I didn’t write to obfuscate, you just obviously did not understand me. Perhaps arguments or posts with any nuance whatsoever are simply lost on you? As I said, America has much higher medical spending than other countries, but I was pointing out that everywhere medical spending has been on a worrying trajectory where it grows faster than the economy.
“Putting value on better treatment” is a stupid, stupid comment because you’re acting like societies around the world can just choose to pay for ever-better and ever more expensive treatments as long as they’re smart like Europeans and “under stand this.” That’s simply not the case. I’ll repeat a very simple concept government programs that grow faster than the economy must always ultimately be changed or take the economy down with it. It doesn’t matter how much we value medical treatment, if it’s taking up 30% of the budget how do we keep funding it? What about when it’s 60%? 90%? What about when we spend all revenues on it? Government revenues are based on the underlying economic activity of the country, if one portion of government spending grows far faster than the economy as a whole that means there is no realistic way for government revenues to keep up with the growth of that spending. It means that ultimately the underlying economy simply isn’t large enough to reasonably fund the government program.
Also, on the issue of medical spending the biggest problem in America by far is not and really never has been the insurance companies. It’s the hospitals, medical device manufacturers, and pharmaceutical companies (and in roughly that order.) These entities have several pillars of unfree markets propping them up.
Hospitals have guild-style labor, monopoly style market power, obfuscated pricing that is rarely paid for directly by the consumer and thus poorly understood, and in general are viciously ran profit machines that relying on disinformation and market failure to reap very high revenues. Hospitals are the single biggest problem in our medical system, followed by device manufacturers and then pharmaceutical companies.
Hospitals should be regulated like public utilities, I suspect the reason they aren’t is they were never recognized as monopolistic and while early 20th century people recognized the need to regulate electric and natural gas service as public goods natural monopolies that realization never dawned on anyone in America about hospitals. Hospitals don’t seem like monopolies many different competing hospitals can exist in one city, for example. But oftentimes for specific procedures there may not be any competition in a given city, further when it comes to emergencies the EMS typically have guidelines on where people must be taken often based on timeliness. For emergency procedures it doesn’t even matter if there are robust alternatives because at that moment the hospital has an “effective monopoly” on the customer, because the customer is faced with the prospect of haggling and going somewhere else over immediately necessary life-saving treatment or just signing (or having a spouse sign) a bunch of documents agreeing to pay whatever insane fees the hospital dreamed up fictitiously in the charge book (which have no relation to hospital costs) and worrying about minor details like money after their life threatening blood clot or whatever is dealt with.
Thank you. I just wanted an acknowledgement that the sequester was originally a White House idea.
In my opinion it was a ‘kick the can down the road’ idea that they thought could be overcome later, a stalling tactic. The Administration never intended for it to go into effect.
Congress is now in a position, as you say a couple years later, where they have already made tax concessions and are unwilling to make more with the 2014 elections approaching.
So whatever the original strategy was, it isn’t working now and Obama owns this as his.
The members of the House are going to be taking care of their own interests and focusing on the midterms in 2014. At this point the individual elections become local.
So here’s the deal, some of the potential profit does already go to vendors who operate in the park. They pay fees to the government to do so, but obviously are turning a profit on top of that. So you could take away those contracts, but then you need to pay the employees to run it.
Another part of the deal is that the Park Service is there to protect and maintain the resources not just open them to the public. So when, for example, the Washington Monument gets damaged in an earthquake, the money needs to be found to fix it. Or people who are repairing storm damage to the beaches around NYC, even though no one is using those beaches right now.
So just jack up the fees you say. Well not so simple. In fact I just got back from a trip to Washington DC, and guess what - most of those places don’t charge fees. Lots of park’s don’t. It is kind of an interesting question: just how much is a visit to the Lincoln Memorial worth to you? Or just to know it is there, and being maintained as part of the greater good?
And now the final ugly truth - things like National Parks, and museums, and our old favorite whipping boy Public Television don’t really ever turn a profit. Now, if you want to argue that the U.S. Government should be paying for those sorts of things, that the Grand Canyon is a luxury, go right ahead. But I can tell you with no fear of contradiction that there is no way to run them for a profit. Not if you actually want them to be the crown jewels of America - the whole reason they were made into National Parks in the first place
Rather have a President who has a bad idea and turns against it than one who follows through to the bitter end. Not that I can think of any recent examples.
And just so you don’t think I am completely making this stuff up about how you can’t run a National Park at a profit, let us take a look at what fees could look like in such a case. Let me introduce you to Old Sturbridge Village - a 200 acre recreation of an 1830s New England village. Now mind you, while a lot of the buildings are old, they were brought there from elsewhere. And not to be unkind, but nothing of importance ever took place there. Kinda cool though if you dig that kind of thing.
Anyway, right now it costs adults $24 a day to go there (you can go a second day on the same pass). The price had been lower, but as attendance went down over the past decade, the raised the rate to make more money. But fewer people went, so they raised the rate again - and you can probably see where this is going. They also charge additional fees for certain activities - kind of what you are describing.
I have attached a link to an issue of their magazine that shows the past two year’s financials. Look for the full story, but in short, last year their total income was $7.7 mil and change. Expenses were $6.8 mil and change.
Well, you say, that proves my point. But (you knew there was a but coming) $3.4 million of the income was from gifts, grants, and bequests - the kinds of things for profiteers don’t usually get. Admissions were only $1.8 million. So, with no other changes, a for profit would almost have to triple the current admission price to make up the difference.
Nobody is going to pay $72 for an admission into Sturbridge. And the same would be true if someone were to charge the fees needed to run our National Parks.
I have no problem with these stipulations in any contract with a private entity. You can operate Antietam Battlefield, but you can’t open a casino in the Cornfield with themed slot machines. You can’t operate the Grand Canyon with brothels at certain points.
That limits the profit but preserves the historical relevance/natural beauty.