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If I open a business tomorrow, what is the purpose of that business?


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Originally Posted By: Derid

We can call your assertion true for now, however that truth does not support any other arguments you typically seem inclined to make.

So I am not sure why you spend so much time on it...


Glad you asked.

Next point to consider, is why any business should be providing health care to its employees? It is logical conclusion, that is if you disregard conventions of human decency and social responsibility, to shed any and all responsibility for health care. If you are in a business of making pizza, why should you also be in a business of managing health care benefits? Also, why is there distinction between part time and full time jobs, is work different in any way?

So in this context a single-payer system, where both employees and employers pay payroll taxes, and health care is administered independent of type of employment one hold makes most sense.

This arrangement moves us closer to a system where everyone is paid 'market rate' wages, whatever it happens to be, and they are not as dependent on whims of employer to meet their basic needs. Throw in subsidized housing for people below some level of income, and you CAN have unregulated job market with no minimal wage and right-to-work.

Last edited by sini; 11/17/12 05:21 PM.

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I know you consider health care to be a right, but I think you need to restate that assertion for the record. It would have more merit if you categorized it as a privilege first world denizens should receive.

A right is something that exists and can be exercised regardless of context, and does not depend on an outside entity providing something. If you switch your definition, you can at least hold the same effective position on health care without being inaccurate on the face of it.
-

The problem with a single payer system, is that it will not work in the USA. In fact if the USA went to one, it would stop working in the small countries. For an example why - see instances in the USA where the current level of govt involvement in health care has already caused shortages of drugs and services where govt decides it doesnt want to pay market prices - and thus the insurance companies can also decline to pay market prices, because they cant be sued for not providing services that cost more than the going govt rate- instead they call it a shortage.

However, conversely, if govt was required to pay whatever was necessary to procure basic drugs and services - you can bet that health cartels extorting govt would become common. Unfortunately once govt gets involved, things tend to swing between extremes rather drastically. This is the result of price distortion. Sometimes these single payer models work for smaller countries, because functionally they work the same as if they were a large HMO or corporate buyer - hence our previous discussion as to why normalizing amount spend per capita on health care was not a valid way to compare efficiency or effectiveness of health systems.

In a pool of say 400 million health care consumers, 300 million of those are the USA lets say - and 6 million for Sweden. Well, the 6 million group of Sweden can band together and purchase health products from the 300 million strong free market - and at cheap bulk rates at that. Most of the provisioning of health products exists outside of the Swedish system, and as long as the Swedish govt is willing to pay market rates it works. As long as the market for the products in general is large enough to create economies of scale in production, Sweden can even get nice discounted bulk rates.

However if the USA group of 300 million became single payer - that is an entirely different ballgame. Suddenly you have one entity setting the price for each health product for the majority of the market - and there exists no larger market from which to obtain market pricing from. There is a huge difference between a small pool of people banding together to purchase at market rates, and the majority of people banding together and attempting to set the rates by fiat.

Lets leave housing out of the discussion for now, just to avoid needlessly introducing more complexity that needed to the arguments.

-

Now, I see your logic. It would be valid, if it could actually work. Unfortunately in reality, it would just create a large dichotomy between all those stuck in an inefficient system of shortages, and those who were wealthy enough to pay exorbitant prices. If you want to see only the ultra elites having access to good, modern health care then a single payer system is the way to do it. Even Obamacare will end up increasing the discrepancy between quality of care between rich and the rest.

-

Now, I have put a good amount of thought into how a single payer system might be made to work in reality, believe it or not. Contrary to what I am sure you assume, my objection to such a system lies in the fact that it will *not* work in the USA as opposed to some vague philosophical or ideological objection.

Assuming that the opponents of their proposals do so out of vague ideology or pure callousness is what I consider the greatest weakness of the modern left - because it prevents self introspection on the actual quality of their proposals, which is unfortunate, because that prevents the left from evolving their ideas and concocting systems that might actually work in reality.

Now, back to making a single payer system work.

-

First of all, for a single payer system to work it would need to not be single payer. In this, the left can look at Sweden as a genuine model - as actually though health is federally subsidized, localities actually manage the disbursement of funds. While their model still has inefficiencies, having actual planning and management occur on a very local level at least increases the responsiveness and efficiency of the planning to a very large degree over a system that was centrally managed.

Second, you need a market mechanism that responds to supply and demand. Without this, welcome to the world of perpetual shortages.

Third, you need a mechanism prevents price fixing, large contracts - we see how efficient govt contracts are in the military arena... ugh. The difference with military, is every other military we fight has to deal with the same efficiency problems - and cartels. The spectre of politically connected company getting govt contracts to provide sub-par services at exorbitant pricing is an absolute given whenever govt becomes the sole or primary purchaser of anything.

And thats all just for starters.

-

The only possible answer I have been able to come up with, is by commoditizing health products and have the buying/selling of such occur on a blind exchange similar to stocks/bonds. Make sure you obscure the purchasers, so you cannot tell if it is a govt or private entity.

At least this way, the market could see what services were available and which were in demand. In theory if someone else could do it cheaper, and still make money then profit motive would provide incentive to be competitive.

Of course there are other issues, including some macro issues regarding inflation - and still need to deal with the concept of what level of service is required or else you may still end up with macro inflation issues.

But turning health products into blind commodities is the only seed from which I can see any working system of universal care growing from. For any economic system to work well, it needs to have a healthy market - and subsidized people need to purchase from that market, much as Sweden purchases from the larger global market or else the entire thing will collapse on itself.


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Originally Posted By: sini
You are desperately trying to move away the argument from the "livable wages" by coming with a long list of excuses and special cases.

Underlying argument, that you are yet to address, is that unless all jobs pay livable wages, that allow recipients of said livable wages to afford basics of food, shelter, clothing and medical care then two things happen: a) they supplement income from the outside source, be it from parents, government or raking up credit card or student debts b) they live below poverty line. There is no c).

Special circumstances, like students holding part time jobs while at school, are still offloading labor costs on the outside source.

Your overall argument sums up to - "more people should be on welfare and/or poor". When combined with your distaste of welfare it simplifies to "more people should be poor".

I don't think it will come as a surprise, but I disagree. Thankfully, so is the rest of the country. See election results.



So the election said everyone will have a livable wage. Maybe you should write Obama a letter telling him that, cause I don't think he knows that's what happened.

The fact that you think EVERY JOB should be a livable wage job is the most idiotic thing I have heard you say so far. You have no idea what you are talking about and this
calls into question everything you have ever said before.
You seem to have a nice little world invented in your minds eye. Maybe you should write a book.

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Originally Posted By: sini
Originally Posted By: Derid

We can call your assertion true for now, however that truth does not support any other arguments you typically seem inclined to make.

So I am not sure why you spend so much time on it...


Glad you asked.

Next point to consider, is why any business should be providing health care to its employees? It is logical conclusion, that is if you disregard conventions of human decency and social responsibility, to shed any and all responsibility for health care. If you are in a business of making pizza, why should you also be in a business of managing health care benefits? Also, why is there distinction between part time and full time jobs, is work different in any way?

So in this context a single-payer system, where both employees and employers pay payroll taxes, and health care is administered independent of type of employment one hold makes most sense.

This arrangement moves us closer to a system where everyone is paid 'market rate' wages, whatever it happens to be, and they are not as dependent on whims of employer to meet their basic needs. Throw in subsidized housing for people below some level of income, and you CAN have unregulated job market with no minimal wage and right-to-work.


First off no business HAS to provide anything to its employees. It is a benefit of employment if a business so choses to.

If you don't know the difference between part time and full time you need more help then I first believed.

Everyone is paid "market rate wages" already. It is not the job of an employer to meet the basic needs of anyone.

Now you say to get rid of minimum wage and subsidize housing, did you just have a seizure?

Seems to me you have found a new way to raise taxes.

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"First off no business HAS to provide anything to its employees. It is a benefit of employment if a business so choses to."

True statement, however, daily hugs and sing-a-longs don't attract the workforce you're going to need to make your business happen. You have to be competitive against the other businesses trying to attract your future employees. Thus, does compensation factor in here. Both in wages and benefits.

With few exceptions, ( part-time, misc odd jobs, etc ) I would like to see all -full time- jobs provide compensation well beyond the poverty level. Pipe dream I know, but it would be nice to see folks carve out a living without having to hold three jobs to do so.

Would it make the end products more expensive ? Probably. Corporations aren't going to cut into their profits, so they'll just pass the costs along to us. Unfortunately, most of us wouldn't pay $20 for a combo meal at one of these places so the whole business would eventually implode. A catch-22.

We're addicted to cheap goods. Unfortunately, that means cheap labor as you can only cut so many corners. Thus my pipe-dream statement above.

In this case, you can't have your cake and eat it too. If we bump up the minimum wage to one that gets folks out of poverty, we run the risk of destroying the idea completely as folks abandon the product due to its rising cost.

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----

Is healthcare a right or privilege?

It doesn’t really matter where you stand on this entirely artificial debate. Practicality of modern life is that health care has to be provided, and the only questions are how much, at what costs and with what outcome. Would you agree that providing health care to uninsured via emergency room visits is not cheap, not effective, and does not result in a good patient outcome?

Point #1: Right or privilege, it still has to be done.

Let also consider insured. Your typical insured health care consumer is not a rational market player, with a rare few exceptions consumption pattern is “all of it, all the time, at any cost”. In an individualistic society like US health care will be universally seen as a matter of self-preservation. In such environment pure market force acting via supply and demand cannot regulate the price. People will not turn away from cures or lifesaving treatments no matter what the cost is, so the ‘market’ forces will drive cost up only constrained by efficiency of extracting value from consumers. Ever-climbing cost of health insurance when some of these unconstrained costs get distributed to the insured population is a grim reminder of market system on-going failure.

For example, at this moment the only downward pressure on certain cancer treatments is an average net worth of a likely cancer patient. We see plenty of evidence of this -medically-related personal bankruptcy is still the leading category; even bankruptcies due to housing market collapse did not dethrone it.

Point #2: Health care demand is inelastic; as a result costs are contained only by ‘net worth’ calculations.

So what are actual sources of health care costs? Unsurprisingly end-of-life treatments come up the list, but so are emergency rooms. Administrative costs are obfuscated, but they greatly exceed stated industry average “profit margins” due to cost of doing business in addition to profit is creating unacceptable drag on the system. Still, with all of these costs it is clear that overall costs keep rising. This drives up price of coverage for everyone, cancer survivor and a healthy and fit 20-something looking for accidental coverage. With increasing wealth inequality and due to ‘net worth’ calculations more and more people are getting priced out of any and all coverage.

Point #3: Wealth inequality creates a situation where increased profit taking from well-off consumers makes pricing bottom out of the market a profitable and acceptable business decision.

------

Could a single-payer system work in US, and is it preferred alternative to existing system?

You mentioned few key concepts as your objections to single-payer – economies of scale and market price. I addressed market price with Point #2. Let us examine economies of scale.

Health care costs can be categorized in a following way – research and development, delivery of treatments, and manufacturing of pharmaceuticals and devices.

Delivery of treatment is a fixed cost, no matter if you amputating the leg with a rusty saw or delivering laser brain surgery you still have to pay for training, facility and personnel. Implements do change, but I put them into separate category.

Your argument then will have to be refined into R&D and/or manufacturing. At this point mass production is well-understood concept, so we can consider costs of treatment and devices as mostly recouping costs of R&D. To support this assertion we can look at a low cost of generics.

R&D, with US doing something close to 60% of worldwide, is where most of expenses occur. Some of it is publicly funded, but lots of it is private. Covering costs of private research, design and clinical tests is the main source of raising healthcare costs.

So where does this entire R&D budget goes? Well, as with any business decision, it goes toward developing treatments that are most profitable. Point #2 and #3 come heavily into play here.

Point #4: Health care costs, at least in private sector research and development, are not driven by improving patient outcomes or quality of life but by maximizing profits.

So what does Point #4 means? It means that development of new treatments is not prioritized according to reducing suffering or finding new cures for obscure condition. This means that a lot, if not most, of private R&D is spent on gaining marginal improvements for blockbuster profit-generators. From the point of “greater good of a society” -this is not an effective use of our collective resources. Last cancer treatment was good enough; we do not need another one, one that we as a society can no longer afford and are not capable of refusing on individual level. (See Point #2).

With Point #4 in mind, single-payer will definitely reduce private investment into R&D. I demonstrated that this is not money well-spent, but rather money that can generate return. Single-payer will not produce shortages; nobody will take “will not sell” decision, they will simply take a loss and reduce future R&D.

Do you know why single-payer countries can negotiate lower prices? Well, partially because of ‘collective’ aspect of it, but mostly because of a threat of revoking patents and manufacturing generics. For example, if you refuse to sell a drug to Canada, they have a right to revoke your patent and manufacture generics right away.

This is exactly why we need single-payer in US. To rationally distribute health care. To put controls on run-away healthcare spending. To address Points 1-4.

----

I am not as concerned with single-payer, as I am concerned with providing universal coverage at a reasonable cost. If we simply take existing system and force universal coverage (Obamacare) then costs will spiral out of control.


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The point was that in the US the federal government cannot and should not force the private businesses to provide the employee anything other than the minimum wage.

Your point on competition was, I thought, implied.

Some people think that the government should force the private businesses to pay wages at what they think is right and provide employees with every benefit known to mankind.

These people seem to want to burn the Constitution and start over with a utopia that is not attainable.

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Unfortunately, there will always be an income disparity.

You can't pay everyone top pay as no one would be able to afford the product. In the emerging global economy, it gets worse.

Cost of living in Poorasdirtistan isn't close to our own. As a result, corporations can outsource simple labor to these countries and provide a cheaper product to undermine their competition who may still employ local ( US ) workers.

There is no fix for this that I can see unless we start taking steps backwards. It's in the companies best interests to cut their costs, but if the majority of the workforce in the US is under or unemployed, we won't be able to afford their product anyway. The end result will be the same. Company implodes.

How do you go about paying folks a decent wage so they can actually afford to buy the goods that keeps the economy going without killing your own company in the process ?

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Originally Posted By: Daye

How do you go about paying folks a decent wage so they can actually afford to buy the goods that keeps the economy going without killing your own company in the process ?


Daye, this is huge question that probably deserves its own thread.

It boils down to following - as a democratically elected government, should its priority be protecting corporate interests and profits or protecting citizens and their quality of life?


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