ObamaCare - exchanges ,report your states options!

[ViperOverLord]

The CBO states that Obamacare will cost $1.76 trillion dollars for 10 years, much more than the $940 billion he stated at the time of passing the law.

[Phatscotty]

New CBO budget is in on the Affordable Care Act.

http://cbo.gov/publication/43076

You know, I hate all of these "mandated spending" accounts and numbers they put out. Since when is it Constitutional to bind a future Congress to spend money that you pass now? That's why we elect a Congress in the first place: to budget and spend the money necessary for that fiscal year. No Congress should have the power to dictate to a future Congress how to spend their money.

That's just Freedom....

[thegreekdog]

I wonder how much 10 years of health insurance costs the UK government. That may be my research project for the day.

Also - VOL... the Washington Examiner article is a little misleading. It's misleading because, net, it doesn't cost almost double. It's a little misleading because it looks like it doesn't cost double on a net basis because of increased tax revenues.

Also, also - I moved VOL's new thread here. We don't need another socialized healthcare thread.

[BigBallinStalin]

I wonder how much 10 years of health insurance costs the UK government. That may be my research project for the day.

More importantly, what do costs actually reflect?

You could decrease costs by overloading your staff, thus decreasing the quality of service, while imposing subjective costs on patients--e.g. waiting in longer lines to see a doctor or have a certain procedure done, etc.

But hey, at least it looks good on paper! Especially since the costs that can't be quantified are totally ignored. Yippee!!

[Symmetry]

Meh, much as any source I cite that shows Universal healthcare is cheaper and more effective will be likely dismissed, here's the WHO comparison:

Link

[thegreekdog]

Meh, much as any source I cite that shows Universal healthcare is cheaper and more effective will be likely dismissed, here's the WHO comparison:

Link

I'm not dismissing (although I'm unclear as to what your definition of "dismissing" is), but...

Currently, the US spends a higher percentage of government revenue on healthcare than the UK, while covering a smaller percentage of costs. Exhibit L for American anti-exceptionalism?

Further, the Affordable Care Act doesn't look like it solves these affordability problems. Exhibit M for American anti-exceptionalism.

[Symmetry]

So, go on. how is the US anti-exceptional while being the exception? The one place where a universal healthcare system of some sort won't work?

[thegreekdog]

So, go on. how is the US anti-exceptional while being the exception? The one place where a universal healthcare system of some sort won't work?

I have to see the statistics on the Affordable Care Act once it's fully in effect. The CBO doesn't think it's going to be cost effective. I think it's a boondoggle for insurance companies. And it's certainly not universal healthcare.

I thought we went over this before.

[BigBallinStalin]

So, go on. how is the US anti-exceptional while being the exception? The one place where a universal healthcare system of some sort won't work?

How does one separate and determine the magnitudes of the incentives from institutions which affect a person's behavior?

People in Continental Europe generally eat healthier. Is it because the government nationalized or heavily regulates the healthcare sector? Or is this an mentality reinforced by cultural norms?

I dunno, neither do you, but I'm not going to spend hours debating something like this.

[john9blue]

How does one separate and determine the magnitudes of the incentives from institutions which affect a person's behavior?

People in Continental Europe generally eat healthier. Is it because the government nationalized or heavily regulates the healthcare sector? Or is this an mentality reinforced by cultural norms?

I dunno, neither do you, but I'm not going to spend hours debating something like this.

so what you're saying is that the magnitudes can't be quantified, so we should just ignore them?

[thegreekdog]

How does one separate and determine the magnitudes of the incentives from institutions which affect a person's behavior?

People in Continental Europe generally eat healthier. Is it because the government nationalized or heavily regulates the healthcare sector? Or is this an mentality reinforced by cultural norms?

I dunno, neither do you, but I'm not going to spend hours debating something like this.

so what you're saying is that the magnitudes can't be quantified, so we should just ignore them?

I don't know what BBS is saying, but here's what I think he meant:

We can't apply what worked in another culture or country to the US and say that it will work.

Example - Like most Americans, I just ate a gigantic cheeseburger and french fries for lunch and washed it down with a 250 calorie Coke. I then got into my car to drive the one mile back to my office where I will sit in front of a computer until 8 PM at an exceedingly stressful job. I will take multiple breaks to chain smoke. I'll get home at 9 PM, park myself in front of the television while eating a half-raw steak, baked potato, and apple pie and washing that down with three gallons of beer. I'll go to bed at midnight to make sure I get at least 5 hours of sleep.

[BigBallinStalin]

@john and Sym and whoever:

No, we shouldn't ignore variables that can't be or are extremely difficult to measure, but either that's what happens, or very little analysis is dedicated to uncovering subjective value.



Here's my beef with the wiki data, and the claim that "Meh, much as any source I cite that shows Universal healthcare is cheaper and more effective will be likely dismissed, here's the WHO comparison":

So, we're looking for lower costs and higher effectiveness.



Using the wiki data, I'll go over each category:

Per capita expenditure on health (GDP, PPP):

it just shows GDP per capita and healthcare spending ratios. Recall that government expenditures are included in GDP, so if a government spends a lot relative to the size of its economy, then the higher GDP will "reduce" the actual health care costs. It's not a good ratio.

GDP = C + I + G + NX
Increase G, and divide health expenditures by GDP, and you get a lower "cost."

Furthermore, it's misleading to compare US healthcare costs with European healthcare costs, because roughly 40% of US healthcare costs is already paid by the government (Medicare and Medicaid, some of which doesn't really go to "healthcare," which further undermines the usefulness of this data).

This criticism applies to the "healthcare costs as a percent of GDP" too.

% of health costs paid by government
Notice the difference between the US and non-US figures. Almost all are roughly double the amount. This lends additional support to my above argument.


Also, the categories aren't clear. Who's paying for the healthcare costs? Is it lumping in expenditures of the entire healthcare industry, for individuals, for insurance companies? How are these expenditures separated? ...


Physicians and Nurses per 1000 people.
How about quality of service?

And how is this relevant? Look at how the figures vary compared to the benefits received (life expectancy, infant mortality rate, mortality amenable...). I'm not going to run regression analysis, but there doesn't appear to be a clear positive correlation between more Physicians/Nurses, "socialized" healthcare, and benefits received.

The effectiveness isn't clear because of the variance in physician/nurse ratios and their alleged relation of unknown magnitude to life expectancy, child mortality, and "prevented"/amenable mortality.


% of health costs paid by government
What matters more is how that money is spent. A government could reduce its costs, but then shift lack of quality service onto customers (e.g. longer queues for treatment, surgery, etc., price controls, the lack of spending on R&D medical research, etc.).

R&D and the production of medicine is an important cost of health care. If the US produces most of it, and the European countries buy it at lower prices, then the data would reflect that the European countries spend less on healthcare (because they don't actually produce most of the medicine, research, etc.). So how are the gains of trade considered here? They aren't. It's just hidden in the data and gives us the appearance that socialized healthcare is totes better.




And then there's what isn't measured:
How responsible are lifestyles, customs, etc. for the higher benefits? How can the data separate these effects from the observable data? I don't think it can, which makes this more problematic. (TGD's above post provides an example).


Data on effectiveness:
There is no strong evidence for this. Where's the regression analysis?


The claim that "Universal healthcare is cheaper and more effective" is not substantiated by the evidence provided.

[Phatscotty]

[Lootifer]

To echo Aradhus' sentiments in another thread, wtf is your point PS? Or do you just like looking like an idiot to those who disagree with the things you say? (I cant say what your "supporter's" think but I know how you are observed by detractors and neutral parties...)

[Phatscotty]

To echo Aradhus' sentiments in another thread, wtf is your point PS? Or do you just like looking like an idiot to those who disagree with the things you say? (I cant say what your "supporter's" think but I know how you are observed by detractors and neutral parties...)

What are you talking about specifically?

[Baron Von PWN]

To echo Aradhus' sentiments in another thread, wtf is your point PS? Or do you just like looking like an idiot to those who disagree with the things you say? (I cant say what your "supporter's" think but I know how you are observed by detractors and neutral parties...)

What are you talking about specifically?

Your random photos/youtube videos. Like the one you posted above. It seems completely irrelevant and doesn't make anything resembling a point.

Maybe in your mind you have an argument and you think this photo represents that argument so you posted it for efficiency's sake. However all we see is a picture and have no idea what your argument is.

They say a picture is worth a thousand words, but there is a good reason war and peace isn't a picture book.

[Symmetry]

@john and Sym and whoever:

No, we shouldn't ignore variables that can't be or are extremely difficult to measure, but either that's what happens, or very little analysis is dedicated to uncovering subjective value.



Here's my beef with the wiki data, and the claim that "Meh, much as any source I cite that shows Universal healthcare is cheaper and more effective will be likely dismissed, here's the WHO comparison":

So, we're looking for lower costs and higher effectiveness.



Using the wiki data, I'll go over each category:

Per capita expenditure on health (GDP, PPP):

it just shows GDP per capita and healthcare spending ratios. Recall that government expenditures are included in GDP, so if a government spends a lot relative to the size of its economy, then the higher GDP will "reduce" the actual health care costs. It's not a good ratio.

GDP = C + I + G + NX
Increase G, and divide health expenditures by GDP, and you get a lower "cost."

Furthermore, it's misleading to compare US healthcare costs with European healthcare costs, because roughly 40% of US healthcare costs is already paid by the government (Medicare and Medicaid, some of which doesn't really go to "healthcare," which further undermines the usefulness of this data).

This criticism applies to the "healthcare costs as a percent of GDP" too.

% of health costs paid by government
Notice the difference between the US and non-US figures. Almost all are roughly double the amount. This lends additional support to my above argument.


Also, the categories aren't clear. Who's paying for the healthcare costs? Is it lumping in expenditures of the entire healthcare industry, for individuals, for insurance companies? How are these expenditures separated? ...


Physicians and Nurses per 1000 people.
How about quality of service?

And how is this relevant? Look at how the figures vary compared to the benefits received (life expectancy, infant mortality rate, mortality amenable...). I'm not going to run regression analysis, but there doesn't appear to be a clear positive correlation between more Physicians/Nurses, "socialized" healthcare, and benefits received.

The effectiveness isn't clear because of the variance in physician/nurse ratios and their alleged relation of unknown magnitude to life expectancy, child mortality, and "prevented"/amenable mortality.


% of health costs paid by government
What matters more is how that money is spent. A government could reduce its costs, but then shift lack of quality service onto customers (e.g. longer queues for treatment, surgery, etc., price controls, the lack of spending on R&D medical research, etc.).

R&D and the production of medicine is an important cost of health care. If the US produces most of it, and the European countries buy it at lower prices, then the data would reflect that the European countries spend less on healthcare (because they don't actually produce most of the medicine, research, etc.). So how are the gains of trade considered here? They aren't. It's just hidden in the data and gives us the appearance that socialized healthcare is totes better.




And then there's what isn't measured:
How responsible are lifestyles, customs, etc. for the higher benefits? How can the data separate these effects from the observable data? I don't think it can, which makes this more problematic. (TGD's above post provides an example).


Data on effectiveness:
There is no strong evidence for this. Where's the regression analysis?


The claim that "Universal healthcare is cheaper and more effective" is not substantiated by the evidence provided.

That was a series of daft arguments clearly designed to uphold an irrational position. A lot of whataboutery without any clear data.

I guess the obvious point on which your argument fails is that universal healthcare, and indeed what might be termed socialised healthcare is not localised to Europe. Perhaps adjust your thinking on that point. You need look no further than Canada, which, last time I checked was not in Europe. Or perhaps Israel? Or Australia? Or maybe you can keep going on about it being a European thing.

The data is not undermined by the massive inefficiencies of the US system, rather it strengthens the argument that the US system is pretty awful.

I guess, to be going on with, you might be surprised to find that the UK is home to a significant number of pharmaceutical companies that somehow research and develop new drugs. Check out GlaxoSmithKline if you're genuinely interested.

Of course, I suspect that you've made your decision already and the evidence comes after. I suspect that evidence is completely replaceable, so I'm not sure how much me knocking down your arguments will persuade you.

[BigBallinStalin]

It seems that you don't understand how GDP is calculated, and how this distorts the data.

Please visit: http://en.wikipedia.org/wiki/Gross_domestic_product


Then there's the issue of how healthcare costs are calculated, and why those costs are different across countries. And, objective costs can only measure so much. Other important determinants are ignored because they can't be, or are very difficult, to be quantified.

Healthcare isn't a homogenous good; therefore, expenditures on healthcare costs across countries can be misleading. It varies in its capital structure, the gains of trade, and the actual good produced. What kind of services are actually rendered for payments received? The data doesn't reveal that. You're trying to compare quality without showing data on quality. It's a weird argument to make.

Also, the countries vary in private and government expenditures on healthcare. This matters for reasons already explained.

That's a few points of my argument which you fail to address. If you can't explain the data which you present, and since the data suffers from the above mentioned problems, then your evidence is suspect. It's okay if you disagree for whatever emotional reasons, but your counter-argument lacks explanation.

For example, "The data is not undermined by the massive inefficiencies of the US system, rather it strengthens the argument that the US system is pretty awful." How is this relevant? If you don't wish to address any of my points with some kind of direct explanation, then <shrugs> okay.


Regarding your one minor contention about pharmaceuticals:

A good indication of the relative size of industries:
http://en.wikipedia.org/wiki/Pharmaceutical_industry#Market_leaders_in_terms_of_revenue

Third paragraph mentions how the pharma companies invest in each other across countries. How shall we determine who spends how much on healthcare? I don't know, neither do you, but you standfast to your data with this additional problem.
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Industrybranch/DH_4000038

You need a new approach to this.

[Symmetry]

It seems that you don't understand how GDP is calculated, and how this distorts the data.

Please visit: http://en.wikipedia.org/wiki/Gross_domestic_product

It seems oddly like you're backtracking on a series of inane remarks, and can't accept that you made some mistakes. Just admit your mistakes and move on. It won't hurt you, and most peeps will forget that you messed up. You'll be better off restating your arguments once you've admitted that you approached them with flawed premises, and can admit now that I was correct. There's no harm to you, and the discussion can get back on track.

Just acknowledge the basic points of my counter-argument, and accept that you were wrong, rather than trying to change the subject to a new point. Is that such a ridiculous suggestion?

[BigBallinStalin]

It seems that you don't understand how GDP is calculated, and how this distorts the data.

Please visit: http://en.wikipedia.org/wiki/Gross_domestic_product

It seems oddly like you're backtracking on a series of inane remarks, and can't accept that you made some mistakes. Just admit your mistakes and move on. It won't hurt you, and most peeps will forget that you messed up. You'll be better off restating your arguments once you've admitted that you approached them with flawed premises, and can admit now that I was correct. There's no harm to you, and the discussion can get back on track.

Just acknowledge the basic points of my counter-argument, and accept that you were wrong, rather than trying to change the subject to a new point. Is that such a ridiculous suggestion?

Point out my mistakes. But if you don't understand GDP and how costs are calculated, then what should I expect?


I added a light summary and additional problems with your counter-argument from my previous post. For your viewing pleasure:

show

[BigBallinStalin]

I guess the obvious point on which your argument fails is that universal healthcare, and indeed what might be termed socialised healthcare is not localised to Europe. Perhaps adjust your thinking on that point. You need look no further than Canada, which, last time I checked was not in Europe. Or perhaps Israel? Or Australia? Or maybe you can keep going on about it being a European thing.

You present data on European countries, so I look at the data and criticize it. If you fail to address my criticisms, or fail to explain how your criticism is relevant, then you have nothing logical to support your argument.

I'll admit, there was Canada and Japan in there, but that doesn't change the nature of my criticism because it still applies to non-European countries as well. So, the ball's still in your field. You can throw it back, or pick it up and go home.

[Symmetry]

I guess the obvious point on which your argument fails is that universal healthcare, and indeed what might be termed socialised healthcare is not localised to Europe. Perhaps adjust your thinking on that point. You need look no further than Canada, which, last time I checked was not in Europe. Or perhaps Israel? Or Australia? Or maybe you can keep going on about it being a European thing.

You present data on European countries, so I look at the data and criticize it. If you fail to address my criticisms, or fail to explain how your criticism is relevant, then you have nothing logical to support your argument.

I'll admit, there was Canada and Japan in there, but that doesn't change the nature of my criticism. So, the ball's still in your field. You can throw it back, or pick it up and go home.

Not sure that's true, ball-wise. I got my data, and you fucked up royally on attacking it, so I think my data stands, and you've got some arguments that you would like me to research for you.

Meh, I think you should work out your own arguments. And, again, possibly admit where you went wrong?

[BigBallinStalin]

Haha,

Over time, I've noticed a pattern of yours. When presented with rational arguments and when the topic is something on which you lack relevant knowledge, over the course of the thread, you tend to dig in your heels, refuse to debate rationally, and then resort to this game where you try to elicit strong emotions from your perceived opponent.

Why do you do this? What's upsetting you?

[Baron Von PWN]

@john and Sym and whoever:

No, we shouldn't ignore variables that can't be or are extremely difficult to measure, but either that's what happens, or very little analysis is dedicated to uncovering subjective value.



Here's my beef with the wiki data, and the claim that "Meh, much as any source I cite that shows Universal healthcare is cheaper and more effective will be likely dismissed, here's the WHO comparison":

So, we're looking for lower costs and higher effectiveness.



Using the wiki data, I'll go over each category:

Per capita expenditure on health (GDP, PPP):

it just shows GDP per capita and healthcare spending ratios. Recall that government expenditures are included in GDP, so if a government spends a lot relative to the size of its economy, then the higher GDP will "reduce" the actual health care costs. It's not a good ratio.

GDP = C + I + G + NX
Increase G, and divide health expenditures by GDP, and you get a lower "cost."

Furthermore, it's misleading to compare US healthcare costs with European healthcare costs, because roughly 40% of US healthcare costs is already paid by the government (Medicare and Medicaid, some of which doesn't really go to "healthcare," which further undermines the usefulness of this data).

This criticism applies to the "healthcare costs as a percent of GDP" too.

I don't see why government expenditure going into Healthcare should matter. How does government expenditure differ from private expenditure?

Wouldn't private expenditure on healthcare also be counted towards GDP?

What dose it matter whether the amount spent on healthcare comes from Public or Private means, why would that be totalled differently when it comes to GDP?

I'm not an economist so if I'm missing something please explain.


As for the rest of it, I won't comment as I don't know. Though I do prefer the Single payer system/ state provided.

[BigBallinStalin]

I don't see why government expenditure going into Healthcare should matter. How does government expenditure differ from private expenditure?

It could differ in quality and efficiency.

Wouldn't private expenditure on healthcare also be counted towards GDP?

Yes.


If those two means were the exact same, then it wouldn't matter (but they aren't).


What happens if the countries vary in the private-to-public spending on healthcare ratios? How does the variance affect the outcomes?

For example, the US government healthcare spending is roughly 40% of the total expenditures on healthcare. In other words, it's already 40% state-managed/state-owned (henceforth, "socialized), and the costs are significantly high already. Now people tend to posit that the US should shift more to state-managed/state-owned healthcare, yet if healthcare costs are so high in the US and since government outlays account for 40%, how would expanding the government spending bring greater returns?

It could be like Britain where they reduce costs by shifting them to subjective costs, i.e. the costs you don't see (more price controls, queues for operations, etc.).

What dose it matter whether the amount spent on healthcare comes from Public or Private means, why would that be totalled differently when it comes to GDP?

GDP doesn't measure quality or efficiency. Recall that bit about objective v. subjective costs.

As for the rest of it, I won't comment as I don't know. Though I do prefer the Single payer system/ state provided.

Honestly, I have no idea which is best because I don't spend much time researching healthcare issues. However, healthcare in the US seems to be a systemic problem. I think much of the problem extends from too much regulation at a national level while granting a monopoly on the certification of various fields (medicine, medical doctors, etc.).