JayB

More fearmongering from the let's privatize everything front. The truth is that SS is doing well considering the current economic downturn (with 8 millions out of work, payroll tax receipts are down 2.5% from 2007). Although some reforms are necessary, like removing the cap on taxable income (anything above 110k per year isn't currently taxed), there is no crisis of social security. Media claims that we have to start borrowing to pay benefits are lies. So per your understanding, is the balance in the Trust Fund filled with something other than special-issue Treasury Bonds? When the total cost of benefits exceeds inputs, and the SSA redeems the bonds in the trust fund to pay for them - where is the money required to cover those redemptions going to come from? Think about that question for a moment and then consider whether or not the fact that the rate that the US government has to pay for money it borrows to cover deficits will have any bearing on the political status of Social Security benefits. It's possible that both Congress and the public will be willing to make heavy cuts everywhere else and raise taxes dramatically in order to fund current entitlement obligations at face value but I'm certainly not going to count on it.

The irony here is that putting all of those funds into Uncle Sam's Cookie jar made it much easier to fund all of the wars, etc than it would have been if the money were in private accounts subject to all of the protections that bank accounts, homes, and other personal property are covered by. huh? "protections" like during the last few bubbles? The truth is you wish SS was privatized but you can't seriously make the argument that people's retirements would be safer in private accounts unless you are already suffering from alzheimers. 1. You can put 100% of your IRA balance in CDs if you wish. Every 401(K) plan will have at least one money market fund or equivalent. People that assume more risk with their retirement assets did so because they chose to, not because they had to. 2. The government can't "borrow" the money in your personal account, issue an IOU, and use the money for whatever it likes. The fact of the matter is that your favorite sacred cow makes more money available to your favorite regressive neocon warmongers to play-with, not less. Much easier to raid the cookie jar and issue an IOU than to borrow the money from savers who get to choose whether or not to loan Uncle Sam money, and on what terms. If the Dukes and Barons had to keep all of their money in the royal safe, there'd be no Magna Carta.

The irony here is that putting all of those funds into Uncle aSam's Cookie jar made it much easier to fund all of the wars, etc than it would have been if the money were in private accounts subject to all of the protections that bank accounts, homes, and other personal property are covered by. wars that you supported? no irony except in the dumb canuck known as Alanis who doesn't understand irony sense So - per your understanding of the term, a "Yes" answer to your question would make pointing out the fact the ability to borrow from the Social Security trust fund makes it easier for the US government to fund wars is...ironic? Looks like we're getting into some recursive, multidimensional irony loops here.

Had mine done in '03. Was something like ~$1250/eye for the old-school LASIK where they created the flap with a blade. Wife had hers done on the East Coast ~'06 or '07 w/ the blade free incision (used a laser) and the total cost was ~$5000. Zero complications for us. Could see clearly right after the operation, was ~20/15 the next day and have pretty much stayed there since. Had blood around the iris for ~10 days after the operation, had to wear eye-protectors while sleeping for ~ 2 weeks or so after the operation. Definitely noticed halos around lights while driving at night, but either that's gone away or I've become so used to it that I don't even notice them any more. I think my wife's experience was pretty similar, but supposedly using a laser to make the incision reduces healing time and reduces the odds of complications. All around it ranks up there with the best money I've ever spent. Not having to deal with glasses and contacts in every-day life alone made it worth it. Not having my contacts knocked out and getting blinded in heavy whitewater, losing a contact on the tent-floor and searching for it by headlamp, etc, etc, etc made it even more worth it. I had my eyes done by Dr. John Jarstad at the Evergreen Eye Center in Federal Way. http://www.evergreeneye.com/about-us.php

The irony here is that putting all of those funds into Uncle Sam's Cookie jar made it much easier to fund all of the wars, etc than it would have been if the money were in private accounts subject to all of the protections that bank accounts, homes, and other personal property are covered by.

Actually, no, that's not how it works. The younger generation is paying for those that receive the benefits. No one is socking away money for their own SS benefits. You put money in as you work with the promise of getting it back with interest. How the government delivers that (spending your money in the interim and paying it off with younger taxpayer's contributions) is irrelevant. I agree that's the way it is supposed to work in theory, but I'm not terribly confident that's the way it'll work going forward. I'm hoping that someone, somewhere, is looking at debt forecasts that incorporate a Monte Carlo simulation of future yields on Treasury debt but I doubt it.... "Treasury Market Fires Warning Shot By RICHARD BARLEY Jitters in the Treasury market: a technical blip or evidence that U.S. fiscal woes are finally starting to test the patience of bond investors? Last week bond auctions struggled, 10-year yields surged to 3.88% from 3.7%, and 10-year yields rose above 10-year swap rates for the first time in living memory—all indicators of market stress. Fiscal worries certainly triggered the initial market wobble. The passage of the $940 billion health-care bill reignited concerns about the U.S. deficit, pushing yields up and narrowing the gap to swap rates, which tends to be driven by expectations of government bond supply. A negative spread could indicate lack of demand for Treasurys or doubts over U.S. creditworthiness.." If this was all about promoting retirement savings then putting the same money in private accounts that you couldn't touch prior to retirement without massive tax penalties would do the trick. The extremely risk averse could easily simulate Social Security like returns by investing their contributions in CD's and converting the balance to an annuity upon retirement. I'd much rather have a system like that and use general tax revenues to take care of the disabled, indigent, etc.

EXACTLY!!! Read aloud what you just wrote. OK, I did. What's the issue? You don't feel the same way? You are content with insurance companies dropping coverage after the insured dares to make them do their job. Content with people paying thousands in premiums each year only to get stuck with losing their life savings anyway if they get sick or injured? Or, you just have a great plan and fuck all if others don't? Or are you saying this situation already exists? Because I don't think it does. Yes many of us can afford the premiums, but to actually get sick and make a claim? Maybe you have $150,000 laying around for a rainy day sickness, but I don't, and I could live out of my car and work full time for the next 20 years and I still won't. Where were you shopping for insurance? I think we've got about the same age and health status. Catastrophic coverage in Washington was cheap. Ditto for excess major medical insurance that kicks in when you exceed the limits on your primary policy. And Hasn't it been illegal to rescind coverage for illness since HIPAA in '96. Ditto for denial of coverage in group plans? Since we're on the topic, if you're worried about going broke after a medical catastrophe, you should really look into getting adequate personal disability coverage if you're the main earner in your household or you are part of a household that needs both incomes to stay afloat. Even if you don't pay a cent in medical bills, the loss of income can easily put you and or your family under. Probably costs quite a bit more than catastrophic insurance, but well worth it IMO. I'm amazed that neither I nor my wife even thought about this until we were in our early thirties.

There's a difference between prices and costs. Government can enact legislation that puts caps on prices, but it can't control the gazillion factors beyond its control that determine what it actually costs to make things or bring services to the market. Government can cap the price of milk at 1$ a gallon, but hard as it may try, it can never control the real cost of all of the inputs that go into producing the said gallon of milk. When the real cost exceeds the price the government sets, then farmers stop producing it. If they're forced to keep delivering it they'll degrade the quality as much as possible in an effort to stay afloat you probably won't want to drink it. Health care is no different. Governments can control the price of delivering healthcare, but they can't control the cost of doing so, much less the demand for it. As of right now, something like 86% percent of all premiums are used to pay for goods and services, and the profit margins run around 2.2%. When you control for the real cost of Medicare, most of the efficiencies disappear. Even if there is a real margin there, the notion that it holds the key to making healthcare more effective is difficult to comprehend. The right way to value the efficiency of health care is to divide the benefit to the patient over the total cost of delivering it. What really matters is the numerator, and of the components that make up the denominator, the .1 to 0.05 that's in play in the "administrative efficiency" component aren't terribly significant. When you actually look at major drivers of total health costs, the obsessive parsing of marginal differences in administrative costs is even more puzzling. The nation is getting older and fatter, and the number of pills and devices at our disposal to address the health consequences of both is continuously expanding. You can scale administrative infrastructure pretty easily without spending much more money. This is not true for delivery - whether it's CT scanners or bariatric surgeons. I suspect that before long the illusion that it's private sector administrative expenses that are driving up the national tab for health-care will vanish, and then the conversation about how to best contain them will start to get very interesting. You've missed the cost savings entirely. Other countries are currently, right now, enjoying a 12% discount due to lower admin/billing costs. Right now. It's not theory, it's not idle CC chat, its reality. For the sake of argument - let's take your figure as granted. If all we were concerned with was administrative efficiency, the argument would be over. If we're concerned with what actually happens to patients, the analysis is more complicated. Then we have to look at what treatment the patient receives, and the net positive effect on their health. In a world where administrative costs trump all, there's no difference between no treatment, a treatment that makes the patient 0.1% better, and one that makes them 100% better. Once you start caring about the clinical efficacy of a given treatment, then you reduce administrative costs to a minor sub-component of the "cost" denominator in a true measurement of medical efficiency. E.g. Efficiency =(Health Benefit/cost of doctors+nurses+imaging+devices+drugs+etc, etc, etc, etc + administrative costs). Administrative costs trump all? Never said that, but idealize the argument (consider the spherical chicken...old engineer joke) to put it in a lab box if you need to. You seem to be ready to trot out the old 'you'd be dead in France' line. Spare us. And for the 30 + million Americans who aren't covered at all, none of what you just posted matters at all. You're the one with the single-metric focus here, kemosabe. Not me. Your claim seemed to be that eliminating marginal differences in administrative costs between would automatically translate into better health care for all by improving "efficiency." I'd be happy to continue that argument for as long as you want to persist in it, but you understandably seem anxious to change the topic. Dead in France? Non, mon ami. Mon Dieu! I do think that any aggregate advantage that the French enjoy in life expectancy has very little, if anything to do with their doctors and hospitals doing a better job, and everything to do with the fact that they take better care of themselves. If you actually look at the life-expectancy rankings from time to time, you'll notice that the differences in life expectancy are: 1) Small. 2) Not terribly well related to the clinical efficacy of the care that their doctors and hospitals deliver. Denmark - 78.3. Albania - 77.96. 0.34 * 365 = 124.1 days. (124.1/(365*78.3)*100 = 0.43% The Danes spend a gazillion times more on their health care and only manage to eke out 0.43% more life than the Albanians. What's the take away here? For me - it's that once you have the rudiments of sanitation and vaccination in place - longevity stats aren't a terribly good basis for making comparative assessments of either the efficacy or efficiency of health care systems. For most of the folks here, it's that Denmark clearly isn't getting much bang for it's health care buck, and it's high time they incorporated the clinical and administrative insights at the heart of the Albanian efficiency miracle into their own system. I wish this was hyperbole, but the the above exercise is no less ludicrous than the claims made by everyone that trots out the infant-mortality/life-expectancy/WHO statistical troika and uses them as a basis to claim that our health care system inferior to country X. All of this will matter a great deal for the 30+ million people who currently lack insurance, and for the 270 odd million people who currently have insurance. That'll be a much more interesting and productive conversation. I can think of lots of topics. -What will happen to the remaining uninsured (illegal immigrants, transients, etc) who rely on hospitals that receive "disproportionate share funding"? -What will happen if the proposed medicare cuts actually go through and even fewer doctors accept medicare patients? -Who will treat all of the new Medicaid patients, since doctors lose money every time they walk in the door, and how will the already bankrupt states foot their share of the bill? Etc, etc, etc, etc.....

Gotta go - but you realize that a giant chunk of the insurers are non-profit, and that profits at for profit health insurance companies has been something like ~2.2% on average for the past few years? I'd like to see that statistic from a reliable source. And of course profit does not include CEO compensation. For a taste of that go here: http://www.fiercehealthcare.com/special-reports/total-package-health-plan-ceo-compensations-2008 So CGNA might post a 5% profit but pays over $12M to its CEO and another $50M+ for a handful of other executives. My heart aches for them. The latest quarterly figures for the sector are here: http://biz.yahoo.com/ic/522.html Scroll down on the right, and look under "Net Profit Margin." The figure there is 4.4%. In the latest ranking of industry profits I could find, circa 2009, Health care plans ranked 86th, a couple of notches below "Packaging and Containers." http://1.bp.blogspot.com/_otfwl2zc6Qc/SuIFQY6zybI/AAAAAAAALwo/IK1ddRvAqhA/s1600-h/profitmargins.jpg It's clear that the CEO's of health insurance companies get paid a ton of money. As is the case with any private sector job that pays a ton of money, the question isn't why they are willing to accept millions of dollars in compensation, it's why the folks who own the enterprises are willing to offer it to them in exchange for running the companies that they own. I'll leave you to ponder that. In the meantime - lets focus on the concrete impact that executive compensation has on the price and availability of health care. If you took total compensation paid to executives, reduced it to zero forever - how many days worth of total health spending could you fund in the US? As a driver of cost increases, where does rising executive compensation fall next to obesity, aging, etc? I'll help you out by noting that the health insurance companies aggregate profits would fund about ~ 2 days worth of the national health bill.

Gotta go - but you realize that a giant chunk of the insurers are non-profit, and that profits at for profit health insurance companies has been something like ~2.2% on average for the past few years?

Jim - you keep trotting these claims out - and when the time comes to separate lifestyle factors and registration artifacts from things that doctors, nurses, and hospitals can actually do something about you seem to disappear. I hope you aren't going to use the infant mortality and life expectancy stats again to try to make this case, since adult life expectancy tells you nothing about the clinical efficacy of care when you are comparing one advanced country to another (life expectancy is high everywhere these days, and death by accidents, suicides, etc generate most of the variance), and infant mortality is defined and measured very differently from one country to the next. Even metrics that seem relatively straightforward when you are comparing clinical outcomes for the same disease, etc can be compromised by selection bias in the patient pool. That is - one country may go forward with treatment that another country would rule out on the basis that it'd most likely be futile for the patient in question. In this case, the outcomes might be worse for the first country simply because the patients that they're treating are sicker, on average. Anyhow - bring out your stats and we can have an interesting discussion.

There's a difference between prices and costs. Government can enact legislation that puts caps on prices, but it can't control the gazillion factors beyond its control that determine what it actually costs to make things or bring services to the market. Government can cap the price of milk at 1$ a gallon, but hard as it may try, it can never control the real cost of all of the inputs that go into producing the said gallon of milk. When the real cost exceeds the price the government sets, then farmers stop producing it. If they're forced to keep delivering it they'll degrade the quality as much as possible in an effort to stay afloat you probably won't want to drink it. Health care is no different. Governments can control the price of delivering healthcare, but they can't control the cost of doing so, much less the demand for it. As of right now, something like 86% percent of all premiums are used to pay for goods and services, and the profit margins run around 2.2%. When you control for the real cost of Medicare, most of the efficiencies disappear. Even if there is a real margin there, the notion that it holds the key to making healthcare more effective is difficult to comprehend. The right way to value the efficiency of health care is to divide the benefit to the patient over the total cost of delivering it. What really matters is the numerator, and of the components that make up the denominator, the .1 to 0.05 that's in play in the "administrative efficiency" component aren't terribly significant. When you actually look at major drivers of total health costs, the obsessive parsing of marginal differences in administrative costs is even more puzzling. The nation is getting older and fatter, and the number of pills and devices at our disposal to address the health consequences of both is continuously expanding. You can scale administrative infrastructure pretty easily without spending much more money. This is not true for delivery - whether it's CT scanners or bariatric surgeons. I suspect that before long the illusion that it's private sector administrative expenses that are driving up the national tab for health-care will vanish, and then the conversation about how to best contain them will start to get very interesting. You've missed the cost savings entirely. Other countries are currently, right now, enjoying a 12% discount due to lower admin/billing costs. Right now. It's not theory, it's not idle CC chat, its reality. For the sake of argument - let's take your figure as granted. If all we were concerned with was administrative efficiency, the argument would be over. If we're concerned with what actually happens to patients, the analysis is more complicated. Then we have to look at what treatment the patient receives, and the net positive effect on their health. In a world where administrative costs trump all, there's no difference between no treatment, a treatment that makes the patient 0.1% better, and one that makes them 100% better. Once you start caring about the clinical efficacy of a given treatment, then you reduce administrative costs to a minor sub-component of the "cost" denominator in a true measurement of medical efficiency. E.g. Efficiency =(Health Benefit/cost of doctors+nurses+imaging+devices+drugs+etc, etc, etc, etc + administrative costs).

Yeah, the "left" has been skeptical of this scheme all along. It was a sop to the insurance industry as a way to spread its risk across the entire population in lieu of a single payer program. As if you didn't know this already... As a fan of the state, you should be thrilled that they've got the insurance companies out front as flack catchers for the backlash that will erupt when the time comes to impose the hard rationing that will be necessary to balance health care costs with health care spending. Think of the kings and tax farmers of yore. If you're sitting on the throne and need to squeeze the people for more revenues, popular anger at the tax-farmers you've contracted with to turn the screws is far preferable to having it directed at the crown.

There's a difference between prices and costs. Government can enact legislation that puts caps on prices, but it can't control the gazillion factors beyond its control that determine what it actually costs to make things or bring services to the market. Government can cap the price of milk at 1$ a gallon, but hard as it may try, it can never control the real cost of all of the inputs that go into producing the said gallon of milk. When the real cost exceeds the price the government sets, then farmers stop producing it. If they're forced to keep delivering it they'll degrade the quality as much as possible in an effort to stay afloat you probably won't want to drink it. Health care is no different. Governments can control the price of delivering healthcare, but they can't control the cost of doing so, much less the demand for it. As of right now, something like 86% percent of all premiums are used to pay for goods and services, and the profit margins run around 2.2%. When you control for the real cost of Medicare, most of the efficiencies disappear. Even if there is a real margin there, the notion that it holds the key to making healthcare more effective is difficult to comprehend. The right way to value the efficiency of health care is to divide the benefit to the patient over the total cost of delivering it. What really matters is the numerator, and of the components that make up the denominator, the .1 to 0.05 that's in play in the "administrative efficiency" component aren't terribly significant. When you actually look at major drivers of total health costs, the obsessive parsing of marginal differences in administrative costs is even more puzzling. The nation is getting older and fatter, and the number of pills and devices at our disposal to address the health consequences of both is continuously expanding. You can scale administrative infrastructure pretty easily without spending much more money. This is not true for delivery - whether it's CT scanners or bariatric surgeons. I suspect that before long the illusion that it's private sector administrative expenses that are driving up the national tab for health-care will vanish, and then the conversation about how to best contain them will start to get very interesting.

Uh-oh. "He sees too clearly and speaks too plainly..."

Seems like it's hard to answer anything but "yes" to the above. Ditto for the levies imposed to fund Medicare. In one case your money will be funneled into a series of highly regulated, nominally private cartels and in the other it's going into a marginally solvent public-monopoly/intergenerational ponzi apparatus. Not sure which should be more worrisome to the principled civil libertarian. I'm moderately relieved that there are people on the left like Tvash who are marginally concerned with the expansion of state power entailed in the entailed in the purchase-or-penalty scheme, but I'm not sure how diverting the funds directly into a state monopoly would be an improvement in that regard.

To summarize: JayB thinks Europe sucks because they actually take responsibility and honestly account for the outlay. Still haven't seen any reason whatsoever why the US is going to come out ahead because this "SERVICE ECONOMY" is just as much bullshit as the old, just easier to outsource (as the Filipino legal assistants will tell you)

well, society has to pay for both. you get massively butthurt over an admin making $75k a year from Washington State and fellate some feeble fuckwhit making $750k a year on Wall Street who has the same skill set (the ability to negotiate the hiring process and a pulse). both are a drag on the rest of us..... Yes. All private sector employees have their pay and benefits financed with tax revenues.

time for "structural reform" Yes. In England and the Netherlands, and rather sooner as a result of the Icelandic vote.

surely you jest? The economy cannot tell whether the debt is public or private. Yet you keep pointing out the public debt to justify ending social welfare and completely ignore a much larger private debt that brought the economy to the brink. I was wondering why you brought this up as a counterpoint - since by your own logic (which I agree with) that means that that the higher private debt gets as a percentage of GDP, the *less* capacity the said economy will have to finance their public debt. It's not as though Greece et al are any less fucked when you add private debt to the pile, or that it's any more likely that the ever-dwindling pool of workers will be able to support the legions of public sector workers and their benefits while the said public sector workers are actively employed, much less while they're enjoying their 30 year retirements.

Seems correct to me. What's your point? That all debt - whether it be car loans or public pension obligations have equal claims on the public purse? Not sure where you're going with that one, but feel free to elaborate.

This pretty good. Just like we did with the S&Ls, Enron, the airlines after 911, Bear Stearns, Freddie and Fannie, AIG, the auto indurstry, TARP, Citigroup, and Bank of America. Going back further we have Continental Bank of Illonis in '84 ($9.5 billion), Chrysler ($4 billion), Franklin National Bank '74 (7.8 bilion), Lockeed '71 ($1.4 billion)--- do I detect a "structural reform" pattern here. Indeed. The repeated pattern is public risk and private profit - all fed by cash through the political system to just tinker on the outside. Just keep shovelling the cash to the masters of the universe, then wail about undeserving welfare queens getting an extra $50 a month. It would be funny if not so tragic. Love the zeal there Jim, but spare a moment to consult an actuarial table or two that lays out the magnitude of unfunded entitlement spending at the state and Federal level and the price of the distortions of the nation's political economy you laid out above will seem trivial by comparison. Nice dodge. Now try and address the issues raised. Fannie and Freddie aren't examples of privatized profits and socialized risk? Farm subsidies, tarriffs, subsidies, etc, etc, aren't examples of the political system distorting public finances for private advantage? Who's the one with the selective outrage here again?

Mmmm-hmmm. I'm puttin' my moneys in the 21st century version of cotton-fields and one of them new Mystery Burgers franchises! Yeah Jay, you're right, structural adjustment of the kind necessary to "save" capitalism isn't going to fly in most of the first world, but given the retardation of America's political scene and the authoritarian streak it's been showing of late, it may just "work" here. Though it probably wouldn't be a society any of us would want to live in. Bought your Quantum Sleeper, yet? Well - you seem to like it well enough to stay despite the continuous and histrionic wails of protest to the contrary, so it must be better than all of the alternatives available to you. I suspect there'll be lots of other folks in the same boat. Could you possibly be as deluded as these statements make you sound? Your "rational actors" and "utility maximizing decision making" have made a prison of your mind. At any rate, the "love it or leave it" recommendation holds for you as well. I'm sure they could use another enlightened despot inside the walls of one of the world's Free Trade Zone paradises. What's delusional about noting the incongruity between your rhetoric and your actions? If you want more political and economic liberty, there's really no place to escape to at the moment. If you want less - your options are unlimited. Like Greece, for example.

Mmmm-hmmm. I'm puttin' my moneys in the 21st century version of cotton-fields and one of them new Mystery Burgers franchises! Yeah Jay, you're right, structural adjustment of the kind necessary to "save" capitalism isn't going to fly in most of the first world, but given the retardation of America's political scene and the authoritarian streak it's been showing of late, it may just "work" here. Though it probably wouldn't be a society any of us would want to live in. Bought your Quantum Sleeper, yet? Well - you seem to like it well enough to stay despite the continuous and histrionic wails of protest to the contrary, so it must be better than all of the alternatives available to you. I suspect there'll be lots of other folks in the same boat. I'd think you'd be rushing at the chance to emmigrate to Greece. They need doughty young lads like yourself to sustain the noble enterprise they've got going over there.

This pretty good. Just like we did with the S&Ls, Enron, the airlines after 911, Bear Stearns, Freddie and Fannie, AIG, the auto indurstry, TARP, Citigroup, and Bank of America. Going back further we have Continental Bank of Illonis in '84 ($9.5 billion), Chrysler ($4 billion), Franklin National Bank '74 (7.8 bilion), Lockeed '71 ($1.4 billion)--- do I detect a "structural reform" pattern here. Indeed. The repeated pattern is public risk and private profit - all fed by cash through the political system to just tinker on the outside. Just keep shovelling the cash to the masters of the universe, then wail about undeserving welfare queens getting an extra $50 a month. It would be funny if not so tragic. Love the zeal there Jim, but spare a moment to consult an actuarial table or two that lays out the magnitude of unfunded entitlement spending at the state and Federal level and the price of the distortions of the nation's political economy you laid out above will seem trivial by comparison.