(08-15-2020 09:23 AM)RiceLad15 Wrote:  

(08-15-2020 09:16 AM)OptimisticOwl Wrote:  

(08-15-2020 08:50 AM)RiceLad15 Wrote:  

(08-15-2020 08:10 AM)OptimisticOwl Wrote:  We already have a private-public partnership. Private carriers deliver my packages to the post office, who take them the final leg of the journey.

Thank you for your concerns about us poor country cousins. But your concerns for us could easily be alleviated by the same mechanism that I and many of my neighbors have used for years - a P. O. Box. My closest neighbor has never taken mail at his house,as is the case with the ATF agent who lives nearby.

In the wild, spread out regions of West Texas, the Post Office could deliver the mail to one central location (more efficient) similar to the way mail to newer apartment complexes is delivered to one central location. People can pick up at their leisure.

I further note that the box need not be at the PO, it could be at a private Pack ‘n Mail type facility.

Or we could use the tried and true method of General Delivery. Every few months when we lead out miles into town to stock up on virtues,we could drop by the Post Office and get our mail. Nothing in the Constitution says it has to begiven to us at whatever place we call home that day.

I don’t think this alleviates the issue I’m talking about. While it would increase efficiency, I would be surprised if it actually made it profitable for a private carrier to manage small parcels and letters at a low price.

But that could be a potential option for reducing the costs of USPS for remote locations if implemented on a wide scale. Then if people have mobility issues, there could be some sort of process to deliver mail directly to those individuals. Mail service, while more outdated than it used to be, still serves a vital role in society on multiple fronts. I agree that we don’t seem to be constitutionally bound to deliver mail to individual homes, but that seems to be addressing a separate issue of whether or not we should fund such a service - we don’t have government services solely because they are constitutionally mandated.

Also, I don’t know why you say some condescending things like “thank you for your concerns about us poor country cousins.” Why add that kind of commentary?

It was the sudden concern for rural people.

I presume you have never lived in the country. It is a trade off. I have privacy, and wildlife, and no problems with unruly neighbors. But I also have to provide my own water, sewer, and road repair. People who chose to live “out” are not going to quibble over petty things like at-home delivery of mail. To use my example for the ease of remote people to get picture ID, they can pick up their mail when they they make their biweekly trip to town, along with getting groceries, getting a haircut, and seeing a dentist. Oh, and dropping by their DPS office for an ID.*

*I drove into town this week to renew my DL. The sign outside directed those there to renew a DL OR TO OBTAIN AN ID how to proceed. Took me about an hour, including driving to and back.

I think you perceive this as a “sudden concern” because we often don’t talk about policies focused on rural Americans. Our conversations very regularly end up focusing on more urban issues. But you shouldn’t be surprised that liberals who view the government as a positive that can balance out the inefficiencies of the free market apply the view to the entire country.

And I agree about the trade off, inherently living someone where rural means that services of all kind are less accessible. As I said, I agree that your proposal could be a good option to reduce costs while still providing a vital service, but I don’t think that private industry would view it as profitable unless prices went way up.

I think we could compare this to rural medical care and hospitals, which really struggle to provide services due to costs, but which provide vital services to the people in the area. I’m of the opinion that we should try and identify and address access issues for urban and rural Americans.

Back to the point of this discussion, there are lots of ways for rural people to get mail and packages without being captive to high, “exorbitant” prices for delivery to the door.

And when I was young, $.03 was considered “exorbitant” for a letter. After all, it was a 50% increase from the previous price.

I see this “sudden concern” as a cover for advocating mail in voting. You never expressed any concern for the particular disadvantages of being rural until you could use it to bolster an unrelated argument.

At least that is the way I saw it.

It reminded of the old fable about the city mouse and the country mouse, where the city mouse thought he was so superior, but the country mouse actually had the better life.

I have lived In both The city and the country. They are different. But if we wanted to be subject to the city rules and ways, we could move there.

A few years ago, I came into some money, and explored moving to the city and “enjoying” urban high rise condo living. Still here. Two years ago, I had an offer for my land at well above market. Thought maybe it was time to move into the city, so I shopped for houses. That deal fell through, but I never found anyplace I wanted to move to anyway, so not all bad. I kind of hope I can live here until the day I die, but guess what is making that harder all the time? Encroaching city, that’s what. Not so much the city itself, but the city $#&*@ government you seem so enamored with.

(08-15-2020 09:33 AM)OptimisticOwl Wrote:  

(08-15-2020 09:23 AM)RiceLad15 Wrote:  

(08-15-2020 09:16 AM)OptimisticOwl Wrote:  

(08-15-2020 08:50 AM)RiceLad15 Wrote:  

(08-15-2020 08:10 AM)OptimisticOwl Wrote:  We already have a private-public partnership. Private carriers deliver my packages to the post office, who take them the final leg of the journey.

Thank you for your concerns about us poor country cousins. But your concerns for us could easily be alleviated by the same mechanism that I and many of my neighbors have used for years - a P. O. Box. My closest neighbor has never taken mail at his house,as is the case with the ATF agent who lives nearby.

In the wild, spread out regions of West Texas, the Post Office could deliver the mail to one central location (more efficient) similar to the way mail to newer apartment complexes is delivered to one central location. People can pick up at their leisure.

I further note that the box need not be at the PO, it could be at a private Pack ‘n Mail type facility.

Or we could use the tried and true method of General Delivery. Every few months when we lead out miles into town to stock up on virtues,we could drop by the Post Office and get our mail. Nothing in the Constitution says it has to begiven to us at whatever place we call home that day.

I don’t think this alleviates the issue I’m talking about. While it would increase efficiency, I would be surprised if it actually made it profitable for a private carrier to manage small parcels and letters at a low price.

But that could be a potential option for reducing the costs of USPS for remote locations if implemented on a wide scale. Then if people have mobility issues, there could be some sort of process to deliver mail directly to those individuals. Mail service, while more outdated than it used to be, still serves a vital role in society on multiple fronts. I agree that we don’t seem to be constitutionally bound to deliver mail to individual homes, but that seems to be addressing a separate issue of whether or not we should fund such a service - we don’t have government services solely because they are constitutionally mandated.

Also, I don’t know why you say some condescending things like “thank you for your concerns about us poor country cousins.” Why add that kind of commentary?

It was the sudden concern for rural people.

I presume you have never lived in the country. It is a trade off. I have privacy, and wildlife, and no problems with unruly neighbors. But I also have to provide my own water, sewer, and road repair. People who chose to live “out” are not going to quibble over petty things like at-home delivery of mail. To use my example for the ease of remote people to get picture ID, they can pick up their mail when they they make their biweekly trip to town, along with getting groceries, getting a haircut, and seeing a dentist. Oh, and dropping by their DPS office for an ID.*

*I drove into town this week to renew my DL. The sign outside directed those there to renew a DL OR TO OBTAIN AN ID how to proceed. Took me about an hour, including driving to and back.

I think you perceive this as a “sudden concern” because we often don’t talk about policies focused on rural Americans. Our conversations very regularly end up focusing on more urban issues. But you shouldn’t be surprised that liberals who view the government as a positive that can balance out the inefficiencies of the free market apply the view to the entire country.

And I agree about the trade off, inherently living someone where rural means that services of all kind are less accessible. As I said, I agree that your proposal could be a good option to reduce costs while still providing a vital service, but I don’t think that private industry would view it as profitable unless prices went way up.

I think we could compare this to rural medical care and hospitals, which really struggle to provide services due to costs, but which provide vital services to the people in the area. I’m of the opinion that we should try and identify and address access issues for urban and rural Americans.

Back to the point of this discussion, there are lots of ways for rural people to get mail and packages without being captive to high, “exorbitant” prices for delivery to the door.

And when I was young, $.03 was considered “exorbitant” for a letter. After all, it was a 50% increase from the previous price.

Agreed, but I don’t believe that complete privatization of the USPS is the answer.

(08-15-2020 09:49 AM)RiceLad15 Wrote:  

(08-15-2020 09:33 AM)OptimisticOwl Wrote:  

(08-15-2020 09:23 AM)RiceLad15 Wrote:  

(08-15-2020 09:16 AM)OptimisticOwl Wrote:  

(08-15-2020 08:50 AM)RiceLad15 Wrote:  I don’t think this alleviates the issue I’m talking about. While it would increase efficiency, I would be surprised if it actually made it profitable for a private carrier to manage small parcels and letters at a low price.

But that could be a potential option for reducing the costs of USPS for remote locations if implemented on a wide scale. Then if people have mobility issues, there could be some sort of process to deliver mail directly to those individuals. Mail service, while more outdated than it used to be, still serves a vital role in society on multiple fronts. I agree that we don’t seem to be constitutionally bound to deliver mail to individual homes, but that seems to be addressing a separate issue of whether or not we should fund such a service - we don’t have government services solely because they are constitutionally mandated.

Also, I don’t know why you say some condescending things like “thank you for your concerns about us poor country cousins.” Why add that kind of commentary?

It was the sudden concern for rural people.

I presume you have never lived in the country. It is a trade off. I have privacy, and wildlife, and no problems with unruly neighbors. But I also have to provide my own water, sewer, and road repair. People who chose to live “out” are not going to quibble over petty things like at-home delivery of mail. To use my example for the ease of remote people to get picture ID, they can pick up their mail when they they make their biweekly trip to town, along with getting groceries, getting a haircut, and seeing a dentist. Oh, and dropping by their DPS office for an ID.*

*I drove into town this week to renew my DL. The sign outside directed those there to renew a DL OR TO OBTAIN AN ID how to proceed. Took me about an hour, including driving to and back.

I think you perceive this as a “sudden concern” because we often don’t talk about policies focused on rural Americans. Our conversations very regularly end up focusing on more urban issues. But you shouldn’t be surprised that liberals who view the government as a positive that can balance out the inefficiencies of the free market apply the view to the entire country.

And I agree about the trade off, inherently living someone where rural means that services of all kind are less accessible. As I said, I agree that your proposal could be a good option to reduce costs while still providing a vital service, but I don’t think that private industry would view it as profitable unless prices went way up.

I think we could compare this to rural medical care and hospitals, which really struggle to provide services due to costs, but which provide vital services to the people in the area. I’m of the opinion that we should try and identify and address access issues for urban and rural Americans.

Back to the point of this discussion, there are lots of ways for rural people to get mail and packages without being captive to high, “exorbitant” prices for delivery to the door.

And when I was young, $.03 was considered “exorbitant” for a letter. After all, it was a 50% increase from the previous price.

Agreed, but I don’t believe that complete privatization of the USPS is the answer.

No need to privatize. Just abolish it, or defund it, the modern way of improving things.

(08-15-2020 09:48 AM)OptimisticOwl Wrote:  I see this “sudden concern” as a cover for advocating mail in voting. You never expressed any concern for the particular disadvantages of being rural until you could use it to bolster an unrelated argument.

At least that is the way I saw it.

It reminded of the old fable about the city mouse and the country mouse, where the city mouse thought he was so superior, but the country mouse actually had the better life.

I have lived I. The city and the country. They are different. But if we wanted to be subject to the city rules and ways, we could move there.

A few years ago, I came into some money, and explored moving to the city and “enjoying” urban high rise condo living. Still here. Two years ago, I had an offer for my land at well above market. Thought maybe it was time to move into the city, so I shopped for houses. That deal fell through, but I never found anyplace I wanted to move to anyway, so not all bad. I kind of hope I can live here until the day I die, but guess what is making that harder all the time? Encroaching city, that’s what. Not so much the city itself, but the city $#&*@ government you seem so enamored with.

Maybe don’t psycho analyze me without asking me first? We don’t talk much about rural service issues on this sub. The notable one has been IDs/DMVs, and I’ve held similar positions. In short, public goods/services should be provided, as best as possible, when good alternatives don’t exist. For example, we don’t need to run sewer or water to all rural residences because septics systems and water wells exist.

You seem to think I have a hidden agenda all the time. I try to be honest and upfront - sometimes I may misunderstand a post or two (or three), but try and take what I’m saying at face value.

(08-15-2020 09:52 AM)OptimisticOwl Wrote:  

(08-15-2020 09:49 AM)RiceLad15 Wrote:  

(08-15-2020 09:33 AM)OptimisticOwl Wrote:  

(08-15-2020 09:23 AM)RiceLad15 Wrote:  

(08-15-2020 09:16 AM)OptimisticOwl Wrote:  It was the sudden concern for rural people.

I presume you have never lived in the country. It is a trade off. I have privacy, and wildlife, and no problems with unruly neighbors. But I also have to provide my own water, sewer, and road repair. People who chose to live “out” are not going to quibble over petty things like at-home delivery of mail. To use my example for the ease of remote people to get picture ID, they can pick up their mail when they they make their biweekly trip to town, along with getting groceries, getting a haircut, and seeing a dentist. Oh, and dropping by their DPS office for an ID.*

*I drove into town this week to renew my DL. The sign outside directed those there to renew a DL OR TO OBTAIN AN ID how to proceed. Took me about an hour, including driving to and back.

I think you perceive this as a “sudden concern” because we often don’t talk about policies focused on rural Americans. Our conversations very regularly end up focusing on more urban issues. But you shouldn’t be surprised that liberals who view the government as a positive that can balance out the inefficiencies of the free market apply the view to the entire country.

And I agree about the trade off, inherently living someone where rural means that services of all kind are less accessible. As I said, I agree that your proposal could be a good option to reduce costs while still providing a vital service, but I don’t think that private industry would view it as profitable unless prices went way up.

I think we could compare this to rural medical care and hospitals, which really struggle to provide services due to costs, but which provide vital services to the people in the area. I’m of the opinion that we should try and identify and address access issues for urban and rural Americans.

Back to the point of this discussion, there are lots of ways for rural people to get mail and packages without being captive to high, “exorbitant” prices for delivery to the door.

And when I was young, $.03 was considered “exorbitant” for a letter. After all, it was a 50% increase from the previous price.

Agreed, but I don’t believe that complete privatization of the USPS is the answer.

No need to privatize. Just abolish it, or defund it, the modern way of improving things.

That would be the partnership model - reduce funding but reduce workload. Keep the USPS focused on small parcel delivery and then let another company manage the larger parcels.

Do some evaluation about where the cut off makes sense in terms or cost or weight or size, and then go to town.

(08-15-2020 10:00 AM)RiceLad15 Wrote:  

(08-15-2020 09:48 AM)OptimisticOwl Wrote:  I see this “sudden concern” as a cover for advocating mail in voting. You never expressed any concern for the particular disadvantages of being rural until you could use it to bolster an unrelated argument.

At least that is the way I saw it.

It reminded of the old fable about the city mouse and the country mouse, where the city mouse thought he was so superior, but the country mouse actually had the better life.

I have lived I. The city and the country. They are different. But if we wanted to be subject to the city rules and ways, we could move there.

A few years ago, I came into some money, and explored moving to the city and “enjoying” urban high rise condo living. Still here. Two years ago, I had an offer for my land at well above market. Thought maybe it was time to move into the city, so I shopped for houses. That deal fell through, but I never found anyplace I wanted to move to anyway, so not all bad. I kind of hope I can live here until the day I die, but guess what is making that harder all the time? Encroaching city, that’s what. Not so much the city itself, but the city $#&*@ government you seem so enamored with.

Maybe don’t psycho analyze me without asking me first? We don’t talk much about rural service issues on this sub. The notable one has been IDs/DMVs, and I’ve held similar positions. In short, public goods/services should be provided, as best as possible, when good alternatives don’t exist. For example, we don’t need to run sewer or water to all rural residences because septics systems and water wells exist.

You seem to think I have a hidden agenda all the time. I try to be honest and upfront - sometimes I may misunderstand a post or two (or three), but try and take what I’m saying at face value.

I didn’t psychoanalize you . If I did, the diagnosis would be very different.

What I did was analyze why the sudden concern for rural people getting mail and packages cheaply. The thread title gives a clue.

(08-14-2020 11:21 PM)RiceLad15 Wrote:  

(08-14-2020 09:53 AM)Owl 69/70/75 Wrote:  

(08-14-2020 09:50 AM)RiceLad15 Wrote:  

(08-14-2020 09:18 AM)Owl 69/70/75 Wrote:  Privatize the USPS. That's hardly a right-wing idea.
Such "right-wing" countries as New Zealand and Germany have done it, for starters.

Would a sort of joint venture be an option?
One issue with privatizing the USPS is that we'd likely see much higher rates to deliver mail to rural areas.
The USPS is a service, and if we're going to privatize it, I'd like to try and maintain some of the service features it has, like making sure people in both urban and rural areas can send/receive mail without exorbitant costs.

What sort of joint venture? Between whom and whom?

New Zealand is way more rural, and thus has a bigger issue with that than we do, and it worked there.

With a current provider like UPS or FedEx?

The rural delivery issue in the US is real - without a government service, there is no incentive for a private company to deliver to our rural communities, unless they charge a really exorbitant fee. And we should not do hike rates for routine mail on those communities - this is a service we should provide.

New Zealand may be “more rural” but shall we compare land mass? Our larger area exacerbates the issue.

But doing a bit of cursory reading, the NZ post is legally obliged to have a certain number of locations open, and it is still given a monopoly on low cost mail. So that’s how they handled the issue I’m discussing, and did it in sort of a joint venture way - government basically mandates that they need to maintain a basic level of service for plain mail, and they can do what they want for the rest.

I think this is taking a governmental approach to a simple business problem.

There are at least two ways to address this problem...
1) charge 29 cents each to deliver 1mm letters across town and $29 each to deliver 100 letters to East Jesus
2) charge 39 cents to deliver 1,000,100 letters anywhere.

You can even make such determinations based on the type of thing being delivered. Maybe we do '2' for things like prescriptions and political ads/voting (in an effort to be fair) and do '1' for letters from mom or junk mail or other, non-essential commercial mail. Maybe WalMart makes an arrangement with USPS to do '2', while Joe's Office Supply in NYC does '1'.... or Walmart just moves their 'free delivery' amount from $35 to $50... which means they're collecting a little more from everyone, and then charging 'one price' for delivery... doing the 'winners/losers' themselves.

Such actions might actually encourage a 5 and dime in a very small town as opposed to just giving that business to Wal-Mart or Amazon.

If the government (either local or Federal) decides that they want to subsidize 'personal or corporate' deliveries for rural areas... they can do that... and they can pay (or through actions like CMS reimbursement, establish) the 'going rate' for 'necessary' deliveries to rural areas.

Amazon, UPS, Fed-Ex and I feel very certain, the USPS have all sorts of algorithms that would allow for simple and quick pricing and comparisons. Think UBER.

I think the risk is that certain mail doesn't get delivered every day to rural areas, and given that it already takes longer for this to happen, I don't really see that as a big problem. Lots of things don't happen every day in the country. People find ways to adapt.

In 1970, we needed mail delivered every day everywhere. In 2020, do we really? I'd rather the government subsidize (more) internet in the country rather than mail delivery.

(08-15-2020 10:13 AM)Hambone10 Wrote:  

(08-14-2020 11:21 PM)RiceLad15 Wrote:  

(08-14-2020 09:53 AM)Owl 69/70/75 Wrote:  

(08-14-2020 09:50 AM)RiceLad15 Wrote:  

(08-14-2020 09:18 AM)Owl 69/70/75 Wrote:  Privatize the USPS. That's hardly a right-wing idea.
Such "right-wing" countries as New Zealand and Germany have done it, for starters.

Would a sort of joint venture be an option?
One issue with privatizing the USPS is that we'd likely see much higher rates to deliver mail to rural areas.
The USPS is a service, and if we're going to privatize it, I'd like to try and maintain some of the service features it has, like making sure people in both urban and rural areas can send/receive mail without exorbitant costs.

What sort of joint venture? Between whom and whom?

New Zealand is way more rural, and thus has a bigger issue with that than we do, and it worked there.

With a current provider like UPS or FedEx?

The rural delivery issue in the US is real - without a government service, there is no incentive for a private company to deliver to our rural communities, unless they charge a really exorbitant fee. And we should not do hike rates for routine mail on those communities - this is a service we should provide.

New Zealand may be “more rural” but shall we compare land mass? Our larger area exacerbates the issue.

But doing a bit of cursory reading, the NZ post is legally obliged to have a certain number of locations open, and it is still given a monopoly on low cost mail. So that’s how they handled the issue I’m discussing, and did it in sort of a joint venture way - government basically mandates that they need to maintain a basic level of service for plain mail, and they can do what they want for the rest.

I think this is taking a governmental approach to a simple business problem.

There are at least two ways to address this problem...
1) charge 29 cents each to deliver 1mm letters across town and $29 each to deliver 100 letters to East Jesus
2) charge 39 cents to deliver 1,000,100 letters anywhere.

You can even make such determinations based on the type of thing being delivered. Maybe we do '2' for things like prescriptions and political ads/voting (in an effort to be fair) and do '1' for letters from mom or junk mail or other, non-essential commercial mail.

If the government (either local or Federal) decides that they want to subsidize 'personal or corporate' deliveries for rural areas... they can do that... and they can pay (or through actions like CMS reimbursement, establish) the 'going rate' for 'necessary' deliveries to rural areas.

Amazon, UPS, Fed-Ex and I feel very certain, the USPS have all sorts of algorithms that would allow for simple and quick pricing and comparisons. Think UBER.

I think the risk is that certain mail doesn't get delivered every day to rural areas, and given that it already takes longer for this to happen, I don't really see that as a big problem. Lots of things don't happen every day in the country. People find ways to adapt.

In 1970, we needed mail delivered every day everywhere. In 2020, do we really? I'd rather the government subsidize (more) internet in the country rather than mail delivery.

Why not both?

(08-15-2020 09:23 AM)RiceLad15 Wrote:  Why not both?

Why would you more generally subsidize a labor intensive, energy consuming and increasingly useless business model? That would be like subsidizing migrant farm workers (and the abuses from many directions that come along with that) doing the jobs that Americans won't do rather than subsidizing technology that creates better jobs and eliminates the need for people who don't really want to be here. Maybe we eliminate migrant visas altogether and focus all those resources and money on immigrant visa processing.

This is why the USPS is struggling right now.

(08-15-2020 09:23 AM)RiceLad15 Wrote:  I think we could compare this to rural medical care and hospitals, which really struggle to provide services due to costs, but which provide vital services to the people in the area. I’m of the opinion that we should try and identify and address access issues for urban and rural Americans.

Then you shouldn't have supported the ACA.

This comparison falls pretty flat though...
The problem of healthcare in rural communities is competencies/education.... and rules about staffing ratios and required equipment designed around urban communities. What I mean is that an ER in East Jesus has to have all of the same basic equipment and competencies as an urban hospital... but that equipment and those people will serve a small fraction of the number of people. The X-ray machine costs $200,000 in both places, but the one in Houston will get used 10,000 times that year while the one in Brazoria will get used 1,000.... and it takes 3-4 Rad Techs to staff either one 24/7.... again, providing 10,000 encounters at one place, and only 1,000 at the other/ Said simply, it's not about costs... the costs are mostly the same... It's about volumes, regulation and reimbursement.

It's bigger than that, but the key point is that MOST mail delivery... like 90+% of it is not remotely as vital as hospital care.

Let's stop subsidizing junk mail. Make junk mailers pay the actual cost to deliver. When they decline, you can save money in more rural areas because the volume would decrease immensely.

Quote:migrant farm workers (and the abuses from many directions that come along with that) doing the jobs that Americans won't do

Americans won’t do those jobs because the pay is too low.

The pay is that low because there is a ready supply of illegals willing to work for the lower pay.

If we had less illegals willing to work for low wages, employers would have to raise wages to get the workers they need. One aspect of controlling illegal immigration would be to raise hourly wages and provide more, better jobs for Americans.

But it does not create more Democratic voters, so we have the Democrats advocating more illegals and a path to citizenship, rather than policies that would help current Americans.

(08-15-2020 10:48 AM)Hambone10 Wrote:  

(08-15-2020 09:23 AM)RiceLad15 Wrote:  I think we could compare this to rural medical care and hospitals, which really struggle to provide services due to costs, but which provide vital services to the people in the area. I’m of the opinion that we should try and identify and address access issues for urban and rural Americans.

Then you shouldn't have supported the ACA.

This comparison falls pretty flat though...
The problem of healthcare in rural communities is competencies/education.... and rules about staffing ratios and required equipment designed around urban communities. What I mean is that an ER in East Jesus has to have all of the same basic equipment and competencies as an urban hospital... but that equipment and those people will serve a small fraction of the number of people. The X-ray machine costs $200,000 in both places, but the one in Houston will get used 10,000 times that year while the one in Brazoria will get used 1,000.... and it takes 3-4 Rad Techs to staff either one 24/7.... again, providing 10,000 encounters at one place, and only 1,000 at the other/ Said simply, it's not about costs... the costs are mostly the same... It's about volumes, regulation and reimbursement.

It's bigger than that, but the key point is that MOST mail delivery... like 90+% of it is not remotely as vital as hospital care.

Let's stop subsidizing junk mail. Make junk mailers pay the actual cost to deliver. When they decline, you can save money in more rural areas because the volume would decrease immensely.

I feel like that’s a good comparison, actually.

Payment to send a letter is the same, regardless of the density of delivery. So USPS makes more money if they can deliver 1,000 pieces of mail in a denser suburb in an hour than say 50 in a rural area in an hour.

So it’s also about volume of service in both instances - greater population density means more customers and more efficiencies in both instances.

(08-15-2020 10:38 AM)Hambone10 Wrote:  

(08-15-2020 09:23 AM)RiceLad15 Wrote:  Why not both?

Why would you more generally subsidize a labor intensive, energy consuming and increasingly useless business model? That would be like subsidizing migrant farm workers (and the abuses from many directions that come along with that) doing the jobs that Americans won't do rather than subsidizing technology that creates better jobs and eliminates the need for people who don't really want to be here. Maybe we eliminate migrant visas altogether and focus all those resources and money on immigrant visa processing.

This is why the USPS is struggling right now.

My understanding is that USPS is also struggling due to some funding mandates imposed by Congress associated with retirement benefits.

Regardless, I think your argument makes sense, but isn’t realistic. There will need to be a significant transition period where two things happen: broadband is actually extended to all parts of America, and technology to use/access needs to equally penetrate those areas.

If we’re talking about whether we should be subsidizing the USPS in 20 years, then I can understand that position. But since we can’t convert all necessary aspects of USPS overnight, we must continue to effectively fund and operate it until a digital alternative is developed.

So, again, why not both?

(08-15-2020 10:48 AM)Hambone10 Wrote:  

(08-15-2020 09:23 AM)RiceLad15 Wrote:  I think we could compare this to rural medical care and hospitals, which really struggle to provide services due to costs, but which provide vital services to the people in the area. I’m of the opinion that we should try and identify and address access issues for urban and rural Americans.

Then you shouldn't have supported the ACA.

This comparison falls pretty flat though...
The problem of healthcare in rural communities is competencies/education.... and rules about staffing ratios and required equipment designed around urban communities. What I mean is that an ER in East Jesus has to have all of the same basic equipment and competencies as an urban hospital... but that equipment and those people will serve a small fraction of the number of people. The X-ray machine costs $200,000 in both places, but the one in Houston will get used 10,000 times that year while the one in Brazoria will get used 1,000.... and it takes 3-4 Rad Techs to staff either one 24/7.... again, providing 10,000 encounters at one place, and only 1,000 at the other/ Said simply, it's not about costs... the costs are mostly the same... It's about volumes, regulation and reimbursement.

It's bigger than that, but the key point is that MOST mail delivery... like 90+% of it is not remotely as vital as hospital care.

Let's stop subsidizing junk mail. Make junk mailers pay the actual cost to deliver. When they decline, you can save money in more rural areas because the volume would decrease immensely.

Just to let you know, the federal government makes the problem worse. Medicare actually incentivizes providers to practice in urban locations. Medicare reimburses services at a higher rate in urban areas because it costs more to live there. In CA, medicare will pay a provider 3X as much to perform the same service in some counties versus others (LA County reimbursement is 3X Fresno County). Additionally, medicare will pay a specialist 3X as much to remove a cancerous skin lesion versus a general practitioner. So, rural providers can get dinged twice in some cases to provide a service to rural residents. Additionally, as Hambone stated about volumes in rural locations for ancillary services being lower and generating less, the reimbursement for that service is less than urban areas (they get dinged twice again). This is all due to lobbying to prop up urban areas (which have more political clout due to greater population and representation) by specialty groups and metropolitan areas. The federal government is actually subsidizing urban healthcare at the expense of rural areas. Since this is already happening, why would the mail service be different and why is the mail service more important than healthcare?

(08-15-2020 12:19 PM)ruowls Wrote:  

(08-15-2020 10:48 AM)Hambone10 Wrote:  

(08-15-2020 09:23 AM)RiceLad15 Wrote:  I think we could compare this to rural medical care and hospitals, which really struggle to provide services due to costs, but which provide vital services to the people in the area. I’m of the opinion that we should try and identify and address access issues for urban and rural Americans.

Then you shouldn't have supported the ACA.

This comparison falls pretty flat though...
The problem of healthcare in rural communities is competencies/education.... and rules about staffing ratios and required equipment designed around urban communities. What I mean is that an ER in East Jesus has to have all of the same basic equipment and competencies as an urban hospital... but that equipment and those people will serve a small fraction of the number of people. The X-ray machine costs $200,000 in both places, but the one in Houston will get used 10,000 times that year while the one in Brazoria will get used 1,000.... and it takes 3-4 Rad Techs to staff either one 24/7.... again, providing 10,000 encounters at one place, and only 1,000 at the other/ Said simply, it's not about costs... the costs are mostly the same... It's about volumes, regulation and reimbursement.

It's bigger than that, but the key point is that MOST mail delivery... like 90+% of it is not remotely as vital as hospital care.

Let's stop subsidizing junk mail. Make junk mailers pay the actual cost to deliver. When they decline, you can save money in more rural areas because the volume would decrease immensely.

Just to let you know, the federal government makes the problem worse. Medicare actually incentivizes providers to practice in urban locations. Medicare reimburses services at a higher rate in urban areas because it costs more to live there. In CA, medicare will pay a provider 3X as much to perform the same service in some counties versus others (LA County reimbursement is 3X Fresno County). Additionally, medicare will pay a specialist 3X as much to remove a cancerous skin lesion versus a general practitioner. So, rural providers can get dinged twice in some cases to provide a service to rural residents. Additionally, as Hambone stated about volumes in rural locations for ancillary services being lower and generating less, the reimbursement for that service is less than urban areas (they get dinged twice again). This is all due to lobbying to prop up urban areas (which have more political clout due to greater population and representation) by specialty groups and metropolitan areas. The federal government is actually subsidizing urban healthcare at the expense of rural areas. Since this is already happening, why would the mail service be different and why is the mail service more important than healthcare?

It sounds less like Medicare makes this worse, and more like Medicare doesn’t address this problem. Or are you saying that, if Medicare reimbursed at the same rate in all areas, providers that currently operate on the city would relocate to rural areas?

Does Medicare keep private practices from opening and operating in rural areas?

And let’s not start down this road with your last comment about “why is mail service more important than healthcare?” C’mon, this has actually been a decent conversation...

(08-15-2020 12:12 PM)RiceLad15 Wrote:  I feel like that’s a good comparison, actually.

Payment to send a letter is the same, regardless of the density of delivery. So USPS makes more money if they can deliver 1,000 pieces of mail in a denser suburb in an hour than say 50 in a rural area in an hour.

So it’s also about volume of service in both instances - greater population density means more customers and more efficiencies in both instances.

Sure... if you assume that the delivery of most mail is as important as the delivery of healthcare. That's my point is that MOST mail isn't remotely important... and that that IS important is most often (in one way or another) funded by the government anyway.

Remove the subsidy for junk mail and keep it for government mail. If Junk mailers still want to deliver it to dense populations, that's fine... the post office can charge them a penny more, and reduce the need for government subsidy for prescriptions to BFE.

(08-15-2020 12:16 PM)RiceLad15 Wrote:  My understanding is that USPS is also struggling due to some funding mandates imposed by Congress associated with retirement benefits.

Regardless, I think your argument makes sense, but isn’t realistic. There will need to be a significant transition period where two things happen: broadband is actually extended to all parts of America, and technology to use/access needs to equally penetrate those areas.

If we’re talking about whether we should be subsidizing the USPS in 20 years, then I can understand that position. But since we can’t convert all necessary aspects of USPS overnight, we must continue to effectively fund and operate it until a digital alternative is developed.

So, again, why not both?

I guess i wasn't clear about my 'more' comment.

I've suggested a way for the government to subsidize 'necessary deliveries'... without having to subsidize NON essential deliveries.... just to make sure that people in rural areas get daily delivery of their junk mail just like people in big cities.

As to the pensions, Revenues for all other 'delivery' services have doubled in the past 10 years or so, while USPS has remained flat. Revenues are not impacted by pensions and benefits.

But you DO bring up one of the problems with government sponsorship/co-opting of private enterprise. The company must play by government rules which other delivery services do not. We're not talking about general employment rules, but specific 'we work for the government' rules.

(08-15-2020 12:30 PM)RiceLad15 Wrote:  It sounds less like Medicare makes this worse, and more like Medicare doesn’t address this problem. Or are you saying that, if Medicare reimbursed at the same rate in all areas, providers that currently operate on the city would relocate to rural areas?

Does Medicare keep private practices from opening and operating in rural areas?

Your comments here demonstrate to me that you don't understand what either of us are saying... which is why you don't see this as a medicare problem.

Let's start with this. Medicare sets the standards. Medicaid, Marketplace and Commercial all follow them. If they don't address it, then it basically doesn't get addressed.

That said, let me show you the simple math of RU's example... just as an example

Medicare pays a GP $100 to remove a skin lesion. They pay a specialist $200 for the same service. Because of the volumes, the GP can fill his day without that, and there is plenty of volume now for a specialist as well. LA county (like almost every urban center) is an expensive town, so they get a 25% positive adjustment... so they actually receive $125 and $250.

The rural county doesn't have a specialist... So on the surface, they pay a GP $100 to remove the lesion... however... because of the lower cost of living, they get a 25% 'hit'... and they only get $75. Now in hard to staff areas, they may bump them back up somewhat... but that requires big studies. 'Cost of living' is a much more readily available and trusted measure than is 'hard to recruit/staff'. They might get a 10% bump or more likely, they get something like a one-time bonus... most often funded through medicare/the state, not medicaid/the feds.

$250 vs $75. That's how they make it worse.

Now throw this in.....
You're an MD... There is more to living in Fresno vs LA than simply cost of living.... and Fresno isn't a tiny place. Culture, peers, diversity, beaches, arts... easy opportunity to participate in CME or an opportunity to develop a specialty practice... the availability of qualified staff and local training for them... I mean, the list of differentials is very long...

Do they stop them from opening? Of course not. That question is meaningless. The question is, do they do anything to 'equalize' the desire for Ben Stone to be a GP in Grady as opposed to being a plastic surgeon in Beverly Hills? Every small town doesn't have a Vialula. More often they have Nancy Lee's.

The reason this matters is because they demand the same quality out of both. If they don't deliver the quality, the reimbursement goes down.... which defeats the whole purpose of the location adjustments, unless they also pay to recruit nurses and staff and fund prettier/better hospitals etc etc.

It's like g5 vs p5. Yes, it's harder to win in p5, but you're easily arguably better off being a losing team in p5 than a winner in g5.

Not speaking for the doctor, just responding to Lad's questions as I see the answers...

(08-15-2020 12:30 PM)RiceLad15 Wrote:  It sounds less like Medicare makes this worse, and more like Medicare doesn’t address this problem.

Maybe Medicare does not see this as a problem, but as "being fair".

Quote: Or are you saying that, if Medicare reimbursed at the same rate in all areas, providers that currently operate on the city would relocate to rural areas?

I'll let the doctor clarify what he is saying, but what I am hearing is that equal reimbursements would eliminate the incentive for (1) new doctors to locate in big cities, and (2) rural doctors to pull up stakes and relocate to more urban centers.

My kidney specialist practiced here one day a week, then pulled up stakes and moved to College Station. Now I have to travel 40 miles to see a replacement specialist.

Quote:Does Medicare keep private practices from opening and operating in rural areas?

IMO, it doesn't forbid them from doing it, if that is your meaning of "keep", but it sure provides a good reason to work in the city instead - especially if they have a mountain of debt.

(08-15-2020 12:30 PM)RiceLad15 Wrote:  

(08-15-2020 12:19 PM)ruowls Wrote:  

(08-15-2020 10:48 AM)Hambone10 Wrote:  

(08-15-2020 09:23 AM)RiceLad15 Wrote:  I think we could compare this to rural medical care and hospitals, which really struggle to provide services due to costs, but which provide vital services to the people in the area. I’m of the opinion that we should try and identify and address access issues for urban and rural Americans.

Then you shouldn't have supported the ACA.

This comparison falls pretty flat though...
The problem of healthcare in rural communities is competencies/education.... and rules about staffing ratios and required equipment designed around urban communities. What I mean is that an ER in East Jesus has to have all of the same basic equipment and competencies as an urban hospital... but that equipment and those people will serve a small fraction of the number of people. The X-ray machine costs $200,000 in both places, but the one in Houston will get used 10,000 times that year while the one in Brazoria will get used 1,000.... and it takes 3-4 Rad Techs to staff either one 24/7.... again, providing 10,000 encounters at one place, and only 1,000 at the other/ Said simply, it's not about costs... the costs are mostly the same... It's about volumes, regulation and reimbursement.

It's bigger than that, but the key point is that MOST mail delivery... like 90+% of it is not remotely as vital as hospital care.

Let's stop subsidizing junk mail. Make junk mailers pay the actual cost to deliver. When they decline, you can save money in more rural areas because the volume would decrease immensely.

Just to let you know, the federal government makes the problem worse. Medicare actually incentivizes providers to practice in urban locations. Medicare reimburses services at a higher rate in urban areas because it costs more to live there. In CA, medicare will pay a provider 3X as much to perform the same service in some counties versus others (LA County reimbursement is 3X Fresno County). Additionally, medicare will pay a specialist 3X as much to remove a cancerous skin lesion versus a general practitioner. So, rural providers can get dinged twice in some cases to provide a service to rural residents. Additionally, as Hambone stated about volumes in rural locations for ancillary services being lower and generating less, the reimbursement for that service is less than urban areas (they get dinged twice again). This is all due to lobbying to prop up urban areas (which have more political clout due to greater population and representation) by specialty groups and metropolitan areas. The federal government is actually subsidizing urban healthcare at the expense of rural areas. Since this is already happening, why would the mail service be different and why is the mail service more important than healthcare?

It sounds less like Medicare makes this worse, and more like Medicare doesn’t address this problem. Or are you saying that, if Medicare reimbursed at the same rate in all areas, providers that currently operate on the city would relocate to rural areas?

Does Medicare keep private practices from opening and operating in rural areas?

And let’s not start down this road with your last comment about “why is mail service more important than healthcare?” C’mon, this has actually been a decent conversation...

My last comment was directed to the government for doing the opposite of what you are proposing (subsidizing rural areas to equalize services). The government has a way of directing resources away from rural areas.
Medicare is the federal government's "insurance". It sets the rules that most other insures follow (especially reimbursement, services and allowable charges ). We could talk hours about the way healthcare is paid.
Yes Medicare does control rural practice. If a rural private practice isn't financially viable, then there will be no rural private practice. And Medicare (the federal government) sets the reimbursement and as such, the viability of a practice. And private insurers follow suite and redirect resources to urban centers to attract more individuals which increases their profit.
More providers may locate to rural areas if the reimbursement to do so was more equitable. The problem is that due to less volume and less reimbursement per encounter rural practice is less viable. There was a problem with primary care in urban areas but larger systems are able to subsidize it because of the increased volume and reimbursement. So, again, the system incentivizes urban delivery of healthcare. And this is the exact opposite of what you are advocating for mail delivery. So my question, if the government already subsidizes and incentivizes urban areas in another industry with private companies following the federal government's lead, and private delivery of mail and parcels already favors urban areas and concentration of services there(just like healthcare), how is the government going to ensure that the pressures to concentrate service to the urban areas be addressed.
Healthcare reimbursement is very complicated and does favor urban and wealthy areas and the federal government through Medicare does control access and delivery.

Not disagreeing with anything else you said... just felt compelled to add to this....

(08-15-2020 01:08 PM)OptimisticOwl Wrote:  

Quote: Or are you saying that, if Medicare reimbursed at the same rate in all areas, providers that currently operate on the city would relocate to rural areas?

I'll let the doctor clarify what he is saying, but what I am hearing is that equal reimbursements would eliminate the incentive for (1) new doctors to locate in big cities, and (2) rural doctors to pull up stakes and relocate to more urban centers.

My kidney specialist practiced here one day a week, then pulled up stakes and moved to College Station. Now I have to travel 40 miles to see a replacement specialist.

I will say this... If Medicaid paid the same for a GP to work in Boerne as they do in NYC, you might get a lot of docs at least working in Boerne long enough to pay off their debts and put money away for that Park Avenue spot.

It's not just about the reimbursement, but also about how and why you become a specialist.

One of the big problems with healthcare reimbursement vs other nations that is so often glossed over here (because there are no 'identical' patients) is that depending on your insurance, a cardiologist can get paid very well to give you bypass surgery. At what point is bypass surgery necessary? Would a stent work? There are so many details, it's really hard to compare apples:apples.

What we know is that if people get paid the same regardless of whether or not they do something (managed care), they're somewhat less likely to do it.... especially if they can simply see another patient and get paid more.... or as in your case, stop paying rent in Boerne and consolidate to a bigger town.

FTR, I don't recall if you're actually in or near Boerne... It's just an example and for some reason, I think of that part of the state when I think of you. ETA, if you're 40 minutes from College Station, you're NOT in Boerne lol