Let's remember, many of those "unsustainable" pension plans became unsustainable because they included medical benefits.

Between 2000 and 2018 medical costs rose on average 3.48% per year. The entire economy only saw inflation of 2.07%. Let's back it up to 1980 since then medical costs have risen 5.03% vs 2.95% for other expenses.

We have a population bubble called baby boomers who are moving into the age category of highest utilization for medical costs. Few boomers putting aside the amount that would have been suggested in 1980 to cover their medical costs in retirement would have saved enough to pay for their medical costs today.

Pension plans were funded based on actuarial estimates. Those estimates in general missed the target horribly in estimating future medical costs so it is no surprise that many are now under-funded.

As discussed in other posts, a number of under-funded plans became under-funded because the actuary brought in to estimate costs determined that plans were over-funded. In turn, the corporate management or government legislative body determined that they could safely remove funds from those plans or let the plans become creditors to fund their current expenditures with the vow they would pay the fund back. Now they don't like the idea of having to pay it back.

The other actuarial mistake was failing to adequately foresee automation. A factory that once needed 800 workers and was assumed would always have 800 workers paying into the pension plan, often today have higher output with only 250 workers paying in (either directly or in the form of lower salaries so the owner can make the contributions).

The same has happened in government. There were more people working for the executive branch (ie. the various alphabet soup agencies) under Nixon than under Obama.

So any pension plan that assumed current workers would help pay pension benefits ended up under-funded.

(04-25-2018 06:43 AM)quo vadis Wrote:  

(04-25-2018 05:30 AM)TerryD Wrote:  We are both old enough to recall the old "social contract". An employee gave his loyalty to the company and worked there for thirty years. In return, the employer fully funded a pension for the employee.

In my opinion, one of the biggest con jobs occurred when the employers broke that social contract and sold the employees a bill of goods ("Here is a 401k, you can invest in the stock market and make a ton of money") which shifted the pension burden from the employer on to the backs of the employees.

I remember my Dad working for years for U.S. Steel near Pittsburgh and retiring comfortably for eighteen years on a company pension, Social Security and Black Lung benefits (he was a coal miner before working for U.S. Steel).

That was great for your dad, but the problem for US Steel, as with many other companies, was that a generous defined benefit pension was unsustainable in the long run.

At the time those plans were created, the company was in a dominant, quasi-monopolistic position, thanks in part to USA economic dominance coming out of WW2, which devastated the economies of other advanced countries but left ours unscathed. It had the wealth to fund generous pensions. But that couldn't last forever, and when countries like Japan and Germany regained their footing, and when China emerged from behind its communist wall, competition eroded its market share. US Steel went from being the biggest, richest company in the world to being what it is today, the #24 steel producer in the world, barely an afterthought in today's economy. But the promises made have endured, even as the conditions that created them haven't.

You and I are old enough to remember when US Steel and GM were dominant firms. GM and US Steel, back in the 60s and 70s they were the Google and Apple of the economy, famous firms, larger than life companies. But huge pension costs have reduced them.Today, US Steel has almost 7 retirees for every one working employee. GM has a unfunded pension obligation of $18 Billion.

Remember Sears? When you and I and JR were young, they were the Walmart of their day, everyone shopped at Sears. Sears of course has been in the dumpster for years, a shadow of themselves, and yet last year, they had to sell property and close stores in order to fund $400m for their legacy pension plan, pension promises made 30+ years ago when Sears could seemingly afford them. That's money desperately needed to try and turn around the business, but it goes to pensions instead. That obviously can't go on.

Defined benefit plans try to do the impossible: Guarantee something that logically cannot be guaranteed, because no company can know how well it is going to compete in the market, the source of its profits, nor can it guarantee how well its pension fund assets will perform as investments, which is the source of the pension benefits. Yet, even if company revenues and profits fall, or even if pension plan assets don't generate the expected ROI, it is still obligated to somehow pay the pension promise. That's untenable, no matter how desirable it might be. It seriously harms the business, as money that could be invested in new products, technologies, etc. has to be used to shore up the pension plan.

For the public sector, the pension costs are on the backs of the taxpayer. In 1999, when California significantly boosted its pension benefits, those enacting it said that over the next 10 years, it would not cost taxpayers anything. In fact, taxpayers had to kick in an extra $18 billion, and that figure has grown. Just last year, taxpayers had to kick in $6.5 Billion to make up the difference in what was projected by the pension fund and what was realized. There is no end in sight to this.

My thoughts are entirely more basic than that.

Any company that doesn't take care of its employees deserves to go bankrupt.

As far as U.S. Steel is concerned, when I working summers in the rolling mills at the Clairton Works near Pittsburgh in the late Seventies while in college, the mills were using late Nineteenth/early Twentieth Century technology, while we were helping Germany and Japan build more modern mills.

Instead of investing in steel mill technology, U.S. Steel was buying Marathon Oil and becoming USX.

I don't buy that pensions and worker's wages were the cause of U.S. Steel's relative demise.

(04-25-2018 05:30 AM)TerryD Wrote:  

(04-23-2018 02:00 PM)JRsec Wrote:  

(04-23-2018 01:13 PM)BadgerMJ Wrote:  

(04-23-2018 12:50 PM)JRsec Wrote:  

(04-23-2018 12:15 PM)quo vadis Wrote:  According to this article, former Oregon football coach Mike Belloti (1995 - 2008 as HC, 21 years total) is drawing a pension of $46,000*.

Seems like over-generous pension costs are squeezing budgets in many states, which in turn is squeezing university budgets, including for athletics:

https://www.nytimes.com/2018/04/14/busin...regon.html

* per MONTH.

1. Young people will likely never see a pension. Most of the state jobs are shifting to 401K's for the newer employees and are phasing out pensions.

2. Those who stayed employed for 30 to 35 years in jobs that traditionally pay less than than their corporate counterparts made a lifelong decision that was a trade off. They traded higher earning potential for end of life security. That needs to be honored.

3. The problem will die out. Boomers started retiring in large numbers in 2010. The last of the boomers will be retiring in 2028 but the tail end of the boom is not the bulge in the snake. Most of the bulge were born prior to '55 and will be retired by 2020. So by 2035 natural causes will have taken care of the largest % of this fiscal liability. And that's a very cautious estimate because it lumps the average life expectancy of men and women at 80 years which of course it isn't that high.

4. The short term attention on pension plans is in the news because it is in many states a protected fund that has not been raided to support bureaucratic wasteful programs or provide raises for current state workers at the expense of the retired.

So I don't fall for a lot of this hype. Does it create a budgetary crunch? Yes. But in many cases that yes is qualified because outflow to pay pensions comes out of funded account so it really doesn't create a "budget" crunch because the funds are earmarked. However in states, like Kentucky, where the pension plan has already been raided to pay for other state projects then heck yeah, honoring those commitments is coming at the expense of the current budget, but then that's not the fault of the retirees, but of rather it is the fault of crooked politicians who raided a long term fund for short term political gains.

So while it might affect what states can appropriate for higher education, in states where this is critical the reason is almost always traceable back to some hack political move to buy short term support at the expense of those who would serve well past the terms of those who passed them and robbed the fund in the first place.

What we should do is confiscate all of the personal property of those who were serving when the funds were raided. That would be justice.

Stupid people get you killed. This is why you should never elect shortsighted feel good types to public office. They are inherently self serving and therefore stupid.

Those pension costs are putting a squeeze on entire states, not just state universities.

It's a tricky situation. On one hand, it isn't the retirees fault crooked politicians stole from their fund. At the same time, it isn't the fault of the hardworking taxpayer who paid in good faith every year.

It's going to have to come down to a choice. Either, in the case of someplace like Illinois, stick it to the taxpayer to the tune of another few BILLION or cut back on the pensions that were promised. My vote? You HAVE to cut back on pensions. It's no different than people who lost their proverbial backsides when the market crashed in 2007. Wasn't their fault others were crooked, yet they lost. Same level should apply to pensioners.

I do like your idea about going after the politicians, but I'd add let's also go after people who benefited from stealing from pensions funds. Any programs/agencies who's funding came from those shady dealings and those who took advantage of said programs/agencies.

There is a huge difference (see your bolded statement).

1. People delegated their right to manage their own portfolios in the crash of '07. Pensioners have money set aside for their retirement and never had the option to manage their own portfolios.

2. Most of those who lost money in '07 were also people who were still working age. Pensioners are not.

3. If a company mismanages your 401k you can change companies. You can't change your state government.

Most states gave you no choice but to contribute and then they control the funding and you can't switch. These are major differences. I lost 35% in equities in '07. But I managed my own risk fund which was in commodities. Therefore my net loss in '07 was less than 5%.

Had I been in retired in '07 it would have been ruinous. The added cost of health care at retirement is significant.

You need to do some serious evaluation here. What states should do when they run in the red is freeze wages, freeze hiring (except where crucial), and cut back utilizing a % of proration. All states waste way too much on crony job perks, and lack of oversight within the budget. The last place you should cut back is on those whose service length was 30 plus years of their lives and who have reached an age where in most cases work is no longer a feasible option.

I will place this curse upon you however. If you choose to cut out the earned benefits of a lifetime on those too old to replenish them by other means, then may the same fate befall your household when you are at that age. It's called karma.

JR, you are right. We do agree on a lot of things.

We are both old enough to recall the old "social contract". An employee gave his loyalty to the company and worked there for thirty years. In return, the employer fully funded a pension for the employee.

In my opinion, one of the biggest con jobs occurred when the employers broke that social contract and sold the employees a bill of goods ("Here is a 401k, you can invest in the stock market and make a ton of money") which shifted the pension burden from the employer on to the backs of the employees.

I remember my Dad working for years for U.S. Steel near Pittsburgh and retiring comfortably for eighteen years on a company pension, Social Security and Black Lung benefits (he was a coal miner before working for U.S. Steel).

He did not contribute to his pension but gave the company years of his work life in return for it.

Terry the bill of goods that these young people have been sold, and mostly by the politics of division, which in this case is that "you must rob from the old because they are limiting the young", is a pernicious evil that divides families today, but more importantly will leave our children and their children in penury. Corporations have bought government and in so doing will once again move us into the era of the "Company Store" only this time around the slavery will shift from low wages and the high cost of supplies at the company store, to low wages and the forfeiture of everything to the debt of a nation which doesn't hold the corporations that buy them off accountable for their fair share of the taxes. They've given the corporations the rights that citizens have as individuals, but without the liability of individuals. Therefore the end game is that those who benefit the most from government (the entities that contribute the most to campaigns) glean the most and their tab is paid for by those least capable of sustaining the burden.

Taken in a panoramic view, the future for our people is more bleak than the time in our past when the worst atrocities were committed by companies in the industrial era. What our kids will face will be relatively low wages versus the rising cost of living, followed by a gap in insurance that will drain their golden years of any luster. They will continue to work harder and longer for less than any preceding American generation and will do so without the ability to organize in a productive way.

It's one reason why I hope when my time comes it is quick. That way my kids will receive, at a time when they are beginning to hit their tougher years, at least some form of benefit from the labor of my life beyond our relationship.

BTW: You are dead right about the 401k which now faces the threat of being annuitized and subtracted from your social security dividend. Companies are pushing for this because that way they keep the principal and can borrow against it and use it as leverage and the spouse of the employee receives only 75% of the annuity payout for their life, and the kids get nothing while the corporation keeps the principal upon the death of the spouse. So the greedy bastards not only eliminated pensions, but find a way to keep anything they might have paid in matching funds by making this move.

(04-25-2018 11:50 AM)JRsec Wrote:  

(04-25-2018 05:30 AM)TerryD Wrote:  

(04-23-2018 02:00 PM)JRsec Wrote:  

(04-23-2018 01:13 PM)BadgerMJ Wrote:  

(04-23-2018 12:50 PM)JRsec Wrote:  1. Young people will likely never see a pension. Most of the state jobs are shifting to 401K's for the newer employees and are phasing out pensions.

2. Those who stayed employed for 30 to 35 years in jobs that traditionally pay less than than their corporate counterparts made a lifelong decision that was a trade off. They traded higher earning potential for end of life security. That needs to be honored.

3. The problem will die out. Boomers started retiring in large numbers in 2010. The last of the boomers will be retiring in 2028 but the tail end of the boom is not the bulge in the snake. Most of the bulge were born prior to '55 and will be retired by 2020. So by 2035 natural causes will have taken care of the largest % of this fiscal liability. And that's a very cautious estimate because it lumps the average life expectancy of men and women at 80 years which of course it isn't that high.

4. The short term attention on pension plans is in the news because it is in many states a protected fund that has not been raided to support bureaucratic wasteful programs or provide raises for current state workers at the expense of the retired.

So I don't fall for a lot of this hype. Does it create a budgetary crunch? Yes. But in many cases that yes is qualified because outflow to pay pensions comes out of funded account so it really doesn't create a "budget" crunch because the funds are earmarked. However in states, like Kentucky, where the pension plan has already been raided to pay for other state projects then heck yeah, honoring those commitments is coming at the expense of the current budget, but then that's not the fault of the retirees, but of rather it is the fault of crooked politicians who raided a long term fund for short term political gains.

So while it might affect what states can appropriate for higher education, in states where this is critical the reason is almost always traceable back to some hack political move to buy short term support at the expense of those who would serve well past the terms of those who passed them and robbed the fund in the first place.

What we should do is confiscate all of the personal property of those who were serving when the funds were raided. That would be justice.

Stupid people get you killed. This is why you should never elect shortsighted feel good types to public office. They are inherently self serving and therefore stupid.

Those pension costs are putting a squeeze on entire states, not just state universities.

It's a tricky situation. On one hand, it isn't the retirees fault crooked politicians stole from their fund. At the same time, it isn't the fault of the hardworking taxpayer who paid in good faith every year.

It's going to have to come down to a choice. Either, in the case of someplace like Illinois, stick it to the taxpayer to the tune of another few BILLION or cut back on the pensions that were promised. My vote? You HAVE to cut back on pensions. It's no different than people who lost their proverbial backsides when the market crashed in 2007. Wasn't their fault others were crooked, yet they lost. Same level should apply to pensioners.

I do like your idea about going after the politicians, but I'd add let's also go after people who benefited from stealing from pensions funds. Any programs/agencies who's funding came from those shady dealings and those who took advantage of said programs/agencies.

There is a huge difference (see your bolded statement).

1. People delegated their right to manage their own portfolios in the crash of '07. Pensioners have money set aside for their retirement and never had the option to manage their own portfolios.

2. Most of those who lost money in '07 were also people who were still working age. Pensioners are not.

3. If a company mismanages your 401k you can change companies. You can't change your state government.

Most states gave you no choice but to contribute and then they control the funding and you can't switch. These are major differences. I lost 35% in equities in '07. But I managed my own risk fund which was in commodities. Therefore my net loss in '07 was less than 5%.

Had I been in retired in '07 it would have been ruinous. The added cost of health care at retirement is significant.

You need to do some serious evaluation here. What states should do when they run in the red is freeze wages, freeze hiring (except where crucial), and cut back utilizing a % of proration. All states waste way too much on crony job perks, and lack of oversight within the budget. The last place you should cut back is on those whose service length was 30 plus years of their lives and who have reached an age where in most cases work is no longer a feasible option.

I will place this curse upon you however. If you choose to cut out the earned benefits of a lifetime on those too old to replenish them by other means, then may the same fate befall your household when you are at that age. It's called karma.

JR, you are right. We do agree on a lot of things.

We are both old enough to recall the old "social contract". An employee gave his loyalty to the company and worked there for thirty years. In return, the employer fully funded a pension for the employee.

In my opinion, one of the biggest con jobs occurred when the employers broke that social contract and sold the employees a bill of goods ("Here is a 401k, you can invest in the stock market and make a ton of money") which shifted the pension burden from the employer on to the backs of the employees.

I remember my Dad working for years for U.S. Steel near Pittsburgh and retiring comfortably for eighteen years on a company pension, Social Security and Black Lung benefits (he was a coal miner before working for U.S. Steel).

He did not contribute to his pension but gave the company years of his work life in return for it.

Terry the bill of goods that these young people have been sold, and mostly by the politics of division, which in this case is that "you must rob from the old because they are limiting the young", is a pernicious evil that divides families today, but more importantly will leave our children and their children in penury. Corporations have bought government and in so doing will once again move us into the era of the "Company Store" only this time around the slavery will shift from low wages and the high cost of supplies at the company store, to low wages and the forfeiture of everything to the debt of a nation which doesn't hold the corporations that buy them off accountable for their fair share of the taxes. They've given the corporations the rights that citizens have as individuals, but without the liability of individuals. Therefore the end game is that those who benefit the most from government (the entities that contribute the most to campaigns) glean the most and their tab is paid for by those least capable of sustaining the burden.

Taken in a panoramic view, the future for our people is more bleak than the time in our past when the worst atrocities were committed by companies in the industrial era. What our kids will face will be relatively low wages versus the rising cost of living, followed by a gap in insurance that will drain their golden years of any luster. They will continue to work harder and longer for less than any preceding American generation and will do so without the ability to organize in a productive way.

It's one reason why I hope when my time comes it is quick. That way my kids will receive, at a time when they are beginning to hit their tougher years, at least some form of benefit from the labor of my life beyond our relationship.

Amen and amen.

As a person who greatly admired Jack Kemp (the politician, he retired from football before I was old enough to remember his playing) and Ronald Reagan, I want to share a Reagan story.

Reagan was attending an event honoring the life and service of FDR. A person asked him why he was going since he was trying to undo what FDR did. Reagan replied, "I want to save the New Deal, it's the Great Society, I want to overturn."

Younger people who carry the mantle do not understand the mindset of the Depression era generations vision of conservatism. They had a strong belief in the collective good. They believed in publicly built highways and airports and harbors and waterways. Those things created greater efficiency by removing obstacles to capitalists.

They understood the great need for public assistance, they just tended to couch it in a two-way contract. The citizen would attempt to labor and the government would insure they did not languish in abject poverty. With the exception of the diehards, Social Security was an essential element of the social contract insuring that the worker was not left destitute when he could no longer work. They invested heavily in public education, K-12, vocational, and college.

The person who grew up under that social contract could work full time for three months in the summer and maybe take a part-time job and in four years walk across the stage to pick up a diploma they had paid for with little to no parental assistance because the government had covered the additional costs. If they had served in the military, the government covered their educational costs and either their check from reserve or guard duty or part-time work covered their living expenses.

If you wanted to become a welder or plumber or work on furnaces before AC became the norm or learn to repair automobiles, you could go to a vocational school paid for by the government with little or even no cost to learn those trades. Or you sought out someone in the local union to sponsor you in so you could become an apprentice and learn what you needed to do to become skilled as an electrician or pipe fitter or whatever. You got paid to learn. You made less than the skilled and experienced guys, but you drew a paycheck to learn your trade.

We didn't include medical care in the social contract because medical care by and large was cheap. When I was born, a person working minimum wage would have needed 2 to 4 weeks salary to pay the doctor and the hospital even with the then normal one week stay at the hospital for a C-section. Today a normal delivery at a hospital will cost a minimum wage worker 88 weeks of salary.

The GOP controlled and later Democrat controlled Congress when Truman was president, rejected the idea of a national health insurance plan because health coverage was affordable for most Americans and roughly a third of all private sector employees were in unions that typically negotiated for health insurance. At the time, the Federal workforce was a much larger percentage of the national workforce, they were covered by health insurance as well. Most state, county, city, and school employees were covered. Those who lacked insurance could generally afford all but the worst expenses out-of-pocket and the charitable hospitals were much more "charitable" than today. They offered a much lower standard of care, but that was true of the standard of care for everyone.

My parents had health insurance but like everyone else, all my vaccinations were received either at the county health clinic or on special days when the nurse would come to the school and vaccinate us in a cattle call. Doctors didn't even stock most vaccinations because why would anyone pay a doctor's office for the shot when you could get the shot your tax dollars paid for just down the street?

Conservatives rejected national health coverage because the system was working extremely well.

We've lost our way.

Many of the European and Asian nations now out-America America.

The public at-large pays a tax bill roughly equivalent to what we paid when Eisenhower or Nixon was in office and they deliver very similar education benefits, vocational training, old age benefits, and the other benefits like paid leave that everyone loved when unions were relevant in the US.

They adapted health care into the social contract out of need. The people were broke and often unemployed in the ruined cities, so as a matter of public safety, they found varying means to deliver health care because their system was not working. With few able to pay doctors and hospitals, they were in danger of losing the entire medical infrastructure.

They slashed their business taxes across the board. The Mom&Pop operation was generally paying the same percentage of income in taxes as their largest nation-wide serving competitor.

Those (generally) low business tax rates and shifting or limiting the burden of medical coverage, and unemployment insurance and old age benefits from the employer to the worker's tax bill helped make them more competitive internationally.

We have no analogy in the US to the common form of unemployment in Northern Europe. We don't mandate that a person come in and take classes or participate in training or perform basic office tasks for the unemployment office for a minimum number of hours a week. We do little to give incentive to employers to hire from the unemployment rolls. But then again we offer our unemployed a significantly smaller and shorter coverage period. It would be a bit unseemly I suppose to ask much in return.

In the US we have created a monster. We deem Bass Pro Shops offering minimum and near minimum wage jobs "tourist attractions" and cut their tax bill and dare the locally owned business to compete, we chide the locally owned business that then fails for failing to be efficient and failing to adapt to the times and pretend that the government isn't part of the reason Bass Pro could undercut them on price by artificially lowering their overhead.

I desperately want to leave PA because of how the state allows Penn State to draw from the state pension despite it not being a fully public institution. Everything is suffering here because of the drain from those now cashing in on their pension eligibility, especially education, which used to be something of which Pennsylvanians could be most proud. PA is pretty bad because of stuff like this...Penn State is a f'n monster, and the state refuses to cut them off. A big problem that came with the "boom times" of the 60's through 80's when the plan was a way to attract and retain a workforce that couldn't compete salary-wise head-to-head with the private sector. And back when collective bargaining could arrange some pretty ridiculous deals and terms.

In some states, enrollment in some program is mandatory for public sector workers (like in NJ).

(04-25-2018 12:36 PM)arkstfan Wrote:  In the US we have created a monster. We deem Bass Pro Shops offering minimum and near minimum wage jobs "tourist attractions" and cut their tax bill and dare the locally owned business to compete ...

Bass Pro gets the unfair tax breaks from these towns in the south for the same reason that most G5 schools soak their students with fees to fund FBS football teams: Irrational pride.

Just as the G5 school wants think of itself as "big time" despite the obvious waste of student fees to fund the "FBS" trappings of a football program it can't afford and paying coaches $400,000 to play games in front of 14,000 fans, even though nobody outside of their campus is fooled, a town that lures a Bass Pro with tax breaks can puff its chest out at having acquired one of these things, which is a Big Deal in their rural world, they can strut it in front of the neighboring towns that don't have one. It marks them (in their minds) as an ambitious, striver, Town on the Rise, even as their taxpayers bend under the burden, much like soaking student fees to pay for shiny helmets and FBS does for the directional G5.

Beyond that, I'm not sure what you're arguing for here. Is it completely socialized medicine? If you are worried that the USA is too individualistic now compared to the past (seriously? What would Abraham Lincoln or John Adams think of a federal Medicare program?), then salve your conscience by reminding yourself that (a) Medicare is the biggest collectivist social program in the history of mankind, and (b) the USA is doing its part to sacrifice for the global common good, because at least one advanced country has to have a semi-capitalist health system. If everyone had "single payer", medical knowledge would fall off, because it's the USA's capitalistic system, with greedy doctors and greedier Big Pharma companies, that develop the majority of medical breakthroughs. Socialistic systems don't because there's no profit in doing so.

So feel good that our high drug prices with some people going without (inevitable under capitalism) allow Canada and the UK and Sweden to have low prices and cover everyone for "free", and with drugs that actually work to kill things inside of us.

The biggest difference in our medicine compared to the "collectivist" days of the Social Contract is how much more our medicine can do compared to then. More than any other reason, our medical costs are high because it costs a lot money to figure out how to kill dangerous diseases and the like, and because of the incredible pile of FDA regulations that must be hurdled to get approval for market. That's the main reason, and there's no way around that, unless you are happy with where medicine is now in terms of what it can do to improve human life.

(04-25-2018 07:45 PM)quo vadis Wrote:  

(04-25-2018 12:36 PM)arkstfan Wrote:  In the US we have created a monster. We deem Bass Pro Shops offering minimum and near minimum wage jobs "tourist attractions" and cut their tax bill and dare the locally owned business to compete ...

Bass Pro gets the unfair tax breaks from these towns in the south for the same reason that most G5 schools soak their students with fees to fund FBS football teams: Irrational pride.

Just as the G5 school wants think of itself as "big time" despite the obvious waste of student fees to fund the "FBS" trappings of a football program it can't afford and paying coaches $400,000 to play games in front of 14,000 fans, even though nobody outside of their campus is fooled, a town that lures a Bass Pro with tax breaks can puff its chest out at having acquired one of these things, which is a Big Deal in their rural world, they can strut it in front of the neighboring towns that don't have one. It marks them (in their minds) as an ambitious, striver, Town on the Rise, even as their taxpayers bend under the burden, much like soaking student fees to pay for shiny helmets and FBS does for the directional G5.

Beyond that, I'm not sure what you're arguing for here. Is it completely socialized medicine? If you are worried that the USA is too individualistic now compared to the past (seriously? What would Abraham Lincoln or John Adams think of a federal Medicare program?), then salve your conscience by reminding yourself that (a) Medicare is the biggest collectivist social program in the history of mankind, and (b) the USA is doing its part to sacrifice for the global common good, because at least one advanced country has to have a semi-capitalist health system. If everyone had "single payer", medical knowledge would fall off, because it's the USA's capitalistic system, with greedy doctors and greedier Big Pharma companies, that develop the majority of medical breakthroughs. Socialistic systems don't because there's no profit in doing so.

So feel good that our high drug prices with some people going without (inevitable under capitalism) allow Canada and the UK and Sweden to have low prices and cover everyone for "free", and with drugs that actually work to kill things inside of us.

The biggest difference in our medicine compared to the "collectivist" days of the Social Contract is how much more our medicine can do compared to then. More than any other reason, our medical costs are high because it costs a lot money to figure out how to kill dangerous diseases and the like, and because of the incredible pile of FDA regulations that must be hurdled to get approval for market. That's the main reason, and there's no way around that, unless you are happy with where medicine is now in terms of what it can do to improve human life.

Sure we can "do more" but other nations do much better.
Number one in health care spending per capita
39th in infant mortality
43rd in adult female mortality
42nd in adult male mortality
36th in life expectancy
Medical bills are a significant factor in about half of all bankruptcies
https://www.cnbc.com/id/100840148

Please feed us more talking points about how great the system is working.

The Europeans, Canadians, Australians, etc..... are certainly in no hurry to copy our healthcare system.

I think that we will end up with their system.

Our profit driven system for doctors, drug companies and hospitals, with an additional profit layer built in for insurance companies, drives up the costs too much.

My money is on single payer, Medicare for all being enacted here in the early 2020's.

(04-26-2018 06:39 AM)TerryD Wrote:  The Europeans, Canadians, Australians, etc..... are certainly in no hurry to copy our healthcare system.

I think that we will end up with their system.

Our profit driven system for doctors, drug companies and hospitals, with an additional profit layer built in for insurance companies, drives up the costs too much.

My money is on single payer, Medicare for all being enacted here in the early 2020's.

The US has been moving toward slowly but surely toward socialism since the 1940's.

(04-24-2018 02:51 PM)JRsec Wrote:  

(04-24-2018 01:27 PM)BadgerMJ Wrote:  

(04-23-2018 08:31 PM)JRsec Wrote:  

(04-23-2018 02:27 PM)BadgerMJ Wrote:  

(04-23-2018 02:00 PM)JRsec Wrote:  There is a huge difference (see your bolded statement).

1. People delegated their right to manage their own portfolios in the crash of '07. Pensioners have money set aside for their retirement and never had the option to manage their own portfolios.

2. Most of those who lost money in '07 were also people who were still working age. Pensioners are not.

3. If a company mismanages your 401k you can change companies. You can't change your state government.

Most states gave you no choice but to contribute and then they control the funding and you can't switch. These are major differences. I lost 35% in equities in '07. But I managed my own risk fund which was in commodities. Therefore my net loss in '07 was less than 5%.

Had I been in retired in '07 it would have been ruinous. The added cost of health care at retirement is significant.

You need to do some serious evaluation here. What states should do when they run in the red is freeze wages, freeze hiring (except where crucial), and cut back utilizing a % of proration. All states waste way too much on crony job perks, and lack of oversight within the budget. The last place you should cut back is on those whose service length was 30 plus years of their lives and who have reached an age where in most cases work is no longer a feasible option.

I will place this curse upon you however. If you choose to cut out the earned benefits of a lifetime on those too old to replenish them by other means, then may the same fate befall your household when you are at that age. It's called karma.

People may have relegated the management of their portfolios to an investment company, but that didn't agree to allowing the entire financial system to be mismanaged by a few divisions of large institutions. It would be one thing if they ignored their fund and it lost money, it's a completely different story when ALL funds were devastated. There were MANY people who were only a few years away from retirement that had their entire savings destroyed. A person at 62 can't make that up quickly, unless you're OK with them basically having to work until they die.

The answers going forward are simple. One would be to take an Elastrator to the public unions. Once that's done, states can transition employees to 401ks. Another step would be to take a page from SS and raise the minimum age. Many states allow retirement as young as 55. That means that some would be able to collect for as long or longer than than paid in. Raise it to at least 62, go from there.

To answer your question, I'd turn the curse back upon you. The piper will need to be paid regardless. Sounds to me like you're advocating that those funds be guaranteed as well as payouts. The only way to make that happen in many places would be for taxes to skyrocket. You can only raise income taxes so much so the next step would be property taxes or sales taxes. I can't in good conscious ask people who paid taxes for years in good faith and managed to save enough for something like a home to lose said home because they can no longer afford the increased property taxes. Sorry, I won't kick people out of their homes to pay pensions. I won't force people to sell because they can no longer afford to stay in their family home. I won't make people choose to forsake some of life's pleasures because they can't afford to pay the sales tax on top of their purchase. People shouldn't have to live to pay the government.

My hope is that you never have to experience the karma of a family member losing a home, being kicked off their property, or forced to sell a business because their state decided to choose pensions over regular people who've done nothing wrong besides save for a house or start a business.

Extremely specious. Property taxes in most states don't exceed the value of two house payments if that. Family businesses? Big Box built in, and bought and paid for, tax advantages killed family business years ago. Sales Tax? Every Big Name chain that locates in your community gets to keep the state portion of the sales tax until their building is paid for, and when that happens they usually close that location, keep the now valuable commercial property and build a new store 2 miles down the road where they again get to keep the state portion of the sales tax until it too is paid for essentially by the public.

And those houses that were lost in too big to fail? Well the banks double dipped on those. Banks can't hold and sell real property unless they have to foreclose. During the '07-'08 crisis the taxpayers picked up the tab on the defaulted homes, and when the banks were bailed out those banks foreclosed those homes that the tax payers essentially paid for and then resold them collecting the resale value in addition to the bailout. It was criminal what happened. But when your outgoing president and the president elect scream crisis and say to do it the public gets hosed every time and not by pensioners, but by the elected officials.

I don't know where you live, but in Illinois for example (where I have family), an average family home will cost you upwards of $10-15k per year in property taxes. Not small castles, but average homes. I'm sorry, but $200 per week just for property taxes is insane. An average sized business sitting on a couple acres in the burbs will run you closer to $50-60k in taxes, not including what they pay in "business taxes".

The thing that politicians will eventually figure out is that "income" is fluid. The "rich" most likely have the resources to either move to a lower tax state or claim residency in a place like Florida. They can only raise income taxes so much before too many people take that option. They'll figure out that property can't move and in order to make those feeding at the trough happy, they'll bleed property owners dry. I have a real problem when a state forces a property owner to pay at that level just for owning a track of land.

Everyone knows the tax game when it comes to "development" and TIF districts. The reason politicians do that is because the public usually WANTS Walmart or Costco to move in. They'll trade some tax "benefits" to have easy access to shopping, restaurants, etc. They'll trade some tax benefits to "rejuvenate" areas. Hell, in my town, they even did it to make the downtown look pretty. Having one's cake and being able to eat it too isn't mutually exclusive to politicians and corporations.

BTW, just because a saying comes from a fictional character of an alien species doesn't make it less relevant or truthful.

Your property taxes are high to make up for the lost revenue in the perks given to the Big Box stores. And guess what? Those guys buying those perks get to open their doors with a 13 point advantage over Mom and Pop who pay all of their taxes and once kept community emergency personnel and schools funded without having to raise the property taxes. And another perk given those chains is a 50% reduction in, drum roll please, local property taxes.

Your thinking is backasswards here bud. The high taxes exist because of crooked politics that allowed privately owned business to be run out of town by phony cheaper prices made possible by that 13 point advantage in tax structure and overhead gifted to these chains who run sweat shops overseas which put even more Americans out of business and which are located where they are not only for cheap wages, but to avoid paying taxes in the good ole U.S.A.

Nobody has magically figured out how to market a cheaper widget here. But they have figured out how to get you to pay more for it in the long run while putting a cheaper price tag on it up front. It's called deferring costs. Their tax cost has been deferred to you and your neighbor courtesy the greased palms of local and state officials.

My generation recognized it as the white collar mafia. The extortion is the same, but now instead of kneecapping you if you don't pay protection they get your elected officials to do it for them in your wallet.

By the way your slogan from Spock was printed on the edge of the German 5 Marks piece making its appearance on that coin only during the years of Adolf Hitlers Regime. It was a slight variation but in English it essentially stated "Country before the Citizen" or "The Collective before the Individual" which is just another way of saying The many before the few". That tenet is anathema to our Founding Fathers. Because in the name of the rights of the many all individual rights and property are forfeit to the realm. Which of course means that those who speak for the many "the Royal family, or dictator" gets to claim everything you have in the name of the many.

So your argument not only fails as to that quote, but is at its heart, anti-American in nature. But I do not believe that you mean it that way. It's one of those things that sounds right, but historically it has been used to commit some of the worst atrocities. BTW: It is a tenet of Communism as well as Socialism.

By that tenet 10 hungry people standing outside of your home have the right to invade and steal your food. There are more of them and they are in need. I don't think you mean that either. Now Spock used it in a sacrificial way. Would you or I give our lives to save many, especially if they were family and friends? Yes. But that is an individual's choice, not something that government could or should compel you to do.

Your explanation might be partially correct for your average burb, but that doesn't explain small rural towns or large cities. Large cities do just about everything they can to keep the Walmarts of the world outside their city limits. With small rural communities, even if a "big box" moves in, that isn't going to have that drastic an effect on the rest of the community. Opening a Dollar General isn't going to cause a financial crisis or require raising taxes. Perfect example. We used to have one of those "Mom & Pop" grocery stores where everyone went. A Super Walmart moved in. My favorite OJ was $1.50 cheaper at Wallyworld. SAME OJ, same size. Not a "cheap import". SO that begs the question. Is Walmart REALLY getting $1.50 per OJ bottle in "tax benefits" or is the truth that "Mom & Pop" had been sticking it up our backsides for years.

The REAL problem is HOW government and it's entities spend money. The largest percentage of my property tax bill comes from schools. You'd think that a group that's based on "education" would be smarter when it comes to finances. Many districts just plain caved to the unions for decades and gave away the store. Increasing benefits while not requiring those receiving those benefits to "pay more in" resulted in ever increasing obligations. But hey, who cares, they can just raise taxes. Schools (especially around here) are notorious for building for the sake of building. It's no longer good enough to just build a school, those schools MUST be mack-daddy Taj Mahals. But once again, hey, what's a few extra million in tax dollars among friends. Makes me wonder how many "pensions" could be covered if Susie didn't need a golden toilet seat to sit on.

The government pension system was NEVER going to be sustainable, especially when school boards have been kowtowing to teachers unions forever. You can't keep guaranteeing full pensions PLUS medical coverage. Getting older means getting more expensive. It's a perfect example of a ponzi scheme, unfortunately the tax payer is at the bottom of that scheme. So we know that all this is going to come to a head. The question STILL is will we make changes to the system for the future and will we make changes to the current system to meet reality. OR... Will we just keep the status quo and fall back on the tried & true "just raise taxes".

I take offense at the "Un-American" comment. I can spin it in a different direction. The needs of the many can be restated as "the majority rules". One of the corner stones of a democracy or a representative republic is the concept that the will of the majority is used in deciding up/down, yeah/nay, etc. The minority (the few) has it's say and its rights, but in the end, the will of the majority (the many) is what's used to decide. There are MANY laws I don't agree with and frankly think should be changed, but the reality is that the majority of the people elected representatives who voted for those laws which were passed. My opinion/belief/needs were trumped. Whether I "like" a law is irrelevant. The onus on on ME and people who believe as I do to change the minds of the majority and vote for those who agree. If I/we can't, then we're STILL required to abide by what the majority ruled.

(04-26-2018 12:39 AM)arkstfan Wrote:  

(04-25-2018 07:45 PM)quo vadis Wrote:  

(04-25-2018 12:36 PM)arkstfan Wrote:  In the US we have created a monster. We deem Bass Pro Shops offering minimum and near minimum wage jobs "tourist attractions" and cut their tax bill and dare the locally owned business to compete ...

Bass Pro gets the unfair tax breaks from these towns in the south for the same reason that most G5 schools soak their students with fees to fund FBS football teams: Irrational pride.

Just as the G5 school wants think of itself as "big time" despite the obvious waste of student fees to fund the "FBS" trappings of a football program it can't afford and paying coaches $400,000 to play games in front of 14,000 fans, even though nobody outside of their campus is fooled, a town that lures a Bass Pro with tax breaks can puff its chest out at having acquired one of these things, which is a Big Deal in their rural world, they can strut it in front of the neighboring towns that don't have one. It marks them (in their minds) as an ambitious, striver, Town on the Rise, even as their taxpayers bend under the burden, much like soaking student fees to pay for shiny helmets and FBS does for the directional G5.

Beyond that, I'm not sure what you're arguing for here. Is it completely socialized medicine? If you are worried that the USA is too individualistic now compared to the past (seriously? What would Abraham Lincoln or John Adams think of a federal Medicare program?), then salve your conscience by reminding yourself that (a) Medicare is the biggest collectivist social program in the history of mankind, and (b) the USA is doing its part to sacrifice for the global common good, because at least one advanced country has to have a semi-capitalist health system. If everyone had "single payer", medical knowledge would fall off, because it's the USA's capitalistic system, with greedy doctors and greedier Big Pharma companies, that develop the majority of medical breakthroughs. Socialistic systems don't because there's no profit in doing so.

So feel good that our high drug prices with some people going without (inevitable under capitalism) allow Canada and the UK and Sweden to have low prices and cover everyone for "free", and with drugs that actually work to kill things inside of us.

The biggest difference in our medicine compared to the "collectivist" days of the Social Contract is how much more our medicine can do compared to then. More than any other reason, our medical costs are high because it costs a lot money to figure out how to kill dangerous diseases and the like, and because of the incredible pile of FDA regulations that must be hurdled to get approval for market. That's the main reason, and there's no way around that, unless you are happy with where medicine is now in terms of what it can do to improve human life.

Sure we can "do more" but other nations do much better.
Number one in health care spending per capita
39th in infant mortality
43rd in adult female mortality
42nd in adult male mortality
36th in life expectancy

Let me guess: We're ranked behind 40 or so countries most of whom are either (a) smaller than the Greater Atlanta area or (b) ethnically and culturally homogeneous. There's a big issue of scale here, let's see a country with 5 million people or 50 million do it when they have 330 million.

And you don't address the most salient thing about a health system, which isn't cost, its what it can do. If I have cancer and am going to die from it, I wlll gladly go bankrupt, clean out all my accounts, mortgage the house, sacrifice my retirement money etc. to pay for a treatment that will save my life. If such a treatment doesn't exist, it doesn't help me if it's true that if it *did* exist, I'd be financially fine because the government-run medical system would pay for it for me.

“U.S. medical research remains the primary global source of new discoveries, drugs, medical devices, and clinical procedures,” said University of Rochester neurologist Ray Dorsey, M.D., M.B.A., a co-author of the study.

When Sweden, the UK, and Canada start making the treatment breakthroughs, then you can post UNESCO talking point statistics about them being better at health care than us.

(04-26-2018 08:40 AM)quo vadis Wrote:  When Sweden, the UK, and Canada start making the treatment breakthroughs, then you can post UNESCO talking point statistics about them being better at health care than us.

Admittedly I'm not well versed on the subject, but I am aware of two things.

1. National foundations like the NIH, NSF, etc. contribute billions of dollars annually to basic and applied research at universities which is then monetized by pharmaceutical companies. That's not to say that pharma doesn't do a lot of research because they do. However, they also spend more on marketing than research... so I'm not sure I'm ready to lay down and say that the breakthroughs are only possible if America "takes one for the team". http://www.latimes.com/opinion/op-ed/la-...story.html

2. I'm not sure socialized medicine is the "right" step, because honestly I don't know much about the pros and cons. However that's not to say that private medical care, insurance, and pharmaceutical companies can't co-exist with universal healthcare. Germany has a universal healthcare system and is also home to a little firm called Bayer. You might have heard of it. Germany is also home to Allianz, one of the worlds largest heath insurers.

(04-26-2018 09:24 PM)McKinney Wrote:  

(04-26-2018 08:40 AM)quo vadis Wrote:  When Sweden, the UK, and Canada start making the treatment breakthroughs, then you can post UNESCO talking point statistics about them being better at health care than us.

Admittedly I'm not well versed on the subject, but I am aware of two things.

1. National foundations like the NIH, NSF, etc. contribute billions of dollars annually to basic and applied research at universities which is then monetized by pharmaceutical companies. That's not to say that pharma doesn't do a lot of research because they do. However, they also spend more on marketing than research... so I'm not sure I'm ready to lay down and say that the breakthroughs are only possible if America "takes one for the team". http://www.latimes.com/opinion/op-ed/la-...story.html

2. I'm not sure socialized medicine is the "right" step, because honestly I don't know much about the pros and cons. However that's not to say that private medical care, insurance, and pharmaceutical companies can't co-exist with universal healthcare. Germany has a universal healthcare system and is also home to a little firm called Bayer. You might have heard of it. Germany is also home to Allianz, one of the worlds largest heath insurers.

For decades the only socialized medical system that has worked well is in New Zealand and it works there because of strict immigration policies. You may apply to immigrate and receive a 3 year visa. During that three years you have to bring a needed job skill to the country, or invest in a new kind of business (not a competing one) and you must be under 35 years of age (they may have amended that). That way before you reach your peak health need years you have paid into the system for 20 something years.

Open borders defeat socialized medicine systems. You can't have those who haven't paid in consuming health care that others are paying to support. Citizenship by virtue of birth on the soil of the nation isn't beneficial in this system either. In many countries, as was introduced here with the Affordable Care Act, some kinds of procedures and treatments are not available to the patient past certain ages. In heavily bureaucratic countries appointments may be scheduled months out (so if you don't have critical illness your fine otherwise the policy amounts to "we'll see you if you don't die first."

But in New Zealand with the controls in place care is accessible, of a good quality, and available to all who are citizens.

So if we can swallow the political pill to become more exclusive like New Zealand then we might be able to pull it off, that is if we can ditch the practice of large companies buying perks from the government. If not then it will be a bottomless pitt for the tax dollars to be tossed into and will provide far less care than what we presently have.

(04-26-2018 08:40 AM)quo vadis Wrote:  When Sweden, the UK, and Canada start making the treatment breakthroughs, then you can post UNESCO talking point statistics about them being better at health care than us.

Not one of the nations you listed, but my uncle went Switzerland in the late 70's in order to learn how to perform coronary angioplasty.

The biggest stem cell work is being done in Europe.

The basic research for laparoscopic surgery was done in Germany with the first human surgeries done in Sweden. The first laparoscopic organ resection was done at a teaching/research hospital in Sweden. First laparoscopic appendectomy was in Germany.

The Rh factor discovered in Austria.

The biggest breakthroughs in drugs to treat breast cancer (most notable Herceptin) came from a Swiss researchers. Gleevec another big cancer breakthrough partnered researchers at two facilities in the US, one in London and one in Milan.

The Journal of American Medicine found that in 2004 the US represented 57% of all medical R&D spending. By 2014 it had fallen to 44% because US spending has remained flat.

You really need to step back from the propaganda and take a hard look at what is really going on.

Japan and France top the US in cancer survival rates for some cancers, and Japan, France, Canada and Australia all rival the US in cancer survival rates.

The US has more variation in survival rates when comparing by race and income.

The US is very middling in survival of heart disease after diagnosis, more than twice the rate of France and three times the rate of Japan.

What people consistently fail to understand is that the UK (who performs poorly in a number of categories) is the rare true socialist medical system. Most providers in Canada, Japan, and Europe are for-profit, the doctors and hospitals are profit-driven. The government sets reimbursement rates, private insurers are common in many of those countries (in Germany anyone making over $67,000 is in private insurance and many employers provide private insurance to people making less).

Hospitals don't invest heavily in marketing. They don't have the large staff filing claims, they don't have large numbers of people calling to dun people to pay up. Two of the larger hospitals locally have made big investments recently. One created an all new atrium "to be a more inviting space" and another built a multi-million dollar courtyard with a fountain. All the sorts of things you do when you don't have shareholders to pay but are flush with cash.

(04-26-2018 10:59 PM)arkstfan Wrote:  

(04-26-2018 08:40 AM)quo vadis Wrote:  When Sweden, the UK, and Canada start making the treatment breakthroughs, then you can post UNESCO talking point statistics about them being better at health care than us.

Not one of the nations you listed, but my uncle went Switzerland in the late 70's in order to learn how to perform coronary angioplasty.

The biggest stem cell work is being done in Europe.

The basic research for laparoscopic surgery was done in Germany with the first human surgeries done in Sweden. The first laparoscopic organ resection was done at a teaching/research hospital in Sweden. First laparoscopic appendectomy was in Germany.

The Rh factor discovered in Austria.

The biggest breakthroughs in drugs to treat breast cancer (most notable Herceptin) came from a Swiss researchers. Gleevec another big cancer breakthrough partnered researchers at two facilities in the US, one in London and one in Milan.

The Journal of American Medicine found that in 2004 the US represented 57% of all medical R&D spending. By 2014 it had fallen to 44% because US spending has remained flat.

You really need to step back from the propaganda and take a hard look at what is really going on.

Japan and France top the US in cancer survival rates for some cancers, and Japan, France, Canada and Australia all rival the US in cancer survival rates.

The US has more variation in survival rates when comparing by race and income.

The US is very middling in survival of heart disease after diagnosis, more than twice the rate of France and three times the rate of Japan.

What people consistently fail to understand is that the UK (who performs poorly in a number of categories) is the rare true socialist medical system. Most providers in Canada, Japan, and Europe are for-profit, the doctors and hospitals are profit-driven. The government sets reimbursement rates, private insurers are common in many of those countries (in Germany anyone making over $67,000 is in private insurance and many employers provide private insurance to people making less).

Hospitals don't invest heavily in marketing. They don't have the large staff filing claims, they don't have large numbers of people calling to dun people to pay up. Two of the larger hospitals locally have made big investments recently. One created an all new atrium "to be a more inviting space" and another built a multi-million dollar courtyard with a fountain. All the sorts of things you do when you don't have shareholders to pay but are flush with cash.

It's not in our corporate and governmental interests to prolong life. If we were to regress in longevity it not only helps SSI but bails out insurance companies who've gleaned record profits during the early lives of Boomers but are fearing the payout now that the end is nearer. So tackling heart disease and cancer is contraindicated by the quarterly statements of the very institutions which helped with the bailout in '07-08.

I think that is worth pondering in light of your statistical information which was appreciated.

(04-26-2018 11:30 PM)JRsec Wrote:  It's not in our corporate and governmental interests to prolong life. If we were to regress in longevity it not only helps SSI but bails out insurance companies who've gleaned record profits during the early lives of Boomers but are fearing the payout now that the end is nearer. So tackling heart disease and cancer is contraindicated by the quarterly statements of the very institutions which helped with the bailout in '07-08.

I think that is worth pondering in light of your statistical information which was appreciated.

Well one difference is a willingness to make data driven decisions. When France was looking at restrictions on smoking, the head of their equivalent to Social Security gave testimony before parliament laying out the impact on the program from more people surviving longer.

I can't see Congress looking at those related impacts and cannot imagine a US agency head giving such unpleasant testimony without being forced to tender a resignation.

I see medical inflation and education inflation as two similar problems.

Education inflation is the product of shifting funding away from the provider to the consumer. The provider then had to invest in non-educational amenities in order to attract students. Paying for those things increased prices. The consumer (mostly) has been price insensitive thanks to the loan system and those rising prices have sucked more and more dollars into the loan program and we produce graduates who no longer go buy a new car when they land their first job (if they land one at all in their field) nor start saving for a down payment on a house.

Medical inflation is primarily driven by rising overhead and a near unfettered payment system.

Dr. Smith seeing a patient for strep throat has a sticker price that is charged (say $110, because that's my doctor's sticker price). There is a price charged to Blue Cross, a price charged to Tricare, another for Aetna, a price for United, a price for Medicare, and one for Medicaid. Then there is a price for the Medicare patient who has supplemental insurance. So now he needs people to collect that money and they have to chase the patient for the co-pay or deductible or coinsurance.

Patients with insurance have no price sensitivity unless they have high deductibles or co-payments.

Gleevec which I think I mentioned earlier cost $26,400 for a year in 2001, in 2016 it was more than $120,000. Medicare paid $780 million for covered patients in 2013 and $1 billion in 2014. Celebrex went up 22% from 2015 to 2016. Lantus a key diabetes drug went from $355 to $454 in a year. Lyrica went up 45% from 2013 to 2014.

Bloomberg found that Pfizer had a $208 million increase in quarterly sales revenue just from price increase.

There are no real controls on prices. When a drug is on patent there is no competition, the very point of gaining patent protection. Once drug makers understood there was no one out there capable of saying NO to a price increase the logical outcome was radical increases.

WIth a typical health insurance plan you may pay $60 out-of-pocket in 2017 and your insurer pays $240 and in 2018 your insurer pays $300 and you still pay $60 plus an increased premium.

Plastic surgery is the only field not seeing crazy inflation and that's because they do very little work covered by insurance. If the patient lacks the cash or borrowing power, they don't get the work done.

I received a bill for $2700 from some lab tests my wife has to have done a few times a year. Insurance ended up paying $162 and I paid $18. Doctor's office announces they've changed to a cheaper lab. It was out-of-network. Got a bill for $1800. My insurance paid $162 and I was on the hook for $1638, finally got them talked into accepting $200 from me, the amount they admitted they would take from insurance so they made $362 for services they normally do for $200.

It's an utterly insane system.

(04-27-2018 01:10 AM)arkstfan Wrote:  

(04-26-2018 11:30 PM)JRsec Wrote:  It's not in our corporate and governmental interests to prolong life. If we were to regress in longevity it not only helps SSI but bails out insurance companies who've gleaned record profits during the early lives of Boomers but are fearing the payout now that the end is nearer. So tackling heart disease and cancer is contraindicated by the quarterly statements of the very institutions which helped with the bailout in '07-08.

I think that is worth pondering in light of your statistical information which was appreciated.

Well one difference is a willingness to make data driven decisions. When France was looking at restrictions on smoking, the head of their equivalent to Social Security gave testimony before parliament laying out the impact on the program from more people surviving longer.

I can't see Congress looking at those related impacts and cannot imagine a US agency head giving such unpleasant testimony without being forced to tender a resignation.

I see medical inflation and education inflation as two similar problems.

Education inflation is the product of shifting funding away from the provider to the consumer. The provider then had to invest in non-educational amenities in order to attract students. Paying for those things increased prices. The consumer (mostly) has been price insensitive thanks to the loan system and those rising prices have sucked more and more dollars into the loan program and we produce graduates who no longer go buy a new car when they land their first job (if they land one at all in their field) nor start saving for a down payment on a house.

Medical inflation is primarily driven by rising overhead and a near unfettered payment system.

Dr. Smith seeing a patient for strep throat has a sticker price that is charged (say $110, because that's my doctor's sticker price). There is a price charged to Blue Cross, a price charged to Tricare, another for Aetna, a price for United, a price for Medicare, and one for Medicaid. Then there is a price for the Medicare patient who has supplemental insurance. So now he needs people to collect that money and they have to chase the patient for the co-pay or deductible or coinsurance.

Patients with insurance have no price sensitivity unless they have high deductibles or co-payments.

Gleevec which I think I mentioned earlier cost $26,400 for a year in 2001, in 2016 it was more than $120,000. Medicare paid $780 million for covered patients in 2013 and $1 billion in 2014. Celebrex went up 22% from 2015 to 2016. Lantus a key diabetes drug went from $355 to $454 in a year. Lyrica went up 45% from 2013 to 2014.

Bloomberg found that Pfizer had a $208 million increase in quarterly sales revenue just from price increase.

There are no real controls on prices. When a drug is on patent there is no competition, the very point of gaining patent protection. Once drug makers understood there was no one out there capable of saying NO to a price increase the logical outcome was radical increases.

WIth a typical health insurance plan you may pay $60 out-of-pocket in 2017 and your insurer pays $240 and in 2018 your insurer pays $300 and you still pay $60 plus an increased premium.

Plastic surgery is the only field not seeing crazy inflation and that's because they do very little work covered by insurance. If the patient lacks the cash or borrowing power, they don't get the work done.

I received a bill for $2700 from some lab tests my wife has to have done a few times a year. Insurance ended up paying $162 and I paid $18. Doctor's office announces they've changed to a cheaper lab. It was out-of-network. Got a bill for $1800. My insurance paid $162 and I was on the hook for $1638, finally got them talked into accepting $200 from me, the amount they admitted they would take from insurance so they made $362 for services they normally do for $200.

It's an utterly insane system.

On the first item what corporations discuss in small groups of its leadership and what they admit to in public are two different things. Ditto for Government.

On the insurance assertions that you make those are correct but here's why and it is also why poor people are the real casualties here.

If 80% of a doctor's patients have insurance and insurance agrees to pay a certain percentage of filed charges, then the doctor cannot set two prices, one for the insured and one for the uninsured. Otherwise the insurance company can subpoena his accounts payable and if they can demonstrate that there are two sets of prices they can legally pay the same percentage but on the lower amount charged to the uninsured persons the doctor treats. Therefore in order to get their expected pay the doctors have to charge everyone the same rate (that of the insured which is naturally higher to account for the % that the insurance company agrees to pay. Only here they have to go with the smallest percentage paid by any insurance which they accept and set prices high enough to get what they desire from that company. So the very fact the insurance company is involved at all and operates so that they only pay a % of what is changed is hyper inflationary and makes simple procedures and vaccinations and basic lab work so very expensive.

I had a cat that had a simple infection. The diagnosis and proscription for a basic Vet antibiotic was almost $500. Do you know why? Pet insurance has now entered the pricing structure of Veterinary medicine and it pays on the % of what is charged basis just like the health insurance companies do for people. What's more is now if blood work is done where Vets once did much of that themselves it is now sent to an off site lab where again inflated charges are made because insurance pays a % of what is charged. So as an old fashioned guy who ignores pet insurance and does some animal rescue for strays my humane intentions are now under a horrible strain due to insurance inflation in Vet Med. Now rescuing a stray costs you 5 x what it did just 10 years ago. A really sick cat or dog I might have been able to vaccinate, worm, deflea, and treat for $100 now costs me $500 to help. And then I pay more for the vaccinations.

So my point is that insurance companies by driving up costs intentionally create their own market at the expense of the health of poor people and abandoned and feral animals.

Now I ask you, where is there room for charity and compassion when interceding on behalf of either our sick poor or the animal victims of our society now that Corporate America has bought out our hospitals, our nursing homes and assisted living establishments, and has permeated our medical care and that of our pets by inserting themselves in a way that necessitates their insurance product, and drives up profits at their hospitals all while they parasitically preys off of the need of the ill?

Our Doctors and Vets have to play the bureaucratic game or their charges can be challenged legally, and the inflation and paperwork is hurting them as well as us.

It's a pretty good example of why government should have stayed out of health care altogether. There wasn't a hospital in America that could turn away a patient due to the inability to pay nor was there a Doctor that didn't work out doable payments when I was a kid. Heck I could get a chest X-ray and have the radiologist pop that picture right up there on the screen and tell me whether I had pneumonia while I was still in the X-ray room. I challenge anyone to get that now. And it's because the radiologist can get more if the picture is taken at the hospital or clinic and then sent out to be read. That way they get to bill for the picture and then again for the reading of it. When everything was performed on site there was only 1 charge. HIPAA now permits for records to be kept beyond the facility and for a separate charge to made for the storage or retrieval of your own danged records. Virtually all of it has facilitated the rapid inflation of medical care. And the capping of ages after which certain procedures were no longer available to you was just another passive way of permitting some patients to die before they cost the program too much.

BTW you better double check your medical records each time you access them. They are emailed from your doctors to the sites now keeping them and the personnel at those sites are not always medically literate so when they transcribe them they make mistakes. So the added level of bureaucracy added for billing purposes now adds to the risk of human error affecting your health.

I see the cost of education as being extremely problematic, but I see what has transpired in medicine as an evil in the midst of what should be a good.

(04-26-2018 10:59 PM)arkstfan Wrote:  

(04-26-2018 08:40 AM)quo vadis Wrote:  When Sweden, the UK, and Canada start making the treatment breakthroughs, then you can post UNESCO talking point statistics about them being better at health care than us.

Not one of the nations you listed, but my uncle went Switzerland in the late 70's in order to learn how to perform coronary angioplasty.

The biggest stem cell work is being done in Europe.

The basic research for laparoscopic surgery was done in Germany with the first human surgeries done in Sweden. The first laparoscopic organ resection was done at a teaching/research hospital in Sweden. First laparoscopic appendectomy was in Germany.

The Rh factor discovered in Austria.

The biggest breakthroughs in drugs to treat breast cancer (most notable Herceptin) came from a Swiss researchers. Gleevec another big cancer breakthrough partnered researchers at two facilities in the US, one in London and one in Milan.

The Journal of American Medicine found that in 2004 the US represented 57% of all medical R&D spending. By 2014 it had fallen to 44% because US spending has remained flat.

You really need to step back from the propaganda and take a hard look at what is really going on.

Your propaganda keeps ignoring the fact that the USA is easily the world leader in medical breakthroughs and innovation, and that comparing us to countries with the population of the New Orleans - Baton Rouge corridor, or even 10 times that, is just not meaningful.

(04-27-2018 06:40 AM)quo vadis Wrote:  

(04-26-2018 10:59 PM)arkstfan Wrote:  

(04-26-2018 08:40 AM)quo vadis Wrote:  When Sweden, the UK, and Canada start making the treatment breakthroughs, then you can post UNESCO talking point statistics about them being better at health care than us.

Not one of the nations you listed, but my uncle went Switzerland in the late 70's in order to learn how to perform coronary angioplasty.

The biggest stem cell work is being done in Europe.

The basic research for laparoscopic surgery was done in Germany with the first human surgeries done in Sweden. The first laparoscopic organ resection was done at a teaching/research hospital in Sweden. First laparoscopic appendectomy was in Germany.

The Rh factor discovered in Austria.

The biggest breakthroughs in drugs to treat breast cancer (most notable Herceptin) came from a Swiss researchers. Gleevec another big cancer breakthrough partnered researchers at two facilities in the US, one in London and one in Milan.

The Journal of American Medicine found that in 2004 the US represented 57% of all medical R&D spending. By 2014 it had fallen to 44% because US spending has remained flat.

You really need to step back from the propaganda and take a hard look at what is really going on.

Your propaganda keeps ignoring the fact that the USA is easily the world leader in medical breakthroughs and innovation, and that comparing us to countries with the population of the New Orleans - Baton Rouge corridor, or even 10 times that, is just not meaningful.

Oh please just fess up you are trolling for the lulz now.

The US period of being the leader in breakthroughs and innovation was a limited time. For many years Americans went to Europe for medical education to learn from the best.

It took two World Wars and the lingering impact to make the US the world leader. Just as we had a period of manufacturing dominance because we had no competitors and then our competitors were under-capitalized as a result of having to recover from two World Wars we could hold that lead.

Half of the 10 largest pharmaceutical companies are from Europe. The Europeans are now our equal in pharmacology. EQUAL.

Population argument
You aren't even trying.
So I suppose India and China are the medical leaders.