Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.
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Nearly Half Of Americans Still Don’t Understand Social Security
What I don't understand is we are making so many advancements in technology, AI, bullshit, biotechnology,...sorry, not bullshit, wait...yes bullshit. THEN how come cost of healthcare does not come DOWN???
We are living longer because of advances in medicine. Good. And apparently, if Monsanto did not F up the corn supply by completely forcing its genetic engineering so natural (we call it organic) corn does not even exist it is because otherwise we would have a shortage of it and couldn't feed everyone.
So now when we made these advancements in Medicine, Agriculture, Bullshit, Technology, err...sorry I keep slipping up on the BS...THEN why are more and more people miserable? If all our development is feeding only a few of us at the expense of others, then perhaps such development is not good? Which jackass cannot make his own barber appointment and needs Google to impersonate him?
Shit happens. I get it. We got 9/11 we had to go to wars, at least some of them legitimately. What then? Stop taking care of veterans and give tax cut to wealthy? When the going is good let's hail the virtues of Capitalism and Democracy. When we are in trouble, let's send the pawns to take care of it.
At least the Greeks and Romans were not hypocrites. Oh wait...those civilizations dissappeared because of the freeloaders, and not those in power. Right.
@VintageFreak: I have no problem with having a 'social contract'. As I stated before, the original framework and intent was noble and sustainable. But somehow it was changed to a slush fund for government wasteful spending. If you want to create a pension for the people, it should be for the people. If you want to take a little more to provide a saftey net, that's fine as well. But, other than recouping administrative cost, the government should have no ability to use those funds. When a person passes, that money should go to their heirs. And, the funds collected should be invested in the Market or age based fund.
@BrianW- I've really no issue with your suggestions as to what the nature of the 'social contract' should be. You make some interesting suggestions, and your format might very well be superior. The problem though is that you are really not making much of a point with respect to any alleged failings of Social Security itself- you are merely arguing that we should have something other than SS. SS, with a bit of non-partisan fiddling, can easily be made to honor it's advertised commitments. Now Medicare- that's a whole different kettle of fish.
@Old_Joe: money is forcibly taken from us to fund an obligation. However, once taken you may or may not ever receive any of it back. The money is immediately taken and used for purposes other than the stated purpose. In its place you are given an imaginary IOU. The current projections for the 'trust' is it will go broke. If Wells Fargo made that pitch, most on here would be screaming to jail them all.
"The current projections for the 'trust' is it will go broke."
@BrianW: I'm afraid that I have to question the accuracy of your assertion. I'll go with info from MFO contributor msf, who has a long and proven track record for balance, accuracy, and detail. An excerpt from his post, above:
"Currently, the Social Security Board of Trustees projects program cost to rise by 2035 so that taxes will be enough to pay for only 75 percent of scheduled benefits. This increase in cost results from population aging, not because we are living longer, but because birth rates dropped from three to two children per woman. Importantly, this shortfall is basically stable after 2035"
Given that, the system is most likely repairable, assuming that Congress and a president can ever agree on anything. (That assumption may be dubious.) As I mentioned earlier, Medicare is something else... I have no idea how that is going to work out.
@BrianW - Yes, I already agreed, spending the SS surplus collections is wrong. The problem is Congress doing that for years. I'll even concede calling it "slush" for no other reason than I don't think it is relevant to what I'm trying to say.
No one had problem with this "slush" at-large in prior years. Every year the clamoring for ending social security grows LOUDER, from a SMALLER percentage of the population who is migrating / feels they are migrating toward the 1%. When things were more "equal" no one had a problem with the "slush". NOW, because the number of people who NEED it is increasing, suddenly I have problem with the "slush" because the size of my D..., I mean TV has to be 80 inches and 65 inches just wont do.
Also let's look at remedy proposed for SS. Government should take portion of it and invest in the Stock Market. Fantastic idea. Even better idea? Let's end the "slush" After all, it was never necessary in the first place right? Poor people supposed die right after they retire. Where is it written in the consitution, we have the right to charity? Nowhere. There is no place for those who worked their life below poverty levels in a free, democratic, capitalistic, merit based society because they didn't do so in the pursuit of happiness. Their fault, those Freeloaders, making everyone unhappy. They are to blame for their miserable lives, and how dare they think they should go on living after they are too old to serve me burger and fries?
So let's reduce taxes. Let's F everyone who can't afford to live. Let's do nothing to get cost of Healthcare down. Let all Freeloaders simply disappear from the face of the earth, and then for whoever is left, we have Utopia. I should write a book. Let me begin with a poem.
No more slush No more slush Lock 'em up No more slush F them up No more slush
Since insurance premiums are obviously, so obviously, a subset of overall healthcare costs, I've been nonresponsive to your entreaties about what I mean, as I have been puzzling how you are not just doing high-grade trolling. But I refuse to think that, and not only 'cause today’s nonstop impugning of the challenger is worse than destructive. So I don’t know exactly what to conclude.
I have never meant insurance premiums alone. I guess I will try and say healthcare spending going forward, like a genuine expert.
Support for a cautious view; Cox is always interesting to read:
'Expenditures' is another totality term, naturally.
These in toto are what I have read were flattening. (One extra variable with insurance contracts of course is not only their profit + admin but also any downward pressure they can exert on provider salaries and expenses. Of course.) At the risk of sounding reverse-trolling and assigning you to do the reading work --- but you have set yourself up as the judge here in some respects, no? --- see for example these three Rand instances:
If you've already posted these, my bad to have forgot.
I am delving their site to see if there is anything about political sabotage efforts.
I am not "fond" of Krugman particularly (for some reason this is a common charge against those who cite him); as a layman I appreciate his comparative clarity and brevity.
Skippable history: I have met Sager and Socolar socially (in the most casual sense) and rather better know college classmate and neighbor Arnie Epstein, Harvard SPH prof of health policy and ex-Clinton advisor (disgusting namedropping), so if I knew I was going to see any of them soon I would ask about their takes on recent cost bending and sabotage effects and the dynamics over the last few years. These letters give a look back:
Anyway, no, I have not been talking about only insurance premiums, though for economists it appears to be, self-evidently, a starting point, since out-of-pocket is not a high percentage, I think. The out-of-pocket skin-in-game argument (= greater exposure to smaller costs):
I think most democrats and Gop in offices over 65 are probably collecting social security cks. My family works for ssi office and states that she encountered many instances that if people can abuse collect funds/over claim from the system they will try to get it
Hi @johnN I do not anticipate a reply from you; as this has not been your pattern back to the FundAlarm days. If you were to continue to work until age 62, paying into the SS system from your wages; and then find a $1 million inheritance to you at age 62, would you take your SS for you and yours benefit or gift the money to the Treasury or a non-profit of your choice ???
JohnN has always been pretty much just an instigator, throwing out right wing hate crap just for the reaction and never responding with a reply or defense for what he posts. Rather cowardly, but that's who he is. You pretty much just have to ignore him.
@MikeM - When people take two separate uncorelated facts and try to link together, "cowardly" does not begin to it. "degenerate" would be the word I would use.
However, we should not ignore. "Ignoring" is what gave us Trump as president. The "noise" needs to be challenged and shut down, because everyone not ignoring.
Let's be honest: the lefts sycophantic, illogical and unsustainable belief system resulted in Trump as president. Those on the right can survive without those on the left. However, the left can only survive and be happy if we all join the cult and begin to march in lockstep. We the people, on the right, can happily survive without you, living law abiding and yet charitable lives. On the left, you cannot survive without pillaging what does not belong to you. And when your idiotic schemes fail, your response is: it'll work if we just throw more money at it. Trump is loud and unapologetic, and frankly we love it because he's telling the truth. Washington is broken. Your average politician is corrupt. People are tired of bending over and taking it. 2020 will be very interesting.
Since insurance premiums are obviously, so obviously, a subset of overall healthcare costs,
It's not at all obvious from your citations. The cited pages don't count premiums as a subset of overall healthcare (except to the extent that they're used to pay net insurance costs).
In Milliman ("Uh, Reinhardt and others typically look to Kaiser and Milliman totals projections"), see Figure 3 which it labels Components of Spending, and the corresponding text under the heading COMPONENTS of COST. No premiums, in fact no insurance costs at all.
The CDC (which you just cited) includes net cost of insurance (but not premiums) in its Table 94 of national health expenditures. Further, even that inclusion of insurance comes to just 6.6% of health expenditures (per CDC). That's a far cry from your "large part, natch".
If anything, the CDC figures show net insurance costs as a percentage of total costs, have been rising since the ACA started limiting net insurance costs in 2012. 5.5% in 2010, 6.4% in 2014, 6.6% in 2015.
You are "obviously, so obviously" counting premiums as a "a subset of overall healthcare costs", while none of your citations do. Given this disconnect between what you're counting and what everyone else is counting, it's hardly a troll to ask, yet again, what are your components of healthcare costs.
I have never meant insurance premiums alone. I guess I will try and say healthcare spending going forward, like a genuine expert.
Thanks. I was afraid that if I had been the one to introduce that term, you'd challenge it. Here's the OECD definition of health spending, which like the CDC's, includes only net insurance costs, not premiums.
Talks about insurance premiums, but says nothing about the components of health costs. At best it talks about the components of health insurance costs. Still nothing showing that premiums are a component of health costs.
Thanks for citing the more recent (2016) study. I'd linked to the 2013 study only because the article you cited that gave data from the Milliman study gave the 2013 figures.
Same issue, though. Figure 8 of the 2016 study gives the components of (health) spending, and none of them relates to health insurance - the components include neither net insurance costs nor insurance premiums. The study shows the rise in health spending declining, as did the 2013 report.
Could you distinguish the 2016 report from the 2013 report? It isn't clear from the 2016 report alone whether (let alone how) any post 2013 changes (such as health exchanges) changed the spending trajectory. I ask because the only GOP impact you have given (copious) links to concern coverage/cost of individual health insurance, which wasn't around in 2013. Nor is health insurance a component of any of the spending figures.
Usage; I am not the only sinner in glomming the components.
Which is why I've asked, repeatedly, for the sinner to repent. De-glom. Especially since the CDC and the CNN story you referenced glom only net insurance costs, not insurance premiums - as already discussed above.
(One extra variable with insurance contracts of course is not only their profit + admin but also any downward pressure they can exert on provider salaries and expenses. Of course.)
"Of course", "obviously". Abandon reasoning, all ye who enter here?
"Provider salaries and expenses". Are these components of health costs? If so (we still don't know what you include in health costs), then ISTM you're double counting provider costs - counting them directly and implicitly (as a pass through) in premiums.
At the risk of sounding reverse-trolling and assigning you to do the reading work --- but you have set yourself up as the judge here in some respects, no? --- see for example these three Rand instances:
Sigh. For the most part they just contain links to multiple Rand pages. Am I supposed to guess which link represents your "instance" of interest on each page?
I am not "fond" of Krugman particularly (for some reason this is a common charge against those who cite him); as a layman I appreciate his comparative clarity and brevity.
You misunderstand. You offered multiple Krugman citations for their supposed discussions of health costs. (In fact, in those columns he was discussing insurance cost/coverage.) Consequently I could freely present a Krugman piece where he actually did discuss health costs, confident that you would not dispute the source (or the age of the column).
Links to a past (but not passed) proposal and to a future possibility. Nothing about the present, about how "health costs are flattening, or were until GOP sabotage" Why bother?
Thanks; this is helpful and patient. I did mean net. I was trying to (mis)understand the Padsim / Compare processes (first of the Rand cites) and customer decisionmaking effects. At the risk of seeming to just be googling further at you:
I'm a bit tied up now, but will review the links. Thanks for the clarifications and focus.
In the meantime, here's another example of a perverse incentive - the way pharmacy benefit managers (the companies that administer insurance drug programs, such as ExpressScript) work with pharma to extract higher drug payments from patients and more generally to keep drug prices high. https://www.nytimes.com/2018/06/03/health/vagina-womens-health-drug-prices.html
Note that in recent years, drug prices have been a large, if not the largest component of health cost rises.
Comments
We are living longer because of advances in medicine. Good. And apparently, if Monsanto did not F up the corn supply by completely forcing its genetic engineering so natural (we call it organic) corn does not even exist it is because otherwise we would have a shortage of it and couldn't feed everyone.
So now when we made these advancements in Medicine, Agriculture, Bullshit, Technology, err...sorry I keep slipping up on the BS...THEN why are more and more people miserable? If all our development is feeding only a few of us at the expense of others, then perhaps such development is not good? Which jackass cannot make his own barber appointment and needs Google to impersonate him?
Shit happens. I get it. We got 9/11 we had to go to wars, at least some of them legitimately. What then? Stop taking care of veterans and give tax cut to wealthy? When the going is good let's hail the virtues of Capitalism and Democracy. When we are in trouble, let's send the pawns to take care of it.
At least the Greeks and Romans were not hypocrites. Oh wait...those civilizations dissappeared because of the freeloaders, and not those in power. Right.
@BrianW: I'm afraid that I have to question the accuracy of your assertion. I'll go with info from MFO contributor msf, who has a long and proven track record for balance, accuracy, and detail. An excerpt from his post, above:
"Currently, the Social Security Board of Trustees projects program cost to rise by 2035 so that taxes will be enough to pay for only 75 percent of scheduled benefits. This increase in cost results from population aging, not because we are living longer, but because birth rates dropped from three to two children per woman. Importantly, this shortfall is basically stable after 2035"
Given that, the system is most likely repairable, assuming that Congress and a president can ever agree on anything. (That assumption may be dubious.) As I mentioned earlier, Medicare is something else... I have no idea how that is going to work out.
No one had problem with this "slush" at-large in prior years. Every year the clamoring for ending social security grows LOUDER, from a SMALLER percentage of the population who is migrating / feels they are migrating toward the 1%. When things were more "equal" no one had a problem with the "slush". NOW, because the number of people who NEED it is increasing, suddenly I have problem with the "slush" because the size of my D..., I mean TV has to be 80 inches and 65 inches just wont do.
Also let's look at remedy proposed for SS. Government should take portion of it and invest in the Stock Market. Fantastic idea. Even better idea? Let's end the "slush" After all, it was never necessary in the first place right? Poor people supposed die right after they retire. Where is it written in the consitution, we have the right to charity? Nowhere. There is no place for those who worked their life below poverty levels in a free, democratic, capitalistic, merit based society because they didn't do so in the pursuit of happiness. Their fault, those Freeloaders, making everyone unhappy. They are to blame for their miserable lives, and how dare they think they should go on living after they are too old to serve me burger and fries?
So let's reduce taxes. Let's F everyone who can't afford to live. Let's do nothing to get cost of Healthcare down. Let all Freeloaders simply disappear from the face of the earth, and then for whoever is left, we have Utopia. I should write a book. Let me begin with a poem.
No more slush
No more slush
Lock 'em up
No more slush
F them up
No more slush
Since insurance premiums are obviously, so obviously, a subset of overall healthcare costs, I've been nonresponsive to your entreaties about what I mean, as I have been puzzling how you are not just doing high-grade trolling. But I refuse to think that, and not only 'cause today’s nonstop impugning of the challenger is worse than destructive. So I don’t know exactly what to conclude.
I have never meant insurance premiums alone. I guess I will try and say healthcare spending going forward, like a genuine expert.
Support for a cautious view; Cox is always interesting to read:
http://www.politifact.com/truth-o-meter/statements/2018/jun/01/families-usa/did-republican-sabotage-cost-32-million-their-heal/
Component relationships.
http://www.ncsl.org/research/health/health-insurance-premiums.aspx
This concurs in the curve-bending-charge warning.
https://www.healthcaretownhall.com/?p=8106#sthash.ub7cJE60.ThyeUphO.dpbs
Usage; I am not the only sinner in glomming the components.
http://money.cnn.com/2018/01/30/news/economy/health-care-costs-eating-the-economy/index.html
https://www.cdc.gov/nchs/fastats/health-expenditures.htm
'Expenditures' is another totality term, naturally.
These in toto are what I have read were flattening. (One extra variable with insurance contracts of course is not only their profit + admin but also any downward pressure they can exert on provider salaries and expenses. Of course.) At the risk of sounding reverse-trolling and assigning you to do the reading work --- but you have set yourself up as the judge here in some respects, no? --- see for example these three Rand instances:
https://www.rand.org/health/projects/padsim.html
https://www.rand.org/health/projects/hie.html
https://www.rand.org/health/key-topics/paying-for-care.html
If you've already posted these, my bad to have forgot.
I am delving their site to see if there is anything about political sabotage efforts.
I am not "fond" of Krugman particularly (for some reason this is a common charge against those who cite him); as a layman I appreciate his comparative clarity and brevity.
Skippable history: I have met Sager and Socolar socially (in the most casual sense) and rather better know college classmate and neighbor Arnie Epstein, Harvard SPH prof of health policy and ex-Clinton advisor (disgusting namedropping), so if I knew I was going to see any of them soon I would ask about their takes on recent cost bending and sabotage effects and the dynamics over the last few years. These letters give a look back:
https://www.nytimes.com/2018/05/31/opinion/republicans-health-care.html
Finally:
https://fivethirtyeight.com/features/how-the-gop-bill-could-change-health-care-in-8-charts/
Anyway, no, I have not been talking about only insurance premiums, though for economists it appears to be, self-evidently, a starting point, since out-of-pocket is not a high percentage, I think. The out-of-pocket skin-in-game argument (= greater exposure to smaller costs):
https://www.bloomberg.com/view/articles/2018-01-04/out-of-pocket-health-costs-are-rising-but-not-that-much
My family works for ssi office and states that she encountered many instances that if people can abuse collect funds/over claim from the system they will try to get it
I do not anticipate a reply from you; as this has not been your pattern back to the FundAlarm days.
If you were to continue to work until age 62, paying into the SS system from your wages; and then find a $1 million inheritance to you at age 62, would you take your SS for you and yours benefit or gift the money to the Treasury or a non-profit of your choice ???
--- One may gift money to the U.S. Treasury
https://www.fiscal.treasury.gov/fsfaq/fs_gifts_to_govt.htm
Awaiting your reply.
Catch
However, we should not ignore. "Ignoring" is what gave us Trump as president. The "noise" needs to be challenged and shut down, because everyone not ignoring.
Just saying...
How can you say that with a straight face? That man doesn't know the meaning of the word, nor does he care.
In Milliman ("Uh, Reinhardt and others typically look to Kaiser and Milliman totals projections"), see Figure 3 which it labels Components of Spending, and the corresponding text under the heading COMPONENTS of COST. No premiums, in fact no insurance costs at all.
The CDC (which you just cited) includes net cost of insurance (but not premiums) in its Table 94 of national health expenditures. Further, even that inclusion of insurance comes to just 6.6% of health expenditures (per CDC). That's a far cry from your "large part, natch".
If anything, the CDC figures show net insurance costs as a percentage of total costs, have been rising since the ACA started limiting net insurance costs in 2012. 5.5% in 2010, 6.4% in 2014, 6.6% in 2015.
You are "obviously, so obviously" counting premiums as a "a subset of overall healthcare costs", while none of your citations do. Given this disconnect between what you're counting and what everyone else is counting, it's hardly a troll to ask, yet again, what are your components of healthcare costs. Thanks. I was afraid that if I had been the one to introduce that term, you'd challenge it. Here's the OECD definition of health spending, which like the CDC's, includes only net insurance costs, not premiums.
Sometimes I wonder if you're just throwing "health" and "cost" at google and showing us the links that you get back. The politifact article cited explains only how Republican actions have "cost" some people their "health" insurance. It's not about health costs at all.
http://www.politifact.com/truth-o-meter/statements/2018/jun/01/families-usa/did-republican-sabotage-cost-32-million-their-heal/ Talks about insurance premiums, but says nothing about the components of health costs. At best it talks about the components of health insurance costs. Still nothing showing that premiums are a component of health costs. Thanks for citing the more recent (2016) study. I'd linked to the 2013 study only because the article you cited that gave data from the Milliman study gave the 2013 figures.
Same issue, though. Figure 8 of the 2016 study gives the components of (health) spending, and none of them relates to health insurance - the components include neither net insurance costs nor insurance premiums. The study shows the rise in health spending declining, as did the 2013 report.
Could you distinguish the 2016 report from the 2013 report? It isn't clear from the 2016 report alone whether (let alone how) any post 2013 changes (such as health exchanges) changed the spending trajectory. I ask because the only GOP impact you have given (copious) links to concern coverage/cost of individual health insurance, which wasn't around in 2013. Nor is health insurance a component of any of the spending figures. Which is why I've asked, repeatedly, for the sinner to repent. De-glom. Especially since the CDC and the CNN story you referenced glom only net insurance costs, not insurance premiums - as already discussed above. "Of course", "obviously". Abandon reasoning, all ye who enter here?
"Provider salaries and expenses". Are these components of health costs? If so (we still don't know what you include in health costs), then ISTM you're double counting provider costs - counting them directly and implicitly (as a pass through) in premiums.
All that aside, thanks to the MLR provision of the ACA (which became effective in 2012), insurers have a "perverse incentive" to see provider salaries and expenses increase. This joint ProPublica/NPR article explains Why Your Health Insurer Doesn’t Care About Your Big Bills.
https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills Sigh. For the most part they just contain links to multiple Rand pages. Am I supposed to guess which link represents your "instance" of interest on each page? You misunderstand. You offered multiple Krugman citations for their supposed discussions of health costs. (In fact, in those columns he was discussing insurance cost/coverage.) Consequently I could freely present a Krugman piece where he actually did discuss health costs, confident that you would not dispute the source (or the age of the column).
> https://www.nytimes.com/2018/05/31/opinion/republicans-health-care.html
(GOP interest in repealing ACA in the future)
> https://fivethirtyeight.com/features/how-the-gop-bill-could-change-health-care-in-8-charts/
(A March 2017 analysis of a GOP proposal, killed by McCain, to repeal/replace the ACA)
Links to a past (but not passed) proposal and to a future possibility. Nothing about the present, about how "health costs are flattening, or were until GOP sabotage" Why bother?
https://www.rand.org/health/projects/compare/how-it-works.html
This from last fall
http://thehill.com/opinion/healthcare/362543-health-care-cuts-in-gop-tax-bill-will-cost-people-and-states-more-long
concludes
... the costs generated by people who go without insurance won’t go away — they’ll be picked up by those who continue to buy coverage, through higher premiums, more limited service, and greater uncompensated care demands.
Is that dynamic modulating?
And here are conservatives recently advocating auto enrollments to lower costs by increasing insurance enrollment and lowering premiums:
https://www.nytimes.com/2018/02/12/opinion/health-care-automatic-enrollment.html
So I must study your comments further to better get the severability of healthcare costs.
Where else do you publish?
In the meantime, here's another example of a perverse incentive - the way pharmacy benefit managers (the companies that administer insurance drug programs, such as ExpressScript) work with pharma to extract higher drug payments from patients and more generally to keep drug prices high.
https://www.nytimes.com/2018/06/03/health/vagina-womens-health-drug-prices.html
Note that in recent years, drug prices have been a large, if not the largest component of health cost rises.
And a rundown of various reasons for the United States' "exceptional" rise in health costs since 1980
https://www.nytimes.com/2018/06/04/upshot/reagan-deregulation-and-americas-exceptional-rise-in-health-care-costs.html
More macro take, noting yet again GOP sabotage via removal of the individual mandate; but none of this is news or a new insight:
https://www.washingtonpost.com/opinions/health-care-is-still-a-mess-republicans-are-making-it-worse/2018/06/04/b04fe66c-5f8b-11e8-b2b8-08a538d9dbd6_story.html
Yes, insurance-related only.
This will be interesting:
https://www.axios.com/health-care-primaries-2018-midterms-voting-issue-democrats-wave-ce9d67ea-c484-4b80-a0ee-2acd48e65aa8.html