My bad. I guess there's no government corruption, is there? It's pretty obvious that more government means more corruption. Larger entities always have more corruption than smaller entities.
Gavin Newsome touches on problems in Democratic Party
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My bad. I guess there's no government corruption, is there? It's pretty obvious that more government means more corruption. Larger entities always have more corruption than smaller entities.
Oh please tax me more. 30+trillion over 10 years for healthcare for all sounds really doable. Tax tax tax tax......am I doing it right?
I never said that there wasn’t corruption. I just pointed out how stupid it is to think all government spending is just corruption.
Comparing our healthcare system to other countries' is a red herring.
Free college made sense a long time ago. Not so much anymore. We need to find a way to reduce cost and push people back towards blue collar jobs.
Maybe one problem is paying Native American women $400,000 to teach one class.
I don't know if it ever made sense, but I agree with the latter part of this post. There are a lot of good paying trade jobs out there that people either don't know about or don't want to work.
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That’s exactly what you said. I said more spending equals more growth. You replied that “keynesians make the claim that more corruption will yield higher growth rates.”
Perhaps. I’m no healthcare system expert. Just reporting some of the stats I’ve heard before. Are you against single payer?
Where in that post did I say that all government spending was waste? Maybe you're dyslexic and "reworded" the first post?
Also, more growth doesn't mean that you are optimizing the growth. If you can grow the economy at 3.5% with government intervention, then you're still growing the economy. However, what if you could grow the economy 6% without government intervention? You seem to just casually dismiss that second part and act as there could never be more growth without the government. It's like you think companies are going to store the money in their mattress, instead of reinvesting it, if the government didn't force them to do it against their will. That's a pretty insane argument, dude.
You didn’t say more spending, when that was what I was talking about. I never said that more corruption would help the economy. It was a poor attempt at reductionism by you.
We don’t have a balanced budget and deficit spending will always juice up the economy. The government is spending more into the economy than it is taking out. I get that you’re a free market fundamentalist but that ideology has been debunked over and over again. When we cut taxes that money ends up invested in financial instruments that don’t provide real value to the market.
I’m not saying we should always jack up government spending, but claiming that less of it will lead to more growth has no basis in reality.
Debunked by who? People taking advantage of the system? Let's get real here. Everyone knows that government fosters corruption and waste. So, the logical conclusion is the more government you have the more waste you have. Now, if you have more waste, you aren't optimizing your investments, which means that you aren't growing as fast. None of the things I've said in our discussion is controversial. Of course, this is met with claims of "the experts say" and other forms of obfuscation and argument from authority. Tell me exactly where and why I'm wrong in my claim. I'll even lay it out for you:
- Government fosters corruption and waste.
- The larger the government, the more waste there will be.
- Corruption and waste hinder growth due to not optimizing investments.
Lol you don’t think private firms incur waste?
Basic macroeconomics...
Y = C + G + I + NX
If you increase G then all other things being equal, Y increases. That’s how deficit spending increases growth. It’s pretty simple actually.
Except that formula doesn't take into account human actions... such as corruption and motivation.
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It doesn’t need to. It’s a measure of economic activity. That’s how you measure gdp. Wasteful spending still counts towards GDP.
But that wasteful spending doesn't generate continued growth. You see where I'm going with this, right? You invest $100 and you get back $500. Now you have $500 to further invest, which increases growth exponentially. Now you invest $100 and lose it. Are you saying that waste doesn't matter to growth? I'm not talking about your neat little formula that makes government spending more attractive. I'm talking about the real world.
Even wasteful spending generates revenue for someone to reinvest. There is always waste. From both corporations and government. That doesn’t change the fact that there is a clear correlation between deficit spending and higher rates of growth. But of course you know more than the actual economists who do this for a living...
I will start by saying that you know more about economics than I do.
I do believe that if the government spends more than it takes in, it can only resolve this gap via two processes:
1) printing money, which leads to more money chasing fewer goods, higher inflation, lower value of existing dollars you or I have. Taken to its worst extreme you end up with hyper-inflation and fiat money, not backed up by any material goods wealth, and worthless money like you see now in Venezuela.
2) borrowing money (ie our $22T debt) - the primary bad part of this borrowing is the amount of interest due annually on this debt, including payments to governments and entities hostile to the US (China) - and what a large swath these interest payments take out of annual federal tax receipts. If interest rates increase just a little bit, the payments to service this debt will crowd out spending on other things that will really bring bad circumstances for US. Annual obligations in the federal budget for medicare, defense spending, federal workforce and all their benefits, etc.
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Of course there's a correlation between deficit spending and a higher rate of growth. If you pump $2 trillion into the economy, it's going to grow short term...but that's the key, short term. You and all your experts always have such a narrow short-term view of the economy. The fact that you ignore motivation and corruption isn't surprising.
As for there being corruption in the private sector, of course there is. A lot of that corruption is also caused by government intervention, just look at the housing market crashing.
This kind of shit is why I can’t take you seriously. There is an entire field of economists who focus on long run growth. It’s one of the main fields of macroeconomics. Long run growth always falls, as the economy adjusts to the shock of infusing spending. It will always fall back to equilibrium level, regardless of the model. We primarily use shocks like deficit spending to help boost the economy during recessions.
You’re ideologically possessed. You can’t even acknowledge the corruption in the private sector without going back to government. It’s a sad obsession of yours.
Just to clarify, I’m not an expert on monetary policy. It’s just not my specialization. I’m more interested in labor markets, and political economy. I’m hoping to do a dissertation on the future impact of AI and automation on our labor markets.
Inflation is certainly problem, but it’s one that is somewhat mitigated by a few factors. Obviously we don’t have a commodity backed currency, so the value of the dollar, to some extent, depends on confidence. Fortunately a lot of countries are betting on the US by holding dollars in their currency reserves. That foreign demand for currency helps maintain the value even when we increase the money supply. Also, the Fed has the ability to manipulate interest rates in the money marking which can impact velocity and inflation. These won’t completely erase inflation, which is why we almost always have some positive amount of inflation year to year.
The debt does bother me. Obviously at some point it will become unsustainable. I’m afraid we may have already dug a very deep hole for ourselves in that regard. I don’t see how that debt can ever actually be paid. Fortunately nobody is sending the collectors to our door. That’s one of the perks of having the most powerful military in the history of the world. But the debt could eventually undermine the confidence in our dollar. Which would be a big problem.
I’m not sure people realize how much trouble we could be in if we don’t adapt our economics. AI and automation are going to eliminate millions of jobs. Possibly tens of millions. I would say sometime in the next century, we will see human labor become almost completely obsolete. Even programming jobs will be done better by a computer that is trained in coding. Robots will fix themselves. Trucks will drive themselves. There’s going to be a certain number of creative jobs that can’t be done by AI, but nowhere near enough to meet the needs of the entire labor force.
You're not telling me anything that I don't already know. It doesn't change the issues that I'm talking about.
Sorry, I should've elaborated.
Comparing the cost of healthcare and health outcomes across different countries is somewhat meaningless. When looking at the factors that determine population health, medical care only represents about 10% of the total. The linked article cites several other factors at play including genetics (30%), social circumstances (15%), environmental conditions (5%), and most importantly, behavioral choices (40%).
We have the most open society in the world. I can smoke half a pack of cigarettes while driving my 8 mpg SUV to a drive-thru 2 miles away to pick up a breakfast that includes 3 bacon, egg, and cheese biscuits; 2 orders of hash browns; and a 48-ounce Mountain Dew. On one hand, I wouldn't have it any other way. On the other, I think it's unfortunate that society will eventually bear the costs these kinds of lifestyles (more on that in a minute).
It doesn't make much sense to compare our healthcare to countries that have less diverse populations, less income inequality, more preventative care, and a greater emphasis on healthy lifestyles. We're already at a disadvantage before there's an event that necessitates medical intervention. The United States is one of the most unhealthy countries on the planet and proud of it. 'Merica!
That's one of the many, many reasons I'm opposed to single payer, Medicare for All, or universal health care. (These are all distinctly different things and should not be used interchangeably, for the record.) I don't want to pay for other people's shitty lifestyle choices. If you want to ride a motorcycle without a helmet, be my guest. Just don't expect me to pick up the tab when you suffer a traumatic brain injury during a crash. The same goes for people who smoke 2 packs a day, engage in promiscuous sex, or eat fried chicken at every meal. I could go on but you get the idea.
Great post.
But a question. You are against Single Payer because you don’t want to pay for other’s lifestyles. But you already do (as you well know). In light of that, what would improve our system? Is it even sustainable?
Are you asking about improvements and sustainability of Medicare, specifically? Or our healthcare system in general? (Warning: tl;dr)
Medicare spending per beneficiary has flattened out over the last few years. That's the good news. The bad news is that about 10,000 people (baby boomers) are aging into the Medicare benefit every single day, which obviously drives up costs for the program. Under our current payment system, Medicare isn't sustainable. That's why Medicare, and the industry in general, is going through a massive provider payment reform right now.
What might be interesting to the layman is that Medicare has traditionally been the biggest innovator in payment reform. They have the statutory authority to ensure provider compliance, whereas commercial insurance companies (BC/BS, Aetna, Cigna, United Healthcare) have to negotiate contractual agreements with providers. Medicare also has national membership, unlike insurance company associations whose membership is fragmented across state lines. Medicare pilot programs typically get adopted by insurance companies rather than the other way around.
Right now the healthcare industry, led by Medicare, is shifting away from fee-for-service (FFS) provider payments towards value-based provider payments. In other words, instead of getting paid for the volume of services, providers get paid based on quality, safety, patient outcomes, and controlling the cost of care. Health insurers and providers in a FFS environment have little incentive to control costs -- quite the opposite, actually -- so value-based care is probably our best hope to ensure Medicare solvency. Insurance companies have less concern about solvency because they can simply raise premiums or curtail benefit coverage.
There are plenty of books and articles written about this subject by people far more knowledgeable than me. Generally speaking, I've found that periodicals and newspapers don't do a good job covering the topic for various reasons. If you're interested in reading more, look to places that specialize in healthcare policy research: universities, accounting/actuarial firms, National Institutes of Health (NIH), Kaiser Family Foundation, Health Affairs, Advisory Board, Avalere, Sg2, etc.
Medicare determines the value of its programs. When they first propose a rule, it's open to comments that they may take into consideration when drafting the final rule. The final rules have statutory authority.
Other insurers typically negotiate the value of their programs with providers. There's wide variation in how negotiable those programs are. For example, Cigna has a national program where all the terms are locked down. A provider either agrees to participate under their rules or doesn't participate at all (foregoing the opportunity for revenue).
Other programs, particularly those administered at a state or local level, have more flexible terms. For example, an insurer might offer a program that includes 30 patient quality measures. A provider can choose to participate in 1 measure or all 30 measures. The measures could be valued individually, or the insurer might say the provider has to fulfill 6 of 10 measures chosen by the provider, or the measures could have different weights and the provider has to achieve a weighted score of X to earn an award.
That's just one overly simple example. We have a joke that once you've seen one value-based care program, you've seen one value-based care program. These programs are incredibly complex and negotiating terms involves a great deal of strategy.
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