Comments by "Xyz Same" (@xyzsame4081) on "Peter Santenello"
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@rajbasra5694 The most important principle under Capitalism is maximizing profits and minimizing costs. Some products are a good fit for a "free market" (consumer products: Nice to have, can do without). Another important condition is that it is easy to have more competitors (no hurdles regarding investment and size of operation).
That is not an absolute deal breaker. When only 2 - 4 large actors dominate the "market" you can expect some shenanigans, and price rigging. If the service is not that expensive (think mobile phone plans, or internet providers) the damage for consumers is somewhat limited. And consumers can not buy, it may be hard or uncomfortable but it will not cost their life.
Consumer productus need creativity. Finding and CREATING demand, marketing and sales skills.
Providing medical services (or admin around it like insurance coverage) is not at all like that. A hospital is a clockwork, you do not need creativity, you need standardized procedures. Routines.
The U.S. private insurers are glorified paper pushers. The non-profit insurance agencies in other nations are also paper (bit, bytes) pushers. But much less - they work quietly in the background, do not give the patients grief and operate at much, much lower costs. since billing is simple and no one is chasing after unpaid medical bills it saves a lot of admin also for doctors and hospitals.
You do not need to find out the consumer preferences of the patients when it comes to gall bladders surgery, chemotherapy or the treatment of a heart attack.
What do consumers want ?
Not needing it - but if they do need treatment - the one that helps best.
That CAN be complex. Medical school and on the job training of doctors takes care of that kind of complexity (diagnosis and finding a treatment plan) - not a marketing campaign planned in advance that intends to increase SALES of certain treatments and procedures.
Medical research is NOT done in regular hospitals (that handle the overwhelming majority of more expensive services) and the field of research is highly regulated and by necessity also very structured and standardized. Standardized is the nature of modern medicine. Creativity or sales does not play a role.
Admin around medicine - like insurance coverage - can and should be be simple, streamlined and cost efficient (typically 2 - 5 % overhead) - it is not rocket science. That is the reason why globally ALL the non-profit public agencies do a much, much better job than the U.S. for-profit insurance companies.
The diversity and product differentiation that is an advantage (and comes with extra costs for instance for marketing and sales) for consumer products (nice to have, can do without) - does nothing to make medical services better.
On the contrary it creates unnecessary costs and toxic incentives.
As for cost control. The only other wealthy nation that relies on private healthcare insurers is Switzerland. They have only private insurance, but unlike the U.S. the for profits were not able to get rid of the elderly over 65. So the for-profits do not get the better clients and the government agency has to take care of the patients that cause the most costs - no, in Switzerland they have to accept ALL. And it is heavily regulated.
But there is only so much regulation can do, to get cost control. There are inherent incentives (and automatic higher costs) that are hard to overcome.
If the Siwss with their impact of direct democracy and ballot measures every few months do not manage to have cost control -- the U.S. can as well stop pretending it could ever pull it off. The Swiss have at least very good services and for everyone, they pay all medical staff well, and they get that for .......
78 % of what the U.S. spends per person.
That is expensive. Neighbour Germany is at 56 % of the U.S spending per person (and is already on the higher side of the normal range for a first world country).
To be clear that means ALL that is spent in the country divided by ALL people. What is already being spent - and in the U.S. that average per persons calculation includes persons that do not even have healthinsurance coverage (or not nearly enough).
If have the data from 2017 (Kaiser Foudation, you can also check out the World bank data).
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@rajbasra5694 you conflate a (massively subsidized * ) consumer product like cars where citizens have a choice (incl. the MOST IMPORTANT CHOICE to NOT have ANY car) with a service that is
a) costly even if delivered under cost efficient single payer systems. some wealthy nations do it as little as approx. USD 5,000 per person (data 2017) - so a healthy family of four would account for 20,000 USD per year even if they hardly ever need the doctor and need no expensive services. it is the aveage (older persons dirve that up).
All nations need to generously subsidize to achieve the universal coverage (that allows for simple and cost effcient admin).
But the single payer nations do not pay as much subsidies per person as the U.S.
If you compare with spending that is double of what it should be - all actors can save.
Government some and the citizens and their employers a lot.
People are either insured or not. IF they are insured they have full coverage (that would apply to tourists from outside the EU for instance). Doctors do not need permission by the the insurance agency. A treatment is on the menu so to speak - eveyone can have it when medically warranted - or no one. Which of course means that all modern treatments are available. The doctors and hospitals (also non profits run by cities or states) would leak it to the media if they would like to have certain tools but they are not greenlighted.
And as the population (incl. the affluent) are all in the same boat there is substantial political pressure to update whenever better options are available. That does not play out like that, people do not have to force the agency to approve of new treatments that is done in the background and is of no concern for citizens.
Example: the new hepatitis C drugs. One cure costs 60 - 80,000 USD (there might be a discount) but the patents do not expire anytime soon. A citizen of Germany or Austria would get that if they have stage 2
There are older medications, that also help, but not always. The new ones help better for aggressive cases that progress fast - and can reverse the condition, so getting it at stage 2 is soon enough, that is still a mild case. German citizens are blissfully unaware about that drug, that infection, and the fact that they would get the drug when their doctor recommends it. No one checks out what their coverage includes.
(a doctor has no incentive either way. if the diagnosis is stage 2 they can and will prescribe it).
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@rajbasra5694 SUBSIDIES for combustion and electric vehicles and fossil fuels *. Back in the day cars were useful for the rich IN the large cities (they replaced horse carriages fast), but for travel across the country they used train, or it was a hassle. Government had to finance the streets that made long distance travel or transport of goods by vehicles an option. (and the car industry undermined railway, there was a lawsuit in the 1960s or 1970s - the lobbying had happened much earlier).
Government struck a deal with the (barbaric) theocratic rulers of Saudi Arabia in the 1940s. Government pulled off a coup against the democratically elected government of Iran in 1953 - over fossil fuel.
The military presence in the Middle East would not happen w/o the dependency on oil. The U.S. had a lot of oil. With a lower investment into good public transportation and good insulation of homes (resp. solid building in the hot areas to get down A/C costs) a LOT of fossil fuel could have been saved - so the U.S. reserves would have sufficed.
No need to mess in the Middle East.
Those costs are never counted. The Capitalistic = short term interests of the profiteers drove the National Security Interests (incl. the goal of energy independency) of the U.S.
Or the Iraq wars. You did not really think this was about tyranny (Saddam Hussein had been a good buddy for decades). Or fReEDom.
Needless to say Tesla also gets massive subsidies. So before you sing the praises of the free market and its marvellous impact on the vehicle sector - be aware they would not exist w/o the government propping them up, massively in the early stages. And to a suprising extent still with fossil fuels.
The business model of U.S. car manufacturing is so flawed (expensive big cars with high consumption) that they need a bailout whenever there is an economic crisis. That business model also needs a deregulated financial sector. I recommend to listen to the Dave Ramsey show to get an idea about the insanity.
Examples
Couple: they have an family income of 60,000, she has 36,000 as social worker in Arkansas (and 120,000 in student loan debt). She bought a car for 30,000. (He did not co-sign).
Her husband was not on board - HE was reasonable. He has no assets, but also no debt.
She seems to have given up. Her motto is - I will always be in debt I can as well drive a nice car. (Which might help to not being pulled over by police).
That insanity would not fly in other nations. And one car for 30k would not be sold, and a bank would NEVER approve that loan. The bank would be sued for criminal practices (criminally negligent conduct of the bank), never mind consumer protection. She would also not be in 120,000 USD debt in order to get a college education.
Cases like these (people buying cars with a loan and they, car dealership and bank should have been more prudent) seem to be common in the U.S.
That means that the car industry is propped up by financial regulation (or lack thereof).
Note that the banks are allowed to "create money out of thin air" whenever they give out a loan. They only need to "have" approx. 10 % of the loan amount (in form of capital or deposits on accounts). SOCIETY allows them that. The concept is called FIAT money, it is the base for all modern banking - but of course that only works if most people pay back their loan - of society at large will take a hit.
Real estate bubble with subprime mortgages ? Try the same kind of bubble NOW with cars and subprime loans. Student loan debt is meanwhile higher than the mortgages that were open in 2007. And the volume of car loans is in that range - not surpassing student loans or mortgages but in that range.
In Europe they would not get the loan. The car producers there (and the car dealers) have to find clients that can afford the vehicles. Or the loan (and buying a car with a loan / under a leasing contract is seen more critically. It is done - but if a person buys an expensive care they would get a lot of critical feedback.
If people default in masses on their car payments the banks will be bailed out. Again.
Another insane (and especially unethical) loan I heard about on a call into the Dave Ramsey show. (I have 69,0000 debt for 3 cars)
A father made his 18 year old son co-sign for his TWO vehicles (but the son is only on the loan, not on the title). After 18 - 24 months still open: 33,000 for the truck (for the "biz" of the father) and 18,000 for his personal vehicle. (Plus son owes 5k for HIS car and some credit card debt - I am afraid that would be 13k, likely also to help out his mother that got divorced over the affair of the father - so in total 69k debt that he is potentially responsible for).
You guessed it - the father is behind with the monthly payments, and ruins the credit score of his son (think job applications, finding an apartment to rent, never mind being approved for a loan).
Debt is not normalized in other nations, and an 18 year old that is pressured by his father might have a chance to get out of the obligation. (And I doubt very much he could have piled up 13k in personal loans, other than for a care, let alone on expensive credit card).
The people granting such loans have an obligation (they see it that way in other countries) and their duty to scan for sanity and prudence is higher than that of consumers, especially if one of the persons is that young.
An adult that NEEDS to have someone signing on a loan for 2 vehicles does not have good credit.
(and vehicles that are expensive, father might do O.K. for a while with an older truck also for private use and a motor bike for driving around in town if he wants to be more agile until his biz does better, then his monthly payments would be be half or less, and he could afford them).
A car dealer in Germany or France would not even try to close such deals. Their is a chance they would taint their reputation. And the bank working with them would not approve such loans. There is a good chance consumer protection would drag them. a) into court and b) taint their reputation.
A car loan with 17 or 26 % interest (that happens too, and for fairly expensive vehicles). That would not even be legal.
Many smaller business owners would like to buy a smaller, agile, lower cost, lower consumption truck. There is a certain FORD model and they don't produce them anymore. The old vehicles hold their price very well and are well maintained. So there would be a market for that kind of vehicles (think a solopreneur as plumber, landscaping, etc.).
But the U.S. manufacturers decided not to produce them, they prefer to FORCE such entrepreneurs to buy their larger, more expensive models.
And they also made sure to not have any imports for that kind of vehicle (which likely would be a strong niche). They have that kind of commercial vehicles by necessity in Japan and Europe.
In Europe the trucks and vehicles tend to be smaller unless you have a FUNCTIONAL reason to go big. The core of the cities and towns was often built in medieval times and streets can be narrow. So any handyman would be well advised to not have a larger vehicle than absolutely needed. Saves them a lot of trouble, they will be able to park and navigating the streets is much easier.
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@rajbasra5694 Government agencies can be corrupt and inefficient (especially if lawmakers chose to make things complicated, or undermine their budgets). But ALL the public non-profit insurance agencies globally beat the private for-profits, it is not even close. With the same sufficient budget per person (roughly half the spending per person compared to the U.S. * a non-profit agency in a single payer system ** will always, always beat the for-profits.
* that means the average per resident that was already spent in 2017, and average includes persons with no insurance coverage, or those that did not need any treatments that year
I challenge you to come up with an example to the contrary
first world, all in the country have comprehenisive coverage.
We are not talking about a developing country where the masses have no or underfunded services and the affluent have their private contracts, and hospitals and doctors only for them. Those private contracts are relativey expensive of course - but that coverage is not comparable to the public coverage (if there is any). The reason being that there is not enough funding PER person for ALL i the country.
single payer =streamlined insurance / admin
In medicine one size fits all is applicable and a good thing
As opposed to consumer goods where individual needs, preferences, and affordability are important, and where the higher spending for admin, marketing and sales does come with a benefit: to have a variety of offers.
And you can chose from that variety - _or not buy.-
This also means that if the companies try price gouging or spend 1 dollar on marketing to make 50 cents more profit - the consumers would stop buying. Too expensive. Spending a lot on marketing (or on lobbying, hiring statisticians to rig the game, excessive complexity to sidestep regulation meant to protect insured / patients) is only possible because they can pass on the costs onto the insured, companies and government - the one dollar in costs is paid by someone else (and they MUST buy) so that the insurance companies or the (for profit) hospitals make 50 cents more profits (or surplus if they pose as non-profits hospitals).
A "variety of offers" and "consumer preferences" do not make sense in medicine:
Either is is medically warranted - or not.
A person with a Cadillac plan would still not "consume" unnecessary X-rays or an extra round of chemo. IF the extra round of chemo is warranted - for ethical reasons the low income person must get it too.
"differentiation of the offer" and all costs, benefits, compexity ! and ambiguity (for the consumer !) that come with it - make no sense for healthcare
If for ethical reasons no one is excluded from necessary treatments - humans have the same body, and the same needs and desires when it comes to health.
There is no incentive to overuse - healthy people usually avoid the doctor. and for one hypochondric person you have 20 that should go earlier to the doctor. never mind that those persons usually to do not get the expensive treatments. they put a strain on the nerve of their family doctor.
So that argument for healthcare free at the point of delivery is also nonsense. Overuse is NOT an issue.
it is also not necessary to SELL to people and to CREATE the DESIRE to come to get treatments. People with medical problems will be motivated just fine.
"If you build it, they will come"
applies to doctor practices, labs and hospitals. And it is very planable. Per 100,000 or 1 or 10 million residents you need a certain number of small hospitals (that handle most and the normal staff), a few larger more specialized hospitals (organ transplants, early born children, severe burns, severe head injuries, neurosurgery, ...) pharmacies, ambulance transports, airlifts, family doctors, specialists. And you want to spread them out over the country, especially the family doctors, pharmacies, and the smaller hospitals.
Marketing would only create toxic incentives (to offer NOT necessary medical services), or at best just be obsolete. As long as the potential patients know where to find the next hospital or doctor they know enough.
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@rajbasra5694 you get the definition of socialism wrong - the means of production are owned by the WORKERS. - Lenin correctly defined what they had as State Capitalism (the government not a few rich industrialists controlling a major part of the industries). Of course neither oligarchs NOR dictatorial minded folks that rise to the top during a revolution (abolishing of a authoritarian monarchy) have any interest to let the workers have so much agency and ECONOMIC INDEPENDENCE.
There were some attempts in Russia in 1917 in the fledgeling democracy (incl. the "soviets" which were communes - comparable to the kibbuzim system or co-ops) - but a few months later the Bolshevics seized control. Also over the means of production. If you control the income of people (or if they even have an income), and you control the output (food, goods) - you control the nation.
In fascist governments the rulers do not seize the means of production, they have a friendly cooperation going on, with lots of perks for the companies (especially the big ones) and the workers or citizens have no say.
And the revolutionaries knew of course that it was only a matter of time that the oligarchies (the U.S. or those that still had a monarch, for instance the British empire or Japan) would come after them. They did not care whether that was a democracy or dictatorship, but rich people had been dispossessed and the monarch had been ousted (the Bolshevics killed them - before they were under house arrest).
Redistribution of wealth and getting rid of the established ruling class (even if they were not killed, and that was not the initial plans) set a bad precedent.
During a VIOLENT revolution that usually happens, especially if outsiders support and finance the former power brokers and it leads to a MORE INTENSE civil war. Invariable the most ruthless, smart, strategic persons - usually with good military skills - will prevail.
France, U.K., U.S. Japan invaded Russia in order to help the troops of the czar. Indirectly they helped the most militaristic, most ruthless group among the revolutionaries to power.
the SAME dynamic played out in China (it needed a figure like Mao to beat the old power brokers that were propped up by the U.S. U.K.), in Korea, in Vietnam.
A Civil War where outsiders pour gasoline into the fire is not the time when the democratically minded, moderate, compromise seeking actors prevail.
The Independence war of the American colonists, was a spat of the 1 % of the colony with the 1 % of the empire, and the colonists took that risk because they had the support of the tyrannical French monarch. But that new government / country did not trigger that much hatred because after all rich people still ran the show so the Eurpean monarchs felt no need to gang up on them.
Lenin and Stalin knew they had to industrialize and to build the military. FAST. And that is easier to pull off in a centralized, top down ruled system. Especially if the building of the military comes with (major) sacrifices for the population. I think they could have done that with a co-op based economy as well - it was a legitimate National Security concern (there can be still incentives and regulations to steer the economy whether the government works with capitalistic companies, feudal units, or co-ops).
I think a genuinely democratic government would have also attracted a LOT of well educated and well trained immigrants (handymen, engineers) from more developed European countries. They got a few black people from the U.S. In the Soviet Union they could be well respected academics, that was not an option in the U.S. at that time.
But Lenin and Stalin (even more so) did not have a democratic mindset, so having a lot of co-ops in the economic system was not even a consideration. They only had the "Soviet" in the name. and invoked the works of Marx (he never writes about government being in charge. The workers controlling the means of production).
The Soviet Union from 1918 - 1953 (Stalin died - or was killed) was another variety of the "Revolution eats its children".
They also crushed a strike of the railway workers early on. They were not pro worker, they were pro power.
They had a window of opportunity with their push to propell the massively uderdeveloped country forward because the European rulers had a hard time to justify another war after WW1. and then the global economic crisis hit in early 1930.
The British empire got into trouble with India, Ireland, Africa..... during and after WW1
Same for the French.
The U.S. meddled - as usual - in Latin America and Asia, especially China and Philippines (The Philippines and Hawaii were colonies with U.S. bases when the Japanese bombed them in 1940).
The Japanese also concentrated on China, so no one got around to knocking out the Soviet Union.
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@rajbasra5694 Now your value system is up for debate, because the most valuable things a person has is health, and TIME. (and friends and loved ones - but that needs also time to nurture and enjoy). We can win and lose fortunes - but we cannot win back time.
You could ask Warren Buffet on that or could have asked Steve Jobs or Larry King when they still were alive.
Once the essentials are comfortably covered, especially ! for the lower to regular income segment (see Denmark)- having MORE money does not increase your experience of wellbeing that much. People get used to their higher standard of living and cannot squeeze more happyness out of the higher spending.
And the well being of the affluent is not disturbed by seeing a lot of homeless persons, high crime rates, a lot of addicts (diseases of despair). it is much SAFER also for the affluent.
They did studies in the U.S.
Up to a family income of 70,000 USD more money means more satisfied with your life. (Money does not buy happyness but it can buy comfort, peace of mind, and some satisfaction, security).
But excess income does not improve that anymore. Or only marginally.
Some people are so ambitious that they are married to work (and maybe genuinely enjoy the internal power games or the thrill to found their own company and see it grow fast. More free time does not have that much appeal for them. the work and the thrill they get from it IS their reward). But for most people the money they can earn is not worth that much if they do not have time to enjoy spending it.
I wonder if some of the U.S. consumerism is not a reward / compensation / bandaid for being in the hamster wheel. Or a reaction to constant push to keep up with the Jones'. Humans are social beings and having status (according the norms of the culture) is important, even for the middle of the road persons.
I reccomend to listen to the Dave Ramsey show. You have people with low income that go into debt for expensive cars or are home-poor, and have credit card debt. The obvious stress does not add to their wellbeing. On the other hand he also gets calls from people that have a household income of 130 or 160 or over 200k and cannot make ends meet. Or pay down their (student loans).
That sound more like "addicted to consumerism" and not enjoying an upper class lifestyle.
Now, if a person wants to start a biz they do so in Denmark. Social mobility is HIGHER than in the U.S. (not hard, it is higher in most wealthy nations).
a society cannot be made up only by the hyper driven persons. If they create a product and service it does not matter how good it is - they must be able to sell it.
Usually they sell to the middle of the road citizens. Not super driven but also not lacking of any ambition. And a lot more of the middle of the road folks are needed for a country and an economy than the super ambitious persons.
Imagine a company where you collect a group of alpha type personalities - and only those.
Good luck with that.
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