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Forums - Politics Discussion - American Government health spending seen hitting $1.8 trillion

mrstickball on 27 February 2012
Squilliam said:
mrstickball said:
Squilliam said:
mrstickball said:
Squilliam said:

The reason why socialised health care is cheaper is that you have a monopsony (single buyer) of health care. If you want to practice in a socialised system you effectively need to sell your service to the government and as a monopsony it has the ability to pay less than what the market price may have otherwise been. On the other hand if you have large private companies with an imperitive to increase profits year after year, they'll have an incentive to not only charge more but also try to influence regulation in their favour as well.


Depends on what kind of regulations the monosopy can force onto the providers. In the US, Medicare is a partial monsopy. They pay for a significant part of US health care. Because of that, they've driven up, not driven down, costs because everything is tied to what they are willing to pay out. Its created gross inefficiencies as some providers peg their prices to whatever the government will pay, which distorts the true price of health care.

Additionally, the kinds of compliance as given by mediare (e.g. "Fill out these 500 papers detailing how you provided a pill to aunt Sally") have driven up costs as well. Its another one of those "Great in theory, horrible in practice" arguments.

That is more bad practice than anything which is inherrently wrong with government departments, healthcare inclusive. Maybe you're jaded by the fact that government departments where you live aren't efficient at all. Where I'm from the government is efficient, lean and often as effective as any private company of equivalent size. It is possible to have public services provided in a fashion similar to private companies, afterall I live in a country where corporatisation was a big movement many years ago and has paid dividends,  even our postal service is profitable.

And exists so because you have a very small, homogenous, populace that is rather well educated and cares about their own life and livelihood. America is about 40 times the size, and has exponential degrees of inefficiencies because of it, among the intrinsic regulatory nightmare that is American health care .

Big entities have a way of being inefficient. Your government has a fraction of the bureaucrats ours does. Heck, we have more government workers than you do people. That brings with it some terrible things.

I suspect the problem then is more Federal vs State. One thing I never understood is why your Federal Government is up to its eyeballs in trivial matters which ought to be left to the state. I don't think it proves that government is itself bad, however surely the states themselves should be paying for their equivalent medicare, medicaid, social security etc. One thing I never understood about the republican candidates is that they all just say 'small government' and yet noneseem to  say 'state rights/state responsibility'.


State responsibility has been Ron Paul's message for 30 years....

Same with Gary Johnson.



Back from the dead, I'm afraid.

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Kasz216 on 27 February 2012
Squilliam said:
mrstickball said:
Squilliam said:
mrstickball said:
Squilliam said:

The reason why socialised health care is cheaper is that you have a monopsony (single buyer) of health care. If you want to practice in a socialised system you effectively need to sell your service to the government and as a monopsony it has the ability to pay less than what the market price may have otherwise been. On the other hand if you have large private companies with an imperitive to increase profits year after year, they'll have an incentive to not only charge more but also try to influence regulation in their favour as well.


Depends on what kind of regulations the monosopy can force onto the providers. In the US, Medicare is a partial monsopy. They pay for a significant part of US health care. Because of that, they've driven up, not driven down, costs because everything is tied to what they are willing to pay out. Its created gross inefficiencies as some providers peg their prices to whatever the government will pay, which distorts the true price of health care.

Additionally, the kinds of compliance as given by mediare (e.g. "Fill out these 500 papers detailing how you provided a pill to aunt Sally") have driven up costs as well. Its another one of those "Great in theory, horrible in practice" arguments.

That is more bad practice than anything which is inherrently wrong with government departments, healthcare inclusive. Maybe you're jaded by the fact that government departments where you live aren't efficient at all. Where I'm from the government is efficient, lean and often as effective as any private company of equivalent size. It is possible to have public services provided in a fashion similar to private companies, afterall I live in a country where corporatisation was a big movement many years ago and has paid dividends,  even our postal service is profitable.

And exists so because you have a very small, homogenous, populace that is rather well educated and cares about their own life and livelihood. America is about 40 times the size, and has exponential degrees of inefficiencies because of it, among the intrinsic regulatory nightmare that is American health care .

Big entities have a way of being inefficient. Your government has a fraction of the bureaucrats ours does. Heck, we have more government workers than you do people. That brings with it some terrible things.

I suspect the problem then is more Federal vs State. One thing I never understood is why your Federal Government is up to its eyeballs in trivial matters which ought to be left to the state. I don't think it proves that government is itself bad, however surely the states themselves should be paying for their equivalent medicare, medicaid, social security etc. One thing I never understood about the republican candidates is that they all just say 'small government' and yet noneseem to  say 'state rights/state responsibility'.

I'd guess because state rights, sometimes leads to state irresponsibility.

 

Even the state governments have a spending problem lately, despite the fact that by law they aren't allowed any deficit....



mrstickball on 27 February 2012
Kasz216 said:
Squilliam said:
mrstickball said:
Squilliam said:
mrstickball said:
Squilliam said:

The reason why socialised health care is cheaper is that you have a monopsony (single buyer) of health care. If you want to practice in a socialised system you effectively need to sell your service to the government and as a monopsony it has the ability to pay less than what the market price may have otherwise been. On the other hand if you have large private companies with an imperitive to increase profits year after year, they'll have an incentive to not only charge more but also try to influence regulation in their favour as well.


Depends on what kind of regulations the monosopy can force onto the providers. In the US, Medicare is a partial monsopy. They pay for a significant part of US health care. Because of that, they've driven up, not driven down, costs because everything is tied to what they are willing to pay out. Its created gross inefficiencies as some providers peg their prices to whatever the government will pay, which distorts the true price of health care.

Additionally, the kinds of compliance as given by mediare (e.g. "Fill out these 500 papers detailing how you provided a pill to aunt Sally") have driven up costs as well. Its another one of those "Great in theory, horrible in practice" arguments.

That is more bad practice than anything which is inherrently wrong with government departments, healthcare inclusive. Maybe you're jaded by the fact that government departments where you live aren't efficient at all. Where I'm from the government is efficient, lean and often as effective as any private company of equivalent size. It is possible to have public services provided in a fashion similar to private companies, afterall I live in a country where corporatisation was a big movement many years ago and has paid dividends,  even our postal service is profitable.

And exists so because you have a very small, homogenous, populace that is rather well educated and cares about their own life and livelihood. America is about 40 times the size, and has exponential degrees of inefficiencies because of it, among the intrinsic regulatory nightmare that is American health care .

Big entities have a way of being inefficient. Your government has a fraction of the bureaucrats ours does. Heck, we have more government workers than you do people. That brings with it some terrible things.

I suspect the problem then is more Federal vs State. One thing I never understood is why your Federal Government is up to its eyeballs in trivial matters which ought to be left to the state. I don't think it proves that government is itself bad, however surely the states themselves should be paying for their equivalent medicare, medicaid, social security etc. One thing I never understood about the republican candidates is that they all just say 'small government' and yet noneseem to  say 'state rights/state responsibility'.

I'd guess because state rights, sometimes leads to state irresponsibility.

 

Even the state governments have a spending problem lately, despite the fact that by law they aren't allowed any deficit....


At least the states with the balanced budget amendments couldn't issue currency to pay for their spending. No state could get away with what the federal government is doing.



Back from the dead, I'm afraid.

Squilliam on 27 February 2012
Kasz216 said:

I'd guess because state rights, sometimes leads to state irresponsibility.

 

Even the state governments have a spending problem lately, despite the fact that by law they aren't allowed any deficit....

So for the most part States are still more responsible fiscally than the federal government. I suspect that there are many states which post a surplus or a small loss. People are much better at borrowing and spending from their own financial limits than from a collective.



Tease.

Mr Khan on 27 February 2012

The issue with leaving it up to the states is that some states would simply half-ass it, like the huge mire we have with education.

Unless you presented certain targets of care that each state had to provide, and left it up to them to figure out how to do it, but how to remove incentive from failure?



Monster Hunter: pissing me off since 2010.

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Kasz216 on 27 February 2012
Mr Khan said:
The issue with leaving it up to the states is that some states would simply half-ass it, like the huge mire we have with education.

Unless you presented certain targets of care that each state had to provide, and left it up to them to figure out how to do it, but how to remove incentive from failure?


I'd actually argue that the opposite is true.  The problem with education is that such targets DO exist.

Because... they do.  Without specific requirements, states that do poorly have no excuse vs states that do try, and people will leave the states that do poorly.

ESPIECALLY with health.  I mean, what company is going to stay in a state with bad healthcare if a better one is right across the state lines?  The states with better healthcare should attract more buisnesses and people because they won't have to pay for it.

Though if you wanted incentives vs the states... there is plenty of things you can do... like withold other money.  Just how the highway money is often used to blackmail states.



Kasz216 on 27 February 2012
mrstickball said:
Kasz216 said:
Squilliam said:
mrstickball said:
Squilliam said:
mrstickball said:
Squilliam said:

The reason why socialised health care is cheaper is that you have a monopsony (single buyer) of health care. If you want to practice in a socialised system you effectively need to sell your service to the government and as a monopsony it has the ability to pay less than what the market price may have otherwise been. On the other hand if you have large private companies with an imperitive to increase profits year after year, they'll have an incentive to not only charge more but also try to influence regulation in their favour as well.


Depends on what kind of regulations the monosopy can force onto the providers. In the US, Medicare is a partial monsopy. They pay for a significant part of US health care. Because of that, they've driven up, not driven down, costs because everything is tied to what they are willing to pay out. Its created gross inefficiencies as some providers peg their prices to whatever the government will pay, which distorts the true price of health care.

Additionally, the kinds of compliance as given by mediare (e.g. "Fill out these 500 papers detailing how you provided a pill to aunt Sally") have driven up costs as well. Its another one of those "Great in theory, horrible in practice" arguments.

That is more bad practice than anything which is inherrently wrong with government departments, healthcare inclusive. Maybe you're jaded by the fact that government departments where you live aren't efficient at all. Where I'm from the government is efficient, lean and often as effective as any private company of equivalent size. It is possible to have public services provided in a fashion similar to private companies, afterall I live in a country where corporatisation was a big movement many years ago and has paid dividends,  even our postal service is profitable.

And exists so because you have a very small, homogenous, populace that is rather well educated and cares about their own life and livelihood. America is about 40 times the size, and has exponential degrees of inefficiencies because of it, among the intrinsic regulatory nightmare that is American health care .

Big entities have a way of being inefficient. Your government has a fraction of the bureaucrats ours does. Heck, we have more government workers than you do people. That brings with it some terrible things.

I suspect the problem then is more Federal vs State. One thing I never understood is why your Federal Government is up to its eyeballs in trivial matters which ought to be left to the state. I don't think it proves that government is itself bad, however surely the states themselves should be paying for their equivalent medicare, medicaid, social security etc. One thing I never understood about the republican candidates is that they all just say 'small government' and yet noneseem to  say 'state rights/state responsibility'.


At least the states with the balanced budget amendments couldn't issue currency to pay for their spending. No state could get away with what the federal government is doing.


I'm not actually sure it is better.  Printing money is awful, but not printing money... look at Greece.

The problem is... there is little to hold governments to their word.

Look at California who mostly ignores cuts, (though when it does, it cuts stupid things) and just takes bailouts from the Federal Government...

and when they aren't doing that, they are doing asinine things like paying companies with IOU's.  Then taxing them on the IOU's as if it was realized income! 

"We owe you 100 dollars, so uh, we'll pay you that... now pay us 20 for the 100 were't going to pay you later."



Mr Khan on 27 February 2012
Kasz216 said:
Mr Khan said:
The issue with leaving it up to the states is that some states would simply half-ass it, like the huge mire we have with education.

Unless you presented certain targets of care that each state had to provide, and left it up to them to figure out how to do it, but how to remove incentive from failure?


I'd actually argue that the opposite is true.  The problem with education is that such targets DO exist.

Because... they do.  Without specific requirements, states that do poorly have no excuse vs states that do try, and people will leave the states that do poorly.

ESPIECALLY with health.  I mean, what company is going to stay in a state with bad healthcare if a better one is right across the state lines?  The states with better healthcare should attract more buisnesses and people because they won't have to pay for it.

Though if you wanted incentives vs the states... there is plenty of things you can do... like withold other money.  Just how the highway money is often used to blackmail states.

You assume greater mobility of people than is actually the case. While there would be some movement in the margins, populations gains/loss from education quality can't be that significant. Florida is apparently known for fairly poor educational standards, yet they keep gaining population

Which is the whole practical problem with all "competition will sort itself out" arguments, simply that people are not as mobile as they "should" be for such systems to really work.



Monster Hunter: pissing me off since 2010.

Kasz216 on 27 February 2012
Squilliam said:
Kasz216 said:

I'd guess because state rights, sometimes leads to state irresponsibility.

 

Even the state governments have a spending problem lately, despite the fact that by law they aren't allowed any deficit....

So for the most part States are still more responsible fiscally than the federal government. I suspect that there are many states which post a surplus or a small loss. People are much better at borrowing and spending from their own financial limits than from a collective.

True, I just think such things would kind of hurt their cause with the general voter anyway though due to...

1) The above, IE states not being perfect, so just not having these rights is easier.  Since those that will vote for them mostly don't want these programs anyway.

2) Some conservative social issues are ones that they don't want being controlled by individual states, these are things that can technically ignored by "Small government" but not "States rights".   For example a gay marriage ban or anti-aborition ban.  These would technically be "Big Government" type laws....

but wouldn't cost anything.  Since it would expand the government's power, but not it's size.



Kasz216 on 27 February 2012
Mr Khan said:
Kasz216 said:
Mr Khan said:
The issue with leaving it up to the states is that some states would simply half-ass it, like the huge mire we have with education.

Unless you presented certain targets of care that each state had to provide, and left it up to them to figure out how to do it, but how to remove incentive from failure?


I'd actually argue that the opposite is true.  The problem with education is that such targets DO exist.

Because... they do.  Without specific requirements, states that do poorly have no excuse vs states that do try, and people will leave the states that do poorly.

ESPIECALLY with health.  I mean, what company is going to stay in a state with bad healthcare if a better one is right across the state lines?  The states with better healthcare should attract more buisnesses and people because they won't have to pay for it.

Though if you wanted incentives vs the states... there is plenty of things you can do... like withold other money.  Just how the highway money is often used to blackmail states.

You assume greater mobility of people than is actually the case. While there would be some movement in the margins, populations gains/loss from education quality can't be that significant. Florida is apparently known for fairly poor educational standards, yet they keep gaining population

Which is the whole practical problem with all "competition will sort itself out" arguments, simply that people are not as mobile as they "should" be for such systems to really work.

This seems like a strange arguement, here you are arguing

1) There is lots of economic mobility to Florida despite their poor education scores.

2) There is not a lot of mobility.

Seems contradicting.   Outside which, though Florida is ranked poorly in achivement.  Standards wise it is one of the highest ranked schools.

http://www.edweek.org/ew/articles/2011/01/13/16stateofthestates.h30.html?tkn=OZWFBPfso6GowQRnY7ZhYpGKp6j6W1ufX5AC&cmp=clp-edweek#

 

I can't really speak of florida, but I can speak of Nevada.  One of the worst states education wise.  Most people with kids either flees or puts their kids in charter schools if they can avoid it.

Yet still saw plenty of population growth due to construction jobs and illegal immigration.  AS such, the tax base has kinda collapsed, Nevada is in huge debt... can't attract buisnesses because it's workers education is poor... etc.