As Obamacare goes into effect, new criticisms leveled

[WhoWee]

No doubt, this plan gets more than the national average, as its riskier to the insurance company. But I didn't actually make the claim, I asked you- what is your point? This plan exists, what conclusions am I supposed to draw from it?

I posted the plan to demonstrate the rich benefits - $0 deductible and lots of $0 co-pays. I don't believe the insurance companies are in favor of this plan structure - regardless of the contract amount.

Perhaps I should have posted a plan to compare it with - here's a $0 premium plan from the Cleveland, OH area - hospital is $220 per day for the first 8 days:

"Physician and Hospital Costs:

Explains details for Physician and Hospital Costs Primary Care Physician: Specialist: Hospitalization:


$10.00 Copay per visit $40.00 Copay per visit $220.00 per day, days 1-8

Amounts apply after any applicable deductible.


--------------------------------------------------------------------------------

Outpatient Mental Health Care
General
Information for Outpatient Mental Health CareAuthorization rules may apply.
In-Network
Benefits for Outpatient Mental Health Care$40 copayment for each Medicare-covered individual or group therapy visit.
Outpatient Services/Surgery
General
Information for Outpatient Services/SurgeryAuthorization rules may apply.
In-Network
Benefits for Outpatient Services/Surgery$150 copayment for each Medicare-covered ambulatory surgical center visit.
$50 to $200 copayment or 20% of the cost for each Medicare-covered outpatient hospital facility visit.
Ambulance Services
General
Information for Ambulance ServicesAuthorization rules may apply.
In-Network
Benefits for Ambulance Services$100 copayment for Medicare-covered ambulance benefits.
Emergency Care
General
Information for Emergency Care$50 copayment for Medicare-covered emergency room visits.Worldwide coverage.If you are admitted to the hospital within 24-hour(s) for the same condition, you pay $0 for the emergency room visit
Outpatient Rehabilitation Services
General
Information for Outpatient Rehabilitation ServicesAuthorization rules may apply.
In-Network
Benefits for Outpatient Rehabilitation Services$40 to $150 copayment for Medicare-covered Occupational Therapy visits.
$40 to $150 copayment for Medicare-covered Physical and/or Speech and Langauge Therapy visits.
$40 to $150 copayment for Medicare-covered Cardiac Rehab services.
Durable Medical Equipment
General
Information for Durable Medical EquipmentAuthorization rules may apply.
In-Network
Benefits for Durable Medical Equipment20% of the cost for Medicare-covered items.
Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies
General
Information for Diabetes Self-Monitoring Training, Nutrition Therapy, and SuppliesAuthorization rules may apply.
In-Network
Benefits for Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies$0 copayment for Diabetes self-monitoring training.
$0 copayment for Nutrition Therapy for Diabetes.
$0 to $10 copayment or 20% of the cost for Diabetes supplies.
Colorectal Screening Exams
In-Network
Benefits for Colorectal Screening Exams$0 copayment for Medicare-covered colorectal screenings.
Immunizations
In-Network
Benefits for Immunizations$0 copayment for Flu and Pneumonia vaccines.
No referral needed for Flu and pneumonia vaccines.
$0 copayment for Hepatitis B vaccine.
Mammograms (Annual Screening)
In-Network
Benefits for Mammograms (Annual Screening)$0 copayment for Medicare-covered screening mammograms.
Inpatient Hospital Care
In-Network
Benefits for Inpatient Hospital CareNo limit to the number of days covered by the plan each benefit period.
For Medicare-covered hospital stays:
Days 1 - 8: $220 copayment per day
Days 9 - 90: $0 copayment per day
$0 copayment for each additional hospital day.Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.
Skilled Nursing Facility (SNF)
General
Information for Skilled Nursing Facility (SNF)Authorization rules may apply.
In-Network
Benefits for Skilled Nursing Facility (SNF)Plan covers up to 100 days each benefit period
No prior hospital stay is required.For SNF stays:
Days 1 - 8: $0 copayment per day
Days 9 - 100: $50 copayment per day
Home Health Care
General
Information for Home Health CareAuthorization rules may apply.
In-Network
Benefits for Home Health Care$0 copayment for each Medicare-covered home health visit.
Chiropractic Services
General
Information for Chiropractic ServicesAuthorization rules may apply.
In-Network
Benefits for Chiropractic Services$10 copayment for each Medicare-covered visit.Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers."

Here is the Summary of Benefits link:

https://www.humana-medicare.com/BenefitSummary/2011PDFs/H8953002SBOSB11.pdf

The residents of Puerto Rico would clearly pay less for medical services than the people of the Cleveland, OH area - even though both would enjoy a $0 premium. Unfortunately, we don't know the contract amount for either plan.

 

[ParticleGrl]

I posted the plan to demonstrate the rich benefits - $0 deductible and lots of $0 co-pays. I don't believe the insurance companies are in favor of this plan structure - regardless of the contract amount.

Then why do they offer it? If they couldn't make money with it, they wouldn't offer it.

 

[nismaratwork]

Then why do they offer it? If they couldn't make money with it, they wouldn't offer it.

That... is a very good point.

 

[WhoWee]

Then why do they offer it? If they couldn't make money with it, they wouldn't offer it.

It seems there are 25 total Medicare Advantage plans with prescription benefitss included, available in Puerto Rico.

http://www.medicare.gov/find-a-plan/results/planresults/plan-list.aspx

 

[talk2glenn]

How do you define efficiency of healthcare delivery? I would argue that in the context we are discussing, the administrative costs are a good measure.

Even if I took that argument as given (which I don't, for obvious reasons administrative costs are a poor measure of efficiency of anything other than administration, including by definition efficiency of healthcare delivery), it is not true that administrative costs are lower in Medicare than in the private sector. Quite the opposite; they are substantially higher.

For the case of medicare, the remaining money is spent mostly on medical bills, obviously. For private insurance, the rest of the money won't be spent on medical bills, some of it is profit. It is obviously unfair to count profit as inefficiency.

This is silly. Forget for a moment than profit margins for private health insurance companies are tiny; what, pray tell, do you imagine profit is? It seems to me that the uneducated imagine "profit" to be some sort of wasteful, unnecesarry corporate overhead largesse thrown fruitlessly at fat cats, and that in its absence everybody could work much more efficiently.

Of course, in real life, profit is nothing more than payment for capital. Do even the tiniest bit of reasoning, and you'll realize that non-profits (charities and government offices) have capital costs that must be paid. Yes, they don't attract capital by investment; in the case of Medicare, it is borrowed or seized. In either case, there are costs. If seized by tax, we can look at the opportunity costs of the foregone alternatives. But the far more interesting case, in this context, is what happens when the government borrows.

In the private sector, we call debt servicing a capital cost, and build it into the health insurance industries administrative costs. Medicare does not internalize payments on government debt when accounting for its own costs, however. According to one source I found, if it did, administrative costs immediately rise 7 points to 10% of total cost:

First, Medicare's "capital costs" are not included in government estimates of Medicare spending. Here is a simplistic, but revealing example: federal net interest payments to the public -- the government's overall capital cost -- totaled $160 billion in fiscal year 2004. In that year, Medicare benefits (net of premiums collected from beneficiaries) comprised about 12 percent of federal non-interest spending. Therefore, Medicare's share of the government's debt-service costs could be estimated at about $19 billion in 2004. Adding these payments alone would boost Medicare's administrative cost rate by almost 7 percentage points, to just under 10 percent.

http://www.ahipresearch.org/pdfs/Administrative_Costs_030705.pdf

Note also that profits are usually internalized as well in studies of industry costs, such that the data usually reads "Administrative costs and profits".

Per patient administrative costs is obviously not a good metric. If I insure a pool of 22 year olds who makes no claims in an average year, my administrative cost can approach 0. The per CLAIM administrative cost would be a better number, but we can't get it from the CBO data above.

No, they can't, as explained above. A significant portion of overall administrative costs are consumed by activities other than paying claims.

BUT, what we can do is directly compare medicare advantage plans (through private companies) to the similar pool of medicare. Now we have the same demographics, I hope you would agree? What do we find- between 3 and 4% administrative costs for medicare, and about 11% for the private medicare advantage plans. Comparing these similar demographics, we find private companies spend more in administration per patient of the same demographic.

No, we don't. Normalize the comparison by excluding costs incurred only by the private sector, and incurring public sector capital costs, and you'll find the Medicare is significantly more expensive than private plans, assuming your initial numbers are accurate.

Of course the perfectly inelastic case doesn't exist. Generally, anything between 0 and -1 is considered inelastic. I would say -0.2 is extremely inelastic.

Er, no, it is not. It is considered relatively inelastic, as in, relative to everything greater than 1. Independently, you can't make any kind of value judgments - you can only say that it is elastic by definition.

Yes, eggs are famously inelastic. Largely because they are among the cheapest proteins, so there are no close substitutes, to follow the econ 101 logic (although I don't know an actual study of their inelasticity, could you provide one?) . Of course, if the price of eggs jumped above the price of chicken or beef, elasticity would set in. With health care, what do you think can explain the inelasticity? Is there a price where health care becomes more elastic? Given that it is obviously a necessity, with no substitutes, might the relative elasticity be due to people who are priced out of the market all together?

Eggs are a famous case, but there are innumerable goods and services with transaction point price elasticities between 0 and 0.2, approaching infinity. It is impossible and pointless to try and track them all; it varies by consumer, market, good, time, etcetera.

Eggs are famous only because they are useful to make a point - point price elasticity tells us very little about aggregate behavior over significant terms, does not imply that prices can or will rise to infinity, does not imply any kind of market failure or necesitate corrective action, and that there is no "magic number" at which we have acceptable and unacceptable price response behaviors.

Yes, all rational participants in the health care market invest the resources to get the MD required to understand the best course of action, and successfully negotiate with their provider and insurance company.

Is this serious, or satire? Is it really your claim that I need an advanced degree in architecture before I can choose a home? Real estate before I can buy it? Agriculture before I can shop for produce? Engineering before I can buy a car? Automotive mechanics before I can hire someone to repair it? Law before I can pick an attorney or make informed legal decisions?

Should I continue?

Right, but the routing is done by the ambulance, not the patient, on the basis of medical reasoning, not patient choice. If you call 911, you are going to where the ambulance takes you, whether or not they are in your provider network, or take whatever payment you have on you, etc. The choice is whether or not to call 911.

That's not the point; choices are made at some point by consumers to effectively maximize their utility. In a strategic game (defined as a game with more than one player - in this case, patients and ambulance drivers) it is elementary that the players' welfare can be increased by restricting their decisions. We call this the value of commitment.

In this case, patients choose to limit their choice of destination in an emergency ahead of time, and to let ambulance drivers know. This informs the decisions of ambulance drivers, and increases the payoff at the end of the game for everyone.

But this is all distraction: the point is, there exists strategic decision making, or "choices".

 

[ParticleGrl]

it is not true that administrative costs are lower in Medicare than in the private sector. Quite the opposite; they are substantially higher.

Even if we include the cost of government borrowing, as you suggest below, medicare still comes out a lower percentage than the private companies.

Since you don't agree that administrative costs are a good measure of efficiency, propose another measure.

Normalize the comparison by excluding costs incurred only by the private sector, and incurring public sector capital costs, and you'll find the Medicare is significantly more expensive than private plans, assuming your initial numbers are accurate.

Prove it- link me to such a study. There is a tremendous amount of data in the CBO report linked above, which I used in generating my percentages. Even including the cost of borrowing, Medicare comes out comparable to, and slightly lower than, the private medicare advantage plans.

Also, subtracting out costs only incurred by the private sectors removes the reasons to believe that medicare is a more efficient deliverer of care- it doesn't have to pay for marketing, assessing risk, etc.

Eggs are famous only because they are useful to make a point - point price elasticity tells us very little about aggregate behavior over significant terms, does not imply that prices can or will rise to infinity, does not imply any kind of market failure or necesitate corrective action, and that there is no "magic number" at which we have acceptable and unacceptable price response behaviors.

Except medical costs, both public and private, are growing 7+% per year, and have been since the 70s. Demand still is not markedly dropping. The only limit to the demand for services seems to be people who get priced out all together, which seems morally problematic.

But this is all distraction: the point is, there exists strategic decision making, or "choices".

By who? At no point do the people calling the ambulance have any choice- they don't chose where they fall ill or have an emergency. Once they call the ambulance, they have no choice on where they go. There is no opportunity to comparison shop, etc.

Btw, these are not new ideas, Kenneth Arrow (no lightweight) pointed out that the standard assumptions underlying a competitive market are violated in the case of healthcare. Non-market institutions are needed to maximize efficiency.

 

[WhoWee]

Has anyone considered the administrative costs charged to HHS, CMS, Medicaid, and Social Security in this discussion? The operations of all four are interlinked with Medicare along with the 50 state insurance agencies and Medicaid offices, plus DC, PR, Guam, etc.

 

[Al68]

It seems to me that the uneducated imagine "profit" to be some sort of wasteful, unnecesarry corporate overhead largesse thrown fruitlessly at fat cats, and that in its absence everybody could work much more efficiently.

People have been convinced of this by power hungry politicians, who themselves know that providing the same product for the same price without profit is impossible, which is why they haven't done it already.

I constantly notice that Democrats complain about profits, yet have no interest in trying to sell the same product, competing with for-profit businesses fairly, ie without the use of government force. Democrats know they can't actually offer consumers a better deal, it's just propaganda for the economically ignorant to gain power over them.

 

[nismaratwork]

People have been convinced of this by power hungry politicians, who themselves know that providing the same product for the same price without profit is impossible, which is why they haven't done it already.

I constantly notice that Democrats complain about profits, yet have no interest in trying to sell the same product, competing with for-profit businesses fairly, ie without the use of government force. Democrats know they can't actually offer consumers a better deal, it's just propaganda for the economically ignorant to gain power over them.

Change that to: "Excessive Profits not placed into the future wellbeing of the corporation, or the country." They're allowed to fight for every dollar, and we're allowed to try and tax or otherwise squeeze it back out.

The results speak for themselves; neither approach is working, but one side is doing well, and the other is in debt.

 

[ParticleGrl]

People have been convinced of this by power hungry politicians, who themselves know that providing the same product for the same price without profit is impossible, which is why they haven't done it already.

Maybe not in this country, but countries with larger public sectors of healthcare spend less on healthcare, AND have better outcomes. Many countries are getting a better product, at less cost, without profit.

http://www.photius.com/rankings/total_health_expenditure_as_pecent_of_gdp_2000_to_2005.html
http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
http://www.businessweek.com/technology/content/sep2006/tc20060920_545838.htm

 

[WhoWee]

Maybe not in this country, but countries with larger public sectors of healthcare spend less on healthcare, AND have better outcomes. Many countries are getting a better product, at less cost, without profit.

http://www.photius.com/rankings/total_health_expenditure_as_pecent_of_gdp_2000_to_2005.html
http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
http://www.businessweek.com/technology/content/sep2006/tc20060920_545838.htm

Healthcare spending as a percentage of GDP - do you have a breakdown of that spending?

What percentage is allocated to the following; R&D, continuing education, certification, regulatory compliance including HIPPA/MIPPA, capital investment, elective procedures, publishing, marketing, plus all of the Government related expenses - about 50% (?) of the total?

Again - please prepare an apples to apples comparison of cost and results. Is the cost of CDC allocated evenly to all who benefit (for instance)? Also, how much of the university medical budgets are included? Without specificity - these numbers are trash.

 

[ParticleGrl]

Healthcare spending as a percentage of GDP - do you have a breakdown of that spending?

The NIH and CDC budget together are a small drop in the bucket, maybe 40 billion out of the more than 2 trillion we spend on health care. This basically captures all the R&D and university medical research budgets.

Enrollment in medical schools is not considered part of the health care expense in these numbers, so continuing education and certification costs are likely trivial, but there isn't an obvious way to break them down.

As to subdividing the private costs, how do you propose to do this? If you have a point you want to make about these numbers- by all means do so.

 

[WhoWee]

The NIH and CDC budget together are a small drop in the bucket, maybe 40 billion out of the more than 2 trillion we spend on health care. This basically captures all the R&D and university medical research budgets.

Enrollment in medical schools is not considered part of the health care expense in these numbers, so continuing education and certification costs are likely trivial, but there isn't an obvious way to break them down.

As to subdividing the private costs, how do you propose to do this? If you have a point you want to make about these numbers- by all means do so.

One quick question. Do you agree the US Government accounts for about $1.1 Trillion of the direct spending on healthcare?

 

[ParticleGrl]

Yes, of course I do. The majority of the spending is medicare, followed by medicaid, and then health services for public employees. Of that, as we've discussed above, an average of 4% are administrative costs (which includes the government spending on complying with HIPPA, etc).

 

[nismaratwork]

So... WhoWee... you answer her question now?

 

[WhoWee]

So... WhoWee... you answer her question now?

Which one - not being trite.

 

[WhoWee]

Since we used a few Humana MAPD's in earlier examples - let's continue to look at them.

http://www.dailyfinance.com/company/humana-inc/hum/nys/10-Q/101155326/html/sec-filings

"Humana Inc.

CONDENSED CONSOLIDATED STATEMENTS OF INCOME

(Unaudited)




Three months ended
September 30, Nine months ended
September 30,
2010 2009 2010 2009
(in thousands, except per share results)
Revenues:

Premiums
$ 8,134,645 $ 7,444,122 $ 24,673,259 $ 22,557,943
Administrative services fees
121,815 133,732 374,441 368,308
Investment income
87,250 74,861 252,495 219,745
Other revenue
80,938 64,104 217,768 181,373

Total revenues
8,424,648 7,716,819 25,517,963 23,327,369

Operating expenses:

Benefits
6,637,470 6,111,351 20,304,590 18,748,206
Selling, general and administrative
1,074,188 1,047,773 3,363,021 3,115,918
Depreciation and amortization
64,557 62,088 196,603 180,580

Total operating expenses
7,776,215 7,221,212 23,864,214 22,044,704

Income from operations
648,433 495,607 1,653,749 1,282,665
Interest expense
26,143 26,259 78,679 79,605

Income before income taxes
622,290 469,348 1,575,070 1,203,060
Provision for income taxes
229,069 167,829 583,005 414,044

Net income
$ 393,221 $ 301,519 $ 992,065 $ 789,016

Basic earnings per common share
$ 2.35 $ 1.80 $ 5.90 $ 4.72

Diluted earnings per common share
$ 2.32 $ 1.78 $ 5.84 $ 4.67 "

To update a bit - Humana was one of the companies that slashed sales expenses at the end of 2010 - independent agent commissions were cut by about 50% on non-Medicare health plans. The Medicare commission structure is much less (only 20% to 40% of regular rates).

 

[ParticleGrl]

So there are some numbers- put them into perspective for me. What conclusions am I supposed to draw from your numbers?

 

[WhoWee]

So there are some numbers- put them into perspective for me. What conclusions am I supposed to draw from your numbers?

It's not specific enough either - looking for additional info such as a breakdown by policy type or industry segment.

 

[nismaratwork]

Which one - not being trite.

No problem: https://www.physicsforums.com/showpost.php?p=3144407&postcount=222

At the end. (I wouldn't think you'd be trite btw)

 

[Al68]

Change that to: "Excessive Profits not placed into the future wellbeing of the corporation, or the country."

You mean all those excess profits that nobody else wants? So much extra profit that there are no rich people greedy enough to compete for it? Profits so high that Democrats are unable to provide the same service for the same price without government force? My point was "put up or shut up". If Democrats really thought they could offer a better deal to consumers, they would do it (sans force) instead of bashing the companies they are unable to compete with, or trying to pass laws.

They're allowed to fight for every dollar, and we're allowed to try and tax or otherwise squeeze it back out.

We are? What claim do we have on the privately obtained wealth of others, obtained through completely voluntary private transactions? Other than billing them appropriately for services rendered (police, defense, fire protection, etc)?

This is one question nobody seems able to give a straight answer to. How is something that would be universally considered theft in the absence of a law authorizing it magically not theft because it was legalized? (I'm obviously not using the legal definition of theft here).

Is an action automatically not theft if government does it, despite the fact that the same exact action is universally considered theft if done by anyone else?

I can't help but be reminded of a http://quotes.liberty-tree.ca/quotes_by/frederic+bastiat" quote, in this same exact context: "When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."

It's difficult to improve of those words written by a dying Frenchman 160 years ago, that describe the U.S. Democratic Party to a T.

 

[WhoWee]

I'm not so sure there are "excess profits" in this discussion -
$ 789,016 in profit on $23,327,369 in revenue or about 3.3% sounds reasonable?

 

[nismaratwork]

You mean all those excess profits that nobody else wants? So much extra profit that there are no rich people greedy enough to compete for it? Profits so high that Democrats are unable to provide the same service for the same price without government force? My point was "put up or shut up". If Democrats really thought they could offer a better deal to consumers, they would do it (sans force) instead of bashing the companies they are unable to compete with, or trying to pass laws.We are? What claim do we have on the privately obtained wealth of others, obtained through completely voluntary private transactions? Other than billing them appropriately for services rendered (police, defense, fire protection, etc)?

Profits so high and concentrated in individuals that the it can be used to create lobbies and keep other from competing... or at least retard the process. Beyond that, there is no "right" to wealth, or poverty, or anything in between. It's all about what you can GET, for the people making profits, and those squeezign them for it.

The problem is the squeezing is largely ineffective. When there are hundreds of people with money in the bank that could bail out every state in the union, it's hard to take a kind view. When profits for the private sector explode, but that isn't re-invested into the this country, then we're just redistributing our wealth in the opposite of the 'dreaded' socialism. Then again, it seems that some are happier in an oligarchy than a democracy.

This is one question nobody seems able to give a straight answer to. How is something that would be universally considered theft in the absence of a law authorizing it magically not theft because it was legalized? (I'm obviously not using the legal definition of theft here).

Because we can; the same reason profits are made, and because the alternative to giving people the illusion that they are "digging" into the wealthy is revolt and crime. See piracy, and other black markets. Why can an entity like AIG be allowed to exist, and how can everyone involved in its destruction not be executed? (not under existing law of course). We live in a RARE country which dangles a dream that few can or will achieve. Why do you think the lottery is so popular, and why do you think it's so very preferable to have a nation with no future, but one that is easy to fleece?

If I were running a multinational now, I'd be thinking about how to best loot the USA in preparation for competing in Asia.

Is an action automatically not theft if government does it, despite the fact that the same exact action is universally considered theft if done by anyone else?

No, it's law, and to quote some 'great' right-wing "thinkers", "If you don't like it, git oooouuuuuttt." That goes for corporations too... pity they take jobs and wealth with them. Say, do you think that using Aruba as a grotesque tax shelter is theft, even though laws and regulations don't act properly?

I can't help but be reminded of a http://quotes.liberty-tree.ca/quotes_by/frederic+bastiat" quote, in this same exact context: "When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."

It's difficult to improve of those words written by a dying Frenchman 160 years ago, that describe the U.S. Democratic Party to a T.

It describes both parties, and above all what Eisenhower warned against... to quote him again...

A vital element in keeping the peace is our military establishment. Our arms must be mighty, ready for instant action, so that no potential aggressor may be tempted to risk his own destruction...
This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence — economic, political, even spiritual — is felt in every city, every statehouse, every office of the federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications. Our toil, resources and livelihood are all involved; so is the very structure of our society. In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist. We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted. Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals so that security and liberty may prosper together.

I think he has it on the Frenchman.

 

[nismaratwork]

I'm not so sure there are "excess profits" in this discussion -
$ 789,016 in profit on $23,327,369 in revenue or about 3.3% sounds reasonable?

I specifically am talking about a far more global set of executives and private interests, including the private sector of health care. I'm also talking about the inability to negotiate pharmaceutical prices with Canada under the rubric of "safety"... which makes me laugh in a truly bitter way.

At every turn on the peripheries, everything related to health care is outsized in its cost, beyond the reasonable (and very high) R&D, in part because of the federal government. As both parties are "ladies of ill repute" for these interests, the profound lack of care shown to individual states is clear.

Here's a better question: Why are we still pretending that there is such a thing as "trickle-down economics" at play here? These companies have only a temporary interest in the USA, and have demonstrated their complete lack of morality and trustworthiness in the past. WWII provides excellent examples of profiteering at any expense, just as history will probably find some nasty bits in the BILLIONS lost in Iraq and Afghanistan. When I say lost, I mean LITERALLY lost; unaccounted for... not just the swath of no-bid contracts which have failed in so many ways, or the adventure itself.

 

[ParticleGrl]

If Democrats really thought they could offer a better deal to consumers, they would do it (sans force) instead of bashing the companies they are unable to compete with, or trying to pass laws.

You seem to have missed the numbers I posted above. Generally, other countries provide health care to a larger percentage of their population, with better outcomes for less cost. Many do it with a single-payer option (Canada). Some do it with highly regulated private insurance companies (the Netherlands). If it can be done in other countries, it can be done here.

What claim do we have on the privately obtained wealth of others, obtained through completely voluntary private transactions? Other than billing them appropriately for services rendered (police, defense, fire protection, etc)?

How do you plan to bill for defense? For fire? For police? Maybe instead of reading Ayn Rand you should read Rousseau's Social Contract. You are free to opt out of the American social contract and move anywhere else in the world.

Consider, companies in the US rely on American educated workers for staffing, American roads to ship their goods, etc. An educated populace helps everyone by spurring innovation, increasing productivity, hence growing GDP. Well maintained roads help everyone- would Walmart's business model be possible without a well maintained highway network?

How is something that would be universally considered theft in the absence of a law authorizing it magically not theft because it was legalized?

Consider your taxation a bill for all those services that you implicitly use on a daily basis.

 

[Al68]

Profits so high and concentrated in individuals that the it can be used to create lobbies and keep other from competing..

Except that neither you or anyone else has provided any reason whatsoever to believe anyone is prevented from competing, except for the barriers caused by government regulation.

Beyond that, there is no "right" to wealth, or poverty, or anything in between. It's all about what you can GET, for the people making profits, and those squeezign them for it.

That's not what it's about to honest people. Honest people don't take the property of others by force, they obtain everything they get through voluntary transactions. That's the difference between an honest transaction and theft.

When profits for the private sector explode, but that isn't re-invested into the this country, then we're just redistributing our wealth in the opposite of the 'dreaded' socialism.

What? Who's wealth? If you voluntarily give someone your dollar for a product, that dollar is now theirs, and you have no legitimate claim on it regardless of how much money they have or how little you have. They obtained it through a voluntary private transaction, making it theirs, not yours. Not "ours". Using force to "take back" money that you voluntarily traded for a product is theft. Neither buyers remorse nor wealth envy changes that.

Then again, it seems that some are happier in an oligarchy than a democracy.

Nope. A institutionalized theft-free society is not an oligarchy. An oligarchy is a country ruled by the wealthy, not a country that declines to steal from the wealthy. And no, failure to succeed in thievery does not constitute being "ruled" by the intended target.

Because we can; the same reason profits are made..

That makes no sense. It's not theft because "we can" engage in it? The difference between an honest transaction and theft is whether or not "we can" do it? That's not any definition of theft I ever heard.

It describes both parties...

Yes, it does. Democrats because it's their primary agenda, and Republicans for going along with it in the name of "compromise".

 

[Al68]

You seem to have missed the numbers I posted above.

Nope.

Generally, other countries provide health care to a larger percentage of their population, with better outcomes for less cost. Many do it with a single-payer option (Canada). Some do it with highly regulated private insurance companies (the Netherlands). If it can be done in other countries, it can be done here.

I never said that couldn't be done. You seem to have missed my point entirely.

How do you plan to bill for defense? For fire? For police?

Taxation. Property taxes, excise taxes, etc.

Maybe instead of reading Ayn Rand you should read Rousseau's Social Contract. You are free to opt out of the American social contract and move anywhere else in the world.

I'm not a party to the "social contract" envisioned by Democrats. And the actual legal charter for the U.S. government prohibits that agenda. And while Rousseau differed from other (far better) philosophers in many aspects, he agreed that government (and the law) is not itself the social contract. Passing a law doesn't create an additional social contract in that sense, regardless of the form of government. You can't just justify any law you want on the basis that if you advocate it, then it's part of the social contract. And in this case, the law you are advocating grossly and obviously violates the social contract recognized by honest societies for centuries, the social contract of classical liberalism, of centuries of American common law, and of the U.S. constitution. Private property ownership, and the right to voluntarily buy, sell, and trade private property is the social contract between honest citizens. You cannot refer to an agreement of some to use force to take from others that which was obtained honestly, with no basis other than the recipients "need it" from those that "can afford it", as a social contract.

And you can't justify government action on the basis that people can leave the country to avoid it. Hopefully that's obvious enough that I don't have to explain.

Well maintained roads help everyone- would Walmart's business model be possible without a well maintained highway network?

I made no objection to billing Walmart accordingly. Why is it that roads are so often used to try to justify taxation for things other than roads, when nobody is objecting to taxation for roads? That's the epitome of a red herring.

And it should be obvious that you can't logically justify B on the basis that A is justified and B uses the same means of collection (taxation) as A.

Consider your taxation a bill for all those services that you implicitly use on a daily basis.

In that case I only actually owe a small fraction of it. Think the IRS will buy that argument?

 

[nismaratwork]

Except that neither you or anyone else has provided any reason whatsoever to believe anyone is prevented from competing, except for the barriers caused by government regulation.That's not what it's about to honest people. Honest people don't take the property of others by force, they obtain everything they get through voluntary transactions. That's the difference between an honest transaction and theft.What? Who's wealth? If you voluntarily give someone your dollar for a product, that dollar is now theirs, and you have no legitimate claim on it regardless of how much money they have or how little you have. They obtained it through a voluntary private transaction, making it theirs, not yours. Not "ours". Using force to "take back" money that you voluntarily traded for a product is theft. Neither buyers remorse nor wealth envy changes that.Nope. A institutionalized theft-free society is not an oligarchy. An oligarchy is a country ruled by the wealthy, not a country that declines to steal from the wealthy. And no, failure to succeed in thievery does not constitute being "ruled" by the intended target.That makes no sense. It's not theft because "we can" engage in it? The difference between an honest transaction and theft is whether or not "we can" do it? That's not any definition of theft I ever heard. Yes, it does. Democrats because it's their primary agenda, and Republicans for going along with it in the name of "compromise".

Al... we can't derail this thread so much to get into another ideological debate about who restricts what. If you think that the government runs Pharmaceutical companies, and not the other way around, I'm not sure how to proceed. Microsoft's history springs to mind however, as one very obvious example.

As for honest people, when you find one you let me know; it will probably be around the same time that Bernie Madoff pays back his victims, and the CEO of Goldman-Sachs is executed in a burning tub of tar (Guy Fawlkes reference).

As for force... Der Wille zur Macht. You know me... here's a list of what I DON'T believe in:

G-d
Complete honesty
The value of absolute trust
Ideology of any kind, and yes, that includes Nietzsche
Absolute morality
Intrinsic Rights
...ect.

You're making a moral argument in the realm of Realpolitik, and setting up any action you disagree with ideologically as "theft". I'm willing to play on those grounds... if you can keep it, great, if not, you lose. You're looking for reasons where only the realities of what must be done to survive, and what others are willing to do for the sake of profit.

As for "voluntarily" giving money... you just answered your own question about theft: you choose to live here, on the grid, in accordance with the law. It is a volunatary choice you make... far more so than someone facing death or a medical procedure.

Hi, I'm a moral relativist, but not a nihilist. Pleased to meet you. I believe in the need for artifical constructs so that society can thrive, but when you dig into it, you'll just find air. We do these things because it works, and because now it's self-sustaining.

 

[Al68]

If you think that the government runs Pharmaceutical companies, and not the other way around, I'm not sure how to proceed.

Huh? Neither is the case, but the former is partially true. It's easy prove that laws exist that restrict the actions of pharmaceutical companies. Can you provide evidence of a pharmaceutical company using force to restrict the actions of government? And failure of government to restrict a pharmaceutical company's action's in some certain way doesn't constitute "ruling" of the government by the pharmaceutical company. That's not what the word "rule" means.

You know me... here's a list of what I DON'T believe in:...Ideology of any kind...

That makes no sense given what the word http://en.wikipedia.org/wiki/Ideology" means.

You're making a moral argument in the realm of Realpolitik, and setting up any action you disagree with ideologically as "theft".

No, you misunderstand. I use the word theft to refer to using force to unjustifiably take private property, not to generically refer to "things I'm against".

you choose to live here, on the grid, in accordance with the law. It is a volunatary choice you make..

No, I choose to live here. I never joined any "grid". And you can't justify any law you want on the basis that people can leave their own country if they want. Using the word "voluntary" that way renders the word effectively meaningless.

I believe in the need for artifical constructs so that society can thrive..

Me too. I'm just against institutionalized theft. And you seem to have my rationale backward: I'm against certain things because I consider them to be theft, not the other way around.

 

[ParticleGrl]

Can you provide evidence of a pharmaceutical company using force to restrict the actions of government?

Since force is a meaningless word in this context, I'll say yes. Medicare plan D, won with much lobbying effort (force), explicitly forbids the government from negotiating bulk rates for prescriptions. This is obviously a major boon to pharmaceutical companies, and is part of the reason the US pays more per pill than other nations.

I use the word theft to refer to using force to unjustifiably take private property, not to generically refer to "things I'm against".

In what way is taxation for roads, police and education fundamentally different than taxation for healthcare?

 

[WhoWee]

Since force is a meaningless word in this context, I'll say yes. Medicare plan D, won with much lobbying effort (force), explicitly forbids the government from negotiating bulk rates for prescriptions. This is obviously a major boon to pharmaceutical companies, and is part of the reason the US pays more per pill than other nations.



In what way is taxation for roads, police and education fundamentally different than taxation for healthcare?

Part D is a valid issue of concern.
Accordingly, does the 2,000+ page "healthcare reform" legislation (that nobody had time to read) address this issue decisively and permanently - if so - how?

 

[ParticleGrl]

Part D is a valid issue of concern.
Accordingly, does the 2,000+ page "healthcare reform" legislation (that nobody had time to read) address this issue decisively and permanently - if so - how?

Unfortunately, no. That is one of my largest complaints about the bill. Also, why is "healthcare reform" in quotes?

However, what the bill does accomplish is using scientific analysis to identify effective treatments. This WILL reduce cost.

Finally- you yourself advocated the use of the scientific method- so how do you feel about a shift to more evidence based medicine?

 

[nismaratwork]

Huh? Neither is the case, but the former is partially true. It's easy prove that laws exist that restrict the actions of pharmaceutical companies. Can you provide evidence of a pharmaceutical company using force to restrict the actions of government? And failure of government to restrict a pharmaceutical company's action's in some certain way doesn't constitute "ruling" of the government by the pharmaceutical company. That's not what the word "rule" means.That makes no sense given what the word http://en.wikipedia.org/wiki/Ideology" means.No, you misunderstand. I use the word theft to refer to using force to unjustifiably take private property, not to generically refer to "things I'm against".No, I choose to live here. I never joined any "grid". And you can't justify any law you want on the basis that people can leave their own country if they want. Using the word "voluntary" that way renders the word effectively meaningless.Me too. I'm just against institutionalized theft. And you seem to have my rationale backward: I'm against certain things because I consider them to be theft, not the other way around.

I don't know how we can even agree on the terrain here... you believe in rights, I don't. You believe that the government is separate from and not made OF the people, and I don't. Finally, you seem to think that pharmaceutical companies don't spank the USA on a regular basis, I'd just point you to Part D again.

We're fighting a war on illegal drugs, while legal ones are now overtaking as a cause of death. Doctors make money, but there's a cieling based on how many people they can see and MASSIVE DEA oversight. Illegal activity still benefits the pharmaceutical company... it's just a ledger at the end of the day, and here I'm speaking from experience in biotech from startups to multinational interests.

So, when I see pushes to treat the FDA like it works on magic and unicorn farts, who stands to GAIN from that? Not me, and not you...

 

[WhoWee]

Unfortunately, no. That is one of my largest complaints about the bill. Also, why is "healthcare reform" in quotes?

However, what the bill does accomplish is using scientific analysis to identify effective treatments. This WILL reduce cost.

Finally- you yourself advocated the use of the scientific method- so how do you feel about a shift to more evidence based medicine?

I emphasized "healthcare reform" because it's a joke (IMO). I don't believe a single piece of legislation (that nobody read) can address all of the issues. I'm for scrapping the legislation completely and moving forward with a real analysis of the existing problems and focused solutions. If that means we need to spend five or six years working through problems and solutions in a series of smaller Bills and reforms - fine. We need leadership at the highest levels - not political games and rhetoric. When Nancy Pelosi said they needed to pass the legislation first - before the details would be known - I said "enough".

 

[nismaratwork]

I emphasized "healthcare reform" because it's a joke (IMO). I don't believe a single piece of legislation (that nobody read) can address all of the issues. I'm for scrapping the legislation completely and moving forward with a real analysis of the existing problems and focused solutions. If that means we need to spend five or six years working through problems and solutions in a series of smaller Bills and reforms - fine. We need leadership at the highest levels - not political games and rhetoric. When Nancy Pelosi said they needed to pass the legislation first - before the details would be known - I said "enough".

I admit, this is the area we really do agree on. If it takes 2000 pages, FINE, but it seems insane to overhaul nearly half of our spending without READING it. I've been on both sides of this issue, but I can't think of a truly logical reason for the "don't read it" side. I can only conclude that it appeals to the element of my personality that wants reform NOW, and that screams, "political manipulation", or games as you say.