[jdonn]

kenberg, on Jan 29 2010, 03:53 PM, said:

Sorry if I am being dense here but I still don't get it. First coordinate = per capital spending, second coordinate=life expectancy.

I would expect the US to have one pair of such numbers, making a dot on the graph. But the US gets a whole line (as does everyone). This would have to represent many different pairs, each with its own spending and life expectancy numbers. From where? Evolving over the years? And both the linearity and the negative slope are suspicious. Increased per capita spending delivers decreased life expectancy in diorect proportion to the increase?

Not trying to be either difficult or dense but I really can't make head nor tail of it.

Forget X and Y coordinates. There is a line drawn from the left edge to the right edge for each country. The higher the line touches on the left edge, the higher spending is. The higher the line touches on the right edge, the higher life expectancy is. So a large positive slope means high life expectancy per amount spent, and a large negative slope (like the US has) means low life expectancy per amount spent.

[kenberg]

Ah!! The line just connects the two pieces of data. Thanks to all! The US graph was clearly some sort of outlier, but I was missing the point.

[kenberg]

Another question, now that I understand that graph.


Under the proposed health care plan, does the cbo expect the per capita expenditure to be more or less than what it would be without the plan? You can see where I am going. Asking whether it will reduce the deficit is a somewhat tricky question because it involves revenue as well as government expenditure. The graph makes a strong case for reducing per capita expenditure, no matter who pays the freight. Would the bill help on that?

Except maybe for some Hollywood plastic surgeons it doesn't seem to me that doctors are particularly overpaid. They make good money, but they do important work, and at least often they do it well. I don't think that I would want to try reducing costs by reducing doctor's incomes.

I have been lucky with my health and so I have very little first hand experience with how this all goes. I had a recent problem with a kidney stone (I'll spare you the details) but everything that was done was well-judged and first rate, as near as I can tell. I can't escape the feeling though that a good part of the problem is that no one has any motivation at all in trying to keep costs down.

I think that some of the worry with the current bill is that it may lock in a number of entitlements, again without adequate regard for the costs. We know how this goes. If I get a prescription filled, it's really very cheap. I don't know why. Medicare? My supplementary insurance? The Bush program? I dunno. But now I expect it. Someone wants to modify it so that I have to pay more? What, they hate old people? Call AARP.


I really wish more attention had been paid, both in design and presentation, to this business of controlling costs. If this had happened, I think we would be in a better position. I favor doing the right thing, but when push comes to shove I don't feel that I have a serious stake in the outcome of this bill.

[Al_U_Card]

Who should control expenditures? (In the sense of defining billing amounts/procedure and supply/demand of goods and services.)

Patients (taxpayers)?
Health care service providers?
Pharmaceutical/medical item suppliers?
Para-public body?
Government?

The current situation seems to be a sort of interplay between 2 and 3 above. This explains the "line" in the graph for the US.

[Winstonm]

Obama, to me, has a curious interpretation of leadership. His idea seems to be in forming coalitions which he helps form and then he stands aside and lets them come up with agenda and ideas.

The latest clash with the Republicans is a case in point. Obama is still railing that he is getting no Republican support. Does the man not realize he still has a Democratic majority? If he wants to whip someone into shape, it should be the members of his own party. Why beg for Republican support when it is blue-dog Democrats holding the party hostage?

IMO Obama needs to learn a simple lesson - you cannot lead well if you do not know where you are going or how you plan on getting there. It's not enough to wave the baton and form a choir - you also have to tell them what they are singing and in what key.

[PassedOut]

Winstonm, on Jan 29 2010, 07:00 PM, said:

If he wants to whip someone into shape, it should be the members of his own party.

Agreed.

[kenberg]

Sounds like the Lyndon Johnson approach to the presidency. But LBJ, besides having a natural talent for head banging, spent many years in the Senate perfecting the style. I doubt BHO is up to it. More than a few senators like to sing in a key of their own choosing.

[Winstonm]

Personally, I think there could be a chance of adopting the Dutch model here in the U.S. - but it cannot work as a bastardization of that model. Only a uniform plan presented by the Party's spokesman (the President) has a chance to galvanize the populace behind the change. The schoolboy attempt to hammer out a bipartisan plan that suits all has to be discarded. To get something done, a cogent plan must be presented - then the small details can be debated, but the plan itself, no.

Without broad public support, no plan can overcome the power of the health insurance lobbies. The Dutch plan, with insurance companies that are heavily regulated may be the idea that can be sold here - not to idiots like Phil Gram - but to the 99.5% who really can think for themselves without watching Hannity.

[Winstonm]

kenberg, on Jan 29 2010, 07:59 PM, said:

Sounds like the Lyndon Johnson approach to the presidency. But LBJ, besides having a natural talent for head banging, spent many years in the Senate perfecting the style. I doubt BHO is up to it. More than a few senators like to sing in a key of their own choosing.

Ken,

I agree. Funny, but I used to dispise LBJ, but over the years as I grew older I realized that without LBJ there would still be black and white bathrooms in Alabama.

You have to admire a southerner taking on sourtherners to pass the civil rights act.

[Al_U_Card]

PassedOut, on Jan 29 2010, 07:55 PM, said:

Winstonm, on Jan 29 2010, 07:00 PM, said:

If he wants to whip someone into shape, it should be the members of his own party.

Agreed.

Indeed. Sounds like the plan of a man with a scam.

Maybe his ploy is to not move forward at all?

[Al_U_Card]

Winstonm, on Jan 29 2010, 08:10 PM, said:

kenberg, on Jan 29 2010, 07:59 PM, said:

Sounds like the Lyndon Johnson approach to the presidency. But LBJ, besides having a natural talent for head banging, spent many years in the Senate perfecting the style. I doubt BHO is up to it. More than a few senators like to sing in a key of their own choosing.

Ken,

I agree. Funny, but I used to dispise LBJ, but over the years as I grew older I realized that without LBJ there would still be black and white bathrooms in Alabama.

You have to admire a southerner taking on sourtherners to pass the civil rights act.

Interestingly, there is some speculation that his "denigration" by the Kennedys led him to want to surpass their "agenda" in his very populist leanings.

OTOH is was his starting of huge expenditures in Vietnam and those social programs that got the ball rolling for the monetization of that debt and the crushing interest rates of the mid-seventies.

Certainly an American "character" of reknown and note.

[Rodney26]

Winstonm, on Jan 29 2010, 07:54 AM, said:

Quote

I hope that the real truth is that the American people are going to start demanding fiscal accountability from all levels of government and aren't going to let social issues wedge how we vote in elections.

If you are so impassioned about fiscal responsibility then you must surely be in favor of reducing the outrageious amount spent on defense spending when there is no U.S.S.R. to defend against.

I think that the US federal government needs to be responsible for the defense of the country. That is not something that can be handled by another model (unless you have any ideas), although the days of the thousand dollar toilet seat are a cautionary tale of how perverse expenditures tend to get when the buyer is spending other people's money and has a reverse incentive to budget properly. The US federal government does not have to be a lender, a car producer, a retirement asset manager, a health insurer, a farmer etc. That's especially true given its current track record of being 50 trillion in debt when SS and Medicare are included in the calculations of just how behind the eight ball we are.

That said, I do agree that we should be playing more defense and less offense when it comes to our military. We as a people need to be more vigilant in our voting patterns. I'm hopeful that we're getting there, but seeing results like that poll are not encouraging.

[Winstonm]

Quote

The US federal government does not have to be a lender, a car producer, a retirement asset manager, a health insurer, a farmer etc.

That's especially true given its current track record of being 50 trillion in debt when SS and Medicare are included in the calculations of just how behind the eight ball we are.

I broke up your statement to address each individually. On the first, the amount of money spent on all these programs is so miniscule compared to the big three: defense, medicare, and social security that it is laughable to even worry about them. It makes for good talking points and sound bytes but in reality they don't matter much to the total U.S. bill.

What's really funny is that we have continually raided the social security trust to finance tax cuts for the wealthy and then cry out that benefits need to be reduced to the ones getting no tax benefit relief.

When Al Greenspan was bemoaning the fate of SS, that program was fully funded. What was not funded was the general budget, which is what brought about the concept of borrowing from SS to fill the gap in the general budget that was brought about by the tax cuts of the Reagan administration and their huge defense spending increases to fight an unnecessary economic escalation war with a counry that was already beginning to collapse from the inside, the U.S.S.R.

SS is still funded by IOUs from the general budget - guess which side is going to have to pay that bill, retirees or the Department of Defense.

Name a country that has any chance whatsoever of invading and taking over the U.S. Protecting against that event is about 95% of how a defense budget should be used, probably no more than 10% of the current defense budget. The rest of our monumental military industrial complex spending is based on the DoD and MIC contractors raiding the treasury in order to enforce our foreign policies around the globe.

We need to do more pillaging, plundering, and robbing. What good is invading Iraq if we don't get their oil?

[Rodney26]

kenberg, on Jan 29 2010, 05:17 PM, said:

Another question, now that I understand that graph.



I think that some of the worry with the current bill is that it may lock in a number of entitlements, again without adequate regard for the costs. We know how this goes. If I get a prescription filled, it's really very cheap. I don't know why. Medicare? My supplementary insurance? The Bush program? I dunno. But now I expect it. Someone wants to modify it so that I have to pay more? What, they hate old people? Call AARP.

The main reason why the American health care system is so financially perverse is that third party payers pay the vast majority of expenses for most Americans. After we make our $25 copay, we don't care how much the actual bill is because there's no difference between 200 and 500 and 1000. I think you're right when you say you don't seem to have a lot of skin in the game.

Last time I had a physical (45 minutes) the actual bill was $650. You can pay the doctor, the nurse, the technician, and the receptionist a nice chunk of change in terms of yearly salary, and that still seems like it is twice as high as it should be. I like my doctor, but if I was paying the $650 out of pocket, there is no way I wouldn't look for something more reasonable. Since my copay never changes, I have no incentive to try to bring costs down.

The tax deduction for companies on health insurance is a big problem, since it drives things like annual physicals, dental visits and optometry under the veil of "insurance," when they are really things that shouldn't be insured. Medical insurance should be like auto insurance, where accidents and other unusual occurances are covered. Imagine what the price of gas would be if auto insurance were like medical insurance and you just had to come up with a $10 copay every time you filled up.