[Stubbs]

Medicare and Medicaid are the government spending money to support people who can't afford heath insurance, do you not think the problem there is the hospitals charging them as much as they can, rather then the government footing the bills?

So should people who can't afford to be treated in a hospital be left to suffer and die in your opinion?

[philo]

Look at what happened before the introduction to the systems in the US and the UK.  people were always charged the least and there were actual charity hospitals that looked after people (i know shock horror.)  They were of course priced out of the market when government came in and gave everyone free healthcare.  I wonder, how much do taxes go towards the NHS?  individually on average on a scale of 1:1.  what does the average person pay towards the NHS in taxes to what they take out in medical bills.

[philo]

Philo, are you suggesting our way out of the depression is exporting cars to developing countries. Why wouldn't it make more sense/profit to build them in developing countries?

The car industry was just an example, you have to look at the raw materials and the cost of production.  When it becomes cheap enough for the developing nations to ship the raw materials here and for the production to occur and export then yes it would be viable.  Our standards of living have to go down, we cannot get around the problem - we have shot all of the bullets from the gun.  We have no-one else to con with our debt fuelled finance spending scheme. 

When no one else will lend us money, we will have the BOE buying up all of our treasuries just like what is happening in the US where the fed is doing just that.  The IMF and ECB bailing out the EURO, the word ponzi scheme comes to mind. 

[slackline]

You just have to look at the US off budget items like Medicare and Medicaid to realise that its a complete fuck up. 
Look at the off budget spending (which includes Medicare and Medicaid)

The axiom was 'substantiate', clicky-link please for me to go and read, this is after all the 'Internet'? 

I've just quickly skimmed the intros to Medicare and Medicaid pages and would be very surprised if given treatment option A which costs $X and option B (which includes many other tests) and costs 10x $X there were any hospital or healthcare administrators who opted for option B given funds are limited.  If its a case of privately run hospitals administering option B to get reimbursed by the government I'd be very surprised if such behaviour wasn't reigned in pretty quick smart by those footing the bill.

Regardless of these finer details, the fact remains, US healthcare is, per capita, more expensive than virtually every other (developed) country in the world, yet their life expectancies are in most instances lower.  Is that really the sort of value that a free market healthcare system achieves and is desirable?  I don't think so.

[slackline]

I wonder, how much do taxes go towards the NHS?  individually on average on a scale of 1:1.  what does the average person pay towards the NHS in taxes to what they take out in medical bills.

I don't really care if I pay more in taxes towards the NHS than I take out in medical bills during my life time, it will be far less than if it were a health insurance company (who will often try and find clauses to avoid covering treatment)

Why?

Because at present its very reassuring to know that should I get injured or become ill that there is a system available that will look after me (to the best of its QALYs) without me or anyone else who will be worrying having to re-mortgage their house and get into horrendous debt to take care of me.

If you want to take out a private health-care insurance policy there is absolutely nothing stopping you, but that doesn't mean everyone else should have to.

[philo]

Here you go:

http://www.cbsnews.com/2100-18560_162-2528226.html?pageNum=2&tag=contentMain;contentBody

theres a video too explaining things:

[philo]

If you want to take out a private health-care insurance policy there is absolutely nothing stopping you, but that doesn't mean everyone else should have to.

that would be all fine and dandy if we could also opt out of the public healthcare too.



Here is the off budget spending, sorry for the lack of clarity:
I highlighted some important ones

Public and government accounts


Detailed breakdown of government holders of treasury debt and debt instruments used of the public portion.
The total or gross national debt is the sum of the "debt held by the public" and "intragovernmental" debt. As of February 2011, the "debt held by the public" was $9.6 trillion and the "intragovernmental debt" was $4.6 trillion, for a total of $14.2 trillion.[14]

The national debt can also be classified into marketable or non-marketable securities. As of February 2011, total marketable securities were $9.0 trillion while the non-marketable securities were $5.2 trillion. Most of the marketable securities are Treasury notes, bills, and bonds held by investors and governments globally. The non-marketable securities are mainly the "government account series" owed to certain government trust funds such as the Social Security Trust Fund, which represented $2.5 trillion in 2010.[14][15] Other large intragovernmental holders include the Federal Housing Administration, the
Federal Savings and Loan Corporation's Resolution Fund and the Federal Hospital Insurance Trust Fund (Medicare).

OFF BUDGET

[edit]Fannie Mae and Freddie Mac obligations excluded
See also: Federal takeover of Fannie Mae and Freddie Mac
Although not included in the debt figures reported by the government, the U.S. government has moved to more explicitly support the soundness of obligations of Freddie Mac and Fannie Mae, starting in July 2008 via the Housing and Economic Recovery Act of 2008, and the September 7, 2008 Federal Housing Finance Agency (FHFA) conservatorship of both government sponsored enterprises (GSEs). The on- or off-balance sheet obligations of those two independent GSEs was just over $5 trillion at the time the conservatorship was put in place, consisting mainly of mortgage payment guarantees.[16] The extent to which the government will be required to pay these obligations depends on a variety of economic and housing market factors. The federal government provided over $110 billion to Fannie and Freddie by 2010.[17]


[edit]Guaranteed obligations excluded
See also: Temporary Liquidity Guarantee Program and Exchange Stabilization Fund
U.S. federal government guarantees are not included in the public debt total, until such time as there is a call on the guarantees. For example, the U.S. federal government in late-2008 guaranteed large amounts of obligations of mutual funds, banks, and corporations under several programs designed to deal with the problems arising from the late-2000s financial crisis. The funding of direct investments made in response to the crisis, such as those made under the Troubled Assets Relief Program, are included in the debt.
[edit]Unfunded obligations excluded
The U.S. government is obligated under current law to mandatory payments for programs such as Medicare, Medicaid and Social Security. The GAO projects that payouts for these programs will significantly exceed tax revenues over the next 75 years. The Medicare Part A (hospital insurance) payouts already exceed program tax revenues, and social security payouts exceeded payroll taxes in fiscal 2010. These deficits require funding from other tax sources or borrowing.[18]

The present value of these deficits or unfunded obligations is an estimated $45.8 trillion. This is the amount that would have to be set aside during 2009 so that the principal and interest would pay for the unfunded obligations through 2084. Approximately $7.7 trillion relates to Social Security, while $38.2 trillion relates to Medicare and Medicaid. In other words, health care programs will require nearly five times the level of funding than Social Security. Adding this to the national debt and other federal obligations would bring total obligations to nearly $62 trillion.[19] However, these unfunded obligations are not counted in the national debt.

The Congressional Budget Office (CBO) has indicated that: "Future growth in spending per beneficiary for Medicare and Medicaid — the federal government’s major health care programs — will be the most important determinant of long-term trends in federal spending. Changing those programs in ways that reduce the growth of costs — which will be difficult, in part because of the complexity of health policy choices — is ultimately the nation’s central long-term challenge in setting federal fiscal policy."[20]

Sourced from:
http://en.wikipedia.org/wiki/United_States_public_debt

[Fultonius]

I think what you're really saying is that the combination of a fully privatised health care service, combined with systems such as Medicare and Medicaid does not work.

I doubt you'll find many people to disagree.

What relevance does this have to the UK?  If we privatise the NHS, how are we going to provide healthcare for those unable to pay for insurance (or with inadequate insurance) without a similarly flawed scheme as Medicare and Medicaid?

I can't quite see the link between the US having a completely unsustainable Medicare/Medicaid system and getting rid of the NHS?

[philo]

My point is that we do not have the right to medical care, we have to pay for it.  I would argue that if we had more choice and competition within the health service, that would drive prices down and the quality up - not because of regulation but because who would pay to go to a hospital with high death rates etc etc?
Its because the government has killed competition by giving a NHS system that is in the long run destined to fail.

Politicians only think in 4 year cycles, and I bet 99% don't even use the NHS.

[philo]

Im posting far too much but why can't the UK look at systems that are working?  Look at Europe, Iceland let banks fail and are in a better position for it.
Switzeland, Norway, these are the countries we should be following.

(none of which are part of the Euro or the political farce)

[tomtom]

Let's privatise everything while we're at it...

Schools, roads, defence, customs, police, social care, prisons, probation.. Fuck it, let's out source the whole civil service and while we're at it the Government too... They could be run by Camelot or Simon Cowell...

[Stubbs]

You seem to be under the illusion that competition will lead to a cheaper better product across the board, this may be true for electronic devices, but you really need to look at how unworkable this would be for services such as healthcare. OK so the hospital in your city has a bad record, or is expensive, do you travel to the next city, or have several hospitals in the same city that would need to be expensive to have all the necessary equipment and staff, but have a smaller catchment?

As mentioned previously in this thread or the other one Iceland has a smaller population then Sheffield, so doesn't make for a great example.

[Fultonius]

  I would argue that if we had more choice and competition within the health service, that would drive prices down and the quality up - not because of regulation but because who would pay to go to a hospital with high death rates etc etc?

What, like has worked so well with the utility companies?

Amazing customer service, consumer choice, low prices?

Or do we just get profit maximisation and cartel price fixing?

Edited to say:  Apologies for helping this thread to turn a bit bitchy!  Cheers slackers and OMMat for bringing it back in line!

[slackline]

Thanks for the links, I'll read in full later as I'm off to the Works, but in the sections you've pasted in I don't see anywhere that it states that those on Medicare/Medicaid will have the most expensive treatment because the gov't will foot the bill.  The scale of the cost is likely down to the huge inequality in the US which means there are lots of poor people who can't afford health insurance and rely on Medicare/Medicaid.

I would argue that if we had more choice and competition within the health service, that would drive prices down and the quality up - not because of regulation but because who would pay to go to a hospital with high death rates etc etc?

Then you'd have to find some evidence to support that argument because most of it suggests it doesn't (e.g. Propper et al. and Scanion et al. 2008).

And the notion of "people not wanting to go to hospitals with high death rates" hints at a mentality of ranking or leagues for performance with "best" and "worst" which I also think is completely misguided in the arena of healthcare, where the aim should be to standardise and ensure all perform to an equally high standard (Funnel plots are very useful in this regard for comparing institutional performance)

Of course we have to pay for health care and there are limited funds (hence the use of QALYs), but the solution isn't competition, the NHS is brilliant and does an exceptionally good job at a very competitive rate to ensure that everyone has access to the same treatments regardless of their background (you could if you had the funds do what Steve Jobs did and eschew conventional, proven treatments and pay for whatever you want, doesn't mean it would work).

[Oldmanmatt]

You know, I started to read this...
But, before I plough through it all.
Britain finished?
Really?
I've got small, high tech, manufacturing companies; cueing up to relocate from the Euro zone to the UK!
Our regime here is very conducive to their needs, our tax burden for corporations and individuals is one of the best there is.
I've seen plenty of industries here suffer through this period and plenty who are positively booming.
The economy is going through a correction and I'm pretty sure it will shift away from the real estate base it has at the moment. Not sure that it will shift from the financial bias, but I think it will change it's nature.
Finished?
I remember hearing that in the 70's (winter of discontent).
I remember hearing that in the 80's (miners strike, down turn in manufacturing).

And I'm not convinced the gov, past or present, bears the lions share of the blame for the current "crisis".
Our borrowing, as individuals, has been fairly responsible. There have not, for instance, been a huge number of repossessions (although I do agree that the prices are over inflated).
In the early 90s, more than half the houses on the new estate (where I had bought my first house) were repossessed! This resulted in a 60% drop in property values. When we sold the house in 2001, we had £2000 equity! After ten years!
I (along with most of those I know), disagreed with the bank bail out. Most of the deposits here were underwritten by the UK gov, anyway. It would have been cheaper on the tax payer (which included the depositors themselves) to bail out the investors...

I suspect, but cannot prove, it was fear of the market response to the bank failure, that drove the decisions during those days. Fear of the irrational response of those same markets, that you believe would be the answer to all problems.

I'm a committed capitalist, social responsibility is not the same thing as socialism. Our welfare state grew out of our industrial revolution. It was not created by the common man, but in large part by the industrialists themselves. The seeds sown, long before the labour gov of the 50s.
I've also had the displeasure of living in weakly governed states and autocratic states. Some of those states all but collapsed recently.

Galbraith, by the way, came to the fore during the second war; it would be hard to say he mishandled the US war time economy...

[philo]

At some point in the future we will have to rename the great depression of the 20/30s.
I am not optimistic about the growth of our economy, nor am I under any illusion that the politicians will do anything right.  When I first started reading into it and researching how an economy grows and why it collapses it does provoke a lot of moral issues such as healthcare and the welfare state as a whole. 
The point I am trying to make is that we cannot give false hopes and promises.  We cannot pretend that we can afford a welfare state when the times are good to then keep it up when the bad times come by putting debt onto our children and children's children to save the face of what was once a good idea. 

We cannot borrow and spend our way out of this mess and is it unrealistic to think that interest rates could rise to 10%?  what about 20%?  Think about how your life would be affected then.  I'm no market trader or stock broker but I will go as far to say that I will protect my wealth by protecting myself from the coming inflation/hyper inflation that we are on the verge of entering - whether we collapse again in 2012 or 2013 is irrelevant.

Some small businesses are doing well OMM sure, but to have a huge trade deficit when we import and consume is no way a healthy economy and looks bleak for real economic growth.

I am also a firm believer of capitalism but you must realise that Galbraith and the Roosevelt era merely prolonged the problems with government stimulus. 

From  the fall of 2007-present, the bubble has moved from the housing market (which is still roughly 70% above what it should be) to the bond market and bond bubble.  The only people who are going to make money from bonds are those who are shorting it to bank of England/ fed/ IMF or whoever is the last holder before it bursts.

[Fultonius]

I actually agree with almost everything you say there*.

I just don't see how privatising the NHS is going to help in any way, shape or form. I think the healthcare and pensions should be completely funded by a central fund. This fund should not be "invested" or rely on growth. The true costs should be made public and be very transparent.


*not quite sure where you're going with the 10% or 20% interest thing. I also think we should move away from "benefits" and use that money for "services" (such as low cost child care to help young mothers back to work). But this is all getting waaaay   .


As an aside - one thing that is commonly cited as en example of why private companies perform better than centrally run institutions is the drive to make profit. However, having worked for 5 years a fairly large engineering firm, I've found that managers who focus to closely on profit maximisation soon lose favour with employees and productivity wanes. Our meagre (~4%) "performance related bonuses" provide more stimulus than purely "improving profit". There's no reason why you can't incentivise excellent performance with a robust performance related pay/bonus system in a non-profit organisational. It's only really bean counters and CEO and investors that care about profit margin anyway.

[Johnny Brown]

Philo, are you suggesting our way out of the depression is exporting cars to developing countries. Why wouldn't it make more sense/profit to build them in developing countries?

The car industry was just an example, you have to look at the raw materials and the cost of production.

Right, okay. I think it was a bad example. If export is as vital as you suggest, I think we should concentrate on exporting services and high-tech goods. I'm not at all convinced that making cars in the UK will become more viable due to a massive downwards quality of life adjustment. Where do you see that adjustment coming from? Our housing is excellent, our infrastructure is excellent. Or do you just mean removing welfare?

[philo]

I was looking at the picture on a whole, when you look at the economy you have to look at the whole standard of living and the promises we have made. 
Throughout history interest rates have risen to pull in inflation. 
We have had 13 weeks of "historic" low interest rates but the Bank of England should not be setting the rates at all!

You have to understand that the low interest rates are the cause to the problem.  Having interest rates at 0% or 0.5% does not allow the free market to work and allows people to gamble without the risk and cause mal-investments.

Without the artificial low interest rates we would not have had a housing bubble from the dotcom bubble crash in the early 2000's.  In a few years time we will be saying exactly the same thing about the bond bubble bursting. 

The bubble we had from 2000-2007 was the problem, the solution is a recession.  When governments step in and prop up the bubble and try to re-inflate it, they only kick the can down the road and prolong the recession hence making it a depression.

[philo]

Philo, are you suggesting our way out of the depression is exporting cars to developing countries. Why wouldn't it make more sense/profit to build them in developing countries?

The car industry was just an example, you have to look at the raw materials and the cost of production.

Right, okay. I think it was a bad example. If export is as vital as you suggest, I think we should concentrate on exporting services and high-tech goods. I'm not at all convinced that making cars in the UK will become more viable due to a massive downwards quality of life adjustment. Where do you see that adjustment coming from? Our housing is excellent, our infrastructure is excellent. Or do you just mean removing welfare?

house prices are still 70% above where they should be IMO and I guess time will tell if i'm correct with that.  We have massive amounts of debt and still have massive trade deficit figures.  We do have some innovative companies that produce and design high tech goods but we are still in a massive TRADE DEFICIT. 

Eventually our creditors will right off the debt and allow their currencies to rise, they will stop propping us up.  At that point the Bank of England will step in and start buying our treasuries.  If they bought our long 30 year bonds then interest rates would rocket up.  They can only buy the short term loans at 0% which will cause so much inflation the writing will be on the wall.

[robertostallioni]

After watching Frozen Planet I've been stockpiling baked beans and bogroll  for a while now. Sounds like you lot are fucked, though.

[Fultonius]

I agree about the impending bond bubble.

As JB says, we need to export goods and services that represent a comparative advantage over other countries. To be honest, I'm not sure what they are!

I don't think low interest rates are the problem, I think a debt based economy is destined to failure by it's nature. Especially so in a world of dwindling resources.

[tomtom]

After watching Frozen Planet I've been stockpiling baked beans and bogroll  for a while now. Sounds like you lot are fucked, though.

Don't forget to equip your bunker with a pull up bar to pass the time

[philo]

low interest rates allowed the government and the tax payers to borrow and spend our way into the debt crisis we have.  It was the 0.5% interest rates that lead to people buying houses they could no way pay back when they reset or adjustment rate mortgages

[andy popp]

Philo, you're talking so much ill-informed contradictory nonsense that its hard to know where to start. One place might be this particularly meaningless nugget.

Every nation that has collapsed so far has moved from a gold standard.

Meaningless since, as the gold standard collapsed in the mid-30s, every nation, successful or otherwise, has moved off it. There is an extremely strong argument that it was adherence to the Gold Standard, rather than the New Deal, the prolonged the great depression. But perhaps you don't mean 'The' gold standard but just some unspecified gold standard. Who knows? I'm not convinced you do.