You said there was evidence of a “misunderstanding of economic terms”. I can see that you disagree over where the rewards of increased productivity should go, but that does not mean someone else is factually wrong about the definition of “productivity”.
And you now say increased productivity “doesn’t mean that any worker anywhere did a damn thing different (or that they didn’t)”. I think it does. Something must be different, unless you think luck plays a role in the manufacturing process. There’s no way to change the output without changing some of the inputs; automation, effort, reorganizing, something must account for the change.
Yes, something must account for the change. That “something” is not the harder work of the American worker, at least not necessarily. In fact, hours worked per worker has decreased over the last 10 years. Someone is factually wrong when they make the laymen’s inference from an economic term that this means the worker created the change, that their hard work is what they have contributed to this delta. You seem to be strenuously missing the point as well.
The misunderstanding is attributable to those who think that the increase in productivity is the result of the hard work and diligence, the “sweat and smarts,” of the workers in question. That it’s an effect they have produced, and since they produced this outcome, they ought to benefit from their efforts. It doesn’t mean that. In fact, it doesn’t mean anything except we’re producing more stuff with fewer (or the same) workers. Why do you keep avoiding this point?
And actually, arguing over who should benefit from the results of the increased productivity is a valid debate. One could argue, for example, that a wise and beneficent employer would share the wealth with workers, in recognition of income inequality, or in the interest of having a contented work force. But if the debate is based on the idea that workers deserve it because they created this benefit, that it’s unfair to cheat them out of a profit they made possible through their hard work, then it’s a non sequitur. Worker productivity can increase by installing changes that make the job easier, for example. And it often does.
May I see your cite that hours worked has decreased over the last ten years, please. Why choose a ten-year horizon, and does that statistic account for unemployment (do the people who can’t find a job bring the hours-per-worker average down)? It’s also true that educational achievement (measured as the highest grade level completed) has advanced steadily over the past 40 years; suggesting that workers now are smarter (or can bring more analytical tools to their work) than a generation ago.
I don’t think I’m missing (strenuously or not) anything. I feel like you’re trying to get me to admit a mistake in a position I’ve never held. The real world is very complicated. I still remember a project in my junior high school, although it wasn’t for a class I was in. The idea was to write down a list of all the jobs that would be influenced if our town were to get a pro basketball franchise. Students were walking around filling up page after page, from the players to the guy who oils the injection-molding machine that makes the plastic eyeballs for the mascot’s costume. Automation puts widget makers out of work, but it’s a boon for the company that produces the WidgetMaker 6000. I don’t think it’s possible to attribute any particular productivity gain to one particular person. I just object to your description that someone who reaches a different conclusion than you do must have a factual misunderstanding of the nature of productivity.
If “hard work and diligence” was the determining factor in how much someone gets paid, coal miners would get more than lawyers. And in my experience, as automation makes a job easier, the person doesn’t get a break, they’re just expected to do it that much faster. I remember when grocery checkers had to pick up an item, find the price tag, and key it in manually. Now they just wave everything in front of the scanner. Item-by-item, the job is probably easier than it used to be. Hour-by-hour, I don’t think it is.
Then why not smack him down properly and present your thoughts on those issues. Whether you like it or not, those are legitimate concerns that around the half the country cares about seriously and a good portion of the other at least acknowledges that there is an issue even if they argue over the severity. I’m not asking you for a comprehensive plan in minute detail, just present what you think might be some good conservative solutions or checks on those issues.
No, I refer to them as meaningless because they are essentially ineffectual. Of course, if those goals were ever met the world would be a better place, but it does not seem to happen. I think this is the fate of any resolution that does not come with effective enforcement.
I freely admit I don’t have one. Lacking the time and interest to do the required research, I will say two things:
[QUOTE=Wikipedia]
Environmental laws that allow citizen suits include:
[/QUOTE]
which strongly implies that there are other laws that do not allow citizen suits. I wonder how extensive that list is?
The other point I want to reiterate is that this is a proposal that could work, under very different conditions than currently prevail, not that it necessarily has been tried or worked up to now.
Roddy
It’s hours worked per worker. The second site goes back farther, if you’re interested. Looks like 3.3% fewer hours worked per worker since 1979.
You may infer all kinds of things. But worker productivity is still the ratio of output to worker, however brilliant that assembly line worker has become.
So, sorry, but you seem to be the poster child for this mistaken position that misunderstands what increased productivity means as an economic term.
You continue to miss the point. Perhaps this is not a strenuous action for you, so I’ll withdraw that qualifier. My point is that worker productivity as an economic term is simply math. It doesn’t attribute anything to anybody, or tell us anything of the “nature of productivity.” It tells us how many widgets are produced per worker hour. Period. It’s folks like you, apparently, who infer something about the “nature” of this statistic, and the fact that it means that workers are killing themselves (or working their asses off, at least) to produce this benefit.
Well, if that’s your experience, that’s good enough for me.
Dude, that’s weak and poor form. You ignored the rest of my response to you, and now you’re going to suggest that you didn’t really mean your comments (come on now, the “hypothesis” was the last sentence). That’s weaselly debating.
How about this quote, from the same thread (emphasis added):
I guess you were just expanding on your hypothesis, and forgot to mention it. You don’t really believe that productivity gains are the result of hard work, and that workers ought to be rewarded for the effort. No, you were just, um, hypothesizing.
Ha. What the heck? 40%? Where did that number come from?
The CBO’s 2008 report estimated that administrative costs account for about 12 cents on the dollar, including marketing and profit, for private insurance.
Medical offices vary tremendously depending on their specialty, size, and a host of other factors but 50% overall overhead (rent, utilities, salary and benefits for all your employees, hardware, malpractice, etc) is considered terrible. 35-40% is more typical. Billing averages around 18% overall but I would argue that for most modernized practices even that’s high.
Medicare overhead is tricky. A lot of what they do is outsourced to other agencies and doesn’t show up on their ledger. More importantly, they spend much more per beneficiary than private insurance, which makes overhead as a percentage of expenditures much smaller. Administrative costs per beneficiary are pretty similar. But low administrative costs aren’t the same as good administrative efficiency. They also have some of the worst fraud detection in the world. If nothing else they should spend more on that, though that’s another topic entirely. Overall Medicare probably still comes out ahead but the idea we could cut medical expenses by 40% is ludicrous.
Also, many MDs who have built a successful practice make an effort to stop accepting new Medicare patients as soon as possible, and finding one that takes Medicaid is harder still. Both programs combine crap reimbursement with terrible customer service and stone age information technology. After a certain point accepting new Medicare patients actually decreases your revenue. It’ll be interesting to see what happens if a single payer system is ever instituted in this country. I honestly have no idea but I suspect medicine will simply become a much, much less attractive option as a career. Not that that’s really a bad thing, really.
Income inequality is not an issue that needs to be addressed, least of all by the government. Those who worry about it are wasting their time.
So are conservatives who let the Left set the agenda for public discourse on things like that. If a complaint is not well-founded, no response to it is necessary.
The insurance company overhead is only one chunk of it. You have the administrative costs of the hospitals and doctors offices that have to haggle with the insurance companies, the cost of employers to deal with the issues regarding group plans, etc.
This paper comparing the US and Canada in terms of administration costs.
Granted, some of the things included as administration aren’t strictly related to private health insurance. But then there are other costs that they don’t take into account, like lost productivity from people unable or afraid to seek medical care, the time spent by people trying to get their insurance companies to pay for their treatment, doctors who have to spend more time dealing with the issue of working within the confines of insurance requirements, etc. That represents real economic value lost.
As a data point, Cigna, with 14m enrollees, is administrated by an employee force of 45000 people, compared to Ontario Health Insurance Plan who cover 12 million with only 1400 employees. But that’s only half the equation - the medical providers themselves have to also have this excess of employees to interface with those insurance companies.
I can’t substantiate the 40% claim, so I’ll withdraw it. I just saw it passed around debates as if it were an accepted number. A search gives me wildly different numbers for estimates for administrative costs - with various methodologies including different stuff.
But this has been my point for many posts now.
Just saying that we have x% admin costs and Ontario (which is what most people think of when you say “Canadian” style) has x-y% does not mean that you will get to x-y% by adopting single payer, unless you do it on a state-by-state basis and make the Federal goverment take their hands off the system completely. Otherwise you have at least two levels of bureaucracy instead of one.
Plus people are not too keen to talk about the flatness of the Canadian system in terms of compensation for doctors. A doctors visit is pretty much paid the same amount, no matter whether that doctor went to Harvard or Guelph. In the US big name doctors and hospitals get bigger payments.
There is an ongoing battle in Massachusetts between the state and certain hospitals which are much more expensive for the same procedures as other hospitals. The patients go completely nuts when you tell them that because the “experts” in Boston are charging $8,500 for that treatment, but there is a regional hospital that only charges $4,000 you can only go to the regional hospital. In Ontario everybody gets $2,500 and you can take it or leave it. The doctors and hospitals, I mean, not the patient.
There is a lot here to talk about but let’s just address two very important points:
Administrative costs != costs related to dealing with insurance companies. The NEJM article you cited included a wide range of costs, including billing, accounting, rent, and legal fees under practitioner related administration, which is fine, but eliminating private insurance does not make most of those costs go away! If you have a non-clinical person who’s only job it is to schedule procedures, or someone who answers the phones, or who deals with medical record requests, they are all part of administrative costs. But you don’t get to fire them if you switch to a single payer system. Nor does your rent decrease if the government is paying for health care. Medical coding taking up provider time is the same whether it is for Cigna or Medicare. In fact, the unfunded mandate to use ICD-10 is going to cost providers a lot of money and was a CMS mandate. But that’s another incredibly annoying topic…
Second thing: haggling with insurance companies is done once every few years and providers are happy to do it. It’s not like you sit down with the insurance company after each appendectomy and argue about how much they owe you. Once you sign a contract the terms are set and it doesn’t represent a significant ongoing expense. Dealing with group plans and private insurance companies is no more painful than dealing with Medicare or Medicaid. At times, they are much less painful because as I’ve mentioned previously, the government run programs have abysmal customer service. They also pay a lot less, which means you need to process more claims for the same amount of collections.
Medicare may have lower administrative costs than private insurance, but the idea that it has some advantage from a hospital or provider perspective is nuts. Ask any doctor if they would trade all their Medicare patients for privately insured patients. It’s not a hard decision. That’s why many providers work hard to eliminate Medicare from their practice eventually. It’s not so they can pay higher administrative costs for fun .
Well, I agree we need better enforcement of existing laws.
I would only infer from that information that those laws provided for additional or expanded torts about which to sue - i.e., I don’t have to prove you gave me cancer by dumping mercury in my pond, only that you dumped mercury in my pond. Which is as it should be.
That’s funny. When the facts you asked for are troubling, time to get back on track.