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Noyes Notebook: Shuhei Nakamoto Interview

Lex, you talk as if 'socialised medical' is something that is not possible. Are you aware that every other civilised country on the planet has it and delivers it with out any difficulty at all?



In Australia you would have to be mad to have private health cover. Many do but they are mad. The public health system is phenomenal.



My 3 kids were all born in the public system. Couldn't have been better. Riding dirt bikes means you front up at the hospital a few times per year. X-rays and treatment all free.



It makes me laugh how you Americans struggle with something that everyone else does and has done for scores of years so easily.
 
I would prefer not to assume away the economic complexities. When public officials assume away complexity they end up with an explanation deficit and they are forced to communicate with their populace using propaganda. Characterizing socialized medicine as 'genuinely civilized' is the work of state propagandists. In reality, socialized medicine or socialized health insurance simply has a different set of economic and social challenges. One of those challenges is social consensus, hence the need for propaganda and the societal mandate that complex economic systems should be simplified for public discourse. Do you think your public officials say 'genuinely civilized' to the national budget and then all the numbers magically balance?



I'm interested in performance. The aesthetic labels, like 'genuinely civilized' and the moral appeals, like 'helping people in need', are of no interest to me unless the underlying system achieves something.
It's people like you that make it needlessly complex, that would rather wrap themselves in red tape than act like a human being. Having compassion is being civilised, much more so than espousing ridiculous abstract ideological concepts as a reason not to upset your comfortable lifestyle.
 
I would prefer not to assume away the economic complexities. When public officials assume away complexity they end up with an explanation deficit and they are forced to communicate with their populace using propaganda. Characterizing socialized medicine as 'genuinely civilized' is the work of state propagandists. In reality, socialized medicine or socialized health insurance simply has a different set of economic and social challenges. One of those challenges is social consensus, hence the need for propaganda and the societal mandate that complex economic systems should be simplified for public discourse. Do you think your public officials say 'genuinely civilized' to the national budget and then all the numbers magically balance?



I'm interested in performance. The aesthetic labels, like 'genuinely civilized' and the moral appeals, like 'helping people in need', are of no interest to me unless the underlying system achieves something.



Equating humane treatment of others, or anything that smacks of humanity, human decency as "aesthetics" only reveals your inability to possess these qualities. Civilization is not something you can measure on calculator. Humanity is not something you can learn at CPA school. What is it like to be a human calculator?
 
Historically - I am not aware of any time austerity has been the underpinning of any economic recovery in the USA.

Many politicians fought the president's plan for recover during the great depression - but eventually he prevailed

and it worked and gave the US a fantastic infrastructure that hadn't existed previously. Over the years that infrastucture

has been decaying due to the way politicians run around blindly with their heads buried in the pockets of special interest

groups, and pissing away the budgetary surplus of the ....... years by throwing money at pork barrel projects owned and operated by cronies and family members.



You speak of American businesses that cannot compete in the global market - but fail to mention how much the economy has suffered due to export of jobs to China, India etc. Those lost jobs that should be here in America would be paying salaries to American workers who in turn would be spending said salaries in American stores increasing faith in the American economy and supporting small businesses here in the USA. You always talk of efficiency - by which you mean keeping down the minimum wage - another thing that cripples the economy because people can't spend what they don't earn. Same for the trend of corporations that fire workers to keep them from collecting pensions and then re-hire them as temps, another "efficiency" trend that undercuts confidence in the economy. All of this is directly related to out-of-balance nature of the Big-Money people who sit on their giant piles of cash and fail to re-invest the money in any socially meaningful way. The ever widening gap between the very rich and the poor and failure to grow the middle-class is incredibly short-sighted and if not reversed, will turn America into another third world county. The blindered Plutocratic arrogance of the 1% is incredible. That Sun King wannabees can have multiple million dollar homes all over the planet and eat off of gold flatware and have elevators for their five Caddilacs all paid for by robber baron tactics, Wall Street swindiling and selling goods at their K Marts and Walmarts manufactured in Chinese prisons and virtual slave-labor conditions and feel that the money from these endeavors is rightfully and honestly earned is bad enough; especially coupled with the tactics of keeping their earnings in off-shore shore accounts to avoid paying their fair share of taxes on the earnings - but when I hear these pin-heads use the word "entitlement' like it's a curse word I have to think that this is perhaps one of the greatest of all ironies.



First, there was no ....... surplus. The surplus was a projection that used profligate dotcom investment as its basis while ignoring the underfunding of US entitlements. It wasn't dishonest, it was just an inaccurate CBO projection, worsened by the unexpected events of 9-11, the airline bailouts, and WOT.



Second, FDR's policies did not lead to recovery. It is true that his infrastructure spending made a difference, but there must be a robust economy to utilize the infrastructure. It was war-time production that saved the US from another decade of depression, and I'd argue that FDR's infrastructure was not terribly important compared to the US interstate system, which arose from post-war economic analysis of Germany's autobahn. I give FDR a pass b/c he was the first person to introduce Keynesian theory in the US, but Obama has no excuses. We know more than enough to have stopped the recession by the end of Obama's first term.



Third, you are correct that outsourcing jobs has hurt corporate earnings and the plight of American workers, and I often wonder why businesses thought they could earn higher profits by laying off their customers. Honestly though, I'm more concerned with the government policies that made businesses believe that laying off their customers was a potentially viable strategy. Chinese government policy is also pertinent as their currency manipulation is part of US outsourcing.



The 1% have made their fortunes by building the American middle-class. The idea that they have a vested interest in destroying the American middle class is a bit preposterous, especially since most of them have the education to know that the democratic electorate will vote against them. You have to remember also that the world has about 4-5B people who want to be part of the middle class, and they work tirelessly to attract our 1% to their economies. The US, on the other hand, tends to discourage employment and capital investment with relatively high payroll and corporate tax rates (when compared to government services).



Localized austerity is what our businesses are looking for and our middle-class needs. We basically need to cleave chunks of wasteful Medicare and Social Security off of our budget. Plus, we need to reduce or eliminate about 50% of our unemployment, welfare, food stamps, etc. by putting people back to work. The payroll tax cuts and drilling initiatives were popular with businesses and economically necessary. Obamacare has been roundly rejected by the business establishment b/c they don't believe the government will reduce per capita healthcare spending if the economy recovers. They never have so why would they start now?



Obama needs to show healthcare cost decline (without baking the data) or we will not recover until we start exporting oil. 2020? 2030? Never? His other option is to take Romney's platform and use it.
 
Obamacare has been roundly rejected by the business establishment b/c they don't believe the government will reduce per capita healthcare spending if the economy recovers. They never have so why would they start now?



Obama needs to show healthcare cost decline (without baking the data) or we will not recover until we start exporting oil. 2020? 2030? Never? His other option is to take Romney's platform and use it.

I don't have any solutions to health care costs, which can easily consume any allocated resources, but the system prior to obamacare was already using a far greater proportion of GDP than in the socialised UK (or anywhere else that I know of) without covering a rather large number of people.
 
It's people like you that make it needlessly complex, that would rather wrap themselves in red tape than act like a human being. Having compassion is being civilised, much more so than espousing ridiculous abstract ideological concepts as a reason not to upset your comfortable lifestyle.



Goat,



He's merely an Ideological Warrior with a line in prolix and patronising rhetoric, a overdeveloped sense of his own correctness, a set of blinkers to anything outside his narrow view on issues and massive blindspot the degree to which he does not necessarily understand the entirety of an issue.



Oh and laminated picture of Alan Greenspan under his pillow.
 
Equating humane treatment of others, or anything that smacks of humanity, human decency as "aesthetics" only reveals your inability to possess these qualities. Civilization is not something you can measure on calculator. Humanity is not something you can learn at CPA school. What is it like to be a human calculator?



There are two types of ethical theory. Deontology, the ethics of methodology, and teleology, the ethics of results/ends. Morality and human decency require both. The United States has made many changes to healthcare policy on the grounds of humanity. Many of those policies have led to the current crisis.



As I said before, universal healthcare is simply a different set of challenges than privatized medicine. Social consensus is one of the challenges of socialized medicine, hence Goatboy's 'genuinely civilized' remarks, and MA's claim that most developed nations on earth have socialized systems without consequences or drawbacks. Both proclaim that better coverage cannot exist.



Does this sound like the result of rigorous study of the economics of government? or does this sound like a talking-point used to build consensus for a system that more-or-less requires societal consensus?



Rock climbing can cause serious injuries; therefore, society should not climb higher than 10ft above the scaffolding the government erects. Sober. Pragmatic. Risk-less. Standardized. These are terms I would use to describe such methods. Humane? Moral? Progressive? No.



If you understood that the original onus for universal medicine is that healthcare doesn't function like a marketplace, the discussion would be a lot more clear. Guess what? When healthcare and insurance moved to the third-party payer format, healthcare started functioning like a marketplace b/c there were no incentives for judicious use of universal flat-fee services. Rationing and cost-controls were the result.



I fully support the existential rights of democratic voters to have the healthcare system they want. But the blandishments heaped on universal healthcare are a bit silly, to be frank.
 
After that lot, I should add:



...with a habit of misrepresenting other's posts in order to smite them with his ideological handbag.
 
There are two types of ethical theory. Deontology, the ethics of methodology, and teleology, the ethics of results/ends.



Lex, you okay? That long bow you been stretching there had to snap on that one.



There is a theory of ethics that says ethics is only process and outcome. There is a million theories that say this is poop.
 
Goat,



He's merely an Ideological Warrior with a line in prolix and patronising rhetoric, a overdeveloped sense of his own correctness, a set of blinkers to anything outside his narrow view on issues and massive blindspot the degree to which he does not necessarily understand the entirety of an issue.



Oh and laminated picture of Alan Greenspan under his pillow.

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I don't have any solutions to health care costs, which can easily consume any allocated resources, but the system prior to obamacare was already using a far greater of proportion of GDP than in the socialised UK (or anywhere else that I know of) without covering a rather large number of people.



True, and that's why Obamacare is an alluring prospect for many Americans.



I will try to explain briefly how we got to this point, AFAIK.



Like Europe, the United States realized that patient-pay healthcare systems do not spread healthcare risks very well. Like Europe, the US moved to third-party payer, but the US reasoned that cost controls could be averted, thus healthcare could remain private. How can cost be controlled? By encouraging health insurance to be directed by employers. The Federal government reasoned that employers have a natural desire to negotiate for better healthcare efficiency by using pools of employees as leverage over healthcare insurance providers. The system is relatively well thought out, and private health insurance profit margins are generally well below 10%. The obvious problem with the system is that unemployment leads to uninsured Americans. Medicaid was created for unemployed or underemployed Americans, but removing insurance-direction from employers could be beneficial.



Unfortunately, cost-controls were also abandoned for public insurance (mainly Medicare) under the proviso that private negotiations would suppress healthcare costs across the entire marketplace. Since the US has voted to spend the same percentage of GDP on public healthcare as other developed nations, but only give the benefits to 1/3 of the population, we created a demand surplus and a supply shortage. Prices began to rise. To combat the rising costs, the federal government announced that it would only reimburse 80% of the cost of healthcare services, and they made it illegal to charge separate Medicare rates and private rates. They reasoned that all costs would default to the private rate; instead, all healthcare costs migrated to private rate +20% (the Medicare rate). This priced Americans out of the marketplace and put extraordinary pressure on private insurance companies and employers to keep prices down. Pre-existing conditions were refused, and expensive patients were dropped. Private insurers pushed for laws to force people to buy healthcare (realized with Obamacare). These humanitarian crises were addressed emotionally with a litany of bad reforms such as state-granted monopolies for health insurance (to eliminate inefficiencies like advertising) and rising Federal Income Tax subsidies for employer-directed healthcare plans. These demand subsidies and anti-competitive initiatives created more demand stimulus and higher prices.



The on-going lack of public entitlement reform has corrupted the private system, imo.
 
This is great stuff. Now I want to hear how the UK, Australia, Sweden, et al got to their existing Healthcare systems.
 
Well we just have a healthcare system and having been through the absolute worst of it I love it. I don't give a rats about political philosophy, jurisprudence, whether plants and earthworms are sentient or any of that. If I get ...... up I get great care.



AND due to my ex wife cutting me off from private and not telling (she still got my mail) and me being a dumb arse and not really noticing what goes out of my pay I had to go through public for my trauma and follow up.



Fantastic, thank you Australia! I am not looking for reds under the bed, or a higher purpose than can justify cruelty There is a "function of government" argument that Rep.Americans in all their Jeffersonian (governed least = best) wisdom have never caught onto. I think it is honestly tragic.
 
Well we just have a healthcare system and having been through the absolute worst of it I love it. I don't give a rats about political philosophy, jurisprudence, whether plants and earthworms are sentient or any of that. If I get ...... up I get great care.



AND due to my ex wife cutting me off from private and not telling (she still got my mail) and me being a dumb arse and not really noticing what goes out of my pay I had to go through public for my trauma and follow up.



Fantastic, thank you Australia! I am not looking for reds under the bed, or a higher purpose than can justify cruelty There is a "function of government" argument that Rep.Americans in all their Jeffersonian (governed least = best) wisdom have never caught onto. I think it is honestly tragic.



Not from you, Andy. From Lex. Sorry.



[though very glad your care was good]
 
Socialized medicine is like giving a naked person ill-fitting clothes. 'Genuinely civilized'? No. Less bad than having naked people freezing in the streets? Yes.



The US has been uncomfortable with providing such a low standard of government and private service. However, we've spent several decades stimulating demand for healthcare and education, rendering both unaffordable. We've also made education and healthcare dependent upon employers and debt-financing. I can see that universal socialism could be less bad than what we have now.



I agree with the vast majority of what you have to say on a wide range of topics. This one however, I think you're dead wrong.



Socialized medicine is like taking very good care of all people. End of story.



I've had my health issues over the years and am very thankful for Canada's medical system. I wouldn't want to imagine it any other way. Some of the nanny state stuff I could definitely do without. Most of it as a matter of fact. But I never feel like my healthcare has ever compromised my personal freedom.



Universal healthcare is a miles better than "less bad". And that's an understatement.
 
True, and that's why Obamacare is an alluring prospect for many Americans.



I will try to explain briefly how we got to this point, AFAIK.



Like Europe, the United States realized that patient-pay healthcare systems do not spread healthcare risks very well. Like Europe, the US moved to third-party payer, but the US reasoned that cost controls could be averted, thus healthcare could remain private. How can cost be controlled? By encouraging health insurance to be directed by employers. The Federal government reasoned that employers have a natural desire to negotiate for better healthcare efficiency by using pools of employees as leverage over healthcare insurance providers. The system is relatively well thought out, and private health insurance profit margins are generally well below 10%. The obvious problem with the system is that unemployment leads to uninsured Americans. Medicaid was created for unemployed or underemployed Americans, but removing insurance-direction from employers could be beneficial.



Unfortunately, cost-controls were also abandoned for public insurance (mainly Medicare) under the proviso that private negotiations would suppress healthcare costs across the entire marketplace. Since the US has voted to spend the same percentage of GDP on public healthcare as other developed nations, but only give the benefits to 1/3 of the population, we created a demand surplus and a supply shortage. Prices began to rise. To combat the rising costs, the federal government announced that it would only reimburse 80% of the cost of healthcare services, and they made it illegal to charge separate Medicare rates and private rates. They reasoned that all costs would default to the private rate; instead, all healthcare costs migrated to private rate +20% (the Medicare rate). This priced Americans out of the marketplace and put extraordinary pressure on private insurance companies and employers to keep prices down. Pre-existing conditions were refused, and expensive patients were dropped. Private insurers pushed for laws to force people to buy healthcare (realized with Obamacare). These humanitarian crises were addressed emotionally with a litany of bad reforms such as state-granted monopolies for health insurance (to eliminate inefficiencies like advertising) and rising Federal Income Tax subsidies for employer-directed healthcare plans. These demand subsidies and anti-competitive initiatives created more demand stimulus and higher prices.



The on-going lack of public entitlement reform has corrupted the private system, imo.

Sounds like the old Irish joke; (I paraphrase) when Paddy is asked for directions, and responds "Well in the first place I wouldn't start from here".
 
This is great stuff. Now I want to hear how the UK, Australia, Sweden, et al got to their existing Healthcare systems.



Much of Europe has a history of constitutional monarchy and aristocratic plutocracy so the original purpose of universal healthcare was kind of a contract between the ruling elites and the common citizens. The insurance acts of the German Empire (1880s IIRC) was the first example of socialized medical care and the first attempt at universal healthcare. During the 20th century, economists made major discoveries about the functionality of markets and the market's relationship with its regulatory environment. Europeans made many of these contributions (Keynes, Hayek, etc.) so they re-evaluated healthcare through the lens of liberalized economics.



IN GENERAL, it seems that Americans and Europeans drew different conclusions about the functionality of healthcare demand. Americans decided that healthcare does have market functionality, meaning price sensitivity and basic laws of supply and demand. Europeans decided healthcare did not function in accordance with basic market theories. The reasons for the differentiation could be as simple as timing. Americans didn't get around to macro healthcare policy until the middle of the century when elective care was more common and choice was more robust. Europeans were analyzing healthcare at the beginning of the century when healthcare was more basic. Complex cultural differences about government tradition, human rights, etc. could also have influenced the differing theories.



In general, the underlying premise is that healthcare doesn't function like a marketplace b/c people don't consume more healthcare than they need. The don't restrict consumption based upon price. They don't shop around when they have injuries. In the US we recognize these observations as generally correct for primary or catastrophic medical service segments. If healthcare doesn't function as a market, why bother with private insurance and the inefficiency of trying to regulate such marketplaces?



The issue with the early 20th century premise for single-payer is that the healthcare market has become much more complex with the rise elective services and choices for care delivery, medical technology, designer pharmaceuticals, etc. The robustness of the system has created market paradigms which created the need for cost controls and supply subsidies or even national ownership of a network of medical care facilities. The third party payer system created a lack price sensitivity as the healthcare industry developed, which caused issues for the market-based healthcare model by radically altering the demand curve.
 
Lex, you do know that the "great stuff" comment was sarcastic?



All you have managed to do is continue to regurgitate your creed while demonstrating a (mis)understanding of heathcare based on purely economic considerations and what appears to be a exceedingly narrow world view (let's just call it blindingly Americancentric).



"...constitutional monarchy and aristocratic plutocracy so the original purpose of universal healthcare was kind of a contract between the ruling elites and the common citizens." Yeah, that's where the NHS came from. FFS.



I'm out. But the baiting was kinda fun.

michaelm can continue his starry-eyed gaze at your turgid writing.
 

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