Tag Archives: economy

I had a great uncle who practiced medicine from the turn of the century until the mid 20th century. In the last chapter of his book “Doctor Do Tell” dealing mostly with his experience delivering medical care to the people of rural Wisconsin……he warned of the evils of “socialized medicine”. Much has changed since the time he practiced….including the willingness of health care providers to be “paid in pickles”. The evils of non “socialized medicine” have become crystal and painfully clear.
The present health care system based on the idea that competition brings about the best result is a failure if for no other reason that there is and will not be true competition. Nationalized health care can minimize system costs….if design and operation remained focused on the goal of efficient, results oriented care measured by and paying for results. A single payer system that assures and pays for results oriented care (as opposed to pay per procedure) is probably the only way that a nation can bring about maximum care per dollar expended. The only logical single payer is government. If a clear goal (as mentioned above) was the standard to which any plan was held….much better product (our health care) could be brought about for all.

Except that not everyone is going to use all they did (or should have) put in. My mother will turn 99 early next year. She is in an assisted living center that costs thousands monthly, but uses just a small fraction of the services the price is meant to cover. This is good thing. Others use much, much more than they ever did (or could have) put in.

The only solution is something based on the underlying concept of insurance. Many put in
X and a fewer number take out Y. Even in countries where there is universal government provided healthcare, the concept is the same with taxes substituted for the bulk of premiums.

The problem in the US is that the insurance paradigm is private and discretionary. Not everyone has to pay in, so healthier lower cost people opt out at a disproportionately high rate. The insurance companies are profit driven, so left to their own they simply do not want to cover those who represent a higher risk.

Average life span in the US is into the 70s. That means both individuals and companies have to think very long term to justify the equation. In a system where participation is discretionary, and the actuarial pool is private and focused on making shareholders and executives happy the following quarter, the actuarial numbers will not to add up.

Human nature simply does not work well in multi-decade time frames. Only an external entity can make the health care actuarial equation work. The ACA is bending the curve, but it is a poor mishmash trying to influence an inherently unworkable model based on private insurance and discretionary participation.

It is only strange if you try to equate health care with consumer goods. Same basic problem as trying to force market principles to “control” health care costs. It is not a market or a consumer good, and should not be.

Most members of Congress may not like it, but could easily afford, good private health insurance. To really understand they should be forced to live six months or a year in the shoes of someone who either cannot afford the insurance, or can buy insurance but not possibly handle a $5000 deductible.

The sad irony is that far more than enough money is actually being spent on health care in the U.S by citizens, employers and the government to provide excellent health care for everyone. It is the ridiculous wasteful way that we collect, allocate, bill and distribute the pool of money that is the problem.

John, I can’t find fault with any of your logic. I can only speak to my circumstances. Over the past year, my rates have decreased by nearly 7% compared to 2014, but I had to move to a new carrier to get them. If I stayed with the old carrier, I was facing an 18% increase for a silver-level HMO-style plan based on wellness/.prevention. I can’t say that the ACA had any impact on moving to a gold-style PPO plan with a top flight carrier here in New England, but my $500/$1000 deductibles are down from last year’s $2,000/$4,000. We’re clearly paying significantly less than 2014. Maybe it’s New England, but competition appears to be a factor. Only 2016 will tell whether our new carrier will emulate the old carrier for exorbitant price increases.

There is innovation which comes from smaller sized organizations. Then they get absorbed by ← larger fish in the food chain. Economic set backs create the groundwork for entrepreneurial growth – starting a business in lieu of not getting a job with bigcorp or the government. it is a cycle. the proven successful small businesses get acquired by larger companies with capital and no innovation. mom and pop video stores were acquired to make Blockbuster but even these have a life cycle and big does not always mean an enconomy of scale. red box in your grocery store lobby seems to be doing just fine as a vending machine operation.
none of us lead active business lives in the historic perspective of 100’s of years. We have to make payroll or the rent this week, satisfy the customer with good qualty at a market price which is not increasing and do all of the other things required of us by the community we operate in. Small business people are heroes but because we do such a poor job of economic education in our schools their success is viewed as a lucky lottery instead of hard work.
we will be in trouble when they start saying why bother?!

The longer insterest rates remaiin at zero or below zero levels, the more difficult things will be for SMBs and middle classes. Because real zero rates are just for Big corps, banks, etc. in most of the Western world. This means they can almost print money.
On the other hand, all the rest of us are deeply indepted with them (either through credits or public bonds), and we have no other resources but our working hours to pay them, competing on a global basis to sell them.
Inequality is absolutely inevitable, and it will get much much worse beacuse politicans and central banks are into this strategy of ‘asymmetrical capitalism’.

Thanks for putting a face on the other side of the immigration issue. Our country benefited greatly economically from immigration in the past. We can benefit now while helping many people at the same time.

I wonder if we as a nation can get past the frustration of extreme political self-interest and see through the pandering on the part of some candidates.

I’m hopeful but concerned.

Good point!
While there are many perspectives that can be taken on this topic, this is certainly one with a positive side effect. – Whilst I don’t think that this is the main motivation for the German government, it could indeed prove true and benefit Germany in a few years … if they succeed on integration.

On Point. One other factor in Germany’s favor is the effectiveness with which they assimilated a less skilled East Germany population back in so efficiently and effectively. We must make education and training of the new immigrants a priority so they can help our economy grow, and not just to perform low skilled low paying jobs.

As with most European countries, meetings etiquette in Germany relies on professionalism, good business sense and formality. Bearing the above in mind, together with a positive attitude will ensure good results.

There is no question about the difficulty in the Main Street market. Another strategy besides fading into the night is to find someone to pass it on to. That likely means finding someone years in advance, nurturing them and at some point starting to share equity. Having said that, I fully recognize that many small businesses are not in a market where a successor is easy to find. While I own a small software company, it is not so easy to find someone willing to start work at 3 AM so there are fresh bagels ready by 6 AM. Thank goodness there are such folks.