Its clearly the right time to slash the social safety net

[kentonio]

kentardio:

Please provide an estimate of what effect a marginal dollar spent on medicare has on spending on children in poverty.

I'm more interested in the effect it has on healthcare provision to the elderly personally, but as you're only ever going to see it in cold financial terms whats the point anyway? Medicare was only mentioned as one of a number of GOP areas for cuts that would have an impact on child homelessness numbers. The point was never that Medicare should never be touched in any way because of the kids, it was that when so many things are slashed at once, the effects of that go far deeper than some of you seem to imagine.

[PLATO]

The idea of social justice is paid for by the citizens here being willing to pay a significant portion of their income to the state to manage many of the essentials of life. You say the state can't pay for it, but that's simply not true as the European countries ARE paying for it and have been for decades. We pay higher taxes than you but then we don't have personal expenses such as healthcare and we never end up in a situation where we can fall into complete desperate poverty.

Some interesting data on what is being spent on health care as a % of GDP. It looks to me that some European Countries that "force" an investment in health care do not do as well as a "voluntary" system like the U.S.

Total Expenditure on Health as % of GDP 2000-2005

Rank Location 2000 2001 2002 2003 2004 2005
------- --------------------------------------------- ------- ------- ------- ------- ------- -------
1 Marshall Islands 22 19.1 18.4 16.3 13.2 15.4
2 United States of America 13.2 13.9 14.7 15.1 15.2 15.2
3 Niue 8 38.1 11.1 12.5 15.5 14.5
4 Timor-Leste 8.8 8.6 8.5 9.2 10.3 13.7
5 Micronesia (Fed. States of) 9 9.8 9.1 10.7 11.7 13.5
6 Kiribati 11.6 12.3 12.6 13.7 13.7 12.7
7 Maldives 6.8 6.8 6.6 7.2 7.8 12.4
8 Malawi 6.1 7.8 10 12.8 12.8 12.2
9 Switzerland 10.3 10.7 11 11.4 11.4 11.4
10 France 9.6 9.7 10 10.9 11 11.2
11 Germany 10.3 10.4 10.6 10.8 10.6 10.7
12 Jordan 9.4 9.6 9.3 9.3 10.1 10.5
13 Nauru 11 10.8 10.6 10.3 10.4 10.3
14 Argentina 8.9 9.5 8.9 8.3 9.6 10.2
15 Austria 10 10 10.1 10.2 10.3 10.2
16 Portugal 8.8 8.8 9 9.7 10 10.2
17 Greece 9.3 9.8 9.7 10 9.6 10.1
18 Canada 8.8 9.3 9.6 9.8 9.8 9.8
19 Sao Tome and Principe 6.3 9.1 8.6 11.9 12.1 9.8
20 Belgium 9.1 9.3 9.5 9.5 9.7 9.6
21 Palau 9.7 9.1 10.1 11.5 9.7 9.6
22 Denmark 8.3 8.6 8.8 9.3 9.4 9.4
23 Iceland 9.3 9.2 9.9 10.2 9.9 9.4
24 Netherlands 8 8.3 8.9 8.9 9 9.2
25 Sweden 8.2 8.6 9 9.1 9.2 9.2
26 Norway 8.4 8.8 9.8 10 9.7 9.1
27 Italy 8.1 8.2 8.3 8.3 8.7 8.9
28 New Zealand 8.1 8.3 8.5 8.4 8.5 8.9
29 Australia 8.3 8.4 8.6 8.6 8.8 8.8
30 Bosnia and Herzegovina 7 6.9 7.7 8.1 8.6 8.8
31 Tuvalu 13.4 10.5 9.4 11.1 9.2 8.8
32 Lebanon 11 10.7 9.4 8.9 8.8 8.7
33 South Africa 8.1 8.4 8.3 8.4 8.5 8.7
34 Georgia 7.4 7.8 8.7 8.5 8.5 8.6
35 Slovenia 8.4 8.7 8.8 8.8 8.5 8.5
36 Malta 6.8 7.2 7.8 8.1 8.2 8.4
37 Botswana 4.8 4.2 5.7 6.4 7.7 8.3
38 Ireland 6.3 6.9 7.1 7.3 7.5 8.2
39 Japan 7.6 7.9 8 8.1 8 8.2
40 Spain 7.2 7.2 7.3 7.8 8.1 8.2
41 United Kingdom 7.2 7.5 7.6 7.7 8 8.2
42 Uruguay 10.5 10.8 10.3 9.8 8.2 8.1
43 Zimbabwe 8.3 6.4 5.8 7.2 8.4 8.1
44 Montenegro 7.5 8 7.9 8.2 8 8
45 Serbia 7.1 7.3 8.3 8.3 8 8
46 Brazil 7.2 7.6 7.7 7.5 7.7 7.9
47 Nicaragua 7.2 7.7 8 8 7.9 7.9
48 Hungary 6.9 7.2 7.6 8.3 8.1 7.8
49 Iran (Islamic Republic of) 5.9 6.1 6.1 6.2 6.2 7.8

Now, obviously this not evaluate the differences in cost controls or even in quality of care. The point is, however, that a "voluntary" system brings more money to the table for health care.

Additionally, one thing people do not realize in the U.S. is that every county in the country has a public health department where people who cannot afford health care can get free care. (including routine things like physicals). Now...is that quality of care as good as what you can get if you pay top dollar? I doubt it, but then is the quality of care you get in ANY government run system as good as you can get if you pay top dollar? I doubt that as well.

Finally...to address your last point...that Europe has been paying for this for decades with no ill effects. This is highly suspect given the financial challenges that many countries in Europe are facing now. Debts are exploding and "austerity" is the new catch word. At what point does health care get looked at for austerity? Once it does, what is the alternative that Europeans are looking at for health care?

There will never be that perfect place where social safety nets are not needed, and putting the onus onto charities and communities to provide essential services just means that you may get great support or you may get ****ty support and it may depend on nothing more than what town or county or state you live in.

No one is saying that there will never be a need to help those that are down on their luck. The point is that I believe money can be spent more effectively in creating circumstances where the need for a safety net is minimized. It is far better to create an environment where people can have a job and pay for their own costs, than for the government to institutionalize a system that, in fact, discourages both job growth and the desire to find a job. This type of system is unsustainable.

[DanS]

PLATO: One thing to keep in mind is that the US system is about half socialized and is becoming more socialized every year (even leaving aside Obamacare). The US socialized medicine is more socialist than, say, Germany's system.

[PLATO]

During the time frame that the WHO GDP report covers, the spending on Medicare (arguably the largest percentage of "socialized" expediture in the U.S.), issignificantly less than 5% of GDP. In correlating this to the WHO report, then in 2005, for example, the "non-socialized" expenditures would still be on par or ahead of European forced spending.

The frightening part of this graph, however, is the future and what "socialized" medical spending looks like in the future...and this was before Obamacare. A good example of the unsustainability of government healthcare....

[MRT144]

I don't know what you mean by "distorts credit risk". The single most important reason to make student debt non-dischargeable is that without this, lenders and students would be unable to freely contract in an extremely beneficial way. Any restriction on th ability of parties to freely contract under any terms and conditions they choose involves a deadweight loss (certain loans which would have been made will not be due to the existence of bankruptcy protection). The problem is orders of magnitude larger when the loans are taken out by people who (in general) have no tangible assets and who will be purchasing an asset which cannot be seized.

Remember that students are still free to contract for loans which can be discharged by bankruptcy (e.g. a regular consumer loan); the fact that this market is almost nonexistent tells you the scale of the benefits shared by both parties due to the change of rules.

The only positive from personal bankruptcy law I'm aware of is the insurance aspect. Dischargeability of debts as a form of insurance only makes sense if the vast majority of borrowers will not experience a situation where bankruptcy is a rational choice, and where this situation is unforeseeable by the borrower; this does not apply to student debt (and as I stated earlier, revealed preference is to contract for non-dischargeable student debt at a lower rate of interest).

Note that the issue of personal bankruptcy is very different from the issue of corporate bankruptcy, especially as it pertains to limited liability corporations which literally could not exist without bankruptcy laws.

Are student loans the exception because of the non siezability of the underlying asset and because you believe higher education is undeniably a positive? If student loans are not an exception then wouldn't this rationale apply to just about anything where installment loans are used to acquire a good or service?

When I say distorts credit risk, I think it's pretty clear that some of those loans being made should not be made because the debtor is going into a field with limited monetary upside or possibly won't even graduate. To what extent are future non performing loans made due to the inability of the debtor to erase them and do you think in the societal calculus, that is worth it?

[Mojotronica]

Some interesting data on what is being spent on health care as a % of GDP. It looks to me that some European Countries that "force" an investment in health care do not do as well as a "voluntary" system like the U.S.

My interpretation of that data is that Europe simply operates more efficiently than the USA. Paying the cost up front instead of trying to squeak by with a disorganized mix of the covered and the bankrupt just makes more sense all around. It's costing us about a 25% premium for the privilege of being able to say that we don't have socialized medicine.

And as you pointed out, we do have socialized medicine, since many are covered by Medicaid or Medicare and we haven't gotten to the point of callousness where we are willing to turn people away at the ER. We push those costs onto the hospitals and counties, where they are covered through our property tax system.

It would be smarter to organize it, provide universal health care and shave 25% off the overall cost of treatment. We don't do that because of the political benefit to the "anti-socialized medicine" lobby.

[Mojotronica]

I'm opposed to spending more money to get less coverage or service, even if by doing so it means I get to ride a pretty, white, American high horse of smug, self-satisfied, fake self-reliance.

[PLATO]

My interpretation of that data is that Europe simply operates more efficiently than the USA. Paying the cost up front instead of trying to squeak by with a disorganized mix of the covered and the bankrupt just makes more sense all around. It's costing us about a 25% premium for the privilege of being able to say that we don't have socialized medicine.

And as you pointed out, we do have socialized medicine, since many are covered by Medicaid or Medicare and we haven't gotten to the point of callousness where we are willing to turn people away at the ER. We push those costs onto the hospitals and counties, where they are covered through our property tax system.

It would be smarter to organize it, provide universal health care and shave 25% off the overall cost of treatment. We don't do that because of the political benefit to the "anti-socialized medicine" lobby.

Where do you get the data that it costs us a 25% premium? I could easily say that the efficiencies of private enterprise over government save us a 25% premium.

If the point is that there is a need for a socialized system at the local level for people who cannot afford health care and that it should be supported by property taxes, then I won't argue that. However, to just simply say that socialized medicine saves 25% just because the government runs it, then I think we could come up with thousands of examples where things like medicare fraud would prove that wrong. In the abscence of credible evidence, I cannot accept that simply because medical care is socialized that it would save money...in fact, I intuitivly feel the opposite.

Regardless of all of that however, the U.S. under the system that was in place in 2005 spends more on health care than European countries do. That, in and of itself, is significant in pointing to the willingness of people to pay for care themselves versus being taxed for it.

[kentonio]

Yeah Plato, you certainly shouldn't be proud of Americans spending far more on healthcare and receiving the level of care you do. Last time I checked you came about 37th in the world for quality of healthcare despite being paying the most of the significant countries.

[kentonio]

If the point is that there is a need for a socialized system at the local level for people who cannot afford health care and that it should be supported by property taxes, then I won't argue that. However, to just simply say that socialized medicine saves 25% just because the government runs it, then I think we could come up with thousands of examples where things like medicare fraud would prove that wrong. In the abscence of credible evidence, I cannot accept that simply because medical care is socialized that it would save money...in fact, I intuitivly feel the opposite.

This is one of many cases where 'intuition' means nothing. Universal healthcare systems are proven by real world evidence to cost less and provide a better standard of care. Look at the hard data.,

Regardless of all of that however, the U.S. under the system that was in place in 2005 spends more on health care than European countries do. That, in and of itself, is significant in pointing to the willingness of people to pay for care themselves versus being taxed for it.

It's significant because you're basically wasting money. You deserve a better system for your dollars.

[Mojotronica]

Where do you get the data that it costs us a 25% premium? I could easily say that the efficiencies of private enterprise over government save us a 25% premium.

If the point is that there is a need for a socialized system at the local level for people who cannot afford health care and that it should be supported by property taxes, then I won't argue that. However, to just simply say that socialized medicine saves 25% just because the government runs it, then I think we could come up with thousands of examples where things like medicare fraud would prove that wrong. In the abscence of credible evidence, I cannot accept that simply because medical care is socialized that it would save money...in fact, I intuitivly feel the opposite.

Regardless of all of that however, the U.S. under the system that was in place in 2005 spends more on health care than European countries do. That, in and of itself, is significant in pointing to the willingness of people to pay for care themselves versus being taxed for it.

From the data that you provided. France spends about 11% of it's GDP on medical coverage, the USA spends about 15%. Approximately 25% more. France's health care is the gold standard, everyone is covered and it's very patient-friendly.

[PLATO]

I'm opposed to spending more money to get less coverage or service, even if by doing so it means I get to ride a pretty, white, American high horse of smug, self-satisfied, fake self-reliance.

Once again, I do not see any evidence that Americans are getting less coverage for their dollar spent. Am I missing where you are pointing to these relevant facts? You seem to be trying to shift this debate to whether or not we should be prideful of sel reliance or not...isn't the real question "Which is more the more efficient way of providing high quality health care?" I could give a rats butt about which system we have...as long as it provides the highest level of care at the least expense. If this is government run, then it being the most efficient way of doing it would go against years of empirical evidence that the government doe NOT run efficiently. In fact, governments are supposed to be designed to provide the services that cannot be done efficiently. Given that the U.S. generally has among the highest standards of care in the world, AND has an existing socialized system for the poor, I simply cannot understand the rationale for moving the entire system to an entity that is inherently inefficient when private industry survives on efficiency and does a good job delivering quality care.

[PLATO]

From the data that you provided. France spends about 11% of it's GDP on medical coverage, the USA spends about 15%. Approximately 25% more. France's health care is the gold standard, everyone is covered and it's very patient-friendly.

I see...so you are equating the money spent as if the coverages were equal. I can see that and it certainly appears to be reasonable on the surface. I simply don't know if thesystems are comparable so I can't argue that point. I will say that from what I have heard of French care that it does have a good reputation.

[PLATO]

This is one of many cases where 'intuition' means nothing. Universal healthcare systems are proven by real world evidence to cost less and provide a better standard of care. Look at the hard data.,

I would love to. Show me the way!

[PLATO]

Yeah Plato, you certainly shouldn't be proud of Americans spending far more on healthcare and receiving the level of care you do. Last time I checked you came about 37th in the world for quality of healthcare despite being paying the most of the significant countries.

I assume that you are referring to the 11 year old data that WHO provided? Included in the components of this data are items such as the health of the people. With Americans leading the unhealthy lifestyles they do, then it is no suprise that they ranked 72 in that category. However, if you will take the time to peek at it, the U.S. ranked #1 in the responsiveness of its health care system. The 37th ranking has a bit more to it than you read into it.