2016 Election Thread

[Mike Sixel]

 

For me Obamacare cost me a significant amount in the quality of my healthcare.  As a teacher I still have great benefits, but they went from outrageously good to pretty good.

 

That may seem like a "boo hoo" statement, but when your profession is wildly underpaid and that is one of the few things that makes up for it, it hurts.

 

Given that rates were rising at double digits before Obamacare, and that companies have been making HC "worse" for the insured for about 2 decades now.....I don't think it is Obamacare that is the issue for you.*

 

*this is my personal opinion, and does not reflect the stance of my employer**
 

**I think I'm supposed to type that, or not comment on HC at all...

[Mike Sixel]

 

So instead of getting zero Republican votes getting what they "wanted" they compromised to get zero Republican votes getting something they didn't want?  It kind of sounds like Republicans weren't the problem.

 

they are 100% the problem in HC. They believe it is like other goods, that you can choose to buy or not. Unfortunately, that just isn't true. Hospitals can't turn the uninsured away. People who are sick shouldn't just say "well, I don't need that <bag of Doritos> today". It isn't the same kind of good as other things at all. We cost more, we get less good outcomes than the entire rest of the world.......that is not a coincidence at all.

 

*this is my personal opinion, and does not reflect the stance of my employer**

**I think I'm supposed to type that, or not comment on HC at all...

[mikecgrimes]

 

they are 100% the problem in HC. They believe it is like other goods, that you can choose to buy or not. Unfortunately, that just isn't true. Hospitals can't turn the uninsured away. People who are sick shouldn't just say "well, I don't need that <bag of Doritos> today". It isn't the same kind of good as other things at all. We cost more, we get less good outcomes than the entire rest of the world.......that is not a coincidence at all.

 

*this is my personal opinion, and does not reflect the stance of my employer**

**I think I'm supposed to type that, or not comment on HC at all...

 

Republicans can be as wrong as wrong can be on the issue, if Democrats passed the wrong version of the law thats on them.  You can bash the stance of the Republicans, but they didn't need a single Republican vote to pass it so they probably should have passed the law they wanted.

[Mike Sixel]

 

Republicans can be as wrong as wrong can be on the issue, if Democrats passed the wrong version of the law thats on them.  You can bash the stance of the Republicans, but they didn't need a single Republican vote to pass it so they probably should have passed the law they wanted.

 

You act like the democrats all agreed on what they wanted, like it is some kind of one brained thing.....trust me, they did not agree. This was as close to what they wanted as they could get. I remain not a fan, frankly. But, Obamacare is not what is driving costs up, or changing what kind of policies are available for purchase. That started a long time ago.

[mikecgrimes]

 

You act like the democrats all agreed on what they wanted, like it is some kind of one brained thing.....trust me, they did not agree. This was as close to what they wanted as they could get. I remain not a fan, frankly. But, Obamacare is not what is driving costs up, or changing what kind of policies are available for purchase. That started a long time ago.

 

Exactly my point.  The Republicans had nothing to do with not getting what some think would have been a better bill, you're not going to get a handful of Republicans to come in on the more liberal version so why are we blaming the Republicans?  Cost are going up because government is trying to do things they aren't good at, and despite it not being represented in all aspects of the economy we do have inflation, it's what happens when you print new money at the rate we are.

[Mike Sixel]

costs are going up because of many reasons, only a tiny handful of which are government related. I do agree government is playing a role, but it is largely driven by drugs and equipment, costs for which are rising much slower in more regulated nations.....

[diehardtwinsfan]

 

No it didn't fix health care, but fixing healthcare, unfortunately wasn't politically viable.  When faced with one party who wanted to do nothing, liberals compromised (even though they would have preferred single-payer) to ensure that many more would have the opportunity to receive healthcare.  The human factor counts for something, even if the economic factor is left largely unresolved.  I'm not happy about the system we choose, but doing nothing was the only other option, so let's not kid ourselves.  

 

Student loans are a mess, but that loan forgiveness is a viable option matters, and so does getting rid middle-men banks as lenders.  Still the system has huge problems.  Again, doing nothing was the other viable option.  

 

In general, I do think it is ideal to expect your government to fix problems when one party doesn't believe in the problem (or will leave the problem to be fixed by the free market, which abdicates such responsibility).  Any compromise between those that resist doing anything and whatever plan is adopted to address the problem will be a half-measure (or subsidized-markets).  

 

At some point we need to figure out that the free market can't address specific aspects of human civilization, and rather than resisting government regulation, let's make it smart and efficient.    Waiting for the perfect solution to come along is akin to rubber stamping the status quo, and doing nothing.  

 

Sorry Pseudo, I think you're being a tad partisan here (and this comes from someone who loves neither party).  Fixing heathcare isn't politically viable because the powers that be have paid for both parties to keep it that way. That, my friend, is problem number 1. There is no way to fix healthcare while keeping cash cow in place for their sponsors, which is why it will not be fixed until both parties are kicked to the curb.

 

Likewise, the healthcare system we have in place IS NOT free market. That, I believe, is one of the big reasons why costs continue to escalate. The system is designed in such a way to keep the costs hidden so that the consumer cannot make a rational decision if they wanted to. There's no true competition, and as such prices are (much like colleges and student loans) set at whatever people want. That isn't the only problem with healthcare, but that's definitely a big one.

[Willihammer]

 

I like what Oregon did.
(I don't have the exact number on me it its close to the following)


State will pay for your tuition (public university in state) and in return you have to give 10% of your income to them for your first 10-15 years out of college. The people that go on to be CEOs then subsidize the ones who become artists and such.

A lot to criticise about that idea. It would drive students who don't want to pay the income tax of state where Oregon can't collect. Federally implemented it would drive graduates out of the country. 

It has been described as "social security but in reverse." That should be a massive red flag since we can't even guarantee SS benefits to people who have paid in for 50+ years. Another thing is that a lot of times tuition is just half the cost of a public education. Housing and living expenses would need to be taken out as loans and repaid just the same.

 

It is very simple IMO. We need close the gap between the degrees universities are producing and the degrees employers are willing to pay for. I would look at ways to get the private sector more involved in pre-hiring undergraduates and financing their education as a way to train them for actual jobs that will be there for them when they graduate. People wouldn't like this since it smells like indentured servitude but the reality is that all the English degrees we graduate today are burdened with just as much debt and none of the job security. The government's role would be to regulate and oversee the process.

[TheLeviathan]

Given that rates were rising at double digits before Obamacare, and that companies have been making HC "worse" for the insured for about 2 decades now.....I don't think it is Obamacare that is the issue for you.*

 

*this is my personal opinion, and does not reflect the stance of my employer**

 

**I think I'm supposed to type that, or not comment on HC at all...

Partially true, there likely was an increase in my responsibility coming but that isn't what happened. There was a total remodeling of the insurance.

 

It is what it is, I understand the need to insure those that needit, but there were costs for many with negotiated benefits or benefits with their employer. Healthcare reform was going to have that price regardless, but it still hurt.

[Mike Sixel]

 

Sorry Pseudo, I think you're being a tad partisan here (and this comes from someone who loves neither party).  Fixing heathcare isn't politically viable because the powers that be have paid for both parties to keep it that way. That, my friend, is problem number 1. There is no way to fix healthcare while keeping cash cow in place for their sponsors, which is why it will not be fixed until both parties are kicked to the curb.

 

Likewise, the healthcare system we have in place IS NOT free market. That, I believe, is one of the big reasons why costs continue to escalate. The system is designed in such a way to keep the costs hidden so that the consumer cannot make a rational decision if they wanted to. There's no true competition, and as such prices are (much like colleges and student loans) set at whatever people want. That isn't the only problem with healthcare, but that's definitely a big one.

 

healthcare is not a free market, and never will be. It isn't like other goods. You don't just choose to not get healthcare, and sellers of services can't turn away non-paying customers morally/ethically/or legally. Every other nation in the world has a more regulated system, and they produce better outcomes at lower costs. It is hard to understand why we can't just see it for what it is.....by looking at how it works here vs the rest of the world. It just isn't and never will be a free market. But going half way like this? Half way is always the least effective and efficient way.

[TheLeviathan]

 

It is very simple IMO. We need close the gap between the degrees universities are producing and the degrees employers are willing to pay for. I would look at ways to get the private sector more involved in pre-hiring undergraduates and financing their education as a way to train them for actual jobs that will be there for them when they graduate. People wouldn't like this since it smells like indentured servitude but the reality is that all the English degrees we graduate today are burdened with just as much debt and none of the job security. The government's role would be to regulate and oversee the process.

 

There are some other potential issues, it would basically require some kind of cost control agreement between businesses and the schools and would really only be viable for large businesses.  

 

If all you want to fix is vocational training, fine, but I think there is real value in a more diverse education.  The liberal arts/renaissance person style isn't the problem.  The problem is that it's been dumbed down so that colleges can attract more mouths to the trough.  We turned higher education into a transaction rather than a process, your idea only furthers that.

[PseudoSABR]

 

Sorry Pseudo, I think you're being a tad partisan here (and this comes from someone who loves neither party).  Fixing heathcare isn't politically viable because the powers that be have paid for both parties to keep it that way. That, my friend, is problem number 1. There is no way to fix healthcare while keeping cash cow in place for their sponsors, which is why it will not be fixed until both parties are kicked to the curb.

 

Likewise, the healthcare system we have in place IS NOT free market. That, I believe, is one of the big reasons why costs continue to escalate. The system is designed in such a way to keep the costs hidden so that the consumer cannot make a rational decision if they wanted to. There's no true competition, and as such prices are (much like colleges and student loans) set at whatever people want. That isn't the only problem with healthcare, but that's definitely a big one.

The problem is the free market.  And we need stop preserving the free market in areas where they pervert the industry.   We can't have a true free market with  inelastic demand.  Without government regulation, pricing would be set at near monopoly prices, excluding anyone who can't meet the most-profit-garnering price.   

 

I don't doubt that the Dems are well paid for, but as a liberal, it's pretty clear we wanted single-payer in spite of however much the party leaders have been paid off.

[diehardtwinsfan]

Pseudo, there is no free market in healthcare. If there was, you could choose your provider and actually see prices for goods and services.

 

If there was a free market system in healthcare, it would be an individual payer cash based system with a high deductible insuranc e for catastrophic situations. Medical providers would be forced to actually show their prices and compete (something that is not done today). Pharmaceutical providers woudln't be able to charge whatever they wanted for drugs as their prices would look a lot closer to those negotiated insurance rates that you or I cannot access now, as providers wouldn't be able to sell said drugs. It's no accident that people prefering these types of plans saw their rates go up significantely under ACA. The powers that be wanted this, which is why you have minimum requirements that essentially make this less likely.

[Mike Sixel]

 

Pseudo, there is no free market in healthcare. If there was, you could choose your provider and actually see prices for goods and services.

 

If there was a free market system in healthcare, it would be an individual payer cash based system with a high deductible insuranc e for catastrophic situations. Medical providers would be forced to actually show their prices and compete (something that is not done today). Pharmaceutical providers woudln't be able to charge whatever they wanted for drugs as their prices would look a lot closer to those negotiated insurance rates that you or I cannot access now, as providers wouldn't be able to sell said drugs. It's no accident that people prefering these types of plans saw their rates go up significantely under ACA. The powers that be wanted this, which is why you have minimum requirements that essentially make this less likely.

 

you could choose not to have insurance, could doctors and hospitals turn away the uninsured?

 

There is NO first world nation on the planet with a free market HC system, the US is the closest, and the most expensive and produces terrible outcomes. 

 

Health care is not an optional thing, that you can just choose not to have. It just isn't. People get sick, they get pregnant, they need vaccinations. Nothing about health care shares the underlying premises that other items in our economy do, that would make it better to have total freedom of choice.

[TheLeviathan]

 

Pseudo, there is no free market in healthcare. If there was, you could choose your provider and actually see prices for goods and services.

 

There are some things the free market shouldn't be used for, chief among them are health care, education, and the military.  

 

Why the right continues to understand that about one of them, but not the others is always baffling to me.

[DaveW]

 

A lot to criticise about that idea.  Federally implemented it would drive graduates out of the country. 

 

Highly doubtful. Even if you are some hot shot doctor who has to pay a large amount, are you really going to give up your US citizenship?

[Willihammer]

There are some other potential issues, it would basically require some kind of cost control agreement between businesses and the schools and would really only be viable for large businesses.  

 

If all you want to fix is vocational training, fine, but I think there is real value in a more diverse education.  The liberal arts/renaissance person style isn't the problem.  The problem is that it's been dumbed down so that colleges can attract more mouths to the trough.  We turned higher education into a transaction rather than a process, your idea only furthers that.

How would you finance higher ed?

[Willihammer]

 

Highly doubtful. Even if you are some hot shot doctor who has to pay a large amount, are you really going to give up your US citizenship?

If the costs outweigh the benefits, yeah, I think so.

[Mike Sixel]

 

How would you finance higher ed?

 

This is a very tricky one. 

 

I'd probably do what I'd do with HC. Give every newborn money into an account that goes in the index funds, every year, and that money can be used for HC or education, or money to be taken out after some age. Not super hard to pay for if you just eliminate all the other ways we subsidize people and companies. 

 

But, I'm not sure that helps with the rising costs.......

[TheLeviathan]

If the costs outweigh the benefits, yeah, I think so.

I think it has to be a capped amount that is only accessible based on academic merit and make trade schools free.

[TheLeviathan]

But, I'm not sure that helps with the rising costs.......

It might help if liberals treated universities like the corporate blood suckers they are and apply the same standard rather than blaming state subsidies and other nonsense.

 

Colleges are lining their pockets off tax payers and 18 year olds. If a corporation was doing that we'd hear no end to the condemnations from the left.

[PseudoSABR]

 

Pseudo, there is no free market in healthcare. If there was, you could choose your provider and actually see prices for goods and services.

 

If there was a free market system in healthcare, it would be an individual payer cash based system with a high deductible insuranc e for catastrophic situations. Medical providers would be forced to actually show their prices and compete (something that is not done today). Pharmaceutical providers woudln't be able to charge whatever they wanted for drugs as their prices would look a lot closer to those negotiated insurance rates that you or I cannot access now, as providers wouldn't be able to sell said drugs. It's no accident that people prefering these types of plans saw their rates go up significantely under ACA. The powers that be wanted this, which is why you have minimum requirements that essentially make this less likely.

I don't want to argue on this point, but the ACA is a quasi-market solution. It is premised with market principles not socialistic principles. It's nothing like the single-payer system, which would totally eliminate the free market from health care.

 

You still haven't addressed the problem of inelastic demand. Mike points some of this out.  Consumers have literally no bargaining power, especially when they are at their sickest or have an emergency.  In a free market, a hospital could negotiate with each emergency patient on a case by case basis, leveraging a person's entire wealth against their life.  It's not like a person can shop around in an emergency situation.  

 

Unless you think we should get rid of patents for pharmaceuticals, I don't see how a free market would really do anything to alter the price of drugs.    

  

Given the demand for healthcare services, there would be little need for healthcare providers to compete on price; it's not as if healthcare providers are fighting for customers.   Any doctor who charges lower than standard rates would be overwhelmed by capacity problems, leaving the doctors who charge higher rates with plenty of customers.  

 

What we find when there's inelastic demand for a given commodity, different firms simply don't compete on price.  They charge as near-a-monopoly price as they can, only limited by their own capacity.  

 

You should read up on Anti-trust, to see how free market conditions over time tend to create monopolies more than it does make competition.  

[diehardtwinsfan]

Consumers have no bargaining power b/c it's setup that way. Somewhere along the lines we decided that every prescription/doctor appointment/etc. needed to be paid for by insurance paving the way for a setup just like this. The best way to reduce costs in healthcare is to go to a system where consumers have to make those choices, such as who to go see, and how much they want to spend to deal with an issue.  It also means that consumers are going to have to weigh their lifestyles (i.e. smoking, drinking, refusing to exercise, etc.) against what it will actually cost them.  You get insurance for the expensive things, but those types of policies are historically fairly inexpensive... and it's not accidental that under ACA they were forced to add far more coverage thus making them far more expensive.

 

As long as we operate that healthcare is an entitlement, there will be no incentive to actually control costs. ACA didn't fix that. It won't fix that. At the core is an assumption that we all deserve it.  But if you don't think it's possible, I strongly recommend that you look at how Ron Paul managed his practice. He was rather successful doing that type of system on it's own.  It's doable. It just means the cash cow comes to an end.

[Craig Arko]

"I can only hope."

 

http://youtu.be/qqLIH2UiPXg

[PseudoSABR]

 

Consumers have no bargaining power b/c it's setup that way. Somewhere along the lines we decided that every prescription/doctor appointment/etc. needed to be paid for by insurance paving the way for a setup just like this. The best way to reduce costs in healthcare is to go to a system where consumers have to make those choices, such as who to go see, and how much they want to spend to deal with an issue.  It also means that consumers are going to have to weigh their lifestyles (i.e. smoking, drinking, refusing to exercise, etc.) against what it will actually cost them.  You get insurance for the expensive things, but those types of policies are historically fairly inexpensive... and it's not accidental that under ACA they were forced to add far more coverage thus making them far more expensive.

 

As long as we operate that healthcare is an entitlement, there will be no incentive to actually control costs. ACA didn't fix that. It won't fix that. At the core is an assumption that we all deserve it.  But if you don't think it's possible, I strongly recommend that you look at how Ron Paul managed his practice. He was rather successful doing that type of system on it's own.  It's doable. It just means the cash cow comes to an end.

You continue to ignore the problem of inelastic demand--that demand will never be curbed no matter what price is set. (Especially in emergency/surgery situations). The market is never going to properly price such a product.  If your goal is cost control a market solution cannot fix it.  If your goal is universal healthcare, the market will not provide. 

 

And I seriously doubt that Ron Paul competitively priced his practice, he charged as close to the monopoly price as he could.  (But I'll do some research on this).  And really, go read the history of anti-trust laws; your assumptions about the free market seem almost religious. 

[drjim]

I generally am in favor of markets, but health care is a terrible good to provide strictly through the market for the following reasons (and others):

 

-Inelastic demand - you covered this well, but if you have a serious health problem, you either get it fixed or potentially die.

 

-Lack of information - Goods and services provided in health care are not generally openly priced. People don't know what it costs and what it should cost, no frame of reference.

 

-Assymetrical information - People generally are and should be deferential to the expertise of medical providers in a way that is not really comparable in other goods

 

-Public good - health care is a public good in that the value of a healthy population has positive value to a society as a whole that is not perfectly captured in the individual price point

 

-True market behavior would lead to undesirable outcomes - This is something of an opinion, but I don't think it is ideal if a health insurance company is able to remove people from the rolls that get sick and cost money, or that people with pre-existing conditions are not able to enter into our health care system

[PseudoSABR]

[Ron Paul's] practice would not participate in any federal health programs, which meant, as Paul described it, "that we will see all Medicare and Medicaid patients free of charge, and they will be treated just like all of our other patients, but we're not going to charge them and accept federal funds."

 

Via npr.  I suppose that's one solution; no federal funding, and just don't charge them. Though that's no exactly a market solution.

[DaveW]

I think it has to be a capped amount that is only accessible based on academic merit and make trade schools free.

Yeah, then cap it at like 50k a year for 10 years. Someone that rich (making like 10+ million a year) isn't going to give up their US citizEnship IMO

 

Force people to have a 2.8 or something to continue recieving it

[TheLeviathan]

 

Yeah, then cap it at like 50k a year for 10 years. Someone that rich (making like 10+ million a year) isn't going to give up their US citizEnship IMO

Force people to have a 2.8 or something to continue recieving it

 

Yeah, there should be a variety of contingencies that ensure it's being used for a higher education and not a place to get drunk.

 

More than anything though, we've fed colleges more money than they deserve and all they do is keep bleeding us year after year for more.  That's the problem.

 

Sanders federally subsidizing it would be an outright disaster in this climate.

[PseudoSABR]

A few thoughts on loans and funding higher education.

 

I'm just thinking out loud and really haven't researched the viability of any of these ideas, but I'm curious to know what others think.

 

I think loans, in general are a horrible way to finance higher ed.  It gives too much leeway to both students and universities to misspend that money in all kinds of ways.  

 

So one idea I've been shuttling around in my head is to offer tuition-free education financed by a tax on post-graduates who meet certain income standards.   So those who utilize the higher education system opt-in to a later tax provided they get jobs--this will emphasize universities to educate towards actual employment to keep their financing as robust as possible.   It would also keep students from having a trough to spend not only on tuition, but anything under the sun.  I realize that this alone wouldn't be enough to fund all of higher education, so another vehicle of finance would be necessary.  

 

Having a whole generation of Americans indebted to their education so that they end up paying twice as much in interest over their lifetimes hurts not only the individual, but deprives the economy of those dollars that could actually buy goods and services instead paying interest rates.  

 

While I don't think total loan forgiveness for everyone is really a solution, perhaps eliminating the interest rate debt all together would be a good step.  It would be a lot more palatable if people could just pay down their primary debt, without the strange interest rules that keep that debt growing while you pay it back. 

 

I also agree with ideas that want to make vocational education more affordable if not free.  There's probably a host of technological jobs that could be served by a vocational education as much as they could a university education. 

 

Part of the problem with current generation not getting the most out of higher education is that their primary and secondary schools don't teach them the skills to succeed at the university, and often universities are forced to dumb down their processes as a result.   Moving away from standardized testing I think would be an important step.   Finding a new way to fund schools other than property taxes would be another good start; I know some states pool all the property taxes, and this might be one solution.  As much as we want problems like education solved locally, I fear, too often, that localized solution often involves inequitable solutions.  

 

All this said, I wouldn't have been able to go to college without access to loans.  My folks made too much (barely) to qualify for a pell-grant, but still couldn't pay for my tuition.  But the truth is, I misspent a lot of that loan money, and while it would have sucked, I should have been more frugal with my hosing, food, and incidental costs.