marcus phoenix Wrote: ------------------------------------------------------- > > Not at all, I was advocating for the use of > foreign healthcare entities in conjunction with > local providers, meant primarily for those who > cannot afford the more expensive treatments > locally or do not have sufficient health coverage. > Add to that foreign (in developing countries) > assisted living centers/ retirement communities > which will give the elderly more discretionary > income since they wont be spending all their ss/ > retirement money on prescription medication and > food. I really dont see any other viable > alternative to bring down the high healthcare > costs, its better than making drastic cuts, > forcing the doctors to abandon patients and > leaving these people on the streets to die. > Getting rid of expensive lawsuits is one, but I > wonder how far that will go. While the older > doctors are willing to treat patients for free, I > wonder how willing some of the younger doctors of > today will be to do the same, despite the > hippocratic oath. Perhaps I misunderstand your plan. Your posts suggest to me that you want to ship 76 million boomers (the less affluent ones anyway) to Asia, South American and Africa and then enact legislation that allows the health and long-term care providers in those contries to receive Medicare and Medicaid payments. Is that not correct?
higgmond Wrote: ------------------------------------------------------- > marcus phoenix Wrote: > -------------------------------------------------- > ----- > > > > Not at all, I was advocating for the use of > > foreign healthcare entities in conjunction with > > local providers, meant primarily for those who > > cannot afford the more expensive treatments > > locally or do not have sufficient health > coverage. > > Add to that foreign (in developing countries) > > assisted living centers/ retirement communities > > which will give the elderly more discretionary > > income since they wont be spending all their > ss/ > > retirement money on prescription medication and > > food. I really dont see any other viable > > alternative to bring down the high healthcare > > costs, its better than making drastic cuts, > > forcing the doctors to abandon patients and > > leaving these people on the streets to die. > > Getting rid of expensive lawsuits is one, but I > > wonder how far that will go. While the older > > doctors are willing to treat patients for free, > I > > wonder how willing some of the younger doctors > of > > today will be to do the same, despite the > > hippocratic oath. > > Perhaps I misunderstand your plan. Your posts > suggest to me that you want to ship 76 million > boomers (the less affluent ones anyway) to Asia, > South American and Africa and then enact > legislation that allows the health and long-term > care providers in those contries to receive > Medicare and Medicaid payments. Is that not > correct? No, not forcibly ship anyone. It can be incentivized/ marketed in some manner to make it an attractive proposition. It will require a more attitudinal change more than anything else on part of the elderly.
Maybe instead of Asia, caribbean hospitals?
marcus phoenix Wrote: ------------------------------------------------------- > > No, not forcibly ship anyone. It can be > incentivized/ marketed in some manner to make it > an attractive proposition. It will require a more > attitudinal change more than anything else on part > of the elderly. Ok, let’s assume that tens of millions of retired boomers decide they want to move to Asia, South America and Africa. What happens to the healthcare and long-term care facilities here that we’ve been building over the last 10 years in anticipation of serving the needs of the boomers? What happens to the employees of those facilities? What happens to the ecomomies of the Carolinas, Florida and Arizona when current retirees die and no one is moving there to take their place? Who will have jurisdiction over possible Medicare/caid fraud when it involves overseas providers?
higgmond Wrote: ------------------------------------------------------- > marcus phoenix Wrote: > -------------------------------------------------- > ----- > > > > No, not forcibly ship anyone. It can be > > incentivized/ marketed in some manner to make > it > > an attractive proposition. It will require a > more > > attitudinal change more than anything else on > part > > of the elderly. > > > Ok, let’s assume that tens of millions of retired > boomers decide they want to move to Asia, South > America and Africa. What happens to the > healthcare and long-term care facilities here that > we’ve been building over the last 10 years in > anticipation of serving the needs of the boomers? > What happens to the employees of those facilities? > What happens to the ecomomies of the Carolinas, > Florida and Arizona when current retirees die and > no one is moving there to take their place? Who > will have jurisdiction over possible Medicare/caid > fraud when it involves overseas providers? Well there is an opportunity costs for everything. Do you suggest status quo?
marcus phoenix Wrote: ------------------------------------------------------- > > > Well there is an opportunity costs for everything. > Do you suggest status quo? How about actually fixing the healthcare system here?
higgmond Wrote: ------------------------------------------------------- > marcus phoenix Wrote: > -------------------------------------------------- > ----- > > > > > > Well there is an opportunity costs for > everything. > > Do you suggest status quo? > > > How about actually fixing the healthcare system > here? Well how do you propose reducing the skyrocketing costs?
marcus phoenix Wrote: ------------------------------------------------------- > > Well how do you propose reducing the skyrocketing > costs? For starters: Legal reform - patients in the US have far too many expensive, redundant tests performed because providers are afraid to get sued. Stop subsidizing the world’s pharmaceutical supply - pharma companies charge less in just about every other country in the world because they know they can just raise the price here to make up the difference. CMS and private insurers should refuse to pay a penny more than what a drug sells for in the EU. Make consumers more responsible for their healthcare decisions - running to the ER because your nose is running should cost more than a $20 - $50 co-pay. Crackdown on billing fraud - I realize this is harder said than done, but CMS alone pays out tens of billions per year in fraudulent claims. Stop diagnosing every kid in the country with ADD and ADHD - it’s amazing what a swift kick in the a$$ can cure for free. Granted, there are some honestly sick kids who need help, but just because a kid acts up in class and gets bad grades doesn’t mean he needs years of Ritalin and psychologists.
marcus phoenix Wrote: ------------------------------------------------------- > higgmond Wrote: > -------------------------------------------------- > ----- > > marcus phoenix Wrote: > > > -------------------------------------------------- > > > ----- > > > > > > > > > Well there is an opportunity costs for > > everything. > > > Do you suggest status quo? > > > > > > How about actually fixing the healthcare system > > here? > > Well how do you propose reducing the skyrocketing > costs? Allow more doctors to be certified, remember their supply is artificially curtailed.
Dwight Wrote: ------------------------------------------------------- > Sweep the Leg Wrote: > -------------------------------------------------- > ----- > > If memory serves, I believe the60% number is > the > > amount of debt held by the public. It’s goes > up > > to 100% once you account for the debt held by > the > > government. Which, unless they plan to forgive > > themselves the debt repayments, you have to > count. > > So go with 100%. > > > You can look at it several ways. As of 2010 US > net debt held by the public is about 70% while > gross debt including debt owed to itself is near > 90%. The CIA Factbook breaks it down correctly I > believe. > > https://www.cia.gov/library/publications/the-world > -factbook/geos/us.html > > > Where people are off-base is when they say: “the > US has spent all my social security money!” and at > the same time “the US has 90% debt/GDP!”. Only > one of these statements can be true in the same > context. If the US has 90% debt/GDP then they > have set aside cash specifically for Social > Security. If they have spent all of the Social > Security money then it has 70% debt/GDP. You > can’t have it both ways. > > > That’s a simplified explanation but accurate I > believe. @Dwight Not so sure that your statement is accurate. 20% or so which is intergovernmental does not include social security/medicare or medicaid. In reality, currently the US debt to GDP if you include the GSE’s, is in excess of 100%. The unfunded liabilities i.e social security, medicare and medicaid have a PV according to the CBO of about $40 trilion based on payments through 2084. Majority is medicare and medicaid. Still, as an American you are correct in saying that the government has spent your SS money. You are currently making those payments by borrowing. You do not have the $40 trillion set aside to fund these liabilities.
C3Po Wrote: ------------------------------------------------------- > @Dwight > > Not so sure that your statement is accurate. 20% > or so which is intergovernmental does not include > social security/medicare or medicaid. In reality, > currently the US debt to GDP if you include the > GSE’s, is in excess of 100%. The unfunded > liabilities i.e social security, medicare and > medicaid have a PV according to the CBO of about > $40 trilion based on payments through 2084. > Majority is medicare and medicaid. Still, as an > American you are correct in saying that the > government has spent your SS money. You are > currently making those payments by borrowing. You > do not have the $40 trillion set aside to fund > these liabilities. That’s why I said it was a “simplified explanation” so as to avoid going into the details. 
GSEs have assets too - you can’t just count the debt against the US. The unfunded liabilities are based on unrealistic projections. 10 years ago Greenspan and company were worried about “surpluses as far as the eye can see”. In the 90’s I remember everyone was terrified the world population was going to explode - China even implemented the 1 child policy. Now we have sub-replacement level births in many countries. The projections are for political purposes and not to be taken seriously. When is the last time you successfully predicted something 72 years in the future? That’s when 2084 is. Future administrations will determine future resource distributions - not the current administration which is just grandstanding for their egos and their constituents. Below is the note on net vs gross debt for the US from the CIA factbook. It corroborates my claims above. Public debt: 58.9% of GDP (2010 est.) note: data cover only what the United States Treasury denotes as “Debt Held by the Public,” which includes all debt instruments issued by the Treasury that are owned by non-US Government entities; the data include Treasury debt held by foreign entities; the data exclude debt issued by individual US states, as well as intra-governmental debt; intra-governmental debt consists of Treasury borrowings from surpluses in the trusts for Federal Social Security, Federal Employees, Hospital Insurance (Medicare and Medicaid), Disability and Unemployment, and several other smaller trusts; if data for intra-government debt were added, “Gross Debt” would increase by about 30% of GDP. https://www.cia.gov/library/publications/the-world-factbook/geos/us.html
Dwight Wrote: ------------------------------------------------------- > C3Po Wrote: > -------------------------------------------------- > ----- > > @Dwight > > > > Not so sure that your statement is accurate. > 20% > > or so which is intergovernmental does not > include > > social security/medicare or medicaid. In > reality, > > currently the US debt to GDP if you include the > > GSE’s, is in excess of 100%. The unfunded > > liabilities i.e social security, medicare and > > medicaid have a PV according to the CBO of > about > > $40 trilion based on payments through 2084. > > Majority is medicare and medicaid. Still, as an > > American you are correct in saying that the > > government has spent your SS money. You are > > currently making those payments by borrowing. > You > > do not have the $40 trillion set aside to fund > > these liabilities. > > > That’s why I said it was a “simplified > explanation” so as to avoid going into the > details. > > GSEs have assets too - you can’t just count the > debt against the US. > > The unfunded liabilities are based on unrealistic > projections. 10 years ago Greenspan and company > were worried about “surpluses as far as the eye > can see”. In the 90’s I remember everyone was > terrified the world population was going to > explode - China even implemented the 1 child > policy. Now we have sub-replacement level births > in many countries. The projections are for > political purposes and not to be taken seriously. > > > When is the last time you successfully predicted > something 72 years in the future? That’s when > 2084 is. Future administrations will determine > future resource distributions - not the current > administration which is just grandstanding for > their egos and their constituents. > > Below is the note on net vs gross debt for the US > from the CIA factbook. It corroborates my claims > above. > > > Public debt: > 58.9% of GDP (2010 est.) > note: data cover only what the United States > Treasury denotes as “Debt Held by the Public,” > which includes all debt instruments issued by the > Treasury that are owned by non-US Government > entities; the data include Treasury debt held by > foreign entities; the data exclude debt issued by > individual US states, as well as > intra-governmental debt; intra-governmental debt > consists of Treasury borrowings from surpluses in > the trusts for Federal Social Security, Federal > Employees, Hospital Insurance (Medicare and > Medicaid), Disability and Unemployment, and > several other smaller trusts; if data for > intra-government debt were added, “Gross Debt” > would increase by about 30% of GDP. > > https://www.cia.gov/library/publications/the-world > -factbook/geos/us.html @ dwight. Perhaps I did not explain myself properly. I have no problems with you claim about the level of debt. I added the GSe’s as their obligations are backed by the full faith of the Gov. As far as their assets are concerned, I do not think that anyone can accurately say what they are worth like the rest of the financials. WRT, the unfunded liabilities it was only to give the big picture. You are probably right. Non one can predict what can happen 2 years from now forget 75 years. Would you allow for a 70% error in the calculations. Even then it would mean an additional 12trilllion in shortfall. Look all I getting at is our debt to GDP is in excess of 100%
^ It’s not unless you think the gov’t has set aside assets for social security. If the government has “spent” the money already then debt is ~70% of GDP. Or the government has 100% debt/GDP and has spent the social security money. Semantics I agree but it is a point worth making since people believe contradictory things. I understand your points as well but think there is a lot of misinformation out there concerning this. People get bogged down with what will happen in 10 years when we can only predict 3-5 years out if even that. We would all be much better off if we stuck to what we can do given what we have. So sure entitlements need reform if you think health care costs will grow at double digit growth into perpetuity (impossible by the way), but nothing the current administration does will constrain the future one. That’s my point.
Dwight Wrote: ------------------------------------------------------- > ^ It’s not unless you think the gov’t has set > aside assets for social security. If the > government has “spent” the money already then debt > is ~70% of GDP. Or the government has 100% > debt/GDP and has spent the social security money. > Semantics I agree but it is a point worth making > since people believe contradictory things. I mis-worded this. Only point there is that saying debt/gdp of 100% and bankrupt social security is double counting the same liability.
Dwight Wrote: ------------------------------------------------------- > Dwight Wrote: > -------------------------------------------------- > ----- > > ^ It’s not unless you think the gov’t has set > > aside assets for social security. If the > > government has “spent” the money already then > debt > > is ~70% of GDP. Or the government has 100% > > debt/GDP and has spent the social security > money. > > Semantics I agree but it is a point worth > making > > since people believe contradictory things. > > I mis-worded this. Only point there is that > saying debt/gdp of 100% and bankrupt social > security is double counting the same liability. Yes. Agreed.
Why is debt/GDP the standard measure of sovereign indebtedness when debt/tax revenue is the more important ratio and makes more sense? Your GDP is irrelevant unless you’re getting revenue from it.
I’ve been wondering this too. I think the reason is historical. It had been assumed for many years that sovereign countries can set the tax rate to whatever they choose (not actually true, but those were 1960s economists making the assumptions, and they can be pretty wacky), so that GDP reflected the maximum possible revenue that can be used to pay principal and interest. In reality, the revenue is pretty important. Higher revenues can lower GDP through tax wedges, crowding out, etc… Revenues that are too low can also be a huge problem, because a country’s solvency risk is levered by 1/(revenue as % GDP). This makes the Tea Party’s obsession with the deficit a little more understandable. The higher the debt, the more progressively difficult it is to cut taxes.
Debt/GDP and Debt/Tax Revenue are both pretty meaningless measures, particularly when applied to fiat currencies like the US where there is no theoretical financing limit (though there are practical ones). For example take Greece. They say “our debt to GDP at 130% is too high, we need to raise taxes to pay it back”. So they raise taxes and what happened? Debt to GDP went to 160% because the economy contracted. Self-defeating. So some people say “well Greece should have not ran up their debt to 130% in the first place, then they would have had room to spend”. However Spain is in that position with only 60% debt/GDP and it does not help them. In fact they ran budget surpluses prior to the crisis. Ireland was in a similar situation. Their debts and deficits are rising along with the rest and their interest rates were skyrocketing last week until the ECB stepped in. Austerity does not work when everyone tries to do it at the same time. For Spain/Greece to pay back their debt the Germans need to spend more, which they do not care to do as the German culture was heavily influenced by the Weimar hyperinflation in the early 1920s and people are scared right now in general. It reminds me of a giant Monopoly game where a few people have accumulated all of the properties but they don’t want the other basically bankrupt players to quit because that is the source of their rental income. So they keep giving them bridge loans to keep them in the game rather than letting them have the opportunity to pay it back.
There’s another issue though, If your tax take is 15%, and your Debt/GDP ratio is 90%, then a 1% increase in your interest rate translates to a 0.90/0.15 = 6x or 6% increase in your interest payments as a proportion of your revenue. If debt goes to 150% of GDP, a 1% increase in the interest rate turns into a 10% increase in your interest rates as a proprtion of your revenue. Yes, you can run the printing presses, and I’ve more or less advocated versions of doing that, but the more extreme the Debt/GDP ratio is the more damaging it will be to do this in terms of the “and what comes next” issues. This also highlights a problem with cutting taxes too low, particularly if you are financing stuff with deficit increases. You become more and more sensitive to interest rate changes as you do it.
bchadwick Wrote: ------------------------------------------------------- > There’s another issue though, If your tax take is > 15%, and your Debt/GDP ratio is 90%, then a 1% > increase in your interest rate translates to a > 0.90/0.15 = 6x or 6% increase in your interest > payments as a proportion of your revenue. > > If debt goes to 150% of GDP, a 1% increase in the > interest rate turns into a 10% increase in your > interest rates as a proprtion of your revenue. > > Yes, you can run the printing presses, and I’ve > more or less advocated versions of doing that, but > the more extreme the Debt/GDP ratio is the more > damaging it will be to do this in terms of the > “and what comes next” issues. > > This also highlights a problem with cutting taxes > too low, particularly if you are financing stuff > with deficit increases. You become more and more > sensitive to interest rate changes as you do it. Ahhhh but for a fiat currency interest rates go down as debt/GDP goes up. Not the other way around. Fiscal deficit spending creates more deposits in the private sector. Those deposits naturally tend to seek out yield. This drives down interest rates unless the central bank decides to issue more bonds to soak up the liquidity. Then it becomes a central bank decision on where interest rates should be - but expansionary monetary policy is to keep rates low. Japan is a good modern day example of this phenomenon. The US is making a stab at going down the liquidity trap path too, though the bubble here was not as large and the policy response has been faster and more effective.