Has U.S. Democracy Been Trumped?

[jogs]

Well, I mean it in the sense that if (I say IF) you want Scandinavian-level cost-efficiency then you basically have to go for this. I may have exaggerated a bit but then again, there were a couple of things I forgot (like: get rid of poverty, get rid of unhealthy (poor) living space in inner cities, and get rid of pharma lobbyists).

 

The four richest counties in the US are all near Wash DC. We need to put all lobbyists out of business.

[helene_t]

"I am not certain Medicare will pay for this but they will if you feel dizzy. I ask you sir, do you feel dizzy?".

Ha-ha that sounds familiar, could certainly happen here. Not so much with drugs which are reimbursed at rates which may depend of all kind of things but usually don't depend on the indication. But things like dental care (I once had a pre-existing problem diagnosed as a work accident because my employer was insured and I was not), cosmetic surgery (we say the scar comes from your last surgery), haptotherapy (we call it "physiotherapy" then you don't have to pay).

 

Yeah there are cases where you need to be able to go somewhere with your complaint about a doctor. If a builder commits an oops he will usually just admit it himself and offer compensation. Happens all the time. With mechanics it's a bit different and with doctors very different.

 

But taking them to court is just ineffective. It doesn't prevent him from keeping practicing and in most cases it shouldn't either because there is almost zero correlation between bad practice and losing malpractice lawsuits.

 

There is a need for a system that will make sure that whenever something goes wrong we all learn from it and draw the propper consequences. Maybe to reschool, reemploy, deregister or even punish the doctor but more likely to review the procedures, or just to register the oopses so that at least future patients will know what risks they take. It requires that nobody has perverse initiatives to sweep problems under the carpet or to find scapegoats for random accidents.

 

It's not anywhere near ideal here, either. Many of the problems described in the book I referred to can be summarized as a sweep-it-under-the-carpet culture which you will find here also. He compares it to the rules in aviation which are designed to give pilots and engineers incitements to report mistakes in an unbiased way, regardless of whether it was their own mistake or somebody's else. Sounds impossible and probably is but that doesn't mean that one shouldn't strive in that direction.

[kenberg]

There is something in WaPo today about tort reform:

https://www.washingtonpost.com/national/house-gop-quietly-advances-key-elements-of-tort-reform/2017/03/09/d52213b2-0414-11e7-b1e9-a05d3c21f7cf_story.html?hpid=hp_rhp-more-top-stories_no-name%3Ahomepage%2Fstory&utm_term=.1dcd6be88f3f

 

It can be complicated. Capping the awards sounds wrong to me in theory since I can well imagine situations where a large award is very justified. The problem is that the possibility of a large unjustified award encourages some people to fle a law suit that has very little merit, trusting that their target will pay off with a small amount to avoid the gamble. This predatory suing doesn't fit into my self-image, nor of most people's, but some are fine with it. One of the more disgusting phrases is "I wouldn't do this but my lawyer says I have to". No, they don't have to.

 

People need to practice some restraint on what they go into battle over. Back to politics for an example. The Russian intervention in the election is serious business, we need to find out what all happened, deal with it, and see how best to protect ourselves in the future. On the other hand, Kellyanne's suggestion that everyone go out and buy Ivanka Trump jewelry is a triviality. I cannot stand Kellyanne. I don't like her voice, I don't like her looks, I don't like what she says, I don't like the way she says it. I just don't like her. But her "endorsement" of Ivanka products was frivolous. Stupid, but frivolous. Possibly she technically broken some law. I really don't care. The sale of men's undershirts supposedly dropped dramatically after Clark Gable, in It Happened One Night, revealed that he wasn't wearing one.There is no accounting for how some people come to a buying decision, but if anyone out there buys Ivanka jewelry because Kellyanne said so, I have no interest in stopping them. George Bush, I forget which one, created a firestorm when he mentioned that he didn't like broccoli. Shocking.

 

At any rate, some people deserve to be sued just as some people deserve to be fired and some people deserve to be put in jail. But suing can turn into a profession. i agree with efforts to make it an unprofitable one.

[billw55]

I wave my right to sue. Give me the inexpensive healthcare, no insurance companies and no lawyers.

$100 a month with medicare. If you wish to retain your right to sue, you should pay $1,000 a month premiums into medicare.

Actually, this sounds like a pretty good idea. Voluntary waiver of right to sue in exchange for substantially reduced premium. Maybe there could be a middle option that accepts arbitration - yes claims, but no courts and greatly reduced lawyers.

 

 

[Winstonm]

The four richest counties in the US are all near Wash DC. We need to put all lobbyists out of business.

 

I still don't understand why you voted for Trump and why you seem to still support him when your ideas and values lie elsewhere. Populists elected a con man who is simply using populism as a means to an end - and he sure isn't about middle class values, you can bet on that.

 

I understand that you thought Washington D.C. was broken and needed to be fixed. But turning the U.S. into a Russian-style oligarchy is not a solution to our problems.

[jogs]

I still don't understand why you voted for Trump and why you seem to still support him when your ideas and values lie elsewhere. Populists elected a con man who is simply using populism as a means to an end - and he sure isn't about middle class values, you can bet on that.

You will lose that bet. Trump will not go on an apology tour.

 

1SPADE

 

Double entendre.

[Winstonm]

You will lose that bet. Trump will not go on an apology tour.

 

1SPADE

 

Double entendre.

 

Are you genuinely doubling down on your personal racism? If you are, I assure you that is a bet you will lose.

[cherdano]

I won't be gloating since everyone - even ldrews and jogs - deserves good policy. But who'd be surprised that Trump (after screwing over contractors, investors, his Trump-University-enrolling fans, wives, ...) would be willing to screw over his voters?

They are the one to lose from the AHCA (endorsed by Trump): https://www.nytimes.com/2017/03/10/upshot/why-trump-supporters-have-the-most-to-lose-with-the-gop-repeal-bill.html

Meanwhile, the AHCA is breaking basically all Trump campaign promises on healthcare: http://www.vox.com/policy-and-politics/2017/3/10/14881200/trump-health-care-promises

 

But of course, according to ldrews, Trump cares about nothing more than the best interests of the middle class and his voters. I am sure it will magically turn out to be good for them.

[ldrews]

But of course, according to ldrews, Trump cares about nothing more than the best interests of the middle class and his voters. I am sure it will magically turn out to be good for them.

 

I assert no such thing! Trump, like everyone else that I know or know about, is interested primarily in his own benefits. It just happens that at the moment Trump's interests seem to align with the working/middle class. Using the Obamacare as a litmus test seems a bit dangerous since it seems to be rapidly imploding.

 

In any case, we just have to wait a while to see how the results turn out. But over the last couple of months the stock market is up, jobs are up, illegal border crossings are down. Immigration/refugee influs from some Middle Easter nations is temporarily suspended. Regulations are being reduced. What's not to like?

[cherdano]

Regulations are being reduced.

Which regulations specifically are you happy to see gone?

[ldrews]

Which regulations specifically are you happy to see gone?

 

As many as possible, consistent with immediate public safety. I appreciate that agencies have been directed to conduct a benefit/cost analysis on existing regulations. I approve of the Executive Order requiring the removal of two regulations for each new regulation introduced.

 

Do you have objections to conducting a benefit/cost analysis on existing regulations and removing those that do not provide enough benefits to offset the costs? Or to requiring agencies to prioritize their regulations by requiring them to remove two regulations for every new one introduced? I would be pretty sure that the agencies will eliminate the obsolete and non-functional regulations first, wouldn't you agree?

[mike777]

Yes.

 

However, I warn you. Getting rid of the insurance companies and let the public sector reimburse (or even provide) all essential healthcare would be a step in the right direction, but it would not in itself bring the cost-effectiveness of the US health care system up to international standards. Here are a few other things that have to change:

 

- Get rid of malpractice lawsuits. If the doctor out of extreme neglect kills someone or causes permanent disability, report it to the police. Otherwise it's just bad luck. You can get his license revoked or maybe even get him in prisson if he's a really bad guy but your personal gain will be small. And if you report him just for failure to administer a treatment or test that in retrospect could have saved you then sorry, you are wasting everybody's time.

 

- Get rid of doctor-shopping. You have a single GP who knows you and if he's on holidays you just wait till he's back if it's not urgent. And I mean URGENT, not just "urgent".

 

- Accept substantial waiting lists for non-urgent (and even "somewhat urgent") specialist care.

 

- 60-70% paycut for doctors. OK, they save on malpractice insurance so they keep a liveable net income.

 

- Get rid of second opinion except if you are happy to pay for it yourself. Same with all diagnostic tests that don't have a clear indication.

 

- Every "condition" that was discovered by one of those ridicolous "general health checks" is given very low priority. They are usually false positives. Not much better than "my astrologist told me I might have cancer".

 

- No antibiotics unless a serious bacterial infection has been diagnosed. This applies to farm animals also.

 

- Start cycling to work and eat normal size meals. And don't drink stuff that contains fructose syrup. Etc.

 

- Drug expenses are reimbursed at the price of the cheapest generics unless a patented drug has been scientifically proven not just to be better but to be so much better that it is worth the cost. This means that at current prescription practice, you will often suffer some 90% co-payment so patients will have to put pressure on their doctors to prescribe something that is covered. Obviously guidelines will have to be written for this so patients don't have to ask for it.

 

- Medical school is free to attend. This actually saves money since doctors won't have justification for demanding ridicolous salaries. More doctors will graduate, creating negative pressure on salaries.

 

I wish you good luck.

 

Thanks Helene for taking the time to post your thoughts. I have not seen these elsewhere.

 

You raise so many thoughtful points, I may not agree with many of them but your main point holds, your program would reduce health care costs or at the very least slow the increase.

[mike777]

Not sure I have any good ideas how to reduce the cost of health care. I note my brother in law who is younger than me just flew across the country to the Cleveland Clinic for heart surgery. Now add in my wife and her family coming from across the country to be with him. NOt sure how that reduces costs but the local hotel, rental cars, airlines, food places must love it.

 

 

I just wonder do you guys and gals in the UK, Canada, Sweden, et al fly around to your hospitals for care and if so does your gov. pick it all up?

 

I can certify I seem to spend more time at the doc as the years go by.

[Vampyr]

- Start cycling to work and eat normal size meals. And don't drink stuff that contains fructose syrup. Etc.

 

The bad stuff is glucose-fructose syrup, known in the US as high-fructose corn syrup, and it is in everything over there. Not just things that normally have sugar in them, like ketchup and Coke, but also thing where you wouldn't expect to find sugar, e.g. bread,

[mike777]

Barmar asked a fair question regarding planes.

 

Here is a partial answer to his question, since so many in my family are Marines

 

75 Percent of the Fighter and Attack Aircraft in the U.S. Marine Corps Can't Fly

 

http://nationalinterest.org/blog/the-buzz/75-percent-the-fighter-attack-aircraft-the-us-marine-corps-19616

[Vampyr]

As many as possible, consistent with immediate public safety. I appreciate that agencies have been directed to conduct a benefit/cost analysis on existing regulations.

 

Happily for you, Trump is proceeding apace with removing regulations to protect the environment.

[barmar]

I think the bigger problems is with doctors who (as jogs suggests) take both public and privat patients. Taking public patients means that they are in charge of public resources - making judgement calls on who needs a surgery most urgently, etc. Taking private patients means you can bribe them, sorry, in a private consultations they may become more aware of this particular patient's urgency.

The problem in general is any system where the doctor has financial incentives that may trump the best interests of patients.

 

I should note that Trump is also getting rid of the fiduciary requirement of financial advisors. Luckily, my financial advisor says that his company (Ameriprise) still has this is one of their policies. I suppose the GOP's idea is that this shouldn't be mandated; if you're OK with an advisor who puts his returns above your own, you can hire them. And if investors don't think this is a good idea, those advisors will lose business -- that's how the free market (theoretically) works.

 

I say "theoretically" because it presumes that investors actually know this is going on, and understands what it means for them. This is arguably not true for many investors, just as many people who were talked into buying subprime mortgages didn't know what they were getting into.

[barmar]

I don't agree any progressive agenda. On healthcare both democrats and republicans got it wrong. If the GOP plan isn't hated by health insurance CEO's, it is not an improvement over Obamacare.

Since I don't need to be re-elected to any office, I can offer my plan which would anger many. On a temp basis, all uninsured can join medicaid. Only it's not free. They will be billed. The young and healthy should be pleased. They will have access to healthcare. And only when they need it.

This doesn't solve the problem with older unhealthy Americans without health insurance. I'm amazed how old looking and unhealthy Americans who are 20 years younger than I are. Republicans can repeal Obamacare with no replacement. Put them into medicaid(and bill them for use) til republicans can agree on a workable plan. Not optimistic. Who will come forward and agree to foot the bill for the poor who are sickly?

Could you explain this? What does it mean to put someone into Medicaid and then bill them? Isn't that a contradiction, since Medicaid is health insurance for people who can't afford to pay for health care?

[mike777]

The problem in general is any system where the doctor has financial incentives that may trump the best interests of patients.

 

I should note that Trump is also getting rid of the fiduciary requirement of financial advisors. Luckily, my financial advisor says that his company (Ameriprise) still has this is one of their policies. I suppose the GOP's idea is that this shouldn't be mandated; if you're OK with an advisor who puts his returns above your own, you can hire them. And if investors don't think this is a good idea, those advisors will lose business -- that's how the free market (theoretically) works.

 

I say "theoretically" because it presumes that investors actually know this is going on, and understands what it means for them. This is arguably not true for many investors, just as many people who were talked into buying subprime mortgages didn't know what they were getting into.

 

ya this was a brand new regulation in the first place, mostly regarding retirement accounts...

I sort of have mixed emotions about it. Keep in mind this increases costs for clients...if you want your advisor to be a fiduciary fair enough,,but you will pay a lot for it.

 

 

This is a big deal for my old company TIAA since I dealt with profs(college) retirement accounts all day long

 

This mAY OR MAY not surprise people but the big issue day after day for us was dealing with angry clients trying to get the retirement money out of their account early so they could spend it on expensive stuff such as a new house.

 

Clients would buy a house expecting to be able to pull their money out, money which the local college puts in for them...they would really be pissed off when I said no, that was not an option.

 

The rest was pretty darn easy to deal with.

[barmar]

ya this was a brand new regulation in the first place, mostly regarding retirement accounts...

I sort of have mixed emotions about it. Keep in mind this increases costs for clients...if you want your advisor to be a fiduciary fair enough,,but you will pay a lot for it.

So I have to pay someone extra not to rip me off? Isn't that called a protection racket?

 

I happened to meet with my financial planner earlier this week. He told me that they're switching all customers from Class A funds, which have 12b-1 fees (fees that the mutual fund charges, and then passes on to the financial advisor) to institutional funds, which don't have those fees. I asked if this meant that he would be increasing his advisory fee to make up for it. He said for his best customers (including me), he's not increasing his fees, he's going to eat this lost income.

[mike777]

So I have to pay someone extra not to rip me off? Isn't that called a protection racket?

 

I happened to meet with my financial planner earlier this week. He told me that they're switching all customers from Class A funds, which have 12b-1 fees (fees that the mutual fund charges, and then passes on to the financial advisor) to institutional funds, which don't have those fees. I asked if this meant that he would be increasing his advisory fee to make up for it. He said for his best customers (including me), he's not increasing his fees, he's going to eat this lost income.

 

 

think of 12b-1 funds as back end fees. You pay a fee if you pull your money out in the first few years.

 

keep in mind this guy was paid up front....to switch you cost him nothing....repeat nothing....regarding your account

 

 

12b1 funds have high expense ratios which pay for the broker fee.

 

If you pay an advisory fee, then think of investing in TIAA or VAnguard...two old companies I worked for. The fee pays for the gals advice, continued advice.

 

 

btw if you pay an advisory fee, great...but advisory fee plus 12b-1 fund sounds.....like double billing....

 

 

btw there is nothing inherently bad or unethical about 12b-1 funds just don't charge me an advisory fee on top of it.

 

----

 

I should note having an MBA,, CFP and CFA Charterholder...these are issues daily ethical issues that we deal with.

 

 

The CFP big wigs people have endless discussions regarding these topics....the CFA people less so but still we hear a lot about the fiduciary issues.

[barmar]

As many as possible, consistent with immediate public safety. I appreciate that agencies have been directed to conduct a benefit/cost analysis on existing regulations. I approve of the Executive Order requiring the removal of two regulations for each new regulation introduced.

It doesn't seem like Trump is giving much consideration to public safety. He got rid of the regulation prohibiting coal companies from dumping waste into waterways.

[mike777]

A fudiciary is a big deal....It means you can come after me....after everything including my house.

 

Think about it barmar if you make a mistake on bbo....I get to come after all your assets including your house if you are a fiduciary.

 

At the very least if you sue me...I have to hire a lawyer...and go through the hassle....expensive. while my family worries if they go live on the street.

[mike777]

It doesn't seem like Trump is giving much consideration to public safety. He got rid of the regulation prohibiting coal companies from dumping waste into waterways.

 

 

Wow so coal companies can legally dump poison waste into waterways....and pay nothing...zero.....nice deal if true.

[ldrews]

Happily for you, Trump is proceeding apace with removing regulations to protect the environment.

 

So are you saying that all of the environmental regulations have benefits that outweigh their costs to family farms, small businesses, and others.

 

I have a friend who lost the use of half of his farm he had for years because occasional light flooding of the pastures was declared "wetlands". He couldn't afford the legal costs of suing the Federal Government. So he was out of business. Do you think that is appropriate?