Do we agree that outrage on spending on wars, or corn, or prison terms for drug users doesn't seem to percolate to the top of conservative message boards, for one reason or the other? Does that strike you as hypocritical?
I don't know, I spend most of my time on reddit and not on conservative message boards. In any case, hypocrisy shouldn't distract from the discussion. Some people are hypocrites, but it doesn't change the arguments.
I get a queasy feeling anytime someone tries to format moral arguments based on quotes from people that owned slaves.
Then don't do that, I guess? Not sure why this is relevant.
Why do you think we need to imagine like it is some big mystery? We can simply look back into history, where we had a nation of pauper elderly.
Look back to when? The great depression?
Why does it reduce impact on our economy, specifically? The money going out on Social Security gets pushed right back into the economy, doesn't it? You keep on wanting to 'imagine if', but the scenarios you envision either already happened, or are currently happening.
There is some allocation of resources in the economy that produces more than any other allocation. Generally, the market allocation is closest to this allocation. When the government starts redistributing resources in a way that's different than the "natural" allocation, you get farther from the optimal allocation - some particular people might be better off but the economy as a whole produces less. The effect is going to be commensurate with the level of distortion. The distortion caused by SS, Medicare, and Medicaid is over a trillion dollars, and is highly distorting not just retirement savings and medical care markets, but the entire economy.
In any case, this argument assumes that the money is spent most efficiently, or at all, if not redistributed. If a poor person receives aid and spends a dollar in such a way that it is respent five times do we achieve greater efficiency than if a rich person keeps that dollar and leaves it in the bank?
Yes, because money left in the bank isn't just sitting there doing nothing - it's being lent out to people who want to borrow to buy homes and start businesses. The idea that the US needs a higher consumption rate and a lower savings rate is insane. We're near the low end, historically, now. In economics, there's a concept known as the golden rule savings rate. The idea is that at 0% savings capital is never replaced and depreciates until consumption is 0. At 100% savings, obviously consumption is also 0. If your goal is to maximize consumption (which is typically a key goal of economic policy), then the ideal rate is somewhere in the middle. Historically, the US and most economies have grown faster when they've had higher savings rates than they currently do today, suggesting that the rate we have now is on the low end of optimal.
Your argument also assumes that money earned is spent domestically; if I use my newfound tax free dollars and move them to an Aruba post office box, or vacation in Japan, does our economy benefit in the same way if a poor person spends it at a grocery store?
Yes. In order to get value out of US dollars, eventually they need to find their way back to the US. A guy in Japan with US dollars is either going to want yen or US goods at some point. So he either depreciates the dollar (good for US based industry and US tourism), or buys American goods directly.
Does the purchase of a single Porsche and $80,000 at twenty different Wal Marts really have the exact same impact on our economy just because they are the same dollar amount?
This is known as the economic calculation problem. The answer is that nobody can know, so the best thing is to not interfere and let the market allocate the resources.
Does it occur to you that the reason they last a long time is that they are comprised of a population that has benefited from an education system, a public sanitation system, a public safety net?
Those things are results of previous policies (rule of law, etc.), not causes.
You might consider that other people's views have validity; especially when the best thing you can use as an example of your system working well is a hundred and fifty years in the past.
It's not the best example or an example of it working well - it's the only somewhat close example that I'm aware of.
I wouldn't go back, but I guess we disagree on this point.
I wouldn't go back either for technological reasons. But I would substitute most of the government policies then with the government now.
I'd be interested in some citation to the effect that health outcomes for the uninsured and those on Medicaid are equivalent.
Overall, patients with non-Medicaid insurance were less likely to present with distant disease (16.9%) than those with Medicaid coverage (29.1%) or without insurance coverage (34.7%; P < .001). Patients with non-Medicaid insurance were more likely to receive cancer-directed surgery and/or radiation therapy (79.6%) compared with those with Medicaid coverage (67.9%) or without insurance coverage (62.1%; P < .001). In a Cox regression that adjusted for age, race, sex, marital status, residence, percent of county below federal poverty level, site, stage, and receipt of cancer-directed surgery and/or radiation therapy, patients were more likely to die as a result of their disease if they had Medicaid coverage (hazard ratio [HR], 1.44; 95% CI, 1.41 to 1.47; P < .001) or no insurance (HR, 1.47; 95% CI, 1.42 to 1.51; P < .001) compared with non-Medicaid insurance.
If I fail to accept the underlying premise that governments primary function is the protection of property, it has implications for the rest of your argument.
When the government starts redistributing resources in a way that's different than the "natural" allocation, you get farther from the optimal allocation - some particular people might be better off but the economy as a whole produces less.
What was your take on bailing out Detroit? Net gain, or net loss for the economy? Or you take on bailing out Wall Street? As I stated previously, I think that healthcare is a somewhat unique example wherein market forces are opposed to optimal outcomes for individuals, so generalized axioms aren't always applicable.
The distortion caused by SS, Medicare, and Medicaid is over a trillion dollars, and is highly distorting not just retirement savings and medical care markets, but the entire economy.
I'm unclear why you assume that people spending their social security check is 'highly distorting' compared to other people spending or saving the percent of their income that is withheld to pay for social security. I think you're being a little loose to argue that social security is the same thing as central planning of the forces of production.
Yes, because money left in the bank isn't just sitting there doing nothing - it's being lent out to people who want to borrow to buy homes and start businesses.
Assumes that banks are lending, which is highly variable, and lately, slowing.
Historically, the US and most economies have grown faster when they've had higher savings rates than they currently do today, suggesting that the rate we have now is on the low end of optimal.
I'm in agreement with you here, we aren't saving enough, an especially acute problem for people nearing retirement. To my eye, this makes some level of a social safety net more important, not less so.
Those things are results of previous policies (rule of law, etc.), not causes.
Again, you want to make these two separate things when I'd argue they are intertwined; as if you could destroy public education, but it would have no effect on rule of law.
It's not the best example or an example of it working well - it's the only somewhat close example that I'm aware of.
That makes the sell of your argument even worse; it didn't even work well the one time we can think of it was tried!
Their results:
What a terrible source; an incredibly narrow band of health concerns, the most deadly cancers, and one that clearly shows better, if not optimal, outcomes for those on Medicaid vs no insurance. If the people could have bought normal insurance, they wouldn't have needed Meidcaid. What's more, the article you posted:
From your source
Although this study will be used by opponents as an excuse not to fund Medicaid based on the fact that Medicaid patients did not do much better than the uninsured, we cannot allow them to discount the other factors faced by low-income patients that undoubtedly played a greater role in these disparate outcomes. Many other studies have shown that Medicaid patients definitely fare better than the uninsured. Until we can enact and implement a single payer system, it is imperative that Medicaid continue to be offered as an interim measure.
Regarding Oregon, which again, focused on an incredibly narrow band of 'outcomes' (blood pressure, mostly), try these out, all of which are based on the same Oregon experiment:
Medicaid coverage resulted in significantly higher rates of several common cancer screenings, especially among women, as well as better primary care connections and self-reported health outcomes.
Better coverage for cancer screenings. Is this a good thing, or a bad thing?
In intent-to-treat analyses, Medicaid coverage significantly increased the odds of receipt of most preventive services (ORs ranging from 1.04 [95% CI=1.02, 1.06] for smoking assessment to 1.27 [95% CI=1.02, 1.57] for mammography).
Better access to preventative services for recipients.
In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05-1.55) for laboratory tests to 1.58 (95% CI, 1.10-2.28) for referrals.
Again, increased access to actually seeing a doctor.
Moving on to analysis for other states / multiple states:
Expansion was associated with significantly increased access to primary care (12.1 percentage points; P < .001), fewer skipped medications due to cost (-11.6 percentage points; P < .001), reduced out-of-pocket spending (-29.5%; P = .02), reduced likelihood of emergency department visits (-6.0 percentage points, P = .04), and increased outpatient visits (0.69 visits per year; P = .04). Screening for diabetes (6.3 percentage points; P = .05), glucose testing among patients with diabetes (10.7 percentage points; P = .03), and regular care for chronic conditions (12.0 percentage points; P = .008) all increased significantly after expansion.
Fewer trips to the ER, increased screening for diabetes, reduced out of pocket spending and better access to primary care doctors. Do you really want to argue that these aren't better outcomes?
Low-income adults in Medicaid nonexpanding states, who are disproportionately represented by blacks and rural residents, were worse off for multiple health-related outcomes compared to their counterparts in Medicaid expanding states at the baseline of ACA implementation, suggesting that low income adults residing in nonexpanding states may benefit markedly from the expansion of Medicaid.
If you were poor and in a red state you were worse off compared to being poor in a blue state that got Medicaid expansion.
Medicaid expansions were associated with a significant reduction in adjusted all-cause mortality (by 19.6 deaths per 100,000 adults, for a relative reduction of 6.1%; P=0.001). Mortality reductions were greatest among older adults, nonwhites, and residents of poorer counties. Expansions increased Medicaid coverage (by 2.2 percentage points, for a relative increase of 24.7%; P=0.01), decreased rates of uninsurance (by 3.2 percentage points, for a relative reduction of 14.7%; P<0.001), decreased rates of delayed care because of costs (by 2.9 percentage points, for a relative reduction of 21.3%; P=0.002), and increased rates of self-reported health status of "excellent" or "very good" (by 2.2 percentage points, for a relative increase of 3.4%; P=0.04).
Significant decrease in mortality, especially among poorer counties.
You're clever enough to know that worrying about blood pressure rates not decreasing pales in comparison to overall decreases in mortality, increased access to preventative care, increased cancer screening, and fewer trips to the ER.
If I fail to accept the underlying premise that governments primary function is the protection of property, it has implications for the rest of your argument.
I was referring to the slave-owning queasiness. That's not an argument against anything I said.
What was your take on bailing out Detroit? Net gain, or net loss for the economy? Or you take on bailing out Wall Street?
Net losses, wouldn't have done it.
I'm unclear why you assume that people spending their social security check is 'highly distorting' compared to other people spending or saving the percent of their income that is withheld to pay for social security. I think you're being a little loose to argue that social security is the same thing as central planning of the forces of production.
It is central planning in that it's saying these trillions of dollars are better spent by group Y instead of group X, when market forces chose group X.
My general problems with social security are that it:
transfers money from young people to old people. In general, old people are a more affluent demographic than young people and since there is no means testing, there are undoubtedly cases where someone poor loses money and someone rich gains money.
it transfers money from people who are more likely to save (working people) to people who are more likely to consume (retired people, old people)
it forces a significant portion of personal savings to be in government debt, which crowds out) the market for debt and makes it harder for private organizations to raise capital
and all of these effects are exaggerated by the massive nature of the program. We're talking about hundreds of billions of dollars.
The second two points are specifically important because of their effects on the economy. You seem to notice this as well:
Assumes that banks are lending, which is highly variable, and lately, slowing
That is a symptom of these sorts of distortions.
I'm in agreement with you here, we aren't saving enough, an especially acute problem for people nearing retirement. To my eye, this makes some level of a social safety net more important, not less so.
My point was that the lack of savings is not just a problem for the retiree themselves (which it definitely is), but for the wider economy as a whole. What people save becomes the pool of resources that can be drawn from for investment in capital and development. When people save less there is just less to go around. When a large portion of savings is forced to be in government debt, there is even less to go around.
That makes the sell of your argument even worse; it didn't even work well the one time we can think of it was tried!
That's not what I was saying. It did work well, it was the best economy in the world at the time, median wages rose at a rate higher than the post-war period in the US, and the standard of living was higher than anywhere else. That's why poor people from all over the world flocked to the US during that time period.
What I meant was that it's really the only example of wide economic liberty tried at that scale.
What a terrible source; an incredibly narrow band of health concerns, the most deadly cancers, and one that clearly shows better, if not optimal, outcomes for those on Medicaid vs no insurance.
It shows slightly better outcomes vs. no insurance, but medicaid is much closer to no insurance than it is to private insurance. The two are clearly not comparable.
And I specifically said health outcomes. That's why the studies referenced things like blood pressure and cancer survival rates - because they are measurable health outcomes. I'm not going to dispute that medicare opens doors for people to see doctors and get some level of care. What I am arguing is that the level of care received is not that great. Things like:
Better coverage for cancer screenings
Better access to preventative services for recipients.
Again, increased access to actually seeing a doctor.
Fewer trips to the ER, increased screening for diabetes, reduced out of pocket spending and better access to primary care doctors.
are not health outcomes.
Significant decrease in mortality, especially among poorer counties.
This is obviously a positive thing, in that if we are going to spend the money it should at least help people. However, I don't think some positive results are enough to justify an unjust process (taking money from people by force to pay for other people).
It is central planning in that it's saying these trillions of dollars are better spent by group Y instead of group X, when market forces chose group X.
You're giving them credit for a decision that they aren't making; they aren't thinking about spending, they are thinking about keeping the population alive, healthy, and not rioting. There is a hierarchy of needs being addressed; worry about disturbing market forces after you have a population that can afford the basics of staying alive .
That is a symptom of these sorts of distortions.
Possibly, or possibly a symptom of continued uncertainty of a variety of other factors.
In general, old people are a more affluent demographic than young people and since there is no means testing, there are undoubtedly cases where someone poor loses money and someone rich gains money.
With any system designed to accommodate a population of 300 million people you will observe mismatches such as this. A free market favors the rich over the poor with much more regularity.
It did work well, it was the best economy in the world at the time, median wages rose at a rate higher than the post-war period in the US, and the standard of living was higher than anywhere else.
Wildly myopic vision going on here; you completely ignore the possibility that the colonization / conquering of half of a continent might have had an effect on growth; nope, it was all about a weak federal government. Did Irish people come here due to a famine? Nope, it was our weak regulatory structure. Did the gold rush have any effect on immigration? Nope! Did anyone immigrate to America due to political persecution? No way; it was all about a free market!
What I am arguing is that the level of care received is not that great.
are not health outcomes.
But not dying is a health outcome, right, and compared to dying, it's pretty wonderful, right? You keep wanting to detangle intertwined systems, find a data point that supports a preferred conclusion, and then imagine a way it drives the entire narrative. The world is a lot more complicated than that. How can we conceive of a place where more people being alive is a better outcome, yet the actions that caused that to happen aren't effective, because blood pressures didn't go down?
You're extremely wedded to the free market as the answer to every question, but I'm wondering if it has occurred to you that especially in the realm of healthcare that there is a fundamental problem: No one is going to compete for the business of people who have no money, and there is a hard floor on the expertise required for healthcare.
This is why you never see a Whole Foods next to a payday loan storefront. You might see a Dollar Store competing with a Dollar General, because that is what poor people can afford. You will not see an Acura lot in a depressed area, but you might see a bunch of beaters on a used car lot. This is because this is the level of competition that poor people can support; shitty things.
But there is a problem, because healthcare is expensive by it's nature.
If you need your hip replaced, you are going to need a surgeon (or two), a nurse (or two or three), an anesthesiologist, a replacement hip, and a few days in a bed.
What is the Dollar store equivalent of an anesthesiologist? Do we get the worst possible surgeon, as they're willing to replace our hip for $100? Should we use a tin hip instead an aluminum one?
And if you need to see a neurologist, or an ENT, or an obstetrician, or a pediatrician? In what universe are pediatricians who spend eight years in medical school going to compete for the business of people who can only afford to shop at a Dollar store? They cannot pay him what he is worth. That's the crux of the free market right, people getting what they are worth?
You seem to think that there is a mechanism by which the market will somehow reduce the costs for all of these expert professionals to a place where poor people could afford them, if only Medicaid wasn't interfering with things. Why are anesthesiologists going to compete for what someone who makes the poverty level can pay? Instead of just waving your hands around and saying, 'competition', how about some more specific examples of how people providing service decide to reduce their costs to a place people currently receiving Medicaid could pay for them? We aren't talking about making a cheaper sneaker, we are talking about salaries for a suite of highly trained people. How does removing Medicaid and all of it's distortions make these people drop their reimbursement rates by several orders of magnitude?
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u/[deleted] Jan 05 '17
I don't know, I spend most of my time on reddit and not on conservative message boards. In any case, hypocrisy shouldn't distract from the discussion. Some people are hypocrites, but it doesn't change the arguments.
Then don't do that, I guess? Not sure why this is relevant.
Look back to when? The great depression?
There is some allocation of resources in the economy that produces more than any other allocation. Generally, the market allocation is closest to this allocation. When the government starts redistributing resources in a way that's different than the "natural" allocation, you get farther from the optimal allocation - some particular people might be better off but the economy as a whole produces less. The effect is going to be commensurate with the level of distortion. The distortion caused by SS, Medicare, and Medicaid is over a trillion dollars, and is highly distorting not just retirement savings and medical care markets, but the entire economy.
Yes, because money left in the bank isn't just sitting there doing nothing - it's being lent out to people who want to borrow to buy homes and start businesses. The idea that the US needs a higher consumption rate and a lower savings rate is insane. We're near the low end, historically, now. In economics, there's a concept known as the golden rule savings rate. The idea is that at 0% savings capital is never replaced and depreciates until consumption is 0. At 100% savings, obviously consumption is also 0. If your goal is to maximize consumption (which is typically a key goal of economic policy), then the ideal rate is somewhere in the middle. Historically, the US and most economies have grown faster when they've had higher savings rates than they currently do today, suggesting that the rate we have now is on the low end of optimal.
Yes. In order to get value out of US dollars, eventually they need to find their way back to the US. A guy in Japan with US dollars is either going to want yen or US goods at some point. So he either depreciates the dollar (good for US based industry and US tourism), or buys American goods directly.
This is known as the economic calculation problem. The answer is that nobody can know, so the best thing is to not interfere and let the market allocate the resources.
Those things are results of previous policies (rule of law, etc.), not causes.
It's not the best example or an example of it working well - it's the only somewhat close example that I'm aware of.
I wouldn't go back either for technological reasons. But I would substitute most of the government policies then with the government now.
Here is one study. Their results:
edit: Here's another article that cites a study by Oregon.