Originally Posted by Steerpike (Post 12642659)

Did anyone catch Bill Maher's commentary last night regarding Amazon? I've stopped watching his show in general because I find it just too depressing, but I happened to flick through the channels and saw him. Basically, he was giving Amazon (deserved) sh*t for their choice of NY for their second HQ, saying that all the 'good'/cool companies are in the blue states, and all the crap companies are in the red states, and we need to spread some of the 'wealth' around a bit if we want to win elections. Quite a good hit job really ...

https://www.realclearpolitics.com/vi...e_america.html

Originally Posted by Hiro11 (Post 12642435)

In my opinion, any healthcare solution that doesn't address reduction of healthcare costs is just going to result in more inefficiency and/or shortages. In fact, I'd say the primary focus of any healthcare policy should be to reduce the cost of healthcare. So far, the vast majority of solutions proposed have focused on expanding access without addressing costs. To me, this is exactly the wrong tack to take: expanding access without lowering costs will simply make the problem worse.

One way to lower costs is to introduce price controls. Throughout history, price controls have resulted in shortages. A better option is to make the cost of healthcare transparent to the consumer. This will force to consumer to make more reasonable judgments about their healthcare. I would argue that the employer-sponsored healthcare system in place in the US is one of the major factors that has driven up healthcare costs precisely because healthcare consumers don't have any motive to reduce healthcare consumption.

Using myself as an example: I'm healthy and I exercise daily. My BMI is 23, I don't smoke and I hardly drink. And yet, any time I've interacted with a medical professional recently, my visit has been larded up with tests and procedures of dubious value. I have to believe this is because I'm lucky enough to have excellent PPO insurance. For example: I was in a minor traffic accident 18 months ago that resulted in almost $17,000 of medical care even though I did not have serious injuries. I paid maybe $800 of this out of pocket. Ridiculously, a doctor even suggested an unnecessary $5,000 MRI that would have added more to this cost. Regarding the cost, the doctor even said to me at te time "you have good insurance, better safe than sorry". I rejected the idea only because I knew I was fine and I didn't want to deal with the hassle. Every medical office I went to through this process was a palace with gleaming hardwood and granite, every employee in fine clothes, every wrist sporting a Rolex. I was handed beautifully bound materials detailing my care. I was signed up for numerous (unnecessary) physical therapy sessions. It was too much. This was an eye opening experience for me. Perhaps if I were on the hook for more of the out of pocket expense, I would have been a bit more careful about what I opted to do.

Getting people to pay more directly for their healthcare is politically a non-starter, so my argument will never fly. It's much more politically expedient to just tell people that big brother will pick up the tab and then impose price controls. Shortages, lack of innovation, poorer service and no real improvement in outcomes are all the likely results. In my opinion.

Originally Posted by Boiler (Post 12642489)

So these rates have been approved by the Politicians.

Originally Posted by Ingles (Post 12642846)

Who are probably promised the earth "cough cough" by the Lobbyist who are paid for by the "persons" who control the Hospitals & Pharmaceutical Manufactures
As before & yes I'm banging the same drum, dark money rears it's ugly head yet again.
The system is utterly corrupt !

Originally Posted by Hotscot (Post 12642437)

'This will force to consumer to make more reasonable judgments about their healthcare.'

Doesn't really help in an accident though, or if you're in an area with limited specialties.

Originally Posted by vespucci (Post 12642681)

Win elections for the left by attracting the votes of the affluent? Where in the world has that worked?

Originally Posted by vespucci (Post 12642681)

You win elections for the left by attracting the votes of the working class. You can flip some of the present "red" states by providing free healthcare for everybody, affordable college, etc. This can be funded through a moderate increase in taxes on the rich. There's a lot of misinformation regarding the increase in tax required, based on not taking into account the far lower healthcare costs under a national system, the benefit to employers and employees of the elimination of healthcare costs, etc. The Democrats haven't shown that they're seriously on the side of the working class with limited programs like Obamacare. Once they do they'll get their votes.

Originally Posted by Hiro11 (Post 12642895)

Certainly true emergencies and true serious medical issues are not relevant to my argument. Catastrophic insurance probably makes sense for everyone and is relatively cheap (because it's low risk). Still, I'd argue that true catastrophes or speciality issues, while potentially ruinous for the person affected, are not the major sources of healthcare spending for the market. Certainly people get truly sick or seriously injured, but most healthcare spending is maintenance or routine procedures for basically healthy people. For example, as part of my treatment for my accident, I had to have three x-rays. This is ancient, mature technology and yet they still charged my insurance $600 per image for a total of $1,800 for x-rays. That's ridiculous, it took 20 minutes. A check-up can easily run to $1K for a basically healthy middle aged man like me depending on what you do. My mother recently had a hip replaced (an extremely common procedure for someone in their late 70s) and the total cost approached $80K including equipment, PT, in home visits etc. These costs are out of control.

Originally Posted by Steerpike (Post 12642987)

I presume your first sentence is in response to my post on Bill Maher / Amazon? Did you listen to his explanation? He made perfect sense. His point was, essentially, there are a lot of angry white males out there in the rust-belt / red states currently supporting Trump because they lack opportunities. Currently, all the good jobs/cool jobs are concentrated in places like CA, NY, etc - almost exclusively blue states. His suggestion is that if companies like Amazon would bring jobs to places that need them, rather than to places that are already economically viable, there would be a lot less support for the likes of Trump. He quoted Clinton to make his point: "...I won the places that own two thirds of America’s Gross Domestic product. I won the places that are optimistic, diverse, dynamic, moving forward. And his whole campaign, Make America Great Again, was looking backwards ... ".

Here's the link again - watch it! https://www.realclearpolitics.com/vi...e_america.html


The American presidential election is won based on a few swing states, and within those few swing states, the election is won based on a fairly small number of swing voters. Your argument is that if the democrats propose more liberal policies, a bunch of voters who would otherwise sit-out the election (not vote) will be motivated to vote and will vote democrat. Fair enough, that is undoubtedly true. But my argument is, those very same liberal policies may cause the swing-voters in the middle to lean away from the democrats and towards the republicans (or not vote). That too is pretty much a given. So the million-dollar question is - what will the net effect be? Will the 'added votes' on the left be enough to compensate for the 'lost votes' in the middle? I've posted articles previously that show support for 'free healthcare for everybody' is initially strong but quickly falls when funding and other issues come into the equation. Assume for the moment that you are correct about the "misinformation regarding the increase in tax required...", but imagine the amount of advertising that is going to be thrown at this issue over the next 18 months.

The funding for such a plan is going to be hellishly complex. Currently, 49% of people get healthcare from their employer. If you take that need away, employers will have to spend less per employee, and will hopefully turn around and pass that on to the employee as an increase in gross pay. This will be countered by an increase in tax so that the government can now fund the healthcare that was previously funded by the employer. If all goes well, this will hopefully be a 'net-zero' calculation - take-home pay of joe public remains essentially unchanged. But there's no way the government can force the employer to give the increase in gross pay; while it will be in the employers best interest to do so (employee retention), this will be another avenue of attack for the nay-sayers. Giving the average wage-earning public a solid assurance that their net take-home pay will not take a hit is going to be the challenge of a lifetime for whichever candidate proposes this.

I did just read this article that gives cautious optimism to the financial feasibility of Sanders plan: https://www.politifact.com/truth-o-m...gs-bernie-san/ . IF you take the optimistic approach that we can cut reimbursements by 40% across the board, then yes, Sanders plan is financially viable. I suspect reality will be somewhat more pessimistic.

Originally Posted by Hiro11 (Post 12642895)

Certainly true emergencies and true serious medical issues are not relevant to my argument. Catastrophic insurance probably makes sense for everyone and is relatively cheap (because it's low risk). Still, I'd argue that true catastrophes or speciality issues, while potentially ruinous for the person affected, are not the major sources of healthcare spending for the market. Certainly people get truly sick or seriously injured, but most healthcare spending is maintenance or routine procedures for basically healthy people. For example, as part of my treatment for my accident, I had to have three x-rays. This is ancient, mature technology and yet they still charged my insurance $600 per image for a total of $1,800 for x-rays. That's ridiculous, it took 20 minutes. A check-up can easily run to $1K for a basically healthy middle aged man like me depending on what you do. My mother recently had a hip replaced (an extremely common procedure for someone in their late 70s) and the total cost approached $80K including equipment, PT, in home visits etc. These costs are out of control.

Originally Posted by vespucci (Post 12643173)

What opportunities has Trump provided for those "angry white males"? The number of swing voters in the middle is far fewer than the masses who don't participate, or who vote Republican because the Democrats haven't had policies that clearly favour the working class. If they do they won't lose California, New York, etc where they have huge majorities, but will gain some of the present "red" states. Market competition will ensure that removal of the insurance burden from employers will lead to higher pay- I don't think it'll be as difficult to convince people of this as you suggest. Voter turnout last year was the highest of any mid-term in a century, and the trend will likely continue with progressive policies. If Trump stands again, it'll be a great opportunity to have a progressive president. The ability of the right to brainwash working people to fear that "the government will take over their healthcare, and the country will go communist" has declined. Many people with employer health insurance are happy with it, but are they so attached to it that they would vote againsteveryone having healthcare? I don't think so. The factors that have made the US an anomaly have to an extent gone away. Sanders deserves a lot of credit and should be selected by the Democrats as their candidate. You've posted a very good video of him where he says: "Here is the bottom line: If every major country on earth can guarantee healthcare to all and achieve better health outcomes, while spending substantially less per capita than we do, please do not tell me that the USA cannot do the same." All the arguments I've seen relate to costs in the present system; I haven't seen any arguments why costs in the US should basically be so much higher than other countries.

Originally Posted by Boiler (Post 12643262)

https://cimg5.ibsrv.net/gimg/british...00ccd0b30e.png

The Dems may be getting more progressive, are their voters?