JayB

"The profit motive can and often does turn an organization into a parasite. Profit oriented corporations have proven themselves willing and able to destroy communities, cultures, and an entire planet to squeeze out another good quarter. They are a potent, amoral, destructive force by definition" Yes -one look at how all of the above fared behind the Iron Curtain, in modern day China, etc, etc, - or the history of government vs private, for-profit malfeasance pretty well validates all of the above claims.

You can have insurance without abolishing price transparency, competition, and incentives to spend as little as necessary. They persist in pretty much every insurance market except for health insurance. Wow. You lie like most people breath. I just shopped for and purchased health insurance a few months ago. It takes about half an hour to have pricing for 3 competing non-profit plans laid out in front of you. EZ PEZY. In contrast, the for profit plans I looked at (not seriously...I wouldn't go there) were large binder clusterfucks of disconnected brochures and fine print. The one I was able to tease the prices out of was significantly more expensive, covered way less, was full of no-service loopholes, and left me far more exposed in case of catastrophe. It had hidden fees all over the place. There was no comparable price comparison service possible or available. Furthermore, one simply needs to type to google the name of these for profits and 'complaint' to instantly learn how many law suits are pending against them for their misleading sales practices, illegally dropping patients or not honoring the policies, etc. So what's this about the greater transparency of for profit health care, you fucking liar? That's all very interesting - but there's a difference between the subset of elective procedures that's not covered by insurance, and health insurance policies that cover virtually every non-elective procedure. I was arguing that the combination of price transparency, competition, and consumer-incentives at play in LASIK and cosmetic medicine was responsible for the price reductions that are clearly evident in Peter's chart - and the absence of any of these three factors was one of the reasons that the price of procedures covered by insurance has been going in the other direction. As an aside, it's entirely possible for profits to go up, while prices go down. I have yet to meet anyone who shops on the basis of which seller is making the least money for good or service A, as opposed to who has the best price. "Sure you're just as good as the other surgeon, but you'll make net $1000 on a $2000 procedure because you've got a more efficient cost structure, do more volume, and have more modern equipment - to hell with that. I'm going with the guy who charges $3000 because I *know* he'll barely break even...."

Except in this case - the prices at the rapacious and boundlessly greedy and selfish for-profit clinics that are dropping, and the prices at the non-profits that are steadily increasing. Speaking of which - anyone remember McAllen and El Paso? "“In contrast to the Medicare population, the use of and spending per capita for medical services by privately insured populations in McAllen and El Paso was much less divergent, with some exceptions,” the article’s abstract states. “For example, although spending per Medicare member per year was 86 percent higher in McAllen than in El Paso, total spending per member per year in McAllen was 7 percent lower than in El Paso for the population insured by Blue Cross and Blue Shield of Texas. We consider possible explanations but conclude that health care providers respond quite differently to incentives in Medicare compared to those in private insurance programs.” http://content.healthaffairs.org/content/29/12/2302.abstract Yeah, I remember the New Yorker article about McCallen (highest per capita health care costs in the country). It flamed private health insurers and providers, and sung the statistical praises of well run non-profits, most notably Kaiser Permanente, as models for how we might move forward. Prices are coming down amongst private health insurers? REALLY? You are not a skilled liar, but you are a prolific one. Glad you can remember what you read a year ago. Can you still read? "Medicare spending for the elderly is much higher in McAllen, Texas, than in El Paso, Texas, as reported in a 2009 New Yorker article by Atul Gawande. To investigate whether this disparity was present in the non-Medicare populations of those two cities, we obtained medical use and expense data for patients privately insured by Blue Cross and Blue Shield of Texas. In contrast to the Medicare population, the use of and spending per capita for medical services by privately insured populations in McAllen and El Paso was much less divergent, with some exceptions. For example, although spending per Medicare member per year was 86 percent higher in McAllen than in El Paso, total spending per member per year in McAllen was 7 percent lower than in El Paso for the population insured by Blue Cross and Blue Shield of Texas. We consider possible explanations but conclude that health care providers respond quite differently to incentives in Medicare compared to those in private insurance programs."

You can have insurance without abolishing price transparency, competition, and incentives to spend as little as necessary. They persist in pretty much every insurance market except for health insurance.

Anyone who missed the chance to shoehorn themselves into a massively cash-flow negative "investment" property with a Neg-Am Option ARM should avail themselves of the opportunity to invest in one of the gajillion empty condos in China at the moment.

Aren't you the guy that rarely missed an opportunity to inform everyone here that you'd retired early on the proceeds of stock-options grants? Or was that someone else?

I doubt he has ever owned a Lexus or any luxury car, so you are talking out of your ass again. Listen - if a 99 Buick Century with a cracked bumper and a driver's side window held in place with mini-cell foam left over from outfitting my last boat doesn't qualify as a luxury vehicle than I don't know what does! I certainly wouldn't trade it for a Lexus that comes along with a $50K loan!

Except in this case - the prices at the rapacious and boundlessly greedy and selfish for-profit clinics that are dropping, and the prices at the non-profits that are steadily increasing. Speaking of which - anyone remember McAllen and El Paso? "“In contrast to the Medicare population, the use of and spending per capita for medical services by privately insured populations in McAllen and El Paso was much less divergent, with some exceptions,” the article’s abstract states. “For example, although spending per Medicare member per year was 86 percent higher in McAllen than in El Paso, total spending per member per year in McAllen was 7 percent lower than in El Paso for the population insured by Blue Cross and Blue Shield of Texas. We consider possible explanations but conclude that health care providers respond quite differently to incentives in Medicare compared to those in private insurance programs.” http://content.healthaffairs.org/content/29/12/2302.abstract

In this case - the "free market insurance industry" has nothing to to with the procedures that are getting progressively cheaper - because they're virtually never covered by insurance, and nothing to to with Medicare's payment for this particular procedure - because it's...Medicare. There are indeed emergency medical procedures that can't be scheduled. Then there are things like child-birth, cataract surgery, colonoscopies, etc, etc, etc that can be planned for and/or scheduled on a non-emergency basis. The primary difference between, say, LASIK and a colonoscopy (aside from the fact that one involves the eye and the other the colon) isn't that one is optional and that the other is necessary - it's that one isn't covered by third-party payers and the other is. People who want to get LASIK done have a strong incentive to minimize the cost of the procedure, prices are transparent, and there's abundant competition. This isn't the case for procedures covered by insurance - either private or public, which is one of the primary reasons why the price of these procedures is continually increasing.

Lee! Good to hear you're still in the game, amigo! You should make a post in the kids forum - might be more folks in the same predicament browsing there. Shoot me a PM with an active e-mail address when you get a chance...

How do you reconcile this statement: "if insurance doesn't pick up the tab, of course the industry is going to adjust the cost to make as much money as they can." With the data showing that procedures not covered by insurance have been getting cheaper? It's not that the guys running LASIK machines are any more altruistic than, say, interventional cardiologists - and that's why they've been dropping prices - it's because the prices they charge are transparent, subject to competition, and the folks getting their eyes done have an incentive to care about which eye-doc provides the best value for the price.

The point is that when you have a bureaucratic system setting prices, they're typically either so low that providers take an automatic loss, or they're so high that they get a big windfall with public money. When payments are too low for a given treatment - doctors will eventually stop delivering it. When there's a windfall available - they naturally deliver more of the treatment that generates the windfall. When the folks setting prices discover the windfall - they attempt to clamp down, set another price that will either be too high or too low, and the whole kabuki dance continues. Unfortunately for fans of central planning - you can control prices but you can't control costs. Since the actual cost is affected by a gazillion things that the planners have no control over - price controls will always result in prices that are either too high or too low to coordinate supply with demand, and will always produce shortages or surpluses. They don't work any better for medical devices and procedures than they do for oil, wheat, etc. Cosmetic procedures are the result of price transparency and competition. That's why they're declining and virtually nothing else in healthcare is.

Single-Payer to the (Cost-Control) Rescue!!!! "A Device to Kill Cancer, Lift Revenue Roughly one in three Medicare beneficiaries diagnosed with prostate cancer today gets a sophisticated form of radiation therapy called IMRT. Eight years ago, virtually no patients received the treatment. The story behind the sharp rise in the use of IMRT—which stands for intensity-modulated radiation therapy—is about more than just the rapid adoption of a new medical technology. It's also about financial incentives. Taking advantage of an exemption in a federal law governing patient referrals, groups of urologists across the country have teamed up with radiation oncologists to capture the lucrative reimbursements IMRT commands from Medicare...." http://online.wsj.com/article/SB10001424052748703904804575631222900534954.html

If as a 19-year old Boulder-born convert to Islam you can't get hammered at a college party, blow a 0.19 when you get pulled over for a DUI stop, *and* keep your hijab on for your booking photo - then there's only one thing to blame - rampant Islamophobia! "To my fellow Americans: I recently decided to make my story public by agreeing to an interview with the Boulder Daily Camera, and I must say that I am not ashamed. The facts have been clearly laid out, and I do not dispute them. On Dec. 1, I went to the jail on my own accord to pre-book for their work-crew program, as had been stipulated by the court for my DWAI (driving while ability impaired) sentence. While I was there, I was repeatedly asked to remove my hijab, and I refused. I am aware that as an American citizen, I have been blessed with the right to religious freedom, and as far as I am concerned, this includes my right to adorn my hijab in any photograph taken for a public record. I will be the first to admit that I made a mistake. I am trying to remedy this situation by completing all of the necessary requirements, and this situation does not indicate any lack of desire on my part to complete what I have been assigned to do. I would have gladly completed my work crew requirement, had I been allowed to be photographed with my hijab on. As this was not the case, I stand in the awkward predicament now seen. I have every intention of completing the outstanding requirements placed upon me in a timely fashion; my goal is to be neither obstinate nor difficult. What people seem to forget is that this story is not about how I got to the jail. This is about what happened after I arrived at the jail, and the constitutional infringements that then occurred. For the record, I do not dispute that I operated my 49cc motorized scooter on the day of Aug. 1. I was at a party, where I was served alcohol without my knowledge. I admit that when I discovered I was being served alcohol, I made no attempt to curb my intake. I am 19 years old and a junior at the University of Colorado. This is far from a unique story in the college experience. For those who are in, or were at one time a college student, you will understand what I am saying. The issue at hand revolves around my First Amendment rights as a United States citizen to freely practice my religion as I see fit. As a Muslim-American woman, I feel let down by my country. I love America. This incident, however, has raised such doubt for me. I understand that the topic of Islam is a tricky one to address in today's political climate, but if America wants to see global unification and peace amongst the nations of the Middle East, we must start at home. We must start in Boulder, Colo. Do not ignore the real issue here. Islamophobia is alive and well in America. This cannot be denied. I am a Muslim as much as I am an America. I was born in Boulder. In fact, if one heads due east on Balsam Avenue, along which sits the hospital where I was born, one will end up at the Boulder County Jail in a matter of minutes. I am neither a fundamentalist nor an extremist. I am not trying to bring Shariah to Colorado. I am just a college student who still believes in the American dream. I am just a citizen who is crying foul at the ignorance surrounding Islam, and the injustices of our legal system. My fellow Americans, I pray that you take pity on Islam and on the Muslims who call this country home as much as you do. All we ask is for an acknowledgement of our tradition and religious freedom. I am an American, I am a Muslim, and I love this country. Read more: http://www.coloradodaily.com/ci_16791538#ixzz17Zc5Mi6s Coloradodaily.com "

More evidence that the regressive neocon warmongers at Faux News have succeeded in implanting a false consciousness in the proletariate.... [video:youtube]

"The West Coast is experiencing a major outbreak of pertussis. Through November 16 of this year, 6795 confirmed, probable, and suspect cases of pertussis have been reported in California, with nine infant deaths. Washington State is also experiencing an increase in cases in 2010, with two infant deaths. In Snohomish County, we have had several confirmed pertussis cases reported in recent weeks. Infants under 6 months of age account for over 40% of the 17 reported Snohomish County cases in 2010. Infants younger than 6 months account for 90% of all pertussis related deaths and the majority of hospitalizations. They are usually infected by older siblings, parents or caregivers in whom the disease is frequently under-diagnosed" Next stops - Vashon and Ashland.

I think that the lesson here is that you can achieve robust economic growth despite all of growth-impairing distortions introduced by bad policies when you have no significant industrial competitors outside of the West, you've got a very high ratio of workers relative to dependents, etc, etc. It does not follow that international protectionism and the cartelization/nationalization of the domestic economy is something that you can get away when you've got an unprecedented dependency ratio, exponentially greater competitiveness around the globe, etc, etc, etc. But hey - good to know that you're a fan of economic growth and any form of the market economy.

The world is far healthier, wealthier, and longer lived now than it was in the mid-70's. Don't think there'd be many volunteers willing to hop in a time-travel machine to take them back to any point and time between 1945 and 1975, particularly amongst the countries in the sick-and-poor quadrant.

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so, folks shouldn't try to tell the market who is boss yet they should tell the banksters threatening to sink our economy that they won't be bailed out. Did I get this right? Doesn't it strike you as contradictory? Dude - they're the best friends that all of the private entities that bought bonds issued by the PIIGS ever had! These "eternal foes of the market" like bondholders so much they're willing to inflict the liabilities for every penny of losses on the said bonds on the public. The public in any country that defaults is going to suffer, but they'll suffer quite a bit more if their governments foolishly commit them to repaying debts that are beyond their capacity to repay under any terms. Defaulting on sovereign debt is disastrous. Committing to an impossible repayment regime and then defaulting is worse. Europe is going to have to default one way or another. Outright or by devaluing the Euro via inflation. Ditto for Japan. The combination of exploding public sector debts and spending obligations and an imploding birth-rate means that people who have lent them money are going to take some losses, they're going to have work more, and longer, and live with less in retirement. There's no escape from this.

20% of the American workforce is currently un or underemployed (just to get that out of the way). But what I'm personally incredulous about is that allowing the "distribution of employment to respond to reality" (aka the further commodification of labor through union busting, flexibilization, and corporate globalization, etc.) is going to result in better life-outcomes and democratic freedoms for the human beings that actually inhabit the theoretical marshmallow-world you concoct than one that incorporates features like coherent industrial policies, strong social welfare programs in health and education. Where is your track record of success, Jay? Point to the successes. We've been going down the neoliberal path for nearly thirty years. By almost any measure, we are practically ruined. Do you really expect us to believe that if we just push down your same path harder, we're going to reach the light? It's astonishing really, the power of your faith. Allowing market mechanisms to function is what generates the economic output that the modern welfare state redistributes to fund things like social services. This is easy to see when you take away or cripple the market mechanisms, but keep the redistribution. Shortly thereafter - there's not much to redistribute. When redistributive mechanisms in place in any state generate distortions that start to significantly reduce output, and/or create liabilities that exceed the economy's capacity to fund them - then you get less output and less to redistribute. That's where Europe will find itself shortly. Quite amusing to hear about the power of faith from a dialectical materialist, though!

They've been singing from that very sheet of music in Euroland for decades and it doesn't end happily. The day of reckoning is here: http://www.nytimes.com/2010/12/01/business/global/01bonds.html?_r=1&partner=rss&emc=rss

There are two things that are going to get us out of this mess. The first is bringing debts down to a level that we can actually repay. This will happen with a combination of structural reforms and bondholder/creditor haircuts. The second is liquidating the cumulative malinvestment in real-estate and other sectors and letting employment shift to sectors that are producing things that people still want to buy. Demand for luxury condos, CDOs, and Escalades is never going to come back. Reality has changed, the composition of demand has changed along with it, and patterns of production and exchange have to change in response to reality. Pumping a gajillion dollars into busted sectors will prevent the expansion of those sectors of the economy where the unemployed might be able to find new jobs. The sooner we accept this fact - the better. Just rolls off the tongue doesn't it? Yeah, creditors and bondholders need to take haircuts, the question in this and other countries is whether or not finance has captured enough state power to determine whether they'll have to take the losses or whether they'll be able to squeeze enough out of citizens through structural adjustments (their haircut or our amputation). As to the second part: Hmmmm, things people still want to buy, which are labor intensive enough to put a significant number of people to work, that Americans are skilled enough to make or at wages low enough to make them competitive with African slum-dwellers, that the resources are inexpensive enough to source, that people can buy without relying on credit, that... Yeah, let us know when you got some specifics. The funny thing about the Euro crisis is that the self-styled foes of the market are the ones that are digging in their heels the most when it comes to transferring the pain to creditors and bondholders, instead of forcing it all onto the public. There isn't enough economic output in Europe to cover all of their debts. A restructuring is inevitable, part of that will be haircuts for bondholders - and the longer the folks who are attempting to show the market who's boss deny this the worse things will be for all concerned. As far as your list of requirements is concerned - you are making the argument from personal incredulity. Pretty much the entire private workforce is engaged in employment that satisfies your criteria at this moment in time, even if neither you nor any other single intelligence can correctly identify or predict all of the factors that make the transmission-fluid plant more viable in Texas than Nigeria at this particular point in time. As the composition of demand changes, so will the composition of employment. More people will stay employed if we allow the distribution of employment to respond to reality, than if we stick our fingers in our ears and deny it, or engage in futile attempts to predict it in the form of a "5 Year Plan."

Exactly.

There are two things that are going to get us out of this mess. The first is bringing debts down to a level that we can actually repay. This will happen with a combination of structural reforms and bondholder/creditor haircuts. The second is liquidating the cumulative malinvestment in real-estate and other sectors and letting employment shift to sectors that are producing things that people still want to buy. Demand for luxury condos, CDOs, and Escalades is never going to come back. Reality has changed, the composition of demand has changed along with it, and patterns of production and exchange have to change in response to reality. Pumping a gajillion dollars into busted sectors will prevent the expansion of those sectors of the economy where the unemployed might be able to find new jobs. The sooner we accept this fact - the better.