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Why Americans Spend So Much on Health Care–In 12 Charts

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Re: Why Americans Spend So Much on Health Care–In 12 Charts

#121
post #119

Earlier quoted context omitted.

California and Illinois have two of the worst fiscal conditions in the country, ranked #43 and #49 (by GMU) among states respectively, based on cash on hand vs. immediate obligations, debt to income, and liabilities to assets. California's unfunded guaranteed pension obligations alone add up to almost half its personal income. Don't even ask about Illinois. New York isn't much better. It's #39. New Jersey, home to a…

California is the 5th fastest growing state economy. This is despite already being the largest state economy by far. That is simply remarkable and to call such a state of affairs "verge of bankruptcy" is just stupid. Further the noise around pension obligations is mostly meaningless alarmism from people who don't know any better. If California is on the verge of bankruptcy why is California's bond rating at AA-? Why…

Those bond ratings are a measure of short-term solvency (if it heads off another unproductive exchange: the ratings agencies work with a very different of "long term" than GMU does). California does reasonably well (11th nationally) on that axis. We're talking about long-term structural solvency.

I don't understand what California's bond rating has to do with the impact of its unfunded pension obligations.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#122
post #115

Earlier quoted context omitted.

The issue is that a big % of medical expenses come from a small % of people. It would only take a relatively small number of these people moving to make a big difference in expenses. And it's the people with the highest expenses who would have the most incentive to move.

Sounds like, if true (I was under the impression that a big % of medical cost is due to artificial cost inflation due to the existence of insurance companies), the people costing the system the most amount of money are the least able to move , because they're, you know, dying. Or have some other debilitating condition that requires them to stay with the doctors that know what's going on.

You're slicing the expense on a different axis than he is. Stipulate any amount of overhead and overpricing due to a given health care regime (fully public and managed like the VA, public/private like Medicare, private insurance, whatever). Within that regime, a very small percentage of health care consumers will make up a disproportionate amount of the expense. It doesn't matter how you fund it or how efficiently you deliver it, because the disparity is on the demand side. 5% of BCBS TN's customers made up over 75% of their total expense!

Those customers are perfectly capable of moving. Many of them are simply chronically ill, with things like kidney disease. But anyone who's been on a plane in the US lately can tell you that the elderly have no trouble getting around, either.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#123
post #119

Earlier quoted context omitted.

California is the 5th fastest growing state economy. This is despite already being the largest state economy by far. That is simply remarkable and to call such a state of affairs "verge of bankruptcy" is just stupid. Further the noise around pension obligations is mostly meaningless alarmism from people who don't know any better. If California is on the verge of bankruptcy why is California's bond rating at AA-? Why…

Those bond ratings are a measure of short-term solvency (if it heads off another unproductive exchange: the ratings agencies work with a very different of "long term" than GMU does). California does reasonably well (11th nationally) on that axis. We're talking about long-term structural solvency. I don't understand what California's bond rating has to do with the impact of its unfunded pension obligations.

If we really are talking long term structural solvency, I think it's bad faith to start arguing any given state is "objectively worse" than any others - obviously we don't know, because we can't even predict the recessions that keep happening every ten years. (we being the majority of the population and law makers - obviously some people are screaming their heads off about it, fruitlessly)

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#124

Earlier quoted context omitted.

Those bond ratings are a measure of short-term solvency (if it heads off another unproductive exchange: the ratings agencies work with a very different of "long term" than GMU does). California does reasonably well (11th nationally) on that axis. We're talking about long-term structural solvency. I don't understand what California's bond rating has to do with the impact of its unfunded pension obligations.

If we really are talking long term structural solvency, I think it's bad faith to start arguing any given state is "objectively worse" than any others - obviously we don't know, because we can't even predict the recessions that keep happening every ten years. (we being the majority of the population and law makers - obviously some people are screaming their heads off about it, fruitlessly)

I didn't start arguing that. The Mercatus Center at GMU did. Mercatus has an ideological bias (and not one I share), but they're serious people with real reputations. It's also a little weird to suggest that the fiscal outlooks of different states aren't comparable. Some states have pension obligations that consume an outsized fraction of their projected income, and others don't. What's complicated about that?

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#125

Earlier quoted context omitted.

We could spend a lot less money on un-needed things. For one, why are we the police of the world? What if we shut down ALL military bases abroad, docked most of our carriers except in times of war, put half the military on reserves. What if we capped politician benefits across America at what the average American's is? One big thing is-- if we ended Healthcare's ability to 'lobby' washington... made it illegal to spe…

> What if instead of single-payer hospitals would take 'subscribers' locally, they'd pay 6% of their income. Make it a requirement that every American needs to signup with a hospital, and that all hospitals need to take anyone regardless of income or lack thereof. Unrealistic ideas are easy to throw around. In Germany, health insurance premiums are a mandatory 15.5% of income. Are we ready to impose a new 15.5% tax o…

> Are we ready to impose a new 15.5% tax on everyone?

If at the same time pre-tax salaries increase by 15-30 percent when the employer no longer has to pay $16k for insurance, most employees would probably prefer it. (Apart from people earning 6 digits -- and in Germany those people can opt for private gold-plated insurance instead, too.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#126

Earlier quoted context omitted.

> What if instead of single-payer hospitals would take 'subscribers' locally, they'd pay 6% of their income. Make it a requirement that every American needs to signup with a hospital, and that all hospitals need to take anyone regardless of income or lack thereof. Unrealistic ideas are easy to throw around. In Germany, health insurance premiums are a mandatory 15.5% of income. Are we ready to impose a new 15.5% tax o…

> Are we ready to impose a new 15.5% tax on everyone? If at the same time pre-tax salaries increase by 15-30 percent when the employer no longer has to pay $16k for insurance, most employees would probably prefer it. (Apart from people earning 6 digits -- and in Germany those people can opt for private gold-plated insurance instead, too.

How does this math work? Those numbers are for salaried employees at large companies, but most Americans work for smaller companies. The new tax has to make the system work for everyone.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#127

Earlier quoted context omitted.

We could spend a lot less money on un-needed things. For one, why are we the police of the world? What if we shut down ALL military bases abroad, docked most of our carriers except in times of war, put half the military on reserves. What if we capped politician benefits across America at what the average American's is? One big thing is-- if we ended Healthcare's ability to 'lobby' washington... made it illegal to spe…

> What if instead of single-payer hospitals would take 'subscribers' locally, they'd pay 6% of their income. Make it a requirement that every American needs to signup with a hospital, and that all hospitals need to take anyone regardless of income or lack thereof. Unrealistic ideas are easy to throw around. In Germany, health insurance premiums are a mandatory 15.5% of income. Are we ready to impose a new 15.5% tax o…

I want universal healthcare, but I want to use technology/common sense and end bloated programs. Military for instance could be cut in half or more (close the bases, keep the carriers, but dock unless during war). Focus on domestic defense, and let the rest of the world figure out their own shit.

End income tax, move to consumption tax/vat. (A modified version that would be sort of a negative tax). Basically, you'd have basic income making everyone who has a physical address (must spend some of the $$ on residence) would receive a check for whatever the poverty level is divided by 12.

Then everyone is a tax payer and pays consumption tax, we'd also have a land value tax, which would be more even on what land is 'worth' regardless of if you're using it for it's total 'worth'.. E.G. -- 2 people own same amount of land, same location, one builds a skyscraper, one doesn't, they both pay what the land/property would be worth if the area was 'fully developed', encouraging people to not just 'hold' land but 'use' it, or pay as if they did, so they might as well develop or sell it to someone who will.

We'd have to figure out ways of getting more off the top of the pile, as consumption does take a bit from the lower classes and funnels it up, but they're getting it back in terms of GBI + Healthcare.

Consumption tax could be tied to a citizen ID, ID = 10%, no ID = 15% tax rate. Could work in a +5% for college grads who used free education grants, until they're > 30 to pay for free college (State/Community schools). This way they pay back when they shop, but it's not permanent and it hurts a lot less than normal loans/etc...and doesn't affect credit. Or could just have a 'twenty's' tax of +5%, whether you go to college or not you pay an extra 5% from 20-30 to on goods, to pay for those who 'took' the advantage to go to school.

I like to believe that there's 'out of the box' ways to do things... I'm a social democrat with some techno-libertarian ideas, I feel the government needs to work and support all people, but it needs to do so in a way that can eliminate the most 'bureacracy' as possible, and drive down costs. I'd be happy if govt could be ran completely by AI and have maybe 10 people over-seeing / auditing the machines.

I'd like to see bills submitted like github issues - small, easily enacted/reversed 'pull requests' that only change small bits of law/codes. Instead of 10-100+ page omnibuses, everything would need to be < 5 pages (or something rudimentarily agreed upon - I'm not a lawyer/politician), and it must only effect a specific item or items that relate to each other. No combining other things for political 'fancy' or posturing.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#128
post #41

Earlier quoted context omitted.

Even if you got complete disclosure of costs, there is no incentive for consumers to negotiate costs because of insurance coverage. Sure, rates go up but that's a detached and opaque process.

A piece of anecdata on what happens when it's not as opaque: I took the script for a lumbar MRI to a standalone imaging chain advertising low costs. The phone quote was 1/10th the price quoted by the hospital. What puzzled me was that although the imaging place accepts my insurance it asked for $395 if I wanted payment to apply against my insurance deductible but only $275 if I paid without going through the insurer.…

The price differential is based on the cost of filing an insurance claim, the risk that the insurer will deny the claim (or require changes before approval), and the delay in receiving payment. A cash payment today is a sure thing.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#129

Earlier quoted context omitted.

> The rest of the developed world shows that anything short of national healthcare system is an expensive mistake. Of "the rest of the developed world", only one country (the UK) has a "national healthcare system", and even that's a bit of a stretch, because England, Scotland, Wales, and Northern Ireland all have different systems. Canada runs healthcare at the provincial level. France, Germany, Spain, the Netherland…

> Of "the rest of the developed world", only one country (the UK) has a "national healthcare system", and even that's a bit of a stretch, because England, Scotland, Wales, and Northern Ireland all have different systems. England, Wales, Scotland and Northern Ireland makes 4 countries, just FYI. This handy graphic explains in case of confusion: https://upload.wikimedia.org/wikipedia/commons/thumb/2/28/Br...

> England, Wales, Scotland and Northern Ireland makes 4 countries, just FYI.

...yes, that's the point. When people talk about "the NHS", as they usually do on HN, they're conflating four different systems (or, more commonly, thinking only of NHS England).

The point, in case you missed it is that nobody outside the UK has what can reasonably be called a "national healthcare system" in this context.

Re: Why Americans Spend So Much on Health Care–In 12 Charts

#130

Earlier quoted context omitted.

> What if instead of single-payer hospitals would take 'subscribers' locally, they'd pay 6% of their income. Make it a requirement that every American needs to signup with a hospital, and that all hospitals need to take anyone regardless of income or lack thereof. Unrealistic ideas are easy to throw around. In Germany, health insurance premiums are a mandatory 15.5% of income. Are we ready to impose a new 15.5% tax o…

I want universal healthcare, but I want to use technology/common sense and end bloated programs. Military for instance could be cut in half or more (close the bases, keep the carriers, but dock unless during war). Focus on domestic defense, and let the rest of the world figure out their own shit. End income tax, move to consumption tax/vat. (A modified version that would be sort of a negative tax). Basically, you'd h…

I'm no fan of high military spending, but an aircraft carrier kept at the dock is worse than useless. Carrier operations are tremendously complex and the crews need constant practice in realistic scenarios (foreign deployments, fleet exercises with allies). When those skills and institutional knowledge are lost they take decades to rebuild.
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