Why Americans Spend So Much on Health Care–In 12 Charts • Hacker News Board

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

#131

Post by gremlinsinc » Tue, Jul 31, 2018, 10:57 PM UTC

nradov wrote: post #130

gremlinsinc wrote: post #127

Earlier quoted context omitted.

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.

Firstly the wars/fighting our military is currently 'engaged' in is mostly useless. We haven't 'won' a war since ww2.

Carriers are like bases that can easily be deployed as needed. Maybe keep 2 or 3 carriers off the coast not necessarily 'docked', to run maneuvers to keep 'training' up, reserves could come and run ops maybe every few months to stay 'fresh'... Ideally, we'd not need to call any up until WE are under direct imminent threat.

Furthermore, I think a lot of our future wars will be fought with technology, drones, robots, and not need as much military personnel anyways.

Our military budget should be on par with Russia, instead we're equivalent to the next 7 largest militaries combined. There's no need for that much expense (except to pad lobbyist coffers).

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

#132

Post by nradov » Tue, Jul 31, 2018, 11:16 PM UTC

gremlinsinc wrote: post #131

nradov wrote: post #130

Earlier quoted context omitted.

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.

Firstly the wars/fighting our military is currently 'engaged' in is mostly useless. We haven't 'won' a war since ww2. Carriers are like bases that can easily be deployed as needed. Maybe keep 2 or 3 carriers off the coast not necessarily 'docked', to run maneuvers to keep 'training' up, reserves could come and run ops maybe every few months to stay 'fresh'... Ideally, we'd not need to call any up until WE are under d…

So for carriers you are essentially proposing the status quo. At any given time only about ⅓ are actually deployed. The others are docked for refit, or doing training close to bases. If they're going to deploy at all the costs are about the same regardless of where they operate. And to maintain proficiency they have to constantly practice operating in all over the world. These are not skills that can be picked up in just a few months. A carrier is not even remotely like a floating base; it's an order of magnitude more complex.

I am all for fighting fewer wars. But until that actually happens our carrier forces are over stretched.

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

#133

Post by dnomad » Wed, Aug 01, 2018, 3:07 AM UTC

tptacek wrote: post #121

dnomad wrote: 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.

The idea that bond investors only care about "short-term solvency" and therefore ignore unfunded pension obligations doesn't make any sense at all. I don't even... Also this idea that California, the 5th largest economy in the world, is ranked "11th nationally" in terms of debt ratings doesn't make any sense. Nobody actually compares an economy like California (GDP 2.5T) with Arizona (GDP 2.5B). There's so much wrong here -- from the pure ideological nonsense that California is "on the verge of bankruptcy" to the idea that bond investors only think 6-10 years into the future -- that it's really not worth continuing this conversation. (It's also quite clear that the legion of downvoters, hard pressed to actually defend their ideological nonsense, can always just suppress the facts. So much for free speech uber alles.)

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

#134

Post by tptacek » Wed, Aug 01, 2018, 3:12 AM UTC

dnomad wrote: post #133

tptacek wrote: post #121

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.

The idea that bond investors only care about "short-term solvency" and therefore ignore unfunded pension obligations doesn't make any sense at all. I don't even... Also this idea that California, the 5th largest economy in the world, is ranked "11th nationally" in terms of debt ratings doesn't make any sense. Nobody actually compares an economy like California (GDP 2.5T) with Arizona (GDP 2.5B). There's so much wrong…

That's literally what a bond rating measures: whether a particular bond is likely to be repaid. A short-term bond is generally anything that comes to maturity before one year, and long-term is anything else.

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

#135

Post by dnomad » Wed, Aug 01, 2018, 5:46 AM UTC

tptacek wrote: post #134

dnomad wrote: post #133

Earlier quoted context omitted.

The idea that bond investors only care about "short-term solvency" and therefore ignore unfunded pension obligations doesn't make any sense at all. I don't even... Also this idea that California, the 5th largest economy in the world, is ranked "11th nationally" in terms of debt ratings doesn't make any sense. Nobody actually compares an economy like California (GDP 2.5T) with Arizona (GDP 2.5B). There's so much wrong…

That's literally what a bond rating measures: whether a particular bond is likely to be repaid. A short-term bond is generally anything that comes to maturity before one year , and long-term is anything else .

> short-term bond is generally anything that comes to maturity before one year, and long-term is anything else.

Yeah that's now how any of this works. First, average muni bonds duration is 10+ years. Short-term debt is inherently safer than long-term debt but all investors will look far beyond a particular bond. Especially when dealing with sovereign entities who can't go bankrupt they are much more concerned about the risk of default (on anything, not just bonds). That's actually what the credit ratings measures -- a comprehensive evaluation of ability to service all debts. They are not at all bond-specific.

Logically, if investors really did believe these states were doomed then they would also be forced to conclude that the states themselves know they are doomed (all information is public) and at any moment the states will take measures before they are destroyed to prevent their own destruction. These measures will inevitably be some form of default. So if you're lending money to an entity who everybody knows will default at some point in the future it would be naive to think any one particular debt instrument is safe. Defaults, by their very nature, are very unpredictable. That's why investors will demand a real risk premium even for extremely short-term debt (30 days) from borrowers with low credit ratings. This isn't economic theory btw, this is economic fact, supported by two centuries of market data.

Suffice to say, Cali and NY bonds are actually set to out perform so the market does not believe that either state is going to default in the next 10 years or even the next 30 years.

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

#136

Post by tptacek » Wed, Aug 01, 2018, 4:21 PM UTC

dnomad wrote: post #135

tptacek wrote: post #134

Earlier quoted context omitted.

That's literally what a bond rating measures: whether a particular bond is likely to be repaid. A short-term bond is generally anything that comes to maturity before one year , and long-term is anything else .

> short-term bond is generally anything that comes to maturity before one year, and long-term is anything else. Yeah that's now how any of this works. First, average muni bonds duration is 10+ years. Short-term debt is inherently safer than long-term debt but all investors will look far beyond a particular bond. Especially when dealing with sovereign entities who can't go bankrupt they are much more concerned about t…

Bond ratings are assigned to individual bonds.

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

#137

Post by cxseven » Thu, Aug 02, 2018, 4:10 PM UTC

thingschanged wrote: post #101

howard941 wrote: post #12

> Consumers, meanwhile, buoyed by insurance and tax breaks, have little idea how much they are really spending and little incentive to know underlying costs. Almost weekly there's another post showing that consumers literally cannot find out costs usually because the provider cannot supply it. It's time to put a stake in the heart of the recurring blame-the-consumer trope.

The govt needs to rip out the tax deduction for employers, which is a big band aid. Until this is done nothing will change. Your company doesnt pay for your car insurance or home insurance, why does it pay for your health insurance?

If this is all that's done and companies stop paying for insurance, I would expect employers to use the opportunity to pocket most of the savings and only pass on a pittance to their employees.

Also, uninformed consumers will opt for cheap plans without checking for (or realizing their personal susceptibility to) major pitfalls that the ACA used to protect against before the Republicans pulled it apart.

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

#138

Post by gameswithgo » Mon, Aug 06, 2018, 6:51 PM UTC

chimeracoder wrote: post #56

gameswithgo wrote: post #25

Earlier quoted context omitted.

there are other kinds of problems. You are in the hospital, you feel queasy after surgery, nurse asks if you would like medication for that. "how much is it?" If you even think to ask that, usually they will not know, and can't or will not find out for you. So you can't make a rational decision about whether to deal with the discomfort or not. Similarly, doctors often won't know the cost difference between various me…

> there are other kinds of problems. You are in the hospital, you feel queasy after surgery, nurse asks if you would like medication for that. "how much is it?" If you even think to ask that, usually they will not know, and can't or will not find out for you. So you can't make a rational decision about whether to deal with the discomfort or not. followed by > One might conclude that private, free markets don't make s…

>is an odd conclusion to draw, since the agent primarily responsible for the inability for providers to provide transparent prices to privately insured patients is, ironically, Medicare.

I'm not sure how you can be so certain that is the 1st order reason. The pricing situation seems to often be obfuscated by our private insurance companies as well. When people have different insurance plans, with different back room deals on rates, and different customer out of pocket rules, or none at all, how is the doctor to know what your price is going to be? How does erasing medicare from the equation fix that?