ObamaCare - exchanges ,report your states options!

[Phatscotty]

@john and Sym and whoever:

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



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

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



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

Per capita expenditure on health (GDP, PPP):

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

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

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

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

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

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

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

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


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

the difference between public and private expenditure is liberty. Force or choice

[Baron Von PWN]

@john and Sym and whoever:

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



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

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



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

Per capita expenditure on health (GDP, PPP):

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

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

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

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

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

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

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

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


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

the difference between public and private expenditure is liberty. Force or choice

I was wrong, you should stick to pictures of eagles.

[BigBallinStalin]

@BVP:

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

"Increase G, and divide health expenditures by GDP, and you get a lower "cost." "

GDP = C + I + G + NX
C = private consumption
I = investment
G = government spending
NX = net exports (exports minus imports)

Further expansion on the above:

Spoiler

So, if the government "takes over" the healthcare industry and private consumption shrinks, yet government expenditure increases, is there any change in GDP since the decrease in private consumption (-100) will be offset by the increase in government outlays (+100)? It depends on how much the government takes from C and adds to G (and thus into healthcare costs). It could be the case that the decrease in C (-100) isn't offset by an increase in G (+100). Suppose G amounts to +50. Where's the other +50? It could be due to deadweight costs, i.e. losses due to price controls. Or it could be that government spending isn't as efficient as private consumption. My main point is that the GDP figure doesn't tell us what's going on.

Note: this scenario would result in a decrease of total GDP, thus enlarging the healthcare costs to GDP ratio, which would contradict my claim. (perhaps, I should've spent an additional hour organizing and explaining my main points, but oh well, my statement "It's not a good ratio" still stands).

Other scenario:
Suppose the economy is doing great. C and I are increasing, thus boosting GDP. Healthcare costs to GDP could become reduced. (so the italized could hold true, but...)

Or what if the government includes fiscal stimulus in its G? It builds a bunch of roads to nowhere, or scraps off 2 inches of the highway and dumps down new asphalt. This is an increase in GDP. Would C fall? It depends on how the government procured the cash, e.g. deficit spending, borrowing money, or additional taxation. If no taxation, then C and I could remain the same, or maybe increase. An increase in GDP would reduce the healthcare costs relative to GDP.


My main point is that the ratio isn't good because it doesn't really explain what's going on. The above two scenarios and more could be occurring simultaneously, or there could be time lags, so the data has yet to catch up, or be updated. (oh god, now I have to get into PPP, and how it varies across countries.... I won't for now.).

On Healthcare "Costs":

Spoiler

It also depends on how each government calculates its spending. If the government controls your economic choices, it can force you to spend less than you're willing to pay for healthcare. Or, since it subsidizes it, perhaps more people would spend more; however, spend more on what? If an increased demand for healthcare is not being met by an increase in supply of healthcare, then there would be a shortage of healthcare services--it depends on how much control the national/local government exerts on the production of healthcare. Usually, increased state control via state ownership or certain regulations over an industry decreases its responsiveness to changes in demand (in short, it depends on more than that, but I don't want to type more).

A shortage would result in longer waiting times for receiving medical attention or to get a certain operation. That cost isn't included, and in order for the healthcare industry to meet this additional demand, it must spend more in order to supply more. The increase in supply results in an additional "cost" in healthcare services, but it can be beneficial since it's meeting the demand of customers. Suppose the government inhibits the expansion of healthcare services. Healthcare costs are prevented from rising, but healthcare services are also prevented from meeting the demand. This means that customer satisfaction is being prevented from being met.


So, as you can see, there's much left wanting in healthcare "costs" and GDP measurements, which is why it's not a good ratio. These measurements lack meaning.
(I'd love to see a cross-country comparison of average wait times for surgeries or doctor visits).

Efficiency and Aggregates

Spoiler

GDP is useful for measuring trends and relative sizes; however, it doesn't explain what's happening beneath that figure.

Consider the formula: GDP = Consumption + Investment + Government + (net exports - net imports)

GDP aggregates various expenditures into these categories, which reflect the value of all final goods and services within a year into an average price. Hence, the price of US GDP is about $15 trillion.

If countries with a socialized healthcare program have relatively less expenditures on health care costs, it doesn't follow that socialized healthcare is the way to go. It depends on what exactly are healthcare costs and how the expenditures, or outlays, are calculated. The aggregates of private consumption, investment, government spending, and (exports - imports) vary in efficiency (thus vary in their ability to satisfy the actual desires of demanders), and within these aggregates are sectors which also vary in efficiency.

And, where exactly do the healthcare goods come from? If it's imported, does that mean that government did a great job in improving healthcare because it spends less on healthcare relative to the US? (No, it's more complicated than what the data reveals).

Furthermore, using Sym's wiki data, the quality of the healthcare goods produced is unknown. The casual relation between increased proportion of government spending on healthcare, the reduced healthcare costs relative to GDP, and the alleged outcomes of decreased amenable mortality, increased life expectancies, etc. is not explained at all.

Conclusion:
(So, this is why I didn't want to expand on the italicized. I spend all this time further explaining what I'm trying (and failed to) compress into a couple of sentences. I apologize for that failure. However, my point that "it's not a good ratio" still stands.

Unfortunately, many people fall for these statistics (like Symmetry). With econometrics comes great responsibility (haha). On face-value, it appears great! But it doesn't really explain what's happening in reality. So, just because a country (government and/or people) spends less on healthcare, it doesn't follow that the services rendered are relatively better. In short, the presented evidence from Sym's wiki link sucks, and further data analysis is required but lacking from the wiki link; therefore, Symmetry's data doesn't support his stance.

My guess is that he's just fitting facts to his previously conceived conclusion (e.g. probably some normative judgment about social justice). Moral standpoints which overlook consequences are dangerous.

The GDP framework cannot tell us whether final goods and services that were produced during a particular period of time are a reflection of real wealth expansion, or a reflection of capital consumption.

For instance, if a government embarks on the building of a pyramid, which adds absolutely nothing to the well-being of individuals, the GDP framework will regard this as economic growth. In reality, however, the building of the pyramid will divert real funding from wealth-generating activities, thereby stifling the production of wealth.

So what are we to make out of the periodical pronouncements that the economy, as depicted by real GDP, grew by a particular percentage? All we can say is that this percentage has nothing to do with real economic growth and that it most likely mirrors the pace of monetary pumping.

We can thus conclude that the GDP framework is an empty abstraction devoid of any link to the real world. Notwithstanding this, the GDP framework is in big demand by governments and central bank officials since it provides justification for their interference with businesses. It also provides an illusory frame of reference to assess the performance of government officials.

Based on what I've written, I hope that the underlined has become more clear.

[Baron Von PWN]

@BVP:

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

"Increase G, and divide health expenditures by GDP, and you get a lower "cost." "

GDP = C + I + G + NX
C = private consumption
I = investment
G = government spending
NX = net exports (exports minus imports)

Further expansion on the above:

Spoiler

So, if the government "takes over" the healthcare industry and private consumption shrinks, yet government expenditure increases, is there any change in GDP since the decrease in private consumption (-100) will be offset by the increase in government outlays (+100)? It depends on how much the government takes from C and adds to G (and thus into healthcare costs). It could be the case that the decrease in C (-100) isn't offset by an increase in G (+100). Suppose G amounts to +50. Where's the other +50? It could be due to deadweight costs, i.e. losses due to price controls. Or it could be that government spending isn't as efficient as private consumption. My main point is that the GDP figure doesn't tell us what's going on.

Note: this scenario would result in a decrease of total GDP, thus enlarging the healthcare costs to GDP ratio, which would contradict my claim. (perhaps, I should've spent an additional hour organizing and explaining my main points, but oh well, my statement "It's not a good ratio" still stands).

Other scenario:
Suppose the economy is doing great. C and I are increasing, thus boosting GDP. Healthcare costs to GDP could become reduced. (so the italized could hold true, but...)

Or what if the government includes fiscal stimulus in its G? It builds a bunch of roads to nowhere, or scraps off 2 inches of the highway and dumps down new asphalt. This is an increase in GDP. Would C fall? It depends on how the government procured the cash, e.g. deficit spending, borrowing money, or additional taxation. If no taxation, then C and I could remain the same, or maybe increase. An increase in GDP would reduce the healthcare costs relative to GDP.


My main point is that the ratio isn't good because it doesn't really explain what's going on. The above two scenarios and more could be occurring simultaneously, or there could be time lags, so the data has yet to catch up, or be updated. (oh god, now I have to get into PPP, and how it varies across countries.... I won't for now.).

On Healthcare "Costs":

Spoiler

It also depends on how each government calculates its spending. If the government controls your economic choices, it can force you to spend less than you're willing to pay for healthcare. Or, since it subsidizes it, perhaps more people would spend more; however, spend more on what? If an increased demand for healthcare is not being met by an increase in supply of healthcare, then there would be a shortage of healthcare services--it depends on how much control the national/local government exerts on the production of healthcare. Usually, increased state control via state ownership or certain regulations over an industry decreases its responsiveness to changes in demand (in short, it depends on more than that, but I don't want to type more).

A shortage would result in longer waiting times for receiving medical attention or to get a certain operation. That cost isn't included, and in order for the healthcare industry to meet this additional demand, it must spend more in order to supply more. The increase in supply results in an additional "cost" in healthcare services, but it can be beneficial since it's meeting the demand of customers. Suppose the government inhibits the expansion of healthcare services. Healthcare costs are prevented from rising, but healthcare services are also prevented from meeting the demand. This means that customer satisfaction is being prevented from being met.


So, as you can see, there's much left wanting in healthcare "costs" and GDP measurements, which is why it's not a good ratio. These measurements lack meaning.
(I'd love to see a cross-country comparison of average wait times for surgeries or doctor visits).

Efficiency and Aggregates

Spoiler

GDP is useful for measuring trends and relative sizes; however, it doesn't explain what's happening beneath that figure.

Consider the formula: GDP = Consumption + Investment + Government + (net exports - net imports)

GDP aggregates various expenditures into these categories, which reflect the value of all final goods and services within a year into an average price. Hence, the price of US GDP is about $15 trillion.

If countries with a socialized healthcare program have relatively less expenditures on health care costs, it doesn't follow that socialized healthcare is the way to go. It depends on what exactly are healthcare costs and how the expenditures, or outlays, are calculated. The aggregates of private consumption, investment, government spending, and (exports - imports) vary in efficiency (thus vary in their ability to satisfy the actual desires of demanders), and within these aggregates are sectors which also vary in efficiency.

And, where exactly do the healthcare goods come from? If it's imported, does that mean that government did a great job in improving healthcare because it spends less on healthcare relative to the US? (No, it's more complicated than what the data reveals).

Furthermore, using Sym's wiki data, the quality of the healthcare goods produced is unknown. The casual relation between increased proportion of government spending on healthcare, the reduced healthcare costs relative to GDP, and the alleged outcomes of decreased amenable mortality, increased life expectancies, etc. is not explained at all.

Conclusion:
(So, this is why I didn't want to expand on the italicized. I spend all this time further explaining what I'm trying (and failed to) compress into a couple of sentences. I apologize for that failure. However, my point that "it's not a good ratio" still stands.

Unfortunately, many people fall for these statistics (like Symmetry). With econometrics comes great responsibility (haha). On face-value, it appears great! But it doesn't really explain what's happening in reality. So, just because a country (government and/or people) spends less on healthcare, it doesn't follow that the services rendered are relatively better. In short, the presented evidence from Sym's wiki link sucks, and further data analysis is required but lacking from the wiki link; therefore, Symmetry's data doesn't support his stance. He's just fitting facts to his previously conceived conclusion (e.g. probably some normative judgment about social justice).

The GDP framework cannot tell us whether final goods and services that were produced during a particular period of time are a reflection of real wealth expansion, or a reflection of capital consumption.

For instance, if a government embarks on the building of a pyramid, which adds absolutely nothing to the well-being of individuals, the GDP framework will regard this as economic growth. In reality, however, the building of the pyramid will divert real funding from wealth-generating activities, thereby stifling the production of wealth.

So what are we to make out of the periodical pronouncements that the economy, as depicted by real GDP, grew by a particular percentage? All we can say is that this percentage has nothing to do with real economic growth and that it most likely mirrors the pace of monetary pumping.

We can thus conclude that the GDP framework is an empty abstraction devoid of any link to the real world. Notwithstanding this, the GDP framework is in big demand by governments and central bank officials since it provides justification for their interference with businesses. It also provides an illusory frame of reference to assess the performance of government officials.

Based on what I've written, I hope that the underlined has become more clear.

It has! thank you very much that was quite comprehensive and informative! Though my inquisitiveness would have been satisfied with the first paragraph,the whole thing was very interesting.

Can you suggest an alternate method of tracking economic performance other than GDP?

[Phatscotty]

It's the same reason military spending is counted in GDP, so they can fudge the numbers. Even if the economy is at a standstill, tons of military spending will show growth.

[Phatscotty]

http://www.latimes.com/news/politics/la ... 8481.story

The Supreme Court's conservative justices said Wednesday they are prepared to strike down President Obama’s healthcare law entirely.

Picking up where they left off Tuesday, the conservatives said they thought a decision striking down the law's controversial individual mandate to purchase health insurance means the whole statute should fall with it.

The court’s conservatives sounded as though they had determined for themselves that the 2,700-page measure must be declared unconstitutional.

"One way or another, Congress will have to revisit it in toto," said Justice Antonin Scalia.

Agreeing, Justice Anthony Kennedy said it would be an "extreme proposition" to allow the various insurance regulations to stand after the mandate was struck down.

Meanwhile, the court's liberal justices argued for restraint. Justice Ruth Bader Ginsburg said the court should do a "salvage job," not undertake a “wrecking operation." But she looked to be out-voted.

Chief Justice John G. Roberts Jr. and Justice Samuel A. Alito Jr. said they shared the view of Scalia and Kennedy that the law should stand or fall in total. Along with Justice Clarence Thomas, they would have a majority to strike down the entire statute as unconstitutional.

An Obama administration lawyer, urging caution, said it would be "extraordinary" for the court to throw out the entire law. About 2.5 million young people under age 26 are on their parents' insurance now because of the new law. If it were struck down entirely, "2.5 million of them would be thrown off the insurance rolls," said Edwin Kneedler.

The administration indicated it was prepared to accept a ruling that some of the insurance reforms should fall if the mandate were struck down. For example, insurers would not be required to sell coverage to people with preexisting conditions. But Kneedler, a deputy solicitor general, said the court should go no further.

But the court's conservatives said the law was passed as a package and must fall as a package.

The justices are scheduled to meet Wednesday afternoon to debate the law's Medicaid expansion.

[thegreekdog]

Some thoughts:

- I read the transcript from the oral arguments; it did not appear that the "liberal" justices were keen on the law either.
- If you don't like slippery slope arguments, don't read any of Justice Scalia's questions. That appears to be his whole schtick.
- What the hell does this - 2.5 million young people under age 26 are on their parents' insurance now because of the new law. If it were struck down entirely, "2.5 million of them would be thrown off the insurance rolls," - have to do with anything? The court doesn't look at a law and say "Well, we'd better keep this or else some 20 to 26 year olds are going to have to buy insurance."

[Symmetry]

@BVP:

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

"Increase G, and divide health expenditures by GDP, and you get a lower "cost." "

GDP = C + I + G + NX
C = private consumption
I = investment
G = government spending
NX = net exports (exports minus imports)

Further expansion on the above:

Spoiler

So, if the government "takes over" the healthcare industry and private consumption shrinks, yet government expenditure increases, is there any change in GDP since the decrease in private consumption (-100) will be offset by the increase in government outlays (+100)? It depends on how much the government takes from C and adds to G (and thus into healthcare costs). It could be the case that the decrease in C (-100) isn't offset by an increase in G (+100). Suppose G amounts to +50. Where's the other +50? It could be due to deadweight costs, i.e. losses due to price controls. Or it could be that government spending isn't as efficient as private consumption. My main point is that the GDP figure doesn't tell us what's going on.

Note: this scenario would result in a decrease of total GDP, thus enlarging the healthcare costs to GDP ratio, which would contradict my claim. (perhaps, I should've spent an additional hour organizing and explaining my main points, but oh well, my statement "It's not a good ratio" still stands).

Other scenario:
Suppose the economy is doing great. C and I are increasing, thus boosting GDP. Healthcare costs to GDP could become reduced. (so the italized could hold true, but...)

Or what if the government includes fiscal stimulus in its G? It builds a bunch of roads to nowhere, or scraps off 2 inches of the highway and dumps down new asphalt. This is an increase in GDP. Would C fall? It depends on how the government procured the cash, e.g. deficit spending, borrowing money, or additional taxation. If no taxation, then C and I could remain the same, or maybe increase. An increase in GDP would reduce the healthcare costs relative to GDP.


My main point is that the ratio isn't good because it doesn't really explain what's going on. The above two scenarios and more could be occurring simultaneously, or there could be time lags, so the data has yet to catch up, or be updated. (oh god, now I have to get into PPP, and how it varies across countries.... I won't for now.).

On Healthcare "Costs":

Spoiler

It also depends on how each government calculates its spending. If the government controls your economic choices, it can force you to spend less than you're willing to pay for healthcare. Or, since it subsidizes it, perhaps more people would spend more; however, spend more on what? If an increased demand for healthcare is not being met by an increase in supply of healthcare, then there would be a shortage of healthcare services--it depends on how much control the national/local government exerts on the production of healthcare. Usually, increased state control via state ownership or certain regulations over an industry decreases its responsiveness to changes in demand (in short, it depends on more than that, but I don't want to type more).

A shortage would result in longer waiting times for receiving medical attention or to get a certain operation. That cost isn't included, and in order for the healthcare industry to meet this additional demand, it must spend more in order to supply more. The increase in supply results in an additional "cost" in healthcare services, but it can be beneficial since it's meeting the demand of customers. Suppose the government inhibits the expansion of healthcare services. Healthcare costs are prevented from rising, but healthcare services are also prevented from meeting the demand. This means that customer satisfaction is being prevented from being met.


So, as you can see, there's much left wanting in healthcare "costs" and GDP measurements, which is why it's not a good ratio. These measurements lack meaning.
(I'd love to see a cross-country comparison of average wait times for surgeries or doctor visits).

Efficiency and Aggregates

Spoiler

GDP is useful for measuring trends and relative sizes; however, it doesn't explain what's happening beneath that figure.

Consider the formula: GDP = Consumption + Investment + Government + (net exports - net imports)

GDP aggregates various expenditures into these categories, which reflect the value of all final goods and services within a year into an average price. Hence, the price of US GDP is about $15 trillion.

If countries with a socialized healthcare program have relatively less expenditures on health care costs, it doesn't follow that socialized healthcare is the way to go. It depends on what exactly are healthcare costs and how the expenditures, or outlays, are calculated. The aggregates of private consumption, investment, government spending, and (exports - imports) vary in efficiency (thus vary in their ability to satisfy the actual desires of demanders), and within these aggregates are sectors which also vary in efficiency.

And, where exactly do the healthcare goods come from? If it's imported, does that mean that government did a great job in improving healthcare because it spends less on healthcare relative to the US? (No, it's more complicated than what the data reveals).

Furthermore, using Sym's wiki data, the quality of the healthcare goods produced is unknown. The casual relation between increased proportion of government spending on healthcare, the reduced healthcare costs relative to GDP, and the alleged outcomes of decreased amenable mortality, increased life expectancies, etc. is not explained at all.

Conclusion:
(So, this is why I didn't want to expand on the italicized. I spend all this time further explaining what I'm trying (and failed to) compress into a couple of sentences. I apologize for that failure. However, my point that "it's not a good ratio" still stands.

Unfortunately, many people fall for these statistics (like Symmetry). With econometrics comes great responsibility (haha). On face-value, it appears great! But it doesn't really explain what's happening in reality. So, just because a country (government and/or people) spends less on healthcare, it doesn't follow that the services rendered are relatively better. In short, the presented evidence from Sym's wiki link sucks, and further data analysis is required but lacking from the wiki link; therefore, Symmetry's data doesn't support his stance.

My guess is that he's just fitting facts to his previously conceived conclusion (e.g. probably some normative judgment about social justice). Moral standpoints which overlook consequences are dangerous.

The GDP framework cannot tell us whether final goods and services that were produced during a particular period of time are a reflection of real wealth expansion, or a reflection of capital consumption.

For instance, if a government embarks on the building of a pyramid, which adds absolutely nothing to the well-being of individuals, the GDP framework will regard this as economic growth. In reality, however, the building of the pyramid will divert real funding from wealth-generating activities, thereby stifling the production of wealth.

So what are we to make out of the periodical pronouncements that the economy, as depicted by real GDP, grew by a particular percentage? All we can say is that this percentage has nothing to do with real economic growth and that it most likely mirrors the pace of monetary pumping.

We can thus conclude that the GDP framework is an empty abstraction devoid of any link to the real world. Notwithstanding this, the GDP framework is in big demand by governments and central bank officials since it provides justification for their interference with businesses. It also provides an illusory frame of reference to assess the performance of government officials.

Based on what I've written, I hope that the underlined has become more clear.

Kind of a long winded blast of hot air, that. Also a bit dismissive given that I simply provided the wiki as a basic source- you can click on the links to World Health organisation reports if you want.

Now, of course, your arguments, while superficially clever , are not what you seem to claim they are. They're just a lot of whataboutery, with little in the way of substance. Which standards, for example, would you claim are reasonable? For healthcare costs, quality, or coverage?

Your argument seems to be freshman year economics about how complicated it all is, with little reference to practicalities, or indeed, alternatives.

I'm still going with the WHO on this, I'm afraid.

[BigBallinStalin]

What's a cost, Symmetry? What is GDP?

You seem to have strong faith in the data you provide. Please explain how they're relevant in order to justify your position.

[Phatscotty]

Some thoughts:

- I read the transcript from the oral arguments; it did not appear that the "liberal" justices were keen on the law either.
- If you don't like slippery slope arguments, don't read any of Justice Scalia's questions. That appears to be his whole schtick.
- What the hell does this - 2.5 million young people under age 26 are on their parents' insurance now because of the new law. If it were struck down entirely, "2.5 million of them would be thrown off the insurance rolls," - have to do with anything? The court doesn't look at a law and say "Well, we'd better keep this or else some 20 to 26

that doesn't stop them from depending on that very tactic though. Won't be long before anyone who opposes Obamacare is eqauted with wanting to personally kill your grandmother and then Spike Lee tweets your home address.

[BigBallinStalin]

@BVP:

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

"Increase G, and divide health expenditures by GDP, and you get a lower "cost." "

GDP = C + I + G + NX
C = private consumption
I = investment
G = government spending
NX = net exports (exports minus imports)

Further expansion on the above:

Spoiler

So, if the government "takes over" the healthcare industry and private consumption shrinks, yet government expenditure increases, is there any change in GDP since the decrease in private consumption (-100) will be offset by the increase in government outlays (+100)? It depends on how much the government takes from C and adds to G (and thus into healthcare costs). It could be the case that the decrease in C (-100) isn't offset by an increase in G (+100). Suppose G amounts to +50. Where's the other +50? It could be due to deadweight costs, i.e. losses due to price controls. Or it could be that government spending isn't as efficient as private consumption. My main point is that the GDP figure doesn't tell us what's going on.

Note: this scenario would result in a decrease of total GDP, thus enlarging the healthcare costs to GDP ratio, which would contradict my claim. (perhaps, I should've spent an additional hour organizing and explaining my main points, but oh well, my statement "It's not a good ratio" still stands).

Other scenario:
Suppose the economy is doing great. C and I are increasing, thus boosting GDP. Healthcare costs to GDP could become reduced. (so the italized could hold true, but...)

Or what if the government includes fiscal stimulus in its G? It builds a bunch of roads to nowhere, or scraps off 2 inches of the highway and dumps down new asphalt. This is an increase in GDP. Would C fall? It depends on how the government procured the cash, e.g. deficit spending, borrowing money, or additional taxation. If no taxation, then C and I could remain the same, or maybe increase. An increase in GDP would reduce the healthcare costs relative to GDP.


My main point is that the ratio isn't good because it doesn't really explain what's going on. The above two scenarios and more could be occurring simultaneously, or there could be time lags, so the data has yet to catch up, or be updated. (oh god, now I have to get into PPP, and how it varies across countries.... I won't for now.).

On Healthcare "Costs":

Spoiler

It also depends on how each government calculates its spending. If the government controls your economic choices, it can force you to spend less than you're willing to pay for healthcare. Or, since it subsidizes it, perhaps more people would spend more; however, spend more on what? If an increased demand for healthcare is not being met by an increase in supply of healthcare, then there would be a shortage of healthcare services--it depends on how much control the national/local government exerts on the production of healthcare. Usually, increased state control via state ownership or certain regulations over an industry decreases its responsiveness to changes in demand (in short, it depends on more than that, but I don't want to type more).

A shortage would result in longer waiting times for receiving medical attention or to get a certain operation. That cost isn't included, and in order for the healthcare industry to meet this additional demand, it must spend more in order to supply more. The increase in supply results in an additional "cost" in healthcare services, but it can be beneficial since it's meeting the demand of customers. Suppose the government inhibits the expansion of healthcare services. Healthcare costs are prevented from rising, but healthcare services are also prevented from meeting the demand. This means that customer satisfaction is being prevented from being met.


So, as you can see, there's much left wanting in healthcare "costs" and GDP measurements, which is why it's not a good ratio. These measurements lack meaning.
(I'd love to see a cross-country comparison of average wait times for surgeries or doctor visits).

Efficiency and Aggregates

Spoiler

GDP is useful for measuring trends and relative sizes; however, it doesn't explain what's happening beneath that figure.

Consider the formula: GDP = Consumption + Investment + Government + (net exports - net imports)

GDP aggregates various expenditures into these categories, which reflect the value of all final goods and services within a year into an average price. Hence, the price of US GDP is about $15 trillion.

If countries with a socialized healthcare program have relatively less expenditures on health care costs, it doesn't follow that socialized healthcare is the way to go. It depends on what exactly are healthcare costs and how the expenditures, or outlays, are calculated. The aggregates of private consumption, investment, government spending, and (exports - imports) vary in efficiency (thus vary in their ability to satisfy the actual desires of demanders), and within these aggregates are sectors which also vary in efficiency.

And, where exactly do the healthcare goods come from? If it's imported, does that mean that government did a great job in improving healthcare because it spends less on healthcare relative to the US? (No, it's more complicated than what the data reveals).

Furthermore, using Sym's wiki data, the quality of the healthcare goods produced is unknown. The casual relation between increased proportion of government spending on healthcare, the reduced healthcare costs relative to GDP, and the alleged outcomes of decreased amenable mortality, increased life expectancies, etc. is not explained at all.

Conclusion:
(So, this is why I didn't want to expand on the italicized. I spend all this time further explaining what I'm trying (and failed to) compress into a couple of sentences. I apologize for that failure. However, my point that "it's not a good ratio" still stands.

Unfortunately, many people fall for these statistics (like Symmetry). With econometrics comes great responsibility (haha). On face-value, it appears great! But it doesn't really explain what's happening in reality. So, just because a country (government and/or people) spends less on healthcare, it doesn't follow that the services rendered are relatively better. In short, the presented evidence from Sym's wiki link sucks, and further data analysis is required but lacking from the wiki link; therefore, Symmetry's data doesn't support his stance.

My guess is that he's just fitting facts to his previously conceived conclusion (e.g. probably some normative judgment about social justice). Moral standpoints which overlook consequences are dangerous.

The GDP framework cannot tell us whether final goods and services that were produced during a particular period of time are a reflection of real wealth expansion, or a reflection of capital consumption.

For instance, if a government embarks on the building of a pyramid, which adds absolutely nothing to the well-being of individuals, the GDP framework will regard this as economic growth. In reality, however, the building of the pyramid will divert real funding from wealth-generating activities, thereby stifling the production of wealth.

So what are we to make out of the periodical pronouncements that the economy, as depicted by real GDP, grew by a particular percentage? All we can say is that this percentage has nothing to do with real economic growth and that it most likely mirrors the pace of monetary pumping.

We can thus conclude that the GDP framework is an empty abstraction devoid of any link to the real world. Notwithstanding this, the GDP framework is in big demand by governments and central bank officials since it provides justification for their interference with businesses. It also provides an illusory frame of reference to assess the performance of government officials.

Based on what I've written, I hope that the underlined has become more clear.

Kind of a long winded blast of hot air, that. Also a bit dismissive given that I simply provided the wiki as a basic source- you can click on the links to World Health organisation reports if you want.

Now, of course, your arguments, while superficially clever , are not what you seem to claim they are. They're just a lot of whataboutery, with little in the way of substance. Which standards, for example, would you claim are reasonable? For healthcare costs, quality, or coverage?

Your argument seems to be freshman year economics about how complicated it all is, with little reference to practicalities, or indeed, alternatives.

I'm still going with the WHO on this, I'm afraid.

Since we've established the fact that you can't successfully defend the evidence which you provided, let's move on to your appeal to authority argument: "I'm still going with the WHO on this, I'm afraid."

I'm afraid of that too. While on my journey of economic knowledge, I've learned how easy it can be to distort the data and trick people who are ignorant of economics, like yourself Symmetry. Fancy graphs and groovy trend lines of GDP and healthcare "costs" across countries will win over the hearts and minds of anyone trying to fit facts with their preconceived notions.

When pressured to address the actual evidence, Symmetry retorts with logical fallacies like the appeal to authority and various forms of ad hominem, or at least rhetoric that is geared toward eliciting strong emotions from the opponent. I personally don't mind this, but here's my point:

It's amazing to see a person fight so hard and so illogically in order to defend his or her stance. It's amazing how difficult it is for humans to evaluate their own stances when receiving new information. Simply saying the words, "I don't know," proves to be an impossibility at times. People like feeling certain--especially if the perceived facts fit their own opinions. Cognitive bias is truly an amazing thing.

[Symmetry]

@BVP:

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

"Increase G, and divide health expenditures by GDP, and you get a lower "cost." "

GDP = C + I + G + NX
C = private consumption
I = investment
G = government spending
NX = net exports (exports minus imports)

Further expansion on the above:

Spoiler

So, if the government "takes over" the healthcare industry and private consumption shrinks, yet government expenditure increases, is there any change in GDP since the decrease in private consumption (-100) will be offset by the increase in government outlays (+100)? It depends on how much the government takes from C and adds to G (and thus into healthcare costs). It could be the case that the decrease in C (-100) isn't offset by an increase in G (+100). Suppose G amounts to +50. Where's the other +50? It could be due to deadweight costs, i.e. losses due to price controls. Or it could be that government spending isn't as efficient as private consumption. My main point is that the GDP figure doesn't tell us what's going on.

Note: this scenario would result in a decrease of total GDP, thus enlarging the healthcare costs to GDP ratio, which would contradict my claim. (perhaps, I should've spent an additional hour organizing and explaining my main points, but oh well, my statement "It's not a good ratio" still stands).

Other scenario:
Suppose the economy is doing great. C and I are increasing, thus boosting GDP. Healthcare costs to GDP could become reduced. (so the italized could hold true, but...)

Or what if the government includes fiscal stimulus in its G? It builds a bunch of roads to nowhere, or scraps off 2 inches of the highway and dumps down new asphalt. This is an increase in GDP. Would C fall? It depends on how the government procured the cash, e.g. deficit spending, borrowing money, or additional taxation. If no taxation, then C and I could remain the same, or maybe increase. An increase in GDP would reduce the healthcare costs relative to GDP.


My main point is that the ratio isn't good because it doesn't really explain what's going on. The above two scenarios and more could be occurring simultaneously, or there could be time lags, so the data has yet to catch up, or be updated. (oh god, now I have to get into PPP, and how it varies across countries.... I won't for now.).

On Healthcare "Costs":

Spoiler

It also depends on how each government calculates its spending. If the government controls your economic choices, it can force you to spend less than you're willing to pay for healthcare. Or, since it subsidizes it, perhaps more people would spend more; however, spend more on what? If an increased demand for healthcare is not being met by an increase in supply of healthcare, then there would be a shortage of healthcare services--it depends on how much control the national/local government exerts on the production of healthcare. Usually, increased state control via state ownership or certain regulations over an industry decreases its responsiveness to changes in demand (in short, it depends on more than that, but I don't want to type more).

A shortage would result in longer waiting times for receiving medical attention or to get a certain operation. That cost isn't included, and in order for the healthcare industry to meet this additional demand, it must spend more in order to supply more. The increase in supply results in an additional "cost" in healthcare services, but it can be beneficial since it's meeting the demand of customers. Suppose the government inhibits the expansion of healthcare services. Healthcare costs are prevented from rising, but healthcare services are also prevented from meeting the demand. This means that customer satisfaction is being prevented from being met.


So, as you can see, there's much left wanting in healthcare "costs" and GDP measurements, which is why it's not a good ratio. These measurements lack meaning.
(I'd love to see a cross-country comparison of average wait times for surgeries or doctor visits).

Efficiency and Aggregates

Spoiler

GDP is useful for measuring trends and relative sizes; however, it doesn't explain what's happening beneath that figure.

Consider the formula: GDP = Consumption + Investment + Government + (net exports - net imports)

GDP aggregates various expenditures into these categories, which reflect the value of all final goods and services within a year into an average price. Hence, the price of US GDP is about $15 trillion.

If countries with a socialized healthcare program have relatively less expenditures on health care costs, it doesn't follow that socialized healthcare is the way to go. It depends on what exactly are healthcare costs and how the expenditures, or outlays, are calculated. The aggregates of private consumption, investment, government spending, and (exports - imports) vary in efficiency (thus vary in their ability to satisfy the actual desires of demanders), and within these aggregates are sectors which also vary in efficiency.

And, where exactly do the healthcare goods come from? If it's imported, does that mean that government did a great job in improving healthcare because it spends less on healthcare relative to the US? (No, it's more complicated than what the data reveals).

Furthermore, using Sym's wiki data, the quality of the healthcare goods produced is unknown. The casual relation between increased proportion of government spending on healthcare, the reduced healthcare costs relative to GDP, and the alleged outcomes of decreased amenable mortality, increased life expectancies, etc. is not explained at all.

Conclusion:
(So, this is why I didn't want to expand on the italicized. I spend all this time further explaining what I'm trying (and failed to) compress into a couple of sentences. I apologize for that failure. However, my point that "it's not a good ratio" still stands.

Unfortunately, many people fall for these statistics (like Symmetry). With econometrics comes great responsibility (haha). On face-value, it appears great! But it doesn't really explain what's happening in reality. So, just because a country (government and/or people) spends less on healthcare, it doesn't follow that the services rendered are relatively better. In short, the presented evidence from Sym's wiki link sucks, and further data analysis is required but lacking from the wiki link; therefore, Symmetry's data doesn't support his stance.

My guess is that he's just fitting facts to his previously conceived conclusion (e.g. probably some normative judgment about social justice). Moral standpoints which overlook consequences are dangerous.

The GDP framework cannot tell us whether final goods and services that were produced during a particular period of time are a reflection of real wealth expansion, or a reflection of capital consumption.

For instance, if a government embarks on the building of a pyramid, which adds absolutely nothing to the well-being of individuals, the GDP framework will regard this as economic growth. In reality, however, the building of the pyramid will divert real funding from wealth-generating activities, thereby stifling the production of wealth.

So what are we to make out of the periodical pronouncements that the economy, as depicted by real GDP, grew by a particular percentage? All we can say is that this percentage has nothing to do with real economic growth and that it most likely mirrors the pace of monetary pumping.

We can thus conclude that the GDP framework is an empty abstraction devoid of any link to the real world. Notwithstanding this, the GDP framework is in big demand by governments and central bank officials since it provides justification for their interference with businesses. It also provides an illusory frame of reference to assess the performance of government officials.

Based on what I've written, I hope that the underlined has become more clear.

Kind of a long winded blast of hot air, that. Also a bit dismissive given that I simply provided the wiki as a basic source- you can click on the links to World Health organisation reports if you want.

Now, of course, your arguments, while superficially clever , are not what you seem to claim they are. They're just a lot of whataboutery, with little in the way of substance. Which standards, for example, would you claim are reasonable? For healthcare costs, quality, or coverage?

Your argument seems to be freshman year economics about how complicated it all is, with little reference to practicalities, or indeed, alternatives.

I'm still going with the WHO on this, I'm afraid.

Since we've established the fact that you can't successfully defend the evidence which you provided, let's move on to your appeal to authority argument: "I'm still going with the WHO on this, I'm afraid."

I'm afraid of that too. While on my journey of economic knowledge, I've learned how easy it can be to distort the data and trick people who are ignorant of economics, like yourself Symmetry. Fancy graphs and groovy trend lines of GDP and healthcare "costs" across countries will win over the hearts and minds of anyone trying to fit facts with their preconceived notions.

When pressured to address the actual evidence, Symmetry retorts with logical fallacies like the appeal to authority and various forms of ad hominem, or at least rhetoric that is geared toward eliciting strong emotions from the opponent. I personally don't mind this, but here's my point:

It's amazing to see a person fight so hard and so illogically in order to defend his or her stance. It's amazing how difficult it is for humans to evaluate their own stances when receiving new information. Simply saying the words, "I don't know," proves to be an impossibility at times. People like feeling certain--especially if the perceived facts fit their own opinions. Cognitive bias is truly an amazing thing.

Meh, your mom was pretty ad hominem at our last swingers party, if you know what I mean.*




















*I mean that myself, and several other men had sex with your mother, and indeed that your mother instigated the encounters.**

**Cognitive bias will be, at this point, suggesting to you that this is an impossibility. Happily this is not true. Indeed, given what I know of her, it's not even improbable- more like regularly scheduled. Still, chin up eh?

[john9blue]

symmetry, you should work on your insult delivery.

it had a good premise, but i must say, the execution was sub-par.

[BigBallinStalin]

symmetry, you should work on your insult delivery.

it had a good premise, but i must say, the execution was sub-par.

Agreed. I think his effectiveness in joke delivery was hampered by nearly lethal amounts of butthurt.

[GreecePwns]

Costs: The US pays more for its healthcare system than all other countries do, when measured in $/capita at PPP. This avoids the problems that % of GDP presents.

Benefits: Wait times are an overrated measurement of the effectiveness of a healthcare system. This is because the effects of short wait times (even a few months) for elective surgeries are, for the most part, negligible.

• At worst, waiting times can lead to deterioration in health, loss of utility and extra costs. However,
  one surprising result is that there is little evidence of health deterioration from a review of studies of
  patients waiting for a few months for different elective procedures across a range of countries. Moreover,
  such patients are quite tolerant of short and moderate waits, although the general public often expresses
  more concern about waiting. OECD's Tackling Excessive Waiting Times for Elective Surgery: A Comparison of Policies in Twelve OECD Countries

But what about emergency surgeries? Or regular doctor visits? The typical reaction by most against a public-run healthcare system is the instant look to Canada. But this is cherrypicking, considering Canada ranks worst among OECD nations for wait times to see a regular doctor. (link for chart).

Maybe the wait time argument implies that people would have to wait for necessary, emergency services. That certain systems are fine with leaving dead people on the street. This is laughable and I will not spend more time than this arguing why.

Either way, wait times are affected by how many doctors there are (supply) relative to patients (demand). If there are a small amount of doctors (which according to the Commonwealth Fund there are in the US, who are all paid based on # of visits instead of on a fixed salary, the doctor maximizes profit by seeing as many patients in the shortest time possible, and with wait times taking preference over quality, you get things like this and this.

TL;DR We're paying way more to be average in some respects and way worse in others. We should follow the models of other countries in order to cut costs and/or improve quality to the point at which it makes our spending more worthwhile. Our system excels in the one thing that doesn't matter so much.

I've heard BBS and others say that similar approaches to other nations cannot apply to the US because of difference in cultural norms (read: being a bunch of fatties). This is mostly due to the infamous American corn-based diet. Now we enter agricultural policy reform, which we can deal with in another thread.

The other argument, that a higher population will affect this, does not apply, because these are all per capita and percentage measures.

[Night Strike]

Even if a single-payer system was better than what the US has now, how would that make it Constitutional to implement in the US? Furthermore, much of the high costs in the US are due to the government mandating what insurance policies cover, not allowing policies to be sold across state lines, and refusal to protect doctors from frivolous lawsuits simply because they did not want to perform unnecessary tests.

[Symmetry]

Even if a single-payer system was better than what the US has now, how would that make it Constitutional to implement in the US? Furthermore, much of the high costs in the US are due to the government mandating what insurance policies cover, not allowing policies to be sold across state lines, and refusal to protect doctors from frivolous lawsuits simply because they did not want to perform unnecessary tests.

Given that the US constitution both bans and allows alcohol, and has a fairly iffy history when it comes to, how should we say, non white people who aren't men, why do you think it's a good guide for a bunch of folk that, in the majority, would be considered second class citizens, non-citizens, or slaves?

You fall back on this argument a lot, and seem fairly indignant when I point out the nasty bits. Are you just basing your arguments on the parts you like, while dismissing the unpleasant elements?

[GreecePwns]

If I had to find a way to make it constitutional, it'd be that the system can be applied by the individual states. As for procedure, the states can consult with professional doctors associations themselves to discuss best practices.

Also, the Constitution is not to be treated as the word of god himself, nor shall it be thumped like a Bible. It being unconstitutional doesn't mean its wrong.

[Night Strike]

If I had to find a way to make it constitutional, it'd be that the system can be applied by the individual states. As for procedure, the states can consult with professional doctors associations themselves to discuss best practices.

Also, the Constitution is not to be treated as the word of god himself, nor shall it be thumped like a Bible. It being unconstitutional doesn't mean its wrong.

But it being unconstitutional does mean the federal government is not allowed to do it. States can do it if they want, but they also can't be forced to do it. If a state does it and it becomes beneficial, other states will mimic the approach. That's why we have the state governments.

Even if a single-payer system was better than what the US has now, how would that make it Constitutional to implement in the US? Furthermore, much of the high costs in the US are due to the government mandating what insurance policies cover, not allowing policies to be sold across state lines, and refusal to protect doctors from frivolous lawsuits simply because they did not want to perform unnecessary tests.

Given that the US constitution both bans and allows alcohol, and has a fairly iffy history when it comes to, how should we say, non white people who aren't men, why do you think it's a good guide for a bunch of folk that, in the majority, would be considered second class citizens, non-citizens, or slaves?

You fall back on this argument a lot, and seem fairly indignant when I point out the nasty bits. Are you just basing your arguments on the parts you like, while dismissing the unpleasant elements?

No, the Constitution does not both ban and allow alcohol. The amendment that banned alcohol was explicitly repealed by the later amendment (can't remember the numbers off the top of my head). And why do you keep ignoring the fact that the constitution has been amended to make sure all people are treated equally? If you want there to be a national healthcare system or national insurance mandate, then amend the Constitution. The Constitution has an amendment process to correct issues that arise through time. It can't be changed simply because lawmakers or judges want it write a different interpretation.

[GreecePwns]

Sounds an awful lot like "Gee, this is a good idea! Now how do we get it to happen?"

Step 1: Allow insurance companies to cross state lines, therefore making it interstate commerce.
Step 2: Do what I said.

[Night Strike]

Sounds an awful lot like "Gee, this is a good idea! Now how do we get it to happen?"

Step 1: Allow insurance companies to cross state lines, therefore making it interstate commerce.
Step 2: Do what I said.

Just because you allow insurance to be sold across state lines doesn't mean you can make individuals participate in the insurance market.

[BigBallinStalin]

If I had to find a way to make it constitutional, it'd be that the system can be applied by the individual states. As for procedure, the states can consult with professional doctors associations themselves to discuss best practices.

Also, the Constitution is not to be treated as the word of god himself, nor shall it be thumped like a Bible. It being unconstitutional doesn't mean its wrong.

But it being unconstitutional does mean the federal government is not allowed to do it. States can do it if they want, but they also can't be forced to do it. If a state does it and it becomes beneficial, other states will mimic the approach. That's why we have the state governments.

NS' response is what a lot of people overlook about the US Constitution. With States applying their own laws, you get different mixes of regulation and market discipline, you get different mixes of State-provided goods and market-provided goods. Surely, have a one-size-fits-all solution (i.e. national laws) prevents the avenues of discovery toward more appropriate mixes.

With a more federalist system, you have decreased costs of "voting with one's feet." As a State becomes more oppressive, more irresponsible, etc., its tax base will decrease on the margin. This acts as a feedback system, so that the proper mix of government and market can be realized through trial-and-error and through "political competition."

Basically, the federal government was primarily established to provide national defense, enforce a common market among the states, and conduct the foreign diplomacy.

[thegreekdog]

If I had to find a way to make it constitutional, it'd be that the system can be applied by the individual states. As for procedure, the states can consult with professional doctors associations themselves to discuss best practices.

Also, the Constitution is not to be treated as the word of god himself, nor shall it be thumped like a Bible. It being unconstitutional doesn't mean its wrong.

All they have to do to make it constitutional (i.e. regulation of interstate commerce) is to permit portability of insurance across state lines.

As to the second point, the Constitution is the guiding document of the country. It is fallible, sure, but the way to fix that is through amendment, not through upholding a law that was signed by a president who won 48% of the vote and that 30% of the people in this country like. "But TGD, the Constitution is too hard to amend." Maybe that was the point dudes.

[Phatscotty]

[Phatscotty]

Pfffffff what a freakin joke! Dumbest thing I have ever heard or else worst straight up lie I have ever heard at 2:35