How ironic the guy mooching off the public as a public employee is complaining about pensions since he gets a fat on and free health care, etc. want to save money? Cut the bloated military.

In any event, yeah I trust the government more than the private market with health financing. The public sector is vastly more efficienct and aren't out to make obscene amounts of money by cheating the public by letting people die

Insurance companies are the ones who provide no medical services and are obscenely profitable

@taylor, you said " Is this due to a collapsed economy, inflation, stagflation, deflation of an NFL football, or the collapse and comeback of the US$ "

This is due to unions in the US around the 30s fighting for jobs to pay for health insurance, and then stopping with their victory. In other countries, people argued for publicly provided healthcare. In the US they did not.

Look up the history of health insurance in the US for the details...

Give the high costs for some, then if most people are actually getting more out than they pay in, no one would be in the insurance business - it would be unsustainable. Apparently on average we spend about $9K per person (source: http://www.pgpf.org/chart-archive/0006_health-care-oecd). Given we know some people cost a lot more, others have to cost a lot less for this to work. So yes, in present day dollars, many people pay out more than they get back.

I say "present day dollars" because this works on the time value of money. A person with health insurance is highly unlikely to use much when he is young, so the insurance companies invest that money and by the time that person starts demanding more services as they get older, the amount the insurance company has is much more than the amount paid in (think of it as the insurance company version of a 401K).

So if a person pays in $10K a year over 40 years, that's $400,000 - which you look at and say the person extracts more than that in health care costs. But at 5% interest, that's about $1.2 million after 40 years. Of course, some costs get paid out over time - so assume in the first 10 years, the person's health care needs are low $500/year on average, $1500/year in the next 10 years, $5000/year over the following 10, and $40,000/year over the final 10 - after 40 years. That would be $470,000 in health care insurance coverage, but because of the time value of money, the insurance company would still have about $525K from you. So I suspect the math works out - some people cost a lot, but many may only require half a million in health coverage in their lifetimes (nothing to sneeze at), and the insurance companies make out great on those people.

If we get single payer with our current prices, then we're going to go bankrupt. so we'll probably do what Europe does, which is set caps that companies can sell drugs at.

and how has that worked for europe? pharmaceutical companies now have been incentivized to come to the USA: it's actually why high-skill manufacturing is doing well in the USA, while low-skill manufacturing is leaving.

it costs up to 2.6 billion dollars (with the lower estimates, depending on whether or not you factor in opportunity cost, 1.2 billion dollars) to get a new drug onto the market: which is still a somewhat risky investment. however, with massive payouts, there are still enough investors who are willing to assume that risk, especially when we're talking about an easy 20% rate of return. of course you look at European price caps that stifle investment considerably.

the USA is getting ahead in producing new innovative drugs, not JUST the usual micro-genetic changes that supposedly are a "new" drug with it being basically identical, but biotechs and universities are really stepping up.

so in europe, where patent laws are much less strict, generic brands basically copy our processed, refined, FDA approved drugs and sell them at relatively low prices to europe. by doing this, the USA is assuming the entirety of the risk and the regulatory expenses, while Europe gets relatively low-cost healthcare.

it's taken me a little while to work this all out, but it seems as if the USA starts to set price caps and go single payer, investors will leave. after all, who will take a 2.6 billion dollar risk for such low return rates?


this is not a moral argument for or against single payer, but if you want it, you have 2 options:

1. government must subsidize biotechs and pharmaceutical companies to make new drugs, including major tax increases and less efficiency due to the favoring of large entities by government subsidies.

2. we allow pharmaceutical companies to have relative freedom, and we start to dismantle excessive regulation by the FDA.

you can have extreme regulation and safety OR affordable healthcare that won't entirely bankrupt us.

if you don't make drugs and equipment cheaper, spreading it out over a population will only absorb some of those costs.

if you want single payer, make drugs cheap. make medical technology cheap. this is not done through massive regulation

I'm ok with less investment in new drugs. Some of that money could be better used to combat pollution and educate people about climate change. Each of those would raise the quality of life for the population as a whole. Also, I still can't get over how Cuba manages the same life expectancy as the U.S. without all the fancy shit.

@slypups - your math isn't all wrong. The issue comes moreso from declining g birthrates and an aging population. What if the insurance companies are just raking it in now because that's the only way they can afford higher payouts over the next 30 years as the baby boomers age and pass away? That's not to excuse them doing it, but I honestly have doubts about the long term viability of private health insurance as a business model unless things change.

(Also, that $9k is a little high. Healthcare =/= health insurance payments.

And Ogion, enough about the military. Spending has been steadily declining for the better part of a decade now. Spending expected to be only 3.5% of GDP by 2020, I think. Which really isn't that bad, seeing as it employs how many millions of Americans directly? Yes, there's still bloat, but nowhere near as egregious as before.

@Hauta

will a bit of that has to do with out obesity epidemic, but also Cuba has damn good doctors. say what you will about their socialized healthcare and murdering of thousands of dissidents and brutal dictatorship that thousands have fled from... but, uh, good doctors.

in any case, i think the real solution to pollution and climate change lies with France, and countries that aren't so squeamish about nuclear technology. hell, both Hydro and Nuclear are more efficient that Fossil Fuels as it is.

https://www.brookings.edu/blog/planetpolicy/2014/05/20/why-the-best-path-to-a-low-carbon-future-is-not-wind-or-solar-power/

Wind is also right on Fossil Fuel's tail, and the innovation curve is in their favor.

Back to Nuclear, the recycling of nuclear waste and the amazing external technological and scientific discoveries surrounding nuclear research, can help us better our understanding of space travel, atomic structure, and a whole slew of other realms in physics.

sadly, while Oil and Fossil Fuels (as well as many alternative energies) receive large subsidies to fuel research, Nuclear has been the subject of much debate. it's not like we lack raw material here, especially with an option of decommissioning missiles on the table.


and to your original point about investment in new drugs: these are private investors. if we socialize medicine and put caps, then the Government is going to have to divert funds to research drugs.


in any case, i think science is the answer here.

And yeah, no thanks on the less investment in research. The sooner ALS, Cystic fibrosis, Crohn's, cancer, etc etc etc are gone the better this world will be

and when i say Nuclear tech has been the subject of much debate, i mean debate AND regulation. i live in Oklahoma where the Karen Silkwood conspiracy thing went down, but it's becoming ridiculous how we are so afraid of shadowy corporations, so instead we should just stick with...

the established shadowy corporations?

oops.

A functioning society can create incentives to channel investment in one area or another, regardless of who owns what. So it doesn't matter if today that private investors spend on drug research; if the country wanted more spending on lessening pollution instead, it could create the incentives/penalties to accomplish that.

that is a spectacular claim Hauta, and I'd like you to give me one example on how we could use European style price caps on drugs, but still attract investors to risk via gov't regulation with a price tag at 2.6 billion.

and while you're at it, an espresso would be nice too

@gold, those are great diseases to work on because each of them seems independent of a crappy diet. But if we spent more on diabetes prevention, we could spend less on diabetes treatment and be better off physically and financially. Alas, the junk food industry drowns out education about healthy living. Cuba's got us beat there too.

i don't understand whew should try to stop the obesity epidemic among adults. among kids? i understand. among adults?

why bother. it's their life.

@James, dunno where you're coming from. I'm not arguing for the same level of research on drugs. I'd rather spend on prevention. For diabetes and heart disease, this is a winner idea. For other diseases, not so much. But a reduction in the rate of diabetes and heart disease would help a great deal.

@James, poor people who get obese and externalize their health care costs to the system are a tax upon us all. We need to tax junk food to reflect the true social cost. You can still choose to eat it all you want, but at least the government will be able to accumulate the tax revenue to pay for your treatment when the grim reaper starts catching up.

and this is a bit of the problem with socialized healthcare.

it's one part a failure of self responsibility, it's one part being unlucky.

At the end of the day, you're asking for a tax on people's luck, and a tax on people's bad decisions.

one of those is an interesting philosophical split, one of those is nonsense.

A tax on people's prospective bad decisions is an awesome idea! High taxes on cigarettes has had a big impact to lessen teen smoking (since they are more price sensitive than addicts). That's EXACTLY how it's supposed to work.

*facepalm*

you're not understanding me. a tax doesn't really affect teenagers as a specific demographic. this is not something that will effectively stop kids from smoking.

meanwhile, why do you not want adults to smoke? yes they'll die earlier, but they'll be happier. why do you think you know better what they should do with their own life?

you see it sounds nice and happy when you say

"A tax on people's prospective bad decisions is an awesome idea!"

but just remember, it used to be a bad decision to free slaves. it used to be a bad decision to hand down a business to a woman. it used to be a bad decision to be homosexual.

it is not the government's place to decide what "is" and what "is not" a bad decision.


if you TRULY believe we should tax bad decisions, then why not just tax EVERYTHING that is bad? if there's no moral qualms you have, let's tax people who stay up late at night and don't get enough sleep (that's bad!) let's tax people who don't get an hour foe exercise every day (it's unhealthy!!!) let's tax religious institutions (they have no basis in science!!!!!)

because if you say something is *bad* then that means you have a set objective realization in what is *good* as well.

i don't want the state to have the power to enforce what they say is good, and whatever they don't like is bad, because the state acts in the state's own interest.

https://www.cms.gov/CCIIO/Resources/Files/Downloads/mlr-report-02-15-2013.pdf

Health insurers are now restricted to a maximum 20% profit from the premiums they collect. Before ObamaCare they were making more and raising premiums even when they were paying out significantly less than the premiums collected. I did get a refund one year under ObamaCare where before my premiums rose significantly without a claim greater than a quarterly premium.

I don't know how we got sidetracked so much into a completely unnecessary discussion on obesity. But I've always supported a sugar tax. Fuck the sugar lobby. The problem with it is, however, that it fucks the poor disproportionately. Which is why it'll never pass. And JY, arguing against cigarette taxes is stupid. In the end, the taxpayer pays for their healthcare. I don't want to pay for someone else's poor decisions.

"it fucks the poor disproportionately. Which is why it'll never pass."
Uh...what? The poor are just about the most underrepresented large group for lobbying Congress, so they can't get any bills passed.

Or are you saying sugar negatively affects the poor disproportionately - then it makes sense that the a sugar tax would never pass.

Something that is so blatantly regressive will never pass Congress. I do have some faith in the system. Moreover, since its effects are mitigated by diet and exercise, Dems can't treat it like cigarettes or other vices. And Republicans won't ever vote for something that restricts freedom of choice.

And what I was saying was the majority of people who will pay this tax are poor. The poor disproportionately drink soda and consume fast food.

Are you suggesting that the poor are also less educated and more heavily influenced by advertising?

Cause yeah, maybe moving towards a finnish model of education could help prevent diabetes, and improve quality of life for millions by allowing them make better choices.

But a sugar tax would help comparative food pricing, and make healthier food look better... Of course, you could simply stop subsidising corn (and thus the corn syrup would be priced appropriately) - but that isn't politically doable...

What? No. The poor often work several jobs and don't have the time to go grocery shopping and make healthy meals all the time. Thats what causes them to disproportionately eat fast food. And often enough, the bad stuff is cheaper than healthy foods, so the the sugar tax would have to be substantial to get healthy foods to be more cost effective.

But I sorta get what you're saying with the education. I'd have to look and see how true that is, but I suspect it's right

@orathaic

You realize that 80% of food products are derived from corn, right? That's why it's so valuable and why it's so heavily subsidized.

Well @yoyo, there's a real argument to be made that the only reason so many food products are derived from corn, are because it was subsided so much. If the corn subsidies went away, production would change and while food prices would likely move up, they wouldn't move up as much as you'd expect.