Egor,

I see the logic behind everything you are saying and....

God, you are SO depressing me.  

Egor,

Now that I'm totally depressed, I have a request.

Could you please write a scenario which outlines how you see a Republican candidate winning in November?  You may yet be able to revive my spirits and avoid my eventual suicide. 

What say you?

Egor:

 And then, in turn, weigh that against our hopefully well-formed and researched opinions on what leads to prosperity, or whatever other issues are important to us (education, health care, foreign policy, energy policy, etc - or all of the above?)

So if Fareed Zakaria runs for president, you know where he stands on this issue regardless of the validity of his statement. 

Firstly, we form our opinions based on available information.  A person who was told that our Constitution is based on Leviticus 17-26 is going to have a different opinion on the separation of church and state (or taxation, or the role of government in providing safety net), then someone who was told that we are a secular state and Constitution is based on ideas of "natural law" of John Locke and similar philosophers.   Alas, only one of these opinions is correct.

Some issues are so divisive right now that dialog is simply impossible.  That being supply-side economics and climate change.  Each side has their own set of facts.

We desperately need accurate information.   

Mark: I was not saying I think Obama will likely win.  I am about 50/50 actually right now. I was just making the case that as things stand today, Republicans are way too overconfident. 

The scenarios under which they are more than 50% likely to win in my opinion are no longer within their control and have more to do with what the economy does between now and November.  There are certainly some unpredictable things on the short-term economic horizon that neither party has control over.

Or Romney can start connecting with people..  Aren't there public speaking/debate classes of some sort?

If something happens that puts Gingrich back on top, I still believe he will absolutely destroy Obama in the debates.  I refuse to believe that social conservatives/evangelicals would stay home and allow Obama to beat Gingrich.  I think they are lying to pollsters, to be perfectly frank.

gtSasha:

Firstly, we form our opinions based on available information.  

This may be true in a small controlled experiment with 2 people in a maze. But I do not believe that to be true of humans in the broader sense..   People with same education, same facts, same media, same social surroundings cannot form a supermajority on virtually any subject of importance and contention before the nation today.   2 economists with PHds in the field do not agree on Supply side versus demand side, and in some cases versus socialism and communism.  We need to stop treating these issues as empirical sciences.  They most certainly, are not.   

gtSasha:

A person who was told that our Constitution is based on Leviticus 17-26 is going to have a different opinion on the separation of church and state (or taxation, or the role of government in providing safety net), then someone who was told that we are a secular state and Constitution is based on ideas of "natural law" of John Locke and similar philosophers.   Alas, only one of these opinions is correct.

But, you see, what created this disagreement between them, is that they both reason the way you do. They, like you said, form their opinions based on available information. So in a sense they are robots, and their opinion can be predicted or controlled by exposing them to the information selectively.

Instead - a person who wants to learn and reason needs to make a choice.  They can spend years and read countless books on the subject, and form their own opinion. Which will also be incomplete, and probably biased.

Or they can say (as I do) - I prefer to live in a country that is run by people who feel the constitution is based on a combination of ideas of "natural law" of John Locke AND religious principles at the time (hey, I am a moderate ).  I don't care which is right.  I have selected what is best for me, I vote accordingly for candidates that share my view, and whether they are right or wrong about it, i honestly care VERY little.  If I did, I would quit my job, leave my family, stop shaving and showering, and become a philosopher.  

gtSasha:

Some issues are so divisive right now that dialog is simply impossible.  That being supply-side economics and climate change.  Each side has their own set of facts.

We desperately need accurate information.   

There are sets of facts that point to both sides being right, and both sides being wrong.  Each of these does not carry a material weight so that you can put them on a scale and weigh them against each other.  Again, as I said earlier - PhDs disagree.  We can study both of these subjects extensively, on our own free time (as i have), and only biased, subjective, and arrogant people will think they found an answer.

So we do this: On global warming - if it exists and is human caused, and is not addressed, the risk outweighs the cost of global warming not happening (or being human caused) but (as insurance) doing something about it just in case.  Especially if done with side-effect benefits of cleaning up air and water and doing it in such a way that instead of hurting the the economy pushes it into a new cycle of unprecedented expansion - I will absolutely side with those politicians on this issue.  If I am wrong on the global warming, i'll take the technological advances, an economic boom, cleaner air and water - and apologize to my opposition very gladly

For economy (demand vs supply) - i want a thriving, filthy rich, obscenely greedy, drowning in cash private sector and upper class, so that a hard-working, educated, individuals such as myself (and my children that I am bringing up with those values) can work for whoever we want, have the standard of living we deserve, and live with dignity of self-reliance, independence and yes, liberty. And having a system that encourages such values in other members of society,  by rewarding them with success and that same dignity is an added bonus i'll take and GLADLY be wrong.  I have a very strong personal aversion to parasitic existence and government dependence that the demand side argument inevitably leads to, and I don't want to live in a country where demand side economics wins the argument, even if that argument is "correct" in some perverted way.  

Egor:

We need to stop treating these issues as empirical sciences.  They most certainly, are not.   

Not empirical?  Are you suggesting we should use a weegie board to choose what we want?  

Egor:

But, you see, what created this disagreement between them, is that they both reason the way you do. They, like you said, form their opinions based on available information. So in a sense they are robots, and their opinion can be predicted or controlled by exposing them to the information selectively. 

... 

  I don't care which is right.  I have selected what is best for me

But how do you know that you have made a right choice?  How do you know that your selection is actually best for you? 

Your statements also imply that your opinion cannot be changed, at least not via empirical evidence.  

For instance, I support changing the definition of marriage to include gay couples.  Not being gay I can't say that it is best for me since it won't affect me, but I think that they should enjoy the same status and recognition of their committed relationships as the rest of us.  However, if someone can provide some fact-based evidence on how it will affect me or society in general in a negative way I may change my mind.  I think it would be silly for me to say "I don't care which is right.", I've made up my mind.

Egor:

There are sets of facts that point to both sides being right, and both sides being wrong.  Each of these does not carry a material weight so that you can put them on a scale and weigh them against each other.  Again, as I said earlier - PhDs disagree.  

It is ok for PhDs to disagree.  Many of these issues call for solutions that are actually trade-offs.  You can get a greater/bigger safety net, but the trade off is higher taxes, for instance.  

Here is a good example.  Let's say Joe wants to create e-commerce web site for his business and hires the two of us to build it for him.  You say that the site should be based on LAMP while I say that ASP .NET is the way to go.  Joe knows very little about IT.  He has no time to learn in depth about these technologies and certainly not get any experience using them.  Instead, he has to rely on us to list the arguments for and against each choice, provide some examples, and facts about each.  Then Joe can understand the trade-offs and make an informed choice.  

Joe would not say that since Egor and Sasha disagree we need to stop treating this issue as an empirical science and just write the site in C++ because I like the plus sign and there are two of them.  That would be coo-coo for cocoa puffs.

Egor, you like Newt Gingrich, don't you :) I can see it from you replies in this topic. You sound like him in expressing your thoughts and inserting phrases like "I refuse to believe…" and "to be perfectly frank". The way you build your arguments is also very much like Gingrich… That's ok with me. Know this Egor, Gingrich has a slight, almost nothing a chance winning the republican nomination. Why? because he is too chaotic, disorganized and unpredictable, even with regards to run his own election campaign (voters don't like that). Do you really want people like him to be the president of the US? He lies and distorts facts much more than the front runner. The credits that he gives himself, and how he does that (calling himself as a Reagan republican among others) is astonishingly frightening, as they are not true and hilarious in some way. Reagan has mentioned him only once in his book, and it was not positive from what I can gather. He, Newt, had to resign in disgrace as the speaker. Many republicans have brought a great deal of concern in terms of working with him in order to put their agenda through, calling him erratic. If they had these concerns then what about democrats who he'd have to deal with?  Newt is a historian teacher from a high school who has a big mouth, an experienced Washington politician who knows how to BS people, and who doesn't know how to make a dime in a real business, except giving his speeches and writing books one might argue. He is very intelligent and an interesting individual, but the presidency of the US is not his job at this time... Think about your family, Egor, bc God forbid if he is the president… it will be much much worse than Obama… If you like him so much then grow beard and be a philosopher :) 

gtSasha:

 If you are going to count on getting treatment, the hospital should count on getting paid for providing it.

On the surface this such a plainly fair statement.   But let's think about this.  "the hospital getting paid" is a statement in passive voice.  Hospital is the object.  What then is the subject? 

So essentially what your statement means is - Egor gets sick, couldn't afford insurance, gtSasha provides care.  And gets paid by... mkgilstrap?  That's fine if mkgilstrap is charitable (and clearly more so than gtSasha in this examle).  But by force of federal governement?  a) unconstitutional in any interpretation, and b) corrupt ethically and morally, even in the absence of any constitution c) is an example of corporate welfare (e.g. reverse distribution of wealth).

Lets try this example under a mandate law.    Egor still can't afford insurance, is covered by government at mkgilstrap's expense.  gtSasha provides care. "gets" paid.

What is the difference?

I'll tell you what the similarities are.  First a,b, and c above, all to a greater extent than before.  But strictly economicaly speaking - there are 100s of mkgilstraps for every Egor.  Maybe 10s if Obama is reelected (joke ) 

Thus - what market force holds your prices down, gtSasha?  There are billions of dollars collected from 300 million healthy people, that's going to be split up by the health care industry, big pharma, and the insurnce conglomorates, according to percentages decided in boardrooms representing NEITHER the interest of US governemnt, individual citizens, nor public health (actually, arguably counter to the interests of public health, as good public health is not profitable). This is REGARDLESS of how many people you treat, what care you provide, and the quality of that care.  How do you decide what to charge, if finances of your clients are not a constricting factor?  What are you constrained by?  The only factor is  what percentage of profit the insurance conglomorates decide they want to keep for themselves and what to share with you.

This is not a warning of what might happen to health care costs under this system, its too late for that.  We all know it's been happening for decades. We pretty much have a symbiotic relationship between increase in costs and a "virtual" mandate which already exists, created by the fact that costs are too high for the moddle class to afford without coverage, so they send more money to insurance companies, and costs increase, and the cycle continues. The ofiicial mandate only adds fuel by adding to extracted wealth and capital of americans in order to be split up by the 3 industries.

It IS a warning to what happens to quality of care, because this is only starting.  Whereas without the mandate there is some competition as insurance companies refuse to cover some people, and many procedures and types of care, encouraging both the providers and in some cases the patients to "shop around" for price and quality, and to encourage a healthier lifestyle and preventative efforts (previously encouraged by smarter providers through health education and discounts), that goes away completely as well under a mandate. 

Today, people who in the absence of a mandate do not have insurance are split into 2 groups - those who can afford it but choose not to, and those who cannot afford any coverage at all.  And, obviously the gray area in between, people on the cusp of lower to middle calss, or middle cass self employed in some cases (this boundary is/has been moving rapidly up the income ladder as costs will always rise significantly faster than the general economy under this structure).

First group is easy to deal with.  Its a loan.  Hospital gets paid with interest.  If they are not paying - garnish their wages if needed, use collection agencies, sieze property, worst case - prison.  No different than any other debt essentially.  Crazy costs or high interest would cause too many defaults, and thus could be controlled pretty tightly by market forces.  If it isn't, i'd support some regulation in this instace, these costs and interest rates need to reasonable and fixed over the entire term.  By law if necessary.

If patients die in treatment or never recover enough to make income, are disabled, etc. I always said - the government can and should step in at this point.  Doctors are salaried, they get paid regardless and this is not even their problem, and hospital - if its that financially strapped that it can't take these hits, or is nonprofit - by all means the governemnt should cover this.  I have no issue with that, and am glad to be taxed for it.  I am as liberal as it gets when the definition of "disadvantaged" and "unable to care for oneself" is met by a physical/mental disability.  And so are most christian conservatives (not to mention mainstream and liberal americans), though people may disagree on method of "collection", there is no disagreement in the American plurality on aiding the truly disadvantaged.  But as a sidenote, these industries already profit better than banks, so like banks, these hits of defaulted debt is an intrinsic part of doing business. They should be taking the hits rather than deferring to taxpayers, who are ALREADY going to be responsible (justly so) for feeding, clothing, an housing for these people.  So rather than blindly having the governemnt pay for this care, i'd be more inclined to regulate debt forgiveness especially for highly profitable heath care providers.  Otherwise, you are not really helping the disabled, you are sending tax revenues to the top 1% (again - reverse redistribution), which is completely unnecessary.

Patients that do recovered fully, are in good health, but just have no income or way to pay off their debt, i'd send to do some janitorial work 10-20 hours a week for as many years as it takes to pay the debt, preferably in the filthiest possible job in that hospital, fitting a parasyte. If they don't show up - prison. But that's too radical, i understand   So I am not really serious about this last part, its probably something Gingrich would suggest

The rest of it - is the correct course of action, but not the only one. There are many. The reason you have not been exposed to such ideas, and are being forced to pick among several evils, is because of the insurance industry lobby, the media they control through financial stakes, and funding they proide to every politician in both parties rivaling in amounts only that of the oil industry. 

All options on the table - involve extraction by force of 100 times the wealth from the general public, than it actually takes to provise high quality care (see other countries with high marks on care and public health as a case study for what it really costs them per capita).

gtSasha:

Egor:

We need to stop treating these issues as empirical sciences.  They most certainly, are not.   

Not empirical?  Are you suggesting we should use a weegie board to choose what we want?  

If we don't care about the outcome - weegie board is fine.  But my point is I care about the outcome.  Communism may be preferred empirically by some economists, economic fascism to others, complete economic anarchy to others, partially regulated capitalism to others.  Do you know who is smarter?  I admit, I do not.  When properly implemented, each of these may even provide some levels of "fairness" (subjective), stability, equality, even prosperity in some cases.

Given all these choices,properly implemented by wise politicians, I would still prefer some over others, even given the same standard of living i would enjoy (hypothetically).  Because of cultural reasons, eithical, moral, and many other factors, none of which are empirical.  They are subjective.  Only because of that subjectivity, i would oppose the weegie board. 

Does that make sense?

(yes, i do have an opinion on which leads to the best life for most people and opportunity for everyone.  and you know what that opinion is.  But there's always someone smarter than me who would disagree.  and someone smarter than them.  and so forth.)

gtSasha:

Your statements also imply that your opinion cannot be changed, at least not via empirical evidence.  

If that were true, I wouldn't be able to have an opinion in the first place.  There were factors that formed it, the same factors can change it. I've changed some major opinions in my lifetime (less and less likely as I get older, obviously).  But yes, there are principles that are core, and that I doubt will ever be changed.  And I am not unique in that at all. You have them too, but you will seek to rationalize them as empirical conclisions, which (if it were true) would leave them vulnerable to anyone smarter than you making a convincing argument. But since i very rarely see people's opinions be viulnerable to reason and logical counter-arguments (including yourself), i actually suspect that people are simply not verbalizing their core values, seeking instad to "outsmart" opponents.  Which works approximatly never.  With all of us.

gtSasha:

It is ok for PhDs to disagree.  Many of these issues call for solutions that are actually trade-offs.  You can get a greater/bigger safety net, but the trade off is higher taxes, for instance.  

Perfect example.  So you get an initial safety net with higher taxes, lets assume that's true.  Why then not raise taxes to 99% (if you assume the greater the safety net, the better), kil off the economy, reducing tax revenies to below what you started with at a low tax rate, and you have neither the revenues, nor prosperity, nor a safety net at all?

Empirical question - what precise percentage is the critical point for maximum revenues?

This can't be answered by the greatest genuis economist known to mankind. Because it varies as the economy evolves, it will kill some industries at much lower numbers, others at higher, some companies may move overseas, or may not.  This cannot be predicted.

But lets say it can - i'll grant that for the sake of the argument.  Next question - say you want to live in that country with the highest revenues and safety net (say 50% tax and 40% of population on government aid).  I do not.

Who is empiricaly correct?

Egor:

gtSasha:

 If you are going to count on getting treatment, the hospital should count on getting paid for providing it.

On the surface this such a plainly fair statement.   But let's think about this.  "the hospital getting paid" is a statement in passive voice.  Hospital is the object.  What then is the subject? 

So essentially what your statement means is - Egor gets sick, couldn't afford insurance, gtSasha provides care.  And gets paid by... mkgilstrap?  That's fine if mkgilstrap is charitable (and clearly more so than gtSasha in this examle).  But by force of federal governement?  a) unconstitutional in any interpretation, and b) corrupt ethically and morally, even in the absence of any constitution c) is an example of corporate welfare (e.g. reverse distribution of wealth).

Lets try this example under a mandate law.    Egor still can't afford insurance, is covered by government at mkgilstrap's expense.  gtSasha provides care. "gets" paid.

What is the difference?

The difference is that under a mandate Egor pays at least part of the cost.  I am sure mkgilstrap would rather pay less for other people's care then more.  

Egor:

Thus - what market force holds your prices down, gtSasha? 

That's a totally separate question.  I would like to see some free market mechanism be part of this to stimulate innovation.  There could be a way for patients to have some "skin in the game" to encourage them to shop around for the most efficient providers.  For instance, I have a high-deductible insurance so unless I get really sick and need expensive care everything pretty much comes out of my pocket.  The last time I saw a doctor he would have charged $114 for his services, but because he has a contract with my insurance he only charged $93.  Of course, I'd rather pay $93 then $114, but the issue is that it is still what the economists call "a perverse competition" - it the insurance company that decides the price, not provider and consumer.  I am not sure what can be done to change the present equation, but once again, it has nothing to do with mandate.

Egor:

Today, people who in the absence of a mandate do not have insurance are split into 2 groups - those who can afford it but choose not to, and those who cannot afford any coverage at all.  And, obviously the gray area in between, people on the cusp of lower to middle calss, or middle cass self employed in some cases (this boundary is/has been moving rapidly up the income ladder as costs will always rise significantly faster than the general economy under this structure).

First group is easy to deal with.  Its a loan.  Hospital gets paid with interest.  If they are not paying - garnish their wages if needed, use collection agencies, sieze property, worst case - prison.  No different than any other debt essentially.

Well, no.  It is essentially not like any other debt, that's the problem. If I come to you for a $10000 unsecured loan you can turn me down.  If I come to a hospital with a heart attack looking to consume $10000 in services they can't turn me down.  That's the difference. 

Of course, if I don't have health insurance and can't pay right away they can send collectors after me, sue me, etc.  However, since it is an unsecured loan they can't get paid unless I have money to pay them.  I don't know of any state where you can go to prison for defaulting on a loan, but even then that won't produce any money.  As the saying goes:  "you can cut a rock, it won't bleed".

I won't paste the rest of your post, but I do agree with you about helping the disadvantaged (and I do mean truly disadvantaged, not free-riders).  I don't know how much regulating debt and debt forgiveness will work.  First and foremost that will require changing the law so that medical debts cannot be discharged in a bankruptcy.  Then legislate the whole system for managing medical debt and deciding who can get it forgiven and why.  Look at all the mess with student loans, it is horrible.  

Anyhow, this system is not necessarily incompatible with a mandate.  Take me for instance, I have an insurance with $5000 deductible for $90/month.  If I have a heart attack tomorrow and will need a quadruple bypass for $150000 the hospital is guaranteed to get $145000 (good news for mkgilstrap).  If I don't have $5000 and mkgilstrap does not feel charitable the hospital has a much better chance of collecting even if I work 10-20 hours a week as a janitor.  A janitor will not be able to repay $150000 in 10 lifetimes. 

Egor:

All options on the table - involve extraction by force of 100 times the wealth from the general public, than it actually takes to provise high quality care (see other countries with high marks on care and public health as a case study for what it really costs them per capita).

Other countries:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5813a5.htm  (looks like it costs them less).  In fact, why can't we just take Finland and copy their healthcare system.  May be copy their education system while we are at it.

gtSasha:

The difference is that under a mandate Egor pays at least part of the cost.  I am sure mkgilstrap would rather pay less for other people's care then more.  

I think you conveniently neglected to notice that Egor cannot afford coverage in my example, whether or not one is mandated.  It also follows from that premise, that Egor is likely not a net tax contributor. In either case, i am relying on mkgilstrap and his bourgeoise buddies, in full entirety :) 

gtSasha:

Egor:

Thus - what market force holds your prices down, gtSasha? 

That's a totally separate question. 

Bingo.  Its a separate question to you.   Maybe this is the root of where we disagree.  You mentioned later in your post (correctly so) that "a janitor will not be able to repay $150000 in 10 lifetimes".

Why does the janitor owe $150k?  Did he buy a house?  Put 5 kids through college?  No.  He had a 3 hour procedure, the cost of which (equipment, labor, etc, etc) plus add 20% to profit the hospital, is maybe 10% of that amount.  I am not throwing out exact numbers here, but can with some research.  Or comparing to the cost of the same procedure in other countries.  So why does he owe $150k.  Hillary Clinton studied this very problem in the 90s, on exaclty how that amount is split up and by what industries and entities.  We can both google it.

Income of an average consumer MUST be the #1 determining factor in costs of procedures offered to the public in general.  Like many dental procedures (which are not covered by any conventional medical insurance).  Yes, they are elective, but everyone gets them if they need them (in developed markets ), and costs are reasonable.

Without a solution to this problem, all other options are equally bad.  In fact, a mandate, is not that revolutionary, its already there for anyone who is smart with their finances, and its consequences have therefore already been shown, ironically now used as some of the most compelling arguments for an on-paper mandate.  I'd argue not much would change actually, this is just another step away from a solution.

gtSasha:

Well, no.  It is essentially not like any other debt, that's the problem. If I come to you for a $10000 unsecured loan you can turn me down.  If I come to a hospital with a heart attack looking to consume $10000 in services they can't turn me down.  That's the difference.

They are mandated by law to provide the service.  If the government chooses to mandate this, it needs to provide a solution. What I offered, were some alternatives, but there are many others. These loans could in fact be secured.  If not by government, banks would love a piece of that pie, and will gladly take the hits of occasional defaults (they are used to them). Yes, no bank in its right mind would/should secure a 150k loan to a janitor.  But they wouldn;t have to, because a hospital charging $150k for that procedure would disappear tomorrow in a somewhat more free market environment. Or if not, the government could cover all poor, but then regulate costs of care for those whom it covers where the hospital still makes a profit.  The options are endless.

gtSasha:

Other countries:  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5813a5.htm  (looks like it costs them less).  In fact, why can't we just take Finland and copy their healthcare system.  May be copy their education system while we are at it.

I would not mind living in Finland under Finland's system.  Same for education, where we brought them up as well.  I admire this country greatly, i did a lot of research on how their government and public institutions function when we had the education discussion.

But putting Finland's system in the US....I don;t see it happening. first we need IQ tests for government officials.  Our government structure and beurocracy was neither built/intended to function this way, nor are officials skilled, interested, or even elected for these purposes.  We also would need to change all laws on campaign finance, special interests, lobbying, political donors, etc.  I believe vast majority of US politicians would be in prison in Finland.

then we repeal the US constitution, send whoever is left in politics to be educated in Finland to at least master's degree level in their area of public service responsibility, remove all personal ambition and greed from their psyches by surgical lobotomy, bring them back - and hope something like what finland has can be implemented by force of a dictatorship on 300 million barely literate, disinterested, and disengaged population.  Because if not by force, every single problem-solver will be voted out in the first available election, most immediately - due to government's intrusion into personal liberty and state's rights - a concern so ingrained in the american public psyche, that it rivals only some tribes in southern Afghanistan

So I argue only for what I consider to borderline practical for this country.  And even that, I am not certain is.  The most pain from what I am discussing will be inflicted on the insurance industry..  And they own the government.  It would take a movement stronger than the tea party and occupy wall street combined and multiplied by 10 to overcome this.  And there's just not that much tangible pain caused by these national dysfunctions..  We get used to it gradually as it gets worse.. or don't even understand the long-term impact on the country, the economy, the quality of care itself...  The most frustrating thing to me is how the governemnt can turn us into cattle.. you are fed, clothed, entitled to free health care. Gradually absorbing more and more of the population into voting robots who cannot reason against the political party that provides these things for them.

By the way, the graph in your link softens the message a little bit, when trying to show relative US overspending on health care. Because it measures the percentage of GDP, which is much higher in the US as a gross number and per capita, versus any other country measured.

A more direct way is to show raw spending per person.  Twice any other country on earth, and 3-4 times many with higher life expectancies and quality of care.  And I'd argue our doctor's standards of living aren't any different than in any prosperous country (need more research on this, but I do know the bulk of US medical costs bypass the hospitals and anyone working in them, and go to insurance companies, taxes, political activities and lobbying, etc).