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livinincali
Participant[quote=SK in CV][quote=livinincali][quote=SK in CV]
No. ER’s utilization will go down, but revenues will go up because the number of patients with coverage will go up. Staffing may go down, but long waits at ER’s should go down. If anything, charges can be reduced for the reduced number of uninsured because less cost sharing will be necessary.[/quote]Do we measure total health care spending in the country based on invoiced amounts or payments actually received?[/quote]
Payments actually made.[/quote]
So if hospital revenues go up because the people that come in actually have insurance to pay doesn’t that mean as a nation we’ve just increased the total cost of health care. More revenue for hospitals means higher spending on health care and we haven’t even gotten to the increased demand for general practitioner or the overhead associated with running the state exchanges.
How is this going to make health care more affordable again, if we are indeed going to be spending more per capita on health care.
Participant[quote=SK in CV]
No. ER’s utilization will go down, but revenues will go up because the number of patients with coverage will go up. Staffing may go down, but long waits at ER’s should go down. If anything, charges can be reduced for the reduced number of uninsured because less cost sharing will be necessary.[/quote]Do we measure total health care spending in the country based on invoiced amounts or payments actually received?
Participant[quote=no_such_reality]
The underlying systemic issue is what is causing our prior model to break. We’re not a heartless nation saying just let people die, so we EMTALA. EMTALA results in 80% of ER visits being uninsured. The ER is one of the LEAST cost effective points for treating people.The facilities all then restructure their chargemaster to recoop their cost through insurance by factoring it in to the cost. So your ER is 5X what it really should be, because the bill is reimbursing the hospital for the fact that 4 out of 5 basically aren’t paying.
Your regular doctor is much the same. But instead of no-pays, they have Usual, Customary and Reasonable charges. And they have to work on collecting any amount over the various UCR which brings us back to the emergency room analogy.
IMO, the biggest savings of ACA will be driven by taking a large subset of the 40+ million uninsured and moving them from expensive, too little too late treatment in the ER, to less expensive, more preventative treatment up stream.[/quote]
So let’s summarize. The ACA will allow more people to see regular doctors rather than go to the ER. As a result ERs should be utilized less often. Do you anticipate ERs being closed and/or ER staff being laid off in response to less ER usage? Or do you expect those charge masters to again adjust prices to re-coop the fixed costs of operating those ERs?
October 3, 2013 at 7:13 AM in reply to: Matt Taibbi’s latest article- Wall Street Hedge Funds Are Looting the Pension Funds of Public Workers #766103Participant[quote=CA renter] But from what I’ve seen, the turnover in the private sector tends to be very high relative to the public sector, and private sector employees seem to spend a lot of time (on the clock) looking for new jobs or getting distracted by personal issues.
[/quote]Well of course turnover is higher in the private sector. There’s no Defined Benefit retirement plan locking the employee to the company if he gets bored or frustrated with the company and chooses to leave. Anybody with an IQ higher than 10 isn’t going to leave a defined benefit pension once they’re 5-10 years into employment. There’s an exponential ramp in annual payments the further you get into a plan because you tend to get an increase due to another year of service and many public employees have set pay increases along the same years of service principal. At the job for 10 years and now you’re a job title III instead of a job title II that comes with an automatic raise.
[quote]
If you look at the requirements for employment for similar positions, you’ll see that the public sector tends to have higher qualification standards WRT education and experience. Additionally, many public employers require candidates to pass thorough background checks and a series aptitude and psychology tests in order to be considered for a position. I’ve not seen anything like it in the private sector (for similar positions) outside of positions that work with sensitive government information.
[/quote]I agree that public employment tends to have greater education standards but I don’t know that it means those are better employees. Is a person with a Masters from National better than a person with a BS from UCSD. In government employment it is but it’s not necessarily true in the private sector.
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Yes, the government needs to hire the best possible candidates because govt entities are seen as deep pockets; they cannot risk hiring someone who will be a liability to them. They compete with private sector companies for employees so they have to offer something that will attract and keep the best employees. In the public sector, the value of training and experience on the job often trumps other variables, so keeping a lid on recruiting and training costs (which are VERY high) is extremely important to public agencies as well.
[/quote]Do you have to offer a defined benefit plan to be better than the private sector. Why not just offer a 10% gross salary defined contribution. That’s already far better than what the private sector is offering. And it’s pretty close to the additional cost that offering a defined benefit plan is.
[quote]
And I’m not just advocating for DB pensions for public sector workers. I think all employees should have DB pensions of some sort.
[/quote]The country is already struggling with how they are going be able to tax enough to maintain social security. Social security is funded by taking 13.4% of your gross salary and for most people social security is going to pay up to 40% of their final year of pay (for the people here it will be much less) while many public sector defined pensions plans pay north of 60% of their final year of pay. It just isn’t likely to work from a mathematical standpoint. You’d probably have to contribute double the social security contribution rate to have a stable pension that’s as generous as the public sector and the public sector employees aren’t contributing that much. They are all betting on asset price inflation to make it work and/or tax payer backstops.
Participant[quote=SK in CV][quote=livinincali]
The bottom line being the media and analysts are lying when they say not raising the debt ceiling means a default. No, it just means there’s an immediate and large cut to government spending.[/quote]It also means a severe recession. A spike in unemployment. Probably a depression.[/quote]
No disagreement on that point. That is very true. The question is don’t we up up there eventually anyways. How big can the total debt get along with changes in the interest rate before you are actually facing default because you don’t have enough money to keep essential government functions going along with paying the interest on the debt.
Participant[quote=SK in CV]Social Security benefits are a current debt. [/quote]
Read the supreme court case. My interpretation of the opinion sounds like social security is not a debt obligation. Maybe you have some source of information that contradicts this supreme court case but I haven’t seen it. Seems like they could they could use the rational justification of we don’t have the money to pay in full to not pay at all or not pay in full. Therefore there would be no debt obligation to default on.
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The Court ruled that no such contract exists, and that there is no contractual right to receive Social Security payments. Payments due under Social Security are not “property” rights and are not protected by the Takings Clause of the Fifth Amendment. The interest of a beneficiary of Social Security is protected only by the Due Process Clause.
Under Due Process Clause analysis, government action is valid unless it is patently arbitrary and utterly lacking in rational justification. This provision of §202(n) is not irrational; it could have been justified by the desire to increase the purchasing power of those living in America, because those living abroad would not spend their payments here.
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Mostly right, but you’ve changed the equation. If the government doesn’t pay debts already incurred, that’s defaulting on debt, irrespective of whether the debt is secured by a bond or a note.
[/quote]I already made it clear that government has plenty of money to pay interest on the debt they’ve already incurred. And as more tax revenue comes in with the government shut down they probably have plenty of money to pay for any already completed services that haven’t been paid yet. While all new services would be suspended.
My point being we can cut 30% of government spending that we are currently borrowing and not default on any debt. Will that cut have a massive impact on the economy. Yeah of course it will just as it is in the European countries that are forced to dramatically reduce their deficits in order to still have access to low interest borrowing.
The bottom line being the media and analysts are lying when they say not raising the debt ceiling means a default. No, it just means there’s an immediate and large cut to government spending.
Participant[quote=SK in CV]
How is not sending out medicare checks or cutting social security checks or failing to pay a defense contractor not defaulting on government debt? It is. Those are still government debts.[/quote]Failing to pay for work already performed may be a default but not issuing a social security check is not a default of debt. It could be classified as a default of a obligation created by a law that government passed but you can choose to change that law. Actually you can change that law rather easily as it isn’t in the constitution even though it would be impossible politically. That’s what happened in Greece when they had to reduce their budget. Government pension payments were cut dramatically.
Certainly you could cut 30% of military spending and they would have to cut employees and cancel orders for planes and ships but that wouldn’t be a default either. You could close the Department of Education and that wouldn’t constitute a default. You could cut the payments for various medical service Medicare will pay for. All of those things would be unpopular but they wouldn’t be a default of debt. They aren’t debt to begin with. They are spending obligations created by government bills that could be overturned.
The Supreme court has already ruled that social security is a tax and entitlement program so it isn’t a debt the federal government has to it’s people. See this supreme court case. http://en.wikipedia.org/wiki/Flemming_v._Nestor
October 2, 2013 at 7:35 AM in reply to: Matt Taibbi’s latest article- Wall Street Hedge Funds Are Looting the Pension Funds of Public Workers #766034Participant[quote=CA renter]
Public employers offer these benefits in order to keep their recruiting and training costs down because of the lower employee turnover, and they also attract the best possible candidates for these positions. Contrary to the myths pushed by the Privatization Movement, most government agencies perform very efficiently and have extremely high-quality employees. With the millions of public employees in this country, you’re bound to get a few bad apples, but for the most part, they are very well-trained, responsible, trustworthy employees. And since many of these employees have positions that require high levels of trust and responsibility, it’s incredibly important to hire and retain the best candidates possible.
[/quote]So public sector employees are better than their private sector counter parts.
[quote=CA renter]
DIY investing might work well for Piggs and other nerds who spend an inordinate amount of time analyzing economic and various market trends. This is a small group of fortunate people who are inclined to have above-average IQs, financial acumen, and investment returns. Even here, we know that many of us will under-perform at one point or another.
[/quote]Yet they aren’t smart enough to manage their own funds.
So they deserve better pay because they are better. They deserve better benefits because they are superior to their private sector counter parts. When their fund managers and leaders make bad benefit and investment decisions their inferior counter parts can pay more taxes to make up the difference. Sounds fair to me.
Participant[quote=no_such_reality]
Either we mint a trillion dollar coin or we default on our debt (or do we?) I don’t think we do, all they have to do is appropriate a modest sum to paying the interest.
[/quote]The government collects about 2.5+ trillion dollars in revenue each year from various sources. The interest on the debt is only about 500 billion. We aren’t going to default on the debt. We have plenty of money to make the interest payments on debt already incurred. We might default on some other obligation like sending out medicare checks on a timely basis or cutting social security checks by some percentage but the last thing the treasury is going to do is default on an interest payment for a bond.
October 1, 2013 at 7:48 AM in reply to: Matt Taibbi’s latest article- Wall Street Hedge Funds Are Looting the Pension Funds of Public Workers #765988Participant[quote=CA renter]
We need to go back to 100% in-house management with NO outside advisors. Anyone found guilty of fraud or corruption, either inside or outside of the institution, should personally lose EVERYTHING and face a very stiff prison sentence.[/quote]Why don’t we just eliminate the middle man completely and just give employees a defined contribution that they are free to invest how they wish. We immediately eliminate all the problems associated with a defined benefit plan. We get rid of all of the following issues.
1) Tax payer risk
2) Pension spiking
3) Lack of employment mobility
4) Corrupt Fund Managers
5) Double dipping
6) Employee Incentives to game the system.If an employee wants income security in old age put more towards retirement and buy an annuity when you retire. You know exactly how much income you’ll get and whether or not you can afford to retire on that income.
The primary benefit of a defined benefit plan is to eliminate the employees personal risk in being able to retire comfortable. Everybody here would probably take a risk free guaranteed rate of return of 7-8%. Why should public sector employees be a special class of citizens that gets a guaranteed 7-8% rate or return in a 2% growth economy.
Participant[quote=SK in CV]
During the 15 years through 2007 (prior to the crash), CalPers average rate of return was almost 11%. Average. That included the dot com bubble burst. It was fully funded through 2007. They had two years in the ’90’s where their return was over 20%. They couldn’t have made that kind of return in low risk investments. The assertion that they only started making higher risk investments after interest rates fell is unsupportable by the evidence.[/quote]The S&P was around 350 in 1992. It was around 1650 in 1997. Guess what that’s compound interest rate of 11%. Surprise, Surprise, CalPers managed to match the S&P over the same time period. Although one that was pretty incredible run for stocks and will likely never be repeated again.
Participant[quote=FlyerInHi]
Faced with inaction from congress on the fiscal side, what’s the fed to do? Bernanke did a masterful job holding down interest rates to benefit mortgage debtors and businesses who can borrow and invest.
[/quote]Did businesses borrow to invest or did they borrow to pay special one time dividends and/or do share buybacks. If businesses were borrowing to invest don’t you’d think you see an significant improvement in earnings and corporate growth 3 years into this policy. Did banks or other short term traders borrow to speculate in assets prices. Does that speculation grow the economy?
Bernanke made borrowing easier and people did so. The problem is that many people borrowed and invested in things that produced asset price inflation rather than growth. There’s going to be long term consequences to this action, we just haven’t seen them yet.
September 20, 2013 at 7:15 AM in reply to: OT: On the killing floor; immigrations impacts on wages #765649Participant[quote=CA renter][quote=Mayze]CA renter,
I have been in manufacturing for many years, starting with an internship in Ford’s Dearborn plant in the 70’s. I would never work in a unionized shop because of all of the inefficiencies that were ‘won’ by the unions in negotiation with management.
At the same time, I share your dismay at the wealth concentration that occurs when labor is exploited.
The best that I can come up with is legally mandated minimum compensation, but that is open to corruption as well.
The question is: how do you get the capital voice and the labor voice working together for both short and long term success for the enterprise, employees, and investors?
You’ve stated a convincing case for labor’s need to have power. How does that power not be abused, just as capital’s power is now being abused?[/quote]
Good question. IMHO, the answer lies in the *balance* of power, with checks and balances that make sure neither side is able to fully exploit unilateral power. It is the balance of power that keeps corruption in check (as much as possible), and ensures that the majority have a voice in how the economy works for everyone involved. As of now, the power is almost entirely tilted toward capital. That’s what’s causing so many of the problems in our economy, IMO.[/quote]
Part of the problem though is labor isn’t really fighting capital directly anymore in most cases. The most powerful labor unions are going to the government for more money/resources and while they might prefer the government getting those resources from the capital owners they’ll take it from where ever they can get it. I think that’s why labor unions have lost the sympathy of the common man. The common man sees labor demanding more taxes and when capital shows up to push those taxes onto the common man the common man sees both groups being greedy bastards.
Participant[quote=FlyerInHi]The loose lending standards led us the economic crisis.
Today is a much different situation. We are not in a bubble and we have a fiscal policy that is counter productive.
Bernanke said than “federal fiscal policy continues to be a restraint on growth and a source of downside risk.” Bernanke repeated his compliants about congress several times.[/quote]
How do you know there’s not a bubble somewhere in the economy. The fed is very good at creating bubbles and usually nobody sees them very well until it’s too late. The problem for the fed this time around is the bubble they are building isn’t being felt in the overall economy. The dot com bubble and housing bubble actually produced quite a few jobs for the common man.
This time the bubble in bonds or perhaps stocks isn’t spilling over into the real economy much and so they aren’t getting much measurable growth from the bubble they are creating this time. If your flooding the market with 7% of GDP in money and only getting 2% growth than that money is finding it’s way into rising prices of goods and assets.
Wwith that said hindsight will be everything yet again. When we look back at this time 5-10 years from my bet is we’ll be saying Bernanke’s policies were dumb because created this future blow up we haven’t experienced yet. The alternative is somehow these policies work to create significant growth and nobody in congress or the future fed president screws it up. You’d think you’d have seen something positive after 4 years of QE and 0 rates but there’s not much there yet. It’s possible I suppose and considering the short term pain that any alternative offers maybe you have a point. It’s better to be on life support than dead if you’re hoping for a miracle.
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