What would it take?

[TheMalcolmConnection]

Basically I'm just saying call it what it is, lol.

Interesting article from a guy who just retired from where I work: Examining The President’s Speech To Congress

He leans left too, but I think he's reasonable...

[JoeRedskin]

Originally Posted by TheMalcolmConnection

Basically I'm just saying call it what it is, lol.

Interesting article from a guy who just retired from where I work: Examining The President’s Speech To Congress

He leans left too, but I think he's reasonable...

It's a good article and I agree with a lot of his points. Healthcare reform was a messy business the first time around and the ACA was a horrible compromise that basically poured gas on the old broken system.

I do think the author's downplaying the role of malpractice is disingenuous. The study he cites analyzes only actual payments for lost claims and legal costs. The study says only these factors are the "costs" of malpractice and to include premiums would be to "double count" those costs because that is what the premiums are intended to cover. Okay, true enough BUT (and it's a big Kim Kardashian type but) the study uses this rational to entirely ignore insurance company profits saying they are not a "cost" of the doctor's actual malpractice. Sorry, that's just intellectual dishonesty. Insurance companies, the premiums they charge, and the profits they make are an essential element of malpractice costs. If insurers don't make a profit, the indemnity payments don't get made, doctors go bankrupt, and injured patients get no financial recoveries. W/out insurance companies, their profits, and the profits the make, the risk of being a doctor would be to great for anyone to bear.

We had a looong discussion about the whole healthcare reform issue back in the day. At the time, I think I predicted the ACA would be good for about four or five years and then competition would dry up because of the structure's systemic unprofitability and shortly thereafter the exchanges would become the only options. Once that occurred, costs would spiral out of control very quickly. The article cited fails to note that it's not just Kentucky where private carriers are leaving; almost every exchange has fewer private carriers than when first enacted - 38% now have only one or two [In 2016, that number was 14%. Even more stark is the growth of single-insurer states: 2% in 2016; 19% in 2017].

Preliminary Data on Insurer Exits and Entrants in 2017 Affordable Care Act Marketplaces | The Henry J. Kaiser Family Foundation

The ACA is imploding. Once it does, simple market dynamics of insurance and the ACA's structure of allowing opt outs with penalties will easily double and treble costs to the government through the exchanges.

The ACA was a Band-Aid to a broken system. It barely addressed the symptoms and most certainly did not address the underlying flaws of our current health-care system. The benefits that it has provided (and there are many) will be short-lived or force draconian economic cuts to other programs.

... but, four years ago, we walked down the road of least resistance. The piper will be coming for his payment shortly.

[Giantone]

Originally Posted by JoeRedskin

It's a good article and I agree with a lot of his points. Healthcare reform was a messy business the first time around and the ACA was a horrible compromise that basically poured gas on the old broken system.

I do think the author's downplaying the role of malpractice is disingenuous. The study he cites analyzes only actual payments for lost claims and legal costs. The study says only these factors are the "costs" of malpractice and to include premiums would be to "double count" those costs because that is what the premiums are intended to cover. Okay, true enough BUT (and it's a big Kim Kardashian type but) the study uses this rational to entirely ignore insurance company profits saying they are not a "cost" of the doctor's actual malpractice. Sorry, that's just intellectual dishonesty. Insurance companies, the premiums they charge, and the profits they make are an essential element of malpractice costs. If insurers don't make a profit, the indemnity payments don't get made, doctors go bankrupt, and injured patients get no financial recoveries. W/out insurance companies, their profits, and the profits the make, the risk of being a doctor would be to great for anyone to bear.

We had a looong discussion about the whole healthcare reform issue back in the day. At the time, I think I predicted the ACA would be good for about four or five years and then competition would dry up because of the structure's systemic unprofitability and shortly thereafter the exchanges would become the only options. Once that occurred, costs would spiral out of control very quickly. The article cited fails to note that it's not just Kentucky where private carriers are leaving; almost every exchange has fewer private carriers than when first enacted - 38% now have only one or two [In 2016, that number was 14%. Even more stark is the growth of single-insurer states: 2% in 2016; 19% in 2017].

Preliminary Data on Insurer Exits and Entrants in 2017 Affordable Care Act Marketplaces | The Henry J. Kaiser Family Foundation

The ACA is imploding. Once it does, simple market dynamics of insurance and the ACA's structure of allowing opt outs with penalties will easily double and treble costs to the government through the exchanges.

The ACA was a Band-Aid to a broken system. It barely addressed the symptoms and most certainly did not address the underlying flaws of our current health-care system. The benefits that it has provided (and there are many) will be short-lived or force draconian economic cuts to other programs.

... but, four years ago, we walked down the road of least resistance. The piper will be coming for his payment shortly.

You're right but as I remember and I have been wrong before wasn't it all so mentioned how close the ACA was to what Mitt Romney had done in Massachusetts and had he won we would be in a similar situation,so the republicans can't just blame Obama for the mess.

[JoeRedskin]

Originally Posted by Giantone

You're right but as I remember and I have been wrong before wasn't it all so mentioned how close the ACA was to what Mitt Romney had done in Massachusetts and had he won we would be in a similar situation,so the republicans can't just blame Obama for the mess.

The dems modeled it on the Massachusets plan that was put in place while Romney was governor. I think he was instrumental in getting passed there.

However, my recollection is that Romney opposed the ACA and that it was not the plan put forward by the R's at the time or even really close to it.

... and I don't JUST blame Obama, I blame everyone who voted for it:

In December 2009, the U.S. Senate voted 60 to 39 for Obamacare. The Washington Post reported “The Senate bill passed without a single GOP vote.”

In March 2010, the U.S. House voted 219 to 212 for Obamacare. 34 House Democrats and all of the House Republicans voted against Obamacare. The NO votes were the only bipartisan votes.

oh, the Democrats.

http://oregoncatalyst.com/25561-remi...lican-vote.htm

[JoeRedskin]

Solid speech. Short on details - big on aspirations. Loved the "I'm not here to represent the world. I'm here to represent the US." (or something like that).

Also, liked the focus on economic goals as opposed to social issues. If he gets off twitter, and pulls off a few more of these speeches - throw in a rally or two for the faithful - the Dems are going to have some real problems in the next election (mid-term) where they have 23 incumbents up for reelection versus only nine for the Republicans - plus two independents who caucus with the Dems.

Someone said to me, "If he fixes healthcare so that costs are controlled and basically retains coverage for the at-risk folks, he will get four more years."

I think the speech was the first step down that road. Still, lots of promises, and for me, I am not seeing how the math is going to work. New infrastructure, more defense spending, fixes to healthcare - lots of new money being spent. Just wondering where it's supposed to come from b/c, apparently, everyone is getting a tax cut.

Speeches like this should be aspirational and outline big picture plans. However, the devil is always in the details.

[CRedskinsRule]

Originally Posted by JoeRedskin

Solid speech. Short on details - big on aspirations. Loved the "I'm not here to represent the world. I'm here to represent the US." (or something like that).

Also, liked the focus on economic goals as opposed to social issues. If he gets off twitter, and pulls off a few more of these speeches - throw in a rally or two for the faithful - the Dems are going to have some real problems in the next election (mid-term) where they have 23 incumbents up for reelection versus only nine for the Republicans - plus two independents who caucus with the Dems.

Someone said to me, "If he fixes healthcare so that costs are controlled and basically retains coverage for the at-risk folks, he will get four more years."

I think the speech was the first step down that road. Still, lots of promises, and for me, I am not seeing how the math is going to work. New infrastructure, more defense spending, fixes to healthcare - lots of new money being spent. Just wondering where it's supposed to come from b/c, apparently, everyone is getting a tax cut.

Speeches like this should be aspirational and outline big picture plans. However, the devil is always in the details.

the devil is in the government. just saying...

[mooby]

Originally Posted by JoeRedskin

Solid speech. Short on details - big on aspirations. Loved the "I'm not here to represent the world. I'm here to represent the US." (or something like that).

Also, liked the focus on economic goals as opposed to social issues. If he gets off twitter, and pulls off a few more of these speeches - throw in a rally or two for the faithful - the Dems are going to have some real problems in the next election (mid-term) where they have 23 incumbents up for reelection versus only nine for the Republicans - plus two independents who caucus with the Dems.

Someone said to me, "If he fixes healthcare so that costs are controlled and basically retains coverage for the at-risk folks, he will get four more years."

I think the speech was the first step down that road. Still, lots of promises, and for me, I am not seeing how the math is going to work. New infrastructure, more defense spending, fixes to healthcare - lots of new money being spent. Just wondering where it's supposed to come from b/c, apparently, everyone is getting a tax cut.

Speeches like this should be aspirational and outline big picture plans. However, the devil is always in the details.

This is a big question for me as well, the numbers aren't adding up. Maybe he's just gonna tax imports so heavily that the budget will go up. Who cares if you make a few enemies in the process, he doesn't care about non-Americans anyways.

[mredskins]

Originally Posted by mooby

This is a big question for me as well, the numbers aren't adding up. Maybe he's just gonna tax imports so heavily that the budget will go up. Who cares if you make a few enemies in the process, he doesn't care about non-Americans anyways.

Probably could find gains in inefficient government spending without having to raising taxes.

[mooby]

Originally Posted by mredskins

Probably could find gains in inefficient government spending without having to raising taxes.

One would think (given the size of its' budget) eliminating wasteful military spending could really save some money, but do you think the Pentagon is really going to allow Trump to dig through its' finances while being made the scapegoat for gov't fund abuse? Think about all the military equipment of ours that ended up in the hands of ISIS, I know it will be nice and dandy to blame Obama for that one all you want (perhaps deservedly so, who's to know who deserves the majority of blame for that one) but it doesn't solve the issue at hand.

[JoeRedskin]

Originally Posted by mredskins

Probably could find gains in inefficient government spending without having to raising taxes.

Call me jaded but I've heard that old chestnut a time too many. Every president, governor, mayor and school board chair or other elected official has raised the battle cry "We will eliminate waste and save [billions/millions/thousands/a couple bucks]."

Here's the problem: Yes. There is waste - a lot of it. I would assume that it accounts for a significantly larger portion of the budget than in the private sector [In 2012, one estimate put it at 7% of the budget. I would imagine that in private companies it is closer to 1% maybe less - I couldn't find any studies]

However, the problem is that the majority of waste in government (as in money misspent through overpayment, wrongful payments, or losses due to penalties or failure to take advantage of discounts) results from the sacrifice of "efficiency for fairness" or in a more classic example - Mussolini may have been a dictator, but the Italian trains always ran on time. Generally, however, I have found, that, what most people mean when they say "cut waste," is that the government should cut programs they don't like or think useless. Good luck with that.

As an aside and a recent example from my own experience on the efficient v. fair issue:
Government client receives an unprecedented offer from vendor. The vendor will double its investment in the public entity AND will maintain pricing of the service it provides at current levels over the next six years. The entity - and its public customers - were already extremely happy with the service provided by the vendor. There were only three other vendors in the entity's municipality providing this particular service and none of them had ever made offer as good as this.

This was a unilateral offer from the vendor - meaning that the government entity was not seeking a bid and the current contract had another year to run. The ONLY thing the vendor sought was to be exempted from the competitive bid process when the current contract expired -- if it had to go through the long, demanding, and expensive process of actually preparing a bid for submission to the appropriations and finance committees, it was just going to use its last submission with a lower investment and up its rates by its standard price multiplier/algorithm. No brainer right? Nope. The government entity is legally barred from accepting bids outside the competitive process's public scrutiny in order to ensure that backroom kickback deals aren't being done with corrupt officials.

So, the governmental entity will end up losing a several hundred thousand dollars b/c it is legally barred from accepting a deal that a private entity would snap up before the vendor could finish their sentence.

[CRedskinsRule]

first rule of being considered politically astute - never blame Obama
second rule of being considered politically astute - always blame Bush
third rule of being considered politically astute - be willing to call a deer a horse if it likes to be a donkey

[JoeRedskin]

Originally Posted by CRedskinsRule

first rule of being considered politically astute - never blame Obama
second rule of being considered politically astute - always blame Bush
third rule of being considered politically astute - be willing to call a deer a horse if it likes to be a donkey

After eight years, the Clinton/Obama/Dems were STILL blaming Bush. Hillary in April, 2016:

There is a lot of frustration, and frankly a lot of anger. Many people are feeling left out and left behind in our great country. And they’re looking for answers and I don’t blame them one bit.

We need more good jobs with rising incomes because we fell back the last 15 years because of the terrible economic policies of George W, Bush.

Hillary Clinton Admits The Job Market Stinks But BLAMES GEORGE W. BUSH (VIDEO)

Economy? Bush's fault.
Huge National Debt? Bush's fault.
Syrian Crisis? Bush's fault.
Water Disaster in Flint? Bush's fault.
Emperor Palpatine destroys the Old Republic? Bush's fault.

[Giantone]

Originally Posted by JoeRedskin

After eight years, the Clinton/Obama/Dems were STILL blaming Bush. Hillary in April, 2016:[/url]

Economy? Bush's fault.
Huge National Debt? Bush's fault.
Syrian Crisis? Bush's fault.
Water Disaster in Flint? Bush's fault.
Emperor Palpatine destroys the Old Republic? Bush's fault.

JR, question? Do you admit that the state of the country was different when Obama took office then when Trump took office?

Why not blame Bush?

Bush vs. Obama on the Economy, In 3 Simple Charts | United Steelworkers

[mooby]

Originally Posted by Giantone

JR, question? Do you admit that the state of the country was different when Obama took office then when Trump took office?

Why not blame Bush?

Bush vs. Obama on the Economy, In 3 Simple Charts | United Steelworkers

Like most things, the truth is probably somewhere in the middle. Is it fair to blame the state of the economy in 2008 on GWB? Sure. Is it fair to blame Obama for rising healthcare costs for the average person? Sure. Is it fair to blame everything on the last president you disliked? Probably not, but it still doesn't stop people from doing it anyways.

[JoeRedskin]

Originally Posted by mooby

Like most things, the truth is probably somewhere in the middle. Is it fair to blame the state of the economy in 2008 on GWB? Sure. Is it fair to blame Obama for rising healthcare costs for the average person? Sure. Is it fair to blame everything on the last president you disliked? Probably not, but it still doesn't stop people from doing it anyways.

Winner winner chicken dinner.