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Old 03-15-2017, 01:00 AM
 
4,197 posts, read 2,494,480 times
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Quote:
Originally Posted by TMKSarah View Post
Steve,

I am curious, would you happen to be someone that would benefit from the proposed tax deductions and not to say least....do you have a Cadillac Plan? Your children are still on your plan? Life is good?

Or do you live on the border and get your healthcare from Mexico?

And last but not least...you are around the same age as me.

Just wondering.

Love Love
I am retired navy. I have tricare for life.
Live in South Carolina. Wife and daughter are still on plan. Oldest is on her own plan, on her own dime..
Retirement is very good, very good.. over 50K a year net..
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Old 03-15-2017, 03:13 AM
 
Location: next up where ever I go
588 posts, read 345,610 times
Reputation: 2087
Quote:
Originally Posted by Steve40th View Post
I am retired navy. I have tricare for life.
Live in South Carolina. Wife and daughter are still on plan. Oldest is on her own plan, on her own dime..
Retirement is very good, very good.. over 50K a year net..
Yes, that is what I thought.
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Old 03-15-2017, 03:23 AM
 
4,197 posts, read 2,494,480 times
Reputation: 1936
Quote:
Originally Posted by TMKSarah View Post
Yes, that is what I thought.
But its not what said, racist.
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Old 03-15-2017, 07:10 AM
 
9,224 posts, read 9,295,009 times
Reputation: 28918
Quote:
Originally Posted by Steve40th View Post
I am retired navy. I have tricare for life.
Live in South Carolina. Wife and daughter are still on plan. Oldest is on her own plan, on her own dime..
Retirement is very good, very good.. over 50K a year net..
One reform I advocate is taking all veterans out of "Tricare for Life" and putting them on medicare when they hit age 65. It would save the taxpayers a considerable amount of money. My understanding is that Tricare pays for medicare part B premiums and does some other things that the rest of us don't get.

Last edited by markg91359; 03-15-2017 at 07:28 AM..
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Old 03-15-2017, 07:57 AM
 
Location: Paranoid State
13,047 posts, read 10,463,702 times
Reputation: 15684
Quote:
Originally Posted by TMKSarah View Post
Misty,

Interesting that your Fortune 50 corps did their due diligence. I suspect that was because of the whole sale slaughter of the Reduction in Force made by the Fortune 1000 corp I worked for where you got a pick slip on Friday, given to you as you left the compound by security, never allowed to return for their belongings, through a plate glass window. Workers were going home and committing suicide over the weekend so they started handing out the slips on Monday.
So sad.

We did the layoffs on Thursday. Part of the layoff was instructions to the affected person to start calling their contacts on Thursday & Friday to set up meetings for the following week (I'm referring to white collar professional jobs). That way, they had something to look forward to so the weekend wasn't as depressing as it otherwise might have been. We provided a separate building with full resources so the affected people had someplace to go.

This all was in Silicon Valley where companies frequently have a boom-bust cycle.

I recall one layoff we did at a famous high tech "California fruit company". The package was generous, and the the higher up you were and the more years with the company added to the size of the package. One guy I know had been there 10 years, and his layoff package coupled with unused vacation & an unused sabbatical came to just over 1 year.

He packed up & went camping/fishing/canoeing for a full year in the Boundary Waters https://www.fs.usda.gov/detail/super...telprdb5202169

After a year, he came back into civilization, called his old boss to see how things were going back at the fruit company. It was back to boomtimes, and his old boss had just opened a req for the job the guy used to do.

Yes -- he was hired back into his old position, and "bridged" for seniority/continuity purposes. The company had effectively paid for a full 1 year vacation.
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Old 03-15-2017, 07:57 AM
 
29,815 posts, read 34,907,142 times
Reputation: 11735
Quote:
Originally Posted by markg91359 View Post
One reform I advocate is taking all veterans out of "Tricare for Life" and putting them on medicare when they hit age 65. It would save the taxpayers a considerable amount of money. My understanding is that Tricare pays for medicare part B premiums and does some other things that the rest of us don't get.
We also didn't serve the country willing to put ourselves in harms way the way they did

This is one of those if you want the gain do the pain. They did! I had no intentions of being in the military and appreciate those who were. They deserve it. I couldn't have done what they did!
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Old 03-15-2017, 09:55 AM
 
Location: Paranoid State
13,047 posts, read 10,463,702 times
Reputation: 15684
Quote:
Originally Posted by TwoByFour View Post
First of all, the work you linked to does not make any "clear" claim that single payer is not the answer.
TwoByFour, your reply is very thoughtful and well reasoned. Thanks. In the spirit of a healthy dialog about this very important topic, I'll offer the following. (I mean everything below to be constructive.)

***

Well, I guess "clear" was the wrong word as his analysis is over the heads of most, but his analysis does indeed shows single payer doesn't solve the cost problem. Let me quote the article here, and please note the section I emphasized below (bold & underlined):

Quote:
In my view, this polynomial model is straight forward (few degrees of freedom), plausible, and most parsimoniously accommodates or otherwise “explains”:

* virtually all of the intra-temporal differences between countries
* large inter-temporal shifts in HCE amongst countries
* the broad global pattern of increasing health care expenditures
* fits rich AND poor countries in the same dataset quite well

If this HCE growth is primarily a consequence of inevitable pressure resulting from demand for technological improvements (medical devices, pharmaceuticals, surgical procedures, etc), why don’t we see proportionally similar increases amongst countries a decade or two behind us in economic development? If high US health expenditures are the product of lack of single-payer (limited market power etc etc), why did the US only really diverge relatively recently? (Did not similar differences in systems exist in the 70s or even early 80s?) If other developed countries have it figured out, why is their HCE increasing so rapidly and why is their trajectory so similar to ours vis-a-vis AIC per capita? If the relationship between HCE and AIC are truly linear in a given year, why should the overall slope change so much over time and why, even allowing for a substantial random slope, are these residuals non-linearly correlated with AIC (rich and poor countries skew high)? Why is the relationship in the much more economically diverse 2011 WHO/WorldBank data so clearly non-linear? (What explains this here, but not between OECD economies?)

In short: why is this not all much better explained as an overall non-linear relationship (as in the 3rd degree polynomial models above)?

Note: That is not to argue that technology had played no role here, I think it has, but it seems to be pretty modest as a root cause or independent predictor (as suggested by the annual coefficients ) as compared to the influence of increasing affluence in the US and abroad. Put differently, spending on new technology (or otherwise stimulated by it, e.g., diagnostics) may account for a significant fraction of the increase in spending in rich countries, but this doesn’t usually seem to happen all that significantly without a larger corresponding increase in broader consumption measures (i.e., even if you exclude HCE).
Here is the problem (I guess I should say IMHO):



The cost of health care has about quintupled since 1970. It’s actually been rising since earlier than that; it looks like it would have been about $1200 in today’s dollars in 1960, for an increase of about 800% in those fifty years.

This has had the expected effects. The average 1960 worker spent ten days’ worth of their yearly paycheck on health insurance; the average modern worker spends sixty days’ worth of it, a sixth of their entire earnings.

Countries like South Korea and Israel have about the same life expectancy as the US but pay about 25% of what we do. Some people use this as evidence of the superiority of centralized government health systems, although Random Critical Analysis has an alternative perspective. In any case, it seems very possible to get the same improving life expectancies as the US without octupling healthcare spending.

Quote:
Originally Posted by TwoByFour View Post
Single payer will solve the equitable distribution of healthcare
Respectfully, that's not the problem. The problem is healthcare costs too damn much for no apparent reason, and because healthcare costs too much, the mis-named health insurance (which is not insurance but rather financing) also costs too much. Necessarily, health insurance must be equal to healthcare costs plus administration costs (including profit).

Quote:
Originally Posted by TwoByFour View Post
...which is the vexing problem facing Congress at the moment ...
I wish that were true. The problem Congress is working on is the misnamed insurance side (really it is the financing), not the underlying escalation of healthcare costs side.

Quote:
Originally Posted by TwoByFour View Post
...and is the topic of this thread.
Respectfully, the "equitable distribution of healthcare" is not the topic of this thread. The costs of healthcare and how to pay for them is the problem.

Quote:
Originally Posted by TwoByFour View Post
Under ACA and AHCA, there are segments of America that are getting screwed. Single payer will fix that.
I disagree. Single payer does not solve the root cause of an escalation in healthcare costs. Single payer would do nothing to roll back the costs of healthcare.

Quote:
Originally Posted by TwoByFour View Post
But more than that, single payer will unify the way that people utilize healthcare.
I don't understand what you mean by "unify". Can you explain?

Quote:
Originally Posted by TwoByFour View Post
People have well developed utility functions that govern how they make choices and those utility functions can be tuned so that people are not over-using or abusing services but are in fact making wise choices.
Can you elaborate? I don't see it -- especially in a system where consumption of services is divorced from payment for services (regardless if payment is done by a single payer or by multiple payers). Moreover, the concept of tuning any individual utility function is an odd phrase -- my understanding is utility functions are not tuned; all that happens is people make rational choices in response to prices & their "non-tunable" utility functions. Can you elaborate?

Quote:
Originally Posted by TwoByFour View Post
Insurance companies have profit as a motive but a single payer system like Medicare will have lowering total healthcare costs as a motive.
Medicare employees, being government employees, have very different motivations than employees in the private sector. I don't think there is any evidence they have a any motive to lower total healthcare costs. At the most basic level, when medicare costs go up, no career government employee is worried about losing their job. In fact, the more people who use medicare & hence driving up total medicare expenditures, the more need there is for even more government employees - so the incentive is the opposite.

Let's look at actual data on just how good a job Medicare employees have done in constraining costs:



There is no evidence government Medicare employees have done anything to constrain costs.


Quote:
Originally Posted by TwoByFour View Post
More needs to happen than just a single-payer payment system to bring down costs. But that does not obviate the need for an equitable way to insure everyone
Insuring everyone is not and should not be an objective. Remember: health insurance is not insurance in the sense that automobile insurance is insurance.

We've seen with Obamacare that many people make rational decisions not to purchase any insurance whatsoever. They have "inside information" about their personal health, and they are in the position to make the decision that the price of insurance just isn't worth it to them. Still others object for other reasons: it is wrong for the government to compel them to purchase something they do not wish to purchase. "I just wish they would leave me the hell alone," is something I've heard from some people in their 60s (!).


Quote:
Originally Posted by TwoByFour View Post
...so single-payer is a necessary but not sufficient element of system that works.
Your conclusion doesn't follow. There is no evidence single payer is necessary for anything.


Quote:
Originally Posted by TwoByFour View Post
...Besides, private insurance companies add about 15% premium on top of all payments they make so by eliminating them we immediately trim 15% off the cost.
I must disagree again. Let's do a thought experiment. Let's say we implement single payer, and to do that we want to have government employees do the work. To get those new employees, we'll need every single employee that works for all the health insurance companies. So, we hire them all. But we'll need many more government employees to integrate the disparate systems and to manage it all. And, of course, these new government employees will have full government benefits including very generous government pensions and health insurance (that is, of course, different from the health insurance provided to those in the private sector). The government costs will go up and up and up.

Here are real-world examples that single payer doesn't address:

* One health insurance company, in order to comply with regulations, expends 100 person-years of effort every year to generate reports that are sent to various federal government entities -- and those governmental entities don't even look at the data in those reports.

* Where there is no insurance coverage for LASIK, competition has driven prices down and consumption of it out-of-pocket has gone up. Where there is insurance coverage for CT & MRI, use has gone up but prices have not gone down as there is no price competition. The anecdote elsewhere in this thread regarding the price of an MRI in China is about $70 is telling: here in the US it is easily $1000 and maybe its more like $2000 all because markets do not set prices as with LASIK. Single payer could easily make things more expensive.

* A personal anecdote. My personal prescription medicine plan says I can use either (1) ExpressScripts or (2) Costco. I went to Costco yesterday and I asked them,
"Hi. You have my insurance on file. Can you please tell me what my price would be for these two medicines? I want to compare your price to the price of ExpressScripts so I know if I want to fill them here, there, or not at all."

"I'm sorry. We are legally prevented from telling you the price of what a prescription would be under your insurance plan unless you actually submit the prescription to us to fill it."
One of the ideas of Obamacare was that pricing would be more transparent so individuals can make decisions based on price. I can call up any LASIK center and ask for their price & they will give it to me over the telephone, as LASIK isn't covered by insurance. Contrast that with a knee replacement. I called a local hospital just for fun & asked "How much for a knee replacement" and got absolutely nowhere.

And I cannot even find out the price of a common statin at Costco -- because it is currently illegal for them to tell me the price unless I submit the Rx for fulfillment.

Single payer isn't the answer.

Let's do another thought experiment about single payer. All of us buy food at grocery stores. Imagine a "single-payer" food system where we purchase food at grocery stores (no prices on merchandise or on shelves) and at the checkout counter, the clerk submits the bill for food to the Government Single Payer system. Over the course of the next 6 months or so, the Government Single Payer system figures out how much its negotiated prices for each line item of food will be, and figures out how much it will pay, pays the grocery store, and the grocery store then sends us a bill for our required portion.

That's nuts, of course -- but that's single payer.

Last edited by SportyandMisty; 03-15-2017 at 10:58 AM..
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Old 03-15-2017, 09:57 AM
 
13,980 posts, read 7,452,675 times
Reputation: 25549
Quote:
Originally Posted by TuborgP View Post
We also didn't serve the country willing to put ourselves in harms way the way they did

This is one of those if you want the gain do the pain. They did! I had no intentions of being in the military and appreciate those who were. They deserve it. I couldn't have done what they did!
I don't buy it. Career combat infantry? Marines? Sure. That's not the career description for most retired military. Maybe 10% to 20% had careers like that. The other 80% are riding the entitlement gravy train.

There are 6,000 personnel on an aircraft carrier. About 200 actually fly airplanes. Since WW II ended, you're safer on a navy ship than commuting to work. Any air force base has similar numbers. There are countless retired military who kept 'Murica safe drinking beer in Germany.

For someone part of that 10% to 20%? Sure. Gold-plated retirement benefits. Everybody else? Not so much. I have the same opinion about retired union suburban cops. A city cop in one of our many failed war zone cities? Absolutely. That's not the job description of most cops but they get the compensation and retirement benefits of those inner city cops.
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Old 03-15-2017, 10:03 AM
 
30,168 posts, read 47,402,141 times
Reputation: 16117
Quote:
Originally Posted by SportyandMisty View Post
So sad.

We did the layoffs on Thursday. Part of the layoff was instructions to the affected person to start calling their contacts on Thursday & Friday to set up meetings for the following week (I'm referring to white collar professional jobs). That way, they had something to look forward to so the weekend wasn't as depressing as it otherwise might have been. We provided a separate building with full resources so the affected people had someplace to go.

This all was in Silicon Valley where companies frequently have a boom-bust cycle.

I recall one layoff we did at a famous high tech "California fruit company". The package was generous, and the the higher up you were and the more years with the company added to the size of the package. One guy I know had been there 10 years, and his layoff package coupled with unused vacation & an unused sabbatical came to just over 1 year.

He packed up & went camping/fishing/canoeing for a full year in the Boundary Waters https://www.fs.usda.gov/detail/super...telprdb5202169

After a year, he came back into civilization, called his old boss to see how things were going back at the fruit company. It was back to boomtimes, and his old boss had just opened a req for the job the guy used to do.

Yes -- he was hired back into his old position, and "bridged" for seniority/continuity purposes. The company had effectively paid for a full 1 year vacation.
But that is not normal for people "riffed"
Depends on age and skills and location
That guy was exceptionally lucky
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Old 03-15-2017, 10:08 AM
 
13,980 posts, read 7,452,675 times
Reputation: 25549
Quote:
Originally Posted by SportyandMisty View Post
Countries like South Korea and Israel have about the same life expectancy as the US but pay about 25% of what we do. Some people use this to as evidence of the superiority of centralized government health systems, although Random Critical Analysis has an alternative perspective. In any case, it seems very possible to get the same improving life expectancies as the US without octupling healthcare spending.


Respectfully, that's not the problem. The problem is healthcare costs too damn much for no apparent reason, and because healthcare costs too much, the mis-named health insurance (which is not insurance but rather financing) also costs too much. Necessarily, health insurance must be equal to healthcare costs plus administration costs (including profit).
The vast majority of health care dollars are spent on labor. The US labor costs in the medical cartel are roughly 2x more than anywhere else in the first world (other than Canada where they need to pay more to stop workers from crossing the border into the US for more money). If you're willing to pay nurses, radiology techs, physicians, janitors, .... 50 cents on the dollar, our health costs line up with the rest of the first world. Sure, we could trim some administrative fat and pay world prices for Rx drugs to Big Pharma but that doesn't fix the problem. Only trimming labor costs fixes the problem.

How do you do that? First, you break up the AMA cartel. Quadruple the number of seats in medical schools. Government-paid education in exchange for service in the under served parts of the country. Do the same with all the community college medical career paths. Make it free to get a nurse-practitioner master's degree.
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