The Buffett Rule

[spence]

Originally Posted by buckman

At the time it didn't matter if 99% of America were against the damn thing . Pelosie and Obama were going to pass it. I hope people don't forget the BS that they pulled in Obama's first year. It got us where we are today.

It's funny, you can dis the Health Care Bill but ignore the fact that private insurance costs are completely out of control.

I agree with the Britts over at the ECONOMIST...the HCB was a good thing, pass it so it can be fixed.

People want reform.

-spence

[justplugit]

Originally Posted by spence

It's funny, you can dis the Health Care Bill but ignore the fact that private insurance costs are completely out of control.


People want reform.

-spence

This is getting old but,
Pass tort reform.
Open up interstate competition.
Get the, what is it, 600-900 billion from Medicare fraud.

[detbuch]

Originally Posted by spence

It's funny, you can dis the Health Care Bill but ignore the fact that private insurance costs are completely out of control.

Which costs are you talking about? The cost to the insurance companies to provide the insurance? The insurance premiums? The price that hospitals, doctors, various health providers charge? Don't all those providers also have to be insured? How about the costs of litigation? The costs of regulation? Little is actually said in your sentence, and much is implied. The major implication is that costs need to be controlled. That begs the question, by whom? I guess your next sentence is the answer.

I agree with the Britts over at the ECONOMIST...the HCB was a good thing, pass it so it can be fixed.

Of course--the government. Not just the government in an old fashioned American Constitutional self government expressed at local and State levels way, but the Federal Government acting in its typical current mode of top down illegal way. Pass a bad unconstitutional bill. And hooray to some socialist Britts telling Americans what is economically good. And what good form--pass a bad bill so that it can be fixed. Not fix a bill (that is not legally the Federal gvt's to legislate) so that it can be passed. Pass it then fix it. Talk about being out of control!

People want reform.

-spence

We the people are told that we want reform. By whom? Rigged polls? Reform is a convenient word. It covers a lot and can mean many things--some contradictory. If you surround it with leading other words, it can sound like exactly the thing you want. It can also lead you away from what really angers you--the thing you mentioned in your first sentence--cost. This is just a guess (I didn't take a poll), I think most people want to pay less (for everything). The illegal HCB doesn't promise to do that. Maybe it will be "fixed." But it is not a true re-forming. It is a third party pay system with more government controls. It is an escalation of the "vector" in which we've been heading.

[spence]

Originally Posted by detbuch

Which costs are you talking about? The cost to the insurance companies to provide the insurance? The insurance premiums? The price that hospitals, doctors, various health providers charge? Don't all those providers also have to be insured? How about the costs of litigation? The costs of regulation? Little is actually said in your sentence, and much is implied. The major implication is that costs need to be controlled. That begs the question, by whom? I guess your next sentence is the answer.

I'd think that if the consumer can't afford the care or taxpayers can't fund Medicare the rest is moot.

Of course--the government. Not just the government in an old fashioned American Constitutional self government expressed at local and State levels way, but the Federal Government acting in its typical current mode of top down illegal way. Pass a bad unconstitutional bill. And hooray to some socialist Britts telling Americans what is economically good. And what good form--pass a bad bill so that it can be fixed. Not fix a bill (that is not legally the Federal gvt's to legislate) so that it can be passed. Pass it then fix it. Talk about being out of control!

Before Medicare, 1/2 of seniors didn't have any health coverage. I think there's a reasonable argument to be made that the States alone either can't or don't want to address the issues. Sure, we could do what Rand says and just let the sick ones die, but the taxpayers would still have to clean up the bodies.

As for the Economist, they had a good article some time ago stating exactly that. I thought you'd appreciate another sovereign nations perspective

We the people are told that we want reform. By whom? Rigged polls? Reform is a convenient word. It covers a lot and can mean many things--some contradictory. If you surround it with leading other words, it can sound like exactly the thing you want. It can also lead you away from what really angers you--the thing you mentioned in your first sentence--cost. This is just a guess (I didn't take a poll), I think most people want to pay less (for everything). The illegal HCB doesn't promise to do that. Maybe it will be "fixed." But it is not a true re-forming. It is a third party pay system with more government controls. It is an escalation of the "vector" in which we've been heading.

Good to agree we don't think polls are necessary on the subject. I think the average person can see the yearly increases in their contributions to coverage and reductions in services, if they actually have it in the first place.

I believe the CBO did estimate cost reductions of 7-10% long-term, primarily to Medicare. While perhaps the benefits of tort reform are over-estimated, I think this would be an easy savings. Interstate competition and ending the price fixing on prescription drugs would also help, but good luck getting them passed. Reducing fraud would be a big savings buy might require more government oversight (certainly centralized records) that many oppose.

The crazy thing is how much more the US spends on health care per person (40% or so?) than other developed nations and how little we're getting for that extra investment. I don't really see how just regulating less will address this issue in a meaningful way. Increasing competition might certainly lower costs but also bears the risk of reducing quality of service below existing standards...and then you're back to more regulation.

I've seen proposals that believe that if health care providers were paid on total treatment rather than individual treatments doctors would have an incentive to administer less unnecessary medications and tests.

The bottom line is that more action is needed to continue to reform the system. I'd prefer a combination of the best ideas where complimentary, but the reality is nobody has the perfect solution...at least not that I've seen.

-spence

[detbuch]

Originally Posted by spence

I'd think that if the consumer can't afford the care or taxpayers can't fund Medicare the rest is moot.

Being as how the consumers are the taxpayers, then neither the pre-HCB "system" nor the impending "HCB" system (fixed or not), are a "solution" to costs. At least the pre-HCB system had more of a relation to market forces, and would have even more with less regulation.

Before Medicare, 1/2 of seniors didn't have any health coverage. I
think there's a reasonable argument to be made that the States alone either can't or don't want to address the issues. Sure, we could do what Rand says and just let the sick ones die, but the taxpayers would still have to clean up the bodies.

Before medicare health costs were much lower.

As for the Economist, they had a good article some time ago stating exactly that. I thought you'd appreciate another sovereign nations perspective

Wha . . .? All nations are sovereign. Our nation has levels of sovereignty. The individual being the most sovereign. Well . . . it sort of used to be that way.

Good to agree we don't think polls are necessary on the subject. I think the average person can see the yearly increases in their contributions to coverage and reductions in services, if they actually have it in the first place.

So far, though the average person bitched about the rising costs, he was able to pay. There certainly have arisen many market options (cadillac plans, cheaper ones, medical savings, catastrophic insurance, etc.) to lower the cost. Wasn't the impetus for the HCB to cover the so-called uninsured. It doesn't, other than fictitious projections which we know are most always over-optimistic, seem to have lowered the price.

I believe the CBO did estimate cost reductions of 7-10% long-term, primarily to Medicare. While perhaps the benefits of tort reform are over-estimated, I think this would be an easy savings. Interstate competition and ending the price fixing on prescription drugs would also help, but good luck getting them passed. Reducing fraud would be a big savings buy might require more government oversight (certainly centralized records) that many oppose.

Yeah, there a lot of "solutions" but Federal mandate is not even legal, never mind more expensive to our debt problem.

The crazy thing is how much more the US spends on health care per person (40% or so?) than other developed nations and how little we're getting for that extra investment. I don't really see how just regulating less will address this issue in a meaningful way. Increasing competition might certainly lower costs but also bears the risk of reducing quality of service below existing standards...and then you're back to more regulation.

Others see how over-regulating was the problem

I've seen proposals that believe that if health care providers were paid on total treatment rather than individual treatments doctors would have an incentive to administer less unnecessary medications and tests.

The bottom line is that more action is needed to continue to reform the system. I'd prefer a combination of the best ideas where complimentary, but the reality is nobody has the perfect solution...at least not that I've seen.

-spence

That "perfect" thing is not resolvable. Market solutions, ugly as they seem to some, work out problems more sustainably than centrally planned economies.

[spence]

Originally Posted by detbuch

Being as how the consumers are the taxpayers, then neither the pre-HCB "system" nor the impending "HCB" system (fixed or not), are a "solution" to costs. At least the pre-HCB system had more of a relation to market forces, and would have even more with less regulation.

We let Pharma companies charge what ever they want for patentable drugs without any negotiation.

Not my idea of market forces at work...

Before medicare health costs were much lower.

Over simplification. I could see medicare raising some costs as it put more people into the health care system. And unlike many industries, health care is still pretty manual and doesn't scale well.

But there are a lot of other reasons costs have increased. A big one is the proliferation of advanced (i.e. expensive) technologies that are now standard and expected. I'd also think that we treat so much more than we did 50 years ago...ailments and diseases that simply weren't diagnosed previously.

Wha . . .? All nations are sovereign. Our nation has levels of sovereignty. The individual being the most sovereign. Well . . . it sort of used to be that way.

Joke. Although I do like the perspective of the Economist. Usually pretty smart.

So far, though the average person bitched about the rising costs, he was able to pay. There certainly have arisen many market options (cadillac plans, cheaper ones, medical savings, catastrophic insurance, etc.) to lower the cost. Wasn't the impetus for the HCB to cover the so-called uninsured. It doesn't, other than fictitious projections which we know are most always over-optimistic, seem to have lowered the price.

Being able to pay doesn't mean it's painless. I remember when my first son was born in 2003 my out of pocket was maybe a few hundred bucks. Fast forward to 2010 and my second son cost easily 10X that out of pocket. Same company and relatively the same plan. While I'm fortunately "able to pay" that few thousand bucks would put a damper on a lot of families budgets.

Yeah, there a lot of "solutions" but Federal mandate is not even legal, never mind more expensive to our debt problem.

I'll let the SCOTUS decide on legality...

Others see how over-regulating was the problem

Like I mentioned above, there are a lot of problems.

Another big one is simply how the system works, where people never really see the cost as it's passed to an insurance company and then you see only your part weeks after. People don't even question the costs they're being charged.

I switched to an HSA this year and it's making me much more aware of what's actually being billed. If the tax exemption will really save any money remains to be seen, the shyte is so complicated I can barely figure out what's going on.

That "perfect" thing is not resolvable. Market solutions, ugly as they seem to some, work out problems more sustainably than centrally planned economies.

I think market solutions are more desirable but are also easily corrupted and can be self consuming when not monitored.

Health care is somewhat unique in that most everybody needs it, we have a very complex system to deliver it, the massive size of the industry attracts a lot of R&D, hospitals are obligated to dispense some of it and most of the system is for profit.

The consumer is in essence quite detached from the market in many ways. If a market solution is the answer, perhaps that's really the root of the problem.

-spence

[detbuch]

Originally Posted by spence

We let Pharma companies charge what ever they want for patentable drugs without any negotiation.

Not my idea of market forces at work...

Free market does allow big pharma to charge whatever they want--usually what it thinks the market will bare. Charging more diminishes sales. The negotiation in a free market is between seller and buyer, usually expressed as sale or no sale. The reason big pharma can charge "whatever they want" is because of the controlled market regulated by the "negotiation" between it and the Government (FDA), which precludes competition from smaller companies and entrepeneurs due to the high price and length of time required by the regulations, and due as well to the cozy collusion between the FDA and pharma.

Over simplification. I could see medicare raising some costs as it put more people into the health care system. And unlike many industries, health care is still pretty manual and doesn't scale well.

Usually, volume permits price to drop. Unlike many industries, health care payment has been put in the hands of third party payers, medicare being one, and the third parties have deeper pockets than most individuals, medicare's being the deepest, which allows higher prices by the sellers (doctors, hospitals, etc.)

But there are a lot of other reasons costs have increased. A big one is the proliferation of advanced (i.e. expensive) technologies that are now standard and expected. I'd also think that we treat so much more than we did 50 years ago...ailments and diseases that simply weren't diagnosed previously.

Again, because of wealthier third party payers, the health industry can pay more for technologies (similar to how government is ripped off as it pays for its technology when buying for "the people"--especially the military). In those industries that have to sell directly to individual buyers their costs, including technology, is lower.

Joke. Although I do like the perspective of the Economist. Usually pretty smart.

OK. Smart, unfortunately, doesn't always equate with right.

Being able to pay doesn't mean it's painless. I remember when my first son was born in 2003 my out of pocket was maybe a few hundred bucks. Fast forward to 2010 and my second son cost easily 10X that out of pocket. Same company and relatively the same plan. While I'm fortunately "able to pay" that few thousand bucks would put a damper on a lot of families budgets.

Please don't tell me that you believe it's the governments responsibility to make our life painless. And if your paying an insurance company to do likewise, then it better come across or you should drop it. At least in a free market you are allowed to drop it. But when government mandates, you have no choice. Suffer the pain and rejoice.

I'll let the SCOTUS decide on legality...

So you have no opinions on Constitutionality? You just blindly accept SCOTUS opinion as infallible? You don't see the obvious mis"interpretation" of the Commerce Clause that presumably gives Congress the power to tell you that you cannot grow your own vegetable garden because if everyone did, in the aggregate it would affect the price of food and destroy or distort the commercial market? You cannot see the obvious fallacy of using the General Welfare clause to give Congress the power to give succor to a select few to be paid for by others when "general" refers to all, equally, and in the construction and syntax of the Constitution the clause refers to general welfare (welfare of ALL in the same manner) as given through its enumerated powers not in any way it chooses, else it would have greater, if not exclusive, power to attend to your welfare than you would have yourself? You do not plainly see that the Necessary and Proper Clause refers to the "foregoing powers" (the enumerated powers) not any power Congress chooses to impose? The Constitution is not that long and difficult, and was meant to be understood by all, not just a select few lawyers and judges. The SCOTUS was meant to interpret whether Congress acted within its powers, not to interpret what the Constitution meant, and to apply the Constitution as written, not to apply it as the judges think would be more "responsible." The individual is supreme in our system, and as such is as much responsible to be involved with governing as are all the "servants." When the citizens "let" judges or politicians act according to their view of "responsible," and don't voice objection when they see bad judgement, they give their Constitutional power of self governing over to those servants and deserve the tyranny they allow.

Like I mentioned above, there are a lot of problems.

Another big one is simply how the system works, where people never really see the cost as it's passed to an insurance company and then you see only your part weeks after. People don't even question the costs they're being charged.

That is the nature of third party pay, whether it's private or government. And we should question both. Just as we should absolutely question our judges bad decisions. It's our money and our freedom that's at stake.

I switched to an HSA this year and it's making me much more aware of what's actually being billed. If the tax exemption will really save any money remains to be seen, the shyte is so complicated I can barely figure out what's going on.

Yes, and as regulations need to be reformed, new regulations pile on old ones and the complexity and lack of transparence becomes greater. That is the nature of law. The more detailed your regulation, the more parties, points of view and opinion are involved, the more it requires finer and more complex points of law. The Ten Commandments just wont do.

I think market solutions are more desirable but are also easily corrupted and can be self consuming when not monitored.

Government is also easily corrupted. And the corruption of Central government reaches farther than most other corruptions.
And who or what is the monitor? And who monitors the monitor? In a free market, there is a, granted loose, self regulation. This can be enhanced by limited governance that is a result of consent of the people on local levels. But Central power over a large diverse market tends to create static, unevolving markets--not only stagnant, often imploding, but, in our case, UNCONSTITUTIONAL.

Health care is somewhat unique in that most everybody needs it, we have a very complex system to deliver it, the massive size of the industry attracts a lot of R&D, hospitals are obligated to dispense some of it and most of the system is for profit.

The consumer is in essence quite detached from the market in many ways. If a market solution is the answer, perhaps that's really the root of the problem.

-spence

Most everybody needs food, and shelter, and energy. And we have a very complex system to deliver them. When the cost of delivery is paid for by the individual buyer, it seems the price is generally lower than when a richer third party, especially the government, pays for it.

[scottw]

this is great...James Madison vs. Mao

[justplugit]

Originally Posted by spence

We let Pharma companies charge what ever they want for patentable drugs without any negotiation.



-spence

Spence, are you for price control???

You are wrong about negotiations, every hospital in the country, community,
county, state and fed has a formulary and belongs to a buying group who put out bids for all compatiable drugs.

As for the price of exclusive drugs, their price is not set on the active
ingredients but on all the costs from finding a compound to bringing it
to market. It costs many millions of dollars to find a compound, test it,
do clinical trials under FDA regulations and getting approval takes years
under stringent government regulations.

Drugs represent 10.5 cents of medical costs and saves millions in
keeping patients out of hospitals. Diseases like pneumoniae, heart failure,
diabetes, depression etc. can now be treated at home.

Pharma is a big political football because people don't want to be sick and
have to pay for it. Of course they won't think twice about buying a six pack,
$5 a day cigs or a bottle of Jim Bean but moan about paying $5 a day
for a drug that gives them quality of life, keeps them out of the hospital
and prolongs their life. Politicians know it and slam Pharma knowing they can
make points because it is popular to do so by the folks.

[spence]

Originally Posted by justplugit

Spence, are you for price control???

You are wrong about negotiations, every hospital in the country, community,
county, state and fed has a formulary and belongs to a buying group who put out bids for all compatiable drugs.

As for the price of exclusive drugs, their price is not set on the active
ingredients but on all the costs from finding a compound to bringing it
to market. It costs many millions of dollars to find a compound, test it,
do clinical trials under FDA regulations and getting approval takes years
under stringent government regulations.

Drugs represent 10.5 cents of medical costs and saves millions in
keeping patients out of hospitals. Diseases like pneumoniae, heart failure,
diabetes, depression etc. can now be treated at home.

Pharma is a big political football because people don't want to be sick and
have to pay for it. Of course they won't think twice about buying a six pack,
$5 a day cigs or a bottle of Jim Bean but moan about paying $5 a day
for a drug that gives them quality of life, keeps them out of the hospital
and prolongs their life. Politicians know it and slam Pharma knowing they can
make points because it is popular to do so by the folks.

I'm well aware of the business process regarding FDA regulated product development.

Here's the issue. There's competition for drug prices inside the US but the development is done for a global market. All that R&D funding to create the next category killer drug is being subsidized by US consumers because drugs are sold at lower costs (often via price controls) in pretty much every other nation. There really isn't a lot of real negotiation. This is government regulation that the industry is highly dependent on.

Hence my comment being in context of "market forces".

-spence