Now, if the law would instead put employers in jail who hire illegal immigrants knowingly, I'd be all for it. That's the problem anyway. If they couldn't get jobs here, the US wouldn't be worth the enormous risk they take crossing the border.
That's not the only goal for illegal immigrants. We also have to get rid of citizenship by birth regardless of the parents' status... this was apparently introduced to deal with legal issues of post-slavery children... today it is unnecessary and counterproductive.
I don't think anybody on a tech website should comment on a medical doctor's salary. There are a lot of tech jobs that pay comparable to the doctor's salary
If by "comparable" you mean "able to be compared" then sure... as in tech salaries are much lower than doctor salaries so they are comparable. There may be a small percentage of tech jobs that pay a high salary, but compare median tech salary to median doctor salary.
I'm sure we'll see a downward pressure on their salary anyway, but the upfront costs needs to be addressed.
That's exactly what I'm talking about. Considering that doctor salaries are one of the biggest costs of health care it's kind of important.
Mostly by looking at the artificial scarcity of available seats in medical schools, and how much those institutions are allowed to charge for education.
Yes, but tuition would come down on its own as more schools open and doctor salaries decrease.
Oh wait... See what happens when you try to meddle with the cost structure? We introduce more governmental intervention.
That's completely backwards, the reason there aren't more medical schools is that the government regulates them. To increase the seats available at medical schools you just have to make it easier to become a medical school, i.e. less government intervention. You should take a look: http://www.medicalschools.com/medical-school-accreditation.html
Now I *wonder* if there's a conflict of interest when the US gives complete authority over medical school accreditation to a panel of privately employed doctors who are keen to protect their own salaries.
We get less governmental intervention if we eliminate all the redundant governmental medical insurance providers and consolidate them into a single universal care system where the only things the government do are pay claims and encourage preventative medicine.
Yes we get less government intervention when the government increases the number of people in government programs and illegalizes private business. I'm not sure how to respond. Surely you see the contradiction?
All I see in your 6 points is that hospitals should eat the costs for America's health care. That is the only complete bullshit that I saw in your post. You haven't came close to bringing universal coverage in your arguement.
I did a little more research and some people ARE experimenting with the idea I've outlined here. Check out this article: The Hot Spotters: Can we lower medical costs by giving the neediest patients better care? http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande
Before you call it "complete bullshit" you should think about it some more! It makes sense, and if nobody does it there's probably a financial reason why.
Your logic appears to be "hospitals could save some of their loses by providing free preventative care but they don't" equates to "universal coverage won't save medical costs". Those have very little to do with each other.
Hmm... the first part is right. I'm not equating it to "universal coverage won't save medical costs" though. I'm saying, if proponents of universal coverage are lying or misleading about that, can you trust them with the other numbers?
I mean, it's a common enough theme and it's always touted as a major cost saver. Are you claiming that you haven't heard that before? Let me quote Obama:
[W]hen somebody doesn't have health insurance, they're forced to get treatment at the ER, and all of us end up paying for it. The average family pays a thousand dollars in extra premiums to pay for people going to the emergency room who don't have health insurance. So you'
I don't see your point. If your commenting on the blogger's second hand account, I think it leaves out quite a few details.
I'm not, I was just searching for ER bills to show the breakdown between actual cost of treatment and the ER "universal coverage" tax that gets applied.
However if your point is that the unfunded mandate that is EMTALA is somehow justified because hospitals are able to recoup their costs then you are mistaken. As I said before, the hospitals do not fully recover their costs from emergency care. Even if they did, eventually the cost structure will reach a tipping point where absolutely no one will be able to afford any care from the hospital and hospitals will close.
Really, you think that the hospital would just shut down rather than reduce costs?
How would they reduce costs you ask? Well they could pay smaller salaries. US doctors earn way way way more than doctors in most countries... there are plenty of other people willing to do the job for less! Before they go to the incredibly drastic step of bringing doctors' salaries in line with other countries, they would probably do stuff like provide cheaper palliative care for patients who can't pay.
I just want to add that the hospital's red ink, if you are right, shows the lie about preventive medicine. Think about it.
1. The hospital is required to provide treatment which costs a lot of money to people who don't/can't pay. 2. There is a theory that widespread preventive care saves oodles of money by preventing emergency care. 3. The hospital could provide free preventive treatment to the subset of the local population served by the hospital that doesn't/can't pay. 4. By the theory of cost savings, this would actually save money for the hospital. 5. Hospitals are losing money and looking for ways to save. And there are plenty of good people working there, and they would like to also help as many people as they can. 6. And yet mysteriously they don't do it.
How do you explain that? It seems like the idea of increased preventive treatment under universal coverage eventually saving money is complete bullshit.
I understand that the cancer patient will be treated in the ER, but explain how cost of cancer treatment is even related to an ER visit. Do you think there's a special cancer doctor in every ER that charges double his normal rate?
Realistically the setting makes no difference at all. They're admitted in the ER, then quickly diagnosed as having advanced lung cancer via an x-ray or something, then sent to the same old place they would have gone if they had made an appointment two weeks in advance and done everything without involving the ER.
So are you saying we'll save the cost of an x-ray? Like $150 plus some inflated ER visit costs? Out of a $150k cancer treatment we're going to save $150 in actual costs, maybe $1k or $2k total? And in the meantime pay for a huge bureaucracy to enable these savings?
Or are you assuming that in the magic world of universal health care, the smoker will still continue to smoke, but knowing that it causes lung cancer, he'll make frequent trips to the doctor to monitor his health, so we'll catch the cancer earlier?
To summarize the pdf, the first 3 months of initial treatment for lung cancer cost about $26k (this is in 1990s dollars). That would be the same, I guess, in both scenarios (I'm not a doctor, perhaps this initial treatment thing would be skipped if the patient were so advanced that they came to the ER because of complications from the cancer). The last 6 months (terminal stage) cost about $30k. That would also be the same in both scenarios I guess. The maintenance stage is $11k per year. It may be callous, but it's quite obvious that under the universal coverage plan where things are caught earlier, smokers will cost society more.
In conclusion, keep in mind I'm not saying they shouldn't be treated, I'm saying using a smoker with lung cancer as an example of how universal coverage will save on ER bills makes no sense at all.
If young people paid a fair price, adding them to the system would not change anybody else's cost by one penny.
Instead we know that adding them to the system will reduce everybody else's cost.
I don't know exactly how inflated the price of insurance for young people is, but it's just a matter of logic to deduce that it is inflated. To me it's unjust.
The jokes is really on you, because if you'd give up your ideological hatred for those people and for the idea that some social problems can be best tackled collectively through strategic actions by government, you'd end up paying less in taxes to cover Universal Healthcare than you currently pay for private insurance and all the unseen costs of having the terrible system we have today in the US.
Okay so to elaborate on the smoking example.
Say a poor person smokes a lot. He doesn't pay taxes and is covered under Universal Healthcare.
Now how are your strategic actions by the government going to help me end up paying less in taxes to cover that person's lung cancer?
How does that compare to the savings of just saying "If you smoke you're not covered for smoking-related diseases unless you pay this extra smoking premium, and you chose to skip the premium and still keep smoking, so you don't get treatment?"
Oh what about the hospital? It will eat your expense along with everyone else's and eventually will just close their emergency room.
Are you kidding? Hospitals already massively inflate the cost of medical services to provide their own form of "insurance" -- make the people who can pay, pay and pay dearly.
The hospital bill came- $39.38 for “Medical surgical supplies and devices- General $249 for Emergency Room- General $600 for Emergency Room- Other ER Total, in addition to the $535 above- another $888.38 Total for 3 stitches: $1423.38 or $474.46 per stitch.
What on earth do you think the $849 "ER" fee is for, given that the ER visit was to get 3 stitches?
When you're young, be on your parents policy or buy your own. It costs the same as an iPod. A young person without health insurance is making poor decisions.
Why's that? It's already admitted that young people are being massively ripped off by insurance prices, that's why Obamacare relies on getting all the young people to buy into the system. Otherwise the system is hugely underfunded.
What would actually make sense would be to have a new insurance that only sells insurance to young people. Premiums would be really low, much less than an iPod per month.
Oh but that's not allowed because it's discrimination against old people. What a nice, free country we live in.
The median household income in the US is $44k. The mean household income in the US is $60k. Where did you get $31k?
I'm also not sure where the other poster got $15k for health insurance after saying an HSA would be $4k. It might get to $10k or $11k if you had to pay the maximum out of pocket expense every single year but that seems pretty unlikely for most people.
So what you're saying is there's very little correlation between universal healthcare and the metric system on one side, and general prosperity and standard of living on the other?
Or are you expecting your audience to swallow the idea that "haha, might as well go to Turkey for my health care needs, it's just as bad" or "I might as well set up my new research lab in Liberia, it's just as bad?"
The human ear is able to pick up to 20 kHz [wikipedia.org], and people over 40 are able to hear at most 16-18 kHz (if ever). This is why 22 kHz is meant to be the absolute upper frequency to digitally encode on an Audio CD and thus 44 kHz the maximum sampling rate required for "absolute audiophile perfection".
Seems to me you'd want the system to be audible anyway. It would let you quickly detect attempts to intercept the handshake, like if someone is standing nearby with a really loud tone emanating from their pocket trying to drown out the checkout machine.
With a best-case cylindrical waveform, the rule of thumb slides to 3dB per doubling of distance.
And so what? Phones aren't made with directional elements. They don't emit cylindrical waveforms. There's one or more little electret mics, and an earspeaker that each operate through a small hole. These arrangements are not things that are known for their superb directionality, but rather the opposite.
Wouldn't it also depend on the shape of the receiver? For instance if you put your phone inside a little padded tube that would change things I would guess.
Houses in other countries are often designed for multi-generational living. My grandparents' house in Germany had 3 floors, each completely independent. Point being, when people from other countries say "kids should live at home until they're married" it's not like here. You would be doing your own cooking, cleaning, laundry, paying utility bills, etc. When you get guests, or your girlfriend stays over, your dad isn't hovering in the next room.
It's not complete independence, but it's closer than the stereotype of living with your parents here in the US suggests.
I must have rotten luck then. My stupid apartment complex's office closes at around 5, making it next to impossible for me to pick up a package from them until the weekend. And every time I call UPS and begged them to leave my package at the door they said they couldn't. They used to leave the slip of paper and let you check the "leave package" option, now the very first time they say "delivered - office". Basically destroyed half the value of Amazon prime for me.
The time it happened to me it was the week before Christmas and I had ordered a king-sized mattress from Amazon (free shipping). It weighed over 100 lbs and I live up a few flights of stairs so it was understandable I guess.
I drew my numbers from memory, but they're backed up here: http://www.ncbi.nlm.nih.gov/pubmed/12930930 [nih.gov], and slightly worse: 31% to 16%. If I read this correctly, it does NOT include salaries for doctors, only for employees engaged in administrative roles:
That's an interesting report but I have a few problems with it.
1. It does not measure administrative costs for all health care dollars. It excludes major portions of the health care industry such as pharmaceuticals and medical equipment.
2. It does include doctor salaries as administrative overhead based on the proportion of time (self-reported) that doctors spend on billing and other administrative costs.
We determined the proportion of physicians' work hours devoted to billing and administration from a national survey and multiplied this proportion by physicians' net income before taxes.
The problem is doctors in America earn almost twice as much as doctors in Canada.
3. It counts ALL expenses on private insurance as overhead.
In 1999 U.S. private insurers retained $46.9 billion of the $401.2 billion they collected in premiums. Their average overhead (11.7 percent) exceeded that of Medicare (3.6 percent) and Medicaid (6.8 percent).
That implies that insurance serves absolutely no purpose when it does things like combat fraud (which is more severe in Medicare/Medicaid and does not get counted as overhead). Obviously this gives an advantage to Canada since much more money is spent on private insurers in the US. Of course "Our analysis also omits the costs of collecting taxes to fund health care."
I think you're somewhat overstating the report's finding. It definitely shows that the US spends too much on administrative overhead, and that the US spends more than Canada in certain segments of health care. So there's a lot of room for improvement. But I don't think it can be applied to ALL health care costs.
There are many areas of financial inefficiency in American health care.
I definitely agree with that. And to me it's the more important problems. If you want to address financial inefficiency in the US health care system, you have to start at doctor salaries. They're too high. It's massively inefficient. Doctor salaries are the largest component of health care costs (even in your efficiency report the first component they studied was the "value" of doctors' time spent on administrative duties) and controlling them is the key to controlling health care costs. Our doctors make 2 - 5 times the money doctors make in other countries with health care systems that are pretty much as good as our own (not getting into life expectancy vs life style again, I think it's close enough to call them all about the same).
The data, which was gathered between 2007 and 2009, reveals that approximately 24.1 percent of Canadians are obese compared to 34.4 percent of Americans.
In 2007, 18 percent of Canadian females and 20 percent of males reported smoking cigarettes. In the US, an estimated 18.3 percent of women and 23.1 percent of men smoke, based on 2008 statistics from The American Heart Association.
Maybe that's changed significantly in the last few years but that seems unlikely.
And there's more to health care costs than the efficiency of health care.
Yes: There's the fact that as a portion of health care dollars spent, the U.S. spends almost twice as much as Canada on administrative costs (28% vs. 16%, last time I checked).
Well... that would be included in what I called "efficiency of health care." More overhead = less efficient, but it's not the only factor in overall cost. In any case, dropping that 28% down to 16% to make it even with Canada would not account for the 45% cost difference you noted.
Also, claiming 28% of ALL health care dollars goes to administrative costs makes me really skeptical. Unless you're counting stuff like doctor salaries as administrative.
There's more to life expectancy than the quality of health care.
And there's more to health care costs than the efficiency of health care.
For instance, eating habits vary from country to country and obviously affect both life expectancy and cost of health care. Would it be fair to call the US health care system inefficient because (in part) Americans eat more Big Macs than Italians?
Basic cable probably refers to the selection of channels not the equipment. Today in a lot of areas you HAVE to get digital cable and a box, it's the lowest option the cable company provides.
Financially separate operations - I'd honestly be angry if they weren't separate.
So should the internet division have its own revenue collection department and its own call center rather than adding a line item to the existing tax bill? That's adding inefficiency... why?
No below-cost service - Again, reasonable. Because doing so would either mean other tax money is being used, or that the government is borrowing to support it. Neither is good.
But that doesn't make sense. Aren't telecoms today required to provide below-cost service in e.g. rural areas? Isn't there some government funding (tax money) to help make that happen?
No borrowing without a referendum - A bit restrictive, but not too much so. Besides, since when has democracy been a bad thing?
The democratic part is where the community says "Hey let's have community internet."
The undemocratic part is where outside companies that don't even have a vote in the community say "Nope you have to go through this checklist of crap first."
We're talking about local municipal broadband, not state or federal. This isn't a central government building a service for people who are only loosely connected to them. It's small towns where everybody knows the mayor and the city council. They go to barbecues together.
Now, the one thing I am worried about is potential censorship. Certain highly-conservative communities might try to ban, say, pornography. Hyper-liberal communities might try to limit other things (a gaming curfew, similar to the recent Korean law, might be one of them). As far as I'm concerned, both are completely unacceptable.
I agree, but they do a pretty good job with stuff like electricity and water. I've never heard of an electric utility say "Sorry we won't provide power to a strip club" or "If you play bad games on your computer we'll cut your power because we don't like that."
So, to start with, taxation is not theft. It's long since been accepted that one of the powers of a sovereign nation is to levy taxes. You have every right to say "The rate should be different", but a sovereign nation levying a tax is not theft.
Taxation is not inherently theft, but 90% taxation is theft. It's simply taking too much of what somebody has earned. Your argument now is like saying "Governments have long had the power to put people in jail, so if the government starts rounding up the Japanese and putting them in internment camps... that's fine. It even happened once during a world war." The degree and manner in which the government does its duty is always relevant.
Now, do keep in mind, my hypothetical 90% rate was for the sake of comparing two extremes-I'm not saying that's the rate we should set.
Okay, fair enough, and keep in mind I was reacting to that extreme, not to the general principle of taxation.
As to your superstars and Warren Buffett and what have you, you can argue they do a lot. But they also use a lot.
If we're talking about personal income tax, I'd say you have to restrict their resource consumption to personal resource consumption.
Their mega-empires use resources, generate pollution, heavily utilize roads, air control, and other forms of infrastructure, are heavily dependent on police and fire protection and a stable society, and in many cases even get direct cash handouts from the government.
A mega-empire uses lots of resources because it involves a lot of people, as you noted -- thousands of people are involved in building a stadium, thousands of police are employed to provide protection, etc. I don't believe the one guy who started the ball rolling should be responsible for the cost of everything, despite thousands of other people also participating and benefiting from the activity.
If Exxon, to take an example, employed 99.9999% slave labor (everybody but the CEO), then you'd have a great point, but the reality is Exxon contributes a huge amount to our economy, as well as the economies of countries around the world. It's not the CEO who benefits most from Exxon's wealth, it's society.
So don't tell me megabillionaires become so in a vacuum. They depend on social resources (even if they don't deliberately abuse them), and they make much heavier use of those resources than Joe Average does. Even just the fact that we have a stable society is dependent on us keeping the vast majority of the population fed and housed.
So you're claiming that the billionaire is happier being a billionaire than someone who would otherwise die of starvation is happier being lower or middle class?
In other words, you're saying the billionaire has the biggest responsibility because he benefits the most in the situation? Personally, I think in the greater scheme of things, employing 10000 people and making them middle or even lower class is a much more positive cumulative change in happiness than making one person a billionaire. From that perspective, the billionaire is already getting the short end of the stick.
That's fine with me because like you said, the billion dollars doesn't come about through one person's efforts alone. But the idea that the billionaire somehow owes those 10000 people something doesn't make sense. They worked together to accomplish something great, isn't that good enough?
My other issue with it is how much political influence the rich exert, and how freely they use it. America is supposed to be "one person, one vote" not "one dollar, one vote". But the wealthy steadfastly shoot down every attempt at outlawing bribery-excuse me, enacting campaign finance reform. I'm not allowed to bribe a cop, a judge, a building inspector, or for that matter even a dogcatcher. Why on earth should I be allowed to bribe a Senator or the President?
1. A 90% tax rate is blatant theft. It's even worse in an environment where you *change* the tax rate to 90% after somebody worked half their whole to build a successful business, get highly educated, or whatever enables them to have such a high income. Anybody who would take 90% of what someone earned is a criminal at heart. Yeah sure if you just give me the options I'll take the $100 million with a 90% tax rate. But look at that. You're sitting here offering me something I didn't earn, and using my response in an argument about how it would feel to have what I did earn taxed at a ludicrous rate. That's your world view. You don't even pretend to consider how more successful people would feel, you focus purely on how less successful could feel if they suddenly had more.
2. I think it has big problems economically. The only time the US had such a rate (and yes I think it's a great mark of shame on our country's history, let's not pretend we're perfect) was during world wars where the rich literally did not have a choice. "Oh you want to move? To France maybe? Spend some time in the occupied riviera?" The reality of peace time is places like Switzerland, France, Germany, England, etc are great places. Another reality for the rich is that the developing world, India, China, Brazil, are really fucking great places. You make $100 million/year... want your own private army? Want compounds with sex slaves? Or maybe you have no deviant desires and just want a mansion in downtown [big financial capital which every developing country has and is just as posh, rich, and entertaining as Manhattan or LA].
America is an awesome place, but you are laboring under the premise that it's awesome because of people like you, and everybody wants to hang out with people like you. The people who aren't rich and are stuck here.
Well it's not. It's awesome because of the rock stars, great artists, successful businessmen, cool sports teams, scientists who want to patent the next Viagra -- the people you want to target! You and I are a necessary part of the machine but I can be honest. On an individual level, someone like Warren Buffett with his "lower than his secretary tax rate" has contributed more to society than you and I by a thousandfold. How many people are rich because of you? How many people feed their families and send their kids to good schools because of what you've contributed to them? How much have you expanded American prestige by being an internationally known and followed figure? How have you made America more powerful by managing a disproportionately large chunk of her economy and making smart long-term investments?
I don't worship Buffett but I don't loathe him and people like him as you seem to. I respect him and consider people like him to be highly valuable assets to society. Warren Buffett is not a leech. He's rich because he earned it. Why would you want to take 90% of his wealth? What on earth makes you think that you, who didn't get rich on your own, would be better at deciding what to do with it than him? I really just don't get people like you.
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Now, if the law would instead put employers in jail who hire illegal immigrants knowingly, I'd be all for it. That's the problem anyway. If they couldn't get jobs here, the US wouldn't be worth the enormous risk they take crossing the border.
That's not the only goal for illegal immigrants. We also have to get rid of citizenship by birth regardless of the parents' status... this was apparently introduced to deal with legal issues of post-slavery children... today it is unnecessary and counterproductive.
I don't think anybody on a tech website should comment on a medical doctor's salary. There are a lot of tech jobs that pay comparable to the doctor's salary
If by "comparable" you mean "able to be compared" then sure... as in tech salaries are much lower than doctor salaries so they are comparable. There may be a small percentage of tech jobs that pay a high salary, but compare median tech salary to median doctor salary.
I'm sure we'll see a downward pressure on their salary anyway, but the upfront costs needs to be addressed.
That's exactly what I'm talking about. Considering that doctor salaries are one of the biggest costs of health care it's kind of important.
Mostly by looking at the artificial scarcity of available seats in medical schools, and how much those institutions are allowed to charge for education.
Yes, but tuition would come down on its own as more schools open and doctor salaries decrease.
Oh wait... See what happens when you try to meddle with the cost structure? We introduce more governmental intervention.
That's completely backwards, the reason there aren't more medical schools is that the government regulates them. To increase the seats available at medical schools you just have to make it easier to become a medical school, i.e. less government intervention. You should take a look: http://www.medicalschools.com/medical-school-accreditation.html
Now I *wonder* if there's a conflict of interest when the US gives complete authority over medical school accreditation to a panel of privately employed doctors who are keen to protect their own salaries.
We get less governmental intervention if we eliminate all the redundant governmental medical insurance providers and consolidate them into a single universal care system where the only things the government do are pay claims and encourage preventative medicine.
Yes we get less government intervention when the government increases the number of people in government programs and illegalizes private business. I'm not sure how to respond. Surely you see the contradiction?
All I see in your 6 points is that hospitals should eat the costs for America's health care. That is the only complete bullshit that I saw in your post. You haven't came close to bringing universal coverage in your arguement.
I did a little more research and some people ARE experimenting with the idea I've outlined here. Check out this article: The Hot Spotters: Can we lower medical costs by giving the neediest patients better care? http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande
Before you call it "complete bullshit" you should think about it some more! It makes sense, and if nobody does it there's probably a financial reason why.
Your logic appears to be "hospitals could save some of their loses by providing free preventative care but they don't" equates to "universal coverage won't save medical costs". Those have very little to do with each other.
Hmm... the first part is right. I'm not equating it to "universal coverage won't save medical costs" though. I'm saying, if proponents of universal coverage are lying or misleading about that, can you trust them with the other numbers?
I mean, it's a common enough theme and it's always touted as a major cost saver. Are you claiming that you haven't heard that before? Let me quote Obama:
[W]hen somebody doesn't have health insurance, they're forced to get treatment at the ER, and all of us end up paying for it. The average family pays a thousand dollars in extra premiums to pay for people going to the emergency room who don't have health insurance. So you'
I don't see your point. If your commenting on the blogger's second hand account, I think it leaves out quite a few details.
I'm not, I was just searching for ER bills to show the breakdown between actual cost of treatment and the ER "universal coverage" tax that gets applied.
However if your point is that the unfunded mandate that is EMTALA is somehow justified because hospitals are able to recoup their costs then you are mistaken. As I said before, the hospitals do not fully recover their costs from emergency care. Even if they did, eventually the cost structure will reach a tipping point where absolutely no one will be able to afford any care from the hospital and hospitals will close.
Really, you think that the hospital would just shut down rather than reduce costs?
How would they reduce costs you ask? Well they could pay smaller salaries. US doctors earn way way way more than doctors in most countries... there are plenty of other people willing to do the job for less! Before they go to the incredibly drastic step of bringing doctors' salaries in line with other countries, they would probably do stuff like provide cheaper palliative care for patients who can't pay.
I just want to add that the hospital's red ink, if you are right, shows the lie about preventive medicine. Think about it.
1. The hospital is required to provide treatment which costs a lot of money to people who don't/can't pay.
2. There is a theory that widespread preventive care saves oodles of money by preventing emergency care.
3. The hospital could provide free preventive treatment to the subset of the local population served by the hospital that doesn't/can't pay.
4. By the theory of cost savings, this would actually save money for the hospital.
5. Hospitals are losing money and looking for ways to save. And there are plenty of good people working there, and they would like to also help as many people as they can.
6. And yet mysteriously they don't do it.
How do you explain that? It seems like the idea of increased preventive treatment under universal coverage eventually saving money is complete bullshit.
I understand that the cancer patient will be treated in the ER, but explain how cost of cancer treatment is even related to an ER visit. Do you think there's a special cancer doctor in every ER that charges double his normal rate?
Realistically the setting makes no difference at all. They're admitted in the ER, then quickly diagnosed as having advanced lung cancer via an x-ray or something, then sent to the same old place they would have gone if they had made an appointment two weeks in advance and done everything without involving the ER.
So are you saying we'll save the cost of an x-ray? Like $150 plus some inflated ER visit costs? Out of a $150k cancer treatment we're going to save $150 in actual costs, maybe $1k or $2k total? And in the meantime pay for a huge bureaucracy to enable these savings?
Or are you assuming that in the magic world of universal health care, the smoker will still continue to smoke, but knowing that it causes lung cancer, he'll make frequent trips to the doctor to monitor his health, so we'll catch the cancer earlier?
To me that sounds like it would cost more. Read this: http://www.epa.gov/opptintr/coi/pubs/II_5.pdf
To summarize the pdf, the first 3 months of initial treatment for lung cancer cost about $26k (this is in 1990s dollars). That would be the same, I guess, in both scenarios (I'm not a doctor, perhaps this initial treatment thing would be skipped if the patient were so advanced that they came to the ER because of complications from the cancer). The last 6 months (terminal stage) cost about $30k. That would also be the same in both scenarios I guess. The maintenance stage is $11k per year. It may be callous, but it's quite obvious that under the universal coverage plan where things are caught earlier, smokers will cost society more.
In conclusion, keep in mind I'm not saying they shouldn't be treated, I'm saying using a smoker with lung cancer as an example of how universal coverage will save on ER bills makes no sense at all.
If young people paid a fair price, adding them to the system would not change anybody else's cost by one penny.
Instead we know that adding them to the system will reduce everybody else's cost.
I don't know exactly how inflated the price of insurance for young people is, but it's just a matter of logic to deduce that it is inflated. To me it's unjust.
The person I responded to said "The average household income in the U.S. is $31,000."
The jokes is really on you, because if you'd give up your ideological hatred for those people and for the idea that some social problems can be best tackled collectively through strategic actions by government, you'd end up paying less in taxes to cover Universal Healthcare than you currently pay for private insurance and all the unseen costs of having the terrible system we have today in the US.
Okay so to elaborate on the smoking example.
Say a poor person smokes a lot. He doesn't pay taxes and is covered under Universal Healthcare.
Now how are your strategic actions by the government going to help me end up paying less in taxes to cover that person's lung cancer?
How does that compare to the savings of just saying "If you smoke you're not covered for smoking-related diseases unless you pay this extra smoking premium, and you chose to skip the premium and still keep smoking, so you don't get treatment?"
Oh what about the hospital? It will eat your expense along with everyone else's and eventually will just close their emergency room.
Are you kidding? Hospitals already massively inflate the cost of medical services to provide their own form of "insurance" -- make the people who can pay, pay and pay dearly.
I mean look at this: http://esrati.com/how-much-do-3-stitches-cost/1192/
The hospital bill came-
$39.38 for “Medical surgical supplies and devices- General
$249 for Emergency Room- General
$600 for Emergency Room- Other ER
Total, in addition to the $535 above- another $888.38
Total for 3 stitches: $1423.38 or $474.46 per stitch.
What on earth do you think the $849 "ER" fee is for, given that the ER visit was to get 3 stitches?
A hospital can most certainly turn you away if your condition is not critical. They're only obligated to stabilize you and send you on your way.
For non-critical care, why is it so darn expensive? Why do we need insurance to go get an antibiotic prescription for strep throat?
Oh, someone broke their arm, that'll be $8k for a plaster cast please.
Oh, you need some stitches for that cut, that'll be 15 minutes and $2k please.
We'll never solve the insurance problem in this country because insurance isn't the problem.
When you're young, be on your parents policy or buy your own. It costs the same as an iPod. A young person without health insurance is making poor decisions.
Why's that? It's already admitted that young people are being massively ripped off by insurance prices, that's why Obamacare relies on getting all the young people to buy into the system. Otherwise the system is hugely underfunded.
What would actually make sense would be to have a new insurance that only sells insurance to young people. Premiums would be really low, much less than an iPod per month.
Oh but that's not allowed because it's discrimination against old people. What a nice, free country we live in.
The median household income in the US is $44k. The mean household income in the US is $60k. Where did you get $31k?
I'm also not sure where the other poster got $15k for health insurance after saying an HSA would be $4k. It might get to $10k or $11k if you had to pay the maximum out of pocket expense every single year but that seems pretty unlikely for most people.
So what you're saying is there's very little correlation between universal healthcare and the metric system on one side, and general prosperity and standard of living on the other?
Or are you expecting your audience to swallow the idea that "haha, might as well go to Turkey for my health care needs, it's just as bad" or "I might as well set up my new research lab in Liberia, it's just as bad?"
The human ear is able to pick up to 20 kHz [wikipedia.org], and people over 40 are able to hear at most 16-18 kHz (if ever). This is why 22 kHz is meant to be the absolute upper frequency to digitally encode on an Audio CD and thus 44 kHz the maximum sampling rate required for "absolute audiophile perfection".
Seems to me you'd want the system to be audible anyway. It would let you quickly detect attempts to intercept the handshake, like if someone is standing nearby with a really loud tone emanating from their pocket trying to drown out the checkout machine.
With a best-case cylindrical waveform, the rule of thumb slides to 3dB per doubling of distance.
And so what? Phones aren't made with directional elements. They don't emit cylindrical waveforms. There's one or more little electret mics, and an earspeaker that each operate through a small hole. These arrangements are not things that are known for their superb directionality, but rather the opposite.
Wouldn't it also depend on the shape of the receiver? For instance if you put your phone inside a little padded tube that would change things I would guess.
Houses in other countries are often designed for multi-generational living. My grandparents' house in Germany had 3 floors, each completely independent. Point being, when people from other countries say "kids should live at home until they're married" it's not like here. You would be doing your own cooking, cleaning, laundry, paying utility bills, etc. When you get guests, or your girlfriend stays over, your dad isn't hovering in the next room.
It's not complete independence, but it's closer than the stereotype of living with your parents here in the US suggests.
I must have rotten luck then. My stupid apartment complex's office closes at around 5, making it next to impossible for me to pick up a package from them until the weekend. And every time I call UPS and begged them to leave my package at the door they said they couldn't. They used to leave the slip of paper and let you check the "leave package" option, now the very first time they say "delivered - office". Basically destroyed half the value of Amazon prime for me.
This.
The time it happened to me it was the week before Christmas and I had ordered a king-sized mattress from Amazon (free shipping). It weighed over 100 lbs and I live up a few flights of stairs so it was understandable I guess.
I drew my numbers from memory, but they're backed up here: http://www.ncbi.nlm.nih.gov/pubmed/12930930 [nih.gov], and slightly worse: 31% to 16%. If I read this correctly, it does NOT include salaries for doctors, only for employees engaged in administrative roles:
That's an interesting report but I have a few problems with it.
1. It does not measure administrative costs for all health care dollars. It excludes major portions of the health care industry such as pharmaceuticals and medical equipment.
2. It does include doctor salaries as administrative overhead based on the proportion of time (self-reported) that doctors spend on billing and other administrative costs.
We determined the proportion of physicians' work hours devoted to billing and administration from a national survey and multiplied this proportion by physicians' net income before taxes.
The problem is doctors in America earn almost twice as much as doctors in Canada.
3. It counts ALL expenses on private insurance as overhead.
In 1999 U.S. private insurers retained $46.9 billion of the $401.2 billion they collected in premiums. Their average overhead (11.7 percent) exceeded that of Medicare (3.6 percent) and Medicaid (6.8 percent).
That implies that insurance serves absolutely no purpose when it does things like combat fraud (which is more severe in Medicare/Medicaid and does not get counted as overhead). Obviously this gives an advantage to Canada since much more money is spent on private insurers in the US. Of course "Our analysis also omits the costs of collecting taxes to fund health care."
I think you're somewhat overstating the report's finding. It definitely shows that the US spends too much on administrative overhead, and that the US spends more than Canada in certain segments of health care. So there's a lot of room for improvement. But I don't think it can be applied to ALL health care costs.
There are many areas of financial inefficiency in American health care.
I definitely agree with that. And to me it's the more important problems. If you want to address financial inefficiency in the US health care system, you have to start at doctor salaries. They're too high. It's massively inefficient. Doctor salaries are the largest component of health care costs (even in your efficiency report the first component they studied was the "value" of doctors' time spent on administrative duties) and controlling them is the key to controlling health care costs. Our doctors make 2 - 5 times the money doctors make in other countries with health care systems that are pretty much as good as our own (not getting into life expectancy vs life style again, I think it's close enough to call them all about the same).
http://wallstreetpit.com/5769-the-medical-cartel-why-are-md-salaries-so-high
Canada: $100,781
US: $199,000
There's the bulk of your 45% cost difference.
Well there's no need to guess from factors like "donut shops per capita".
http://thestatsblog.wordpress.com/2011/03/04/united-states-vs-canada-which-has-the-lower-obesity-rate/
The data, which was gathered between 2007 and 2009, reveals that approximately 24.1 percent of Canadians are obese compared to 34.4 percent of Americans.
So we have a 42% higher obesity rate.
As for smoking, I'm not sure where you got your stats. I did a quick search and found http://www.livestrong.com/article/258448-canada-smoking-vs-america-smoking/
In 2007, 18 percent of Canadian females and 20 percent of males reported smoking cigarettes. In the US, an estimated 18.3 percent of women and 23.1 percent of men smoke, based on 2008 statistics from The American Heart Association.
Maybe that's changed significantly in the last few years but that seems unlikely.
And there's more to health care costs than the efficiency of health care.
Yes: There's the fact that as a portion of health care dollars spent, the U.S. spends almost twice as much as Canada on administrative costs (28% vs. 16%, last time I checked).
Well... that would be included in what I called "efficiency of health care." More overhead = less efficient, but it's not the only factor in overall cost. In any case, dropping that 28% down to 16% to make it even with Canada would not account for the 45% cost difference you noted.
Also, claiming 28% of ALL health care dollars goes to administrative costs makes me really skeptical. Unless you're counting stuff like doctor salaries as administrative.
There's more to life expectancy than the quality of health care.
And there's more to health care costs than the efficiency of health care.
For instance, eating habits vary from country to country and obviously affect both life expectancy and cost of health care. Would it be fair to call the US health care system inefficient because (in part) Americans eat more Big Macs than Italians?
There's a blog with more information: http://savencbb.wordpress.com/
It may also be interesting for people to read about the project that caused so much angst among ISPs: http://www.greenlightnc.com/
Basic cable probably refers to the selection of channels not the equipment. Today in a lot of areas you HAVE to get digital cable and a box, it's the lowest option the cable company provides.
Financially separate operations - I'd honestly be angry if they weren't separate.
So should the internet division have its own revenue collection department and its own call center rather than adding a line item to the existing tax bill? That's adding inefficiency... why?
No below-cost service - Again, reasonable. Because doing so would either mean other tax money is being used, or that the government is borrowing to support it. Neither is good.
But that doesn't make sense. Aren't telecoms today required to provide below-cost service in e.g. rural areas? Isn't there some government funding (tax money) to help make that happen?
No borrowing without a referendum - A bit restrictive, but not too much so. Besides, since when has democracy been a bad thing?
The democratic part is where the community says "Hey let's have community internet."
The undemocratic part is where outside companies that don't even have a vote in the community say "Nope you have to go through this checklist of crap first."
We're talking about local municipal broadband, not state or federal. This isn't a central government building a service for people who are only loosely connected to them. It's small towns where everybody knows the mayor and the city council. They go to barbecues together.
Now, the one thing I am worried about is potential censorship. Certain highly-conservative communities might try to ban, say, pornography. Hyper-liberal communities might try to limit other things (a gaming curfew, similar to the recent Korean law, might be one of them). As far as I'm concerned, both are completely unacceptable.
I agree, but they do a pretty good job with stuff like electricity and water. I've never heard of an electric utility say "Sorry we won't provide power to a strip club" or "If you play bad games on your computer we'll cut your power because we don't like that."
So, to start with, taxation is not theft. It's long since been accepted that one of the powers of a sovereign nation is to levy taxes. You have every right to say "The rate should be different", but a sovereign nation levying a tax is not theft.
Taxation is not inherently theft, but 90% taxation is theft. It's simply taking too much of what somebody has earned. Your argument now is like saying "Governments have long had the power to put people in jail, so if the government starts rounding up the Japanese and putting them in internment camps... that's fine. It even happened once during a world war." The degree and manner in which the government does its duty is always relevant.
Now, do keep in mind, my hypothetical 90% rate was for the sake of comparing two extremes-I'm not saying that's the rate we should set.
Okay, fair enough, and keep in mind I was reacting to that extreme, not to the general principle of taxation.
As to your superstars and Warren Buffett and what have you, you can argue they do a lot. But they also use a lot.
If we're talking about personal income tax, I'd say you have to restrict their resource consumption to personal resource consumption.
Their mega-empires use resources, generate pollution, heavily utilize roads, air control, and other forms of infrastructure, are heavily dependent on police and fire protection and a stable society, and in many cases even get direct cash handouts from the government.
A mega-empire uses lots of resources because it involves a lot of people, as you noted -- thousands of people are involved in building a stadium, thousands of police are employed to provide protection, etc. I don't believe the one guy who started the ball rolling should be responsible for the cost of everything, despite thousands of other people also participating and benefiting from the activity.
If Exxon, to take an example, employed 99.9999% slave labor (everybody but the CEO), then you'd have a great point, but the reality is Exxon contributes a huge amount to our economy, as well as the economies of countries around the world. It's not the CEO who benefits most from Exxon's wealth, it's society.
So don't tell me megabillionaires become so in a vacuum. They depend on social resources (even if they don't deliberately abuse them), and they make much heavier use of those resources than Joe Average does. Even just the fact that we have a stable society is dependent on us keeping the vast majority of the population fed and housed.
So you're claiming that the billionaire is happier being a billionaire than someone who would otherwise die of starvation is happier being lower or middle class?
In other words, you're saying the billionaire has the biggest responsibility because he benefits the most in the situation? Personally, I think in the greater scheme of things, employing 10000 people and making them middle or even lower class is a much more positive cumulative change in happiness than making one person a billionaire. From that perspective, the billionaire is already getting the short end of the stick.
That's fine with me because like you said, the billion dollars doesn't come about through one person's efforts alone. But the idea that the billionaire somehow owes those 10000 people something doesn't make sense. They worked together to accomplish something great, isn't that good enough?
My other issue with it is how much political influence the rich exert, and how freely they use it. America is supposed to be "one person, one vote" not "one dollar, one vote". But the wealthy steadfastly shoot down every attempt at outlawing bribery-excuse me, enacting campaign finance reform. I'm not allowed to bribe a cop, a judge, a building inspector, or for that matter even a dogcatcher. Why on earth should I be allowed to bribe a Senator or the President?
A fair
It's got a few problems.
1. A 90% tax rate is blatant theft. It's even worse in an environment where you *change* the tax rate to 90% after somebody worked half their whole to build a successful business, get highly educated, or whatever enables them to have such a high income. Anybody who would take 90% of what someone earned is a criminal at heart. Yeah sure if you just give me the options I'll take the $100 million with a 90% tax rate. But look at that. You're sitting here offering me something I didn't earn, and using my response in an argument about how it would feel to have what I did earn taxed at a ludicrous rate. That's your world view. You don't even pretend to consider how more successful people would feel, you focus purely on how less successful could feel if they suddenly had more.
2. I think it has big problems economically. The only time the US had such a rate (and yes I think it's a great mark of shame on our country's history, let's not pretend we're perfect) was during world wars where the rich literally did not have a choice. "Oh you want to move? To France maybe? Spend some time in the occupied riviera?" The reality of peace time is places like Switzerland, France, Germany, England, etc are great places. Another reality for the rich is that the developing world, India, China, Brazil, are really fucking great places. You make $100 million/year... want your own private army? Want compounds with sex slaves? Or maybe you have no deviant desires and just want a mansion in downtown [big financial capital which every developing country has and is just as posh, rich, and entertaining as Manhattan or LA].
America is an awesome place, but you are laboring under the premise that it's awesome because of people like you, and everybody wants to hang out with people like you. The people who aren't rich and are stuck here.
Well it's not. It's awesome because of the rock stars, great artists, successful businessmen, cool sports teams, scientists who want to patent the next Viagra -- the people you want to target! You and I are a necessary part of the machine but I can be honest. On an individual level, someone like Warren Buffett with his "lower than his secretary tax rate" has contributed more to society than you and I by a thousandfold. How many people are rich because of you? How many people feed their families and send their kids to good schools because of what you've contributed to them? How much have you expanded American prestige by being an internationally known and followed figure? How have you made America more powerful by managing a disproportionately large chunk of her economy and making smart long-term investments?
I don't worship Buffett but I don't loathe him and people like him as you seem to. I respect him and consider people like him to be highly valuable assets to society. Warren Buffett is not a leech. He's rich because he earned it. Why would you want to take 90% of his wealth? What on earth makes you think that you, who didn't get rich on your own, would be better at deciding what to do with it than him? I really just don't get people like you.