[blackshoe]

Winstonm, on 2015-October-21, 20:49, said:

My objective is prevent a Right Wing ideological theocracy - i.e., to save and even increase the social safety nets and slow defense spending, corporate subsidies, and regressive taxation.

I don't think the latter things, or rather their opposites, are necessarily things a "Right Wing ideological theocracy" would do, or continue doing.

Surprisingly, to me, four of the five things you want I would agree with: turning this country into a theocracy, right wing or left, is anathema to me. The only thing I would object to in your list is "increase the social safety nets". The others, well, it depends how much slowing you want to do, at least on defense spending (we do need some imo). Corporate subsidies (and bailouts) can go right into the trash as far as I'm concerned. Taxation should be reduced to the minimum necessary to fund the few things government ought to be doing. Paying Joe Blow so he can sit on his butt in front of the TV all day is not one of them.

[hrothgar]

blackshoe, on 2015-October-23, 18:48, said:

Paying Joe Blow so he can sit on his butt in front of the TV all day is not one of them.

Sorry, don't you live off of your Navy pension?

[kenberg]

hrothgar, on 2015-October-24, 06:15, said:

Sorry, don't you live off of your Navy pension?

As a guy drawing a pension I feel compelled to comment. The pension is for work performed. It was performed earlier in my life, but it was performed. Any job a person takes gives compensation. Part, but only part, of the compensation is a paycheck at regular intervals. Further compensation can be in the form of health insurance, a pension, or other added inducements. The upshot is that being given an agreed upon pension for doing agreed upon work is simply part of the compensation agreement.

Having siad that, I do recognize a problem. I took a job with the University of Maryland in 1967 and the pension agreement was part of it. To some extent this means that the state government in 1967 generously agrees that the state would be giving me money in 2015. The taxpayers of 2015 were not, in 1967, consulted. There is, however, a pension fund and if (a very big if) this is managed properly then the money is socked away early on so the citizens of 2015 are not saddled with the decisions of the citizens of 1967. This had been working pretty well until, quite some years back, the guy running it made a mess of things. The money was at least badly managed and I believe there were some legal issues. I don't know the details but I think the fund is in better shape than some but not in the shape we could wish.

So not everything is perfect, but I strongly insist that pension payments are an agreed upon, but delayed, payment for work performed. The fact that, through varying life spans, some will get more than others does not change this. The same applies to health benefits. I had good health throughout (most of) my life so I got very little from my health benefits. Others, with more health problems, got more benefit from the health provisions. That's ok, it is still part of the compensation package.

I am not, with the above, making an argument for or against helping people of normal working age who are not working. I am simply stating that pensions and help for the working age unemployed are two different things. In general I favor helping people of any age who are in need, but I believe that the help should be deigned to help them need less assistance in the future. I recognize that there are situations where this goal is, in reality, very far off. I still think that it is a worthy goal, both for them and for us.

Added: There are problems with pensions. I took emeritus status (in plain English I retired) when I was 65. The financial issues are complex. If I take a pension for myself, I get X dollars per year, with X increasing as I work longer. But there are options. I have my pension set so that upon my death Becky still gets X/2. So they set the bean counters to work to make this balance out statistically. The amount we get is Y, where Y depends on how long the acuarial tables say they will have to fork over cash to becky after I croak. Becky is 8, almost 9, years younger than I am. This becomes actuarially more significant as we get older. They look at teh tables and say "Oh, if we were just paying Ken he would be dead in 2 years so his pension is worth 2X. But we will be paying Becky and so we have to lower y enough to make it work out right". This is fine if I plan to live only as long as the actuarial tables suggest, but the whole point of a pension is so that if you are so "unlucky" as to have a long life you have enough money. This feature by itself was not enough to induce retirement at 65 (actuarial table expect a 65 year old to live for a good deal more than 2 years), but there were other financial features as well. These are real. A guy who retired at 75 or so, also with a "young" wife, was shocked to discover his pension would have been larger if he had retired earlier. I used to joke that if someone would pay me to stop working I would accept, but as I reached an age where this was an option I cam to realize it was not entirely a joke.I retired, sort of. I work from time to time.

[Winstonm]

Social Security is also a pension fund, albeit one managed by the government. It, too, pays for work performed.

[Winstonm]

blackshoe, on 2015-October-23, 18:48, said:

I don't think the latter things, or rather their opposites, are necessarily things a "Right Wing ideological theocracy" would do, or continue doing.

Surprisingly, to me, four of the five things you want I would agree with: turning this country into a theocracy, right wing or left, is anathema to me. The only thing I would object to in your list is "increase the social safety nets". The others, well, it depends how much slowing you want to do, at least on defense spending (we do need some imo). Corporate subsidies (and bailouts) can go right into the trash as far as I'm concerned. Taxation should be reduced to the minimum necessary to fund the few things government ought to be doing. Paying Joe Blow so he can sit on his butt in front of the TV all day is not one of them.

I agree that any ideological theocracy is antithetic to a free society. Where I disagree is that the government needs to be smaller. I do not think the government needs to be smaller but better. Re-inventing the military/defense apparatus to where it was in line with other countries spending would actually cause the government to have a smaller footprint. It does not take extra bodies in the government offices to increase social security checks by $100 a month. It may require additional bodies to offer free advanced education and universal healthcare - if it does, then that is good government, IMO.

[y66]

Except for the plan to bring white blue collar voters back into the fold, it was a very good week for the good guys.

[mike777]

Winstonm, on 2015-October-24, 08:06, said:

I agree that any ideological theocracy is antithetic to a free society. Where I disagree is that the government needs to be smaller. I do not think the government needs to be smaller but better. Re-inventing the military/defense apparatus to where it was in line with other countries spending would actually cause the government to have a smaller footprint. It does not take extra bodies in the government offices to increase social security checks by $100 a month. It may require additional bodies to offer free advanced education and universal healthcare - if it does, then that is good government, IMO.

If you want to reduce Defense spending to less than 2% of GDP fair enough. That will mean cutting back capabilities such as oversees bases/troops, Carrier groups, NATO, etc. If one advocates for the nonatomic military capability of Denmark or Norway or Sweden, fair enough. Keep in mind other countries or armies will rush to fill that void in some manner. As Winston points out a smaller military certainly makes the govt smaller.

Also as Winston points out if everyone in health care/hospital or University works for the central govt that will make govt much bigger. I believe Health Care is roughly 20% of the economy.

The concern has always been putting the economic power and political power in the same very few hands. Winston you clearly believe this is a good thing and will work for the better not the worse.

[Winstonm]

mike777, on 2015-October-24, 09:13, said:

If you want to reduce Defense spending to less than 2% of GDP fair enough. That will mean cutting back capabilities such as oversees bases/troops, Carrier groups, NATO, etc. If one advocates for the nonatomic military capability of Denmark or Norway or Sweden, fair enough. Keep in mind other countries or armies will rush to fill that void in some manner. As Winston points out a smaller military certainly makes the govt smaller.

Also as Winston points out if everyone in health care/hospital or University works for the central govt that will make govt much bigger. I believe Health Care is roughly 20% of the economy.

The concern has always been putting the economic power and political power in the same very few hands. Winston you clearly believe this is a good thing and will work for the better not the worse.

It does not cost more to protect 10 million dollars than it does to protect 1 million dollars. Percentage of GDP is a poor comparison for reasonable defense spending. The richer the country, the smaller percentage of GDP should be necessary for reasonable safety.

[mike777]

it does cost more to protect ten million than one
2) you advocate for even less than 2% of GDP wow.

[kenberg]

A detour, but still on the general theme of the election.

I caught a portion of "Wait Wait Don't tell me" and Faith someone was commenting on the Benghazi hearing, expressing a thought I had: Being grilled for eleven hours without collapsing is really impressive. Faith particularly thought sh demonstrated that she had a "presidential bladder". That particular quality had not occurred to me but I really think Hillary should express her gratitude to the committee for giving a live demonstration of her fortitude. .Btw, I know many here like Bill Maher or Steven Colbert. I really like Wait Wait.When the news was that terrorist networks were using fundraising efforts along the lines used by public radio, they suggested having a show called "Wait Wait Don't Kill me. " I like that.

Other suggested programs: "Car Bomb Talk" and "This Anti-American Life".

[Winstonm]

mike777, on 2015-October-24, 10:49, said:

it does cost more to protect ten million than one
2) you advocate for even less than 2% of GDP wow.

I argue for less than the 18% of the annual budget that is spent on defense. I argue for protective defense spending rather than fantasy Pax Americana by might defense spending.

[Winstonm]

mike777, on 2015-October-24, 09:13, said:

If you want to reduce Defense spending to less than 2% of GDP fair enough. That will mean cutting back capabilities such as oversees bases/troops, Carrier groups, NATO, etc. If one advocates for the nonatomic military capability of Denmark or Norway or Sweden, fair enough. Keep in mind other countries or armies will rush to fill that void in some manner. As Winston points out a smaller military certainly makes the govt smaller.

Also as Winston points out if everyone in health care/hospital or University works for the central govt that will make govt much bigger. I believe Health Care is roughly 20% of the economy.

The concern has always been putting the economic power and political power in the same very few hands. Winston you clearly believe this is a good thing and will work for the better not the worse.

Mike,

Medicare is a single payer system - does that mean that doctors and hospitals who accept Medicare payments work for the central government? Put down your John Birch placard and quit worrying about the pinkos being everywhere.

[y66]

kenberg, on 2015-October-24, 10:52, said:

A detour, but still on the general theme of the election.

I caught a portion of "Wait Wait Don't tell me" and Faith someone was commenting on the Benghazi hearing, expressing a thought I had: Being grilled for eleven hours without collapsing is really impressive. Faith particularly thought sh demonstrated that she had a "presidential bladder". That particular quality had not occurred to me but I really think Hillary should express her gratitude to the committee for giving a live demonstration of her fortitude. .Btw, I know many here like Bill Maher or Steven Colbert. I really like Wait Wait.When the news was that terrorist networks were using fundraising efforts along the lines used by public radio, they suggested having a show called "Wait Wait Don't Kill me. " I like that.

Other suggested programs: "Car Bomb Talk" and "This Anti-American Life".

Wait Wait Don't Tell Me is hilarious.

I tuned into the last 40 minutes of the hearing. Trey Gowdy looked a hundred times more exasperated than Clinton. Evidently he missed The Wire episode in which Omar says: You come at the king, you best not miss. Or maybe he just took that too literally. Game over, yo.

[kenberg]

Winstonm, on 2015-October-24, 11:39, said:

Mike,

Medicare is a single payer system - does that mean that doctors and hospitals who accept Medicare payments work for the central government? Put down your John Birch placard and quit worrying about the pinkos being everywhere.

I have had trouble understanding the phrase "single payer system". This is not a rhetorical comment, i really have had trouble grasping just what is meant. I went to the Wikipedia and found, for single payer health care:

Quote

Single-payer health care is a system in which governments, rather than private insurers, pay for all health care costs.^[1] Single-payer systems may contract for health care services from private organizations, as is in Canada, or they may own and employ health care resources and personnel, as in the United Kingdom.

The term "single-payer" thus describes only the funding mechanism, health care financed by a single public body from a single fund. It does not specify the type of delivery or for whom doctors work.

The actual funding of a "single payer" system comes from all or a portion of the covered population. Although the fund holder is usually the state, some forms of single-payer use a mixed public-private system.

Later they say

Quote

Medicare in the United States is a single-payer healthcare system, but is restricted to senior citizens over the age of 65, people under 65 who have specific disabilities, and anyone with End-Stage Renal Disease.^[41]

I am having trouble reconciling this description. I have health insurance to go with my Medicare. If I did not, my share of the cost would be greater. Medicare definitely does not "pay all the costs". Since I have good insurance, my share of the costs is, usually, not all that much. Low enough so that if the claim is that Medicare and my insurance together :"pay all the costs" I would not bother to quibble, although it does depend on just what costs we are talking about. Of course I pay, and a fair sized amount, for the insurance.


Now to the question of whether the docs are working for the government or not: No, of course they are not. But the government definitely makes its presence felt. This is just a case of the golden rule: The person, or agency, with the gold makes the rules. So far I have not had all that much quarrel with in their actual policies, once I can figure out what they are. I do quarrel with their (lack of) clarity and their responsiveness.

^{I am not all that much griping about Medicare, I am trying to understand in what sense it is a "single payer system" . The language and the reality do not seem to match well.}

[mike777]

Winstonm, on 2015-October-24, 11:39, said:

Mike,

Medicare is a single payer system - does that mean that doctors and hospitals who accept Medicare payments work for the central government? Put down your John Birch placard and quit worrying about the pinkos being everywhere.

OF course medicare does not cover many many things...IN fact there is a massive need for private insurance combined with medicare. People tend to use the term single payer to mean many things....we have discussed this often. What it seems to mean at a minimum is not a single payer....see Canada or the UK or etc. There is not one and only one payer.

If that is what you advocate fair enough...but you come across wanting to take over and control the entire health care industry.
---

edit I see Ken already made these points.

[kenberg]

I thought about this while peeling and slicing apples (strudel will be forthcoming, I do the grunt work).

I think Medicare is "single partial payer", meaning that if five senior citizens are having a medical procedure done, there is a Medicare portion of the bill, all five will have that paid for by Medicare, and all five doctors/hospitals/whatever will receive the same amount from Medicare. The remainder of the bill will be covered in a variety of ways.

The essence of "single payer" then is that for whatever portion of the bill falls under "single payer", that will be uniform.

Every November "single payer" starts to sound attractive. As a retiree I am still eligible for partially subsidized insurance. That's the good news. The bad news is that I have to read all the crap they send me describing what I get. Well, I read this stuff in the same sense that I read A Tale of Two Cities when I was in high school. It was the best of plans, it was the worst of plans..... Will this be on the test?

[mike777]

Ken I am not sure your example is correct. For example for the same procedure there may be different payouts by region of the country or other factors but to be honest I am not sure. For example would a NYC doc or hospital get the exact same payout as one in Wyoming? You can see my point, their costs are not the same.

"How doctors are reimbursed by Medicare

If your provider does take Medicare, then the services received are, in part, reimbursed through the Medicare program.

Since 1992, the Medicare program has been using a Resource-Based Relative Value Scale (RBRVS) to determine how doctors should be paid for the health-care services they provide. Instead of being paid on an absolute fee-for-service basis, payments for services through the RBRVS system are relative to the combination of three separate determining factors: doctor's work, relative practice expenses, and professional liability insurance. The reimbursement fee is then adjusted for the geographical location in which the service is provided.

Three times a year, a special committee of doctors meets to discuss recommendations on updates to how much doctors should be paid for their work and other relative values. The committee, also known as the Relative Value Scale Update Committee (RUC), is made up of individuals convened by the American Medical Association (AMA) and other medical-specialty trade groups. Around 90% of the recommendations by the RUC are followed by the Center for Medicare and Medicaid Services (CMS), allowing the committee great influence over the billions of taxpayer dollars in the Medicare program"

http://www.planpresc...e-news/doctors/

-----------------


which brings it all back to the same point, single payer means many different things to many people in practice.

It does however put great economic and political power in a few very few hands.

[Winstonm]

mike777, on 2015-October-24, 15:28, said:

Ken I am not sure your example is correct. For example for the same procedure there may be different payouts by region of the country or other factors but to be honest I am not sure. For example would a NYC doc or hospital get the exact same payout as one in Wyoming? You can see my point, their costs are not the same.

"How doctors are reimbursed by Medicare

If your provider does take Medicare, then the services received are, in part, reimbursed through the Medicare program.

Since 1992, the Medicare program has been using a Resource-Based Relative Value Scale (RBRVS) to determine how doctors should be paid for the health-care services they provide. Instead of being paid on an absolute fee-for-service basis, payments for services through the RBRVS system are relative to the combination of three separate determining factors: doctor's work, relative practice expenses, and professional liability insurance. The reimbursement fee is then adjusted for the geographical location in which the service is provided.

Three times a year, a special committee of doctors meets to discuss recommendations on updates to how much doctors should be paid for their work and other relative values. The committee, also known as the Relative Value Scale Update Committee (RUC), is made up of individuals convened by the American Medical Association (AMA) and other medical-specialty trade groups. Around 90% of the recommendations by the RUC are followed by the Center for Medicare and Medicaid Services (CMS), allowing the committee great influence over the billions of taxpayer dollars in the Medicare program"

http://www.planpresc...e-news/doctors/

-----------------


which brings it all back to the same point, single payer means many different things to many people in practice.

It does however put great economic and political power in a few very few hands.

What "few very few hands" are you talking about? Congress? The Department of Health and Human Services? I would rather have the power over my healthcare in the hands of the government than have it be decided by a dozen board members of some insurance company that is concerned more with how they appear to their shareholders than with my health. Now that is what I call a "few very few hands".

[kenberg]

I accept that Mike is probably right in saying my description of Medicare's approach is inadequate. But I was trying to understand in what sense Medicare can be said to be "single payer" . "Single partial payer " still seems right, but I grant that the uniformity of the partial pay probably isn't as clear as I phrased it.

My experience with Medicare is not exactly that decisions are in "too few hands" but rather that it is in "too remote hands". A few years back I had a medical issue (I'll spare you the details). I was referred to a specialist who made a correct diagnosis of the problem, who then turned things over to an assistant to work out the details, and then left the country for a month without assigning my case to anyone except the assistant. The assistant was a jerk who thought he knew all of Medicare rules and was not open to discussion. This was going to work out badly for me, again I will spare you the details, I was pretty certain he was wrong, so I phoned Medicare for assistance in clarifying the rules. This was a total dead end. You talk to robots that have you push buttons. Finally you get a human who is little better than a robot. The information I wanted on rules is only available to doctors, not to patients. Say what? This got resolved by my saying that I wanted exactly the treatment that the doc had said I needed, and if it should turn out that this would result in Medicare not paying for it I would pay for it myself. They backed down, I got the treatment, Medicare paid for it. Of course I fault the doc for his lax supervision and I fault the extremely uncooperative assistant, but I also fault Medicare. They were totally useless in resolved the problem. The issue was Medicare rules, through perseverance I reached someone who had direct access to the rules, she refused to tell me the rules because I wasn't a doctor.

Bureaucracy can be a major blockage in getting something done. What else is new? If you can cope with it, Medicare is fine.

I am still unclear as to why it is a single payer system.

[barmar]

kenberg, on 2015-October-25, 08:57, said:

I am still unclear as to why it is a single payer system.

I think the simple way to understand it is as: for whatever treatments and costs the insurance covers, those will be paid by the government, rather than requiring the insured to pay premiums.

This still allows for the insurance to only pay a percentage of the medical costs, copayments, and deductibles, just like ordinary medical insurance does. You may be able to buy other insurance to fill in the gap.