I notice that the subjects relating to how to deal with other people are not in your list. You don’t think that philosophy and literature and art have useful applications for a business and political environment in which people from vastly different cultures and experiences need to cooperate voluntarily on complex projects?
Econ had a class which detailed how other cultures' basic assumptions about time/law/money/relations/religion were different, how to deal with them, and what all that meant in a practical sense in terms of making multi-national project work.
The case studies had some real howlers. The auto company which sold the 'Nova' in Mexico... and 'Va' in spanish means 'go' so No-Va means "No-Go". The oil company which presented to Saudi officials it's proposal in an expensive pig-leather folder... which resulted in both the binder and the proposal being burned and the company officials ordered out of the country.
How many classes in philosophy/literature/art do you need to have to get the same thing?
I also never understood the libertarian sneer against a mass educated class. I agree that there are problems now but a well educated society should be a goal for advanced society.
Agreed, but some letters on a piece of paper and a $100k debt doesn't make you "educated". Education is supposed to let you know more about how the world at large works and how to make good choices in society.
That should include:
1) Reading and Writing... although one *hopes* the high schools do this.
2) Physics (the very definition of 'how the world works').
3) Statistics (it's very hard to make sensible choices without this).
4) Logic (ditto, lots of bad ideas are out there, knowing why they're bad is pretty key).
5) Economics (ditto, and yes, money is important)
Some of these are on how-to-evaluate-information and some of them are backbone on how the world works. But as far as I can tell it's possible to go through college, get your degree in 'being-indoctrinated', skip most everything I just mentioned, and after that you can parrot whatever you 'learned'... and then be totally shocked that the world doesn't actually care and you've got $100k in debt for a min-wage job.
The original college degrees were measurements of wealth, intelligence, and social status. The new college degrees need some underlying value to have value, and all to often they don't.
We stay out of WW2 and Hitler takes over Europe.
We stay out of the Cold War and Stalin takes over Europe and various other countries.
South Korea loses to North Korea and the Kims rule both.
We skip Gulf War One and Saddam takes over various Middle East countries and dominates oil.
Various other regional conflicts are taken to their natural conclusions, these conclusions are often ugly.
Partly this depends on what the "average" voter looks like and where he's running, but more importantly, this puts his name out in front of the average person.
This is a PR stunt, which isn't to say he doesn't believe in what he's doing or he'd be unlikely to be a Public Defender to begin with.
Agreed. Not Cruz. Rubio, Jeb, maybe John Kasich.... so call it two of the three, no clue who is VP... probably Rubio since he's the least experienced but whatever.
:sigh: I can't disagree with any of that. For the GOP this election was stunningly winnable... which I suppose is why we had 15(ish) people run. Looks like there's a lot to be said for smoke filled back rooms.
This is because insurance networks need *medical professionals*. No insurance company could sell insurance here when they don’t have a network here! And they’re not going to try to set one up from another state.
First, the bigger insurance companies already function in multiple states, and thus already have networks in multiple states. What's going on is every state wants to have the insurance company's administration (i.e. jobs) in their own state.
2nd, needing "networks", at all, is a rotten side effect coming from using insurance companies for cost control. When my car crashed they wrote me a check and let me deal with it rather than insist every bolt come from the supplier with whom they'd made a deal.
nothing was stopping, say, Oklahoma and Texas from creating a joint market and centralizing all their regulation.
So the solution to too much central planning and political interference is more political interference? State level politicians don't want to compete with other states. Consumers would benefit from larger markets and more competition.
The ACA divides allows insurance companies to divide ages into three ranges, and requires the price be even inside that range. Additionally, the high end can be no more than three times the low end.
A young and invincible can only have a policy one third the price of the elderly? :Ouch: And of course the young are largely poor and the old are largely rich.
That’s not to say there are points in health care where people *do* make decisions, but *that* decision-making process shouldn’t involve costs, only various risks and recovery times and stuff.
Shear nonsense. Try applying that logic to anything else, say buying a car, or a college education. Should the decision-making process really not involve costs for either of those?
Dark Matter: And that world class surgeon’s $10k ... in theory I could saved a lot of money by flying to a different state… assuming I could find someone like that who isn’t attached to a massive bureaucracy.
I have no idea what a different state has to do with anything.
The other docs I found of his caliber weren't in my state.
I don’t understand why you think a HSA plus insurance to cover major expenses is any different than currently existing high-deductible plans. Because that’s basically what you’re suggesting….a large deductible
I think there's an emotional difference, an HSA is money in hand, it's yours, if you reduce medical spending.
So someone like me, who was born with a heart defect, should never be able to get insurance?
I don't know whether a heart defect is an "increases risk" thing or a "treat every day" thing or both. If it's just risk, then you should be paying for the risk you bring into the pool, which might be large enough that you can't afford it. If it's a "treat every day" thing then that's not something "insurance" should be dealing with, meaning in theory they'd just add it to the cost of your insurance.
And you should be able to get insurance as cheap as anyone else for issues that are unrelated to the heart defect.
It’s incredibly easy to point to people who do not have insurance, get some major disease, and then try to get insurance, and say ‘Those people should not be able to do that’.
Sure, just like you shouldn't be able to buy home insurance after your place burns down.
And the other problem, of course, is the fact that those people who didn’t have insurance until they got sick *are still sick and still need medical treatment*.
This is a problem, and a big one, but it really shouldn't be handled via insurance. Tax dollars probably are appropriate, but forcing it onto insurance companies is just politicians *literally* spending other people's money.
The solution is to get rid of free riders by having everyone pay to start with. The way we *normally* do that in society, the way we make everyone pay for the police and roads, is taxes. For some reason the right wasn’t in favor of that, so demanded the mandate instead, which they also are not in favor of apparently.
The mandate was proposed by a right-wing think tank and then got shot down when it was pointed out just how intrusive it'd be. Given that the left voted in lockstep to implement it, the left owns it. They didn't have the votes for a single payer or we'd have that instead.
The history of single payer in this country has been the left wanting to implement it but flinching away from how much it would cost.
You want public money for healthcare (and we're already spending a lot)... but what is the limit on this? *That* is the reason single payer (or whatever) keeps failing. What exactly is the line here which prevents this from breaking the budget? Do we spend a million dollars so a premature baby can grow up with various problems? Do we spend a million dollars to give a 90 year old man another few months? Is it realistic to expect Congress to make decisions which kill little old ladies?
The death rate in this country holds steady at 100%. Whatever we do, people are going to die, whatever line we draw, people are going to die, and yes, some of them on the street. As far as I can tell, your solution is to draw no lines.
"Word on the street" turned out to be outright lies spread by his political opponents, i.e. that he hadn't paid any tax at all.
Keep in mind if we're going to put finances under a microscope, Trump is running against Hillary... and that foundation looks a lot like a money laundering scheme.
they actually ran a big study because a very large company –10k+ employees– (possibly even mine, it was the right time frame) switched to all HSA plans one year. And indeed, people put off necessary care and ended up costing both themselves and the company more money.
I think you're talking about the Commonwealth Fund study. The thing is that although consumer satisfaction went down (compared to 'more comprehensive' insurance, i.e. more expensive), health didn't.
https://en.wikipedia.org/wiki/Health_savings_account#Consumer_satisfaction
You don’t NEED financial disincentives, because the mere fact that going is an unpleasant chore is plenty to prevent most overuse.
So the next time you buy a car, just give the salesman a blank check and tell him to use his own judgement on what you need.
That was sufficient to make me uninsurable.
I'm sorry to hear that, and I don't understand the medical/actuarial ins and outs to even begin to justify this nor to know whether or not it is justifiable. This sort of thing hits the radar as exceptionally poor consumer service.
The reason the costs aren’t being controlled is that the patients are getting the correct amount of health care, but they’re getting it with absolutely no concern, or even knowledge, of the cost. There is no price comparison.
Very, very close... although I’d quibble with “the correct amount of health care” because there are multiple factors which inflate that. I don’t regret the $10k I paid for a surgeon, but I do regret the $200 I paid for a test which probably wasn’t going to reveal anything and didn’t. If you go to a used car lot and let the salesman decide how much car you “need”, the answer is probably “a lot”. The benefits of the system flow to both the patient and the health system itself, the costs do not.
And that world class surgeon’s $10k had a huge administrative overhead baked into it which is also a problem. If we take our ‘college administration’ example and assume three quarters of that isn’t value added (:massive handwave:), in theory I could saved a lot of money by flying to a different state... assuming I could find someone like that who isn’t attached to a massive bureaucracy.
If we had competition then a guy like that could set up his own shop, with thin administration, and he’d personally get a massive pay increase while at the same time charging less. The ACA supposedly strongly encourages the opposite.
And the weird thing is, it’s perfectly possible to have cost controls with reimbursement just by having a *fixed* reimbursement for most things.
You’re totally correct in that the solution is for consumers to have skin in the game. But why not go whole hog?
Get the insurance company totally out of the picture for small items, force consumers to have HSAs, if they save money then they keep it. There are multiple other things which need to happen, the big one being prices need to be clear and easily available.
Insurance companies are this massive impediment to competition and letting them stay in there ‘helping’ people by ‘negotiating’ is just making things way more complex for no good reason. Keep in mind how college costs have zoomed up to support their bureaucracy.
Now, in medicine, *sometimes* this is hard to figure out, especially in surgeries, where dozens of different variables exist. I know that. But there are a lot of places it could work. All labs, for one.
All labs. What a “typical” labor costs. I think we’d be really surprised at what could be compared (especially in the age of smart phones) if there weren’t so many road blocks set up to prevent it. When my kid sliced her head open, I went to her local doctor because I figured (correctly) that he’d be much more skilled and a lot cheaper than some emergency room intern (and that’s without waiting the multiple hours).
This means if different ages/races/genders/classes have different risks, they should be paying different amounts.
Down to what specificity, and what difference in amounts?
Those are political questions to what really should be a market decision.
The current rules are: Smokers can be charged more, and ages are allowed to be divided into three groups and internally each group is charged the same amount.
The current rules have heavy political pandering and so forth. You’re not allowed to sell across state lines so some/many state insurance industries are micro managed by their state regulators and there’s no competition between different states. So the result is a heavily shielded industry which doesn’t need to serve it’s consumers very well.
OTOH, you *didn’t* list pre-existing conditions there, so that solves a lot of that. Health insurance companies really really shouldn’t be allowed to vary their prices based on *that*.
I'm taking "Pre-existing" to mean "before you got insurance". The moment a pre-existing condition (say, cancer) becomes a ‘regular’ part of you then you’re not spreading risk anymore, you’re trying to cover costs. If a disease has a million dollar cure and effects one-in-a-million, then insurance should be able to cover everyone for a dollar each. That’s spreading risk. If someone goes without insurance thinking that it can’t happen to him but does, then we’re not dealing with risk any more.
To address multiple other comments you made, the insurance companies aren’t serving their customers well, they’re acting like a heavily shielded near-monopoly who has corrupted it’s regulators.
And I am not sure how you think insurance companies can judge what class, or even what race, someone is.
The amount of publicly available information is scary, but the issue is whether different groups have different risks which should be insured differently. Anything which gets in the way of pricing risk correctly is a problem, that includes lack of competition and political meddling.
For example one of the flaws of the ACA was it wanted to pander to the elderly, so there are rate caps (don’t remember the mechanics). So the young are risk-priced incorrectly too-high. Which in turn contributes to the difficulty in getting the young to sign up.
If you could somehow magically divide the bills of those two things between the actual involved parties, if we billed father’s insurance for half the cost of sonograms and childbirth, if the cost of every other birth-control pill was on the boyfriend’s insurance, it would basically equalized the amount of medical care the genders needed, and thus the cost of their insurance.
We already have this, it’s called ‘family insurance’. It’s an interesting idea to split medical costs in this situation, but you’re raising a ton of other issues, 3rd party pays, proving paternity, etc.
Because competition exists, or people might not even buy insurance at all, it is in the best interest of insurance companies to have as low rates as possible…which means they do, indeed, have a strong incentive to reduce the amount of illness of their customers, as long as *that* is cheaper than dealing with the illnesses.
In theory, reducing the risk of a customer *should* result in reducing the cost of that customer’s insurance and not profit for the insurance company itself. Where it doesn’t we’re probably looking at market distortions, poor service, gov mandates, and so on (which admittedly we already know we’re looking at). But we’re trying to look at insurance as it’s supposed to function, not as it does.
Let’s look at “perfect” risk sharing, say a company hires an insurance company to administer insurance for their employee pool. All medical costs are distributed to the employees, the insurance company itself has *zero* exposure to anything. If someone gets cancer, all that happens is those costs are distributed to the pool via rates. Co-pays, HSAs, health of the employees, risk profile of the employees, none of those things matter (or increase/decrease profit) to the insurance company. As a matter of public health they matter to the employees, but that’s a different issue.
This is the theory of insurance, and in practice, with a sufficiently large pool with competition, it gets close to this ideal.
Multiple issues:
1) Pool size (that 1-in-a-million, million dollar disease needs a pool measured in many multiple millions). A small and unlucky pool can just fall apart, say a thousand people who need to cover one of their members who gets our ‘million’ disease. Their risk is $1 but their cost that year is $1000, or it can be spread over a thousand years which is nonsense.
Being unable to sell across state lines is a huge problem because ideally you’d be matched up with others in your risk pool, and if that pool is small (per state) then no sane insurer would want to touch it.
2) As both you and I have pointed out, this works for spreading risk, it sucks for controlling cost.
3) Pre-existing conditions which don’t add to risk should be covered normally other than the condition itself. If it’s not then that’s either a competition issue or a regulation issue.
4) Medical insurance, as a construct, is poorly suited to be linked to a job. The average job lasts perhaps 3 years, losing your job (perhaps even because you’re ill) shouldn’t also require you to seek re-insurance.
5) There are people who are too sick to get insurance. This is an issue of cost, not risk, so it really should be outside the bounds of insurance-working-as-it-should. That it does is mostly an accident of history and politicians looking to spend other people’s money.
Note that any fiscally sane answer on what to do is also going to be ugly. The left’s answer is typically ‘write a blank check and spend until society goes bankrupt’ (which is nuts), the market’s answer is ‘let them seek charity or failing that, be untreated’. Note there’s also an element of personal responsibility here, assuming health insurance is cheap (which it should be aka life/house insurance), widely available, and not connected to a job, lack of insurance becomes a result of personal choice.
6) There are going to be problems with an insurance company takes, or is forced to take, people at rates different from their risk. This isn’t all that different from the homeowners on the coast of Florida being unwilling to pay for flood insurance and insisting that the gov step in. Sooner or later a really nasty hurricane will move down the coast and break the bank.
I still think that the 1% financing thing is an argument that only a libertarian can love. Sometimes things are shocking to a majority for completely understandable reasons.
That logic can and has been applied to all sorts of things, abortion, drug/alcohol use, gay sex, economic inequality, etc.
But moral outrage isn't the same as sound social/economic policy, often it's the opposite.
There is an old joke from the 80's(?) about how half the members of Communist cells were FBI agents.
The thing is, we probably want about as many 'infiltrators' as potential terrorists, and if you think 911 was a good thing, then you're already pretty far over the line.
With the information in front of me, I can't tell the difference between the FBI doing what we want them to and the FBI creating problems... and what's worse, I'm not even sure there is a difference.
Saul’s claim, and the WSJ’s claim, was that American banks won’t lend to Trump. The WSJ article also said, pretty definitively, that Deutsche Bank does lend to Trump. I’m not sure what the problem is.
Ignoring that German banks are not Russian banks....
The issue is what is the definition of "won't lend". Does that mean...
1) Won't lend to Trump under any circumstances?
2) Won't lend to Trump without strong collateral?
3) Won't lend to Trump at rates lower than the German bank?
There is a *vast* difference between #1 (Trump is going bankrupt) and #3 (German banks don't want to invest in negative rate gov bonds so even golf courses look like a good idea).
Dark, I think you’re looking for a level of “proof” which cannot be provided.
Let's just quote the article:
The court rejected Mr. Trump’s arguments but the suit forced Deutsche Bank to the negotiating table. The two sides agreed to settle their suits out of court in 2009. The following year, they extended the original loan by five years. It was paid off in 2012—with the help of a loan from the German firm’s private bank.
While Deutsche Bank didn’t lose money on the deal, the fracas soured its investment bankers on working with Mr. Trump. “He was persona non grata after that,” said a banker who worked on the deal.
But not everyone within Deutsche Bank wanted to sever the relationship. The company’s private-banking arm, which caters to ultrarich families and individuals, picked up the slack, lending well over $300 million to Trump entities in the following years.
One of those loans, for $125 million, was to finance the purchase of Miami’s Doral Golf Resort and Spa in 2011, which he re-christened Trump National Doral.
So... the bank, which is supposedly refusing to give him loans, is in fact loaning him money, apparently to this day. And *that's* our proof that he's got problems.
Refusal by someone to help Trump buy a golf course is very different from refusal by everyone to help him (and even that wouldn't be death because not all deals work). If you actually want to claim he's got problems, then what you need is forclosures, or lack of payment of loans (as opposed to loans which were paid off).
Exactly. For "current" problems we need to go back to 2008? Really?
The claim on the table is that banks have refused to finance him. Which banks, under what conditions, and so forth? My one minute google search found those two articles, and that's as far as I could get, and basically it's unsourced undetailed rumor about a guy running for President. What they were claiming about Romney at this point was that he didn't pay taxes *at* *all*.
The overall economic conditions strongly favor Trump, this is the wrong part of the business cycle for him to die in unless some massive screw up destroys him... but what's actually on the table is rumors and 2008.
I don't like Trump, I'm not his supporter, I think the GOP would be best served by him stepping down and letting his VP take over... and even with all that, this still hits the radar as election year slime.
I think it says something when American banks refuse to loan you money and you are allegedly a brilliant business person.
As far as I can tell you're quoting this... http://www.dailynewsbin.com/opinion/deeply-in-debt-to-russians-donald-trump-may-only-be-running-for-president-to-avoid-bankruptcy/25398/
Whose chief source was this... http://www.wsj.com/articles/when-donald-trump-needs-a-loan-he-chooses-deutsche-bank-1458379806 (this is from March)
...and the problems they're referencing were individual businesses and the problems related to the crash of 2008.
So we're talking about old news from the WSJ when they were trying to prevent him from getting the GOP's nod. Or in other words, this looks like election year mud rather than 'he's falling apart right now'.
Cnn claims we're talking about 500 companies. I fully expect some of them are having problems.
But I can't tell the difference between what I'd hear about Trump's finances if they were real and what I'd hear if they're not. Hillary's people are going to throw mud. Digging up the worst Trump company is like presenting the worst McDonalds.
*Comment archive for non-registered commenters assembled by email address as provided.
On “University reform: Demand driven system has devalued degrees and made some feel like failures”
If you mean reading/writing, then agreed, if you mean foreign-language, then which one?
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Econ had a class which detailed how other cultures' basic assumptions about time/law/money/relations/religion were different, how to deal with them, and what all that meant in a practical sense in terms of making multi-national project work.
The case studies had some real howlers. The auto company which sold the 'Nova' in Mexico... and 'Va' in spanish means 'go' so No-Va means "No-Go". The oil company which presented to Saudi officials it's proposal in an expensive pig-leather folder... which resulted in both the binder and the proposal being burned and the company officials ordered out of the country.
How many classes in philosophy/literature/art do you need to have to get the same thing?
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Agreed, but some letters on a piece of paper and a $100k debt doesn't make you "educated". Education is supposed to let you know more about how the world at large works and how to make good choices in society.
That should include:
1) Reading and Writing... although one *hopes* the high schools do this.
2) Physics (the very definition of 'how the world works').
3) Statistics (it's very hard to make sensible choices without this).
4) Logic (ditto, lots of bad ideas are out there, knowing why they're bad is pretty key).
5) Economics (ditto, and yes, money is important)
Some of these are on how-to-evaluate-information and some of them are backbone on how the world works. But as far as I can tell it's possible to go through college, get your degree in 'being-indoctrinated', skip most everything I just mentioned, and after that you can parrot whatever you 'learned'... and then be totally shocked that the world doesn't actually care and you've got $100k in debt for a min-wage job.
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The original college degrees were measurements of wealth, intelligence, and social status. The new college degrees need some underlying value to have value, and all to often they don't.
"
Math is shockingly useful and versatile in modern society in terms of building a career. The others, not so much.
On “What Would a Parliamentary System Look Like in the US?”
We stay out of WW2 and Hitler takes over Europe.
We stay out of the Cold War and Stalin takes over Europe and various other countries.
South Korea loses to North Korea and the Kims rule both.
We skip Gulf War One and Saddam takes over various Middle East countries and dominates oil.
Various other regional conflicts are taken to their natural conclusions, these conclusions are often ugly.
On “Missouri’s Lead Public Defender Assigns Governor to Case in Protest of Budget Cuts – Hit & Run : Reason.com”
Partly this depends on what the "average" voter looks like and where he's running, but more importantly, this puts his name out in front of the average person.
This is a PR stunt, which isn't to say he doesn't believe in what he's doing or he'd be unlikely to be a Public Defender to begin with.
On “Does It Really Matter That Trump Won’t Release His Tax Returns?”
Agreed. Not Cruz. Rubio, Jeb, maybe John Kasich.... so call it two of the three, no clue who is VP... probably Rubio since he's the least experienced but whatever.
On “New TED-ED Animation Provides a Case Study in How Fascists Get Democratically Elected”
They skipped the hyper inflation. Everyone lost all of their savings. Economic wrath of god.
https://en.wikipedia.org/wiki/Hyperinflation_in_the_Weimar_Republic
On “Missouri’s Lead Public Defender Assigns Governor to Case in Protest of Budget Cuts – Hit & Run : Reason.com”
Let me guess, he's running for office soon?
On “Does It Really Matter That Trump Won’t Release His Tax Returns?”
:sigh: I can't disagree with any of that. For the GOP this election was stunningly winnable... which I suppose is why we had 15(ish) people run. Looks like there's a lot to be said for smoke filled back rooms.
On “This Party Cannot Be Saved”
First, the bigger insurance companies already function in multiple states, and thus already have networks in multiple states. What's going on is every state wants to have the insurance company's administration (i.e. jobs) in their own state.
2nd, needing "networks", at all, is a rotten side effect coming from using insurance companies for cost control. When my car crashed they wrote me a check and let me deal with it rather than insist every bolt come from the supplier with whom they'd made a deal.
So the solution to too much central planning and political interference is more political interference? State level politicians don't want to compete with other states. Consumers would benefit from larger markets and more competition.
A young and invincible can only have a policy one third the price of the elderly? :Ouch: And of course the young are largely poor and the old are largely rich.
Shear nonsense. Try applying that logic to anything else, say buying a car, or a college education. Should the decision-making process really not involve costs for either of those?
The other docs I found of his caliber weren't in my state.
I think there's an emotional difference, an HSA is money in hand, it's yours, if you reduce medical spending.
I don't know whether a heart defect is an "increases risk" thing or a "treat every day" thing or both. If it's just risk, then you should be paying for the risk you bring into the pool, which might be large enough that you can't afford it. If it's a "treat every day" thing then that's not something "insurance" should be dealing with, meaning in theory they'd just add it to the cost of your insurance.
And you should be able to get insurance as cheap as anyone else for issues that are unrelated to the heart defect.
Sure, just like you shouldn't be able to buy home insurance after your place burns down.
This is a problem, and a big one, but it really shouldn't be handled via insurance. Tax dollars probably are appropriate, but forcing it onto insurance companies is just politicians *literally* spending other people's money.
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The mandate was proposed by a right-wing think tank and then got shot down when it was pointed out just how intrusive it'd be. Given that the left voted in lockstep to implement it, the left owns it. They didn't have the votes for a single payer or we'd have that instead.
The history of single payer in this country has been the left wanting to implement it but flinching away from how much it would cost.
You want public money for healthcare (and we're already spending a lot)... but what is the limit on this? *That* is the reason single payer (or whatever) keeps failing. What exactly is the line here which prevents this from breaking the budget? Do we spend a million dollars so a premature baby can grow up with various problems? Do we spend a million dollars to give a 90 year old man another few months? Is it realistic to expect Congress to make decisions which kill little old ladies?
The death rate in this country holds steady at 100%. Whatever we do, people are going to die, whatever line we draw, people are going to die, and yes, some of them on the street. As far as I can tell, your solution is to draw no lines.
On “Does It Really Matter That Trump Won’t Release His Tax Returns?”
"Word on the street" turned out to be outright lies spread by his political opponents, i.e. that he hadn't paid any tax at all.
Keep in mind if we're going to put finances under a microscope, Trump is running against Hillary... and that foundation looks a lot like a money laundering scheme.
On “This Party Cannot Be Saved”
I think you're talking about the Commonwealth Fund study. The thing is that although consumer satisfaction went down (compared to 'more comprehensive' insurance, i.e. more expensive), health didn't.
https://en.wikipedia.org/wiki/Health_savings_account#Consumer_satisfaction
So the next time you buy a car, just give the salesman a blank check and tell him to use his own judgement on what you need.
I'm sorry to hear that, and I don't understand the medical/actuarial ins and outs to even begin to justify this nor to know whether or not it is justifiable. This sort of thing hits the radar as exceptionally poor consumer service.
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@davidtc
Very, very close... although I’d quibble with “the correct amount of health care” because there are multiple factors which inflate that. I don’t regret the $10k I paid for a surgeon, but I do regret the $200 I paid for a test which probably wasn’t going to reveal anything and didn’t. If you go to a used car lot and let the salesman decide how much car you “need”, the answer is probably “a lot”. The benefits of the system flow to both the patient and the health system itself, the costs do not.
And that world class surgeon’s $10k had a huge administrative overhead baked into it which is also a problem. If we take our ‘college administration’ example and assume three quarters of that isn’t value added (:massive handwave:), in theory I could saved a lot of money by flying to a different state... assuming I could find someone like that who isn’t attached to a massive bureaucracy.
If we had competition then a guy like that could set up his own shop, with thin administration, and he’d personally get a massive pay increase while at the same time charging less. The ACA supposedly strongly encourages the opposite.
You’re totally correct in that the solution is for consumers to have skin in the game. But why not go whole hog?
Get the insurance company totally out of the picture for small items, force consumers to have HSAs, if they save money then they keep it. There are multiple other things which need to happen, the big one being prices need to be clear and easily available.
Insurance companies are this massive impediment to competition and letting them stay in there ‘helping’ people by ‘negotiating’ is just making things way more complex for no good reason. Keep in mind how college costs have zoomed up to support their bureaucracy.
All labs. What a “typical” labor costs. I think we’d be really surprised at what could be compared (especially in the age of smart phones) if there weren’t so many road blocks set up to prevent it. When my kid sliced her head open, I went to her local doctor because I figured (correctly) that he’d be much more skilled and a lot cheaper than some emergency room intern (and that’s without waiting the multiple hours).
Those are political questions to what really should be a market decision.
The current rules have heavy political pandering and so forth. You’re not allowed to sell across state lines so some/many state insurance industries are micro managed by their state regulators and there’s no competition between different states. So the result is a heavily shielded industry which doesn’t need to serve it’s consumers very well.
I'm taking "Pre-existing" to mean "before you got insurance". The moment a pre-existing condition (say, cancer) becomes a ‘regular’ part of you then you’re not spreading risk anymore, you’re trying to cover costs. If a disease has a million dollar cure and effects one-in-a-million, then insurance should be able to cover everyone for a dollar each. That’s spreading risk. If someone goes without insurance thinking that it can’t happen to him but does, then we’re not dealing with risk any more.
To address multiple other comments you made, the insurance companies aren’t serving their customers well, they’re acting like a heavily shielded near-monopoly who has corrupted it’s regulators.
The amount of publicly available information is scary, but the issue is whether different groups have different risks which should be insured differently. Anything which gets in the way of pricing risk correctly is a problem, that includes lack of competition and political meddling.
For example one of the flaws of the ACA was it wanted to pander to the elderly, so there are rate caps (don’t remember the mechanics). So the young are risk-priced incorrectly too-high. Which in turn contributes to the difficulty in getting the young to sign up.
We already have this, it’s called ‘family insurance’. It’s an interesting idea to split medical costs in this situation, but you’re raising a ton of other issues, 3rd party pays, proving paternity, etc.
In theory, reducing the risk of a customer *should* result in reducing the cost of that customer’s insurance and not profit for the insurance company itself. Where it doesn’t we’re probably looking at market distortions, poor service, gov mandates, and so on (which admittedly we already know we’re looking at). But we’re trying to look at insurance as it’s supposed to function, not as it does.
Let’s look at “perfect” risk sharing, say a company hires an insurance company to administer insurance for their employee pool. All medical costs are distributed to the employees, the insurance company itself has *zero* exposure to anything. If someone gets cancer, all that happens is those costs are distributed to the pool via rates. Co-pays, HSAs, health of the employees, risk profile of the employees, none of those things matter (or increase/decrease profit) to the insurance company. As a matter of public health they matter to the employees, but that’s a different issue.
This is the theory of insurance, and in practice, with a sufficiently large pool with competition, it gets close to this ideal.
Multiple issues:
1) Pool size (that 1-in-a-million, million dollar disease needs a pool measured in many multiple millions). A small and unlucky pool can just fall apart, say a thousand people who need to cover one of their members who gets our ‘million’ disease. Their risk is $1 but their cost that year is $1000, or it can be spread over a thousand years which is nonsense.
Being unable to sell across state lines is a huge problem because ideally you’d be matched up with others in your risk pool, and if that pool is small (per state) then no sane insurer would want to touch it.
2) As both you and I have pointed out, this works for spreading risk, it sucks for controlling cost.
3) Pre-existing conditions which don’t add to risk should be covered normally other than the condition itself. If it’s not then that’s either a competition issue or a regulation issue.
4) Medical insurance, as a construct, is poorly suited to be linked to a job. The average job lasts perhaps 3 years, losing your job (perhaps even because you’re ill) shouldn’t also require you to seek re-insurance.
5) There are people who are too sick to get insurance. This is an issue of cost, not risk, so it really should be outside the bounds of insurance-working-as-it-should. That it does is mostly an accident of history and politicians looking to spend other people’s money.
Note that any fiscally sane answer on what to do is also going to be ugly. The left’s answer is typically ‘write a blank check and spend until society goes bankrupt’ (which is nuts), the market’s answer is ‘let them seek charity or failing that, be untreated’. Note there’s also an element of personal responsibility here, assuming health insurance is cheap (which it should be aka life/house insurance), widely available, and not connected to a job, lack of insurance becomes a result of personal choice.
6) There are going to be problems with an insurance company takes, or is forced to take, people at rates different from their risk. This isn’t all that different from the homeowners on the coast of Florida being unwilling to pay for flood insurance and insisting that the gov step in. Sooner or later a really nasty hurricane will move down the coast and break the bank.
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@DavidTC
Non-Smokers Discount: http://www.bankrate.com/finance/insurance/10-hidden-home-insurance-credits-9.aspx
Giving "discounts" to 70% of society is the equiv of increasing premiums for the other 30%.
"Being disorganized" is translatable into english as "doesn't pay bills on time and credit rating reflects this".
On “Does It Really Matter That Trump Won’t Release His Tax Returns?”
@saul-degraw
That logic can and has been applied to all sorts of things, abortion, drug/alcohol use, gay sex, economic inequality, etc.
But moral outrage isn't the same as sound social/economic policy, often it's the opposite.
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10 points is already epic-loss time.
On “FBI Agent Apparently Egged on ‘Draw Muhammad’ Shooter – The Daily Beast”
There is an old joke from the 80's(?) about how half the members of Communist cells were FBI agents.
The thing is, we probably want about as many 'infiltrators' as potential terrorists, and if you think 911 was a good thing, then you're already pretty far over the line.
With the information in front of me, I can't tell the difference between the FBI doing what we want them to and the FBI creating problems... and what's worse, I'm not even sure there is a difference.
On “Does It Really Matter That Trump Won’t Release His Tax Returns?”
Ignoring that German banks are not Russian banks....
The issue is what is the definition of "won't lend". Does that mean...
1) Won't lend to Trump under any circumstances?
2) Won't lend to Trump without strong collateral?
3) Won't lend to Trump at rates lower than the German bank?
There is a *vast* difference between #1 (Trump is going bankrupt) and #3 (German banks don't want to invest in negative rate gov bonds so even golf courses look like a good idea).
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Let's just quote the article:
The court rejected Mr. Trump’s arguments but the suit forced Deutsche Bank to the negotiating table. The two sides agreed to settle their suits out of court in 2009. The following year, they extended the original loan by five years. It was paid off in 2012—with the help of a loan from the German firm’s private bank.
While Deutsche Bank didn’t lose money on the deal, the fracas soured its investment bankers on working with Mr. Trump. “He was persona non grata after that,” said a banker who worked on the deal.
But not everyone within Deutsche Bank wanted to sever the relationship. The company’s private-banking arm, which caters to ultrarich families and individuals, picked up the slack, lending well over $300 million to Trump entities in the following years.
One of those loans, for $125 million, was to finance the purchase of Miami’s Doral Golf Resort and Spa in 2011, which he re-christened Trump National Doral.
So... the bank, which is supposedly refusing to give him loans, is in fact loaning him money, apparently to this day. And *that's* our proof that he's got problems.
Refusal by someone to help Trump buy a golf course is very different from refusal by everyone to help him (and even that wouldn't be death because not all deals work). If you actually want to claim he's got problems, then what you need is forclosures, or lack of payment of loans (as opposed to loans which were paid off).
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Exactly. For "current" problems we need to go back to 2008? Really?
The claim on the table is that banks have refused to finance him. Which banks, under what conditions, and so forth? My one minute google search found those two articles, and that's as far as I could get, and basically it's unsourced undetailed rumor about a guy running for President. What they were claiming about Romney at this point was that he didn't pay taxes *at* *all*.
The overall economic conditions strongly favor Trump, this is the wrong part of the business cycle for him to die in unless some massive screw up destroys him... but what's actually on the table is rumors and 2008.
I don't like Trump, I'm not his supporter, I think the GOP would be best served by him stepping down and letting his VP take over... and even with all that, this still hits the radar as election year slime.
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@saul-degraw
As far as I can tell you're quoting this... http://www.dailynewsbin.com/opinion/deeply-in-debt-to-russians-donald-trump-may-only-be-running-for-president-to-avoid-bankruptcy/25398/
Whose chief source was this... http://www.wsj.com/articles/when-donald-trump-needs-a-loan-he-chooses-deutsche-bank-1458379806 (this is from March)
...and the problems they're referencing were individual businesses and the problems related to the crash of 2008.
So we're talking about old news from the WSJ when they were trying to prevent him from getting the GOP's nod. Or in other words, this looks like election year mud rather than 'he's falling apart right now'.
Unless I'm looking at the wrong sources?
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This brings us back to upper 1% financing.
Cnn claims we're talking about 500 companies. I fully expect some of them are having problems.
But I can't tell the difference between what I'd hear about Trump's finances if they were real and what I'd hear if they're not. Hillary's people are going to throw mud. Digging up the worst Trump company is like presenting the worst McDonalds.
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