Stagflation Nation

[nathanm]

Our debt rating will fall in the future regardless if we raise the ceiling or not.  Sooner or later the interest rate goes up for irresponsible borrowers.  It's an immutable fact of finance on the micro and macro levels.

It sure will if we have to keep spending through a prolonged recession and then don't do anything to resolve the long term issues even after the economy picks back up.

And something else that could be impacted by the debt limit that I hadn't thought of: The FDIC. I'm not sure what the state of their insurance fund is at the moment, but given a prolonged recession, they could very well need to borrow from the Treasury to pay claims. If Treasury doesn't have it and can't borrow it, I guess people just lose their savings?

The ironic thing is that savage cuts to the government in the midst of a stagnant economy only makes the situation worse. Now is not the time to put more people out of work. Besides, if investors were clamoring for us to do something about our borrowing in the short term, the real yield on 5 year Treasuries would be more than .01 percent. This "OMG National Debt" schtick is just a stick used by the party not holding the Presidency to beat up the party that has it.

We do need to get health care costs under control, but that's something we need to do anyway. We simply can't have a healthy economy when we spend nearly twice as much (as a percentage of GDP) on health care than any other nation and get worse outcomes. Fixing health care cost growth would solve the Medicare problem as a bonus.

[Red Arrow]

I can't tell you why the Dems voted against the ceiling in 2006...

I can.  Bush was President.

[Conan71]

It sure will if we have to keep spending through a prolonged recession and then don't do anything to resolve the long term issues even after the economy picks back up.

And something else that could be impacted by the debt limit that I hadn't thought of: The FDIC. I'm not sure what the state of their insurance fund is at the moment, but given a prolonged recession, they could very well need to borrow from the Treasury to pay claims. If Treasury doesn't have it and can't borrow it, I guess people just lose their savings?

The ironic thing is that savage cuts to the government in the midst of a stagnant economy only makes the situation worse. Now is not the time to put more people out of work. Besides, if investors were clamoring for us to do something about our borrowing in the short term, the real yield on 5 year Treasuries would be more than .01 percent. This "OMG National Debt" schtick is just a stick used by the party not holding the Presidency to beat up the party that has it.

We do need to get health care costs under control, but that's something we need to do anyway. We simply can't have a healthy economy when we spend nearly twice as much (as a percentage of GDP) on health care than any other nation and get worse outcomes. Fixing health care cost growth would solve the Medicare problem as a bonus.

Take a look at other countries which spend less on healthcare and you will find they have a much more proactive approach to their health and well-being.  Here, we beat the smile out of our bodies and poison them then spend the rest of our lives pumped up on pills and procedures to try and un-do the damage.

[nathanm]

Take a look at other countries which spend less on healthcare and you will find they have a much more proactive approach to their health and well-being.  Here, we beat the smile out of our bodies and poison them then spend the rest of our lives pumped up on pills and procedures to try and un-do the damage.

We do that because it costs a lot of money to go to the doctor for most of us, so we don't get the benefit of preventative medicine. Moreover, procedures cost more here. Med mal costs more here. Administrative costs are higher. Everything costs more, even if it's the same treatment. Plus we have much more expensive treatments that don't actually have better outcomes than the old way of doing things. It's got less to do with our obesity than you'd think. Our per capita GDP is higher than most nations, making the 13% we spend look that much worse.

If it was all down to us being in poorer health, you'd expect that we'd have more nurses and hospital beds per capita than other countries, but we're actually below the OECD average on both.

Additionally, when you look at things like smoking, there are fewer smokers (as a percentage of the population) in the US than there are in most other OECD countries (only Canada has fewer smokers). I'm getting more stats, but I probably won't have the time to digest it all for at least a couple of hours.

Edited to add: A cursory examination shows that we perform MRIs and CTs far more often than they're performed anywhere else in the world. It's stuff like that helping to drive up health care costs. One other thing that stands out is that we graduate fewer medical students than any other OECD nation except Israel (we're tied with Chile).

[Conan71]

We do that because it costs a lot of money to go to the doctor for most of us, so we don't get the benefit of preventative medicine. Moreover, procedures cost more here. Med mal costs more here. Administrative costs are higher. Everything costs more, even if it's the same treatment. Plus we have much more expensive treatments that don't actually have better outcomes than the old way of doing things. It's got less to do with our obesity than you'd think. Our per capita GDP is higher than most nations, making the 13% we spend look that much worse.

If it was all down to us being in poorer health, you'd expect that we'd have more nurses and hospital beds per capita than other countries, but we're actually below the OECD average on both.

Additionally, when you look at things like smoking, there are fewer smokers (as a percentage of the population) in the US than there are in most other OECD countries (only Canada has fewer smokers). I'm getting more stats, but I probably won't have the time to digest it all for at least a couple of hours.

Edited to add: A cursory examination shows that we perform MRIs and CTs far more often than they're performed anywhere else in the world. It's stuff like that helping to drive up health care costs. One other thing that stands out is that we graduate fewer medical students than any other OECD nation except Israel (we're tied with Chile).

Seriously, Nate, is $120 per year too much money for someone to spend once a year to make sure everything is still operating correctly?  The real problem is Americans have some sort of culturally-flawed thinking that makes them believe someone else either A) is or B) should be responsible for their health and well-being and that access to health care is some sort of Constitutional right.  It's not.

You are trying to apply ratios of things like smokers per capita, obesity per captia, and health care spending as a percent of GDP, not realizing statistical thinking like that is not relevant when you consider that smoking and obesity are the root cause of some of the most expensive medical treatments and procedures.  

Yes we do graduate fewer med students.  It's because we have demanding standards for doctors.  I really don't care to have a "D" student putting me under or cutting me open and it's not a supply and demand system which will determine what a doctor is paid if that's your implication about having fewer doctors.

You can ignore our general pathetic attitudes toward proactive healthcare all you like.  It doesn't change the fact that Americans are lazy in their daily diets, lead sedentary lifestyles, they drink too much, they smoke too much, they eat preservative-laden crap which increases the incidence of all sorts of maladies from allergies to diabetes, to heart disease & cancer.  Doctors prescribe all sorts of crazy drug cocktails to offset the negative side-effects of the primary meds someone is supposed to take which drives up the costs further and number of specialists one must see (a certain med causes CHF, great now you have a cardiologist on your team).  No other country is near as addicted to fast and mass-produced food as we are.  It's an immutable fact.  Add all these factors up and it makes an extremely strong case as to why our life expectancy is lower here in the states.  

Doctors in our country are paid what they are worth, apparently.  Med-mal attorneys will tell you they are paid what they are worth as well.  When the topic of med-mal has come up in debate here before, it's squarely shot down as being somewhere around 1-3% of total health care costs in the U.S.  

Where I do see an upward pressure on health care costs in the U.S. is the rapid decentralization of care centers into many smaller specialty hospitals which has also allowed doctors to become a part owner in their own hospital.  I do see a good need for specialties to be able to have more focused and directed care.  But, look at a city like Tulsa.  Do we really need far-flung campuses for heart, surgical, spine, bone and joint, cancer, etc. in a metro our size?  Are the major campuses bursting at the seams so much that we could not have provided more space within existing health care infrastructures?  One side-effect this has had is the rise in the number of expensive diagnostic procedures (your MRI/Cat example) required to pay for the latest state-of-the-art equipment.

It's a matter of priorities.  I had an accident when I was 20 years old and broke my hand, I was just off my mother's insurance and it required surgery.  Since I was young and invincible and "didn't need" health insurance, I had not gotten on my own program.  I paid back every single penny to EOOC, the anesthesiologist, and St. Francis.  I could have shirked my responsibility and not paid so that I could have had more money to play with dirt bikes, drink beer, buy pot, or whatever, but I realized I had a responsibility to pay for the care which was given to me.  Incidentally, an MRI would have ruled out surgery in that case, but they were not widely in use at the time and were un-Godly expensive.  Ironically when I've had MRI's since then, they have confirmed what I and my doc already knew: that I needed surgery.

There are plenty of people who could afford to pay for their care if they prioritized it, they simply don't.  No, I'm not making the broad stroke that everyone is out to game the system, however you need to open your eyes and realize there are people who have no problem dropping in on the minor emergency center or ER and skating their tab to leave others to pick up the tab in the way of increased medical costs for everyone else and their insurer.  There are also people out there who could make insurance premiums a priority which would help manage their h/c costs, yet they don't.

You seem to live in a theoretical and statistical world which doesn't take human behavior into account. I was married to a healthcare professional for five years and saw first hand through her why we do spend so damn much on health care and it's not for a lot of the reasons you suspect.  

You seem to make the assumption that all chronically or terminally ill people are in hospitals or would necessarily require an up-tick in nurses.  Read up on home health care and hospice.  Not all those people are locked away in nursing homes or hospitals nor do they have an RN seeing them every day.  

Just wait until you have a relative in a nursing home or cancer care center who can qualify for their own home health aide AND hospice care and see how quickly the nursing home or hospital administrator tries to run off either one of those additional healthcare companies.  In the waning days of your life you may well have three or four companies fighting to make money off your carcass before you finally croak.  I am not exaggerating one iota.  My ex worked for a large hospice after hospital, clinical, and private practice experience.  If Medicare or Medicaid will pay for it, there is no shortage of people ready to collect it.

[nathanm]

Seriously, Nate, is $120 per year too much money for someone to spend once a year to make sure everything is still operating correctly?  The real problem is Americans have some sort of culturally-flawed thinking that makes them believe someone else either A) is or B) should be responsible for their health and well-being and that access to health care is some sort of Constitutional right.  It's not.

You are trying to apply ratios of things like smokers per capita, obesity per captia, and health care spending as a percent of GDP, not realizing statistical thinking like that is not relevant when you consider that smoking and obesity are the root cause of some of the most expensive medical treatments and procedures.

Yeah, smoking and obesity are the cause of a lot of health problems. That's precisely my point. Other countries have much worse statistics on both fronts, yet spend less and still manage to live longer lives than we do.

There are plenty of people who could afford to pay for their care if they prioritized it, they simply don't.  No, I'm not making the broad stroke that everyone is out to game the system, however you need to open your eyes and realize there are people who have no problem dropping in on the minor emergency center or ER and skating their tab to leave others to pick up the tab in the way of increased medical costs for everyone else and their insurer.  There are also people out there who could make insurance premiums a priority which would help manage their h/c costs, yet they don't.

When we had that same problem with people shirking their responsibility in car wrecks we required that all autos be insured. I seem to remember you not being particularly fond of the individual mandate.

And what are we getting for our spend? Where is the money going such that we have fewer doctors, fewer nurses, fewer hospital beds, and so on down the line? You seem to say we have fewer because we don't need as many. Great! But if the money isn't going there, where is it going?

Lastly, who said anything about D student doctors? Seems like we could use more, though, as we have (nationally) pretty long wait times for appointments.

[we vs us]

Seriously, Nate, is $120 per year too much money for someone to spend once a year to make sure everything is still operating correctly?  The real problem is Americans have some sort of culturally-flawed thinking that makes them believe someone else either A) is or B) should be responsible for their health and well-being and that access to health care is some sort of Constitutional right.  It's not.

You are trying to apply ratios of things like smokers per capita, obesity per captia, and health care spending as a percent of GDP, not realizing statistical thinking like that is not relevant when you consider that smoking and obesity are the root cause of some of the most expensive medical treatments and procedures.  

This is what I don't understand.  How we can base policy on the emotional observation that we've somehow become more of a corrupt or flawed or simply less personally responsible people than we used to be.  Why should I trust this as part of why I support or deplore a piece of policy?  It's absolutely unmeasurable.  It's based entirely on what you, Conan, see, and not at all what I see.   It's all your opinion, and while that's valid as far as it goes (and just as valid as mine, as far is it goes), it's a bad piece of logic. 

It's reliance on conventional wisdom to legislate, and we know that as much as its right, conventional wisdom is wrong.  This is why we should look to things that are fact-based rather than opinion-based.  Ie. Nate's numbers and stats, which while dry, paint a more realistic picture. 

Not only is personal responsibility unmeasurable, it's also unlegislatable.  We can't build law around making people more responsible.  Stuff like that turns into the equivalent of Prohibition and we all know how that turned out.  It inherently limits freedom, which seems counter to what the GOP really wants.

[Gaspar]

Not only is personal responsibility unmeasurable, it's also unlegislatable.  We can't build law around making people more responsible.  Stuff like that turns into the equivalent of Prohibition and we all know how that turned out.  It inherently limits freedom, which seems counter to what the GOP really wants.

I love it when your words reveal you.  Here we see you have taken two non-divergent stances and attempted to clobber them together in an effort to make a point.

1. Personal Responsibility means freedom from law, regulation, or the guidance of of outside rule.  It is not reliant on "building laws."  People naturally become more responsible when life requires it.  As long as laws exist that restrain the need for personal responsibility, some people will not rely upon it, and over time they will feel simply entitled.

2. Prohibition is an example of the exact opposite.  It establishes that people have no ability to engage in activities that require Personal Responsibility.  It is government regulation and prohibition of an activity.  We can actually see this applied to this very subject.  In many countries laws have been adopted to make the practice of medicine outside of the socialized or insurance funded programs illegal. It is also illegal for people to seek medical care outside of the state run program.  Now most countries have relaxed these laws because just like alcohol prohibition, medical prohibition caused a thriving un-taxed black market.

[Gaspar]

VERY ON TOPIC. . .

From Hardcore Democrat Businessman Steve Wynn (in his quarterly company conference call):

I believe in Las Vegas. I think its best days are ahead of it. But I'm afraid to do anything in the current political environment in the United States. You watch television and see what's going on on this debt ceiling issue. And what I consider to be a total lack of leadership from the President and nothing's going to get fixed until the President himself steps up and wrangles both parties in Congress. But everybody is so political, so focused on holding their job for the next year that the discussion in Washington is nauseating.

And I'm saying it bluntly, that this administration is the greatest wet blanket to business, and progress and job creation in my lifetime. And I can prove it and I could spend the next 3 hours giving you examples of all of us in this market place that are frightened to death about all the new regulations, our healthcare costs escalate, regulations coming from left and right. A President that seems, that keeps using that word redistribution. Well, my customers and the companies that provide the vitality for the hospitality and restaurant industry, in the United States of America, they are frightened of this administration. And it makes you slow down and not invest your money. Everybody complains about how much money is on the side in America.

You bet and until we change the tempo and the conversation from Washington, it's not going to change. And those of us who have business opportunities and the capital to do it are going to sit in fear of the President. And a lot of people don't want to say that. They'll say, God, don't be attacking Obama. Well, this is Obama's deal and it's Obama that's responsible for this fear in America.

The guy keeps making speeches about redistribution and maybe we ought to do something to businesses that don't invest, their holding too much money. We haven't heard that kind of talk except from pure socialists. Everybody's afraid of the government and there's no need soft peddling it, it's the truth. It is the truth. And that's true of Democratic businessman and Republican businessman, and I am a Democratic businessman and I support Harry Reid. I support Democrats and Republicans. And I'm telling you that the business community in this company is frightened to death of the weird political philosophy of the President of the United States. And until he's gone, everybody's going to be sitting on their thumbs.

http://www.businessinsider.com/wynn-ceo-steve-wynn-conference-call-transcript-obama-2011-7

[we vs us]

I love it when your words reveal you.  Here we see you have taken two non-divergent stances and attempted to clobber them together in an effort to make a point.

1. Personal Responsibility means freedom from law, regulation, or the guidance of of outside rule.  It is not reliant on "building laws."  People naturally become more responsible when life requires it.  As long as laws exist that restrain the need for personal responsibility, some people will not rely upon it, and over time they will feel simply entitled.

2. Prohibition is an example of the exact opposite.  It establishes that people have no ability to engage in activities that require Personal Responsibility.  It is government regulation and prohibition of an activity.  We can actually see this applied to this very subject.  In many countries laws have been adopted to make the practice of medicine outside of the socialized or insurance funded programs illegal. It is also illegal for people to seek medical care outside of the state run program.  Now most countries have relaxed these laws because just like alcohol prohibition, medical prohibition caused a thriving un-taxed black market.

Um, yes.  That's what I said, minus all that strawman stuff about illegal healthcare yadda-yadda.  Prohibition is an example of legislating personal responsibility.  It did not work, and by and large does not work.  This is because "personal responsibility" is a nebulous term that means separate things to each person. 

This doesn't mean that we shouldn't ask for accountability for some things, both from entities and individuals that interface with the government.  We should do so for practical reasons (ie. encourage people on welfare to search for jobs in exchange for help; ask corporate America to pay a fair share of taxes for use of our infrastructure, laws, and enforcement structure), rather than to encourage people to be "personally accountable."  Accountability and responsibility are qualities that come from within.  Encouraging that is not government's job.

[nathanm]

1. Personal Responsibility means freedom from law, regulation, or the guidance of of outside rule.  It is not reliant on "building laws."  People naturally become more responsible when life requires it.  As long as laws exist that restrain the need for personal responsibility, some people will not rely upon it, and over time they will feel simply entitled.

You have a strange (and limited) definition of personal responsibility, but it's one that is very common among those on the right.

By the way, how much responsibility did we get out of the bankers when we largely deregulated the industry..oh, right. Part of personal responsibility is following the rules set forth to keep the market fair, open, and stable. It's also helping to make those rules by being informed and engaged in the political process. The Feds constantly ask for input, and often listen, yet few bother to give it. Yet, like you, they throw up their hands and declare government is the problem when rules get written based on what the corporate lobbyists who are giving their input at every opportunity desire.

The Government is just people. Nothing more, nothing less. It is all of us. Its failures are also our own failures.

[Conan71]

Yeah, smoking and obesity are the cause of a lot of health problems. That's precisely my point. Other countries have much worse statistics on both fronts, yet spend less and still manage to live longer lives than we do.
When we had that same problem with people shirking their responsibility in car wrecks we required that all autos be insured. I seem to remember you not being particularly fond of the individual mandate.

And what are we getting for our spend? Where is the money going such that we have fewer doctors, fewer nurses, fewer hospital beds, and so on down the line? You seem to say we have fewer because we don't need as many. Great! But if the money isn't going there, where is it going?

Lastly, who said anything about D student doctors? Seems like we could use more, though, as we have (nationally) pretty long wait times for appointments.

I'm sorry, which countries were those with higher obesity rates?

The U.S. sits proudly at #1 with over 30%.  Our nearest challenger for that coveted prize?  Mexico at 24.2%.  Canada sits at less than 1/2 the rate of the U.S.  It has nothing to do with their health care system either.  It sure as hell doesn't in Mexico.

Since you love graphs:


http://www.nationmaster.com/graph/hea_obe-health-obesity

Here's another which claims the U.S. sits at 74%.  The only others ahead of us, aside from Kuwait, are underdeveloped island nations.  We are most definitely the leader in obesity amongst developed nations.  FYI, the first citation is much closer in line with CDC statistics.  I have no clue where this site got their stats, but figured someone would spend the time to look up some stats which show other fatter nations.

http://www.infoplease.com/world/statistics/obesity.html

Granted, the United States does not lead the world in smoking.  However, according to a Gallup Poll 24% of Americans over 18 are smokers.  2% higher than the global median rate.

http://www.gallup.com/poll/28432/smoking-rates-around-world-how-americans-compare.aspx

According to CDC, it adds up to $96 billion per year in healthcare costs:

"Smoking costs Americans in dollars and lives
All Americans—smokers and nonsmokers—pay the price for smoking. Smoking is still the leading preventable cause of death in the United States, causing 443,000—or nearly 1 of every 5—deaths annually. These include 46,000 heart attack deaths and 3,400 lung cancer deaths among nonsmokers who are exposed to secondhand smoke.

Smoking is also a major contributor to many chronic diseases that are driving up the nation's health care costs. Each year, diseases caused by cigarette smoking result in $96 billion in health care costs, much of which is paid by taxpayers through publicly-funded health programs."

http://www.cdc.gov/Features/TobaccoControlData/

"The CDC Vital Signs report, titled "State-Specific Obesity Prevalence Among Adults – United States, 2009," points out that people who are obese incurred $1,429 per person extra in medical costs compared to people of normal weight, and that the nation's total medical costs of obesity were $147 billion in 2008.

Obesity is a contributing cause of many other health problems, including heart disease stroke, diabetes, and some types of cancer. These are some of the leading causes of death in the U.S. Obesity can cause sleep apnea and breathing problems as well as limit mobility. Obesity can also causes problems during pregnancy or make it more difficult for a woman to become pregnant.

Obesity is a complex problem that requires both personal and community action. People in all communities should be able to make healthy choices. To reverse this epidemic, we need to change our communities into places that strongly support healthy eating and active living."

http://www.cdc.gov/Features/VitalSigns/AdultObesity/

Neither report even gets into the issue of lost productivity or increased dependence on Social Security disability or other social programs.  There have been studies done in the past on the lost productivity issue due to smoking and as I recall it was around $100 billion per year.

The final two sources are CDC, but feel free to keep cobbling together your own reality.

/edited to add:

Chronic disease – The nature of health care in the U.S. has changed dramatically over the past century with longer life spans and greater prevalence of chronic illnesses. This has placed tremendous demands on the health care system, particularly an increased need for treatment of ongoing illnesses and long-term care services such as nursing homes; it is estimated that health care costs for chronic disease treatment account for over 75% of national health expenditures.

Prevention - The burden of chronic diseases, such as diabetes and cardiovascular disease, has risen dramatically; both of these chronic conditions are known to be correlated with obesity, smoking, and diet, and are very expensive to treat over long periods of time.

http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx

[Conan71]

Um, yes.  That's what I said, minus all that strawman stuff about illegal healthcare yadda-yadda.  Prohibition is an example of legislating personal responsibility.  It did not work, and by and large does not work.  This is because "personal responsibility" is a nebulous term that means separate things to each person. 

This doesn't mean that we shouldn't ask for accountability for some things, both from entities and individuals that interface with the government.  We should do so for practical reasons (ie. encourage people on welfare to search for jobs in exchange for help; ask corporate America to pay a fair share of taxes for use of our infrastructure, laws, and enforcement structure), rather than to encourage people to be "personally accountable."  Accountability and responsibility are qualities that come from within.  Encouraging that is not government's job.

It's not that difficult.  Personal responsibility is what a reasonable person does to be self-reliant and to minimize their burden on others.  That goes from taking better care of one's self to buying auto liability insurance, to not throwing a gum wrapper on the ground. 

Explain why it is incumbent on those of us who make better better choices to pick up the trash and slack from those who know better but refuse to do anything about being more responsible to themselves and others. 

It's not a matter of legislating anything, though Democrats have used the idea of taxation to modify personal behavior for years.  What do you think "sin taxes" on alcohol, tobacco, and tanning (and eventually fat or fast food) are all about?  It's their basic belief that people are too stupid or arrogant to take care of themselves so they will raise the stakes to the point people will quit a certain behavior.  In reality, it seems to hit lower income groups the worst.

Sorry, I guess I'm not wired to make excuses for people who refuse to take care of or pick up after themselves.

[nathanm]

I'm sorry, which countries were those with higher obesity rates?

I was citing per capita mortality from obesity. Sorry for the confusion. The point is that, all things considered, we don't actually lead significantly more unhealthy lifestyles than every other nation in the world, yet we do spend far more on health care than any other nation in the world.

Well, we are unhealthy in one respect: We always feel the need to place blame on ourselves, whether it is actually deserved or not.

[Conan71]

I was citing per capita mortality from obesity. Sorry for the confusion. The point is that, all things considered, we don't actually lead significantly more unhealthy lifestyles than every other nation in the world, yet we do spend far more on health care than any other nation in the world.

Well, we are unhealthy in one respect: We always feel the need to place blame on ourselves, whether it is actually deserved or not.

Funeral costs are decidedly a lot cheaper than long term care costs.