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By wat0n
#15111045
Drlee wrote:It is quite clear why it is so expensive. Not difficult at all. Start another thread and I will explain it. (I am not being sarcastic.)


Feel free to PM me, but from what I recall the US spends like 2.5% of its GDP on admin costs... Which is a lot, actually, but then again its overall human healthcare spending is 17.7% of GDP, which is absolutely insane (easily the highest one globally... The second place stands at like 10% so that doesn't account for much of the difference).

XogGyux wrote:This is simply not true. Universal healthcare, for instance, is one of those things that Republicans like to use for fearmongering.
You wan't to know the dirty little secret... we have already "universal healthcare" of sorts, in fact we have had it for decades. If you have no insurance, you get into an accident and end up in the ICU... doctors don't throw you away from the hospital, you get treated even if your care cost 3m. Who pays for that? You'll get a bill alright, but chances are that if you were not carrying health insurance you won't be paying 3M USD. You might get thrown to courts and you might end up in bankrupsy paying a tiny percentage of the whole bill while you are bankrupt but who pays for the rest? Well, that is more complicated but the answer is a combination of government and a portion might end up being paid by private health insurance (when hospital charges $3000 for an MRI that really cost a couple hundred).
The problem with this system is that you lose on a lot, and I mean A LOT, of preventative medicine that you could address early on and not only improve quality of life for those patients but you could save real $$, money that could easily fund most if not all of the universal care.
I put this example on another thread. A patient with ESRD almost always end up getting medicare/medicaid and disability regardless of age. Just the dialysis for this patient would cost 50-70k per year that they are alive, but dialysis is not the only cost, to that add disability benefits? another 20-30k? to that add hospitalizations due to complications (these patients are sick, they get their fistulas infected/clotted, they get bloodstream infections, pneumonias, bleeding, electrolyte abnormalities) So add a few thousand dollars per hospitalizations as well. Surgical procedures? (e.i fistula creation, insertion of tunneled dialysis catheters, amputation of extremities, and many more). By the time you compile the expenses you end up with a number that is in the multiple of hundreds of thousands of dollars and in a few instances you could very well be talking about millions of dollars in costs per year. What are the 2 most common cases of ESRD? Well almost 2/3rd of cases occur due to Diabetes and Hypertension. Hypertension is super cheap to control, the vast majority of BP medication cost less than 100USD/year. Diabetes could be very cheap but it could also be a bit more expensive if the patient requires more sophisticated medications and/or insulin because their diabetes is hard to control, but in any case it is not going to be more than a few thousand dollars per year AT MOST, simpler cases could be similar to high blood pressure and cost hundreds and not thousands.
On average, the goverment could easily cover this cost for hundreds if not thousands of patients and just preventing one of those to progress to ESRD would pay for the whole program cohort, including medical consults.
This is just one simple example, you could do the same analysis for heart disease (the leading cause of death) and stroke.
Furthermore, it is not like there are not examples of countries to show this working. We see it working in most other civilized countries to various degrees of success and this idea that "we cannot afford it" is nonsense.
Insurance companies won't like it. Probably doctors won't be a fan either. The docs would likely need the same sort of liability protection that other countries offer and/or loan student aid given that in this country a doc might end up with half a million dollars in student loans while in many of the other countries their education is subsidized and/or free. The quality of life of a doc that makes less $$ but has no student debt, doesn't have to pay expensive liability insurance, is not crazy overworked with 20+ daily patient panels, etc has been shown to be similar between countries. As for the insurance companies... well they can go suck a dick, they have been leeching on people for decades.


Well, one question one may also ask is if the cost of these procedures is the same globally. One theory I've heard for why the hell is American healthcare so expensive is that Americans will tend to use the newest treatments available, and being the first adopter of anything is pricey - and new treatments appear all the time.

Other countries may use other older treatments with similar or very, very slightly lower effectiveness yet pay a LOT less. As such, their aggregate healthcare outcomes don't really worsen compared to the counter-factual in which they adopt the new treatment first, but the treatment itself is already way cheaper from the get go.

To the above, you can also add that the US has a de facto protectionist regime for pharmacological manufacturing through insanely stringent FDA regulations that essentially ban the imports of several medicines, even from countries with good regulations on the matter like Canada. That undoubtedly makes these more expensive as well.

Could these two institutional features help explain the issue?

XogGyux wrote:Anyhow, the US is in no imminent danger of getting "medicare for all" anytime soon. Most likely even if a "woke" president such as Bernie were elected, he/she might start with this plan of "medicare for all" in negotiations, and with any luck we get something like "medicare for more" or some Obamacare-like expansion or something like that.


Right, but that will happen because there may be many taxpayers who would not find tax hikes palatable. I'd be surprised (tbh) if it turned out no tax hikes were necessary to get an European-style healthcare system, particularly since the American tax burden is lower than in most European countries.

The real question, then, is if the "woke" wing of the Democrats would be able to accept it, or if it would try to force Biden and the party's hand. I think they'll do the latter, which will lead to an implosion within the party. And I think so because if they were nuanced, if they were moderate, I doubt they would have rioted (mostly) against Democratic mayors in the midst of this election, and I also don't think there would be any further riots that make Trump's election ads for him. If Trump wins, it will be their fault.

XogGyux wrote:Health insurance is tied to your work is ridiculous. When I left residency, since my contract did not start for a month I lost health insurance for 1 month. I looked into paying it myself... good lord it was $700 USD.... and the plan was crappy to begin with (since I am young I had a high deductible crappy insurance) I ended up just going that month without insurance, which is obviously a risk for me (not much because I am young and other than a bit fat nothing else, but a risk nonetheless, I could have gotten in a car accident or something). The problem is... if young people like me don't pay for the insurance to help subsidize the rest of the "sicker patients" that do use the insurance more... then you end up with companies that keep increasing their premium (or in previous times flat out declining to insure "sick people" AKA pre-existing conditions) that is why the "Obamacare mandate" as to encourage young people like me to buy into the insurance and prevent the crazy runaway effect of more and more "healthy" people not buying insurance. It is a crude solution but a necessary one.


That's weird because I come from a country (Chile) where private and public insurance systems coexist. There, you must choose one but you can opt to just take a public one (which isn't all that great) or have access to a very basic "just keep you barely alive" one that is also public (which is geared towards homeless people).

There, employers (often) don't offer insurance, it's your own responsibility to arrange that for yourself. That may sound nice, but if that happens employees may actually get a worse deal than if the company pooled everyone in and negotiated plans with insurers - although they'll still need to find an (expensive) alternative if fired.

XogGyux wrote:As for Green New Deal. People like to play the armaggedon "we gonna go bankrupt" kind of shit but this is also nonsense. What is green? Let's see, electric cars maybe? Tesla model S has a profit margin of 25% as compared to the traditional luxury (gasoline/diesel) companies like mercedez/bmw whose profit margin look more like 10%... or what about solar panels/winds/hydroelectric that in many cases end up being cheaper than oil with the added benefit that we don't pollute our lakes/rivers/beaches that could wreak havoc on our tourism/food industries. The fact is the rest of the world is embracing this... even china has built CO2 capturing plants and devices/plants that clean other pollutants (smog) from the air. Forget about having a pretty healthy earth, if you want our products to compete in a market that is embracing those "clean technologies" you need our country to start shifting our production.
I am a pragmatic even if a Tesla were to generate the exact same amount of CO2 over its lifetime as the BMW... if hippies in Sweeden perceive that they generate less and prefer to buy the tesla... I sure hope it is an American company rather than a german one that gets the sale.
Same thing with solar panels... if the germans are willing to pay for American solar panels/technology even if coal is cheaper who am I to opose :lol: ... Now, if we are not competitive because we have a government that constantly talking nonsense and fighting amongst themselves meanwhile the rest of the world's governments are quitely subsidizing and promoting their "green companies" we will lose any sort of competitive advantage.
Green energy is an opportunity to create new technologies that we hold patents and sell. Green energy is an opportunity to create high paying jobs. The environmental perks are just that, bonus :lol:


Here, a good taxation and/or cap and trade systems would probably be the best options.
User avatar
By Julian658
#15111062
XogGyux wrote:Your erroneous perception is understandable given the poor functioning of the sand brain.


As a liberal, I spent many years holding conservative values in contempt. Not care about global warming? Exploit and vilify immigrants? Hold men and women to different standards of sexual behavior? Dismiss those living in poverty? Enact legislation to help those who were already successful keep their wealth? Harmful, wrong, and unfair!

So what hit me so hard when reading the work of Jonathan Haidt was the realization that the three moral systems that liberals disavow, but conservatives embrace (that is, respect for authority, prioritizing in-group members, purity) are the hallmarks of the collectivist value systems I learned about as part of doing cross-cultural research and living overseas. My current and more sympathetic understanding is that the central goal of collectivist societies (and social conservatism as a political ideology) is reserving resources for the in-group, a strategy that was necessary in earlier eras when the neighboring tribe was encroaching on your territory and daily survival was often uncertain. Purity rules and emphasis on obedience to authority are tools that help small-scale societies increase group cohesion and survival.

My research, my teaching, and my traveling showed me that for the majority of cultures that have thrived on our planet, socially conservative political views made a lot of sense. But what really made me more tolerant about “the other side” was when I started rubbing shoulders in a collaboration with scholars who self-identified as centrist, middle-of-the-road, politically moderate, religious, and even conservative.


https://www.bu.edu/bostonia/fall13/conservative/
User avatar
By XogGyux
#15111070
wat0n wrote:Feel free to PM me, but from what I recall the US spends like 2.5% of its GDP on admin costs... Which is a lot, actually, but then again its overall human healthcare spending is 17.7% of GDP, which is absolutely insane (easily the highest one globally... The second place stands at like 10% so that doesn't account for much of the difference).

If 2.5% on administrative costs seems insane to you wait until you hear what we spend on interest for debt :lol: .
How about the military? "Conservatives", in general, like to vilify everything else yet they would spend more on military and/or refuse to consider cutting cost.
We have a budget that is approximately the combined budget of the next 10 higher spenders in the world despite the vast majority of those being our close allies (well at least they were before Trump started poking their eyes, soon we won't know :lol: ). This is insane. To make things worse, none of those countries that could potentially pose a risk for us reside within this continent, meaning we have a pretty decent natural defense (two oceans in between) that could justify not going overboard with military budget, after all, we are in no danger of Canada or Mexico attacking us. Furthermore, the most important dangers in this era are those related to cybersecurity, misinformation and/or threats within one's country and in that regard, we are not that strong.

The cost of medicare/social security is not so much an entitlement as it is an obligatory insurance payment. You and I are paying towards a benefit that we both expect to enjoy and don't expect to pay towards during our retirements (assuming republicans don't cut it sometime along the way :lol: ). As a 30 year old male (insurance a bit cheaper because we tend to not become pregnant and use insurance) my premium for a relatively shitty coverage was $700/month if I had to pay it myself... Let that sink in. Oh and this did not include dental or vision health. This comes up to about $8400 for the year, add dental/vision and we would be looking at $9000. What percentage of income does this represent to the average American? Google tells me the median american makes roughly $30k so paying for insurance would be 1/3rd of their total pre-tax salary. Granted, if employer doesn't cover it, perhaps they would pass along a bit of their saving towards their worker, but time after time we see that when companies get a tax break, most of this makes it towards their stock and/or CEO/administrator and just a fraction makes it to workers.
Now... that was the health cost of a young healthy male. How much do you think the cost of a 65+ retiree that does not have medicare would cost? $1k? $2K?/month. I promise you, the vast majority of retirees would never be able to pay for their own health insurance.

Well, one question one may also ask is if the cost of these procedures is the same globally. One theory I've heard for why the hell is American healthcare so expensive is that Americans will tend to use the newest treatments available, and being the first adopter of anything is pricey - and new treatments appear all the time.

Other countries may use other older treatments with similar or very, very slightly lower effectiveness yet pay a LOT less. As such, their aggregate healthcare outcomes don't really worsen compared to the counter-factual in which they adopt the new treatment first, but the treatment itself is already way cheaper from the get go.

That could account for a tiny portion I have no doubt about it but that is certainly not the case.
There are many reasons. I can tell you for instance in the US we don't practice any sort of prudent "common sense". The doctor is going to be biased towards covering their ass to avoid sues and thus we don't think twice about ordering every test we think could offer this. We get malingering patients with clear history of malingering and their still get their CT brain even though 2 weeks ago he got one in this hospital and he has about 30 CT scans in the last 2 years and 2 nights ago he was seen in the hospital across town for the same reason and discharged 10h ago after all tests were negative.
We have shit systems to communicate across hospitals, can you believe we still use FAX machines? and there is no automation so if are on a weekend or Friday/holiday we are out of luck.
Let say we got a patient on Thursday with cough. We do a CT scan and find out a small mass in the lung. We tell the patient listen this could be cancer have you heard about this before? And the patient is well last month I was in this other hospital and they did some tests but I don't know why and I don't know what tests (believe me, patients don't know shit most of the time). Well at this point we have a few options:
1.- If everything else is OK, we could discharge patient and instruct them to follow up. This is actually probably the most reasonable thing to do... but remember we live in a time that every doctor is scare ape shit about a sue, in their head missing a cancer diagnosis and sending the patient home is an absolute no no. Even though legally they would be protected by just documenting "we found incidental mass, this does not pose immediate danger to the patient but he should follow up with his doctor within the next week" should be enough to cover them, in reality the vast majority of doctors will not do that.
2.- Request records from the other hospital. This will certainly guarantee that patient will remain in the hospital until next Monday or Tuesday. If the patient arrived a Thursday afternoon or later, chances are that by the time the local nurse collects the appropriate authorization form, searches on the other hospital's website the appropriate fax to send it to, send it to the other hospital, the other hospital receives it but stays unattended on the fax machine for hours until someone realizes, then in the other hospital someone has to go to their electronic med records and print whatever you asked, and then send it back to our hospital's fax machine, where it could sit unattended for hours before it makes it to the patient's chart.... and most of this never happens on weekends or holidays or after hours... chances are it will not happen until next Monday in our hypothetical scenario. So this patient spends 4 days just waiting for us to get his records. 4 days that costs more/night that the most fancy 5star hotel in the area :lol: .
Oh btw. Modern records are extensive, very extensive. 90% of the times we request "everything available" they only send a tiny portion of what we do request, because the other hospital would have to spend hours printing shit and then faxing it... so we might not even get what we want after all.
Option 3, we do the tests locally. Meaning we could end up repeating scans or biopsies or bloodtests, bronchoscopies, etc. This of course is expensive. But for the doctor, who is detached from this expense. This is the perceived safest (from the liability point of view, certainly not for the patient that could be exposed to more radiation in more tests or unnecessary biopsy that could have been done prior) so believe it or not, despite this option being probably the most expensive and probably the worse for the patient, we might end up proceeding with this.

This is not the only reason our care is so much more expensive, believe me there are dozens of other examples. I am just taking the time to just share one so that you can see how retarded our approach is.
And this is because of multiple factors that are broken (aka, highly litigious society, electronic records that do not communicate properly and are ancient, companies that don't like to share proprietary information (e.g. interface different EMRs so that transfer of information is seamless), hospitals that do not keep adequate staff during weekends that could handle/expedite record sharing, old technologies (FAX), and many other factors).
This country needs more than just a "insurance plan for all", it also needs to streamline some of the processes. Believe it or not, medicare is the reason that many hospitals end up reforming certain systems (aka being compliant).
To the above, you can also add that the US has a de facto protectionist regime for pharmacological manufacturing through insanely stringent FDA regulations that essentially ban the imports of several medicines, even from countries with good regulations on the matter like Canada. That undoubtedly makes these more expensive as well.

I have no quarrel with this, I think you are right. The only caution is that we also need to be care with the floodgates opening meaning hospitals just having a race for the bottom to obtain the cheapest possible price for medication X and ends up sourcing it from less than reputable source in Indonesia and then you find out that this company was buying expired/recalled medication from some other source and crazy shit like that. If this sounds like science fiction just take a look at the kind of crap that occurred during the mask/ventilator frenzy not long ago.

Could these two institutional features help explain the issue?

Certainly, but there are more than just 1 issue. There are hundreds if not thousands of little systemic issues that aggregate to make a poorly functioning system.
Right, but that will happen because there may be many taxpayers who would not find tax hikes palatable. I'd be surprised (tbh) if it turned out no tax hikes were necessary to get an European-style healthcare system, particularly since the American tax burden is lower than in most European countries.

I think the problem is more insidious than "we cannot sell this to Americans". After all, the problem starts with 2 parties throwing shit at each other and quite literally sending misinformation down the line to the american people.
If I told you, listen, your marginal tax will go up 5%, your effective tax that you actually pay might go up by maybe 2% but then you don't have to pay the biweekly $80 in health insurance and your employer doesn't have to pay their portion either and this law stipulates that at least 50% of of these savings will be passed towards the employee meaning that you should see an increase of your salary by about $40-50 pay payroll. I am sure that most people would be "wow, it is not such a big deal, and this guarantees that if I lose my work I get to keep my insurance? count me in!".
But instead, all they hear is "Democrats want to take your insurance away and give you death panels" and "Republicans don't care for human life" and shit like that.
The real question, then, is if the "woke" wing of the Democrats would be able to accept it, or if it would try to force Biden and the party's hand.

Doubtful. Donors. We need significant election/donation/term limit reforms before we can see any sort of major reform. Alternatively if a bunch of new "idealists" was to be elected suddenly, enough to create enough pressure before they themselves get "corrupted" this could happen, but very unlikely in the current political situation.
I see the prospect of real healthcare reform as mostly symbolic honestly. The green new deal-style plans might be more viable, because after all, there is a lot of money in "green" energy and it seems people are slowly realizing about this.
Here, a good taxation and/or cap and trade systems would probably be the best options.

Taxation schemes doesn't work. They end up being loopholes and shit for companies to take deductions but then they don't really work at the end as intended.
By wat0n
#15111102
XogGyux wrote:If 2.5% on administrative costs seems insane to you wait until you hear what we spend on interest for debt :lol: .


Maybe. But 2.5% of GDP is around $535 billion, purely on admin costs - just to put this in raw dollars.

XogGyux wrote:How about the military? "Conservatives", in general, like to vilify everything else yet they would spend more on military and/or refuse to consider cutting cost.
We have a budget that is approximately the combined budget of the next 10 higher spenders in the world despite the vast majority of those being our close allies (well at least they were before Trump started poking their eyes, soon we won't know :lol: ). This is insane. To make things worse, none of those countries that could potentially pose a risk for us reside within this continent, meaning we have a pretty decent natural defense (two oceans in between) that could justify not going overboard with military budget, after all, we are in no danger of Canada or Mexico attacking us. Furthermore, the most important dangers in this era are those related to cybersecurity, misinformation and/or threats within one's country and in that regard, we are not that strong.


But even then, the Federal government military spending is around 60% of the healthcare spending alone:

https://www.cbo.gov/publication/56324

Note that the above doesn't consider spending at the State or local level, which is (obviously) a lot heavier on healthcare. Even worse, even stopping military spending altogether would still leave around $400 billion of deficit. And this was in 2019, with a good economy and no pandemic.

I don't think there are any easy fixes on the "spending cut" side here. Ultimately, Trump's tax cuts will need to be undone (and the few taxes he hiked, like the removal of SALT, would need to stay in place), and this is just as a start. In the end I think that the only way to truly fix this mess will be to actually impose Federal gas and value added taxes, like in Europe, the latter because it's a revenue generating (cash cow) tax.

XogGyux wrote:The cost of medicare/social security is not so much an entitlement as it is an obligatory insurance payment. You and I are paying towards a benefit that we both expect to enjoy and don't expect to pay towards during our retirements (assuming republicans don't cut it sometime along the way :lol: ). As a 30 year old male (insurance a bit cheaper because we tend to not become pregnant and use insurance) my premium for a relatively shitty coverage was $700/month if I had to pay it myself... Let that sink in. Oh and this did not include dental or vision health. This comes up to about $8400 for the year, add dental/vision and we would be looking at $9000. What percentage of income does this represent to the average American? Google tells me the median american makes roughly $30k so paying for insurance would be 1/3rd of their total pre-tax salary. Granted, if employer doesn't cover it, perhaps they would pass along a bit of their saving towards their worker, but time after time we see that when companies get a tax break, most of this makes it towards their stock and/or CEO/administrator and just a fraction makes it to workers.
Now... that was the health cost of a young healthy male. How much do you think the cost of a 65+ retiree that does not have medicare would cost? $1k? $2K?/month. I promise you, the vast majority of retirees would never be able to pay for their own health insurance.


Indeed, that's why Medicare will need to remain as is for the time being. Social Security too, but let's keep in mind that higher incomes don't get a particularly high replacement rates from it either. You can get a quick estimate of your own social security income here:

https://www.ssa.gov/OACT/quickcalc/index.html

Of course if you earn more you probably have a greater chance of saving on 401(k) or equivalent, so I don't think this is a bad thing. Poorer people will get a better deal because they need it. OTOH the social security tax will also need to go up at some point too, since the population is getting older.

Either way, as you suggest I don't think it's feasible to actually remove or decrease these benefits. So my guess is that taxes will need to go up, even without proposing greater social benefits such as M4A, free higher education and so on.

XogGyux wrote:That could account for a tiny portion I have no doubt about it but that is certainly not the case.
There are many reasons. I can tell you for instance in the US we don't practice any sort of prudent "common sense". The doctor is going to be biased towards covering their ass to avoid sues and thus we don't think twice about ordering every test we think could offer this. We get malingering patients with clear history of malingering and their still get their CT brain even though 2 weeks ago he got one in this hospital and he has about 30 CT scans in the last 2 years and 2 nights ago he was seen in the hospital across town for the same reason and discharged 10h ago after all tests were negative.
We have shit systems to communicate across hospitals, can you believe we still use FAX machines? and there is no automation so if are on a weekend or Friday/holiday we are out of luck.
Let say we got a patient on Thursday with cough. We do a CT scan and find out a small mass in the lung. We tell the patient listen this could be cancer have you heard about this before? And the patient is well last month I was in this other hospital and they did some tests but I don't know why and I don't know what tests (believe me, patients don't know shit most of the time). Well at this point we have a few options:
1.- If everything else is OK, we could discharge patient and instruct them to follow up. This is actually probably the most reasonable thing to do... but remember we live in a time that every doctor is scare ape shit about a sue, in their head missing a cancer diagnosis and sending the patient home is an absolute no no. Even though legally they would be protected by just documenting "we found incidental mass, this does not pose immediate danger to the patient but he should follow up with his doctor within the next week" should be enough to cover them, in reality the vast majority of doctors will not do that.
2.- Request records from the other hospital. This will certainly guarantee that patient will remain in the hospital until next Monday or Tuesday. If the patient arrived a Thursday afternoon or later, chances are that by the time the local nurse collects the appropriate authorization form, searches on the other hospital's website the appropriate fax to send it to, send it to the other hospital, the other hospital receives it but stays unattended on the fax machine for hours until someone realizes, then in the other hospital someone has to go to their electronic med records and print whatever you asked, and then send it back to our hospital's fax machine, where it could sit unattended for hours before it makes it to the patient's chart.... and most of this never happens on weekends or holidays or after hours... chances are it will not happen until next Monday in our hypothetical scenario. So this patient spends 4 days just waiting for us to get his records. 4 days that costs more/night that the most fancy 5star hotel in the area :lol: .
Oh btw. Modern records are extensive, very extensive. 90% of the times we request "everything available" they only send a tiny portion of what we do request, because the other hospital would have to spend hours printing shit and then faxing it... so we might not even get what we want after all.
Option 3, we do the tests locally. Meaning we could end up repeating scans or biopsies or bloodtests, bronchoscopies, etc. This of course is expensive. But for the doctor, who is detached from this expense. This is the perceived safest (from the liability point of view, certainly not for the patient that could be exposed to more radiation in more tests or unnecessary biopsy that could have been done prior) so believe it or not, despite this option being probably the most expensive and probably the worse for the patient, we might end up proceeding with this.

This is not the only reason our care is so much more expensive, believe me there are dozens of other examples. I am just taking the time to just share one so that you can see how retarded our approach is.
And this is because of multiple factors that are broken (aka, highly litigious society, electronic records that do not communicate properly and are ancient, companies that don't like to share proprietary information (e.g. interface different EMRs so that transfer of information is seamless), hospitals that do not keep adequate staff during weekends that could handle/expedite record sharing, old technologies (FAX), and many other factors).
This country needs more than just a "insurance plan for all", it also needs to streamline some of the processes. Believe it or not, medicare is the reason that many hospitals end up reforming certain systems (aka being compliant).


Yeah, that's probably part of the problem too. And not just at the hospital level, I'm pretty sure States are not keen on sharing their records with each other or with the Feds either.

Perhaps it would be interesting to see how other Federal countries manage their information sharing. But of course modernizing those systems would help to save on all sorts of expensive tests (plus your own medical history should be recognized as being your property above all).

XogGyux wrote:I have no quarrel with this, I think you are right. The only caution is that we also need to be care with the floodgates opening meaning hospitals just having a race for the bottom to obtain the cheapest possible price for medication X and ends up sourcing it from less than reputable source in Indonesia and then you find out that this company was buying expired/recalled medication from some other source and crazy shit like that. If this sounds like science fiction just take a look at the kind of crap that occurred during the mask/ventilator frenzy not long ago.


No, that's a good point and indeed is why this de facto ban exists. But it would then be more reasonable for the FDA to reach agreements with other agencies to streamline the process of cross border approvals. Like, if the FDA recognizes EU counterparts are doing a good job, and the recognition is reciprocal (this needs to go both ways) then the approval by the EU regulator would at least be considered by the FDA as a preliminary approval of sorts

XogGyux wrote:Certainly, but there are more than just 1 issue. There are hundreds if not thousands of little systemic issues that aggregate to make a poorly functioning system.


No disagreement there.

XogGyux wrote:I think the problem is more insidious than "we cannot sell this to Americans". After all, the problem starts with 2 parties throwing shit at each other and quite literally sending misinformation down the line to the american people.
If I told you, listen, your marginal tax will go up 5%, your effective tax that you actually pay might go up by maybe 2% but then you don't have to pay the biweekly $80 in health insurance and your employer doesn't have to pay their portion either and this law stipulates that at least 50% of of these savings will be passed towards the employee meaning that you should see an increase of your salary by about $40-50 pay payroll. I am sure that most people would be "wow, it is not such a big deal, and this guarantees that if I lose my work I get to keep my insurance? count me in!".
But instead, all they hear is "Democrats want to take your insurance away and give you death panels" and "Republicans don't care for human life" and shit like that.


I think part of the problem is that you can't guarantee that either. I think there's a large amount of uncertainty of what would something like M4A do to the healthcare-related markets.

In that sense it would be good to admit that too. But then again most people like simple, prefabbed messages.

XogGyux wrote:Doubtful. Donors. We need significant election/donation/term limit reforms before we can see any sort of major reform. Alternatively if a bunch of new "idealists" was to be elected suddenly, enough to create enough pressure before they themselves get "corrupted" this could happen, but very unlikely in the current political situation.
I see the prospect of real healthcare reform as mostly symbolic honestly. The green new deal-style plans might be more viable, because after all, there is a lot of money in "green" energy and it seems people are slowly realizing about this.


Maybe. I think the role of donors and campaign finance in general should not be overestimated - ultimately voter attitudes do matter and particularly now during these culture wars that are currently going on.

XogGyux wrote:Taxation schemes doesn't work. They end up being loopholes and shit for companies to take deductions but then they don't really work at the end as intended.


Fuel taxes aren't that easy to dodge though, particularly since I'm guessing most people already pay with credit cards when filling the tanks. They are not corporate or income taxes, which are indeed more complicated to monitor.
By Pants-of-dog
#15111105
Julian658 wrote:POD,
you always ask for citations even when I mention that the Earth is not flat. You have got to be pretending to be uninformed, there is no other explanation.
Image
https://www.theatlantic.com/politics/ar ... er/612808/
https://www.cbsnews.com/news/mitt-romne ... ington-dc/
https://www.cnn.com/2020/06/07/politics ... index.html


Quote the relevant text.

——————

@Patrickov

I was pretty clear: all current Republicans are openly racist or support racism.
User avatar
By Tainari88
#15111106
The conman is back and is into his trip as usual:

User avatar
By XogGyux
#15111112
wat0n wrote:Maybe. But 2.5% of GDP is around $535 billion, purely on admin costs - just to put this in raw dollars.

You mean 2.5 of the Budget right? Not GDP. Remember the budget is what it is planned, usually in the range of 3 trillion. Still a humongous amount of money, but we do have probably the largets/most sophisticated/complicated government other than the EU which is multiple countries and I bet are more inefficient than us.

But even then, the Federal government military spending is around 60% of the healthcare spending alone:

https://www.cbo.gov/publication/56324

Note that the above doesn't consider spending at the State or local level, which is (obviously) a lot heavier on healthcare. Even worse, even stopping military spending altogether would still leave around $400 billion of deficit. And this was in 2019, with a good economy and no pandemic.

I don't think there are any easy fixes on the "spending cut" side here. Ultimately, Trump's tax cuts will need to be undone (and the few taxes he hiked, like the removal of SALT, would need to stay in place), and this is just as a start. In the end I think that the only way to truly fix this mess will be to actually impose Federal gas and value added taxes, like in Europe, the latter because it's a revenue generating (cash cow) tax.

Spending cuts large enough to justify any meaningful tax cuts are not viable for politicians. Best case scenario they don't increase the raw number and with inflation overall the percentage slowly drops over time. This might be the only palatable solution for spending cuts for instance, allow inflation to slowly/sneakily drop the percentages over time. Cutting military does not even have to do with actual defense, after all our military back in 1970s/1980's already had the capability of making the world inhabitable, anything above that is just overkill :lol: We are delegated to proxy wars through smaller countries and/or terrorists or cyber war or economic, but real actual military war, the countries that could actually pose a significant fight can destroy the world the same way we can... you know the mutual assured destruction kind of thing.
The real issue with budget is jobs/contracts/campaign donations. That beautiful Lockheed plane probably has the left nuts made in texas and the sun glare glass made in Oregon and rubber made in Alabama or some shit like that which makes it harder for the congresspeople to cut the spending not to mention they lose the donations and they get the other side to cry "you are soft on our military people".
Indeed, that's why Medicare will need to remain as is for the time being. Social Security too, but let's keep in mind that higher incomes don't get a particularly high replacement rates from it either. You can get a quick estimate of your own social security income here:

https://www.ssa.gov/OACT/quickcalc/index.html

Of course if you earn more you probably have a greater chance of saving on 401(k) or equivalent, so I don't think this is a bad thing. Poorer people will get a better deal because they need it. OTOH the social security tax will also need to go up at some point too, since the population is getting older.

Either way, as you suggest I don't think it's feasible to actually remove or decrease these benefits. So my guess is that taxes will need to go up, even without proposing greater social benefits such as M4A, free higher education and so on.

Look, the way I see it, this is the insurance that we pay for having a reasonable expectation that we won't have a future in which a large portion of the people you went to highschool with are in the streets or are their family's burden.
Imagine you have 4 friends and yourself. You don't drink but they do. You guys go on a party and all of them are drinking heavily and by the time the party is over you can either let them alone which means they could try to get home on their own and either crash, get lost, etc. Or what most decent friends do, they call them a taxi/uber and send them home, except you might end up paying the bill of taxi if your friends spent all their money on booze. Wouldnt it be more reasonable to ask them at the beginning for all of them to pay pay you and then when they need the taxi you use that money?
This is the same thing except on a much larger scale.

Forget the "its expensive" excuse. The fact is, the healthcare is already getting paid. Hospitals cannot refuse to give care, the expense already exists. The controversy is on making it official and making sure people get preventative care. You may say, gotcha, preventative care will add costs. Not really, it is preventative for a reason, it prevents a much larger problem from developing. It ensures that the localized lump stage 1 cancer gets removed in a $10k surgery rather than having stage 4 cancer that not only is incurable but could cost many thousand more in terms of chemo/radiation, multiple surgeries, mechanical ventilation, palliative care, etc etc etc.
Just like in the friends/drinking party example, the taxi driver is getting paid. The question is who is paying, your pocket or your friend's pocket or the driver.
Now, the trick for congress would be to navigate the intricacies of costs to ensure that the taxpayer doesn't get screwed. But that has nothing to do with whether universal care is feasible, expensive or reasonable, that only has to do with whether congress has your best interest in mind or their donors :lol: .
I think part of the problem is that you can't guarantee that either. I think there's a large amount of uncertainty of what would something like M4A do to the healthcare-related markets.

In that sense it would be good to admit that too. But then again most people like simple, prefabbed messages.

Well, that is where politics end up fucking us up. Because in theory, if both parties agree to proceed with their best intention in mind, there is absolutely no rule that say that if it is not working they can roll back, delay, change, alter, etc their plans until it is something manageable and improved. This is a complex issue, even with both parties focused on doing this, hiring the absolute best minds, I would still expect to find many problems along the way that are unforeseen. This is not a big issue if both parties are committing at a reasonable reform. However, if its an opposition kind of thing like it is now, you will undoubtedly have one party trying to sabotage the other and/or road-blocking. Politics are disgusting.
That is one of the reasons that I don't think this country will see medicare for all system anytime soon. Because even if democrats were to get the sweeping victory and get supermajority in both wings of congress and the presidency and steamroll medicare for all legislation and pass it.. it will not be very good right away, it will take months and perhaps a couple of years to identify the major problems and it could take decades to identify the minor ones. All it takes that 2 years into the future they lose the majority of one of the wings of congress for the other party to start sabotaging and start running adds of what a failure it is.
That is not to mention, the ripple effects that such a large change in our health system will have. What happens to health instance companies? Do they simply go out of business or do they become some sort of kind of sub-contractor for the government. Can the hospitals that are for-profit continue to be for-profit? What happens to the doctors/nurses/staff salaries... and if they change... what happens to their loans, their liability insurance, etc. I am one to say that this sort of change is possible and I think it is inevitable but I am pragmatic enough to realize this cannot (and should not) happen in a 4 year or even 8 year presidential term (or double term). This is something that should take a couple of decades or more. But I do think it is healthy to have a sincere debate on the topic and I think we should start taking the first steps because I think this will happen regardless, the question is wether you want to participate and help build it or whether you will oppose it and being dragged unhappy and kicking the road along the way.

Fuel taxes aren't that easy to dodge though, particularly since I'm guessing most people already pay with credit cards when filling the tanks. They are not corporate or income taxes, which are indeed more complicated to monitor.

Fuel taxes might be a portion but it is complicated because it could be perceived as a punishment, in essense it is another consumer tax. I am not a fan of consumer tax as I think they tend to skew towards lower-earning people.
For instance, say you have 2 people, John makes 50k, Marcie makes 100k. They both have a budget of 40k and they save the rest (john saves 10k, Marcie saves 60k) and they both get a flat 5% consumer tax. Because John spent 40k, he is being taxed about 2k which is 4% of his income. Because Marcie has the same budget (spent the same) she spent also 2k, however this is only 2% of her total income. In essense, even though Marcie makes twice as much, as a proportion of her income she is is paying less.
This could be a disproportional burden on people, especially poor. The guys that drive big old inefficient cars are probably the people that cannot afford to pay for a new car and/or a premium for an electric one (assuming they are more expensive, which probably won't be the case soon enough).

I am not saying that this couldn't be a part of it, but it should probably be a tiny tiny portion to just give it a tiny kick and accelerate it. I don't think it would be the driving force.
I think if I raise you the fuel price from $2 to 4$, you are more likely to go on a riot than you are to go buy a new car that is electric :lol:
By wat0n
#15111214
XogGyux wrote:You mean 2.5 of the Budget right? Not GDP. Remember the budget is what it is planned, usually in the range of 3 trillion. Still a humongous amount of money, but we do have probably the largets/most sophisticated/complicated government other than the EU which is multiple countries and I bet are more inefficient than us.


No, I meant GDP, although the figure is more like 1.4%. That's still $300 billion though, and that's mostly paperwork (e.g. billing).

https://www.nytimes.com/2018/07/16/upsh ... re-us.html

XogGyux wrote:Spending cuts large enough to justify any meaningful tax cuts are not viable for politicians. Best case scenario they don't increase the raw number and with inflation overall the percentage slowly drops over time. This might be the only palatable solution for spending cuts for instance, allow inflation to slowly/sneakily drop the percentages over time. Cutting military does not even have to do with actual defense, after all our military back in 1970s/1980's already had the capability of making the world inhabitable, anything above that is just overkill :lol: We are delegated to proxy wars through smaller countries and/or terrorists or cyber war or economic, but real actual military war, the countries that could actually pose a significant fight can destroy the world the same way we can... you know the mutual assured destruction kind of thing.
The real issue with budget is jobs/contracts/campaign donations. That beautiful Lockheed plane probably has the left nuts made in texas and the sun glare glass made in Oregon and rubber made in Alabama or some shit like that which makes it harder for the congresspeople to cut the spending not to mention they lose the donations and they get the other side to cry "you are soft on our military people".


Indeed, there would also be an employment effect in those states. But even getting rid of that would not be enough to solve the problem of the deficit - I think a tax hike should be regarded as a foregone conclusion.

XogGyux wrote:Look, the way I see it, this is the insurance that we pay for having a reasonable expectation that we won't have a future in which a large portion of the people you went to highschool with are in the streets or are their family's burden.
Imagine you have 4 friends and yourself. You don't drink but they do. You guys go on a party and all of them are drinking heavily and by the time the party is over you can either let them alone which means they could try to get home on their own and either crash, get lost, etc. Or what most decent friends do, they call them a taxi/uber and send them home, except you might end up paying the bill of taxi if your friends spent all their money on booze. Wouldnt it be more reasonable to ask them at the beginning for all of them to pay pay you and then when they need the taxi you use that money?
This is the same thing except on a much larger scale.

Forget the "its expensive" excuse. The fact is, the healthcare is already getting paid. Hospitals cannot refuse to give care, the expense already exists. The controversy is on making it official and making sure people get preventative care. You may say, gotcha, preventative care will add costs. Not really, it is preventative for a reason, it prevents a much larger problem from developing. It ensures that the localized lump stage 1 cancer gets removed in a $10k surgery rather than having stage 4 cancer that not only is incurable but could cost many thousand more in terms of chemo/radiation, multiple surgeries, mechanical ventilation, palliative care, etc etc etc.
Just like in the friends/drinking party example, the taxi driver is getting paid. The question is who is paying, your pocket or your friend's pocket or the driver.
Now, the trick for congress would be to navigate the intricacies of costs to ensure that the taxpayer doesn't get screwed. But that has nothing to do with whether universal care is feasible, expensive or reasonable, that only has to do with whether congress has your best interest in mind or their donors :lol: .


When I say "expensive" I mean it because of healthcare's aggregate costs for the economy. The high spending is not because Americans have such a high demand for healthcare (despite the obesity rates and other issues) but mainly because the services are themselves expensive. Just because the patient doesn't pay for them directly it doesn't mean nobody pays.

XogGyux wrote:Well, that is where politics end up fucking us up. Because in theory, if both parties agree to proceed with their best intention in mind, there is absolutely no rule that say that if it is not working they can roll back, delay, change, alter, etc their plans until it is something manageable and improved. This is a complex issue, even with both parties focused on doing this, hiring the absolute best minds, I would still expect to find many problems along the way that are unforeseen. This is not a big issue if both parties are committing at a reasonable reform. However, if its an opposition kind of thing like it is now, you will undoubtedly have one party trying to sabotage the other and/or road-blocking. Politics are disgusting.
That is one of the reasons that I don't think this country will see medicare for all system anytime soon. Because even if democrats were to get the sweeping victory and get supermajority in both wings of congress and the presidency and steamroll medicare for all legislation and pass it.. it will not be very good right away, it will take months and perhaps a couple of years to identify the major problems and it could take decades to identify the minor ones. All it takes that 2 years into the future they lose the majority of one of the wings of congress for the other party to start sabotaging and start running adds of what a failure it is.
That is not to mention, the ripple effects that such a large change in our health system will have. What happens to health instance companies? Do they simply go out of business or do they become some sort of kind of sub-contractor for the government. Can the hospitals that are for-profit continue to be for-profit? What happens to the doctors/nurses/staff salaries... and if they change... what happens to their loans, their liability insurance, etc. I am one to say that this sort of change is possible and I think it is inevitable but I am pragmatic enough to realize this cannot (and should not) happen in a 4 year or even 8 year presidential term (or double term). This is something that should take a couple of decades or more. But I do think it is healthy to have a sincere debate on the topic and I think we should start taking the first steps because I think this will happen regardless, the question is wether you want to participate and help build it or whether you will oppose it and being dragged unhappy and kicking the road along the way.


Correct, there are many incentives to deviate from whatever road the Government at the time proposes. In the end, it's voters who are to stay steady in whatever way they choose.

XogGyux wrote:Fuel taxes might be a portion but it is complicated because it could be perceived as a punishment, in essense it is another consumer tax. I am not a fan of consumer tax as I think they tend to skew towards lower-earning people.
For instance, say you have 2 people, John makes 50k, Marcie makes 100k. They both have a budget of 40k and they save the rest (john saves 10k, Marcie saves 60k) and they both get a flat 5% consumer tax. Because John spent 40k, he is being taxed about 2k which is 4% of his income. Because Marcie has the same budget (spent the same) she spent also 2k, however this is only 2% of her total income. In essense, even though Marcie makes twice as much, as a proportion of her income she is is paying less.
This could be a disproportional burden on people, especially poor. The guys that drive big old inefficient cars are probably the people that cannot afford to pay for a new car and/or a premium for an electric one (assuming they are more expensive, which probably won't be the case soon enough).

I am not saying that this couldn't be a part of it, but it should probably be a tiny tiny portion to just give it a tiny kick and accelerate it. I don't think it would be the driving force.
I think if I raise you the fuel price from $2 to 4$, you are more likely to go on a riot than you are to go buy a new car that is electric :lol:


The problem though is that 1) it would help to decrease fuel consumption (not by that much in the short run, but by a lot more in the long run by providing an extra incentive to switch to electric cars) and 2) it can really help to close the deficit. Yes, consumption taxes are usually regressive (although fuel taxes would probably burden the middle and upper middle classes for the most part) but governments can get a lot of revenue from them, with low evasion rates. And indeed, the European countries tend to have some rather high consumption taxes (~20% VAT rates are not unusual in Western Europe).

Of course, on top of those it would also be necessary to increase income tax rates.
User avatar
By XogGyux
#15111220
wat0n wrote:No, I meant GDP, although the figure is more like 1.4%. That's still $300 billion though, and that's mostly paperwork (e.g. billing).

https://www.nytimes.com/2018/07/16/upsh ... re-us.html

I don't have access to the article (wants me to pay which I won't :lol: ) From the tittle alone it is hard to understand what does it mean or what it is included in the article.
"Astonishing cost of the administrative cost of US healthcare" could also include the administrative cost of private insurances, not just government plans. We need perspective to judge what it means. I would not surprised of that sum (although putting it in terms of GDP does not make sense if we are talking only about government-sponsored healthcare. in such case putting it in terms of budget makes more sense. Putting it in terms of GDP makes senses if they are analyzing the whole healthcare market including private insurers, since private insurer's finances would not be part of the US government but it is part of the GDP).
But this is not news, we know the US healthcare costs are the highest even though we don't have the best outcomes. That alone should be sending alarm bells as to why it is. The typical answer from the republicans of "well can you really trust the government with your healthcare" or "government is incompetent" while I can see how congress is in fact incompetent... if you use the "government incompetent and/or untrustworthy" then you cannot trust the government with nuclear weapons or with 100million F-35 fighter planes or tanks or aircraft carriers...

Indeed, there would also be an employment effect in those states. But even getting rid of that would not be enough to solve the problem of the deficit - I think a tax hike should be regarded as a foregone conclusion.

It could help with deficit, it won't help with debt considering interest would probably outpace inflation.
Other than high taxes, or an economic explosion (ie. sustained GDP growth year after year in the 2 digits percentage point for several years, for reference prior to pandemic it seems to be averaging at 2-3 percentage points) the only other thing that could help with this would be borrowing some theories from the Modern Monetary Theory fox and print.
I am not an economist and although I do follow finances as a hobby, macroeconomics is not my forte, but my understanding is that this just going to mask a problem with another by the means of inflation, meaning you are essentially taxing wealth. But instead of being a "surgical" tax on wealth (i.e. you target billionaires and big pocket millionaires) you end up taxing anyone that has wealth. This means retirees as well. While I don't think it is preposterous to tax a reasonable chunk of $$ to someone holding 500million or 2bil or something like that, I am less inclined to be as aggressive to grandpa's 2mil nest egg after their retired. I am in fact surprised that the republicans are not that worried about all the money printing that the Fed is currently doing :lol: , we are not seeing much inflation now... but that is probably going to change :lol:

Correct, there are many incentives to deviate from whatever road the Government at the time proposes. In the end, it's voters who are to stay steady in whatever way they choose.

I am not so confident on that. Nowadays it seems that politicians are more successful in controlling their electorate than the other way around. With the help of the news they tell them how they need to feel and how they should vote and it seems that is the way it is most of the time. Back in 2018 you would see republicans (trump supporters) being asked about Obamacare... which they all hated, but when asked 5 secs later about ACA they all loved it and wanted more programs like that. At the end of the day the voters were able to let the politicians that they didn't want to abolish it, but they are not always successful at all and they get tricked quite often. In fact, I think that's the reason we got Trump.

The problem though is that 1) it would help to decrease fuel consumption (not by that much in the short run, but by a lot more in the long run by providing an extra incentive to switch to electric cars) and 2) it can really help to close the deficit. Yes, consumption taxes are usually regressive (although fuel taxes would probably burden the middle and upper-middle classes for the most part) but governments can get a lot of revenue from them, with low evasion rates. And indeed, the European countries tend to have some rather high consumption taxes (~20% VAT rates are not unusual in Western Europe).

I get it, it might help and I am not totally opposed to being part of a more comprehensive system. I am not much of a fan though. I am of the theory that you catch more flies with honey than vinegar :lol: .
By wat0n
#15111222
XogGyux wrote:I don't have access to the article (wants me to pay which I won't :lol: ) From the tittle alone it is hard to understand what does it mean or what it is included in the article.
"Astonishing cost of the administrative cost of US healthcare" could also include the administrative cost of private insurances, not just government plans. We need perspective to judge what it means. I would not surprised of that sum (although putting it in terms of GDP does not make sense if we are talking only about government-sponsored healthcare. in such case putting it in terms of budget makes more sense. Putting it in terms of GDP makes senses if they are analyzing the whole healthcare market including private insurers, since private insurer's finances would not be part of the US government but it is part of the GDP).
But this is not news, we know the US healthcare costs are the highest even though we don't have the best outcomes. That alone should be sending alarm bells as to why it is. The typical answer from the republicans of "well can you really trust the government with your healthcare" or "government is incompetent" while I can see how congress is in fact incompetent... if you use the "government incompetent and/or untrustworthy" then you cannot trust the government with nuclear weapons or with 100million F-35 fighter planes or tanks or aircraft carriers...


Yes, it includes private insurers as well. My concern is not so much about how much is private vs public but about the overall cost of the whole thing.

XogGyux wrote:It could help with deficit, it won't help with debt considering interest would probably outpace inflation.
Other than high taxes, or an economic explosion (ie. sustained GDP growth year after year in the 2 digits percentage point for several years, for reference prior to pandemic it seems to be averaging at 2-3 percentage points) the only other thing that could help with this would be borrowing some theories from the Modern Monetary Theory fox and print.
I am not an economist and although I do follow finances as a hobby, macroeconomics is not my forte, but my understanding is that this just going to mask a problem with another by the means of inflation, meaning you are essentially taxing wealth. But instead of being a "surgical" tax on wealth (i.e. you target billionaires and big pocket millionaires) you end up taxing anyone that has wealth. This means retirees as well. While I don't think it is preposterous to tax a reasonable chunk of $$ to someone holding 500million or 2bil or something like that, I am less inclined to be as aggressive to grandpa's 2mil nest egg after their retired. I am in fact surprised that the republicans are not that worried about all the money printing that the Fed is currently doing :lol: , we are not seeing much inflation now... but that is probably going to change :lol:


The very first step to solve the debt problem is to solve the deficit, so it stops going up. Specifically the primary deficit (deficit without considering interest payments on debt).

XogGyux wrote:I am not so confident on that. Nowadays it seems that politicians are more successful in controlling their electorate than the other way around. With the help of the news they tell them how they need to feel and how they should vote and it seems that is the way it is most of the time. Back in 2018 you would see republicans (trump supporters) being asked about Obamacare... which they all hated, but when asked 5 secs later about ACA they all loved it and wanted more programs like that. At the end of the day the voters were able to let the politicians that they didn't want to abolish it, but they are not always successful at all and they get tricked quite often. In fact, I think that's the reason we got Trump.


That's one reason indeed, and what you describe is of course one of the major problems in the US. It's all about polarization in the end.

XogGyux wrote:I get it, it might help and I am not totally opposed to being part of a more comprehensive system. I am not much of a fan though. I am of the theory that you catch more flies with honey than vinegar :lol: .


Yeah, but in this case this would necessitate cutting Federal spending. I doubt this will be happening anytime soon.

Of course best scenario would be a growth spurt in the US economy, due to a greater increase in productivity. In a developed economy like the US (that is already one of the most productive in the world), this would come out as a result of some profitable innovation - and those are essentially unpredictable.
User avatar
By XogGyux
#15111227
wat0n wrote:Yes, it includes private insurers as well. My concern is not so much about how much is private vs public but about the overall cost of the whole thing.

Well, it is all interconnected. Most insurances follow the lead of whatever Medicare/Medicaid does in terms of coding, covering for medications, pricing, etc. Hospitals inflate the pricing of things because they have revenue losses every time there is a patient that does not pay. That inflated cost then is passed to insurances and then maybe they pay a portion but not the whole thing. But when because they got so overcharged, insurance companies then raise premiums. People that have insurance but are relatively healthy might take the risk of canceling the insurance altogether and then this eats the profit of the private insurance company which further raises the premium for the remaining pool (presumably the less healthy people). Meanwhile, those young people that dropped insurance because it was too expensive, might not get preventative care (which means they might become the unhealthy person in the future) or they might get a surprise medical expenditure (an accident, young people also get cancer, etc).
Realize that the driving force has always been money at every step of this wheel. The individual dropped insurance because he was paying too much, the hospital charged more because many patients din't pay and the insurance company raised premiums because they lost costumers (the healthy individual) and they got charged more (the hospital). It is profit/money driving this wheel of madness.
There are only two reasonable solutions... either we go with a system that only those that pay get care (e.i, you didnt get insurance, you then cannot go to the hospital) which obviously is quite unpallatable for most people or you go with a system that is not profit-motivated. The only way to take the profit out of the equation and ensure that people that need care stills get it is if this is subsidized by government and taxes are compelled for it's financing.
Its the proverbial "you cannot have the cake and eat it too" kind of approach.

Yeah, but in this case this would necessitate cutting Federal spending. I doubt this will be happening anytime soon.

Of course best scenario would be a growth spurt in the US economy, due to a greater increase in productivity. In a developed economy like the US (that is already one of the most productive in the world), this would come out as a result of some profitable innovation - and those are essentially unpredictable.

Federal spending is not such a bad thing. A small amount of spending on roads, for instance, could lead to workers getting more $$ but also because the roads are in better conditions you could have more business opeing in the area and because those workers that made the road got paid, they can go spend the money in the business that opened next to the road and this can quickly snowball.
Look for instance NASA spending historically. The price the goverment paid early on might have been high enough to at least warrant an eyebrow-raising but look at how many industries and technological advances in communications, GPS, television/broadcast, transportation, material technologies and many other more.
I think the most important is to have a healthy relationship with taxes, and to have a system that is fair. I think by far the worse thing about our taxes is not how high but rather how confusing, how filled with loopholes and traps and shit like that.
The other day I was listening to the White Coat investor podcast. This is an ER physician that started talking about personal finances many years ago, he has a website/forum, he has conferences, sells personal finance courses and has the podcast (as well as sponsors and commisions, etc). In one of his previous episodes, he happens to reveal that he pays less than 20% of his gross income. I believe him, I don't think that he is doing anything fraudulent. I have listened enough of his content to realize that he is taking full advantage of all those pesky "loopholes" and "rules" that have accumulated over the decades and he is min/maxing them. The reality is that technically there is nothing preventing anyone of us to take advantage of this but it is unlikely that an average worker can get the same benefit of all of these options the same way a wealthy person.
For instance, I could max out my 401 personal contribution of $19500 and take advantage of a nice deduction but a nurse making 50k a year cannot reasonably put aside 40% of her paycheck to avoid that money to get taxed now. Same thing with real state, Jim from white coat investor can buy a nice 1mil property and depreciate it over 30 years and get nice yearly deduction not to mention that the rental income might not get taxed at the same rate as his payroll income. That nurse from my previous example does not have the capital/credit/etc to buy properties to take advantage of depreciation. And there are many, many more examples... Tax law harvesting?
Perhaps if there were no loopholes we could actually have a smaller income tax percentage... Amazon, largest corporation, healthy balance sheet. One of the very few companies that not only got spared by coronavirus nonsense but actually had a business boom... why is it that they are paying shit to the government?

The other two points I think I agree with you at least on the surface.
By wat0n
#15111232
XogGyux wrote:Well, it is all interconnected. Most insurances follow the lead of whatever Medicare/Medicaid does in terms of coding, covering for medications, pricing, etc. Hospitals inflate the pricing of things because they have revenue losses every time there is a patient that does not pay. That inflated cost then is passed to insurances and then maybe they pay a portion but not the whole thing. But when because they got so overcharged, insurance companies then raise premiums. People that have insurance but are relatively healthy might take the risk of canceling the insurance altogether and then this eats the profit of the private insurance company which further raises the premium for the remaining pool (presumably the less healthy people). Meanwhile, those young people that dropped insurance because it was too expensive, might not get preventative care (which means they might become the unhealthy person in the future) or they might get a surprise medical expenditure (an accident, young people also get cancer, etc).
Realize that the driving force has always been money at every step of this wheel. The individual dropped insurance because he was paying too much, the hospital charged more because many patients din't pay and the insurance company raised premiums because they lost costumers (the healthy individual) and they got charged more (the hospital). It is profit/money driving this wheel of madness.
There are only two reasonable solutions... either we go with a system that only those that pay get care (e.i, you didnt get insurance, you then cannot go to the hospital) which obviously is quite unpallatable for most people or you go with a system that is not profit-motivated. The only way to take the profit out of the equation and ensure that people that need care stills get it is if this is subsidized by government and taxes are compelled for it's financing.
Its the proverbial "you cannot have the cake and eat it too" kind of approach.


Yeah, the issue of people being allowed to opt out of having some sort of insurance (creating a huge adverse selection problem) is also a huge problem. Normally, you are forced to take some sort of insurance whether you like it or not.

XogGyux wrote:Federal spending is not such a bad thing. A small amount of spending on roads, for instance, could lead to workers getting more $$ but also because the roads are in better conditions you could have more business opeing in the area and because those workers that made the road got paid, they can go spend the money in the business that opened next to the road and this can quickly snowball.
Look for instance NASA spending historically. The price the goverment paid early on might have been high enough to at least warrant an eyebrow-raising but look at how many industries and technological advances in communications, GPS, television/broadcast, transportation, material technologies and many other more.
I think the most important is to have a healthy relationship with taxes, and to have a system that is fair. I think by far the worse thing about our taxes is not how high but rather how confusing, how filled with loopholes and traps and shit like that.
The other day I was listening to the White Coat investor podcast. This is an ER physician that started talking about personal finances many years ago, he has a website/forum, he has conferences, sells personal finance courses and has the podcast (as well as sponsors and commisions, etc). In one of his previous episodes, he happens to reveal that he pays less than 20% of his gross income. I believe him, I don't think that he is doing anything fraudulent. I have listened enough of his content to realize that he is taking full advantage of all those pesky "loopholes" and "rules" that have accumulated over the decades and he is min/maxing them. The reality is that technically there is nothing preventing anyone of us to take advantage of this but it is unlikely that an average worker can get the same benefit of all of these options the same way a wealthy person.
For instance, I could max out my 401 personal contribution of $19500 and take advantage of a nice deduction but a nurse making 50k a year cannot reasonably put aside 40% of her paycheck to avoid that money to get taxed now. Same thing with real state, Jim from white coat investor can buy a nice 1mil property and depreciate it over 30 years and get nice yearly deduction not to mention that the rental income might not get taxed at the same rate as his payroll income. That nurse from my previous example does not have the capital/credit/etc to buy properties to take advantage of depreciation. And there are many, many more examples... Tax law harvesting?
Perhaps if there were no loopholes we could actually have a smaller income tax percentage... Amazon, largest corporation, healthy balance sheet. One of the very few companies that not only got spared by coronavirus nonsense but actually had a business boom... why is it that they are paying shit to the government?

The other two points I think I agree with you at least on the surface.


I'm not too familiar about the intricacies of US corporate taxation, but I also agree it's an issue. In the end having a simpler tax system would help close all those loopholes.

As for Federal spending, there's nothing wrong with it per se (as long as there's no corruption and rent seeking behavior involved, that is) and I also agree that you can make a case that it needs to go up to fix infrastructure. Which is yet another reason why it's not realistic to rely on spending cuts for the most part.
User avatar
By XogGyux
#15111245
wat0n wrote:As for Federal spending, there's nothing wrong with it per se (as long as there's no corruption and rent seeking behavior involved, that is) and I also agree that you can make a case that it needs to go up to fix infrastructure. Which is yet another reason why it's not realistic to rely on spending cuts for the most part.

Corruption exists everywhere, obviously even in private business. I am not sure I prefer a Bernie Madoff anymore than a Rod Blagojevich. I wouldn't take corruption as a good argument against government spending.
By wat0n
#15111247
XogGyux wrote:Corruption exists everywhere, obviously even in private business. I am not sure I prefer a Bernie Madoff anymore than a Rod Blagojevich. I wouldn't take corruption as a good argument against government spending.


One difference though is that Bernie Madoff can't jail people for not paying taxes to him. He also doesn't get to control the Government structure (when government payoffs are used to capture votes), particularly its ability to use force.
User avatar
By XogGyux
#15111252
wat0n wrote:One difference though is that Bernie Madoff can't jail people for not paying taxes to him. He also doesn't get to control the Government structure (when government payoffs are used to capture votes), particularly its ability to use force.

Well.
We are getting into the nitty-gritty stuff here. For one, it is not that common for the regular fox to go to jail due to taxes. Not impossible, but not common. Most cases are wealthy and/or perhaps more important very public figures and they have to get caught in some sort of deliberate deception of the government, such as fraudulent filings etc.
On the other hand, we have non-government financially powerful "private sector" individuals that hold an immense amount of power and often time get away with far more than they should. The "Epsteins" of the world if you wish. Remember the 2008 banking crisis? How about the fraud and the total disregard of those individuals for anything that resembles integrity. How many of them are in jail now?
Exactly.
For governments, at least in theory, we have the power to regulate/expose and quite frankly term limits for most posts of the government that has any sort of power should be advised but that's a whole other debate.
By wat0n
#15111256
XogGyux wrote:Well.
We are getting into the nitty-gritty stuff here. For one, it is not that common for the regular fox to go to jail due to taxes. Not impossible, but not common. Most cases are wealthy and/or perhaps more important very public figures and they have to get caught in some sort of deliberate deception of the government, such as fraudulent filings etc.
On the other hand, we have non-government financially powerful "private sector" individuals that hold an immense amount of power and often time get away with far more than they should. The "Epsteins" of the world if you wish. Remember the 2008 banking crisis? How about the fraud and the total disregard of those individuals for anything that resembles integrity. How many of them are in jail now?
Exactly.
For governments, at least in theory, we have the power to regulate/expose and quite frankly term limits for most posts of the government that has any sort of power should be advised but that's a whole other debate.


It's nitty gritty indeed, but an important one I think. Of course corruption also includes incestuous relations between the Government and the private sector.

Either way, I of course don't make way too much out of it either. As I said, Federal spending is necessary for the most part, and even more so now during the pandemic. It's not as simple as just cutting spending like crazy and not expecting any repercussions.
By Doug64
#15111262
An excellent (if rather long) look at why Trump has a real chance of winning come November (even if the columnist doesn’t think so):

Kansas Should Go F--- Itself

    The People, No: A Brief History of Anti-Populism

    Thomas Frank is one of America’s more skillful writers, an expert practitioner of a genre one might call historical journalism – ironic, because no recent media figure has been more negatively affected by historical change. Frank became a star during a time of intense curiosity about the reasons behind our worsening culture war, and now publishes a terrific book, The People, No: A Brief History of Anti-Populism, at a time when people are mostly done thinking about what divides us, gearing up to fight instead.

    Frank published What’s the Matter with Kansas? in 2004, at the height of the George W. Bush presidency. The Iraq War was already looking like a disaster, but the Democratic Party was helpless to take advantage, a fact the opinion-shaping class on the coasts found puzzling. Blue-staters felt sure they’d conquered the electoral failure problem in the nineties, when a combination of Bill Clinton’s Arkansas twang, policy pandering (a middle-class tax cut!) and a heavy dose of unsubtle race politics (e.g. ending welfare “as we know it”) appeared to cut the heart out of the Republican “Southern strategy.”

    Yet Clinton’s chosen successor Al Gore flopped, the party’s latest Kennedy wannabe, John Kerry, did worse, and by the mid-2000s, Bushian conservatism was culturally ascendant, despite obvious failures. Every gathering of self-described liberals back then devolved into the same sad-faced anthropological speculation about Republicans: “Why do they vote against their own interests?”

    Frank, a Midwesterner and one of the last exemplars of a media tradition that saw staying in touch with the thinking of the general population as a virtue, was not puzzled. What’s the Matter with Kansas? was framed as an effort to answer that liberal cocktail-party conundrum – “How could anyone who’s ever worked for someone vote Republican?” was the version Frank described hearing – and the answer, at least on the surface, was appealing to coastal intellectuals.

    Frank explained the Republican voter had thrown support to the Republicans’ pro-corporate economic message in exchange for solidarity on cultural issues, as part of what he called the “Great Backlash”:

      While earlier forms of conservatism emphasized fiscal sobriety, the backlash mobilizes voters with explosive social issues—summoning public outrage over everything from busing to un-Christian art—which it then marries to pro-business economic policies.

    What’s the Matter with Kansas? was about more than that, but for the chattering classes, this thesis was enough. What they heard was that the electorally self-harming white Republican voter from poor regions like the High Plains was motivated not by reason, but by racial animus and Christian superstition.

    For a certain kind of blue-state media consumer, and especially for Democratic Party politicians, this was a huge relief, the political version of Sean’s hug-it-out message to Will Hunting:



    A reader looking back at that book will note Frank also predicted political disasters that would later befall Democrats, and outlined the thesis of his current book The People, No, which will probably suffer financially for being pretty much the opposite of “All this shit, it’s not your fault.”

    The Kansas title alone spoke to one of Frank’s central observations: while red state voters might frame objections in terms of issues like abortion or busing, in a broader sense the Republican voter is recoiling from urban liberal condescension.

    That Democrats needed Thomas Frank to tell them what conservatives fifteen miles outside the cities were thinking was damning in itself. Even worse was the basically unbroken string of insults emanating from pop culture (including from magazines like Rolling Stone: I was very guilty of this) describing life between the cities as a prole horror peopled by obese, Bible-thumping dolts who couldn’t navigate a Thai menu and polished gun lockers instead of reading.

    Republicans may have controlled government at the time, but when they turned on TV sets or looked up at movie screens, their voters felt accused of something just for living in little towns, raising kids, and visiting church on Sundays. What’s the matter, they were asking, with that?

    As Frank and basically anyone who’d been to an antiwar meeting knew, actual liberals in the Bush era were “an assortment of complainers – for the most part impoverished complainers – who wield about as much influence over American politics as the cashier at Home Depot.” In those circles, the union member was still revered, and the villain in small towns was a GM or Cargill executive, whose assaults on factory workers and family farmers of all races were central to the story of America’s decline.

    Still, by the Bush years something had gone terribly wrong, in liberalism’s effort to reach small-town America:

      Liberalism may not be the monstrous, all-powerful conspiracy that conservatives make it out to be, but its failings are clear nonetheless. Somewhere in the last four decades liberalism ceased to be relevant to huge portions of its traditional constituency, and we can say that liberalism lost places like Shawnee and Wichita with as much accuracy as we can point out that conservatism won them over.

    Frank ripped the political strategy of Clinton Democrats, who removed economic issues from their platform as they commenced accepting gobs of Wall Street money in a post-Mondale effort to compete with Republicans on fundraising. Gambling that working-class voters would keep voting blue because “Democrats will always be marginally better on economic issues,” New Democrats stopped targeting blue-collar voters and switched rhetorical emphasis to “affluent, white collar professionals who are liberal on social issues.”

    The move seemed smart. This was the go-go eighties, we were all Material Girls (for whom the boy with the cold hard cash was always Mr. Right), and as Frank put it, “What politician in this success-loving country really wants to be the voice of poor people?”

    While Clinton Democrats were perfecting a new image of urban cool, opponents were honing a new approach:

      Republicans, meanwhile, were industriously fabricating their own class-based language of the right, and while they made their populist appeal to blue-collar voters, Democrats were giving those same voters—their traditional base—the big brush-off…

    The news media and Hollywood shifted accordingly. Working-class voices disappeared from the press and earnest movies like Norma Rae and The China Syndrome gave way to a new brand of upper-class messaging that reveled in imperious sneering and weird culture-war provocations:

      In an America where the chief sources of one’s ideas about life’s possibilities are TV and the movies, it’s not hard to be convinced that we inhabit a liberal-dominated world: feminist cartoons for ten-year-olds are followed by commercials for nonconformist deodorants; entire families of movies are organized around some transcendent dick joke…

    In Frank’s home state of Kansas, voters reacted by moving right as the triumvirate of news media, pop culture, and Democratic politics spoke to them less and less. “The state,” he wrote, “watches impotently as its culture, beamed in from the coasts, becomes coarser and more offensive by the year.”

    Perceiving correctly that there would be no natural brake on this phenomenon, since the executive set was able to pay itself more and more as the country grew more divided, Frank wondered, “Why shouldn’t our culture just get worse and worse, if making it worse will only cause the people who worsen it to grow wealthier and wealthier?”

    We have the answer to that now, don’t we?

    ————————————————————————-

    When I was first sent out to cover the Donald Trump campaign years later, I assumed the editorial concept would be simple: mockery. New York’s infamous “short-fingered vulgarian” had taken over national headlines in the summer of 2015 with a foul-mouthed stream-of-consciousness rap, organized around an impossible Pharaonic wall project and scare tales about rape-happy Mexicans – the Diceman doing Pat Buchanan. If this was taking over the Republican Party, there wasn’t much to report. The enterprise was doomed, and journalism’s only mission was to make sure the silliest bits were captured before being buried under the sands of history.

    Twenty minutes into my first Trump campaign event, I knew this was wrong, and was seized by a sinking feeling that really hasn’t left since. Trump in person sounded like he’d been convinced to run for president after reading What’s the Matter with Kansas? His stump act seemed tailored to take advantage of the gigantic market opportunity Democrats had created, and which Frank described. He ranted about immigrants, women, the disabled, and other groups, sure, but also about NAFTA, NATO, the TPP, big Pharma, military contracting, and a long list of other issues.


    In 2016, it was clear only a few people in the lefty media world understood what Trump was up to, and why he was a real threat to win. Michael Moore was one, and Frank was another. I don’t think it’s a coincidence both were Midwesterners. Frank released his next book, Listen, Liberal, in May of 2016, just as Trump was seizing the nomination. It began with the following observation:

    In the summer of 2014, with the Dow Jones Industrial Average hitting all-time highs, a poll showed that nearly three-quarters of the American public thought the economy was still in recession—because for them, it was.

    He noted that workers’ share of GDP hit the lowest levels in American history in 2011 and stayed there, as inequities stemming from the Obama “recovery” became a “quasi-permanent development.”

    Most of the press lived in a different America, though, and saw Frank’s warning as annoying, repetitive whining. Cocky reviewers at places like the New York Times bemoaned the book’s “pessimistic note” and berated him for seeing the “uneven recovery” of the Obama years as “a tragedy rather than a triumph.” Listen to what? Hadn’t he read the latest polls? Didn’t he know the rout was on?

    (It should be noted that new Times reviews of books this week by Robert Reich and Zephyr Teachout, under the familiar headline, “Why the Working Class Votes Against Its Economic Interests,” are similarly snooty in telling both to “temper their anti-corporate zeal” in this election year. Very little learning takes place at these institutions).

    After Trump’s election in November 2016, the first instinct of everyone wandering amid the smoldering wreckage of Democratic Party politics should have been to look in all directions for anyone with an explanation for what the hell just happened.

    Of course the opposite took place. Frank seemed to be put into deep-freeze after Listen, Liberal, largely I think because he was telling a truth no one wanted to hear about the difference between the way the New York Times saw America, and how, say, Iowans or Nebraskans saw it. Trump meanwhile constructed his argument for the presidency atop that difference, and is still doing it today.

    Also: the word, “populism,” became a synonym for plague or menace. Post-Trump and post-Brexit, pundits tended to use the term in tandem with other epithets, e.g. the “populist threat.” For Frank, a liberal intellectual whose breathless admiration for the actual Populist movement of the 1890s had been a running theme across two decades, this must have stung.

    He responded by plunging into a history of Populism that probably began as quaint nostalgia but quickly turned into something else: a portrait of anti-Populism. The People, No documents the furious elite propaganda response to bottom-up political movements that has recurred in uncannily similar fashion at key moments across nearly a century and a half of American history, and is firing with particular venom today.

    The Populists were a third-party movement that popped into view in the late 1800s in response to the excesses of monopoly capitalism. It centered around regulation of railroads, currency reform, federal loans to farmers, and other issues. In a development that particularly frightened the very wealthy at the time, it sought and secured alliances with Black farmers. Proving the concept of breaking the political and economic monopoly of New York elites with sheer voter energy was almost more important than the individual issues.

    A sort-of populist, William Jennings Bryan, became the Democratic nominee in 1896, only to be slaughtered by a mediocrity named William McKinley. The Republican was backed by mountains of corporate money and the dirty-pool genius of his campaign “generalissimo,” Mark Hanna (whose media-dominating, cash-gobbling wizardry in suppressing voter preference ironically made him the hero of Karl “Turd Blossom” Rove). Mountains of propaganda depicted populists as diseased demons, unshaven slayers of American virtue:

    Image

    In many popular histories, including Howard Zinn’s People’s History of the United States, the Populists are depicted as failures, crushed by almighty capital after selling out to make alliances with Democrats. But many of their ideas were implemented after the 1929 crash. Frank writes in detail how the same corporate messengers scrambled to defame Franklin Roosevelt in 1936 with an 1896-style anti-Populist attack.

    F.D.R. himself was a genteel aristocrat, but battered as a Russian agent – one Chicago Tribune cartoon showed his hands covered with the “red jam of Moscow” – and his followers were described as a mob of “sentimentalists and demagogues” who wanted to “take away from the thrifty what the thrifty or their ancestors have accumulated.” His followers were “people of low mentality” who backed policies that were the “laughingstock of the leading monetary authorities of the world.” This campaign, which should sound familiar, failed over and over, as F.D.R. retained broad support and populism even became culturally dominant in the thirties and early forties, through the films of people like Orson Welles and Frank Capra.

    It wasn’t until after World War II that the more effective version of anti-Populist messaging was developed, as Frank writes:

    Now anti-populism was taken up by a new elite, a liberal elite that was led by a handful of thinkers at prestigious universities … In short, the highly educated learned to deplore working-class movements for their bigotry, their refusal of modernity, and their borderline madness.

    The new conception of populism, as popularized by historians like Richard Hofstadter, pitted the common run of voters against a growing class of elite-educated managerial professionals, philosopher-kings who set correct policy for the ignorant masses.

    The model of enlightened government for this new “technocratic” class of “consensus thinkers” was John Kennedy’s “Camelot” cabinet of Experts in Shirtsleeves, with Robert McNamara’s corporatized Pentagon their Shining Bureaucracy on a Hill. This vision of ideal democracy has dominated mainstream press discourse for almost seventy years.

    Since the establishment of this template, Frank notes, “virtually everyone who writes on the subject agrees that populism is ‘anti-pluralist,’ by which they mean that it is racist or sexist or discriminatory in some way… Populism’s hatred for ‘the elite,’ meanwhile, is thought to be merely a fig leaf for this ugly intolerance.”

    Trump and Bernie Sanders both got hit with every cliché described in Frank’s book. Both were depicted as xenophobic, bigoted, emotion-laden, resistant to modernity, susceptible to foreign influence, and captured by “unrealistic” ideas they lacked the expertise to implement.

    At the conclusion of The People, No, Frank sums up the book’s obvious subtext, seeming almost to apologize for its implications:

      My point here is not to suggest that Trump is a “very stable genius,” as he likes to say, or that he led a genuine populist insurgency; in my opinion, he isn’t and he didn’t. What I mean to show is that the message of anti-populism is the same as ever: the lower orders, it insists, are driven by irrationality, bigotry, authoritarianism, and hate; democracy is a problem because it gives such people a voice. The difference today is that enlightened liberals are the ones mouthing this age-old anti-populist catechism.

    The People, No is more an endorsement of 1896-style populism as a political solution to our current dilemma than it is a diatribe against an arrogant political elite. The book reads this way in part because Frank is a cheery personality whose polemical style tends to accentuate the positive. In my hands this material would lead to a darker place faster — it’s infuriating, especially in what it says about the last four years of “consensus” propaganda, in particular the most recent iteration.

    The book’s concept also reflects the Sovietish reality of post-Trump media, which is now dotted with so many perilous taboos that it sometimes seems there’s no way to get audiences to see certain truths except indirectly, or via metaphor. The average blue-state media consumer by 2020 has ingested so much propaganda about Trump (and Sanders, for that matter) that he or she will be almost immune to the damning narratives in this book. Protesting, “But Trump is a racist,” they won’t see the real point – that these furious propaganda campaigns that have been repeated almost word for word dating back to the 1890s are aimed at voters, not politicians.

    In the eighties and nineties, TV producers and newspaper editors established the ironclad rule of never showing audiences pictures of urban poverty, unless it was being chased by cops. In the 2010s the press began to cartoonize the “white working class” in a distantly similar way.

    This began before Trump. As Bernie Sanders told Rolling Stone after the 2016 election, when the small-town American saw himself or herself on TV, it was always “a caricature. Some idiot. Or maybe some criminal, some white working-class guy who has just stabbed three people.” These caricatures drove a lot of voters toward Trump, especially when he began telling enormous crowds that the lying media was full of liars who lied about everything.

    After 2016 it became axiomatic that the Trump voter, or the Leave voter, was – without exception now – a crazed, racist monster. As detailed here multiple times, ruminations on Republican voter behaviors became not merely uninteresting to pundits after November 2016, but actively taboo. By 2020, the official answer to What’s the Matter with Kansas? was Kansas is a White Supremacist Project and Can Go Fuck Itself.

    Frank in 2004 wrote about how confused Midwestern voters were, watching TV images of the beautiful people of the time. Movie stars and hedge-funders donned ribbons in support of animals or the “underprivileged,” while spending huge sums on pictures of Jesus covered in ants or on crucifix-shaped popsicles that supposedly were comments on “fanaticism and violence.” This, while factory towns were basically being moved en masse to China.

    Imagine the reaction in these places now, to editorials in the New York Times instructing white liberals to cut off their relatives (by text, incidentally) until they donate to Black Lives Matter, or a CNN tweet instructing “individuals with a cervix” to start getting cancer screens at age 25, or to widespread denunciations of Mount Rushmore as a “monument of two slaveholders” when visited by Trump, after those same outlets praised its “majesty” just four years earlier.

    These stories are as incomprehensible to Middle America as the pictures of MAGA fanatics going maskless and dying of Covid-19 to own the libs are to blue-state audiences. Yet both groups are bombarded with images of their opposite extremes, with predictable results: we all hate each other.

    It’s no accident that the consensus press pumping out these messages spent the last four years denouncing Sanders – whose campaign was a polite promise to restore New Deal values for everyone, Republicans included – as far too radical for America.

    Once Sanders was out of the way, those same news outlets embraced a significantly more radical ideology, one that swore a lot, described everyone to the right of Ibram Kendi as a white supremacist, and told small business owners they should put up with their stores being smashed for the cause of progress.

    The history outlined in The People, No predicts this. America’s financial and political establishment has always been most terrified of an inclusive underclass movement. So it evangelizes a bizarre transgressive politics that tells white conservatives to fuck themselves and embraces a leftist sub-theology that preaches class as a racist canard. Same old game, same old goal: keep people divided. The only cost to the “consensus thinkers” who will likely re-take the White House under Joe Biden is, they will have to join Nike and Bank of America in flying a “Black Lives Matter” banner above a conference room or two as they re-take their seats at the controls of the S.S. Neoliberalism.

    Frank was never a David Broder type, preaching airy centrism and celebrating phony “bipartisanship.” Instead his books, which filled a vacuum created by the disappearance/expulsion of working-class writers like Mike Royko or Studs Terkel, said conservative Middle America was worth understanding, and there was overlap between its concerns and those of the frustrated, oft-impoverished complainers who were the Democrats’ base.

    Frank insisted there was both a danger in ignoring those shared concerns, and a huge potential benefit in addressing them. Fifteen years ago, that was an acceptable topic for elite discussion. In the Trump era it’s heresy, and even an eloquently-argued warning like The People, No will likely be denounced, as too much like paying attention to deplorables.
By Doug64
#15111363
And a look at the races in Montana (including a Senate race that the Democrats are hoping for):

Republicans Trump, Daines lead in latest Montana poll

    A poll released Monday found Sen. Steve Daines, Montana Republican, leading in his 2020 reelection bid, a race that was declared a toss-up after the entry of Democratic Gov. Steve Bullock.

    The Emerson College poll found Mr. Daines ahead by 50% to 44% for Mr. Bullock, who launched his Senate campaign in March after exiting the Democratic presidential primary.

    The results offer good news for Mr. Daines, who has been running neck-and-neck with Mr. Bullock, now serving his second term as governor, in a state that went heavily for President Trump four years ago but also has a history of electing moderate Democrats.

    The same poll showed Mr. Trump leading former Vice President Joseph R. Biden, the presumptive Democratic presidential nominee, by 53% to 42% with Big Sky voters. The undecideds leaned toward Mr. Biden by a 3-1 margin, according to poll director Spencer Kimball.

    “Montana could be a bellwether of sorts to see if Gov. Bullock can buck the trend of 2016 when Trump states went Republican in Senate races while Clinton states went Democratic,” said Mr. Kimball.

    Mr. Trump won Montana in 2016 by a margin of 56% to 34% over Democrat Hillary Clinton.

    After Mr. Bullock entered the race, both Inside Elections and the Cook Political Report moved the Senate contest to “toss-up,” with Cook saying Mr. Bullock’s name recognition and handling of the novel coronavirus crisis were likely to boost the Democrat against the first-term Senate incumbent.

    So far fundraising has been competitive. Mr. Daines had raised $12.9 million as of the June 30 financial report, while Mr. Bullock was close behind at $10.9 million. The Real Clear Politics average has Mr. Daines leading by 2 percentage points.

    In the state’s one House race, the poll found Republican Rep. Greg Gianforte running ahead of Democrat Mike Cooney by 50% to 41%.
By Doug64
#15111364
And the Democrats might be losing the Senate race in Montana, the teachers’ unions might be making in kind contributions to Republicans and the trump campaign with their threats to strike over attempts to reopen the schools, and Biden might be losing the police unions, but at least he still has the Communists and Socialists!

Revolutionary Communist Party leader backs Biden

    For Bob Avakian, founder and leader of the Revolutionary Communist Party USA, this year’s election is actually an easy call: The need to stop President Trump is so overwhelming that he has no qualms about backing Democrat Joseph R. Biden.

    The far left usually finds itself at election time grappling with tricky questions about lesser-of-two-evils, and fears of boosting what they see as a corrupt Democratic Party. But that’s not happening this year.

    From Maoists to Marxists, leftists say it’s actually an easy choice.

    Mr. Avakian says this is not the year for protest votes, and while he still considers Mr. Biden and the Democratic Party “representatives and instruments of this exploitative, oppressive, and literally murderous system of capitalism-imperialism,” Mr. Trump and the Republicans are even worse.

    “Biden is not ‘better’ than Trump, in any meaningful way — except that he is not Trump and is not part of the move to consolidate and enforce fascist rule, with everything that means,” he said in an email to supporters Monday.

    He continued: “To approach this election from the standpoint of which candidate is ‘better’ means failing to understand the truly profound stakes and potential consequences of what is involved. The fact is that there can be one — and only one — ‘good’ that can come out of this election: delivering a decisive defeat to Trump and the whole fascist regime.”

    Compatriots, competitors and fellow travelers from America’s communist movement are coming to the same conclusion.

    Angela Davis, who gained fame as a 1970s-era radical and was the Communist Party USA’s vice presidential nominee in the 1980 and 1984 elections, told RT in an interview last month that the left should pick Mr. Biden because he can be “most effectively pressured” into accepting their demands.

    Indeed, some on the left say they’ve already seen that in Mr. Biden’s willingness to work with Sen. Bernard Sanders, who bills himself as a democratic socialist and was runner up for Democrats’ presidential nod.

    The two men teamed up on a blueprint for the party’s platform, producing a document last month calling for stopping deportations and offering the chance for citizenship rights for 11 million illegal immigrants, opening the door to reparations for slavery, embracing a $15-an-hour national minimum wage and imposing national policing standards.

    The collaboration is what helped win over William Ayers, a former leader of the violent Weather Underground. He wrote that to see Mr. Sanders and Rep. Alexandria Ocasio-Cortez working with Mr. Biden is comforting.

    “That’s because, in my view, Trump and Trumpism represent the most reactionary political force in the world today and the most immediate and serious threat to peace and human freedom in the post-WWII era,” he wrote in May.

    Mr. Biden’s leftward drift was also welcomed by John Bachtell, a former chairman of the Communist Party USA. He said Mr. Biden is not taking the far left for granted.

    Rossana Cambron, current co-chair of the CPUSA, is actively working to boost Mr. Biden — or, more precisely, to oust Mr. Trump.

    “This is a strategic action to remove Trump,” she told People’s World. “The moment calls upon us to look beyond ourselves and do what’s best for all of us. This is why we need a massive voter turnout in November, a victory margin so undeniable it cannot be contested.”

    Joe Sims, her fellow CPUSA co-chair, warned followers against approaching this election worried about “lesser evilism.” He said Karl Marx “worked to lend aid” to Abraham Lincoln and the Republican Party over the Confederacy and its president, Jefferson Davis, in order to end slavery.

    Mr. Sims said the Democratic Party is “an imperfect vehicle” that at times subverts the labor movement.

    “Yet an imperfect vehicle is still a vehicle, and Bernie Sanders, Alexandria Ocasio-Cortez, and others in the African American, Latino, women’s and labor movements have run effective campaigns through it,” he reasoned.

    One major movement that has not gone all-in, though, is the Democratic Socialists of America, Mr. Sanders’ core backers.

    Last year DSA adopted a policy that if Mr. Sanders wasn’t the nominee, it wouldn’t endorse anyone. An effort this year to reverse that plan and tell DSA members to support Mr. Biden fell short.

    DSA didn’t respond to an inquiry from The Washington Times, but some of its members said they’ve chosen to back Mr. Biden, despite their misgivings.

    Andre Vasquez, a Chicago alderman, called Mr. Biden “a wet noodle” but said there’s no alternative.

    “It’s tough. I know it’s tough because I feel it,” he told Red Star Live, the video channel of Midwest Socialist. “But to me, stopping Trump is something we have to do.”

    Plus, he said, if the left begs off and Mr. Biden loses, it’s the socialists who will be blamed, which will set them back in their quest for major political transformation.

    It’s not clear whether the willingness of the far left to embrace Mr. Biden is reciprocated, but the Trump team said Mr. Avakian’s support should not be celebrated.

    The RCP leader has backed some violent movements including serving as a leading acolyte of the Shining Path, a Maoist movement that waged a violent guerrilla campaign to overthrow Peru’s government in the 1980s and 1990s.

    “Avakian’s endorsement further demonstrates that Joe Biden is an empty vessel for the radical left,” the Trump campaign said.

    Mr. Biden’s supporters counter by pointing to the likes of David Duke, a former leader in the Ku Klux Klan, backing Mr. Trump.
User avatar
By Drlee
#15111367
Posted this in another thread too.

The CDC now projects the death toll in the U.S. could hit 180,000 by August 22. Dr. Deborah Birx, the Trump administration’s coronavirus coordinator, said “anything is possible” when asked about former Food and Drug Administration commissioner Dr. Scott Gottlieb’s prediction that virus deaths could top 300,000 by the end of the year.


Republicans won't care. Empathy is a sign of weakness to them.

Let me edit my post a little. Republicans also are desperately hoping for a racist president. When asked about an icon of the civil rights movement, the best he can do is:

Asked about the legacy of Lewis and how history would remember him, Trump told Axios: "I really don't know ... I don't know John Lewis. He chose not to come to my inauguration ... I never met John Lewis, actually, I don’t believe."


Way to go party of Lincoln.

Hey Doug. I'll bet Trump takes Utah.

...from the mid-1800s until 1978, the LDS Church had a policy which prevented most men of black African descent from being ordained to the church's lay priesthood and barred black men and women participating in the ordinances of its temples


They were not, as I recall, banned from church "membership" not prohibited from giving a tenth of all they earn to the church.
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