Our Next President?

[Morgasbord]

Re: Our Next President?

ok, candidates talking about national debt. the deficit. oh noes! I alluded to it earlier, maybe it should be a separate thread, but can we talk about Modern Monetary Theory (MMT)? I've drank of the koolaid, and now all talk of national debt makes my eyes roll.

Federal debt. Who is it owed to? how is it paid? what are federal taxes for?

This article goes into the thinking driving Bernie and AOC's views on spending, and the progressive caucus are correspondingly getting increasingly annoyed with the centrist camp of paygo rules and narrative framing of the federal deficit.
https://www.counterpunch.org/2018/01...netary-theory/

Why, exactly, can we not deficit spend to marshall real resources to provide medicare for all, and re-tool our infrastructure, but we can spend on the military just fine? Deficit spending only matters in as much as it leads to inflation in the sector you are spending in, at least according to MMT. Republicans seem to get this, but keep it on the down low.

[dcarrigg]

Re: Our Next President?

I haven't drunk the koolaid, and I still say ditch paygo and fund a healthcare system that doesn't suck. Debt might cause real constraints down the road. But I refuse to believe that it's possible to have a public healthcare system more wasteful and inefficient and with worse outcomes than we have in the US today. And paygo is just stupid for Democrats without a corresponding Republican 'cutgo.' Seems baldly on the face stupid to me that one side has a rule against spending without raising revenue while the other side doesn't have a corresponding rule about cutting revenue without cutting spending. Why kneecap your own party like that?

You don't have to believe a damned thing about MMT to think that 1) America has the most expensive, worst designed, and least moral healthcare system in the developed world, or that, 2) the Democrats are strategically handicapping themselves by self-imposing paygo. In fact, I'd suggest that both of these things are plainly true to anybody examining the evidence, regardless of proclivities toward one economic theory or another.

(PS the thing called 'cutgo' where they pledge to cut mandatory spending for increases in discretionary is not what I'm talking about, that's just robbing grandma to pay boeing)

[Morgasbord]

Re: Our Next President?

The truly maddening thing is universal health care would be SO GOOD for business owners, large and small.

[dcarrigg]

Re: Our Next President?

On every level. Not having to pay huge money. Not having to waste time with open enrollment every year. Not having to waste time with insurance salesmen. Not having employees so scared of deductibles they wait too long for treatment and miss work. All the trillions in wasted overhead and admin costs. It's not like the big boys don't realize this; they have employees in other countries. But still they're dead set against it, and they've geared up the US chamber to make Medicare for All public enemy number 1. I think the real fear is personal, not business. Even if it would be better for business, the idea of not having preferential access is the real fear that keeps the fight alive. Shit like concierge medicine, and this. The prospect of losing that horrifies them. My friends who are nurses in Boston have told some amazing stories about the stops that get pulled out for Mid East princelings. Like special treatment an order of magnitude better than this. But mis-triaging like that is only possible in a very corrupt and broken system that has no ethical foundation.

[vt]

Re: Our Next President?

I agree with JK that the best use would be to rebuild the infrastructure.

That's would create a lot of high paying jobs and be a real boost for the middle class.

Plus if we don't fix crumbling water and sewer systems, bridges, and other critical parts of the infrastructure the bill will be much higher later.

[dcarrigg]

Re: Our Next President?

Yeah, this is an interesting one where you have more or less broad bipartisan agreement, and yet they cannot seem to get it done.

[jk]

Re: Our Next President?

we're already spending a ton of money on less than world-class care. we don't need to spend more than we're spending, we need to spend it smarter. so there's no extra spending needed. it's just a question of how the money goes 'round. the reason business owners oppose universal healthcare is that they figure it means they're going to have to pay higher taxes. but the reality is it makes u.s. businesses more competitive. a canadian company doesn't have to worry about funding its healthcare. a u.s. company does. there is no problem in paying for universal healthcare, the only problem is how to distribute the pain of paying for it.

[thriftyandboringinohio]

Re: Our Next President?

we're already spending a ton of money on less than world-class care. we don't need to spend more than we're spending, we need to spend it smarter. so there's no extra spending needed. it's just a question of how the money goes 'round. the reason business owners oppose universal healthcare is that they figure it means they're going to have to pay higher taxes. but the reality is it makes u.s. businesses more competitive. a canadian company doesn't have to worry about funding its healthcare. a u.s. company does. there is no problem in paying for universal healthcare, the only problem is how to distribute the pain of paying for it.

I spoke at length with a gent from Canada who owns a construction company. He loves their national healthcare for two practical reasons. First, he spends zero time and effort on health insurance for his employees. Second, he does not worry his employees will be hired away by competitors due to differences in health plans. He cold not say enough good things about the whole system, both as a business owner and as an individual healthcare consumer.

As to US healthcare costs, we are dancing around the central issue, unwilling to speak it directly. To get costs down, lots of people in the healthcare industry need to be fired, and many others need a pay cut. Who's pay will we cut, and who will we fire? If we don't do that costs will stay high. In other nations they've zeroed out all costs and profits for health insurance companies, and for the clerks working insurance paperwork on the provider side. That's a big slice of the pie chart that stays in the customer's pocket.

[jk]

Re: Our Next President?

I spoke at length with a gent from Canada who owns a construction company. He loves their national healthcare for two practical reasons. First, he spends zero time and effort on health insurance for his employees. Second, he does not worry his employees will be hired away by competitors due to differences in health plans. He cold not say enough good things about the whole system, both as a business owner and as an individual healthcare consumer.

As to US healthcare costs, we are dancing around the central issue, unwilling to speak it directly. To get costs down, lots of people in the healthcare industry need to be fired, and many others need a pay cut. Who's pay will we cut, and who will we fire? If we don't do that costs will stay high. In other nations they've zeroed out all costs and profits for health insurance companies, and for the clerks working insurance paperwork on the provider side. That's a big slice of the pie chart that stays in the customer's pocket.

i believe the affordable care act said that medical losses [i.e. actual spending on medical care] couldn't be less than 80% of premiums collected. so the remaining 20% includes admin costs, profits, exec bonuses, etc. otoh, medicare iirc has admin costs around 2%. that's a lot of savings. further, if we repeal the provision of medicare part d which forbids medicare from negotiating drug prices, there can be major savings.

so the immediate losers are health insurance execs, health insurance staff in general, and the stockholders and to some degree execs of big pharma. some other big pharma staff might be cut- drug reps? some of the bogus research brand extension personnel?

in general, between 18% savings on the admin costs and savings on drug costs i have little doubt you can save 30% immediately.

then, too, medicare fees for docs are distinctly lower than private insurance fees. docs will take a hit, but otoh they won't have to hire as many back office staff to make sure the insurance companies pay them properly, so their overhead will go down. this will represent further system-wide savings, say 10% immediately. so now we've healthcare spending down 40% and we've just started and further, haven't changed any of the services being delivered.

these are just first thoughts off the top of my head.

[dcarrigg]

Re: Our Next President?

I spoke at length with a gent from Canada who owns a construction company. He loves their national healthcare for two practical reasons. First, he spends zero time and effort on health insurance for his employees. Second, he does not worry his employees will be hired away by competitors due to differences in health plans. He cold not say enough good things about the whole system, both as a business owner and as an individual healthcare consumer.

As to US healthcare costs, we are dancing around the central issue, unwilling to speak it directly. To get costs down, lots of people in the healthcare industry need to be fired, and many others need a pay cut. Who's pay will we cut, and who will we fire? If we don't do that costs will stay high. In other nations they've zeroed out all costs and profits for health insurance companies, and for the clerks working insurance paperwork on the provider side. That's a big slice of the pie chart that stays in the customer's pocket.

Sure. But wouldn't anything they do be more productive and more moral than making a living doing busy work just for the sake of gouging the sick?

I mean, nobody feels bad for electronics assemblers whose jobs get automated. Hell, people gleefully threaten fast food workers picketing for a higher wage with automation. But I'm supposed to care that the local Blue Cross marketing executive might no longer make half a million per year at a non-profit by jacking up my deductibles?

If we're going to have make-work schemes, wouldn't it be better to just use tax money to pay them to dig a hole and fill it in again rather than have them extract their wages from cancer patients under duress?

[thriftyandboringinohio]

Re: Our Next President?

...nobody feels bad for electronics assemblers whose jobs get automated. Hell, people gleefully threaten fast food workers picketing for a higher wage with automation. But I'm supposed to care that the local Blue Cross marketing executive might no longer make half a million per year at a non-profit by jacking up my deductibles?...

You misunderstand me. The US seems to be going to great lengths to keep them rolling in the dough, and it may be time to stop. When the topic comes up we invariably hear from our conservative friends how the magical forces of the free market can somehow make healthcare cheaper and better if we would just give the insurance companies everything they want - selling polices across state lines with no regulation, and increased ability to sell entirely worthless polices for half the price of real insurance. There is no place in the world now where a fully private, for-profit health insurance system delivers excellent care for most people at a low price.

[dcarrigg]

Re: Our Next President?

Wasn't meant to be argumentative. Just pointing out that I think you're right. It's a make-work scheme. For every manufacturing job lost the US has gained a healthcare job. Lots are in marketing and billing and other nonsense that only exists because we've overcomplicated things and abstracted too far away from the plain truth: That there's functionally a monopoly of geography with most healthcare needs, and a layer of competition about who gets to middleman the price structure at that monopoly point isn't going to create real competition in care delivery. Nobody's shopping around from the back of an ambulance. Nobody's getting to make the call to wait for an in-network anesthesiologist for their emergency surgery. All the wild layers of private incentives and competition in the world aren't going to change the facts on the ground.

I mean, think about it this way: As a nation we're blowing hundreds of billions advertising and marketing schemes for various healthcare products and services in an attempt to boost sales. At the same time, we're also blowing hundreds of billions on copays and deductibles expressly designed to dis-incentivize overconsumption of healthcare products and services. I'd literally rather give Trump triple the money he wants for his wall just to adorn the goddamned thing in gold leaf than continue this charade. America will survive without 700 commercials per day telling you to ask your doctor about Xarelto, or $12,000 deductibles for spending a couple hours in the ER.

[DSpencer]

Re: Our Next President?

Straight from the horse's mouth:

"The ultra-rich have rigged our economy & rigged our tax rules. We need structural change. That’s why I’m proposing something brand-new: An annual wealth tax on the tippy-top 0.1%. We’d get $3 trillion in new revenue to invest in rebuilding the middle-class. Let’s make it happen."

https://twitter.com/ewarren/status/1...946817/video/1

So in the example from her video the heir who has $500,000,000 is making $50,000 per year? I suppose it's possible, but not very likely.

How is it determined how much money a person has? Do they have to pay for a yearly appraisal of all their "yachts and jewelry and fine arts"?

I do appreciate that this at least uses the .1% instead of the standard "1%". Many people in the 1% are still essentially wage-earners, albeit high income ones. A doctor or lawyer making $500k with a few million net worth is doing great, but not really comparable to someone worth $50 million, let alone $500 million. I think it was a mistake to vilify the 1% as if they were a homogenous group of hedge fund managers and fortune 500 CEOs.

[dcarrigg]

Re: Our Next President?

I'm not 100% sure the details of this particular plan. But it seems to me the IRS already does some form of this assessment, at least for estate taxes. I suppose the process would have to be streamlined somewhat to do it annually for a larger group of people. I imagine whatever they came up with would look like a somewhat simplified version of Form 706. I figure if you're over the $50 million threshold, you probably have a pretty good CPA who's capable of figuring all this stuff out anyways. You pretty much have to be somewhat on top of it if you're bequeathing over $11 million as it stands now.

[thriftyandboringinohio]

Re: Our Next President?

...How is it determined how much money a person has? Do they have to pay for a yearly appraisal of all their "yachts and jewelry and fine arts"?...

That an extraordinarily good question. At first glance it seems impossible. Maybe a total of account balances for a person could be reported by banks and brokerages, but even that gets dicey for the shifting values of stocks and bonds. Real estate, fine collectibles, trust balances -fuhgetaboutit.