in various corporations. I think there are probably a number of LuLa members in the US who are independent workers as well. Do they not enjoy the benefits of Obamacare?
So are they pay much less because someone else...the taxpayers...is picking up the a big part of the tab via subsidies? I am required to pay the full price myself. I can only speak for myself. My priemums are 2k a month for my wife and myself, and I'm forced onto the marketplace with only one company to choose from. It wa not this way pre Obamacare and the plans were better and cheaper. What I'm paying for is mostly useless with over 10 deductibles and 14k out of pocket. Obamacare is worthless. Ymmv.
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I like LuLa. It brings people together. It's an international community of photographers. I hope politics will not spoil the fun.
Already started in a sense - withdrawal of National Endowment for the Arts funding will not help artists of any sort.
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Already started in a sense - withdrawal of National Endowment for the Arts funding will not help artists of any sort.
(Hoping my power supply doesn't cut.)
That's a basic problem with artists: we are on an ego trip, pure and simple, and some of us expect the rest of society to finance us through it. I disagree: if we can't cut it, then back to the drawing board (ironically enough) and do something with which we can pay our way. Society at large owes us zilch. What we do is because we like to do it. There is no entitlement. IMO the more tax money spent on the arts, as such, the more the top jobs magnify in benefits for the incumbents. 'Starving artists' will still starve, but mainly through their own fault. I wouldn't pay tuppence to subsidise some con artist (?) who builds a room with an electric light going on and off, on and off, and calls that art. That this specific cat may need no subsidy is neither here not there: but, you get a sense of the value of much so-called art from the dross that gets space to show. And you want tax dollars to fund similar crap? Be real, please.
Rob C
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Hardly Mrs T's fault now, is it? Why so bitter?
Rob
Hi Rob,
You have to understand that these people didn't just THINK Hillary was going to win. They were assured of it. It was something like Moses receiving the Ten Commandments. Hillary's coronation as the first female president was written in stone on tablets handed down to the DNC by Obama himself. They can't get over the fact that their religion turned out to be false.
And I can't understand why. You really have to bury your head in the sand to miss the fact that people outside the largest U.S. cities are fed up with the PC crap and the arrogance of the people who were "leading" the country. Shortly after the primaries were over I got an email from a longtime friend who expressed his delight that Hillary would be our next president. I wrote back and told him that Trump would blow her out of the water. Instead of discussing the question he replied that maybe we'd better stop writing about politics.
But just because their political god turned out to be false doesn't mean left-wingers are going to stop worshiping him. This crap's gonna go on for a long time to come, and the more windows they break and the more angry women's marches they have the more they're going to convince the rest of the nation that we did the right thing. They're working to make sure it'll be a generation before a Democrat becomes president again. But that's the way it is when religions fail to come through with the gods and the goods.
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But that's the way it is when religions fail to come through with the gods and the goods.
Get back to us when the forgotten folk that Trump appealed to are still forgotten in 4 years time, and no longer have health care, and are joined by a whole lot more folk who lost their jobs when protectionism fails.
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Politics, sex, and religion are highly personal and subjective topics. There's enough divisiveness to go around and then some. So, why not save it for the "rantitorial" section? As far as LuLa goes, doesn't that seem like the best place to editorialize and or argue?
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Politics, sex, and religion are highly personal and subjective topics. There's enough divisiveness to go around and then some. So, why not save it for the "rantitorial" section? As far as LuLa goes, doesn't that seem like the best place to editorialize and or argue?
+1000.
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So are they pay much less because someone else...the taxpayers...is picking up the a big part of the tab via subsidies? I am required to pay the full price myself. I can only speak for myself. My priemums are 2k a month for my wife and myself, and I'm forced onto the marketplace with only one company to choose from. It wa not this way pre Obamacare and the plans were better and cheaper. What I'm paying for is mostly useless with over 10 deductibles and 14k out of pocket. Obamacare is worthless. Ymmv.
But you are seeing the exact same thing happening with corporate plans as well as Medicare. $2K a month seems to be a lot to pay but maybe because of the geographical region you live in that's the way it is. You have to remember that regardless of Obamacare lots of insurers are restricting the regions they underwrite in. My daughter was covered by Aetna when she lived in Philadelphia but was not covered when she moved to Oakland in September because Aetna doesn't write individual policies there. She asked what she should do if she needed to see a doctor and Aetna said to go to the ER as that was all Aetna would cover. Great money saving advice. She had a month transition before she was eligible for Kaiser Permanente.
Wait until you go on Medicare and you will see the same thing happening. I'm looking for a new internist and two practices I called are not accepting Medicare patients. I told them I had excellent secondary coverage through our local BlueCross company but that did not matter. also, don't think Medicare is free. My wife and I will be paying about $13K this coming year for Medicare and our secondary insurance. It's a little on the low side as I have a discount as the secondary policy is provided by my former employer as a retirement benefit. Fortunately, we have investment income that lives us financially in good shape. I cannot figure out how anyone who relies only on Social Security can live.
My comments about Obamacare were simple, it worked for my two daughters who are free lancers.
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Politics, sex, and religion are highly personal and subjective topics. There's enough divisiveness to go around and then some. So, why not save it for the "rantitorial" section? As far as LuLa goes, doesn't that seem like the best place to editorialize and or argue?
Coffee corner: A forum for open discussion of both photographic and non-photographic topics of a general nature.
It is assumed (and required) that posters conduct themselves in a civil and adult manner.
Rantatorials: Discussions about Kevin & Michael's Rantatorials.
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Coffee corner: ....
It is assumed (and required) that posters conduct themselves in a civil and adult manner.
Rantatorials: Discussions about Kevin & Michael's Rantatorials.
Correct indeed. Civil discussion on a topic such as this is encouraged - but generally frowned upon in other fora here.
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Reading the premiums you guys pay for health insurance in the USA makes me think that either you all earn millions, or some sectors are being severely overpaid!
It's nothing like as high as that in Spain - not enough folks could afford it to make it a viable business - and the private services are excellent. As are the state ones, once you get into a hospital. The problem is a shortage of staff doing early tests etc. which results in long waiting times for a first visit, and even a routine repeat one. But if they ambulance you in, you are in fairly good hands.
Best staying healthy!
Frankly, I am in favour of a better tax revenue distribution scheme than seems prevalent. Car-tax money should be spent on roads, and health should have a clear label on it when the tax for it is being raised. In the UK the national health system is a bit of a holy cow - and I understand that. People would be far more inclined to go along with higher taxation to fund it if they were convinced the money raised would go where it was supposed to be going, and not vanish funding all manner of hairbrained political exercises in vote-catching. A national health system is a wonderful thing which grants every citizen the right to survival in the face of health disasters, a right not dependent on how much money you can make.
I don't think any marriage between state and private medicine will ever be 'fair': the private part is obliged to make as much money as it possibly can - it's in the nature of business to have to do that; there is no other choice for it if it is to prosper and survive. I simply feel that some things just deserve to be out of the profit sphere of influence.
Rob
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But you are seeing the exact same thing happening with corporate plans as well as Medicare. $2K a month seems to be a lot to pay but maybe because of the geographical region you live in that's the way it is. You have to remember that regardless of Obamacare lots of insurers are restricting the regions they underwrite in. My daughter was covered by Aetna when she lived in Philadelphia but was not covered when she moved to Oakland in September because Aetna doesn't write individual policies there. She asked what she should do if she needed to see a doctor and Aetna said to go to the ER as that was all Aetna would cover. Great money saving advice. She had a month transition before she was eligible for Kaiser Permanente.
Wait until you go on Medicare and you will see the same thing happening. I'm looking for a new internist and two practices I called are not accepting Medicare patients. I told them I had excellent secondary coverage through our local BlueCross company but that did not matter. also, don't think Medicare is free. My wife and I will be paying about $13K this coming year for Medicare and our secondary insurance. It's a little on the low side as I have a discount as the secondary policy is provided by my former employer as a retirement benefit. Fortunately, we have investment income that lives us financially in good shape. I cannot figure out how anyone who relies only on Social Security can live.
My comments about Obamacare were simple, it worked for my two daughters who are free lancers.
Yet you failed to answer the very simple question I asked. Do your daughters get government assistance with the cost of their insurance?
Prices are raising among all insurers due the restrictions required by Obamacare. For example I am forced to pay for pregnancy coverage even though we will never use it. I must pay for colonoscopy coverage that I will never be able to use. (Trust me on that one, it's impossible). Children's dental and vision...never use those. Drug abuse rehab. Nope. Keep 26 year old children on my policy, nope. There is more. I am not alone.
http://www.cnsnews.com/news/article/susan-jones/rand-paul-were-going-legalize-sale-inexpensive-insurance
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Reading the premiums you guys pay for health insurance in the USA makes me think that either you all earn millions, or some sectors are being severely overpaid!
It's nothing like as high as that in Spain - not enough folks could afford it to make it a viable business - and the private services are excellent. As are the state ones, once you get into a hospital. The problem is a shortage of staff doing early tests etc. which results in long waiting times for a first visit, and even a routine repeat one. But if they ambulance you in, you are in fairly good hands.
Best staying healthy!
Frankly, I am in favour of a better tax revenue distribution scheme than seems prevalent. Car-tax money should be spent on roads, and health should have a clear label on it when the tax for it is being raised. In the UK the national health system is a bit of a holy cow - and I understand that. People would be far more inclined to go along with higher taxation to fund it if they were convinced the money raised would go where it was supposed to be going, and not vanish funding all manner of hairbrained political exercises in vote-catching. A national health system is a wonderful thing which grants every citizen the right to survival in the face of health disasters, a right not dependent on how much money you can make.
I don't think any marriage between state and private medicine will ever be 'fair': the private part is obliged to make as much money as it possibly can - it's in the nature of business to have to do that; there is no other choice for it if it is to prosper and survive. I simply feel that some things just deserve to be out of the profit sphere of influence.
Rob
I don't make millions and I'm not overpaid, but this is just one of the costs of being self employed. Back when I left a corporate job in 1999 and my wife left hers to work with me, our heath insurance costs were $300 a month. By the time Obamacare started we were at $1200 a month. Now it's 2k and the deductibles have gone from $1000 to $5300. Even worse its no longer 80/20 but 60/40.
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Yet you failed to answer the very simple question I asked. Do your daughters get government assistance with the cost of their insurance?
Prices are raising among all insurers due the restrictions required by Obamacare. For example I am forced to pay for pregnancy coverage even though we will never use it. I must pay for colonoscopy coverage that I will never be able to use. (Trust me on that one, it's impossible). Children's dental and vision...never use those. Drug abuse rehab. Nope. Keep 26 year old children on my policy, nope. There is more. I am not alone.
http://www.cnsnews.com/news/article/susan-jones/rand-paul-were-going-legalize-sale-inexpensive-insurance
Neither daughter received any subsidy to purchase their policy. Yes, you are not alone regarding some of the things you write about. However, do you want to return to the old days where everything was risk based, pre-existing conditions were the rule of the day, and women paid more than men for health insurance. That's fine, let's go back to medical underwriting and you will soon see people who can't get stuff covered or they have to pay very high premiums. BTW, pregnancy coverage is a drop in the bucket. the only time things add up is if the baby is born premature and in those cases costs can be very high (I know from experience). Colonoscopies also are pretty inexpensive these days. Big cost drivers for insurance are Rx drug and complicated care the last two or three years of life.
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Neither daughter received any subsidy to purchase their policy. Yes, you are not alone regarding some of the things you write about. However, do you want to return to the old days where everything was risk based, pre-existing conditions were the rule of the day, and women paid more than men for health insurance. That's fine, let's go back to medical underwriting and you will soon see people who can't get stuff covered or they have to pay very high premiums. BTW, pregnancy coverage is a drop in the bucket. the only time things add up is if the baby is born premature and in those cases costs can be very high (I know from experience). Colonoscopies also are pretty inexpensive these days. Big cost drivers for insurance are Rx drug and complicated care the last two or three years of life.
Thank you. And yes I would gladly go backwards. What we have now is not working.
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Thank you. And yes I would gladly go backwards. What we have now is not working.
When I was still working in the pharmaceutical industry I was tracking the whole healthcare reform issue (started doing so in about 1990 when Dr. Paul Ellwood convened the first Jackson Hole meeting). I was not a fan of Obamacare as it really is a Kludge to try to make something work for the widest number of people. We currently have a very inequitable healthcare system where those who have nice employer-based insurance do well at the expense of everyone else. As I noted in an earlier post, even Medicare is not perfect. You have a 20% co-pay on doctor visits and can be on the hook if the doctor charges more than Medicare reimburses. Rx drugs cost more than they should and so on.
My belief is that we need some form of national health insurance that covers every one. I don't particularly care if it is run by the government the way Medicare is or if it relies on the private insurance market with vouchers to everyone for the purchase of insurance. the status quo continues to be unacceptable.
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I don't make millions and I'm not overpaid, but this is just one of the costs of being self employed. Back when I left a corporate job in 1999 and my wife left hers to work with me, our heath insurance costs were $300 a month. By the time Obamacare started we were at $1200 a month. Now it's 2k and the deductibles have gone from $1000 to $5300. Even worse its no longer 80/20 but 60/40.
I'm not suggesting that you are overpaid - I have no idea what you earn; what I'm suggesting is that somebody down the line is making a helluva lot of money out of health insurance, or they wouldn't be in the business. Seems to me that there's a huge moral issue here going unfaced. Maybe Mr Trump really will cut some of the fat there, as well as with Messrs Boeing.
The whole issue about percentages is a weakness in the system: you shouldn't have to pay any part of it directly; those sorts of expenses are far better paid as part of income tax, as they are under a state system. The Brit concept of 'free at point of delivery' doesn't suggest nobody pays anything at all: it's not magic money - taxation provides it. It's spread over everybody, and everybody is entitled to its benefits. The guys making money out of illness and misfortune are the insurance guys and the medics. But at least the medics spend years of their lives learning and doing something for humanity; in my view, medical insurance companies just suck the easy blood. Yes, I got help out of mine, at high annual monetary cost, but I only went with them because at the time I took it up (a policy) a state system wasn't available to me. With Brexit, God knows where I'm gonna find myself in that area at the end of the negotiations. Myself, and many millions more. Interesting times.
Rob
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With Brexit, God knows where I'm gonna find myself in that area at the end of the negotiations. Myself, and many millions more. Interesting times.
Rob
I suspect that, like me, you will end up as collateral damage in our countrymen's xenophobic impulse to blame the forriners for their plight.
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My belief is that we need some form of national health insurance that covers every one. I don't particularly care if it is run by the government the way Medicare is or if it relies on the private insurance market with vouchers to everyone for the purchase of insurance. the status quo continues to be unacceptable.
Absolutely.
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Absolutely.
I think you really have to remove the private insurance element from the public sphere. The twain cannot function in harmony because the private will always seek all ways by which to drive up costs and exploit the situation to profit. It's its raison d'être.
Beyond medicine, I would expand that public ownership to transport and to the provision of electricity and gas. The single factor that stops me ever voting for the left, however, is the certainty in my head that the moment such a well-intentioned grand plan were implemented, these unions that exist within those sectors would flex their muscle for political objectives and reduce everything to greater chaos than we see at present. In other words, the objective is noble but the implementation releases the devil in man. Again, it would be people who destroy the greater good. I stretch my faith to exclude the medical profession from that, though recent UK actions do slightly undermine my faith...
Rob
P.S.
An example of what happens when business and medicine mingle:
http://www.heraldscotland.com/news/15040143.Hospitals_pay_more_than___1500_a_shift_to_some_agency_nurses/?ref=ebln
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Absolutely.
The government makes a mess of everything. No thanks. Take a look at the pile of I.O.U's in a filing cabinet in Ohio that is what's left of the Social Security fund.
More open commerce, not less is the answer.
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The government makes a mess of everything. No thanks. Take a look at the pile of I.O.U's in a filing cabinet in Ohio that is what's left of the Social Security fund.
More open commerce, not less is the answer.
Commerce is great; health is not commerce. Bad management is bad management, it happens in all walks of enterprise.
No idea how it was done in Ohio, but on anything but a truly national level and scale, it's never going to work: the first problem is health tourism, state to state. It's already a well-established problem within the European arrangement, but should/could have been avoided by obvious limits of applicability.
In the UK the huge problems in public health funding exist because of the nebulous manner in which funding is allocated; as with roads - another troubled area of spending - there should be clear sources from whence will come funding. Education is another service plagued by funding mystery. Hiding and throwing all tax revenues into a communal pot prevents the public appreciating (and knowing) where their money goes; shown that it goes to health, when raised for that specific purpose, would, I'm sure, encourage a lot of people to accept a reasonable charge via their taxation levels. It's when taxpayers suspect that their money goes to finance absurd projects, that are of no purpose other than to encourage votes from strident minority groups next time around, that resentment begins and essential services become deprived of resources better spent on those essentials that do not include the arts, minority language public broadcasting, etc. etc. If the time comes when the nation has too much money, then think about the peripherals of life, the entertainments, the ego-trippers.
Transparency of spending, of the raising of what for use where, will either silence those who suspect the worst of governments or create a society where the public really, and democratically, can determine the direction of its future well-being.
Basic life-support comes first.
Rob
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Commerce is great; health is not commerce. Bad management is bad management, it happens in all walks of enterprise.
No idea how it was done in Ohio, but on anything but a truly national level and scale, it's never going to work: the first problem is health tourism, state to state. It's already a well-established problem within the European arrangement, but should/could have been avoided by obvious limits of applicability.
In the UK the huge problems in public health funding exist because of the nebulous manner in which funding is allocated; as with roads - another troubled area of spending - there should be clear sources from whence will come funding. Education is another service plagued by funding mystery. Hiding and throwing all tax revenues into a communal pot prevents the public appreciating (and knowing) where their money goes; shown that it goes to health, when raised for that specific purpose, would, I'm sure, encourage a lot of people to accept a reasonable charge via their taxation levels. It's when taxpayers suspect that their money goes to finance absurd projects, that are of no purpose other than to encourage votes from strident minority groups next time around, that resentment begins and essential services become deprived of resources better spent on those essentials that do not include the arts, minority language public broadcasting, etc. etc. If the time comes when the nation has too much money, then think about the peripherals of life, the entertainments, the ego-trippers.
Transparency of spending, of the raising of what for use where, will either silence those who suspect the worst of governments or create a society where the public really, and democratically, can determine the direction of its future well-being.
Basic life-support comes first.
Rob
I know you are not an American so some of this is confusing. Social Security, simply put i the government run retirement we are all requried to fund via income taxes ( its actuall FICA tax but that even add more co9nfusion) The problem is tha tover the decades, GOVERNMENT has raided this fund and used the money for other things, leaivng behind a huge pile of IOU's in that filing cabinet in Ohio. Now we are using borrowed money instead and the system is broke. Medicare, our grovenment run insurance for Seniors ( again that we have paid for via those FICA taxes) is not in any better shape. To add insult to injury many DR's will not accept patients who have medicare coverage. The goverment screws everything up.
And Healthcare really is commerce. Dr's build a practice and are right to expect a profit for the time and money spent learning their trade and building their practice. Hospitals are right to expect a profit atfer speand vast sums of mony creating the facitity, outfitting it, staffing it and maintaining it. all to provide a very valuable service to people who need it. Drug companoes are als entitled to a profit, for the products they produce. There is a trend in the US for medical facilities that operate on a cash only basis, no insurance will be taken. They list the price of their services openly, so the consummer can tell upfront what his care will cost. The point here is a that this is commerce. The consummer gets to choose. And in many cases gie teh very high deductabke that need to be met before an insurance company pays, it is often a far better deal for the consumer for many procedures.
I'm not a big fan of the government being involved in this part of my life. And I would like more market driven choices. Your mileage may vary.
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And Healthcare really is commerce.
And that's the root of your problem in a nutshell.
Cheers,
Bart
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And that's the root of your problem in a nutshell.
Cheers,
Bart
No Bart. that will be the salvation when true commerce is in place.
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...the private will always seek all ways by which to drive up costs and exploit the situation to profit. It's its raison d'être.
I have to agree. For-profit health insurance has a built-in conflict of interest. It's all about maximizing profit and minimizing loss so there is a very strong incentive to deny claims and provide the cheapest possible treatments. That's in direct conflict with maximizing patient care and good outcomes.
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I have to agree. For-profit health insurance has a built-in conflict of interest. It's all about maximizing profit and minimizing loss so there is a very strong incentive to deny claims and provide the cheapest possible treatments. That's in direct conflict with maximizing patient care and good outcomes.
I was recently in Cuba, and something that struck me is many of the buildings are crumbling and collapsing. When it comes down to it, the real reason is self policing never works.
You see, they built the rain gutters within the walls of the buildings directly connecting to the sewers. Aesthetically very nice, unless you don't perform regular maintenance, then they get clogged, crack, water seeps into the wall, erosion takes over and so on.
Since the government took over in 59, no real maintenance has taken place, no self policing is happening and now a new building collapses every 3 or 4 months.
Regardless if a private industry says it can self police or if the government takes over and says it can self-police, you should be worried.
This is the same reason why the recent NYC free-lancers law made me laugh. Essentially, now, if you bill a client in NYC and they don't pay within 30 days, you can sue them for it along with reasonable legal fees. First off, if you conducted business properly, you would not run into situation enough for it to matter. Second, I did a project for the city and it took over 90 days to get paid; does this law not apply to them?
Anyway, if government takes over health care, we will need to rely on self policing by the government on the government. I can't say this will lead to problems, but history surely suggests it would.
Having a private industry being policed by government always seems to be the better alternative. It's just a question of how intense should the policing be.
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No Bart. that will be the salvation when true commerce is in place.
Not for the sick who cannot pay the price.
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Not for the sick who cannot pay the price.
Many are currently covered in most states by Medicaid.
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Regarding doctors and making a profit.
Doctors in Spain get paid to work for the health service, as they do in the UK and anywhere else I know of that has a national health service funded by taxation. Of course they get paid, but that's not commerce: that's having a job.
In Spain, for sure, some docs also have a private practice of their own, but they also work a given amount of time for the state provision. I remember seeing one doctor who dealt with my wife in a private hospìtal also working in the emergency section of the public service when she was taken there in an emergency. There's a cross-over that seems to work.
The problems arise when private companies become embroiled in the provision of state services. Medicines, as in drugs, are another thing altogether, and the cost of those is negotiated most of the time, with the R&D costs etc. proportioned out in various ways via those prices. Problems arise when some new drug comes along and the companies want too high a price for the pubic services' pockets. As result, medication touted as cure for cancer or some other highly emotive ailment is refuses listing as prescribed drug by the public service, and then all hell breaks loose as to why. At which point the wonderful press leaps in and cries foul! and sells even more rubbish on the back of promised exposés, when most of the time all they can expose is the total non-news that drug companies make a bleedin' fortune. Just look at their listings on the stock market if in any doubt: they are money in the bank, pre-collapse bank.
Separation is key, in my opinion, and I can never accept that access to medical assistance should depend on wealth of patient, which any form of private health insurance cannot avoid representing. Of course, if sufficient exclusions and restrictions are built in, then a low-cost insurance becomes of less value than none.
Bit of a mess, really.
Rob
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The underlying problem in the US regarding the cost of health care is, imho, fairly simple. It isn't the cost of insurance or drugs or who pays for it. It is the total amount of money that flows to the industry. Too many people involved, earning too much money. Money only flows to, or benefits people. A relatively small amount goes to shareholders of public corporations involved in the industry. But it mostly goes to salary/benefits for people involved directly and indirectly in this industry. These include: medical professionals and all other employees of health care companies and; to all the employees of pharmaceutical and med equipment companies; to researchers; to construction workers who build immense hospitals and clinics; and to the people who research, design, manufacture, install and maintain all of the equipment in those facilities.
I have a friend who spent 20 years of his career in executive management of a couple high tech, stock exchange listed computer based firms at the Chief Financial Officer type level. He was recruited away into the bio-med research/pharma world in a similar position for another exchange listed company. All of these firm's HQ's were in the same area. He was stunned at the salaries in his new industry being paid to people, top to bottom, at ALL levels, not just the top people. As just one example, he said that low level accounting staff in the Finance Department earned, on average, about 60% more per year in his new med related company than the same type people in the high tech computer company.
Unless and until something is done to either reduce the number of people in and/or supporting the industry or to reduce their salaries, we're just proverbially rearranging the deck chairs on the Titanic.
Brad
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I think you really have to remove the private insurance element from the public sphere. The twain cannot function in harmony because the private will always seek all ways by which to drive up costs and exploit the situation to profit. It's its raison d'être.
Both the Netherlands and Switzerland provide healthcare to all citizens though a highly regulated private insurance network. There have been some very good proposals here in the US to do the same thing. Of course it doesn't provide Cadillac care but one could purchase after market insurance for that. Medicare right not doesn't provide everything and one needs to have an add on policy. If you want to read more see: http://www.hamiltonproject.org/assets/legacy/files/downloads_and_links/A_Comprehensive_Cure-_Universal_Health_Care_Vouchers_Brief.pdf My friend Zeke Emanuel is one of the authors of the voucher proposal
Alan
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Many are currently covered in most states by Medicaid.
But not if they move to block grants to the states. Even Dr. Price who is the nominee for Secretary of Health and Human Services said so at his confirmation hearing.
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But not if they move to block grants to the states. Even Dr. Price who is the nominee for Secretary of Health and Human Services said so at his confirmation hearing.
It would then be up to the states to fund them, if they wish, if that were to happen. I have no problems with that at all. I
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Both the Netherlands and Switzerland provide healthcare to all citizens though a highly regulated private insurance network. There have been some very good proposals here in the US to do the same thing. Of course it doesn't provide Cadillac care but one could purchase after market insurance for that. Medicare right not doesn't provide everything and one needs to have an add on policy. If you want to read more see: http://www.hamiltonproject.org/assets/legacy/files/downloads_and_links/A_Comprehensive_Cure-_Universal_Health_Care_Vouchers_Brief.pdf My friend Zeke Emanuel is one of the authors of the voucher proposal
Alan
Yea, Emanuel did such a fine job on the ACA. [/sarcasm] I think I'll pass.
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Get back to us when the forgotten folk that Trump appealed to are still forgotten in 4 years time, and no longer have health care, and are joined by a whole lot more folk who lost their jobs when protectionism fails.
The positive impacts of the ACA have been inflated. This idea that it provided 20 million people with insurance is grossly misleading. Several million of these were just children under 26 who stayed on parent's plans. Many if not most of these would have had some other health insurance without the ACA. The largest portion of these 20 million (12-14 million) were covered by state Medicaid plans that were extended by the ACA, not ACA exchanges as most people are lead to believe. The problem with extended Medicaid is that it is funded by the ACA for a few years and then reverts back to the states to pay for. None of the states that accepted this could afford their own Medicaid budget before and certainly will be plunged into fiscal crisis when they will have to pay for more than they could afford before.
So in fact, no more than about 8 million or so have gone on ACA exchanges. Of these a certain percentage would have afforded existing commercial plans before the ACA gutted them.
And the fact is that even this smaller number could not be supported by the companies who ran the exchanges. They were losing millions on these plans and most of the major providers bailed late last year and this year.
Also, many if not most physicians and hospital systems did not accept ACA exchanges. In my previous practice (part of one of the largest healthcare systems in the nation, did not). So I lost patients who signed up, confirming Obama's calculated lie that you could keep your doctor. Then, they could find no one to see them. The had insurance but couldn't access care. I now accept ACA exchanges but they are next to useless for people who are really sick. The cost is high and the deductibles are astronomical. My truly ill ACA patients are no better off than before. Many of my currently uninsured patients cannot afford any ACA exchange and are now 'tax' criminals for remaining uninsured.
Too many people are still drinking the ACA kool-aid. No matter what you think about how the system was before, the ACA has been an unmitigated disaster and this is not to mention how many physicians are leaving medicine because of the oppressive bureaucratic burdens it has required. We are 20 percent less efficient than before the ACA. That means 20% fewer patients seen. That means decreased access for EVERYONE.
My prediction is that Trump and the Republicans are going to make a staggering mess of all this. But I also predict that their mess will not be any worse than the mess Obama has caused. From the inside, as a physician, and insurance customer and a patient, US healthcare is at its worst level in 30 years.
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The underlying problem in the US regarding the cost of health care is, imho, fairly simple. It isn't the cost of insurance or drugs or who pays for it. It is the total amount of money that flows to the industry. Too many people involved, earning too much money. Money only flows to, or benefits people. A relatively small amount goes to shareholders of public corporations involved in the industry. But it mostly goes to salary/benefits for people involved directly and indirectly in this industry. These include: medical professionals and all other employees of health care companies and; to all the employees of pharmaceutical and med equipment companies; to researchers; to construction workers who build immense hospitals and clinics; and to the people who research, design, manufacture, install and maintain all of the equipment in those facilities.
I have a friend who spent 20 years of his career in executive management of a couple high tech, stock exchange listed computer based firms at the Chief Financial Officer type level. He was recruited away into the bio-med research/pharma world in a similar position for another exchange listed company. All of these firm's HQ's were in the same area. He was stunned at the salaries in his new industry being paid to people, top to bottom, at ALL levels, not just the top people. As just one example, he said that low level accounting staff in the Finance Department earned, on average, about 60% more per year in his new med related company than the same type people in the high tech computer company.
Unless and until something is done to either reduce the number of people in and/or supporting the industry or to reduce their salaries, we're just proverbially rearranging the deck chairs on the Titanic.
Brad
Yes, great idea. Pay your cardio-thoracic surgeon less. Let's see, four years of college, four years of med school, residency programs for this level are often 7 years and the pay is pathetic and the workload is far more than any other field will even allow. Debt for them at this point often hundreds of thousands of dollars. So sure, cut their pay. Then see what you get.
It is already happening in primary care, the lowest paid physicians. The best and brightest either reject medicine altogether or they elect not to do primary care. You suggest fewer providers when there is a national shortage and access to care is getting worse every day?
It is amazing that people who think like this still expect and demand the highest levels of technology and care when their lives and health are on the line. And all of this in a culture that does not bat and eye at a basketball player or movie star making 20 million dollars a year.
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I do not know anything about ACA or Obamacare...
I live in the Netherlands and here everybody needs to have a standard basic heath insurance. If you earn too little the state pays for it.
You can have a basic heath insurance for 100$ a month for an employee and some part for the employer.
Adds on can be bought separately.
The insurance has a yearly own risk of 350$
It used to be a state insurance now it is privatized ; we have about 4-5 insurance companies. You can change your insurance company every year.
It works reasonably well. The insurance companies have reduced medicine costs and made hospitals work more together.
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The positive impacts of the ACA have been inflated. This idea that it provided 20 million people with insurance is grossly misleading. Several million of these were just children under 26 who stayed on parent's plans. Many if not most of these would have had some other health insurance without the ACA. The largest portion of these 20 million (12-14 million) were covered by state Medicaid plans that were extended by the ACA, not ACA exchanges as most people are lead to believe. The problem with extended Medicaid is that it is funded by the ACA for a few years and then reverts back to the states to pay for. None of the states that accepted this could afford their own Medicaid budget before and certainly will be plunged into fiscal crisis when they will have to pay for more than they could afford before.
So in fact, no more than about 8 million or so have gone on ACA exchanges. Of these a certain percentage would have afforded existing commercial plans before the ACA gutted them.
And the fact is that even this smaller number could not be supported by the companies who ran the exchanges. They were losing millions on these plans and most of the major providers bailed late last year and this year.
Also, many if not most physicians and hospital systems did not accept ACA exchanges. In my previous practice (part of one of the largest healthcare systems in the nation, did not). So I lost patients who signed up, confirming Obama's calculated lie that you could keep your doctor. Then, they could find no one to see them. The had insurance but couldn't access care. I now accept ACA exchanges but they are next to useless for people who are really sick. The cost is high and the deductibles are astronomical. My truly ill ACA patients are no better off than before. Many of my currently uninsured patients cannot afford any ACA exchange and are now 'tax' criminals for remaining uninsured.
Too many people are still drinking the ACA kool-aid. No matter what you think about how the system was before, the ACA has been an unmitigated disaster and this is not to mention how many physicians are leaving medicine because of the oppressive bureaucratic burdens it has required. We are 20 percent less efficient than before the ACA. That means 20% fewer patients seen. That means decreased access for EVERYONE.
My prediction is that Trump and the Republicans are going to make a staggering mess of all this. But I also predict that their mess will not be any worse than the mess Obama has caused. From the inside, as a physician, and insurance customer and a patient, US healthcare is at its worst level in 30 years.
True story about how even the simple things have gotten worse since Obamacare. When my Dr used to order blood work she checked off boxes on a single page. Now I get, anywhere from four to 6 pages from the printer for the same tests. So much more efficient and cost effective. The reality for me now is that I end up paying for everything out of pocket now because I don't reach my deductible. In practice I don't really have a problem with that, but I can't just buy a catastrophic policy to cover the big stuff. I'm forced by the government to buy an"ACA" compliant policy that covers many things I don't need.
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Yes, great idea. Pay your cardio-thoracic surgeon less. Let's see, four years of college, four years of med school, residency programs for this level are often 7 years and the pay is pathetic and the workload is far more than any other field will even allow. Debt for them at this point often hundreds of thousands of dollars. So sure, cut their pay. Then see what you get.
It is already happening in primary care, the lowest paid physicians. The best and brightest either reject medicine altogether or they elect not to do primary care. You suggest fewer providers when there is a national shortage and access to care is getting worse every day?
It is amazing that people who think like this still expect and demand the highest levels of technology and care when their lives and health are on the line. And all of this in a culture that does not bat and eye at a basketball player or movie star making 20 million dollars a year.
I loved that line too. Let's rephrase it.
High end fashion photographers get paid too much. Their compensation should be lowered so the are paid the same as the average baby photographer. After all they are both just taking photos of people....
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I loved that line too. Let's rephrase it.
High end fashion photographers get paid too much. Their compensation should be lowered so the are paid the same as the average baby photographer. After all they are both just taking photos of people....
If those high-fliers work shooting fashion for the state (highly unlikely!) then you may have hit on something... Thing is, neither I nor my wife ever had to hire a photographer, which would have been a discretionary action; having cancer is not. Neither is a heart attack nor a broken leg.
Nobody was suggesting, AFAIK, that docs not be rewarded for their efforts, and if they are working in the private sector, sky-high payment might be fair too: as long as there's a choice for the citizenry of a good public system, taxation funded, at reasonable cost. That will never be offered via a business model. Business means business, which means as much as you can pull out of the deal. I already suggested an earnings point at which you jump from state medicine to private insurance. I wouldn't expect Mr Trump or his fellow politicos to expect to go public health. Nor Mr Gates, of course.
As I suggested posts ago, there has to be a totally independent national system, where all docs owe the country that educated them so many years of their trade. For example: you want to study medicine in the UK, fine: then accept that you give back ten, fifteen years after which you can also do private work, as long as the state still gets a slice of your time as well. If you are a foreign student studying in the UK, then great, too: you pay whatever the courses cost, and can then waltz back to where you came from and syphon the blood of your own people, but the UK will have incurred no debt for you to reimburse: you paid up front.
Seems fair to me.
Rob C
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If those high-fliers work shooting fashion for the state (highly unlikely!) then you may have hit on something... Thing is, neither I nor my wife ever had to hire a photographer, which would have been a discretionary action; having cancer is not. Neither is a heart attack nor a broken leg.
Nobody was suggesting, AFAIK, that docs not be rewarded for their efforts, and if they are working in the private sector, sky-high payment might be fair too: as long as there's a choice for the citizenry of a good public system, taxation funded, at reasonable cost. That will never be offered via a business model. Business means business, which means as much as you can pull out of the deal. I already suggested an earnings point at which you jump from state medicine to private insurance. I wouldn't expect Mr Trump or his fellow politicos to expect to go public health. Nor Mr Gates, of course.
As I suggested posts ago, there has to be a totally independent national system, where all docs owe the country that educated them so many years of their trade. For example: you want to study medicine in the UK, fine: then accept that you give back ten, fifteen years after which you can also do private work, as long as the state still gets a slice of your time as well. If you are a foreign student studying in the UK, then great, too: you pay whatever the courses cost, and can then waltz back to where you came from and syphon the blood of your own people, but the UK will have incurred no debt for you to reimburse: you paid up front.
Seems fair to me.
Rob C
The original posters example was talking about accounting people, not DRs. You seem fine with having the government in charge, and that's fine. Others are not, and in the US that's a lot of people. Different strokes. And here, you pay your own costs for education. The "state" does not train you.
Let's just say we agree to disagree.
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True story about how even the simple things have gotten worse since Obamacare. When my Dr used to order blood work she checked off boxes on a single page. Now I get, anywhere from four to 6 pages from the printer for the same tests. So much more efficient and cost effective. The reality for me now is that I end up paying for everything out of pocket now because I don't reach my deductible. In practice I don't really have a problem with that, but I can't just buy a catastrophic policy to cover the big stuff. I'm forced by the government to buy an"ACA" compliant policy that covers many things I don't need.
A Bronze Obamacare Policy does just what you want.
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And the fact is that even this smaller number could not be supported by the companies who ran the exchanges. They were losing millions on these plans and most of the major providers bailed late last year and this year.
Not true, only a few bailed and of course were highly profiled in the press. The one real failure has been in the more rural areas where providers have a difficult time making a go of it. That was true before Obamacare as well.
Also, many if not most physicians and hospital systems did not accept ACA exchanges. In my previous practice (part of one of the largest healthcare systems in the nation, did not). So I lost patients who signed up, confirming Obama's calculated lie that you could keep your doctor. Then, they could find no one to see them. The had insurance but couldn't access care. I now accept ACA exchanges but they are next to useless for people who are really sick. The cost is high and the deductibles are astronomical. My truly ill ACA patients are no better off than before. Many of my currently uninsured patients cannot afford any ACA exchange and are now 'tax' criminals for remaining uninsured.
I don't understand what you are saying here. Participants get an insurance policy and not an exchange. Now some of these policies may have a very restrictive network but hey, that's nothing new. This was started by the insurance industry back in the 1990s and it was called "managed care" Stay in network and things are cheap go out of network and thing cost. It's not different from non-Obmacare corporate policies. Physicians are even refusing to take Medicare patients these days (I can point to two internal medicine practices I contacted recently) Don't blame all the faults of the health care system on Obamacare.
Too many people are still drinking the ACA kool-aid. No matter what you think about how the system was before, the ACA has been an unmitigated disaster and this is not to mention how many physicians are leaving medicine because of the oppressive bureaucratic burdens it has required. We are 20 percent less efficient than before the ACA. That means 20% fewer patients seen. That means decreased access for EVERYONE.
Where do you get this statistic from? How is it any different from other insurance? I've had two daughters on Obamacare policies (no subsidies, the paid the full freight) and their experience has not been what you describe.
My prediction is that Trump and the Republicans are going to make a staggering mess of all this. But I also predict that their mess will not be any worse than the mess Obama has caused. From the inside, as a physician, and insurance customer and a patient, US healthcare is at its worst level in 30 years.
This is an evolutionary fault. I spent my whole working career in the pharmaceutical industry and followed healthcare reform throughout that time. The only people who have found that express satisfaction are those who belong to well run HMOs (Kaiser, Geisinger, Harvard Pilgrim, Intermountain and some others). those of us who have had coroporate plans and/or Medicare can tell you lots of stories about what is wrong.
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As I suggested posts ago, there has to be a totally independent national system, where all docs owe the country that educated them so many years of their trade. For example: you want to study medicine in the UK, fine: then accept that you give back ten, fifteen years after which you can also do private work, as long as the state still gets a slice of your time as well. If you are a foreign student studying in the UK, then great, too: you pay whatever the courses cost, and can then waltz back to where you came from and syphon the blood of your own people, but the UK will have incurred no debt for you to reimburse: you paid up front.
Seems fair to me.
Rob C
In the US, the military, which runs its own medical school, will provide free medical education in return for some number of years of service. My two skin cancer surgeons are both ex-Army field surgeons. Some small rural communities are doing something similar if the doctor promises to come to their community for a set number of years.
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The original posters example was talking about accounting people, not DRs. You seem fine with having the government in charge, and that's fine. Others are not, and in the US that's a lot of people. Different strokes. And here, you pay your own costs for education. The "state" does not train you.
Let's just say we agree to disagree.
In Britain there are choices: some elect to pay for expensive - therefore by definition - exclusive private schools (called public schools, I know not why) and the education is better for many reasons, not least the support some of those kids - not all - receive back home; for the rest, state-provided schooling is there, good, bad and indifferent, depending on your luck in where you find yourself living/studying. There's a premium on houses within the catchment area of a good school...
University is heavily subsidised, but still unavoidably expensive, but in Scotland (different, non-independent country with own laws) pretty much affordable, which is why it attracts a lot of students from more expensive areas of Britain. In many university towns rented accommodation for students is incredibly expensive.
Social engineering constantly tries to force top universities to accept people from underprivileged backgounds, regardless of whether they are actually bright enough or not. A huge problem that this "forced equality" causes is for the student there under those circumstances: university is a helluva lot more than education and attending lectures, and it's remarkable how much money has to be found to pay for all sorts of social and spin-off ventures in which the students are expected to take part, and not having the parental money is a very obvious problem that must make many students (and parents) feel terrible, quite apart from the instant social differences (and stigmas) that they encounter from accent to peer ability.
Social mobility is very low in Britain, but then it probably is everywhere else, too. Some mountains are too steep to climb, and when havng money is often not enough, impossible.
Rob
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In the US, the military, which runs its own medical school, will provide free medical education in return for some number of years of service. My two skin cancer surgeons are both ex-Army field surgeons. Some small rural communities are doing something similar if the doctor promises to come to their community for a set number of years.
You see? There really are ways to be fair if people are willing to give it a try and not live by the motto of screwing everybody else. I hope those ventures become widely popular and create change.
Rob
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In Britain there are choices: some elect to pay for expensive - therefore by definition - exclusive private schools (called public schools, I know not why) and the education is better for many reasons, not least the support some of those kids - not all - receive back home; for the rest, state-provided schooling is there, good, bad and indifferent, depending on your luck in where you find yourself living/studying. There's a premium on houses within the catchment area of a good school...
University is heavily subsidised, but still unavoidably expensive, but in Scotland (different, non-independent country with own laws) pretty much affordable, which is why it attracts a lot of students from more expensive areas of Britain. In many university towns rented accommodation for students is incredibly expensive.
Social engineering constantly tries to force top universities to accept people from underprivileged backgounds, regardless of whether they are actually bright enough or not. A huge problem that this "forced equality" causes is for the student there under those circumstances: university is a helluva lot more than education and attending lectures, and it's remarkable how much money has to be found to pay for all sorts of social and spin-off ventures in which the students are expected to take part, and not having the parental money is a very obvious problem that must make many students (and parents) feel terrible, quite apart from the instant social differences (and stigmas) that they encounter from accent to peer ability.
Social mobility is very low in Britain, but then it probably is everywhere else, too. Some mountains are too steep to climb, and when havng money is often not enough, impossible.
Rob
The difference is everyone pays the state. Regardless. Again I'm more than happy to retain our system.
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You see? There really are ways to be fair if people are willing to give it a try and not live by the motto of screwing everybody else. I hope those ventures become widely popular and create change.
Rob
So paying your own way is now unfair and exchanging the fruits of your labor with others for the fruits of theirs is unfair? Who is John Galt?
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Not true, only a few bailed and of course were highly profiled in the press. The one real failure has been in the more rural areas where providers have a difficult time making a go of it. That was true before Obamacare as well.
Big ones bailed in big markets. don't blame the liberal media for reporting that. Virtually all others were losing money and weighing getting out.
I don't understand what you are saying here. Participants get an insurance policy and not an exchange. Now some of these policies may have a very restrictive network but hey, that's nothing new.
This is not a network or managed care issue. This is a problem with the ACA exchange plans. They are private but contracted differently. The problem is they pay providers and hospitals poorly so practices and hospital systems do not contract with them. Simple as that. Has nothing to do with a restrictive network
Physicians are even refusing to take Medicare patients these days (I can point to two internal medicine practices I contacted recently) Don't blame all the faults of the health care system on Obamacare.
You don't seem to understand. Its the same problem. Medicare pays about 30 cents on the dollar. Thats why most of us don't take new Medicare patients. Obamacare exchanges are exactly the same. Government over management and lowballing.
Where do you get this statistic from? How is it any different from other insurance? I've had two daughters on Obamacare policies (no subsidies, the paid the full freight) and their experience has not been what you describe.
I get the statistics from my own practice and the hospital system I was employed by. It gets extremely complicated because physician contracts are in flux right now transitioning to an RVU system. I'll be glad to explain but it will take a long time. The bottom line is that these policies are not desirable to providers. We are accepting them now but it is for political reasons. Trust me, they suck for providers unless the provider is on an RVU contract.
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A Bronze Obamacare Policy does just what you want.
Few of my most needy patients can afford it.
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A Bronze Obamacare Policy does just what you want.
Have you actually looked closely at the specifics of a bronze policy? The networks, or lack of them more like it? And I'm still paying for a lot of things I don't need or want and my choices of providers still suck.
The problem...again...is the government is DEMANDING I purchase certain coverage items. I HAVE NO CHOICE.
Heck, if your friend Zeke gets his way I will someday be denied life extending care after I reach 75. According to your friend life is over after 75. No value in saving those worthless seniors.
I'll think of that while I attend the 87th birthday of my Father in Law. He is one of the most vital, and productive people I know. I'm sure if your friend Zeke had his way, my FIL's Carpel Tunnel surgery scheduled for Monday would be cancelled. No use wasting all that money.
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You know, you have a point. There was a lot of rhetoric about death panels and all that. Obvious hyperbole, but there was a reality to it that no one paid attention to. Part of the funding for the ACA came from cuts to Medicare. Funny how the libs didn't scream about that. So to pay for insurance for all you cut healthcare for the elderly. So that slides by. Doesn't get a lot of attention in the media (imagine that). But look a little closer at what was cut. What got cut was payments to oncologists and cardiologists. So decrease the funding for two things that kill most old people. No, not a death panel, but the effect is the same and so is the intent.
The other interesting thing is that AARP, which is extremely liberal, openly supported the ACA even though the law contained cuts to Medicare. As soon as the ACA was passed the AARP starts running ads about how Medicare doesn't cover enough expenses for old people so you need to buy secondary insurance from them. Follow the dollar.
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You know, you have a point. There was a lot of rhetoric about death panels and all that. Obvious hyperbole, but there was a reality to it that no one paid attention to. Part of the funding for the ACA came from cuts to Medicare. Funny how the libs didn't scream about that. So to pay for insurance for all you cut healthcare for the elderly. So that slides by. Doesn't get a lot of attention in the media (imagine that). But look a little closer at what was cut. What got cut was payments to oncologists and cardiologists. So decrease the funding for two things that kill most old people. No, not a death panel, but the effect is the same and so is the intent.
Generally you make well-reasoned arguments, and I enjoy reading your POV even though I disagree more often than not. This is a bridge too far though - you do yourself a disservice. Besides, as a class, the over 65 crowd holds the lion's share of the wealth in this country.
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Yes, great idea. Pay your cardio-thoracic surgeon less. Let's see, four years of college, four years of med school, residency programs for this level are often 7 years and the pay is pathetic and the workload is far more than any other field will even allow. Debt for them at this point often hundreds of thousands of dollars. So sure, cut their pay. Then see what you get.
It is already happening in primary care, the lowest paid physicians. The best and brightest either reject medicine altogether or they elect not to do primary care. You suggest fewer providers when there is a national shortage and access to care is getting worse every day?
It is amazing that people who think like this still expect and demand the highest levels of technology and care when their lives and health are on the line. And all of this in a culture that does not bat and eye at a basketball player or movie star making 20 million dollars a year.
You ignored my underlying point and took the easy way out in your response. I specifically avoided MD salaries because they are a relatively small part of the overall expenditures on medical costs. My point was that given that per capita medical spending in the US dwarfs the per capita spending in the rest of the "advanced" nations in the world, and that our medical outcomes are somewhere below average for these nations, we are either paying far more in salaries or we are paying far more people. Probably both. And our outcomes compared to other "wealthy or advanced" countries is at best, average.
And regarding your example about the income of the cardio-thoracic surgeon, others can judge if their average salary in the US in 2011 (per Medical Group Management Assoc) of approx $475,000 is "too high". If I correctly follow your logic, our society should double the pay of all of the people I was referring too, and then our medical care problems would all go away. Oh, except that the cost will have doubled.
Because this thread has wandered so far afield, I'm done with it at this point.
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You ignored my underlying point and took the easy way out in your response. I specifically avoided MD salaries because they are a relatively small part of the overall expenditures on medical costs.
You said "medical professionals". That includes doctors and nurses, mostly. So if I interpreted your response wrong, I'm sorry.....that I'm not a mind reader.
My point was that given that per capita medical spending in the US dwarfs the per capita spending in the rest of the "advanced" nations in the world, and that our medical outcomes are somewhere below average for these nations
That is a far more complicated problem. The biggest problem is not that we're big spenders. The problem is primarily four-fold. Number one, we are, as a nation, fat, rich and sedentary. Lifestyle is the biggest killer. It takes a lot of money to fix people who are, as a nation, trying to kill themselves. That has absolutely nothing to do with the capability of the healthcare system. Second, we expect the best, the quickest and no limits. An American with a tummy ache expects a full body MRI and now. We have an insatiable appetite for healthcare. Again, this has nothing to do with the delivery of good care. Third, the US pretty much foots the bill for medical research and innovation. The rest of the world follows. That costs. Big. Fourth, medical malpractice. It is a lottery that costs this nation billions. It shapes the way physicians treat their patients and if you think we practice CYA medicine all day every day, then you are right. We order way too many tests and procedures but you only get sued for the test you didn't order. So yes, we're a fat, lazy, spoiled rotten and litigious nation that pretty much pays for the bulk of cutting edge medical innovation. But NONE of that impugns our ability to deliver good care.
The other issue is that our healthcare system is constantly compared to those of tiny socialist western European nations who have the money to fund universal healthcare primarily because the US spend billions keeping them from killing each other or at the very least keeping the Russians out of their backyards. Let Sweden build a military capable of keeping the Russians (or the Germans) at bay and see what their healthcare system looks like. And the truth is, the majority of European nations are crumbling fiscally under their socialized systems the most costly of which is likely healthcare. So at least compare apples to apples.
And regarding your example about the income of the cardio-thoracic surgeon, others can judge if their average salary in the US in 2011 (per Medical Group Management Assoc) of approx $475,000 is "too high".
I'm a primary care physician. I don't make anywhere near that much. But I know how a CT surgeon gets where he is and I know how he lives when he gets there. They work like dogs. They work hours that most people can't even dream of. Even in my residency program we routinely worked 120 hours a week, sometimes straight through for 36 hours. Surgery programs are worse, or used to be, there are limits now. But it does't stop when they get done with residency. It keeps going. And further, they are the top of the pyramid when it comes to skill and brains. Almost no one else can do what they do. And you seem to insinuate that $500k is too much. It is not. In my opinion it is not enough. Especially when your local beer and wine distributor or any big city ambulance chaser lawyer makes more than that. Or consider a professional football player, non starter: base salary about 5 years ago was about $400,000.
But this line of reasoning is dangerous. You have a computer. I bet you have a nice camera. Already most of the world's population could claim you have too much money. Its easy to spend other people's money.
If I correctly follow your logic, our society should double the pay of all of the people I was referring too, and then our medical care problems would all go away. Oh, except that the cost will have doubled.
You neither followed my logic or used any yourself in that statement.
Because this thread has wandered so far afield, I'm done with it at this point.
The dramatic exit!
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"You see? There really are ways to be fair if people are willing to give it a try and not live by the motto of screwing everybody else. I hope those ventures become widely popular and create change.
Rob"
..........................................
So paying your own way is now unfair and exchanging the fruits of your labor with others for the fruits of theirs is unfair? Who is John Galt?
And you reached this conclusion from the lines you quoted by...¿?
Why invoke Atlas? He's not gonna foot the bill, however you make him twitch. And I bet he doesn't pay for any wall, either.
;-)
Rob C
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Getting back to the original post, Milania is not wearing an American designed dress on her most important day, she won't be living in the White House, it seems that she has no interest in her new duties including charities, she will make a lousy first lady. She did look good, Trump continues to look freakishly bad, any chance of a new hairdresser.
Cheers,
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Getting back to the original post, Milania is not wearing an American designed dress on her most important day, she won't be living in the White House, it seems that she has no interest in her new duties including charities, she will make a lousy first lady. She did look good, Trump continues to look freakishly bad, any chance of a new hairdresser.
Cheers,
She did say during the campaign that her principal issue if she became first lady would be to address bullying. This is an admirable cause and I would like to see her make some progress on this (seriously). Regarding the design of her dress, a key issue here is whether her jewelry line and Ivanka's comprehensive clothing lines will shift manufacturing to the US in keeping with the President's desire.
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The difference is everyone pays the state. Regardless. Again I'm more than happy to retain our system.
Insurance of me but not for thee! I imagine that you do not regard affordable healthcare as a right.
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Big ones bailed in big markets. don't blame the liberal media for reporting that. Virtually all others were losing money and weighing getting out.
I don't think that is correct, there are a fair number of them that are still staying in and they adequately priced their products so they are not losing money.
You don't seem to understand. Its the same problem. Medicare pays about 30 cents on the dollar. Thats why most of us don't take new Medicare patients. Obamacare exchanges are exactly the same. Government over management and lowballing.
I'm well aware of Medicare since I'm on it and also worked on health policy issues at various times during my career. Medicare only works because the patient pool is so large. Imagine if doctors in Florida started to refuse Medicare assignment in large numbers.
Obamacare specified things that were to be covered, it didn't say how this was to be accomplished. It was up to the plans to make those decisions. Now maybe they did this wisely and maybe not, we likely won't ever know. I'm sympathetic to all the critics out there, I personally felt that Obamacare was a complicated kludge and it was the only way that healthcare could have been done at the time. I well remember Senator Baucus trying in vain to get some of his Republican counterparts engaged and was willing to accept some of their ideas but of course this failed when Senator McConnell established 'massive resistance' to anything President Obama might propose as the party mantra.
I get the statistics from my own practice and the hospital system I was employed by. It gets extremely complicated because physician contracts are in flux right now transitioning to an RVU system. I'll be glad to explain but it will take a long time. The bottom line is that these policies are not desirable to providers. We are accepting them now but it is for political reasons. Trust me, they suck for providers unless the provider is on an RVU contract.
Thanks for clarifying this. I'm also aware of the flux right now as I have a number of close friends who are in the medical profession. A lot of them are fed up with the current situation and want some form of national health care that would simply things and improve access. the American Medical Association is not the monolith it once was. I'm still interested in hearing what solutions there are to the current issue of healthcare access. I've looked at all the proposals over the years and only find a couple of them that are workable. the key difficulty that I find in the "educated consumer" model of choice and "skin in the game" is that pricing and quality are not transparent at all. One can not really shop around for the best bargain and quality. Secondly, health savings accounts that have been touted by many only work if one is reasonably healthy and has enough income that he/she can seed the HSA and build up principal. Anyone who is on a lot of meds or has a complicated medical condition can't do this and will have full out of pocket expenses every year.
It's a hugely complicated matter and I always felt that there would be a major push towards nationalized system at some point.
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Insurance of me but not for thee! I imagine that you do not regard affordable healthcare as a right.
No, health insurance is not a right, no more that affordable food, or affordable heat etc.
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And you reached this conclusion from the lines you quoted by...¿?
Why invoke Atlas? He's not gonna foot the bill, however you make him twitch. And I bet he doesn't pay for any wall, either.
;-)
Rob C
You miss the point entirely.
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She did say during the campaign that her principal issue if she became first lady would be to address bullying. This is an admirable cause and I would like to see her make some progress on this (seriously). Regarding the design of her dress, a key issue here is whether her jewelry line and Ivanka's comprehensive clothing lines will shift manufacturing to the US in keeping with the President's desire.
I thought she was wearing Hervé Pierre? He's originally from France, but moved to America a long time ago, and has worked in the States ever since. Doesn't that count as 'American made' in the brave, embracing sense of the words? I'm sure the seamstresses etc. beavering away would be shocked to have been thought, for even a fleeting second, as being anything less - even if they may have been illegals! (This is not an allegation, just a joke! ForAIK, the thing might have been run up over the weekend in some little shop in Hong Kong! They are quick, talented and nimble out there.)
If anything, as a former model, she was able to, and exercised a lot of professional savvy in selecting something that looked the part so well. I mean, the opportunities for coming out clad like a diamond dog were immense! The lady should be given her due! Which forces the question; a BMW made in America, is that really a BMW, then? I'm sure any buyer would certainly like to pride himself that it is! I wonder is folks buying Chevrolet in Asia believe they really are, or whether it's still little old, bankrupt old Daewoo under the paint? The mysteries of international commerce and the frailties of the human ego!
Regarding any private companies she or Trump offspring may have, they are not in office as President; why would they be held to the same rules and be obliged to surrender something that may have been grown on the back of their own expertise?
Naturally, the arguments against my position just stated above are obvious enough; but the problem that brings them about is something else even more obvious: I believe that politics should be left to career politicians and that businessmen or busnesswomen should never have access to similar state positions. Try as they will to change their status quo, nobody but a hick from the deepest sticks (with the straw still attached) will ever believe that the reality of real ownership has been given away. If it has, one has voted into power the most unsuitable person ever! Someone who can't protect his own position effectively is never going to be able to do it on behalf of an even larger firm: a country.
As for throwing out entire administrations-worth of civil servants just to replace them with chosen true believers, what an unimaginable waste of broader experiences gained under varying party colours, mistakes and successes. I'd have expected that people who have spent their lives working under the leash of a variety of different parties would not need to reinvent any wheels each time.
But then that's the olde worlde.
;-)
Rob
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You miss the point entirely.
I'm hardly surprised! It's totally hidden.
;-)
Rob
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She did say during the campaign that her principal issue if she became first lady would be to address bullying. This is an admirable cause and I would like to see her make some progress on this (seriously).
And Mexicans everywhere slapped themselves in the forehead and said ¡Ay, caramba! :o
I'm sure the First Lady was speaking primarily about young people, cyberbullying and such. Bullying is one of the many social issues that will require a concerted and sustained effort in education (and law) to bring about social change. And it is a global issue. For example, there is a man currently on trial in the Netherlands whose cyberbullying (allegedly) caused one young girl here in Canada to take her own life. He is on trial for dozens of charges of similar cyber activity.
Unfortunately, we seem to inundated with examples of bullying tactics (and other despicable behaviours) both in the news, and in media (reality shows, fictional dramas, video games, and Internet sites that that glorify aggressive and violent behaviour, as well as xenophobia, homophobia, and bigotry in general). It takes leadership to set the tone, set the example, and push to see effective change. I wish the First Lady well on her endeavours.
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I'm hardly surprised! It's totally hidden.
;-)
Rob
No, it was right in front of your face if you had chosen to see it.
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No, it was right in front of your face if you had chosen to see it.
Do you have a handy little arrow or Shakespearean pointy-glove to attach to it, so I can find it? I don't think I choose not to see things; I tend to think it's smarter to notice them where one can.
But as you wrote, let's agree to disagree. It saves a whole heap of sore fingers.
;-)
Rob C
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I just saw a patient who will start on Obamacare in February. He is unemployed but still has enough money to get on it. He has multiple medical problems. For he and his wife (she is a smoker) their monthly Obamacare payment is $700. Their deductible is $14,000. There is only one provider of ACA exchanges in this state, BC/BS. The others dropped out.
If either of them requires hospitalization they will be immediately bankrupt and unable to pay their premium. This is the real story of the ACA.
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I just saw a patient who will start on Obamacare in February. He is unemployed but still has enough money to get on it. He has multiple medical problems. For he and his wife (she is a smoker) their monthly Obamacare payment is $700. Their deductible is $14,000. There is only one provider of ACA exchanges in this state, BC/BS. The others dropped out.
If either of them requires hospitalization they will be immediately bankrupt and unable to pay their premium. This is the real story of the ACA.
but they would be bankrupt under the old system as well! Why is ACA any different? Let's not try to pretend that everything is the fault of the ACA! If someone goes into a hospital and is uninsured they are on the hook for the whole bill and not some insurance company negotiated bill. What you don't know is what hospitalization would be covered as part of the policy. Yes, their premium might be $700 but at least they were not subject to medical underwriting which might have made it much higher than that. the deductible seems to be a little on the high side. My younger daughter (now in CA and at Kaiser Permanente) had a $6K deductible but lots of stuff was covered before the deductible kicked in. A bunch of hospitalization stuff was covered by the policy.
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Regarding any private companies she or Trump offspring may have, they are not in office as President; why would they be held to the same rules and be obliged to surrender something that may have been grown on the back of their own expertise?
It's just that there is a sense of hypocrisy for them to not have made an attempt to "make things in America" when the husband/father is preaching this.
As for throwing out entire administrations-worth of civil servants just to replace them with chosen true believers, what an unimaginable waste of broader experiences gained under varying party colours, mistakes and successes. I'd have expected that people who have spent their lives working under the leash of a variety of different parties would not need to reinvent any wheels each time.
But then that's the olde worlde.
;-)
Rob
I don't think the President has advocated this. they are just implementing a hiring freeze.
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but they would be bankrupt under the old system as well! Why is ACA any different? Let's not try to pretend that everything is the fault of the ACA! If someone goes into a hospital and is uninsured they are on the hook for the whole bill and not some insurance company negotiated bill. What you don't know is what hospitalization would be covered as part of the policy. Yes, their premium might be $700 but at least they were not subject to medical underwriting which might have made it much higher than that. the deductible seems to be a little on the high side. My younger daughter (now in CA and at Kaiser Permanente) had a $6K deductible but lots of stuff was covered before the deductible kicked in. A bunch of hospitalization stuff was covered by the policy.
Prior to the ACA, catastrophic plans were less money and had lower deductibles. I know, I use to have one.
However today, with the ACA, it appears, for all intents and purposes, all we have is catastrophic plans, because really what normal procedure is more then $14K? The only difference is we need to pay more for it.
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Prior to the ACA, catastrophic plans were less money and had lower deductibles. I know, I use to have one.
However today, with the ACA, it appears, for all intents and purposes, all we have is catastrophic plans, because really what normal procedure is more then $14K? The only difference is we need to pay more for it.
Did you read my post? Do you know someone who has an Obamacare policy as I do? ACA policies were not catastropic plans. they covered lots of things including hospitalization. Also look around at corporate plans. they are increasing co=pays, hiking premiums, and increasing deductibles (I know this for a fact as the premium payment for my Medigap plan is from my former employer that I get as a retiree. In the past three years my premium has doubled and my co-pays have gone up for both Rx coverage and doctor visits. My Medicate Part B premiums have gone up as well. I sick of all the sycophants blaming Obamacare for everything that is wrong with healthcare in the US when all parties are equal culpable. Everyone wants to turn the clock back to the Norman Rockwell 1950s. Ain't going to happen.
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Did you read my post? Do you know someone who has an Obamacare policy as I do? ACA policies were not catastropic plans. they covered lots of things including hospitalization. Also look around at corporate plans. they are increasing co=pays, hiking premiums, and increasing deductibles (I know this for a fact as the premium payment for my Medigap plan is from my former employer that I get as a retiree. In the past three years my premium has doubled and my co-pays have gone up for both Rx coverage and doctor visits. My Medicate Part B premiums have gone up as well. I sick of all the sycophants blaming Obamacare for everything that is wrong with healthcare in the US when all parties are equal culpable. Everyone wants to turn the clock back to the Norman Rockwell 1950s. Ain't going to happen.
Yes, I read your point and I do know people with ACA plans.
However, did you get my point?
The deductibles on the plans are so high that they might as well be catastrophic plans of the past. Yes, they cover hospitalizations and such, but only after some extreme deductible.
I had a hernia removed a few years ago and some of the plans on the ACA exchanges have deductibles higher then the cost of that surgery.
At least with my last plan, I would need to pay for 20% of the surgery, but now I would have had to pay nearly 100% of the cost.
We essentially created a near worthless plan that cost an extreme amount of money and is only going up both in price and overall cost (deductibles).
And the reason the prices are going up is because we absolutely need young people to offset the cost and their not buying. Young people are unreliable and not signing up in the mass numbers we need.
And to add insult to injury, the hopes of young people signing up were further destroyed by allowing 26 year old children to stay on their parents' plans. Either they (the writers) designed it to fail, or they are completely inept of determining the consequences of their decision.
It baffles me that law makers actually thought that all of a sudden young people would start buying health insurance just because it is now the law. And the fines for not buying are a joke, since they are so much lower then the actual cost of the insurance.
Not to mention, how are you going to enforce it? What if they don't get a tax return and owe money, or simply do not need to file a return, and refuse to pay the fine? Are we going to start locking people up for non-compliance?
The exchanges are already in a death spiral.
But keep on signing that song and completely ignore all of the logic that I have listed a few times already about why the law is failing.
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Essentially, the ACA is a law that absolutely relies on the most unreliable group of people in the country for it to work, 20 year olds. Then, if 20 year olds decide not to buy, which was predicted before it was even signed into law, there is no real way to enforce the law or the fines. Last, even if we could collect the fines, they are not nearly high enough to make up for the lack of 20 year olds buying plans, not to mention the fines are probably not even allocated to the exchanges anyway.
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I'm getting an interesting perspective on US Health Care reading posts from both sides of the ObamaCare debates.
Here in Canada, our health care is administered provincially, and the Federal government assists provinces with some transfer payments from the general tax pool. For all my working life, I paid into the provincial health care plan through payroll deductions. Those earning less than $20,000 per annum don't pay anything. Others pay on an indexed system from $60 to a $900 per year ($900 per year cap for those earning more than about $200,000 per year). Self-employed individuals contribute separately, in the same order of cost.
I had a heart attack (lots of family history) and spent a few days in the hospital with appropriate tests, etc., etc. Later, I had quadruple bypass surgery, and a few days in the hospital. Then I had 3 months of cardiac rehab therapy (twice a week). Regular visits with the GP and cardiologist, gradually diminishing over time. The cost? Zero. The treatment? First rate. And everyone is entitled to the same treatment.
Is our health care system perfect? Of course not. I pay for my ongoing generic statin and blood pressure medication. And generics in Canada are very costly compared to other countries in the world. Higher even than the US. Brand-name drugs are on a par with the US, but still much higher than countries like New Zealand (there's pressure on the government to see how we can reduce costs here). And waiting lists, yes, we certainly have them. My brother was put on an 18-month waiting list for knee surgery. Fortunately for him, he changed his diet, lost a few pounds and declined to have the surgery when it came due, because the pain was mostly gone.
There is always wrangling between the Feds and Provinces regarding the amount of health-care funding transfers. And, more recently, wrangling about the Feds wanting to provide targeted monies toward mental health and elder-care at home, rather than letting the provinces decide on their own priorities for all funding.
During the US election campaigning, Mr. Trump said that our Canadian health care system was so broken that patients were pouring across the border into the US to be treated. Perhaps I like in a bubble, but I don't personally know anyone who has gone to the US for surgery or any other treatment. I do know many friends and relatives who have had excellent care for everything from premature deliveries and months of subsequent hospital care, to transplants, to cancer treatment, etc.. etc. All covered by their provincial health care plan. People here complain about our system (and things could always be better), but I think most of us are very glad we have it.
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Yes, I read your point and I do know people with ACA plans.
However, did you get my point?
The deductibles on the plans are so high that they might as well be catastrophic plans of the past. Yes, they cover hospitalizations and such, but only after some extreme deductible.
Umm, not quite. One can get a gold or platinum plan with much lower deductibles. Don't assume that everyone just gets a Bronze plan.
I had a hernia removed a few years ago and some of the plans on the ACA exchanges have deductibles higher then the cost of that surgery.
Yes, but what is the cost of hernia surgery today? Greater or lower than when you had yours? I could have bought a lot of things several years ago for less than I would have to pay today.
At least with my last plan, I would need to pay for 20% of the surgery, but now I would have had to pay nearly 100% of the cost.
Not necessarily
We essentially created a near worthless plan that cost an extreme amount of money and is only going up both in price and overall cost (deductibles).
What is the alternative that you would have done? Would you have accepted the status quo? It's easy to throw bricks, much more difficult to formulate a plan.
The exchanges are already in a death spiral.
If so, why are so many people still signing up? Maybe they haven't received the message that their polices are worthless.
But keep on signing that song and completely ignore all of the logic that I have listed a few times already about why the law is failing.
It's the way it is because the Republicans never wanted to do any heavy lifting during the Congressional discussion and the small number in the Senate were cowed into submission by Minority Leader McConnell.
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I'm getting an interesting perspective on US Health Care reading posts from both sides of the ObamaCare debates.
Here in Canada, our health care is administered provincially, and the Federal government assists provinces with some transfer payments from the general tax pool. For all my working life, I paid into the provincial health care plan through payroll deductions. Those earning less than $20,000 per annum don't pay anything. Others pay on an indexed system from $60 to a $900 per year ($900 per year cap for those earning more than about $200,000 per year). Self-employed individuals contribute separately, in the same order of cost.
We have good friends in Montreal who also have great healthcare for a fraction of what we in the US pay for. I have friends in The Netherlands who were astonished by how much my wife and I pay for insurance. they have an insurance based system the provides healthcare for everyone and those at the low end of the economic spectrum pay little or nothing.
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Umm, not quite. One can get a gold or platinum plan with much lower deductibles. Don't assume that everyone just gets a Bronze plan.
Yes, but what is the cost of hernia surgery today? Greater or lower than when you had yours? I could have bought a lot of things several years ago for less than I would have to pay today.
Not necessarily
What is the alternative that you would have done? Would you have accepted the status quo? It's easy to throw bricks, much more difficult to formulate a plan.
If so, why are so many people still signing up? Maybe they haven't received the message that their polices are worthless.
It's the way it is because the Republicans never wanted to do any heavy lifting during the Congressional discussion and the small number in the Senate were cowed into submission by Minority Leader McConnell.
Thank you for providing an ample amount of Red Herrings! I may be a photographer, buy my degrees are in mathematics and logic, so lets stick with logical arguments that do not contain fallacies.
Any comments on my point that the fiscal architecture does not work? Any comments on the fact that 20 year olds are not buying in the droves we need and that their is no real way to force them, leading to an utter collapse of the system?
In all of your comments, you are completely ignoring the heart of the matter, that the bill is not working financially due to design on the law of the reliance on young people, whom are inherently unreliable, signing up.
They are not, and study after study is finding this to be the case.
I am a realist and a numbers guy. I really don't care how much good the ACA is doing for some, or how much pain it is causing others. I want the plan to be budget neutral and cost controlling. The ACA is far from that.
Not to mention, it has stifled competition and decrease , even contracted, growth in the market, which history has shown repeatably is the end result whenever you introduce more regulations into a market.
Now since you keep on mentioning the amount of people singing up, lets remember that only 20M additional people are covered by the ACA. However, the majority of that 20M are covered by medicare expansion, so less then 10M are covered in the exchanges. Of that remaining <10M, most are sick and old, I think around 80%. When the plan was first signed into law, it was proposed that over 40M would have signed up on the exchanges by now, and that at least 60% of those would be young and/or healthy.
Actually, 60% or more being young/healthy is what the financial architecture of he law is based on for it to work properly.
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Not to mention, it has stifled competition and decrease , even contracted, growth in the market, which history has shown repeatably is the end result whenever you introduce more regulations into a market.
What is the role of competition in health care? To reduce costs? Have you compared the cost of health care in the US with that in any other country?
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Now since you keep on mentioning the amount of people singing up, lets remember that only 20M additional people are covered by the ACA. However, the majority of that 20M are covered by medicare expansion, so less then 10M are covered in the exchanges. Of that remaining <10M, most are sick and old, I think around 80%. When the plan was first signed into law, it was proposed that over 40M would have signed up on the exchanges by now, and that at least 60% of those would be young and/or healthy.
Actually, 60% or more being young/healthy is what the financial architecture of he law is based on for it to work properly.
I'm sure you meant Medicaid expansion and not Medicare. They are getting Medicaid funding to purchase private insurance policies. One thing that has not been counted in the numbers are people such my two daughters and their friends who bought their insurance polices outside of the exchanges as they knew which provider they wanted and also that they would not qualify for any subsidy. This number is of course not knowable except to the insurance industry. The tax penalty part of the mandate was poorly designed and useless. A far better approach would have been to allow medical underwriting for anyone who didn't sign up. the healthy might have had a different take on things if they realized that their premiums would be sky high if they got sick and tried to sign up. Maybe it would have made a difference but probably not.
Don't get me wrong I was not a fan of what it turned out to be and my employer was heavily involved in the discussions and ultimately endorsed the legislation (I'm retired now). It was a kludge from the get go and they are reaping the problems right now. the problem is that it was the only game in town and has provided benefits to a lot of people. You might thing those benefits were bad, I have a different personal experience as I'm sure that my daughters would have had to pay more for health insurance in its absence. I was fortunate to have a good corporate plan while I was working and that I could keep upon retirement. However, my premiums have gone up much more than any of the Obamacare stories that I have read about (65% over three years) and that's on top of Medicare premiums that I have to pay for as well.
The whole thing is a train wreck and I'm looking forward to seeing what the Republican proposal is. I'm not at all counting on allowing insurance companies to sell across statelines will move the dial at all. the major insurers already do that today and the only other players are the BlueCross/BlueShield franchises and I'm not sure that they are prepared to do so. I think Health Savings Accounts only work for those who are healthy and can bank the full amount every year. Look at your own example of the hernia surgery. With an HSA you would have been on the hook for the full amount until the deductible was met. You might not have been able to bank a single dollar that year. If you are on any Rx meds you would be on the hook for those until the deductible was met. I just don't understand how it works. Tax credits might be good 'if' they are enough to buy insurance. I've only seen $3K mentioned. that doesn't buy one a lot of insurance. We'll have to see what happens but I doubt it is going to be "terrific" and "cost less" to quote our President. I hope to be proven wrong.
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What is the role of competition in health care? To reduce costs? Have you compared the cost of health care in the US with that in any other country?
US pays the most for healthcare per capita than any other western country. https://www.oecd.org/unitedstates/Briefing-Note-UNITED-STATES-2014.pdf
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What is the role of competition in health care? To reduce costs? Have you compared the cost of health care in the US with that in any other country?
Competition lowers cost and increases quality. Once again, shown repeatably throughout history.
N80 replied to your other question in a much better way that I could.
"That is a far more complicated problem. The biggest problem is not that we're big spenders. The problem is primarily four-fold. Number one, we are, as a nation, fat, rich and sedentary. Lifestyle is the biggest killer. It takes a lot of money to fix people who are, as a nation, trying to kill themselves. That has absolutely nothing to do with the capability of the healthcare system. Second, we expect the best, the quickest and no limits. An American with a tummy ache expects a full body MRI and now. We have an insatiable appetite for healthcare. Again, this has nothing to do with the delivery of good care. Third, the US pretty much foots the bill for medical research and innovation. The rest of the world follows. That costs. Big. Fourth, medical malpractice. It is a lottery that costs this nation billions. It shapes the way physicians treat their patients and if you think we practice CYA medicine all day every day, then you are right. We order way too many tests and procedures but you only get sued for the test you didn't order. So yes, we're a fat, lazy, spoiled rotten and litigious nation that pretty much pays for the bulk of cutting edge medical innovation. But NONE of that impugns our ability to deliver good care.
The other issue is that our healthcare system is constantly compared to those of tiny socialist western European nations who have the money to fund universal healthcare primarily because the US spend billions keeping them from killing each other or at the very least keeping the Russians out of their backyards. Let Sweden build a military capable of keeping the Russians (or the Germans) at bay and see what their healthcare system looks like. And the truth is, the majority of European nations are crumbling fiscally under their socialized systems the most costly of which is likely healthcare. So at least compare apples to apples."
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I'm sure you meant Medicaid expansion and not Medicare. They are getting Medicaid funding to purchase private insurance policies.
Yes, I meant Medicaid.
One thing that has not been counted in the numbers are people such my two daughters and their friends who bought their insurance polices outside of the exchanges as they knew which provider they wanted and also that they would not qualify for any subsidy. This number is of course not knowable except to the insurance industry.
This is meaningless since prior to the ACA you could do this as well, which is exactly the route I went.
The tax penalty part of the mandate was poorly designed and useless. A far better approach would have been to allow medical underwriting for anyone who didn't sign up. the healthy might have had a different take on things if they realized that their premiums would be sky high if they got sick and tried to sign up. Maybe it would have made a difference but probably not.
Better to enforce, however it probably would not have made a difference. The young and healthy would have still ignored the need for insurance until it was too late and they needed it.
Don't get me wrong I was not a fan of what it turned out to be and my employer was heavily involved in the discussions and ultimately endorsed the legislation (I'm retired now). It was a kludge from the get go and they are reaping the problems right now. the problem is that it was the only game in town and has provided benefits to a lot of people. You might thing those benefits were bad, I have a different personal experience as I'm sure that my daughters would have had to pay more for health insurance in its absence. I was fortunate to have a good corporate plan while I was working and that I could keep upon retirement. However, my premiums have gone up much more than any of the Obamacare stories that I have read about (65% over three years) and that's on top of Medicare premiums that I have to pay for as well.
The whole thing is a train wreck and I'm looking forward to seeing what the Republican proposal is. I'm not at all counting on allowing insurance companies to sell across statelines will move the dial at all. the major insurers already do that today and the only other players are the BlueCross/BlueShield franchises and I'm not sure that they are prepared to do so. I think Health Savings Accounts only work for those who are healthy and can bank the full amount every year. Look at your own example of the hernia surgery. With an HSA you would have been on the hook for the full amount until the deductible was met. You might not have been able to bank a single dollar that year. If you are on any Rx meds you would be on the hook for those until the deductible was met. I just don't understand how it works. Tax credits might be good 'if' they are enough to buy insurance. I've only seen $3K mentioned. that doesn't buy one a lot of insurance. We'll have to see what happens but I doubt it is going to be "terrific" and "cost less" to quote our President. I hope to be proven wrong.
Agree here.
Get ride of all the necessities of coverage with the exception of no life time coverage limits.
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Competition lowers cost and increases quality. Once again, shown repeatably throughout history.
Nobel Laureate Kenneth Arrow argued that healthcare doesn't fit into traditional market based thinking and I agree. http://web.stanford.edu/~jay/health_class/Readings/Lecture01/arrow.pdf
What you say is correct only if you have transparency in pricing and some type of quality measurement. ONe of the things Obamacare did do was to improve hospital practices such that there are far fewer infections in surgical wards and as well as fewer mistakes in Rx dosing. There is no transparency in pricing at all. I tried to get the prices of a lumbar spine MRI and no provider would tell me how much they charge. the only control on pricing right now is through insurance negotiations and if you go to an in plan facility or have Medicare you can get a preferred price. What if you are on your own and you can't get pricing information. this is exactly what will happen if you have an HSA or some other high deductible policy.
As to quality, how do you define it? How do you know the hernia surgeon was the best one? How do you know about surgical infections in the hospital? etc. To make this argument that market forces will take care of this is specious at best and certainly not a recipe for good healthcare.
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What is the role of competition in health care? To reduce costs? Have you compared the cost of health care in the US with that in any other country?
Any time I had to get insurance for foreign shoots, the travel agent would hope I wasn't going to the States. It's a problem that is perhaps just visible to others outside (foreigners) who do not live within the US system. Unless you experience something else, you can't know if you get value for your buck or not, and especially do you not know if the buck you're paying is way too large in the first place.
I think many systems are in trouble because of money; the Brit one, certainly, is facing problems with recruitment, and one factor is doctors not wanting to opt for general practice work - too much stress with too little funding to make it work, as well as patients who expect the Earth and waste surgery time with friggin' colds! Or simply don't turn up for appointments. Spain is without doubt having serious problems on the financial side. And they grow, as I know having waited zonks for a test I need. I recently saw figures (on tv news) showing that France spends a far higher percentage of GDP on medicine than does Britain, and it seems to have a pretty workable sytem in place. If France can do it...
As I've mentioned before, I think that most people (apart from the USA) cherish their national health services, if they are fortunate enough to have them, and would gladly pay more direct taxation if they were convinced that such money would indeed go into the health sytem, and that it would be spent according to the wishes of the professionals working there, medical professionals, not bean-counters recruited at inflated rates to push paper. Or mice. Those doing that seem to have wasted millions getting IT systems that don't work... I haven't heard if the health system gets its money back when computer system failures occur. Probably not.
Apart from US health services being or not being accessible to all Americans, I think an even greater calamity is waiting in the wings. Mexico is now estranged via Twitter. Dear God, what have you guys unleashed both on yourselves and the world at large? It took centuries for a working diplomatic system to be created; now we are playing at Caesar again. I don't think it will last; even the Romans had to sort out their messes at home.
Rob C
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A few days later...
Waterboarding is permitted;
Oil pipelines cross the US unhindered
Climate scientists reports will be screened by the White House
The Embassy in Israel will move to Jerusalem.
The US president said meeting Enrique Pena Nieto would be "fruitless" if Mexico didn't treat the US "with respect" and pay for a new border wall.
and now the US will raise import taxes for the Mexican goods to fund this Wall
and still uses his unsafe Samsung S3, an easy to hack device.
It always takes less time to destroy a reputation than to built one.
Trump is a specialist in destroying the US reputation within days.
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The reputation the US has had over the last 8 years needs destroying. Will Trump do better? Probably not. But again, he can do no worse.
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A few days later...
Waterboarding is permitted;
Oil pipelines cross the US unhindered
Climate scientists reports will be screened by the White House
The Embassy in Israel will move to Jerusalem.
The US president said meeting Enrique Pena Nieto would be "fruitless" if Mexico didn't treat the US "with respect" and pay for a new border wall.
and now the US will raise import taxes for the Mexican goods to fund this Wall
and still uses his unsafe Samsung S3, an easy to hack device.
It always takes less time to destroy a reputation than to built one.
Trump is a specialist in destroying the US reputation within days.
Lots of Fake news in there....
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Lots of Fake news in there....
"Alternative facts" is the appropriate new buzz word. :D
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"Alternative facts" is the appropriate new buzz word. :D
Oh yea...I forget. 😜
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Lots of Fake news in there....
so be specific...
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A few days later...
Waterboarding is permitted;
Wrong, Trump believes it works but also said he will defer to his people who say they won't waterboard. Btw, we have used waterboarding as advanced training for our military for years.
Oil pipelines cross the US unhindered
They have for years. We have 72,000 or more miles of pipeline currently in place. Keystone will need to reapply for permits for example .
Climate scientists reports will be screened by the White House
SOP when a new administration takes over.
The Embassy in Israel will move to Jerusalem.
Maybe, maybe not. Right now it is talk.
The US president said meeting Enrique Pena Nieto would be "fruitless" if Mexico didn't treat the US "with respect" and pay for a new border wall.
and now the US will raise import taxes for the Mexican goods to fund this Wall
Again no terms have been formalized. Right now it's talk. Have you ever negotiated?
and still uses his unsafe Samsung S3, an easy to hack device.
One story based on un-named sources published by the NYT make that claim and it has been repeated by other publications. It has not been confirmed. Yet another story says Trump was given a different phone by the Secret Service, again not confirmed. And even if he is, it's his choice. Besides he does not email.
It always takes less time to destroy a reputation than to built one.
Trump is a specialist in destroying the US reputation within days.
It depends on your perspective. From mine he has done more in 4 days to rebuilt the reputationof the US that any recent President. YMMV.
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Nobel Laureate Kenneth Arrow argued that healthcare doesn't fit into traditional market based thinking and I agree. http://web.stanford.edu/~jay/health_class/Readings/Lecture01/arrow.pdf
What you say is correct only if you have transparency in pricing and some type of quality measurement. ONe of the things Obamacare did do was to improve hospital practices such that there are far fewer infections in surgical wards and as well as fewer mistakes in Rx dosing. There is no transparency in pricing at all. I tried to get the prices of a lumbar spine MRI and no provider would tell me how much they charge. the only control on pricing right now is through insurance negotiations and if you go to an in plan facility or have Medicare you can get a preferred price. What if you are on your own and you can't get pricing information. this is exactly what will happen if you have an HSA or some other high deductible policy.
As to quality, how do you define it? How do you know the hernia surgeon was the best one? How do you know about surgical infections in the hospital? etc. To make this argument that market forces will take care of this is specious at best and certainly not a recipe for good healthcare.
Although I agree that the health care market does not currently fit a traditional market, I do not think that this is inherent.
The problem with health care is that insurance has become a middle man for almost every procedure imaginable, which is what we have come to expect. So, those whom are receiving the care never really know how much it cost or the quality. Those whom do know these answers are not the ones making the decision on whom to use or what to get (usually).
The market has become distorted.
How do you fix this, let people negotiate the fees themselves. Prices will come down. People will stop buying and, of course, die, initially, but the net effect will be to equalize the market and bring pricing down. This sounds draconian, but like any other market, it will work.
I am not sure I would be prepared to go this far though.
Instead, maybe only have insurance for terminal illnesses and deceases, much like car insurance. We don't expect car insurance to cover oil changes and basic checks, so why should we expect health insurance to cover cost associated with the common cold, or a broken bone, etc.?
Now, insofar as getting pricing for procedures, I am sure the lack thereof set prices is partially due to insurance coming into the market as well. Hospitals and complex heath care centers most likely invest in MRI or Gamma Knife Radiation machines (or whatever) without really knowing how much they need to charge per screening to produce a profit. They just know what their overall revenues will be from insurance payments and allocates a certain percentage to advancements in care.
Once again, take away insurance as a middle man and they will quickly figure this out.
For simpler procedures, not like the ones you listed, you can get pricing fairly easily.
I did go about two years with out coverage. In that time, I broke my hand in two places and (thankfully) only needed a cast. The x-ray initially cost $120, but I got it lowered to $80 since I was paying out of pocket. The cast was $450, but was lowered to $280 for the same reason. I doubt they felt bad for me, but more likely since they were being paid on the spot (cash in hand without any paper work) that was a cut to their business admin cost for my service.
Should I have had insurance? Not sure. I know the cost of insurance during those two years would have added up to a lot more then $360, and any money I had at that time went to marketing my business. I think I made the right choice to go uninsured for two years, especially now that my business is doing well.
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The market has become distorted.
Bingo! And there are three primary factors that distort them.
The first is the trend for employers to provide insurance. This was a horrible idea because the employer contracts and buys the insurance. The employee has little or nothing to say about it. And contracts are different with different employers and insurance providers. This takes away choice and makes understanding various plans almost impossible for the average person, me included, and I'm a doctor! If each person bought his own insurance he could shop for value and benefits. It would also be far easier for groups like consumer reports to evaluate plans and rate them publicly. As it is, no one can do this. This would lead to competition and cost savings. Some might think this would decrease their employee benefits. Not so, their salary would simply be higher and employers could gut bloated HR departments too.
The second is that insurers and heath providers should NEVER contract together. No money from an insurer should ever go directly to a doctor or hospital. The patient should pay the doctor with money he gets from his insurance company. Period. This would also allow competition among health providers and drive down that cost as well. Contracting between hospitals and insurance companies is convoluted and purposefully misleading. It needs to stop.
The third is that all aspects of managed care need to be thrown out. Managed care is pure evil and one of the main causes of bloated healthcare costs. Why? Many reasons. It puts insurance companies between patients and their doctors. The conflict of interest here is staggering. Insurance companies make decisions about what they will and will not pay for with no liability. They deny a test, you die, you cannot sue. They have no responsibility. But the worst aspect of it is bureaucratic bloat. At one time our practice of eight physicians had 50 employees the majority of which dealt with billing, referrals and prior authorizations. This drives expenses through the roof. Those expenses are passed on to the patient. It is obscene.
Doing these three SIMPLE things would transform healthcare in this nation. It promotes the kind of transparency we haven't had in years, it promotes competition, it would drive down prices and costs, it would give individuals freedom and choice, patients would never wonder which doctor they could see or which hospital they could go to. And instead of a simple primary care visit costing $150 it would cost $40. This alone would be transformative as it would allow us to go for inexpensive catastrophic plans for those in generally good health and then when you need to see your primary care doctor for a cold or your blood pressure you pay him cash.
Ad tort reform to this plan and you're done.
And make no mistake about it, the paperwork and bureaucratic red tape of managed care was NOTHING compared to what Obamacare ushered in. Its a simple principle folks: Socialized medicine in the US will look like the VA system. Research it. Read about it. It is a shame on this nation and an outrage. It has been for 50 years or more and change still hasn't come. Want to know what it is like to get your healthcare at the VA? There are two ways to visualize this: One, think about your experiences at your local DMV. Two, read the book Catch-22.
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...It depends on your perspective. From mine he has done more in 4 days to rebuilt the reputationof the US that any recent President. YMMV. ...
It certainly depends on your perspective...
I am from Holland ; this is our perspective...
https://youtu.be/j-xxis7hDOE
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It depends on your perspective. From mine he has done more in 4 days to rebuilt the reputation of the US that any recent President. YMMV.
I think most of the world is wondering why you elected a racist misogynist bully who mocks the disabled, advocates torture, claims climate change is a Chinese plot etc etc etc. I'm not sure the reputation he has built is one you want to be built.
https://www.washingtonpost.com/politics/trump-says-torture-works-backs-waterboarding-and-much-worse/2016/02/17/4c9277be-d59c-11e5-b195-2e29a4e13425_story.html?utm_term=.20ebac3a5502
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I think most of the world is wondering why you elected a racist misogynist bully who mocks the disabled, advocates torture, claims climate change is a Chinese plot etc etc etc. I'm not sure the reputation he has built is one you want to be built.
I'm looking forward to seeing how the great wall (which will drive up cost of imported goods for average Americans) will stop the Zika virus (https://www.cdc.gov/zika/) ..., oh wait, maybe the new jobs that will be created to produce locally will be at Mexican wage levels?
Cheers,
Bart
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The first is the trend for employers to provide insurance. This was a horrible idea because the employer contracts and buys the insurance. The employee has little or nothing to say about it. And contracts are different with different employers and insurance providers. This takes away choice and makes understanding various plans almost impossible for the average person, me included, and I'm a doctor! If each person bought his own insurance he could shop for value and benefits. It would also be far easier for groups like consumer reports to evaluate plans and rate them publicly. As it is, no one can do this. This would lead to competition and cost savings. Some might think this would decrease their employee benefits. Not so, their salary would simply be higher and employers could gut bloated HR departments too.
That began in the 1930s but really caught on during WWII when there were price controls and the only thing that companies could do for their employees was to offer them 'free' insurance. this ended up breaking the 'fee for service' model of medicine. The best model for individual choice is the Federal Employee Benefits Program that covers the almost 2M employees and retirees. I worked at the National Institutes of Health a long time ago and was in that program. One has a choice of a huge number of plans and they all have to be fully transparent to the Office of Personnel Management about the benefits which are published each fall in a rather large book that goes to all those in the plan as they can elect to change coverage each year. A cottage industry exists that examines each plan and outlines the pros and cons. Back in the early 1990s during Ms. Clinton's failed effort to solve the healthcare problem to just open up the program to everyone as a simple way to expand coverage. It probably would have worked.
The second is that insurers and heath providers should NEVER contract together. No money from an insurer should ever go directly to a doctor or hospital. The patient should pay the doctor with money he gets from his insurance company. Period. This would also allow competition among health providers and drive down that cost as well. Contracting between hospitals and insurance companies is convoluted and purposefully misleading. It needs to stop.
Isn't this the primary way costs are controlled? One reason networks work is that they have negotiated pricing. You are making assumptions that individuals can easily do this for themselves. Perhaps you and I can but I doubt that a vast majority of the American public would be able to do so.
The third is that all aspects of managed care need to be thrown out. Managed care is pure evil and one of the main causes of bloated healthcare costs. Why? Many reasons. It puts insurance companies between patients and their doctors. The conflict of interest here is staggering. Insurance companies make decisions about what they will and will not pay for with no liability. They deny a test, you die, you cannot sue. They have no responsibility. But the worst aspect of it is bureaucratic bloat. At one time our practice of eight physicians had 50 employees the majority of which dealt with billing, referrals and prior authorizations. This drives expenses through the roof. Those expenses are passed on to the patient. It is obscene.
I've followed this ever since Paul Ellwood convened the first Jackson Hole meeting back in the late 1980s. You are correct about the billing issue. I'm not sure that your statement about 'denying a test and dying' is valid. I would be most interested to know of an example or two here.
Doing these three SIMPLE things would transform healthcare in this nation. It promotes the kind of transparency we haven't had in years, it promotes competition, it would drive down prices and costs, it would give individuals freedom and choice, patients would never wonder which doctor they could see or which hospital they could go to. And instead of a simple primary care visit costing $150 it would cost $40. This alone would be transformative as it would allow us to go for inexpensive catastrophic plans for those in generally good health and then when you need to see your primary care doctor for a cold or your blood pressure you pay him cash.
You seriously think doctors are going to lower their fees? I'm sure the AMA would go crazy.
Ad tort reform to this plan and you're done.
In the states where this has already been done there has been very little impact of the cost of healthcare
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I think most of the world is wondering why you elected a racist misogynist bully who mocks the disabled, advocates torture, claims climate change is a Chinese plot etc etc etc. I'm not sure the reputation he has built is one you want to be built.
https://www.washingtonpost.com/politics/trump-says-torture-works-backs-waterboarding-and-much-worse/2016/02/17/4c9277be-d59c-11e5-b195-2e29a4e13425_story.html?utm_term=.20ebac3a5502
Perhaps you missed the most important point he makes that lots of Americans agree with. America FIRST. Now if the rest of the wold finds that offensive, perfect. Our country is 19 Trillion in debt, and it's time we take care of ourselves. We did'nt elect a pope or Jesus. Welcome to the big boy world.
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I'm looking forward to seeing how the great wall (which will drive up cost of imported goods for average Americans) will stop the Zika virus ..., oh wait, maybe the new jobs that will be created to produce locally will be at Mexican wage levels?
Cheers,
Bart
Stay tuned....
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It certainly depends on your perspective...
I am from Holland ; this is our perspective...
https://youtu.be/j-xxis7hDOE
That's actually pretty funny.
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Perhaps you missed the most important point he makes that lots of Americans agree with. America FIRST. Now if the rest of the wold finds that offensive, perfect. Our country is 19 Trillion in debt
Yep - not least to the Chinese. Perfect time to piss them off.
Welcome to the big boy world.
Indeed. Too bad you elected a baby.
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Yep - not least to the Chinese. Perfect time to piss them off.Indeed. Too bad you elected a baby.
Perhaps it IS the perfect time. No, we elected a leader. Welcome to the new reality.
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Trump will have a hard time silencing the National Park Service and the scientific community.
Park Rangers to the Rescue (https://www.nytimes.com/2017/01/27/opinion/park-rangers-to-the-rescue.html?_r=0)
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.... Our country is 19 Trillion in debt, and it's time we take care of ourselves. ...
I suspect the opposite;
I think the US deficit will grow under Trump; he wants to lower taxes and built new highways and bridges ( and even more fences)
The rich will be richer and the poor will be poorer; perhaps they have a job, but need to work around the clock to pay their bills...
With his lack of diplomacy he already made China and Mexico pissed without any good reason; even before he was president.
He twitters from the hip, without thinking. Next day he changes his mind again...
It is wrong to think a country can do it alone. Welfare is built on world wide trade and mutual understanding. That is what history shows.
Protectionism was a big mistake that the 1930 crises deeper and longer.
The US is now (again) ruled by a bunch of cynic old conservative men deciding what is right for the young.
My biggest fear is that the US welfare will go down with Trump;
Then we have a nation with angry old men at the top and the most/best arms in the world, with a 'leader' as you call it, that pulls the trigger without too much thought.
for America First; America First.
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Trump will have a hard time silencing the National Park Service and the scientific community.
Park Rangers to the Rescue (https://www.nytimes.com/2017/01/27/opinion/park-rangers-to-the-rescue.html?_r=0)
Sure he can. He can simply say, you're fired.
But I agree its a stupid argument and as point in fact I compared the CNN Gigapixel image taken at 12:10 to the 12:01 Reuters image in detail and they are for the most part a perfect match. Trumps team got it wrong. BTW I even forwarded my comparitive analysis to the White House.
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I suspect the opposite;
I think the US deficit will grow under Trump; he wants to lower taxes and built new highways and bridges ( and even more fences)
The rich will be richer and the poor will be poorer; perhaps they have a job, but need to work around the clock to pay their bills...
With his lack of diplomacy he already made China and Mexico pissed without any good reason; even before he was president.
He twitters from the hip, without thinking. Next day he changes his mind again...
It is wrong to think a country can do it alone. Welfare is built on world wide trade and mutual understanding. That is what history shows.
Protectionism was a big mistake that the 1930 crises deeper and longer.
The US is now (again) ruled by a bunch of cynic old conservative men deciding what is right for the young.
My biggest fear is that the US welfare will go down with Trump;
Then we have a nation with angry old men at the top and the most/best arms in the world, with a 'leader' as you call it, that pulls the trigger without too much thought.
for America First; America First.
You are clearly welcome to your own opinion. Thanks for sharing. Time will tell.
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You seriously think doctors are going to lower their fees? I'm sure the AMA would go crazy.
A comment like this, combined with your previous Red Herring response of implying my hernia operation would cost more now then when I had it, just shows a lack of understanding of markets.
Prices do not stay consistent nor are they guaranteed to go up. Pricing a product or service is complicated and many factors go into it. One such factor is logistics and administration costs.
If those cost go down substantially, one would expect the overall cost to decrease as well, especially in a monopolistic competitive market like medicine. I could see in a pure monopoly or oligopoly a supplier(s) trying to keep their cost the same, but with so many providers, it is only a matter of time until one of them tries to draw in more business and lowers his fees.
In the long run (50+ years, at least) prices do go up due to inflation, but in the short run (less than 50 years) it is not uncommon for prices to come down even if quality goes up. In real dollars (not including inflation) the price of lasik eye surgery has dropped substantially since the 80s while the quality has risen. Same thing is true with computers.
Need a not so new technology as an example, looking at shipping. One of the oldest services in the world has seen price decreases and increased quality of service in the last couple of decades.
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Sure he can. He can simply say, you're fired.
You display a woeful lack of knowledge about civil service employment protections. As much as you would like this to be a reality television show, it is not. It's serious business running a country and I don't think that has registered with Mr. Itch Twitter Fingers.
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A comment like this, combined with your previous Red Herring response of implying my hernia operation would cost more now then when I had it, just shows a lack of understanding of markets.
Prices do not stay consistent nor are they guaranteed to go up. Pricing a product or service is complicated and many factors go into it. One such factor is logistics and administration costs.
If those cost go down substantially, one would expect the overall cost to decrease as well, especially in a monopolistic competitive market like medicine. I could see in a pure monopoly or oligopoly a supplier(s) trying to keep their cost the same, but with so many providers, it is only a matter of time until one of them tries to draw in more business and lowers his fees.
take the automobile industry. Can you point to any particular model whose price has dropped in the face of a wildly competitive industry that epitomizes the market. We have owned three Honda Accords and three Honda CR-Vs over the years and each time we buy a new car it is more expensive than the one it replaced and the increase is more the inflation. I am pathological about keeping receipts for lots of good and services including medical bills (in case we ever have enough expenses for a tax write off). I have never seen a reduction in doctor's fees and both my wife and I have used the same doctors for a lot of years. Lab fees should be the first to go down given is is a very competitive industry with lots of providers but they have not. The price of my EKG as a part of my physical should either stay the same or go down, yet it also increases.
Now you may be right about additional providers coming in and offering lower prices but the US prohibits foreign doctors from coming over to the US and practicing unless they first do a residency here. Do you really thing a British, French, German, Canadian (probably can name many other countries whose medical training is equivalent to the US) doctor is that much inferior that we need to have this requirement in place. Lots of doctors in our area are Indian born and trained though they do residence requirement; why not eliminate that and increase the supply thus lowering the price?
Have you priced a hernia operation recently? If not, you cannot say whether it is more or less than what it is now.
Finally, a true market relies on transparent pricing and the ability to judge quality of product/service. I don't think we have either in healthcare right now. this is not to say it won't evolve to that point but until it does arguing that there is a rational market in healthcare is a fools errand.
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take the automobile industry. Can you point to any particular model whose price has dropped in the face of a wildly competitive industry that epitomizes the market. We have owned three Honda Accords and three Honda CR-Vs over the years and each time we buy a new car it is more expensive than the one it replaced and the increase is more the inflation. I am pathological about keeping receipts for lots of good and services including medical bills (in case we ever have enough expenses for a tax write off). I have never seen a reduction in doctor's fees and both my wife and I have used the same doctors for a lot of years. Lab fees should be the first to go down given is is a very competitive industry with lots of providers but they have not. The price of my EKG as a part of my physical should either stay the same or go down, yet it also increases.
Now you may be right about additional providers coming in and offering lower prices but the US prohibits foreign doctors from coming over to the US and practicing unless they first do a residency here. Do you really thing a British, French, German, Canadian (probably can name many other countries whose medical training is equivalent to the US) doctor is that much inferior that we need to have this requirement in place. Lots of doctors in our area are Indian born and trained though they do residence requirement; why not eliminate that and increase the supply thus lowering the price?
Have you priced a hernia operation recently? If not, you cannot say whether it is more or less than what it is now.
Finally, a true market relies on transparent pricing and the ability to judge quality of product/service. I don't think we have either in healthcare right now. this is not to say it won't evolve to that point but until it does arguing that there is a rational market in healthcare is a fools errand.
Once again, you are arguing in fallacies, creating red herrings and straw mans.
Your example of the prices of cars going up is nothing more than a loosely related example you are providing with the intention of knocking down, hence a straw man.
The price of a single item has nothing to do with the overall economy when looking at all services and products combined. Nor does it hold any weight in arguing that the price of a different item in a different market, doctor visits, would only go up, especially considering the premise that admin costs would be lowed dramatically. Your example is then negated even further when you consider all of the products and services that have gone down in price over the short run (in the last couple of decades) and that this is not unique to any one item or industry. (You only need one counter example to disprove a statement; I have provided many to the premise that prices always go up.)
Your example of not allowing foreign doctors from coming over is yet again a red herring, bordering on a straw man. Whether or not foreign doctors can practice in the USA has no meaning to the idea of the possibility of doctor prices coming down due to a cut in admin costs. Insofar as additional providers, medicine within the USA is a monopolistic competitive market with many providers already whom can raise or lower prices (at there own expense) depending on how costs fluctuate. Additionally, native citizens are free to open their own businesses or practices, thus adding more businesses to the larger market place already and effecting pricing.
Sorry, but I feel the need to call out a fallacy when I see one, especially since I was trained so thoroughly in college and grad school to spot and avoid writing them in mathematical proofs.
With this being said, I do agree that there is a lack of transparency in the health care market that distorts the market.
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You display a woeful lack of knowledge about civil service employment protections. As much as you would like this to be a reality television show, it is not. It's serious business running a country and I don't think that has registered with Mr. Itch Twitter Fingers.
Are you telling me he can't fire the head of the National Park Service? You do understand, don't you, that you don't always need to fire the little guys to get the job done. Yes it is serious business and finally after a disasterious 8 years we have a real leader in charge. I'm really sorry that does not meet your desires.
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take the automobile industry. Can you point to any particular model whose price has dropped in the face of a wildly competitive industry that epitomizes the market. We have owned three Honda Accords and three Honda CR-Vs over the years and each time we buy a new car it is more expensive than the one it replaced and the increase is more the inflation. I am pathological about keeping receipts for lots of good and services including medical bills (in case we ever have enough expenses for a tax write off). I have never seen a reduction in doctor's fees and both my wife and I have used the same doctors for a lot of years. Lab fees should be the first to go down given is is a very competitive industry with lots of providers but they have not. The price of my EKG as a part of my physical should either stay the same or go down, yet it also increases.
Now you may be right about additional providers coming in and offering lower prices but the US prohibits foreign doctors from coming over to the US and practicing unless they first do a residency here. Do you really thing a British, French, German, Canadian (probably can name many other countries whose medical training is equivalent to the US) doctor is that much inferior that we need to have this requirement in place. Lots of doctors in our area are Indian born and trained though they do residence requirement; why not eliminate that and increase the supply thus lowering the price?
Have you priced a hernia operation recently? If not, you cannot say whether it is more or less than what it is now.
Finally, a true market relies on transparent pricing and the ability to judge quality of product/service. I don't think we have either in healthcare right now. this is not to say it won't evolve to that point but until it does arguing that there is a rational market in healthcare is a fools errand.
You need better Dr's and other medical service providers. Or learn to negotiate better. My primary physician offered me a discount if I paid cash and did not file with insurance. This was pre Obamacare. The lab I use still offers me a discount for cash with no insurance filling. And they are roughly 70% cheaper that the lab in the medical center that is hospital affiliated. All of this adds up since I have a high deductible policy and I pay out of pocket. My dentist is willing to negotiate prices if there is no insurance and i pay cash. Heck even the hospital we use offers a cash payment discount if you have not met your deductible. The last time we had a hospital visit they offered 10%, I countered with 20% and they took it.
Cash only providers are opening all over the country. Pricing is far less that insurance based services. If a person decides to put some skin in the game it is possible to do much better than insurance based pricing. I believe this trend will continue.
https://www.google.com/search?q=cash+only+medical+practices+and+surgical+centers&ie=UTF-8&oe=UTF-8&hl=en-us&client=safari
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Are you telling me he can't fire the head of the National Park Service? You do understand, don't you, that you don't always need to fire the little guys to get the job done. Yes it is serious business and finally after a disasterious 8 years we have a real leader in charge. I'm really sorry that does not meet your desires.
I think you forgot that when Barack Obama came in charge, it was exactly the deepest point of the financial crises, the deepest after 1929...
That problem had been brought to the US by the 8 years leadership before him; the Bush-es administrations of which the last one started an absurd expensive war with many casualties in Irak - without any good reason.
( Weapons of Mass destruction......)
It was Barack Obama that managed to turn the downward economic spiral and he saved the Detroit car industry by investments (TAX! payed by you).
Also he managed to put down the enormous unemployment. Yes that took 8 years.
Maybe for you personally it did not turn out the best, but in many ways he saved the country as a whole.
His biggest personal accomplishment was the so called Obamacare;
He decided that a -so called wealthy country- ( the best in the world?) would need to be able to give all its citizens -also the poorest ones - some basic medical care.
(That is common thing in most part of Europe and even in Cuba.)
Because he lost his majority in the Senate and the House of Congress, the Republicans killed every proposal he made ( no matter the contains- that is a basic problem in the US political system, i think)
I think Obama was one of the most intelligent and social minded presidents you have ever had. He showed respect to every human being. He is very much respected around the world.
Unlike you 'Real Leader'
Mr Trump ' does not seem to respect:
Women in general
scientists ( when the outcome of the investigation was not what he had in mind)
Independent journalists ( When they are critical to his policy, especially when they are women or disabled)
islamic people
Mexico/ Mexicans
China
Indians, that do not want an oil pipeline through their holy soil.
...
In fact you could ask yourself who he respects ... apart from mr Trump...
I honestly think that he only respects the people that voted for him for their vote, and that is history.
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I think you forgot that when Barack Obama came in charge, it was exactly the deepest point of the financial crises, the deepest after 1929...
That problem had been brought to the US by the 8 years leadership before him; the Bush-es administrations of which the last one started an absurd expensive war with many casualties in Irak - without any good reason.
Come on now, really? Brush up on your recent history and stop making red herrings.
No, the crisis was caused by a collapse in the housing market and nothing to do with the War (your red herring). Now, as for the cause of the collapse, we can look at the Bill Clinton administration, since he repealed Glass-Stegal (something I do agree with) and he opened to the door to more risking mortgage lending by lowering the qualifying thresholds of Franny & Freddy and agreed to allow the government to back any mortgages. G. Bush merely continued this trend, something that I am disappointed in since he claimed to be a conservative.
Since the government now backed all mortgages, it was no longer unsafe to lend to risking individuals, so the banks followed suit, did what made sense and what they were told to do.
It was Barack Obama that managed to turn the downward economic spiral and he saved the Detroit car industry by investments (TAX! payed by you).
Who is to say that if the car companies went to bankruptcy court they would not have turned out better and more efficient? And if they did go, the industry would not have been lost, but bought by other investors with lower debts and a more efficient debt to revenue ratio.
Also he managed to put down the enormous unemployment. Yes that took 8 years.
This is misleading. The USA needs to create at least 150K jobs per month to keep up with population growth, and the average of the job numbers over the last 8 years is not more then 150K. This means unemployment came down due to people dropping out of the work force not being hired.
In addition to this, if you look at history, we still have the lowest labor participation rate since the great depression, highest amount of Americans on food stamps, average wages are much lower (due to lower paid jobs being created) and the average family income is almost $10K less now then when he took office. Not a great record. Even the DNC, through email hacks, was discovered to be talking to Obama about his lack-luster economic performance and how it could effect the election.
Not to mention, Dodd-Frank, a bill he signed, has caused there to be no new banking institutions to be created, the first time in USA history. Although proving a direct connection is impossible economically, this is the first time it has ever happened in American history, and that period of no growth started right after the bill went into effect. This is causing big banks to become only bigger and clamped down on business funding, a much needed fuel for growth.
Maybe for you personally it did not turn out the best, but in many ways he saved the country as a whole.
No president, or elected official for that matter, would have set ideally by while the economy was imploding, so giving him credit for doing something is nonsense. Instead, we need to look at the end results, and, from what I listed above, they are lack luster and no reason to celebrate.
His biggest personal accomplishment was the so called Obamacare;
He decided that a -so called wealthy country- ( the best in the world?) would need to be able to give all its citizens -also the poorest ones - some basic medical care.
(That is common thing in most part of Europe and even in Cuba.)
Although the idea was noble, the ACA is imploding. Everyone agrees on this, even liberal economists when pressed; they disagree on the solution.
On top of that, I would not use Cuba as an example. The average Cuban in the 50s was healthy then today, and infant mortality rates were much lower then too.
Because he lost his majority in the Senate and the House of Congress, the Republicans killed every proposal he made ( no matter the contains- that is a basic problem in the US political system, i think)
Leadership stems from the top, and he was horrible at being a leader. Compare Obama to Bill Clinton. Both started off with a majority in the congress, both lost that within two years to a very combative opposition party. Both had shut downs and such. However, Bill Clinton was able to rise above, find compromise, and ultimately get a good deal of his agenda through. Obama could not; he is a failure compared to Clinton.
On top of this, he has overseen the greatest amount of losses for his party out of any modern US president.
I think Obama was one of the most intelligent and social minded presidents you have ever had. He showed respect to every human being. He is very much respected around the world.
This does not and has never guaranteed economic success on both a micro and macro level, although the qualities are a plus to have.
Think of the happiest and nicest person you have ever worked with. If he was a poor performer and inept, would that really save his job?
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I think you forgot that when Barack Obama came in charge, it was exactly the deepest point of the financial crises, the deepest after 1929...
That problem had been brought to the US by the 8 years leadership before him; the Bush-es administrations of which the last one started an absurd expensive war with many casualties in Irak - without any good reason.
( Weapons of Mass destruction......)
It was Barack Obama that managed to turn the downward economic spiral and he saved the Detroit car industry by investments (TAX! payed by you).
Also he managed to put down the enormous unemployment. Yes that took 8 years.
Maybe for you personally it did not turn out the best, but in many ways he saved the country as a whole.
His biggest personal accomplishment was the so called Obamacare;
He decided that a -so called wealthy country- ( the best in the world?) would need to be able to give all its citizens -also the poorest ones - some basic medical care.
(That is common thing in most part of Europe and even in Cuba.)
Because he lost his majority in the Senate and the House of Congress, the Republicans killed every proposal he made ( no matter the contains- that is a basic problem in the US political system, i think)
I think Obama was one of the most intelligent and social minded presidents you have ever had. He showed respect to every human being. He is very much respected around the world.
Unlike you 'Real Leader'
Mr Trump ' does not seem to respect:
Women in general
scientists ( when the outcome of the investigation was not what he had in mind)
Independent journalists ( When they are critical to his policy, especially when they are women or disabled)
islamic people
Mexico/ Mexicans
China
Indians, that do not want an oil pipeline through their holy soil.
...
In fact you could ask yourself who he respects ... apart from mr Trump...
I honestly think that he only respects the people that voted for him for their vote, and that is history.
Too bad you lived this from somewhere else besides here in the US because you have a really bad grasp of history. To understand the crash of 08 you need to research the community reinvestment act. This massive load of crap started in 1977 and passed through a bunch of presidents. I'll also remind you that the bulk of the world supported the claim that Iraq had WMDs including Bill Clinton. Now we can debate the Iraq war, which is really easy to do in hindsight, but I'll also remind you that terrorist had recently destroyed the Twin Towers in New York.
You will also be wise to check out the results of Obamas record of creating jobs. Just recently a member of his staff finally admitted that the bulk of the jobs created were very low paying part time jobs. You should also note that the number of working age adults who were no longer in the job market and looking for work rose to an all time high of 94 million workers. Another interesting fact about this so called Obama recovery is the fact that a record number of Americana are now on public assistance. It's amazing how many people are willing to take disability or other forms of assistance rather than working. And let's not forget Obamas 8 trillion addition to the US national debt. It would have been much worse had the Republicans not instituted sequestration.
Detroit....instead of letting GM proceed with a standard bankruptcy, Obama turned basic bankruptcy rules and trashed the bond holders, who had the right to first money out, and instead gave the union the money instead. Gotta pay for those union voters to keep him in office you know. In the process he stiffed many investors and pension funds including many States. Then to add insult to injury Obama sold the Governments shares of GM stock for a tidy 10 BILLION loss. And let's remember Ford did not need Government help, nor did Toyota, BMW, KIA, MB, Honda, Subaru or any of the other car companies making cars in the USA. So did Obama really save the auto industry? Nope. And he hurt a lot of people in the process.
Obamacare...that horse has been beaten to death and it's a really bad program. That's why 51 percent of Americans want it gone (rcp Ave)
The division of power is a feature of our republic, not a bug. Obama had complete control of the executive and legistrative branches for two years. That's how Obamacare got passed. Then he had a divided congress and thankfully it kept the lawmaking to a minimum. That's the feature. Gridlock keeps a check on a government gone wild. Now Trump,has the same complete control for the next two years...not quite as complete as Obama with a 60 vote Senate, but rest assured the Dems will be whining to high Heaven.
I'm happy for you that you hold such a high opinion of Obama. I don't believe history will judge him kindly. But let's put a few final points on the Obama legacy. His approval average over his 8 years in office was 47.9. Lower than Clinton, GWB and even Richard Nixon. In fact only three presidents had lower ratings since this survey started in 1945...Ford at 47.2, Carter at 45.4 and Truman at 45.4
Let's also not forget that Obama to the biggest defeat of the Democratic Party in local, state and Federal elections. Democrats are down to 192 members of Congress. Under President Obama, Democrats have lost 900+ state legislature seats, 12 governors, 69 House seats, 13 Senate seats. Quite the record
As for Trump. Not my first choice and I did not vote for the Pope or Jesus. But the guy gets things done, insults the right people, works tirelessly and I fully believe he will re-energize the American business. His wins in this regard since his election is amazing. If the rest of the world does not like it, well that's just too bad.
Finally, the crash of 2008 was a huge hit for me. I had a very nice 10,000sq ft drive through studio and we were very busy with RV, transportation and Marine clients. All items based on a strong economy, reasonable gas prices and available credit. Late 2008 ended all of that. My customers quit buying and unemployment in my work area went to 20%. But I dusted myself off, reinvented my busness model to fit the state of my industry and we thrived. I'm far more profitable now. Did Obama help? Maybe. But most of it was on me, finding a way to work in the new environment.
It's really easy to sit half a world away and read news accounts that may or may not tell you the whole truth.
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If the rest of the world does not like it, well that's just too bad.
Really? Is this really what you call a "leader"? The pussy grabber? The torturer? The islamophobe? The mocker of the disabled? The climate destroyer?
Wow. Just, wow.
https://www.washingtonpost.com/politics/trump-says-torture-works-backs-waterboarding-and-much-worse/2016/02/17/4c9277be-d59c-11e5-b195-2e29a4e13425_story.html?utm_term=.20ebac3a5502
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Are you telling me he can't fire the head of the National Park Service? You do understand, don't you, that you don't always need to fire the little guys to get the job done. Yes it is serious business and finally after a disasterious 8 years we have a real leader in charge. I'm really sorry that does not meet your desires.
If he is a civil servant he cannot fire him but must go through administrative procedures which make it very difficult unless there is gross malfeasance. People can always be reassigned to other positions within the organization but this is quite different from a firing.
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Once again, you are arguing in fallacies, creating red herrings and straw mans.
Your example of the prices of cars going up is nothing more than a loosely related example you are providing with the intention of knocking down, hence a straw man.
Automobiles are but one example and numerous others could be cited just as there are some products that have come down in price (semiconductors). It's not a straw man but one example. Within healthcare there is ample statistical history of consistent increases in prices. I spent my career in the pharmaceutical industry and the rise in prices was always consistent and higher than the rate of inflation.
The price of a single item has nothing to do with the overall economy when looking at all services and products combined. Nor does it hold any weight in arguing that the price of a different item in a different market, doctor visits, would only go up, especially considering the premise that admin costs would be lowed dramatically. Your example is then negated even further when you consider all of the products and services that have gone down in price over the short run (in the last couple of decades) and that this is not unique to any one item or industry. (You only need one counter example to disprove a statement; I have provided many to the premise that prices always go up.)
Other than generic drugs (and even then it's not always true), can you point to goods and services within the healthcare sector that have constrained or lowered prices?
Your example of not allowing foreign doctors from coming over is yet again a red herring, bordering on a straw man. Whether or not foreign doctors can practice in the USA has no meaning to the idea of the possibility of doctor prices coming down due to a cut in admin costs. Insofar as additional providers, medicine within the USA is a monopolistic competitive market with many providers already whom can raise or lower prices (at there own expense) depending on how costs fluctuate. Additionally, native citizens are free to open their own businesses or practices, thus adding more businesses to the larger market place already and effecting pricing.
I guess you are arguing that by increasing the supply of doctors, pricing will not be affected. Doesn't economic theory argue the contrary? Economist Dean Baker has been arguing the point about arbitrary restrictions on doctors as a key factor in maintaining high prices.
Sorry, but I feel the need to call out a fallacy when I see one, especially since I was trained so thoroughly in college and grad school to spot and avoid writing them in mathematical proofs.
Glad to hear this. I too graduated college and have an advanced degree in a STEM field.
With this being said, I do agree that there is a lack of transparency in the health care market that distorts the market.
Also good to hear and of course you realize that this means that in the absence, market approaches will not work as individuals are hamstrung by a lack of information.
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Cash only providers are opening all over the country. Pricing is far less that insurance based services. If a person decides to put some skin in the game it is possible to do much better than insurance based pricing. I believe this trend will continue.
I think this depends on which region of the country you live in. We too have a number of practices that do not accept insurance assignment and my internist who I have been with for over 30 years is one of them. He is getting ready to retire in a year of so and I've been looking for another provider. I contacted a recommended practice and was told that since I was on Medicare they would not accept me. This practice is fee for service and I asked why they would not accept me if I was willing to pay the fee as per their policy and the reply was only, "we don't accept patients covered by Medicare." This is not unique in the Washington DC area as I have found out and has been confirmed by many others. Of course, one can spend a lot of time making calls to try to find the best value but in an area as big as the one I live in it would take an inordinate amount of time. It's not like most other areas where you can go on the Internet and get pricing information fairly quickly. The more important point, is that although there is a huge amount of choice where I live there is very little information on quality.
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Automobiles are but one example and numerous others could be cited just as there are some products that have come down in price (semiconductors). It's not a straw man but one example.
You're using the example of automobile pricing going up to imply that the pricing of health care services will also go up. It is a loosely related example which you presented because you knew you could knock it done and try to prove your premise that health care pricing would go up regardless. It's a straw man.
The two are not related to each other and one does not have an effect on the other. (Okay, if you take into account that shipping will be effected due to the price increase of vehicles, there may be a relation, but it would be extremely small.) As I have shown before, pricing fluctuates up and down all of the time, and previous pricing history of any one product does not necessarily imply that the pricing of that product will continue to grow. Technological advances along with better logistics, including admin costs, can bring down pricing of even the most expensive products.
Anyway, look at housing. Much of the mess we are still in, or feeling the after effects of, was due to a decrease in home values, something that had always gone up prior to 2008. High prices are the solution to high prices, and if a market is allowed to act properly, they will come down. I think we agree, however, the healthcare market does not currently act properly.
Within healthcare there is ample statistical history of consistent increases in prices. I spent my career in the pharmaceutical industry and the rise in prices was always consistent and higher than the rate of inflation.
True, but then again there has always been an increase in the amount of regulations and bureaucracy within medicine as well. History has shown that increases in regulations and bureaucracy always lead to less suppliers and high prices. N80 is recommending taking this away, or at least toning it down, so one could infer that prices could come down as well.
Other than generic drugs (and even then it's not always true), can you point to goods and services within the healthcare sector that have constrained or lowered prices?
Lasik eye surgery, a largely unregulated service compared to other healthcare service, has come down substantially in price. Once again, you only need to provide one counter example to disprove a statement.
I guess you are arguing that by increasing the supply of doctors, pricing will not be affected. Doesn't economic theory argue the contrary? Economist Dean Baker has been arguing the point about arbitrary restrictions on doctors as a key factor in maintaining high prices.
Not what I was implying. I was implying that increasing the supply of doctor would lower pricing. I felt that you were implying the only way to do this would be to allow foreign doctors to practice in the USA, which is currently not allowed. I was merely pointing out that, once again, this is a straw man argument since that would have nothing to due with lowering pricing through lower admin costs and/or more native doctors opening practices. Not sure if this is what you meant, but if not, why bring up foreign doctor restrictions.
Insofar as the restrictions on doctors, I agree here too. Milton Friedman made the same point years ago as well.
Glad to hear this. I too graduated college and have an advanced degree in a STEM field.
Also good to hear and of course you realize that this means that in the absence, market approaches will not work as individuals are hamstrung by a lack of information.
Yes, I do agree, and more information would help. However, I feel we should move in a direction where consumers become more aware of the pricing. Allowing government to become even more involved in medicine will only obscure the pricing further.
I am not sure if the Republicans will move in this direction either since their plan seem to be reliant on (fall back to) insurance making decisions and negotiating with doctors directly, which will continue to obscure pricing.
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Too bad you lived this from somewhere else besides here in the US because you have a really bad grasp of history. To understand the crash of 08 you need to research the community reinvestment act. This massive load of crap started in 1977 and passed through a bunch of presidents.
Other than Peter Wallinson at AEI who is delusional on this point, numerous experts on the housing industry have totally debunked this viewpoint. The Calculated Risk blog was writing in 2005 as was Dean Baker of CEPR about the horrible mortgage practices by the private sector (IndyMac, Countrywide, Wachovia, and a bunch of others) that granted NINJA mortgages. Also complicit were some of the big investment banks that were creating tranche mortgages that were almost impossible to rate yet Moodys and others gave these AAA ratings (at the same time there were just six US corporations that had AAA ratings). AIG., Lehman, and some others got in big trouble underwriting swap insurance against these bonds which forced them into liquidation or in need of a bailout. The Community Reinvestment Act and FannieMae and and Freddie Mac maybe contributed a very small amount but in no way the majority.
And let's not forget Obamas 8 trillion addition to the US national debt. It would have been much worse had the Republicans not instituted sequestration.
Detroit....instead of letting GM proceed with a standard bankruptcy, Obama turned basic bankruptcy rules and trashed the bond holders, who had the right to first money out, and instead gave the union the money instead. Gotta pay for those union voters to keep him in office you know. In the process he stiffed many investors and pension funds including many States. Then to add insult to injury Obama sold the Governments shares of GM stock for a tidy 10 BILLION loss. And let's remember Ford did not need Government help, nor did Toyota, BMW, KIA, MB, Honda, Subaru or any of the other car companies making cars in the USA. So did Obama really save the auto industry? Nope. And he hurt a lot of people in the process.
The increase in the national debt is a phony issue and has been consistently debunked. Had the auto industry not been bailed out, countless companies that supply parts would have gone under and all of the other car companies would have been at risk of failing as well. This was well documented at the time GM and Chrysler were bailed out. Of course we could have chosen to not do this and not engage in deficit spending (the appropriate Keynesian response) and found this country in a major depression. The reason the Federal Reserve has had to act the way they did in terms of low interest rates and buying securities is that Congress refused to do the right thing from an economic perspective. I'm sure you also advocate austerity in terms of Federal spending. Have you seen how well that has worked in other countries that have employed it? Why do you think the US has fared much better than the rest of the world?
Finally, the crash of 2008 was a huge hit for me. I had a very nice 10,000sq ft drive through studio and we were very busy with RV, transportation and Marine clients. All items based on a strong economy, reasonable gas prices and available credit. Late 2008 ended all of that. My customers quit buying and unemployment in my work area went to 20%. But I dusted myself off, reinvented my busness model to fit the state of my industry and we thrived. I'm far more profitable now. Did Obama help? Maybe. But most of it was on me, finding a way to work in the new environment.
I'm glad it worked out well for you in the end. It also worked out fabulously for me as well for reasons I need not belabor other than I realized the what was going to happen in late 2007 and capitalized on that (though not to the same effect as the players in "The Big Short").
It's really easy to sit half a world away and read news accounts that may or may not tell you the whole truth.
I'm not a half world away and I spend two hours a day reading economic forecasts and corporate filings. As long as President Trump does not zero out the SEC I'll continue to have some faith in corporate filings.
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@JoeKitchen - I can't respond to your posts as they are not formatted correctly. However, you are just plain wrong about this statement: "Anyway, look at housing. Much of the mess we are still in, or feeling the after effects of, was due to a decrease in home values, something that had always gone up prior to 2008. "
Robert Shiller, an econmomist and Nobel Laureate, has published extensively on this topic and also was the co-founder of the Case/Shiller price index. His book, "Irrational Exuberance" totally debunks that statement.
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@JoeKitchen - I can't respond to your posts as they are not formatted correctly. However, you are just plain wrong about this statement: "Anyway, look at housing. Much of the mess we are still in, or feeling the after effects of, was due to a decrease in home values, something that had always gone up prior to 2008. "
Robert Shiller, an econmomist and Nobel Laureate, has published extensively on this topic and also was the co-founder of the Case/Shiller price index. His book, "Irrational Exuberance" totally debunks that statement.
I am sick and not in the mode to learn how to actually format my response correctly, sorry.
I am familiar with the Case/Shiller indexed Robert Shiller and maybe I was being too broad. It is true that housing has not really changed in price throughout the years, if you take into account inflation. However, it is still true that the house crisis was caused by deflation in the housing market, something that had not occurred in recent memory of working bankers.
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If the rest of the world does not like it, well that's just too bad.
Really? Is this really what you call a "leader"? The pussy grabber? The torturer? The islamophobe? The mocker of the disabled? The climate destroyer?
Wow. Just, wow.
https://www.washingtonpost.com/politics/trump-says-torture-works-backs-waterboarding-and-much-worse/2016/02/17/4c9277be-d59c-11e5-b195-2e29a4e13425_story.html?utm_term=.20ebac3a5502
You are the perfect example of why I think Trump is perfect for the times. Heck you are really clueless. But thanks for playing. Btw, perhaps you should consider some other news sources than the -Washington Post. Let me guide you away from one of your falsehoods...
http://www.investors.com/politics/commentary/fake-news-trump-did-not-mock-disabled-reporter-and-other-lies-from-the-left/
Like a few other of your posts you believe fake news because it fits your worldview.
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Other than Peter Wallinson at AEI who is delusional on this point, numerous experts on the housing industry have totally debunked this viewpoint. The Calculated Risk blog was writing in 2005 as was Dean Baker of CEPR about the horrible mortgage practices by the private sector (IndyMac, Countrywide, Wachovia, and a bunch of others) that granted NINJA mortgages. Also complicit were some of the big investment banks that were creating tranche mortgages that were almost impossible to rate yet Moodys and others gave these AAA ratings (at the same time there were just six US corporations that had AAA ratings). AIG., Lehman, and some others got in big trouble underwriting swap insurance against these bonds which forced them into liquidation or in need of a bailout. The Community Reinvestment Act and FannieMae and and Freddie Mac maybe contributed a very small amount but in no way the majority.
The increase in the national debt is a phony issue and has been consistently debunked. Had the auto industry not been bailed out, countless companies that supply parts would have gone under and all of the other car companies would have been at risk of failing as well. This was well documented at the time GM and Chrysler were bailed out. Of course we could have chosen to not do this and not engage in deficit spending (the appropriate Keynesian response) and found this country in a major depression. The reason the Federal Reserve has had to act the way they did in terms of low interest rates and buying securities is that Congress refused to do the right thing from an economic perspective. I'm sure you also advocate austerity in terms of Federal spending. Have you seen how well that has worked in other countries that have employed it? Why do you think the US has fared much better than the rest of the world?
I'm glad it worked out well for you in the end. It also worked out fabulously for me as well for reasons I need not belabor other than I realized the what was going to happen in late 2007 and capitalized on that (though not to the same effect as the players in "The Big Short").
I'm not a half world away and I spend two hours a day reading economic forecasts and corporate filings. As long as President Trump does not zero out the SEC I'll continue to have some faith in corporate filings.
I'm sorry, but the root of this problem lies directly with the community investment act. Did the bankers, ratings houses and others have a part, sure, but the ball started rolling with the CRA. Who pressured the banks to start writing loans they never would have written? CRA. This is what happens when the a government tries to play God. Gotta love the law of unintended consequences.
And again, the AUTO INDUSTRY did not get bailed out . GM did. Chrysler to a much smaller extent. And it was done very badly. Quite frankly you have no idea if GM had done a regular bankruptcy if it would have killed the supplier industry. I don't either. But the undisputed fact remains that in at least GM's case this was a massive payout to the unions, while screwing the bond holders. I think GM would have fared much better with a regular bankruptcy. Of course that's my opinion and I'm not one of your vaunted "experts". I have family that owns a major, multi state supply company to the industry. Needless to say their business had more clients than just GM. And they survived and prospered, and in fact grew as they acquired other companies that faltered. That's how it works in real life. No,need for the government to decide the winners and the losers. The marketplace did just fine.
The increase of the national debt is a phony issue? Well, Alan, you have just destroyed any shrewd of credibility you may have had. So we have fared better than the rest of the world because we continue to rack up massive debt that we can never repay? That's your position? Let me ask you, could you live your personal life like that? What happens when the tap gets turned off and the hand is out asking for the money back? Reasonable debt, and debt that gets repaid is one thing. Consistently overspending year after year with no means to pay more than interest alone is a death sentence. Yes, austerity is a good thing. In fact it's a virtue. It's one thing for a business or family to go bankrupt. It's quite another for a country. This will not end well unless we as a country learn to live within our means.
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If you want a close encounter with the making of the economic crisis, one that starts with some lovely landscape scenes from Iceland, then I suggest you try to get hold of a video called Inside Job which consists of a series of interviews with, among others, key US players in that event.
I watched the thing twice, and came away with the impression that there was nobody, yep, nobody in the game who really managed to understand what they were playing with, and that in fact, it was the biggest pyramid scheme ever, with an absolute supsension, at every level of it, of the sense of the implication of what was being cooked.
Several key governmental advisors (mainly professors) were interviewed (still holding their university jobs despite the glaringly bad advice they had been giving), and it was almost funny to see them squirm and splutter and attempt to stand on dignity as defence.
Perhaps the banks and governments should have called in a few vegetable market traders instead; they probably employ more common sense every day of their lives. Another feather in the cap for PhDs then. ;-)
Rob
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I think this depends on which region of the country you live in. We too have a number of practices that do not accept insurance assignment and my internist who I have been with for over 30 years is one of them. He is getting ready to retire in a year of so and I've been looking for another provider. I contacted a recommended practice and was told that since I was on Medicare they would not accept me. This practice is fee for service and I asked why they would not accept me if I was willing to pay the fee as per their policy and the reply was only, "we don't accept patients covered by Medicare." This is not unique in the Washington DC area as I have found out and has been confirmed by many others. Of course, one can spend a lot of time making calls to try to find the best value but in an area as big as the one I live in it would take an inordinate amount of time. It's not like most other areas where you can go on the Internet and get pricing information fairly quickly. The more important point, is that although there is a huge amount of choice where I live there is very little information on quality.
IIRC, you are retired. What's an inordinate amount of time, when you are not working for a living? But I digress, the point here is that people CAN have skin in the game and they can find better deals if they try. I think we all would agree that the vast majority never really care about the cost of medical service unless they are on a high deductible plan or one that excludes certain services. They just blindly let the insurance companies pay. I'm not saying that makes them bad people but it plays a big role in the upward spiral of costs.
There are ways to reduce your medical spending costs, as I've shown. I can't believe that this Midwest city is somehow radically different than anywhere else in the country.
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Perhaps the banks and governments should have called in a few vegetable market traders instead; they probably employ more common sense every day of their lives. Another feather in the cap for PhDs then. ;-)
Rob
I think that is absolutly true. I'm not saying that these so called experts and advisors are all full of beans, but the vast majority make their claims having never made a payroll, dealt with poor cash flow, or had to risk their personal savings to start and run a business. Let alone deal with a creative team 😂
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If he is a civil servant he cannot fire him but must go through administrative procedures which make it very difficult unless there is gross malfeasance. People can always be reassigned to other positions within the organization but this is quite different from a firing.
Thank you for making my point for me.
The Director is a political appointee. He can be fired. Crap runs downhill.
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You are the perfect example of why I think Trump is perfect for the times. Heck you are really clueless. But thanks for playing. Btw, perhaps you should consider some other news sources than the -Washington Post. Let me guide you away from one of your falsehoods...
http://www.investors.com/politics/commentary/fake-news-trump-did-not-mock-disabled-reporter-and-other-lies-from-the-left/
Like a few other of your posts you believe fake news because it fits your worldview.
If you imagine that the link you cite proves, demonstrates, suggests anything remotely credible, then you are truly delusional. That is perhaps what one expects from a peddler of sophomoric insults - "clueless", "thanks for playing".
The truth is that Trump is a disgrace to the US. You choose to pretend otherwise, for whatever motives you may have, but the facts are clear.
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I'm sorry, but the root of this problem lies directly with the community investment act. Did the bankers, ratings houses and others have a part, sure, but the ball started rolling with the CRA. Who pressured the banks to start writing loans they never would have written? CRA. This is what happens when the a government tries to play God. Gotta love the law of unintended consequences.
There has been a lot of writing about the mortgage industry over the past decade and the effect of the CRA has been totally debunked. Now you might disagree with that which is fine but you then go into the area of "alternative facts."
The increase of the national debt is a phony issue? Well, Alan, you have just destroyed any shrewd of credibility you may have had. So we have fared better than the rest of the world because we continue to rack up massive debt that we can never repay? That's your position? Let me ask you, could you live your personal life like that? What happens when the tap gets turned off and the hand is out asking for the money back? Reasonable debt, and debt that gets repaid is one thing. Consistently overspending year after year with no means to pay more than interest alone is a death sentence. Yes, austerity is a good thing. In fact it's a virtue. It's one thing for a business or family to go bankrupt. It's quite another for a country. This will not end well unless we as a country learn to live within our means.
This is just too laughable to take seriously.
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That is perhaps what one expects from a peddler of sophomoric insults - "clueless", "thanks for playing".
Wait....up until now that has been you.
The truth is that Trump is a disgrace to the US.
And now you're the arbiter of truth. That's not sophomoric at all.
the facts are clear.
Then trot them out. Make no mistake, I'm not a Trump defender, I despise the man, but your palaver is based on a week in office. Maybe you've let in a little forecast bias? But that could not be so, right, I mean, I'm sure you thought it was insane when they gave Obama the Peace Prize before he'd done anything....and yes, even before he incubated ISIS. Now that was crazy, right?
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Then trot them out. Make no mistake, I'm not a Trump defender, I despise the man, but your palaver is based on a week in office. Maybe you've let in a little forecast bias? But that could not be so, right, I mean, I'm sure you thought it was insane when they gave Obama the Peace Prize before he'd done anything....and yes, even before he incubated ISIS. Now that was crazy, right?
You are so very boring, N80. Trump is not judged solely on his week in office - he has a long track record of appalling behaviour. Now - do you actually have a point? What did Camus have to say about grabbing pussy? Or did you just pop up here for the pleasure of contradicting me?
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Ad hominem attacks will not be tolerated and will lead to banning - even on this Coffee Corner Forum.
Please, do I have to lock this down? Or can you all argue as adults who differ?
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There has been a lot of writing about the mortgage industry over the past decade and the effect of the CRA has been totally debunked. Now you might disagree with that which is fine but you then go into the area of "alternative facts."
This is just too laughable to take seriously.
Japan's debt to GDP ratio is extremely large and one of the main reason economists believe they have anemic growth.
The question is what is the threshold where debt becomes a burden? Also, if your currency is the reserve currency, are you as subject to poor growth due to large debts as another country?
No one really knows the answers here, however I would prefer to not find out.
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You are the perfect example of why I think Trump is perfect for the times. Heck you are really clueless. But thanks for playing. Btw, perhaps you should consider some other news sources than the -Washington Post. Let me guide you away from one of your falsehoods...
http://www.investors.com/politics/commentary/fake-news-trump-did-not-mock-disabled-reporter-and-other-lies-from-the-left/
Like a few other of your posts you believe fake news because it fits your worldview.
A commentary piece in a publication that consistently leans to the right of center, in accordance with your world view, can hardly be regarded as evidence of anything. I read the piece and the basis upon which it is written comes from two places. One is "Rebel Media's fiery host Gavin McInnes" who rants and raves about fighting liberals and teaches people "talking points" for defending Trump. He also wrote a piece called "5 Reasons To Vote For Trump". The other is a group called "Catholics 4 Trump", a right wing group that condemns all things "liberal". These are certainly not unbiased sources.
The evidentiary videos show that the reporter does not flail his arms when he talks, thereby claiming Trump could not possibly have been mocking his obvious physical deformity. They also show Trump making erratic arm movements on two other occasions, but more briefly, less exaggerated, and talking with reasonable normalcy while doing it. Anyone can distinguish that from what he did when talking about the reporter. In that case only he acted like a child mocking a disabled kid. We are apparently in an age where we should believe what we are told and ignore what we see and hear.
Similarly, we are to ignore Trumps own words about groping women, and the 13 women who confirmed them because Trump said "It never happened". 1984 anyone?
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Back in the early 1990s during Ms. Clinton's failed effort to solve the healthcare problem to just open up the program to everyone as a simple way to expand coverage. It probably would have worked.
Hillary's plan had traction until the prospect of lost freedom was brought up. Her program could not promise it and its popularity fell immediately. Putting everyone on a Federal program would never had been sustainable. It would have sunk under bureaucratic burden.
Isn't this the primary way costs are controlled? One reason networks work is that they have negotiated pricing.
Are you kidding? Large systems negotiate higher payments for themselves because they are large. Small providers get screwed. If a large healthcare system has large market penetration then the prices soar, as they have done in the market I work in.
You are making assumptions that individuals can easily do this for themselves.
No I'm not. As it stands the average person cannot understand the coverage decisions they make even with limited choices. I see it with Medicare secondary coverage everyday. The patients are lied to and scammed. Even the options from employers are staggeringly complex. So, first, it wouldn't be any worse, but second, the insurance companies would have to simplify because they would be selling directly to us. Think IBM vs Macintosh in 1984.
I'm not sure that your statement about 'denying a test and dying' is valid.
What are you confused about. I order an MRI on a patient. His insurance company denies it. We appeal as the patient gets sicker. I talk to an MD who works for the insurer who looks at a set of guidelines and denies the scan. The patient cannot afford the scan and suffers the consequences. State medical boards claim that the insurance physician is practicing medicine on this patient and 1) must have a state license to do so and 2) is liable for his decisions. State medical boards have no teeth and federal laws do not hold them accountable. So he cannot be sued for his mistake. End of story.
You seriously think doctors are going to lower their fees?
I know they will and they already are. Direct Primary Care is a new (very old concept) in which you pay cash for primary care visits. No insurance is accepted, no Medicare is accepted. Ever. You either pay for office visits or you pay, on average, $1000 a year for unlimited primary office care. Office visit rates are around $50. That's 1/3 what I charge under the current system. Those with large deductibles pay that out of pocket. Those on managed care plans have copays that range from $20-$40. I have two former partners doing this now. Super low overhead, 24/7 access for patients. For $500 a year for young patients. The patients will still need a catastrophic plan and hopefully under Trump those will become available again.
I'm sure the AMA would go crazy.
I don't think people know what the AMA is. The AMA is almost irrelevant and has suffered low and/or declining membership for years. They are extremely liberal, advocated the ACA and actively seek a single payer system. They have little or no lobbying clout. They make no decisions whatsoever that affect physicians in any legal or binding sense. They certainly care nothing about physician compensation.
In the states where this has already been done there has been very little impact of the cost of healthcare
That can't be good, right?
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If you imagine that the link you cite proves, demonstrates, suggests anything remotely credible, then you are truly delusional. That is perhaps what one expects from a peddler of sophomoric insults - "clueless", "thanks for playing".
The truth is that Trump is a disgrace to the US. You choose to pretend otherwise, for whatever motives you may have, but the facts are clear.
Actually the link does prove you are wrong and there are videos of before and after the so called shaming of that reporter that prove it is nothing of the sort.
That's reality.
Maybe this will help you.
https://www.catholics4trump.com/the-true-story-donald-trump-did-not-mock-a-reporters-disability/
You got suckered by the media....
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I suspect the opposite;
I think the US deficit will grow under Trump;
As it did under Obama.
built new highways and bridges
As Obama promised but failed to do. Remember "shovel ready jobs"?
The rich will be richer and the poor will be poorer;
Exactly what we have from Obama.
With his lack of diplomacy he already made China and Mexico pissed without any good reason; even before he was president.
Obama had the same sort of diplomacy as Neville Chamberlain. Who cares if Mexico is pissed? China needs to be pissed. We've been their cash cow for far too long.
He twitters from the hip, without thinking. Next day he changes his mind again...
Agreed. He's an idiot.
It is wrong to think a country can do it alone.
Prove it. The global village hasn't worked out too well either, right?
Welfare is built on world wide trade and mutual understanding. That is what history shows.
When have we ever had that? Are you serious?
The US is now (again) ruled by a bunch of cynic old conservative men deciding what is right for the young.
You clearly have no idea what happened in this election. The Democrats became the synical old men. They forgot the people. The people threw them out. But the bigger is that the cynic old conservative men are getting a boot in the butt right now too. This is not business as usual. The status quo, on both sides of the isle is gone.
My biggest fear is that the US welfare will go down with Trump;
What on earth do you mean by welfare and what makes you think the liberals did ANYTHING to enhance it?
Then we have a nation with angry old men at the top and the most/best arms in the world
You just don't get it. The Republicans are reeling under Trump and the Democrats STILL don't realize that for the last 8 years have been the angry old establishment.
with a 'leader' as you call it, that pulls the trigger without too much thought.
for America First; America First.
Could be. Hardly any worse that Barak "Neville Chamberlain" Obama laying the ground work for ISIS and a Middle East far more disastrous than what Bush left him with.
The point is, Trump is an unknown. And if he does everything you say he will then he has only continued the legacy of Obama who spent 8 years wrecking this nation.
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A commentary piece in a publication that consistently leans to the right of center, in accordance with your world view, can hardly be regarded as evidence of anything. I read the piece and the basis upon which it is written comes from two places. One is "Rebel Media's fiery host Gavin McInnes" who rants and raves about fighting liberals and teaches people "talking points" for defending Trump. He also wrote a piece called "5 Reasons To Vote For Trump". The other is a group called "Catholics 4 Trump", a right wing group that condemns all things "liberal". These are certainly not unbiased sources.
The evidentiary videos show that the reporter does not flail his arms when he talks, thereby claiming Trump could not possibly have been mocking his obvious physical deformity. They also show Trump making erratic arm movements on two other occasions, but more briefly, less exaggerated, and talking with reasonable normalcy while doing it. Anyone can distinguish that from what he did when talking about the reporter. In that case only he acted like a child mocking a disabled kid. We are apparently in an age where we should believe what we are told and ignore what we see and hear.
Similarly, we are to ignore Trumps own words about groping women, and the 13 women who confirmed them because Trump said "It never happened". 1984 anyone?
No, the MEDIA took a snippet of time and warped it to fit their agenda. You fell for it. What you did was believe what you were told without seeing with your eyes. You have a problem with the source of my link, but the facts are the facts regardless. Even worse you chose to believe the false narrative of the MSM because it fit your worldview, facts be danged
As to the groping claims, has any of those women, actually proven those claims in a court of law or are you just choosing to believe what you hear?
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And you really are clueless, but again, thanks for plying. Better luck next time.
Maybe this will help you realize just how guliable and foolish your position on this makes you look.
Thanks for the ad hominem, Craig.
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There has been a lot of writing about the mortgage industry over the past decade and the effect of the CRA has been totally debunked. Now you might disagree with that which is fine but you then go into the area of "alternative facts."
This is just too laughable to take seriously.
I've read quite a bit about this as well, and saying that the effects of the CRA has been debunked is laughable as well. Might I suggest your position also fits the area of Alternative facts.
Just to make sure I can understand you correctly. You feel that a 19 trillion National Debt, that keeps growing, and a country that consistently outspends its income is just fine? Is that your position Alan?
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I've read quite a bit about this as well, and saying that the effects of the CRA has been debunked is laughable as well. Might I suggest your position also fits the area of Alternative facts.
Do you mean that your (undisclosed) Alternative facts 'trump' the other facts?
Cheers,
Bart
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Thanks for the ad hominem, Craig.
Right...did you call me delusional?
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Do you mean that your (undisclosed) Alternative facts 'trump' the other facts?
Cheers,
Bart
No, I'm saying there are two sides to this issue and both some have merit. I believe the CRA had a huge hand in the crash of 08. Alan seems to believe otherwise.
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No, I'm saying there are two sides to this issue and both some have merit. I believe the CRA had a huge hand in the crash of 08. Alan seems to believe otherwise.
I would appreciate seeing some primary sources on this. My sources debunking this are:
http://economistsview.typepad.com/economistsview/2008/09/it-wasnt-the-co.html
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I would appreciate seeing some primary sources on this. My sources debunking this are:
http://economistsview.typepad.com/economistsview/2008/09/it-wasnt-the-co.html
Krugman, really.?
Let's keep it simple to start.
http://www.businessinsider.com/the-cra-debate-a-users-guide-2009-6
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Krugman, really.?
Let's keep it simple to start.
http://www.businessinsider.com/the-cra-debate-a-users-guide-2009-6
Funny, I thought I had linked to Mark Thoma's blog where he aggregated comments from a number of sources. I didn't see any links to a Krugman comment. Anyway here is a statistic from Janet Yellen when she headed up the San Francisco Fed,
" Most important, the lenders subject to CRA have engaged in less, not more, of the most dangerous lending. Janet Yellen, president of the San Francisco Federal Reserve, offers the killer statistic: Independent mortgage companies, which are not covered by CRA, made high-priced loans at more than twice the rate of the banks and thrifts. With this in mind, Yellen specifically rejects the "tendency to conflate the current problems in the sub-prime market with CRA-motivated lending." ...
Yellen is hardly alone... One of the only regulators who long ago saw the current crisis coming was the late Ned Gramlich... But Gramlich praised CRA...
It's telling that, amid all the recent recriminations, even lenders have not fingered CRA. That's because CRA didn't bring about the reckless lending at the heart of the crisis. Just as sub-prime lending was exploding, CRA was losing force... And the worst offenders, the independent mortgage companies, were never subject to CRA -- or any federal regulator. Law didn't make them lend. The profit motive did. ..."
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When I read through the comments here, it makes me wonder if the real legacy of President Trump will be the "normalization" of his tactics and style of rhetoric. It's difficult to deny that they are very different than what people are used to from a President of the United States. And no one can deny that there are many people who find them deeply offensive (including here, in a photography forum). Throughout the campaign President Trump resorted to tactics such as blame, belittling, bullying, bluffing, and blurring of issues and facts. And that's just what the Republican establishment said about him (never mind the Democrats), though many voted for him anyway. Perhaps the end (promise of more jobs, end to Obamacare, etc. etc.) justified the means (the wild-card of Trump).
The President shows little sign of changing his approach. Will his precedent embolden others? Personally, I think the world needs fewer blamers, belittlers, and bullies, and not more. The President seems to be setting a tone of confrontation and unpredictability. Once again, I'd rather have less than more of that in the world.
It has been suggested that President Trump has/will restore the reputation of the United States. I guess my question might be which reputation? For the United States certainly has many different reputations around the world. I wonder if Americans working or travelling abroad might be more or less welcome, more or less at risk, as a result of President Trump's rhetoric?
It has even been suggested that President Trump has "insulted the right people". I wonder who the right people are? I suspect that if President Trump were asked, he might deny insulting anyone (well, not intentionally). But certainly there are many who have felt insulted -- Republicans, Democrats, women, Mexicans, Muslims, parents of a deceased serviceman, the intelligence community, scientists, auto-executives, etc., etc.
Whether or not Trump mimicked a reporter's disability is moot. The video shows him trying to belittle the reporter by mimicking his response in a whiny voice and exaggerated gestures. Schoolyard stuff, really. Perhaps to go along with his locker-room stuff.
Only time will tell how President Trump's legacy will be written: more American jobs (or not)? better health care (or not)? more security (or not)? a wall? fights over women's and LGBT rights? But I think the real story is the emergence of a style of politics that I find very troubling.
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Hillary's plan had traction until the prospect of lost freedom was brought up. Her program could not promise it and its popularity fell immediately. Putting everyone on a Federal program would never had been sustainable. It would have sunk under bureaucratic burden.
There is no bureaucratic burden with the FEHB Program other than paying the premiums to the insurer. All OPM does is analyze and certify the eligible programs and leaves it up to the employees to choose. That's it. Can you explain how this bureaucratic or a burden?
Are you kidding? Large systems negotiate higher payments for themselves because they are large. Small providers get screwed. If a large healthcare system has large market penetration then the prices soar, as they have done in the market I work in.
Fortunately the FTC has stopped the Aetna/Humana merger but it remains to be seen what Trump will do. Small providers are exiting the market in any event as their risk pools are not large enough.
second, the insurance companies would have to simplify because they would be selling directly to us. Think IBM vs Macintosh in 1984.
Have you taken a recent look at insurance offerings on the Internet? They are not very simple at all.
I know they will and they already are. Direct Primary Care is a new (very old concept) in which you pay cash for primary care visits. No insurance is accepted, no Medicare is accepted. Ever. You either pay for office visits or you pay, on average, $1000 a year for unlimited primary office care. Office visit rates are around $50. That's 1/3 what I charge under the current system. Those with large deductibles pay that out of pocket. Those on managed care plans have copays that range from $20-$40. I have two former partners doing this now. Super low overhead, 24/7 access for patients. For $500 a year for young patients. The patients will still need a catastrophic plan and hopefully under Trump those will become available again.
I've seen higher concierge fees in my area than what you cite. $50 is 1/3 of what you charge, are you a specialist. My internist also an endocrinologist charges $85 an office visit. He has never accepted insurance and only files with Medicare, he doesn't accept Medicare reimbursement.
I don't think people know what the AMA is. The AMA is almost irrelevant and has suffered low and/or declining membership for years. They are extremely liberal, advocated the ACA and actively seek a single payer system. They have little or no lobbying clout. They make no decisions whatsoever that affect physicians in any legal or binding sense. They certainly care nothing about physician compensation.
I would be most interested in seeing where the American Medical Association has advocated for single payer or that they are an extremely liberal organization. I'm sure this would come as a surprise to Dr. Price the HHS nominee and longstanding AMA member.
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There is no bureaucratic burden with the FEHB Program other than paying the premiums to the insurer. All OPM does is analyze and certify the eligible programs and leaves it up to the employees to choose. That's it. Can you explain how this bureaucratic or a burden?
No. But do you really believe that if it was nationalized that it would not create its own bureaucratic burden like all other large government agencies, bar none and including Medicare, Medicaid, CHS, DoD, the VA, and EVERY aspect of the ACA. I suspect if you think it would not become a bureaucratic nightmare like all the rest of these you may either be naive, or an actual bureaucrat. :D
Fortunately the FTC has stopped the Aetna/Humana merger but it remains to be seen what Trump will do.
Trump is the wheel of fortune. As I've mentioned before, I do not hold any hope in Trump but doubt that he could mess it up any worse than it is now even if that were his expressed goal.
Have you taken a recent look at insurance offerings on the Internet? They are not very simple at all.
They are terribly complex. That's my point. The interaction between employers, the government and insurers is the reason. There should only be the interaction between the insured and the insurer. Then things would be simplified. At least no worse.
I've seen higher concierge fees in my area than what you cite. $50 is 1/3 of what you charge, are you a specialist.
I'm not talking about concierge medicine. Direct Primary Care is not the same. DPC programs only accept payment from the patient. I am a specialist in the technical sense (3 year residency program) but as a Family Physician we're considered by most to be GP's. Our board is considered a specialty board. But no, I do not charge specialist prices. My two former partners charge about $1200 per year for a person over $65. They do not pay for anything else done in the office.
My internist also an endocrinologist charges $85 an office visit. He has never accepted insurance and only files with Medicare, he doesn't accept Medicare reimbursement.
I do not understand how that is possible. Not the $85 but filing Medicare but not accepting payment. I did not think that was possible. It is not for DPC. But good for him if he has found a way.
I would be most interested in seeing where the American Medical Association has advocated for single payer or that they are an extremely liberal organization.
The AMA lost its way a while back. Mostly because of sub specialization. If you are an ENT you likely belong to your various ENT associations that are more relevant to you. The AMA also suffered for its liberal ivory tower views. They openly endorsed the ACA. No conservative organizations of physicians did. So maybe not "extremely" liberal. But liberal. My association, the AAFP also supported the ACA. There has been a backlash, but not of much substance.
But, you're probably right. In black and white they probably do not advocate, specifically, a single payer system. They advocate, explicitly, universal healthcare. A noble hope, but everyone knows it is a euphemism for socialized medicine.
I'm sure this would come as a surprise to Dr. Price the HHS nominee and longstanding AMA member.
It would not surprise him one bit. Many academics and policy makers are members of the AMA. Lots of average trench workers like me are members too. I might have been a member years ago myself. They still think I'm a member because they have been sending me JAMA for years along with a dues statement that hasn't been paid in years. Makes me wonder about their claims of membership numbers. The only physicians who wouldn't call the AMA liberal are....liberal.
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$50 is 1/3 of what you charge,
I'm tackling this separately to demonstrate how broken the system is. So take a large regional hospital/healthcare system. They contract with insurance companies to accept payment from them or not. The most common of these sorts of contracts (the intricacies of which I do not understand) is discounted fee for service.
The advertised fee for a complex office visit might be $300. But since it is "discounted fee for service" there is this mythical "discount". This is usually determined by a contracted percentage of what Medicare pays, which is how Medicare, via the federal government, dominates the market. (How have they done? Not too good. Obviously). So what they actually pay the physician is far less than $300. But that $300 is what the patient sees on the bill and thinks his insurance had to pay. All of this, both sides of it, are revolting to me. What is even worse, if someone comes into my office without insurance and wants to pay cash, I'm technically required to bill him $300 or the contract with the insurance company was not technically "discounted". There were ways around this. I used to see at least 4-5 indigent patients a week for free. That was allowed. I think things have changed in this regard in the last few years. Maybe because of the ACA, I don't know. But also because of the ACA most physician contracts are now based on "work relative value units" or wRVUs. This takes the physician out of the equation in terms of how patients pay. In some ways it is liberating. In other ways it ties our hands in regard to how we help our patients. Under an RVU contract I can no more see a patient for free than a car salesman can give a customer a car for free. I can get away with not billing some patients. Corporate has given a wink and a nod to it. But if your chart audits show that you do it a lot, they will stop you.
This is just a small example of how the interaction between government, healthcare systems, insurers and patients is badly, deeply broken.
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This is just a small example of how the interaction between government, healthcare systems, insurers and patients is badly, deeply broken.
I'm in total agreement with you. As I've noted in earlier posts, I've been working on this issue on and off since 1990 and don't see any good choices out there other than an NHS model or an insurance model with vouchers. both approaches work in Europe and there tends to be satisfaction with those models. Similarly the provincial model of insurance in Canada works well. We have a number of friends who live in both Ontario and Quebec and they are extremely satisfied with their healthcare. A couple of them had critical care in the hospital and it was delivered in a timely manner and with a positive outcome. I cannot see how any of the past proposals from the Republicans (health savings accounts, insurance across state lines, high risk pools, etc) will work. As I've noted, Obamacare was a kludge and not my preferred way of doing things but it worked for my daughters and a number of their friends who are self-employed.
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I'm in total agreement with you. As I've noted in earlier posts, I've been working on this issue on and off since 1990 and don't see any good choices out there other than an NHS model or an insurance model with vouchers. both approaches work in Europe and there tends to be satisfaction with those models. Similarly the provincial model of insurance in Canada works well. We have a number of friends who live in both Ontario and Quebec and they are extremely satisfied with their healthcare. A couple of them had critical care in the hospital and it was delivered in a timely manner and with a positive outcome. I cannot see how any of the past proposals from the Republicans (health savings accounts, insurance across state lines, high risk pools, etc) will work. As I've noted, Obamacare was a kludge and not my preferred way of doing things but it worked for my daughters and a number of their friends who are self-employed.
Alan, I have to respond to this.
First, I do agree that what the Republicans are currently proposing, or at least have in the past, is not really going to effect the pricing. Buying across state lines never made any sense since all states have different health care regulations that need to be followed. The exception might be those whom live at a border and can easily travel to a neighboring state for health services. Also, high risk pools only work if low risk people join as well, but that was the intent of the ACA exchanges, and we all see what that is turning into, a kludge as you put it.
However, I do remember you writing that your daughters purchased their insurance from the private market place. Unless your daughters have pre-existing conditions, how could the ACA have actually helped?
Prior to the ACA, you could just as easily purchased insurance in the private market as you can now.
Additionally, if you mention geography issues, I also remember you mentioning they (or at least one) use to live in Philly, my current home, and I had no problem finding insurance prior to the ACA.
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Alan, I have to respond to this.
First, I do agree that what the Republicans are currently proposing, or at least have in the past, is not really going to effect the pricing. Buying across state lines never made any sense since all states have different health care regulations that need to be followed. The exception might be those whom live at a border and can easily travel to a neighboring state for health services. Also, high risk pools only work if low risk people join as well, but that was the intent of the ACA exchanges, and we all see what that is turning into, a kludge as you put it.
I still don't understand the across state line thing. The greatest number of companies in the country are the BlueCross/BlueShield plans. Some are non-profit other not. Most are confined to very narrow geographic territories except the Texas one which I think is one of the four largest insurers in the country. I find it difficult to believe that a BC/BS plan in Minnesota would want to operate in Wisconsin. they would have to establish new networks and so on. The other main point is that most of the big corporate insurers already operate in multiple states. I think you don't understand the high risk pools. These are ONLY for high risk people and would be underwritten by the state. This concept was tried in the past and was pretty much a failure as the states that ran them quickly ran out of money. Maybe this is something the Federal government would do. Some patients cost $100K/year to take care of.
However, I do remember you writing that your daughters purchased their insurance from the private market place. Unless your daughters have pre-existing conditions, how could the ACA have actually helped?
Prior to the ACA, you could just as easily purchased insurance in the private market as you can now.
Additionally, if you mention geography issues, I also remember you mentioning they (or at least one) use to live in Philly, my current home, and I had no problem finding insurance prior to the ACA.
Both of their policies are ACA compliant and cover women's health things which was not a requirement prior to the ACA. They did not purchase them through an exchange as they did not qualify for a subsidy (which in my mind would be the only reason to do it that way). Their premiums were lower than they would have been pre-ACA. Now I can understand that a man of the same age would be paying more for ACA compliant policies as he would not need those services. Yes, you are correct that people living in large Metro areas usually did not have any issues purchasing insurance before the ACA. The lack of choice of insurers through the ACA is really a function of large insurers not wanting to service small population areas. Most of the complaints about the ACA come from those living in more rural areas and likely they had issues getting insurance prior to the ACA.
I wish there were an easy solution to all of this. Part of the problem with US competitiveness is that we pay too much for health care. It used to be a contentious issue during union negotiations but since unions are disappearing these days, management pretty much can do what they want. There was a story some years back on a GM plant in Ontario Canada (Buick, I think) and it was the most productive of all the GM plants. They were talking with the union representative about this and he said it was pretty simple, then never had to discuss health care. It's the same with many EU industries, health care is already taken care of. A lot of conservatives tend to overlook this fact.
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Surely the important questions that remain are...
... will Trump's presidency lead to civil war? It seems inevitable that there will be riots at some stage.
... will Trump's presidency lead to states leaving the union? It's becoming more and more clear that there are very different ideals between the coasts and the heartland, perhaps irreconcilable differences.
... will Trump's presidency lead to things being fixed in what presidents can achieve via executive order? And will any of those that Obama signed off on that Trump is now exploiting be ear marked for being dissolved?
... how quickly will Trump's presidency lead to NATO being broken up? Look at how Europe is reacting to Trump.
and finally...
... will Trump's presidency lead to World War III?
I'm just waiting for Russia to fully invade Ukraine and for Trump to go "Not My Problem" and for the USA to be too caught up in dealing with Trump to care. Where will Putin stop?
Trump is going to be a gift from God to Putin.
Yes, there's lots of flame bait and maybe trolling in the above questions, BUT, when you look at how the country is reacting, you can't help but wonder if it is really all that far fetched.
Come back and tell us in 10 years, that is if Emperor Trump hasn't decided to ignore the 2-term limit. He filed with the FEC for re-election in 2020 just 5 hours after he was sworn in - even without the Republican party deciding if they want to back him. Have you seen the "Dial 1-800" TV ads for donations to support Trump because he is being attacked?
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Are you telling me he can't fire the head of the National Park Service?
When people are being fired because they are doing The Right Thing in disobeying orders, then something is very wrong. In times like this disobedience is essential to making people aware that the orders being given are wrong.
Look at what is going on with the airports and DHS.
The CBP/DHS are ignoring judges and judges are ordering in federal marshals in. How do you think that is going to go down? That the CBP/DHS are blindly following orders from the president and not the courts means that "rule of law" has broken down.
When "rule of law" breaks down in a country, you have a regiem. When most news services talk about foreign countries and regiems, said countries have dictators running them.
The 2nd amendment exists for a reason and that reason is not to do with defending your home, it is to do with overthrowing tyrannical governments.
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... will Trump's presidency lead to civil war?
No. We will complain/bitch/whine as is our right. When the mid-term congressional elections come around, there will probably be a change in power just like in 2009. Americans tend not to like having the same party holding the Executive Office and both houses of Congress.
... will Trump's presidency lead to states leaving the union?
No. States do not have the legal ability to unilaterally leave the union. Texas V White (1869)
... will Trump's presidency lead to things being fixed in what presidents can achieve via executive order?
Probably not. An EO is a statement on how the Executive Branch will enact existing laws. There can't be an EO without supporting legislation. Executives on both sides use and abuse EOs. Neither side will insist on rule changes that can ultimately, in the future, affect their candidate.
... how quickly will Trump's presidency lead to NATO being broken up?
NATO will continue to exist. The US involvement may change and certainly our influence may change.
... will Trump's presidency lead to World War III?
Impossible to tell how some other country may decide to start a war. It is doubtful that the US will start a world war. Small OOTW are more to our advantages.
"Come back and tell us in 10 years, that is if Emperor Trump hasn't decided to ignore the 2-term limit."
People said the same thing about Bush and Obama. Neither of them even hinted at ignoring the law. We do not need the president's consent to limit their terms to two.
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Come back and tell us in 10 years, that is if Emperor Trump hasn't decided to ignore the 2-term limit. He filed with the FEC for re-election in 2020 just 5 hours after he was sworn in - even without the Republican party deciding if they want to back him. Have you seen the "Dial 1-800" TV ads for donations to support Trump because he is being attacked?
My feeling and a lot of friends here in Washington who are also politically astute do not believe Trump will serve out his first term. Unless he does something more than he has about his business interests he may get caught up in an ethics issue that he cannot get out of. There is increasing pressure on him to release his tax returns (437K have signed a petition on the White House website requesting that he release his tax returns. The petition is active for 30 days after which the White House is supposed to respond providing a 100K threshold has been met. this shows that his statement that "only the press cares about my tax returns" is false). We don't know what his tax returns contain but there could be some embarrassing information about loans from foreign banks. His family is being savaged on social media. Perhaps that doesn't matter to him but I wonder what the family members feel.
There are a fair number of Republicans who are tired of all the antics and they may also put pressure on him. I'm skeptical that he will be impeached but some experts believe that's possible. Anyway, him running for a third term is as close to zero possibility as there is in the world.
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In order for a president to be impeached and removed from office, the president has to be found guilty, by the Senate, of committing "High Crimes and Misdemeanors" and that bar is pretty high. So high that we have never done it in our history.
Being stupid, ineffectual, biased, egotistical, worthless, or a danger to humanity itself are not causes for impeachment. A good thing or we would be going through presidents like M&Ms.
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In order for a president to be impeached and removed from office, the president has to be found guilty, by the Senate, of committing "High Crimes and Misdemeanors" and that bar is pretty high. So high that we have never done it in our history.
Being stupid, ineffectual, biased, egotistical, worthless, or a danger to humanity itself are not causes for impeachment. A good thing or we would be going through presidents like M&Ms.
Well, he seems to be providing homegrown and Middle-Eastern terrorists enough reasons to act upon.
Let's make discrimination (https://www.google.nl/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwjmodSwhurRAhWJXBoKHVFyDL0QFggnMAE&url=https%3A%2F%2Fwww.washingtonpost.com%2Fnews%2Fthe-fix%2Fwp%2F2017%2F01%2F29%2Ftrump-asked-for-a-muslim-ban-giuliani-says-and-ordered-a-commission-to-do-it-legally%2F&usg=AFQjCNEwdR5VGZS7-qtSsEvyDsfmgqH9Cg) great again ..., but try to frame it in a way that it looks legal.
Also strange is that he's targeting people from countries that have not committed any attacks inside the USA, unlike countries where he seems to have personal business interests, like Saudi Arabia, and other Gulf state sponsors of terrorism. Here's some more factchecking (https://www.washingtonpost.com/news/fact-checker/wp/2017/01/29/what-you-need-to-know-about-terror-threat-from-foreigners-and-trumps-executive-order/?hpid=hp_rhp-top-table-main_fc-threat-232pm%3Ahomepage%2Fstory&utm_term=.334cd6853b8a).
Cheers,
Bart
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Perhaps leaving a question mark over tax declarations is being maintained as a rapid - and possibly convenient - exit strategy, should he tire of playing politics within a month or so.
After all, once you've achieved the goal of being the most powerful employee in the world, could be that the "freedom" of self-employment becomes irresistible again - and far more enjoyable (and much less aging). A plus might be that he will end up with a better security guard than might be available via the private sector, too. If you have to have one anyway, then what's not to like about a connected one?
I wonder if those chaps need to buy more jackets than trousers: the way they appear permanently to be clutching the lapels of their suits must wear the fronts out far more rapidly than the rest of the garment. Just an observation; you know, the paparazzo-in-the-soul bit showing through...
;-)
Rob C
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Well, he seems to be providing homegrown and Middle-Eastern terrorists enough reasons to act upon.
Let's make discrimination (https://www.google.nl/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwjmodSwhurRAhWJXBoKHVFyDL0QFggnMAE&url=https%3A%2F%2Fwww.washingtonpost.com%2Fnews%2Fthe-fix%2Fwp%2F2017%2F01%2F29%2Ftrump-asked-for-a-muslim-ban-giuliani-says-and-ordered-a-commission-to-do-it-legally%2F&usg=AFQjCNEwdR5VGZS7-qtSsEvyDsfmgqH9Cg) great again ..., but try to frame it in a way that it looks legal.
Also strange is that he's targeting people from countries that have not committed any attacks inside the USA, unlike countries where he seems to have personal business interests, like Saudi Arabia, and other Gulf state sponsors of terrorism. Here's some more factchecking (https://www.washingtonpost.com/news/fact-checker/wp/2017/01/29/what-you-need-to-know-about-terror-threat-from-foreigners-and-trumps-executive-order/?hpid=hp_rhp-top-table-main_fc-threat-232pm%3Ahomepage%2Fstory&utm_term=.334cd6853b8a).
Cheers,
Bart
That list of countries is also predominantly those that are Shia Islam, not Sunni Islam and as such, looks more like a continuation of the "Saudia Arabia vs Iran" problem in the middle east.
Why the USA continues to get involved in that little family/religious spat, I do not know.
Compare the map of banned countries with the map of Islam relgious houses:
(https://en.wikipedia.org/wiki/Shia_Islam#/media/File:Madhhab_Map3.png)
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Well, he seems to be providing homegrown and Middle-Eastern terrorists enough reasons to act upon.
http://www.theonion.com/article/fbi-uncovers-al-qaeda-plot-to-just-sit-back-and-en-35788
.
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Funny, I thought I had linked to Mark Thoma's blog where he aggregated comments from a number of sources. I didn't see any links to a Krugman comment. Anyway here is a statistic from Janet Yellen when she headed up the San Francisco Fed,
" Most important, the lenders subject to CRA have engaged in less, not more, of the most dangerous lending. Janet Yellen, president of the San Francisco Federal Reserve, offers the killer statistic: Independent mortgage companies, which are not covered by CRA, made high-priced loans at more than twice the rate of the banks and thrifts. With this in mind, Yellen specifically rejects the "tendency to conflate the current problems in the sub-prime market with CRA-motivated lending." ...
Yellen is hardly alone... One of the only regulators who long ago saw the current crisis coming was the late Ned Gramlich... But Gramlich praised CRA...
It's telling that, amid all the recent recriminations, even lenders have not fingered CRA. That's because CRA didn't bring about the reckless lending at the heart of the crisis. Just as sub-prime lending was exploding, CRA was losing force... And the worst offenders, the independent mortgage companies, were never subject to CRA -- or any federal regulator. Law didn't make them lend. The profit motive did. ..."
We can trade quotes forever Alan. I can muster just as many to support my positon as you can to support yours.
You opening position on this is was: "Other than Peter Wallinson at AEI who is delusional on this point, numerous experts on the housing industry have totally debunked this viewpoint."
Well, its not totally debunked at all. Opinions differ. No one it taking the banks off the hook. Rather some are pointing out that abused governmental policy and the law of unintended consequence had a big part to play. It does not suprise me at all to see liberals and big government types looking to absolve the goverenment of blame.
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My feeling and a lot of friends here in Washington who are also politically astute do not believe Trump will serve out his first term. Unless he does something more than he has about his business interests he may get caught up in an ethics issue that he cannot get out of. There is increasing pressure on him to release his tax returns (437K have signed a petition on the White House website requesting that he release his tax returns. The petition is active for 30 days after which the White House is supposed to respond providing a 100K threshold has been met. this shows that his statement that "only the press cares about my tax returns" is false). We don't know what his tax returns contain but there could be some embarrassing information about loans from foreign banks. His family is being savaged on social media. Perhaps that doesn't matter to him but I wonder what the family members feel.
There are a fair number of Republicans who are tired of all the antics and they may also put pressure on him. I'm skeptical that he will be impeached but some experts believe that's possible. Anyway, him running for a third term is as close to zero possibility as there is in the world.
There is no law or requirement that Trump must post his tax returns. It is totally up to him. Lets get real. A "fair number of Rebublicans" were tired of him before the primary was over. He has been pressured fron day one and I don't think he will buckle. He is not working for the political class, or those who have made Washington their life. He is working for people like me.
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He is working for himself.
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Interesting podcast featuring a couple of legal experts from past administrations: http://www.npr.org/2017/01/19/510574687/ethics-lawyers-call-trumps-business-conflicts-nakedly-unconstitutional (http://www.npr.org/2017/01/19/510574687/ethics-lawyers-call-trumps-business-conflicts-nakedly-unconstitutional)
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He is working for himself.
Exactly what does he have to gain?
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There is no law or requirement that Trump must post his tax returns. It is totally up to him. ...
I am not american so have no oar in this lake, but do you think that this makes it ok then?
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Interesting podcast featuring a couple of legal experts from past administrations: http://www.npr.org/2017/01/19/510574687/ethics-lawyers-call-trumps-business-conflicts-nakedly-unconstitutional (http://www.npr.org/2017/01/19/510574687/ethics-lawyers-call-trumps-business-conflicts-nakedly-unconstitutional)
some legal experts from some past administration were also clearing waterboarding, etc
those "experts" are always in smb's pocket.
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I am not american so have no oar in this lake, but do you think that this makes it ok then?
Yes. Tax returns are personal information. If one chooses to make them public, good for them. If one declines also good for them. In the end the people have spoken and elected Trump without needing to see his tax returns. Game over.
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Exactly what does he have to gain?
Seriously, you don't know?
Cheers,
Bart
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Seriously, you don't know?
Cheers,
Bart
Tell us....
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Tell us....
certainly not the shnobel prize... Obama & Walesa are enough ;D
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We can trade quotes forever Alan. I can muster just as many to support my positon as you can to support yours.
You opening position on this is was: "Other than Peter Wallinson at AEI who is delusional on this point, numerous experts on the housing industry have totally debunked this viewpoint."
Well, its not totally debunked at all. Opinions differ. No one it taking the banks off the hook. Rather some are pointing out that abused governmental policy and the law of unintended consequence had a big part to play. It does not suprise me at all to see liberals and big government types looking to absolve the goverenment of blame.
It's not quotes Craig. Virtually all housing economists have demonstrated that the CRA was not responsible for the financial meltdown. This is not an issue of liberal v conservative but one of facts regarding who was doing the mortgage underwriting. The bad mortgages were coming from Countrywide, Wachovia, Washington Mutual and IndyMac They were abetted by the companies that were packaging these bonds and the ratings agencies that were giving them AAA ratings despite having no clue that that many of the tranches that made up the securities were poisoned fruit. Furthermore there were fools such as Lehman and AIG that were writing insurance policies on these bonds thinking that they would never default. But default they did and the whole house of cards came tumbling down. All of these were corporations in the private sector and I fail to see how 'Big Government' was involved in a private sector collapse. Now maybe we should have let nature take its course and not have done anything back in 2008 and see what would have happened. We could have let GM and Chrysler fail and not have bailed out AIG or forced some of the bank mergers that took place after the failure of Lehman. Now perhaps you would have wanted to see this happen as a test case that markets correct themselves. Had that come to pass you would be living in a completely different world today.
You can continue to cling to the fantasy that the CRA and your other 'alternate facts.' I'm pretty damn happy that the government stepped in but saddened that they didn't do a larger stimulus to get the country righted faster than it has.
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It's not quotes Craig. Virtually all housing economists have demonstrated that the CRA was not responsible for the financial meltdown. This is not an issue of liberal v conservative but one of facts regarding who was doing the mortgage underwriting. The bad mortgages were coming from Countrywide, Wachovia, Washington Mutual and IndyMac They were abetted by the companies that were packaging these bonds and the ratings agencies that were giving them AAA ratings despite having no clue that that many of the tranches that made up the securities were poisoned fruit. Furthermore there were fools such as Lehman and AIG that were writing insurance policies on these bonds thinking that they would never default. But default they did and the whole house of cards came tumbling down. All of these were corporations in the private sector and I fail to see how 'Big Government' was involved in a private sector collapse. Now maybe we should have let nature take its course and not have done anything back in 2008 and see what would have happened. We could have let GM and Chrysler fail and not have bailed out AIG or forced some of the bank mergers that took place after the failure of Lehman. Now perhaps you would have wanted to see this happen as a test case that markets correct themselves. Had that come to pass you would be living in a completely different world today.
You can continue to cling to the fantasy that the CRA and your other 'alternate facts.' I'm pretty damn happy that the government stepped in but saddened that they didn't do a larger stimulus to get the country righted faster than it has.
It's not a fantasy Alan, it's fact. The CRA set the stage, weakened underwriting and then fanny and Freddy showed the banks how to repackage. This is undeniable whether you want to accept it or not.
Like i said, no one is giving the banks a pass. But it's time to be honest where this started. Your statement " I fail to see how big government was involved" pretty much says it all. This discussion has run its course.
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It's not a fantasy Alan, it's fact. The CRA set the stage, weakened underwriting and then fanny and Freddy showed the banks how to repackage. This is undeniable whether you want to accept it or not.
Like i said, no one is giving the banks a pass. But it's time to be honest where this started. Your statement " I fail to see how big government was involved" pretty much says it all. This discussion has run its course.
Enjoy your 'alternate facts' universe.
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Enjoy your 'alternate facts' universe.
Enjoy your "big government is right" universe.
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I really think big government supporters fail to see the fact that the government initiated the cause for the recession, or at least created an environment that allowed it flourish. Of course Kurgman and his cohorts are never going to come out and say this, but they are big government guys and never blame anyone but big business. It's never the governments fault.
The government, through their policies, produced an environment of lax banking checks. The government is not directly responsible for the greed that took place at the banks and the financial stupidity of those too naive or lazy to understand a mortgage agreement (and I put both banks and those who borrowed equally at fault), but they sure encouraged it. Through Franny and Freddy, they supported an environment that pushed off the crash much further then it should have, and both Clinton and Bush felt every American should own a home regardless of the cost.
Same thing happened in the 1920s. It was obvious to those paying attention the stock market was inflated in the early 20s, but the Fed decided to cut interest rates and increase money supply to spur off a recession, hoping that the economy would just flat line for a while. Unfortunately, and unforeseen to them, this only made it easier to borrow money, which then went to stock market and derivative betting, and made the problem worse. The greed that lead to the depression was not the governments fault, but the environment they created allowed it flourish. If you took away the easy money from the Fed in the early 20s, the crash would have happened sooner. Milton Friedman spoke and wrote on this many times.
I think one of the reasons why so many big government economist ignore this is because they believe a complicated economy can be controlled. It is an insult to their intelligence that it can not, and their arrogance prevents them from accepting the fact that they can not control it. Unfortunately for us who actually make this economy go round and don't have cushy University jobs to fall back on, the law of (their) unintended consequences has an adverse effect on us.
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Same thing use to happen in the ASMP, my professional organization. Prior to a few years ago, anyone involved in the photography world could get on the board and issue suggestions and what not. Some of the recommendations on how to operate business were off the charts crazy, but those making the suggestions were photography professors, not professionals, or at the very least did not have to worry about making a profit due to other reasons (rich spouse, etc.).
They had no real experience making it as a pro, and never felt the fire under their ass to get out there, find clients, negotiate contracts and perform.
Thankfully it was put in place that you needed to make over 50% of your income directly from image making and they slowly phased out of leadership positions.
I give the same creditability, which is zero, to any college professor that has never had a leadership role in a successful business who gives business advice. They have no practical knowledge, no real experiences, only theoretical ones, and that does not cut. Like the man who questioned Sander's a week ago said, "you've never lived until you put payroll on your personal credit card."
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Exactly what does he have to gain?
The only thing that matters to Trump - making himself feel like he's winning, that he's better than everyone else, that he's the greatest. That's his entire business and personal life wrapped up - narcissist.
There's nothing specifically wrong with that, right up until the point where he does something that hurts others.
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The only thing that matters to Trump - making himself feel like he's winning, that he's better than everyone else, that he's the greatest. That's his entire business and personal life wrapped up - narcissist.
There's nothing specifically wrong with that, right up until the point where he does something that hurts others.
I think it goes beyond that, at least in this case. But that's just my personal opinion.
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I really think big government supporters fail to see the fact that the government initiated the cause for the recession, or at least created an environment that allowed it flourish. Of course Kurgman and his cohorts are never going to come out and say this, but they are big government guys and never blame anyone but big business. It's never the governments fault and never is it possible for an entire group of people to develop a mindset that would have a negative reaction on them. (But of course, they always praise a group of people that develop a mindset that produces a positive reaction, funny how it never works the other way.)
The government, through their policies, produced an environment of lax banking checks. The government is not directly responsible for the greed that took place at the banks and the financial stupidity of those too naive or lazy to understand a mortgage agreement (and I put both banks and those who borrowed equally at fault), but they sure encouraged it. Through Franny and Freddy, they supported an environment that pushed off the crash much further then it should have, and both Clinton and Bush felt every American should own a home regardless of the cost.
Same thing happened in the 1920s. It was obvious to those paying attention the stock market was inflated in the early 20s, but the Fed decided to cut interest rates and increase money supply to spur off a recession, hoping that the economy would just flat line for a while. Unfortunately, and unforeseen to them, this only made it easier to borrow money, which then went to stock market and derivative betting, and made the problem worse. The greed that lead to the depression was not the governments fault, but the environment they created allowed it flourish. If you took away the easy money from the Fed in the early 20s, the crash would have happened sooner. Milton Friedman spoke and wrote on this many times.
I think one of the reasons why so many big government economist ignore this is because they believe a complicated economy can be controlled. It is an insult to their intelligence that it can not, and their arrogance prevents them from accepting the fact that they can not control it. Unfortunately for us who actually make this economy go round and don't have cushy University jobs to fall back on, the law of (their) unintended consequences has an adverse effect on us.
I'll try to make this simple if this is at all possible. There were a number of economists who called the housing bubble as early as 2004. A couple of these were academic economists such as Robert Shiller who has published extensively on housing prices and is co-developer of the Case-Shiller housing index that is used by many to track housing prices. Others including Dean Baker and Bill McBride are independent economists and can in no way be called 'big government economists'. It is most instructive to read Bill McBride's Calculated Risk historical blog posts(I do so every day as it is a valuable synthesis of all types of economic data). He had a collaborator, Tanta (aka Doris Dungey), who was an experienced mortgage underwriter whose life was taken way too early. She had expertise in the area and her collective posts covered a lot of what was wrong in that industry. Bill McBride's singular post summing up the subprime debacle is here: http://www.calculatedriskblog.com/2010/12/commentary-subprime-thinking.html
There is a huge amount of source material out there and I follow most of it for investment purposes as I am in the "trust but verify" school of investing. I take issue with a lot of what you have stated but if you point to any original source material that back up those contentions I will gladly revisit things. The blunt fact is that the CRA had nothing to do with the meltdown. Mortgage underwriting standards are not controlled by the government. NINJA (No Income No Job no Assets) loans were made by the private sector. The quasi-government entities Fannie and Freddie have standards regarding what kind of mortgages they will purchase from lenders and then seculritize. The real toxic mortgages were not purchased by those two but rather repackaged by others into the complicated bonds that were given AAA ratings despite the ratings agencies not knowing what was in them. No government role here as it was all the glorious private sector.
You guys have worn me out on this. I'll let this be the final post on the matter. If anyone is interest, I can provide a lot of resources (send me a PM) For those who want to live in their alternate fact universe that's fine too. I've got better things to do in looking after my investment portfolio than in trying to educate those who don't want to be educated.
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The only thing that matters to Trump - making himself feel like he's winning, that he's better than everyone else, that he's the greatest. That's his entire business and personal life wrapped up - narcissist.
There's nothing specifically wrong with that, right up until the point where he does something that hurts others.
Phil, I agree but it's leading to some pretty delusional behavior. He's also surrounding himself with an inner circle that is only reinforcing his behavior. The bigger question is whether any of the Republicans in Congress will stand up to him. take the tax return issue; he said the only ones who cared about those were the press (of course they have good reason to). However, the petition page on the WhiteHouse.gov website now has 460,000 signatures (https://petitions.whitehouse.gov/petition/immediately-release-donald-trumps-full-tax-returns-all-information-needed-verify-emoluments-clause-compliance ) Once the thirty days are up the White House is supposed to respond to the petition. We'll see if that happens.
There are a lot of us who think we live in a very dark time right now which is why the demonstrations have been so large. I certainly cannot remember any point in my life that I felt our government sitting on a fragile edge.
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There is a huge amount of source material out there and I follow most of it for investment purposes as I am in the "trust but verify" school of investing. I take issue with a lot of what you have stated but if you point to any original source material that back up those contentions I will gladly revisit things. The blunt fact is that the CRA had nothing to do with the meltdown. Mortgage underwriting standards are not controlled by the government. NINJA (No Income No Job no Assets) loans were made by the private sector. The quasi-government entities Fannie and Freddie have standards regarding what kind of mortgages they will purchase from lenders and then seculritize. The real toxic mortgages were not purchased by those two but rather repackaged by others into the complicated bonds that were given AAA ratings despite the ratings agencies not knowing what was in them. No government role here as it was all the glorious private sector.
I dont negate any of this. I just add to the premise that the government had some culpability in the meltdown with overly encouraging home ownership without thinking about any consequences. They created an environment where bad loans and bad borrowers could thrive. Maybe not wrongdoing, but negligence.
You are suggesting government had no guilt what so ever, which I consider wrong.
It's just like my brother who insist only the banks were at fault and the borrowers hold no culpability what so ever. I mean they were targeted right, so how could they be at fault? However I hold both the banks and the borrowers guilty. I consider it a requirement to have a certain level competency in mathematics and finance to be considered intelligent and if you fail to obtain those by the time you're an adult, you are at fault for it.
I think this recession is a great example of "never underestimate the power of stupid people in large numbers." As a former mathematics teacher, trust me, there are a lot of stupid people out there. And it annoys me to no end that we as a culture consider it acceptable to be deficient in mathematics. "Oh, I am horrible at math, don't give me a math problem, I won't be able to do it."
You never hear, "oh, I can't read, don't give me a book, I would not be able to read it." Saying the phrase above should be just as embarrassing as saying the this.
Insofar as the economists you just list, I do not consider them (very) to big government, however you did mention Krugman, whom I view as extremely biased.
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Insofar as the economists you just list, I do not consider them (very) to big government, however you did mention Krugman, whom I view as extremely biased.
I'm breaking my rule. I never cited Krugman as a source. Someone else said that I did and I point out that the link I posted was from Mark Thoma, professor of Econ at Oregon. Krugman is opinionated (and he admits so) as he writes an op-ed column and blog. I have never seen anyone dispute his academic work as biased.
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I'm breaking my rule. I never cited Krugman as a source. Someone else said that I did and I point out that the link I posted was from Mark Thoma, professor of Econ at Oregon. Krugman is opinionated (and he admits so) as he writes an op-ed column and blog. I have never seen anyone dispute his academic work as biased.
Okay, sorry about this. I did not read back to check. With that said, I am not a fan of his school of thought on economics.