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      04-06-2013, 04:27 AM   #49
mmcnulty
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Quote:
Originally Posted by bbbbmw View Post
Okay - I'm giving up on this "quote" thing - will try to respond to a couple and make sense:
Oh fine, make me do all the hard work ;-) I'm ready to give up on this particular line of debate after this purely because it is so #$!@# hard to write these replies. They really need to make this easier.

Quote:
Originally Posted by bbbbmw View Post
Yeah, the *people* in hollywood pay the same in taxes, though. You are talking about corporations. I was talking about personal income taxes. And I am not sure hollywood gives out more local tax breaks than other areas do to attract businesses, auto factories, sports teams, etc. It's a pretty general problem.

Me: Yes - sorry - I was speaking of corporate tax breaks - both Federal and State. They get huge breaks, and only employ very few people.
I agree, and think the same applies to the other breaks I mentioned. Stadiums alone are totally absurdly packed with giveaways no city can really afford.

Quote:
Originally Posted by bbbbmw View Post
I was being hyperbolic - I apologize. They don't lose everything, but they lose most everything. And those costs they can't pay are picked up by the rest of us already - instead of taxes, they are in higher premiums and device costs. The costs are already shared.

Agree - in an earlier post I mentioned that the high Medical Bankruptcy number is a myth. I've also worked with many hospitals that collect $.03-.09 per dollar, on their uninsured patients. They don't bother to sue, as there are no assets. And we all ultimately share the burden.
I'm curious as to your line of work now...

Quote:
Originally Posted by bbbbmw View Post
There's two points in here, both of which I disagree with. One, people absolutely die because they lack coverage. Emergency care is one thing - long term chronic untreated conditions are completely another, and cause a lot more death than emergencies covered by laws.

Me: If you have assets and choose to roll the dice without insurance, you may lose those assets if you have a healthcare event. If you end up losing your assets, you then qualify for Medicaid, at no cost to you. So no one should end up dying because of a lack of care.
They shouldn't, but they do. Diabetes alone kills tons of poor people, when it should not and is totally manageable.

Quote:
Originally Posted by bbbbmw View Post
Second, the health care across state lines thing is bogus. States regulate insurance. The regulations are different in every state. If you allowed this, insurance companies would cluster in the least-regulated and cheapest state, offering cheaper coverage that covers a lot less. This doesn't actually save any costs - it just makes it easier for insurance companies to game the system.

Me: It's illegal to live in one state, and buy insurance in another. So if you live in CT and must pay high premiums, you can't buy it from IA, which has low premiums. The law is what prevents insurance companies from clustering in a low-cost state. That law could be changed.
I think you missed my point - if this law was changed, it would open the door for gaming the system in ways that would further reduce coverage and encourage games by insurance companies. This isn't a workable solution.

Quote:
Originally Posted by bbbbmw View Post
Medicare is not really managed at all, which is why people like it - they go get what they or their doctors want and there isn't really any oversight unless it gets excessive, but that's pretty rare. And see my other response regarding waste/fraud/abuse vs the built-in problems in pricing and payment that are really the root cause, illustrated in Steven Brill's book, if I recall his name correctly.

Me: Medicare is highly regulated - in payment and practice patterns for the Doctors. Which is why many docs no longer accept it - it is too much hassle, and the payments are too low. Same goes for Medicaid.
We're out of my knowledge sphere, so I'm willing to give up on this one. My understanding, however, is that doctors are underpaid for the services and there is extremely uncertain future payments due to the whole cuts that have to be avoided each year. I believe that is why doctors are refusing medicare patients. I don't think there is actually much practice pattern hassle, but again, I could be wrong.


Quote:
Originally Posted by bbbbmw View Post
The problem is that isn't working. Relatively few college students pay the total cost of college out of pocket, so that connection is already tenuous, and the system preys on students. I don't see how guaranteeing what is now required to get a real career is out of control. The more we educate our citizens, the more money flows back in the end. It's the long game, so it's more difficult to draw the line from X to Y, but it exists.

I agree with reluctance to influence what people study, but I also think there might be something clever in that realm that I won't rule out.

Me: I think we are on the same track - about the education system preying on students - that was my point. I'd love to see the Unversity system go to an accountable model - where you pay them based upon getting a job, and perhaps a percentage of your first 10 years earnings - or something like that.
I agree with that.

Quote:
Originally Posted by bbbbmw View Post
We need a system that retains financial incentives for drug companies while preventing gouging, or pricing that has nothing to do with market demand or forces. That market feedback loop is broken, and, imo, is the main problem.

Me: Agreed. But again, much of the problem is the government. The FDA takes years to get a drug to market, and the process is byzantine and expensive. The legal system allows unlimited lawsuits. These issues could be easily fixed.
The drug approval process could definitely be improved - I agree there. I don't think unlimited lawsuits are the problem though - I'll get to that in a separate post so that we can talk about it easier.

Quote:
Originally Posted by bbbbmw View Post
Money that goes to salaries is not taken out of the economy. That money pays for things people need, which goes into those people's salaries and companies, etc. There is a multiplicative effect - the money does not disappear. The basic point remains - basic scientific research is on the whole helpful to society and bears economic and other fruit down the line, and it's problematic to pick apart individual studies or programs and ignore the whole.

Me: The first part of your statement reminds me of Nancy Pelosi saying that Unemployment Compensation actually stimulates the economy - I would disagree. I understand your second point.
The multiplier effect may be somewhat controversial, but suggesting it is some Nancy Pelosi thing betrays some bias.

You can make an argument, imo, that unemployment insurance does not help unemployment as much as it could. I don't think it is valid to say that it does not stimulate the economy. That money gets spent, immediately. That does have a stimulative effect.

Quote:
Originally Posted by bbbbmw View Post
I lived in Boston through the big dig, and have been there since, and it's a revelation. Sure it was absurdly expensive, but the benefit to both commuters and city dwellers with massive amounts of green space and parks and a waterfront no longer cut off from the rest of the city is immense. Ask someone in Boston whether the big dig was worth it, even at that cost - I don't think many would say no at this point.

I agree that diverting gas tax money and other money earmarked for transportation infrastructure is a bad idea, and we are paying for it now. I don't see how that is a reason why we should not have government still handle that side of things.

Me: Of course they love the Big Dig now - it was billions of Federal dollars, not City of Boston tax dollars! I hope they are enjoying that Lobster Roll on the lawn that we all are paying for, while the traffic flows under their feet. Thanks, Tip O'Neill!

My point about government handling infrastructure is that all the Stimulus money was supposed to be spent on infrastructure repair - whereas it should never have been allowed to disintegrate in the first place. It's becoming yet another overfunded, wasteful debacle...
I think large infrastructure investments are a good thing. You disagree about some of them. I don't think we'll bridge this divide so we should probably let it go.