Can Obamacare be Fixed?

[dblack]

"wedge to eliminate freedom" is an emotional assessment, not a scientific assessment. And there is no attempt to inject a socialist ethic unless you mean giving a shit about others.

Right, and 'giving a shit about others' is an utterly rational assessment. Obviously, anyone who doesn't endorse the coercive state doesn't 'give a shit about others'.

So your opinion is now meaningless in any social context.

Good to know. I'll keep that in mind when considering your 'social context'.

 

[KissMy]

These people discovered they will pay more for healthcare due to the Obamacare law.

 

[itfitzme]

"wedge to eliminate freedom" is an emotional assessment, not a scientific assessment. And there is no attempt to inject a socialist ethic unless you mean giving a shit about others.

Right, and 'giving a shit about others' is an utterly rational assessment. Obviously, anyone who doesn't endorse the coercive state doesn't 'give a shit about others'.

So your opinion is now meaningless in any social context.

Good to know. I'll keep that in mind when considering your 'social context'.

There is no "coercive state". There is a democratic-republic, a cooperative state.

Actually, giving a shit about others is a rational assessment. You will find that sociopath is the clinical term for an illness. It is also higher before the age of adulthood as the prefrontal cortex has not fully developed.

It is a rational behavior to have empathy for the people around us. Human beings are the ultimate pack animal and cooperation is the single greatest achievement in economic efficiency.

Seeing as money is a social tool, you should avoid using it. Voting is also a social act. You should avoid that too. You should avoid using language, far to social. I'd suggest avoiding books, but I believe you have that covered already.

 

[Bern80]

One thing to keep in mind is that the ideal supply and demand curves are boundary conditions, what supplier and consumer would charge and pay in a perfectly competitive markets.

Fact is, most are not perfectly competitive and have imbalances in the market forces that lean either towards the supplier or the consumer. Usually the supplier, but not always.

The supply and demand curves really put upper and lower limits on the supplier and customer prices. Customer's will happily pay less and suppliers will happily take more, if the market will bear this out. The supplier cost is an obvious lower bound. Suppliers can't sell below cost for very long.

The only thing that restricts the demand curve is the other markets, how much we have to spread around. I'll happily pay less, but at some point I have to have enough for food, housing, gasoline, etc. And property management companies know what minimum wage and Social Security pays. So, COLA goes up, up goes rents.

Still, say for instance the local service stations, act as oligopolies. I talked to one owner who said, "We don't get into price wars. That's just tacky." They price as high as the market will bear. They don't compete for the most customer's and don't price at rock bottom cost. They don't talk to each other, but they do watch each others prices. Those price signs aren't just for you and I. The advertisements that say, "will beat any price in town" aren't for you and me. Those are for the competition. The owner of the Shell station knows that the owner of the Arco knows that the Shell station owner knows that the Arco owner is watching Shell prices.

When insurance becomes part of it, the whole thing is up for grabs. Dentists typically charge different prices for insured than non-insured. The difference is that out of pocket is the same, they just get more when insurance is picking up a portion. A 50% deductible and I pay $1000 for a root canal and my insurance picks up $1000. No insurance and I get half off, so I pay $1000. And, frankly, that's the game and no-one can to otherwise because if they do, they get buried in the market.

As far as ACA goes, it is a hugely complex bill and if anyone says they know what is going to happen, they are fooling you, me and themselves.

Put in incentives like loan repayment programs to medical students and tuition costs will rise. Typically, the difference gets split. Like the Cash For Clunkers program... A $1000 rebate and price of autos went up. Depending on the elasticity of the supply and demand curves, it got split between buyer and seller. Depending on how many students take advantage of the loan repayment, the demand for professionals in the hard to fill geographic areas, and the increase in monies gets split up between saving students money and increasing profits to medical schools.

Having insurance companies capping operating expenses and profits to 20% keeps them from being a bottomless well for the rest of the industry. Still, that isn't going to be enough.

Medical device manufactures make bank. So implementing a medical device tax isn't going to increase the price of a $350 hip joint from $35,000 to $45,000. It won't happen.

Medicare is a huge player in the health care markets. So whatever Medicare does, it holds prices down. In a free market system, someone gets less for a lower price. The price of a McDonald's cheeseburger from the $1 menu keeps the price of a Wendy's hamburger down. Union wages at Safeway increase wages at the non-union Raley's.

On the medical device tax I have to say you're just plain wrong. Now admittedly I only know that because that's what my brother does for a living. He sells replacement hips, but yes the tax does have a significant impact on their bottom line and he has to work more to stay where they were before the tax. They either have to lower the price of their product or the hospital has to pay more. If the later the price gets passed on to the consumer. You have to remember changes in prices of anything, especially when forced by government, don't happen in a vacuum. The market reacts.

As far as our supply and demand curve goes not only is demand going to go up overall, supply is going to go down (supply curve shifts left) because of things like the medical device tax. This makes the actual devices cost the hospital more, which gets passed on to the consumer. You can say medicare will cover that for the consumer, but the double whammy to the hospital is their remibursement rates are going to god down as well under Obamacare. Obama had to do this because he took $700 million and some out of medicare to pay for the 30 million uninsured. The reality of Obamacare is most doctors are going to take a pay cut, which makes being one a less attractive professional option.

There is a difference between price, cost and utility. Now, I am just going on the recent article

http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html?_r=0

"An artificial hip, however, costs only about $350 to manufacture in the United States, according to Dr. Blair Rhode, an orthopedist and entrepreneur whose company is developing generic implants. In Asia, it costs about $150, though some quality control issues could arise there, he said."

We don't even need to know this information to know that price is above cost. First off, in the ideal of micro economic supply and demand, there are no profits. Perfect competition drives profits to zero. Then there is the simple disparity between regions that is not accounted for by simple costs. Price is above cost, at the level of demand willingness to pay.

Regardless, there will be no change in supply due to the medical device tax. For one thing, supply doesn't change as a result of a tax. A tax doesn't increase cost. A tax applies only to earnings before taxes. This one is an excise tax of 2.3% that applies to the sale and is calculated on the price, like the excise tax on car tires.

But as you've so aptly pointed out, the above is not reality. A company that doesn't make a profit can't do business. Hips are actually sold for a few grand. And 2.3% on a few grand per hip a hospital purchases is not chump change. My brother only does hips. He travels to the same doctor 2-3 times per week for replacement procedures. You do the math. Why are we burdening hospitals with more unneccessary bearuacratic red tape and expenses when they already have enough overhead?

 

[Bern80]

There is this gross error made in applying the ideal model of supply and demand to the real markets as if it was some hard-fast rule.

The fact is that it is an ideal model, just like the binomial distribution in probability. Applying the ideal supply and demand model to real markets is like saying, "the last coin flip was heads so the next is guaranteed to be tails because the probability is 50:50" Ideal models simply don't work this way.'

The supply and demand curves in macro economics set the upper and lower bounds for prices and quantities. For the demand curve, this is called "willingness to pay" which includes simply income availability as well as "utility" of the product. Customers will happily pay less. The supply curve is based on production costs which is not the same as price. Suppliers will always happily take more.

In perfect markets with perfect information, no barriers to entry, no inefficiencies of scale... that is no imperfections, the number of buyers and sellers is sufficiently large that both buyers and sellers are price takers. Profits don't exists because any profit attracts new suppliers, supply increases, and price falls to cost.

The curves set boundary conditions for the equilibrium point where, typically, the price is taken as cost. What the actual equilibrium point is depends on market imperfections. In the case of monopolies there is not price cap due to costs. In the case of oligopolies, there is a natural movement to a price level above cost.

I wouldn't call it a gross error. It's not like there's nothing we can learn or that can be predicted by applying these concepts to Obamacare. If they were useless tools in a real world economy or market I would imagine it's a concept we no longer teach since it has no real world application as you seem to be contending. That's simply not true. You know and I know that we can quite easily determine whether policy x or some aspect of policy x has on supply and demand. We know reducing the cost to the customer has an effect on demand. You've agreed to that, so don't pretend there's nothing we can learn from it. Personally I think the reason you would rather have us all ignore supply and demand is when we do look at them and how Obamacare effects them it really doesn't make the program look real good, which in turn doesn't help the argument of anyone advocating for Obamacare.

 

[itfitzme]

On the medical device tax I have to say you're just plain wrong. Now admittedly I only know that because that's what my brother does for a living. He sells replacement hips, but yes the tax does have a significant impact on their bottom line and he has to work more to stay where they were before the tax. They either have to lower the price of their product or the hospital has to pay more. If the later the price gets passed on to the consumer. You have to remember changes in prices of anything, especially when forced by government, don't happen in a vacuum. The market reacts.

As far as our supply and demand curve goes not only is demand going to go up overall, supply is going to go down (supply curve shifts left) because of things like the medical device tax. This makes the actual devices cost the hospital more, which gets passed on to the consumer. You can say medicare will cover that for the consumer, but the double whammy to the hospital is their remibursement rates are going to god down as well under Obamacare. Obama had to do this because he took $700 million and some out of medicare to pay for the 30 million uninsured. The reality of Obamacare is most doctors are going to take a pay cut, which makes being one a less attractive professional option.

There is a difference between price, cost and utility. Now, I am just going on the recent article

http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html?_r=0

"An artificial hip, however, costs only about $350 to manufacture in the United States, according to Dr. Blair Rhode, an orthopedist and entrepreneur whose company is developing generic implants. In Asia, it costs about $150, though some quality control issues could arise there, he said."

We don't even need to know this information to know that price is above cost. First off, in the ideal of micro economic supply and demand, there are no profits. Perfect competition drives profits to zero. Then there is the simple disparity between regions that is not accounted for by simple costs. Price is above cost, at the level of demand willingness to pay.

Regardless, there will be no change in supply due to the medical device tax. For one thing, supply doesn't change as a result of a tax. A tax doesn't increase cost. A tax applies only to earnings before taxes. This one is an excise tax of 2.3% that applies to the sale and is calculated on the price, like the excise tax on car tires.

But as you've so aptly pointed out, the above is not reality. A company that doesn't make a profit can't do business. Hips are actually sold for a few grand. And 2.3% on a few grand per hip a hospital purchases is not chump change. My brother only does hips. He travels to the same doctor 2-3 times per week for replacement procedures. You do the math. Why are we burdening hospitals with more unneccessary bearuacratic red tape and expenses when they already have enough overhead?

"A company that doesn't make a profit can't do business."

This is simply not factual. Most businesses do not make a profit. They pay salaries, they cover costs. They make no profit. Profit is not a requirement for a business. It is nice, it isn't required.

This doesn't even begin to approach the fact that the term "profit" means everything from $1 to $1,000,000,000,000,000.00 and beyond. It is pretty meaningless without quantification.

The whole idea of patent laws is to give an inventor time to see a profit, a return on his initial investment of time and money, before competition comes in and drives market profits to zero.

 

[dblack]

"wedge to eliminate freedom" is an emotional assessment, not a scientific assessment. And there is no attempt to inject a socialist ethic unless you mean giving a shit about others.

Right, and 'giving a shit about others' is an utterly rational assessment. Obviously, anyone who doesn't endorse the coercive state doesn't 'give a shit about others'.

So your opinion is now meaningless in any social context.

Good to know. I'll keep that in mind when considering your 'social context'.

There is no "coercive state". There is a democratic-republic, a cooperative state.

Nah... most all modern governments are coercive in nature. Ours certainly is.

Actually, giving a shit about others is a rational assessment. You will find that sociopath is the clinical term for an illness. It is also higher before the age of adulthood as the prefrontal cortex has not fully developed.

It is a rational behavior to have empathy for the people around us. Human beings are the ultimate pack animal and cooperation is the single greatest achievement in economic efficiency.

I have plenty of empathy for others. That's why I'm opposed to forcing my will (or yours) on them via government. Community and altruism flourish as voluntary acts, not as mandates.

 

[Bern80]

There is a difference between price, cost and utility. Now, I am just going on the recent article

http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html?_r=0

"An artificial hip, however, costs only about $350 to manufacture in the United States, according to Dr. Blair Rhode, an orthopedist and entrepreneur whose company is developing generic implants. In Asia, it costs about $150, though some quality control issues could arise there, he said."

We don't even need to know this information to know that price is above cost. First off, in the ideal of micro economic supply and demand, there are no profits. Perfect competition drives profits to zero. Then there is the simple disparity between regions that is not accounted for by simple costs. Price is above cost, at the level of demand willingness to pay.

Regardless, there will be no change in supply due to the medical device tax. For one thing, supply doesn't change as a result of a tax. A tax doesn't increase cost. A tax applies only to earnings before taxes. This one is an excise tax of 2.3% that applies to the sale and is calculated on the price, like the excise tax on car tires.

But as you've so aptly pointed out, the above is not reality. A company that doesn't make a profit can't do business. Hips are actually sold for a few grand. And 2.3% on a few grand per hip a hospital purchases is not chump change. My brother only does hips. He travels to the same doctor 2-3 times per week for replacement procedures. You do the math. Why are we burdening hospitals with more unneccessary bearuacratic red tape and expenses when they already have enough overhead?

"A company that doesn't make a profit can't do business."

This is simply not factual. Most businesses do not make a profit. They pay salaries, they cover costs. They make no profit. Profit is not a requirement for a business. It is nice, it isn't required.

This doesn't even begin to approach the fact that the term "profit" means everything from $1 to $1,000,000,000,000,000.00 and beyond. It is pretty meaningless without quantification.

The whole idea of patent laws is to give an inventor time to see a profit, a return on his initial investment of time and money, before competition comes in and drives market profits to zero.

True. There are of course not for profit organizations. It is also true that most businesses are not profitable. What you left out of that is this typically results in the business failing. Your expenses can't exceed your revenue or you're simply not going to make it.

 

[PMZ]

The health care market has all sorts of imperfections that make it not a competitive free market. There are efficiencies of scale in some markets, like drugs and insurance, which results in natural oligopolies. There are regulations on education level that restricts the supply of doctors and nurses, thus increasing doctor and nursing salaries. There are every manner of regulations for health and safety reasons which creates barriers to entry.

There is no "shopping around" when it comes to most medical procedures simply because when one is bleeding to death, any hospital will do. There is an utter imbalance in information. We are, after all, paying medical professionals for the very fact that they have the information and we don't.

The health care markets, are definitively not the ideal competitive free market that the introduction to micro-economics presents in the model of supply and demand.

No markets are 'ideal competitive free market's, and the above arguments can almost always be used to justify limiting free trade. Most medical concerns aren't emergencies, and even emergencies can be planned for.

Health care evokes emotional responses, which is why it's used as a leverage point to inject the socialist ethic. But it's only that - and will be used as a wedge to eliminate freedom across the board. Statists won't be satisfied until we're under their thumb(s).

What the heck is the ''socialist ethic''. It's an economic system, not a religion.

 

[PMZ]

Health care costs are not only high, but highly variable. The only solution to the variability is to spread the risk. Insurance.

Not even a little bit true. There are plenty of mechanisms that can be used to be bring the cost of health care down.

Do you even know what the term variability means? If not, you should refrain from commenting on it.

The high average cost comes from the fact that health care is practiced in a market where effective competition is impossible. Who would go to the cheapest Dr or hospital they could find to cure a serious disease?

Wrong again. You've said this before and again you presume that less expensive is the same thing as inferior quality. That simply isn't true.

How do you measure quality for a medical procedures? That’s precisely why health care delivery is not anywhere near a free market.

Most countries doing better than we in health care solve those problems by socializing it. So far, the evidence is that's an effective solution.

Will that ever happen here?

We collectively apparently aren't smart enough to do what works elsewhere.

Wrong a third time. What is your criteria for 'works'? Simply that it costs the consumer less? That's a pretty poor measurement of the quality of an entire health care system. In sustainability terms it's not working a lot of places. Frances system is billions in debt. It's not working from a supply side as we know it takes longer to be seen in many cases.

I don't need criteria. WHO has it. They say that we have by far the most expensive health care in the world and our results are mediocre.

Don't you ever think about evidence?

 

[PMZ]

Right, and 'giving a shit about others' is an utterly rational assessment. Obviously, anyone who doesn't endorse the coercive state doesn't 'give a shit about others'.



Good to know. I'll keep that in mind when considering your 'social context'.

There is no "coercive state". There is a democratic-republic, a cooperative state.

Nah... most all modern governments are coercive in nature. Ours certainly is.

Actually, giving a shit about others is a rational assessment. You will find that sociopath is the clinical term for an illness. It is also higher before the age of adulthood as the prefrontal cortex has not fully developed.

It is a rational behavior to have empathy for the people around us. Human beings are the ultimate pack animal and cooperation is the single greatest achievement in economic efficiency.

I have plenty of empathy for others. That's why I'm opposed to forcing my will (or yours) on them via government. Community and altruism flourish as voluntary acts, not as mandates.

That’s the beauty of democracy. Government of, by, and for we, the people. What you're talking about is called tyranny.

 

[dblack]

There is no "coercive state". There is a democratic-republic, a cooperative state.

Nah... most all modern governments are coercive in nature. Ours certainly is.

Actually, giving a shit about others is a rational assessment. You will find that sociopath is the clinical term for an illness. It is also higher before the age of adulthood as the prefrontal cortex has not fully developed.

It is a rational behavior to have empathy for the people around us. Human beings are the ultimate pack animal and cooperation is the single greatest achievement in economic efficiency.

I have plenty of empathy for others. That's why I'm opposed to forcing my will (or yours) on them via government. Community and altruism flourish as voluntary acts, not as mandates.

That’s the beauty of democracy. Government of, by, and for we, the people. What you're talking about is called tyranny.

It is? By what definition?

 

[Bern80]

There is no "coercive state". There is a democratic-republic, a cooperative state.

Nah... most all modern governments are coercive in nature. Ours certainly is.

Actually, giving a shit about others is a rational assessment. You will find that sociopath is the clinical term for an illness. It is also higher before the age of adulthood as the prefrontal cortex has not fully developed.

It is a rational behavior to have empathy for the people around us. Human beings are the ultimate pack animal and cooperation is the single greatest achievement in economic efficiency.

I have plenty of empathy for others. That's why I'm opposed to forcing my will (or yours) on them via government. Community and altruism flourish as voluntary acts, not as mandates.

That’s the beauty of democracy. Government of, by, and for we, the people. What you're talking about is called tyranny.

Ummm how is a government not forcing people to do things considered tyranny?

 

[dblack]

Nah... most all modern governments are coercive in nature. Ours certainly is.



I have plenty of empathy for others. That's why I'm opposed to forcing my will (or yours) on them via government. Community and altruism flourish as voluntary acts, not as mandates.

That’s the beauty of democracy. Government of, by, and for we, the people. What you're talking about is called tyranny.

Ummm how is a government not forcing people to do things considered tyranny?

That's what I'm wondering. Seems kinda inside out.

 

[PMZ]

That’s the beauty of democracy. Government of, by, and for we, the people. What you're talking about is called tyranny.

Ummm how is a government not forcing people to do things considered tyranny?

That's what I'm wondering. Seems kinda inside out.

A government without laws and the ability to enforce them is called an anarchy.

A government with laws and the ability to enforce them that's directed by a majority of the people is called a democracy.

A government with laws and the ability to enforce them that's directed by a minority of the people is called a tyranny.

 

[dblack]

Ummm how is a government not forcing people to do things considered tyranny?

That's what I'm wondering. Seems kinda inside out.

A government without laws and the ability to enforce them is called an anarchy.

A government with laws and the ability to enforce them that's directed by a majority of the people is called a democracy.

A government with laws and the ability to enforce them that's directed by a minority of the people is called a tyranny.

I haven't advocated for any of those things, so I'm not really sure what you're talking about.

 

[PMZ]

That's what I'm wondering. Seems kinda inside out.

A government without laws and the ability to enforce them is called an anarchy.

A government with laws and the ability to enforce them that's directed by a majority of the people is called a democracy.

A government with laws and the ability to enforce them that's directed by a minority of the people is called a tyranny.

I haven't advocated for any of those things, so I'm not really sure what you're talking about.

Only 3 choices. Anarchy, democracy, tyranny.

You don't advocate for democracy?

 

[dblack]

You don't advocate for democracy?

I'm a strong proponent of liberal democracy. But I think what confuses you is my conviction that for a democracy to remain viable, the rights of minorities must be protected. Constitutionally limited government is what makes democracy tolerable when we find ourselves in the minority. When those limits are removed, and the majority can use government to impose its will arbitrarily on the minority, all bets are off - the minority can and will fight back, regardless of the 'will of the people'.

That's the unfortunate direction we're headed now, as the Court allows Congress to erode Constitutional limits, and government intrudes on more and more areas of our life, political differences become intractable and democracy disintegrates.

 

[PMZ]

You don't advocate for democracy?

I'm a strong proponent of liberal democracy. But I think what confuses you is my conviction that for a democracy to remain viable, the rights of minorities must be protected. Constitutionally limited government is what makes democracy tolerable when we find ourselves in the minority. When those limits are removed, and the majority can use government to impose its will arbitrarily on the minority, all bets are off - the minority can and will fight back, regardless of the 'will of the people'.

That's the unfortunate direction we're headed now, as the Court allows Congress to erode Constitutional limits, and government intrudes on more and more areas of our life, political differences become intractable and democracy disintegrates.

Everybody's rights are protected by the Bill of Rights. Specific limits to federal government that have always been maintained. For everyone.

The only way to define the will of the people is democratically. Majority decision making.

In today's world, minorities are represented as special interests. Most of us think that their interests are over represented in today's government.

''the Court allows Congress to erode Constitutional limits''

This is an opinion and the very reason why the founders gave the responsibility of interpretation to the Supreme Court and not the people. Just like the very reason we empowered the IPCC to find the science relative to AGW. They're experts. They've devoted their lives to the study of a narrow field and are head and shoulders above us amateurs in their field.

 

[dblack]

Everybody's rights are protected by the Bill of Rights. Specific limits to federal government that have always been maintained. For everyone.

The Bill of Rights has been largely neutralized, especially via disregard for the ninth and tenth amendments.

The only way to define the will of the people is democratically. Majority decision making.

Agreed.

In today's world, minorities are represented as special interests. Most of us think that their interests are over represented in today's government.

Sad but very true. Corporatism turns the foundations of liberal democracy inside out, replacing universal, individual rights with group rights and special interest politics. Rule of law is subverted and the regulatory regime ensures that everybody gets a different deal, depending on how much political influence they can bring to bear. That's clearly the direction of "today's world" and I think it's a dreadful mistake.

Anyway, I'd like to return to your claim that my views represent tyranny. I'm not sure what you base this on. I'm not an anarchist, nor am I opposed to majority rule. You seem to be equating principles of limited government with tyranny, which seems almost Orwellian to me.