Is Government Healthcare Socialism?

This has become a standard plank of the 21st century Republican Party.    So lets look at what the GOP think the Government SHOULD fund without being called socialism:  

• The Military.
• The Police.
• The Fire Department.

The last two are particularly telling.   People generally call 911 if they want the police, the fire department, or an ambulance.  Why are the cop car and the fire engine paid for, but not the ambulance?

All of these essential government services have three things in common.   

1. When crisis happens, it is often time sensitive.   When you need these emergency services, most of the time, waiting even an hour will be a big mistake.  You don't want to delay dealing with a military invasion, a crime, or a fire.
2. They are often life threatening.  Invasions, criminals, and fires kill people.
3. They spread.  If the <sarcasm> dreaded Canadian scourge</sarcasm>  invades my neighbor's property, chances are those polite invaders will take my house next.   If my neighbor gets mugged, I could be next.  If my neighbor's house is on fire, might could be next.

These traits are pretty obvious.   They also directly impact capitalism, which is why the government pays.  The key feature of capitalism is a Free Market.  Free Markets require someone to think about something, not make a decision in a panic.  Free Markets require a free choice, not one done with a gun to your head.  Capitalism also do not work when your purchases or lack of purchases affects your neighbor.  That's not really private property, another requirement of capitalism.

 

So capitalism is ill suited in any situation that is an immediate crisis, deadly, or spreadable.  For those situations, capitalism  REQUIRES government intervention.   

 

Most of you can see where this is going.  The far majority of Healthcare falls in at least one of those three categories, if not all three.   Trauma, such as car crashes and bullets, is immediate.   The majority of health issues are potentially deadly, and infections are practically the definition of spreadable.

 

But not all healthcare qualifies.  Clearly cosmetic surgeries do not qualify for any of those three.   In addition, things like anti-anxiety treatment, impotence treatment, fertility treatment,  and unproven treatments (this is research, not healthcare).   Part of the issue is that private healthcare has taken to covering a lot of things that the government should not cover.  But there is no reason a government funded healthcare has to do the same. 

Government healthcare is not socialism, as long as it is restricted to covering: Emergencies, Life threatening issues, and infectious diseases.   

 

So why do people decry it?   Because they are not capitalists.  They are Plutocrats - people that believe in rule by the rich.   They WANT to abuse the rules of capitalism - to trick people into buying without taking the time to research, to buy when you have a gun to your head.  Most of the time an infection will be controlled and in times of plague you can issue 'emergency' orders to have the government pay for treating just that plague, rather than having your taxes give good health care for all.

 

Real capitalism has the government pay for all 911 services, including most healthcare.   Plutocrats hate real capitalism, so they lie and say government healthcare is socialism rather than capitalism.

Help Superheroes Donate Organs

There are real superheroes in this world.  Real Sacrifice, with real costs, for real lives saved.  They don't wear capes or masks, but that doesn't make them any less a super hero.

They donate organs.   Doing it after death makes you a hero, in my book.   Doing it while you are still alive?   That's better than Batman or Hawkeye, in my book.  Mostly they give kidneys, but some donate part of their liver.  

First, let's do the pitch.  We need more superheroes, so join the League of Organ Donors, sign up here.

Currently (2016), there are over 120,000 men, women and children in need of organ transplants.

Every day about 144 people are added to that list, 82 people get off the list the good way - transplant, and another 22 people get off the list the hard way - death.  Notice that means the list keeps growing longer by about 40 people a day.  That's a new development, up until recently people were more likely to die, but medicine has gotten better at keeping those with failing organs alive.

Most of these people are waiting for a kidney.


Being a superhero is not easy.   The surgery to donate a kidney is painful and will take about six-eight weeks for you to recover.  During that time you can't drive.  The organ recipient's insurance pays for all the medical stuff.  But not travel or hotel costs.   Which really aren't that much (most of the time), so it isn't that important.  Organ recipients are in a similar situation, but most are just thankful to be alive.

But how many people get TWO MONTHS time off with pay?  Most people have to take time off work. It's pretty good if you get four weeks off a year.  The businesses that employ these heroes generally give them the time off, but not with pay.

So let's give them one month of Unemployment checks during that time.

I am not proposing paying for organs.  If you are an unemployed/retired superhero, you get no money.  But if you are medically unable to work because of such a heroic act, can we do no less than to give you the same payments as he jobless and/or disabled?


These people are superheros that are saving a human life.  The least we can do is recognize that for two whole months they can not work, and that they therefore deserve at the minimum a single month's worth of unemployment checks.  Have the paperwork filled out by the transplant doctor, to limit fraud.

Full Disclosure: I am intimately connected to someone that has a failing kidney.   I am not in any way impartial. 

Capitalism, Patents and Healthcare.

I am a strong believer in capitalism who also realizes the need for government intervention in healthcare.   How can I reconcile such apparently divergent views?

The United State's of America does NOT use capitalism in it's healthcare system - and never has.  

Wikipedia list six separate characteristics of Capitalism:

1. Private Property
2. Capital Accumulation
3. Wage Labor
4. Voluntary Exchange
5. Price System
6. Competitive Market

If you don't have those features, it's not capitalism.   Socialism is famous for preventing capital accumulation via taxes and the competitive market via regulating prices.  Communism goes further, wanting to get rid of the rest, but even the Soviets at their height claimed that was an ideal utopia they aspired to, rather than something they could implement.

But Capitalism predates Communism by more than 100 years.  Lets' compare it to Mercantilism, the system we had before Capitalism.

In Mercantilism, there was Private Property, Capital Accumulation, Wage Labor and a Price System.  They did not have really have Voluntary Exchanges, nor a Competitive Market.  Specifically, they had government control of exchanges - what you could buy and sell was strictly controlled.   They were known for banning the importing of many protected goods and the export of gold.  They also were known for monopolies.   Lots and lots of monopolies created by the government, given to favored people.    Queen Elizabeth of England granted monopolies on everything from coal to wine.

In Elizabethan England, under Mercantilism, they called these monopolies "patents of monopoly".

Yes, that's right, patents are not part of Capitalism.   Patents restrict people from engaging in business, which directly prevents a competitive market. They are a hold over from Mercantilism.    If you are defend the concept of patents, you are not a pure Capitalist, you are at least partly a Mercantlist.

Why do we still have patents?   We needed a way to incentivize invention, so we took the old concept of a patent, reworked it, and now they only apply to things you invent, rather than any old thing the government wanted you to have a monopoly on.

Capitalism is a pretty strong systems.  It is more than robust enough to handle some flecks of impurity.  Patents have always been a problem for Capitalists, but it's something we can usually live with.

As long as we keep the other five characteristics of Capitalism, it works well enough.


But that brings us to Health Care.   Here, we don't just have patents on medicines, techniques, and devices.  If you don't buy necessary health care or you die.  That's involuntary, not voluntary.  No different from putting a gun to your head - or ordering people to buy this or go to jail.

Notice how hospitals don't list prices?  Name one other business where that happens.  I can't think of any.  The reason is simple:  you have to pay or you die.  It's not a voluntary exchange, and they know it, so they don't even bother to tell you the cost till after it's done.

Still, it would be mostly OK, as long as we didn't also have the patents and other restraints on free trade.   If there was open market, where you could get the stuff you need to live from multiple sources, the free market would keep the price down.  When you take away both the voluntary exchanges and the patents, there is no free market - that's Mercantilism, not Capitalism.

Which   is why the US has such a problem with Healthcare - we don't use capitalism, we use a mercantile system.  That's not something new that Obama created, it's been that way for more than a hundred years.

I'm not saying we have to get rid of patents* - and by it's very nature, we can't make health care "voluntary".  (Note, we could at least require hospitals to list prices and stick to them).   But we can recognize that system is not capitalist, and that it requires government intervention in this case, because we have already intervened to help out the suppliers (by enforcing patents, among other things).  We need to counter the aid to the suppliers by also helping out the patients.

Price limits are a totally reasonable method.   We don't want to do it directly, so we chosen let the insurance industry negotiate the prices, rather than have government legislate it.  But that means everyone has to have insurance to do the price negotiating for them.  If you don't want to let the government legislate the prices, you have to require that all people have insurance to do the negotiating for them.  Or we could simply rule that the government sets prices if you don't have insurance. 


Health care is not and never has been a free market.  That's why we need consumer protections and pro-patient regulations, on top of the many pro-business regulations such as patents.**

------
*Note 1:  I am also not saying we can't get rid of patents - a bounty system could be established by the government rewarding innovation might work.  So could a set 10% royalty systems where anyone would be allowed to sell patented objects as long as they paid a 10% royalty would also work.

**Note 2:, I do know that not all health care involves patents, but  the far majority of medical care is involuntary, rather than voluntary, and even without patents there are other issues with the competitiveness of the market (see hospital prices mentioned above, one sided information, limited providers with barriers against entry) that similar issues apply throughout the entire industry, not just patented medicine.

Soda Ban

Bloomberg committed a horrible offense against liberty.  Not because he attacked soda, but because of HOW he did it.   Which is why the Judge overturned his ridiculous law.

As I have said before, the appropriate way to deal with activities the government wants to discourage ids to TAX it, not outlaw it.  Just like we do with cigarettes.   Specifically we can tax large containers of soda versus small ones (just like Bloomberg only planned on banning large containers).

There was no reason whatsoever to ban it.  It was, as the judge said, capricious.   It did not actually prevent you fro drinking more soda, it just made it less convenient.   Or, as my friends say "a dick move'.

It was done without regard to reason, without regard to freedom, and without regard to others.


At heart, his 'inconvenience' technique is a poor attempt at mind control.   I am not against attempts at mind control, but I am against POOR attempts at mind control.   If the government wants to brainwash me, they have to put forth some effort! 

Taxes are a much better method of behavior modification than portion control.

1. The reason the stores like to sell the big portions rather than small is the minimum transaction cost (you pay the same rent and server salary whether they sell 10 ounces or 30 ounces, but you can charge more for 30 ounces).  So they just switch to "2 for 1" and sell two 16 ounce cups - maybe even glued together), negating your ban with no gain whatsoever.  Taxes however lower sales.
2. Even if the taxes fail to lower sales, it gives the government money, which it desperately needs. 
3. Bans anger people more than taxes.  We live with taxes, they make us mutter, not sue.
4. Taxes can easily be set to auto adjust for inflation.  Ban's don't adjust for anything.

Why didn't Bloomberg tax it away?   Mainly because he is wealthy and therefore did not consider a tax as effective.  He knows how to get around it, and can easily afford the tax.  Also, the GOP is anti-tax, and while Bloomberg is not a Republican, he is affected by partisan politics. 

The judge made the right decision to overthrow Bloomberg's capricious law.  Maybe now Bloomberg will get off his dictatorial butt and realize he should just tax large Soda containers as opposed to banning them..

Hospital Bills

Inflated Hospital bills are in the news recently.  Time magazine did an informative article about them.


They talk about things like charging $13,702 for something that retails for about $4000. (A wholesale price would probably be around $3,000 to $3,500)

They have something called a Chargemaster that lists all the prices - but do not let you see them.  That's like being given a menu with no prices until you see the bill.

Also note that most people don't pay these prices.   Insurance companies negotiate their prices based on Medicare charges, not the Chargemaster prices.   As in they have contracts that read "All charges will be 50% higher than the Medicare prices", rather than all charges will be 5% of the Chargemaster prices.

The only people paying these numbers are the uninsured, the under-insured and insurance companies for emergency visits to hospitals they don't have a deal with.  Note that if you are uninsured or under-insured, you can hire someone to negotiate with the hospital - even after your services are rendered.  They typically cut the bill at least in half.

Why don't they start with that half price?  Apparently they like to overcharge the sick whenever they can get away with it.  This is wrong.  They should not charge the ignorant that much more money.


To my mind, the real problem is not the amount of money, but instead the billing procedures that abuse patients, particularly the ignorant.

What do I mean by this?  Well, the hospitals charge outrageous amounts for the things they charge because so many of their services are losses.  That is, they offer free emergency service to the homeless. that will never get paid.  There are tons and tons of services like that.

My problem is not the total bill, but instead the billing method.  When you bill things incorrectly, you encourage waste and limit the ability to save money.

Lets say for example you were running a printer company.  You choose to give away your printers at cost, charge ten times normal for the ink, and supply free (i.e. at a loss) paper to your customers.

Guess what?  The customers will waste the paper, and do silly things like set the ink to print at 50% darkness.

When the politicians come in, they start passing laws that force you to off ink conserving modes, and to stop you from abusing the system you get blindsided by a law requiring you to continue to provide free paper, and suddenly you are covered with stupid bullshit regulations.


Here are the proposals I would make to fix the situation.

1. Right to Know.  The Chargemaster (computer program that lists all the things you charge for) must be publicly available to EVERYONE.  No hiding your prices. Put it on the Web. 
2. Right to Compare. The must also list the amount they charge to Medicare next to the price they charge you.  (The Medicare prices are in effect reasonable, as they are negotiated, rather than set)
3. Optional negotiation. The Hospital can ignore all the rules below, if they offer (and the patient accepts) to charge everything at a stated multiple of Medicare rates, when you enter the hospital  I.E.  ignore the Chargemaster and pay 1.5 or maybe 2 times  Medicare.
4. Right to Bring Your Own. Customers are allowed at any time to bring their own products in.  That is, if you are stupid enough to charge $13,000 for a drug that retails for $4,000, the customer can pay an express delivery guy to pick it up at a pharmacy down the street and deliver it to you and they must use it.  Yes it might not be of the same quality, but it's your body, your choice.  This includes food, as long as it conforms to the dietary limits your doctors set.
5. Right to Replace. If for some reason the hospital must charge you for something immediately (as there is no time for you to get it), then you can instead choose to replacement in an unopened condition - as long as you give back at least as one more than you used.  That is, if they want to charge you $25 for 19 aspirins, you can go to the store and get a package of 20 aspirins for $15 and deliver it to them. 
6. Right to Buy.  If they charge you more than 10% of the cost to them to buy something, they must give you that item when you leave. I.E.  No charging you $1.5 (let alone $40) to 'lease' a $15 warming blanket, then keeping the blanked and using it on someone else.
7. Right to Pick your Tester.  The hospital must use any third party testing service you pay for (and any third party test analysis - i.e. they don't just overcharge to do the cat scan, they then overcharge to have a radiologist look at it.)   That is, if the Hospital charges you $7,000 for a blood test, you can pay $200 to have your blood rushed, in a refrigerated container across town to a private lab that will do the test for $500.
8. Right to Pick your Provider.  If you object to the service prices the hospital charges, the Hospital by law must allow you to pay for a private nurse and/or Doctor that you negotiate payment  for in advance, to provide all the regular services for.   That is no "He doesn't have privileges here."  You can bring in ANYONE you want to provide the services.  Or they can offer you a more reasonable price.
9. Right to Shop Around. Anytime a customer uses one of the rights I list above, the hospital must a reasonable attempt to get the name and contact information of their provider/supplier and put their name on a list of 'alternative medical providers' available for all Hospital patients. 
10. Hospitals right not to be sued.   The Hospital can require anyone using these rights you to sign a notice stating that the Hospital is not responsible for the quality of care you get from these outside service/product providers.

Most of these proposals stand alone (Although 1 and 2 go together, 9 requires the use of 7 or 8, and #10 only works if you exercise 4, 8, or 9.)

Note, I do not expect many people to actually exercise these rights.  Instead I suspect that the hospital will suddenly reduce their prices to something a little more reasonable.

More importantly, note that I do NOT implement any kind  of price controls.   At no point do I attempt to force the Hospital to lower their prices.  I just make it a lot harder for them to charge you something without telling you the price before hand - or to stop you from comparison shopping.

Finally, I don't actually expect most people's total Hospital bills to change.   Most people do it through insurance, so this won't affect the Hospital's profit margin all that much  (as per the Time article I referenced above, insurance typically pays 35% of the Chargemaster prices).   I do expect that the Hospital bill for the room to go up a bit, as that you can't 'outsource'.

The anti-crime political party

There is a new study out claiming that lead levels are responsible for crime.  They compare lead levels with crime rates 23 years later (i.e. after the criminals grew up eating, drinking and breathing the lead), and found a high correlation.


It is well known that lead lowers IQ, damaging learning and memory, as well as causes brain, kidney and cardiovascular damage.  Now, some think it encourages violent actions as well.


I myself feel that crime is more likely to be related to legalized abortion, as unwanted children get a bad upraising and that leads to crime.   Among other things, I think China would have had a higher crime rate as they are a late comer to anti-lead laws, while they have family planning under strict government control..


But assuming that the studies are at least partly correct and lead plays a significant role in crime, then the Democrats just took back the pro-law and order crown.

Much of our anti-lead laws were enacted during Nixon's presidency- both the Clean Air Act and the Lead Based Paint prevention act.  But they were pushed by Democrats, particularly Senator Edmund Muskie, who ran as VP against Nixon.  He was one of the first environmentalists in the senate.

Then in 1990,,the Clean Air Act was amended (by Democrats), and again in 2008, under Obama, the EPA finally tightened lead rules.

If this study is true than the Democratic Party is and always has been the real anti-crime party.

How to fix Medicare and Medicaid.

Medicare and Medicaid are in serious trouble.  Shortly their costs will skyrocket above their assets and income from the taxes designed to pay for them.  There are three distinct ways we can deal with this situation.

1. Tax the general population to pay for the elderly health care and/or healthcare for the poor.
2. Have Medicare/Medicaid not pay for certain extremely expensive treatments.
3. Focus medical research on finding cheaper ways to treat/cure illness, as opposed to finding new ways to treat/cure diseases that we do not currently have effective treatments

First, those are the not the only possible ways to cure the problem.  We could theoretically grow the economy to a huge extent, giving jobs for all and offering huge salaries so retired people choose to go back to work, moving them to private insurance.   Or if you prefer a nightmare as opposed to a fantasy, we could be swept by disease, famine, or war, which would kill significant numbers of the poor and elderly.  But for obvious reasons, I am going to ignore these possible 'solutions'.   Enough fantasy and nightmares, lets move back to the real world.

Lets' start out by saying that we already do all three of these things and that in all likely-hood the solution will continue to be a combination of all three.

Now let's talk about which of these three reasonable situations we should focus on.

Well, we have a large national debt, so option 1 is not the best idea. Note, if we do nothing at all, it automatically gets used (as there is no law preventing the government from using general taxes to fund those health care programs) so it would probably be a better idea to work on the other options.

Option # 2 is slightly better - have medicare/medicaid not pay for certain extremely expensive treatments.    Right away, someone is going to shout 'rationing'.  Nope.  Rationing is some group decides who gets a treatment and who doesn't.   If insurance doesn't pay for anyone to get that treatment, it's simply called an uncovered treatment.  Or, if you are Ayn Rand, CAPITALISM.   There are a lot of uncovered treatments.

This is not a liberal/democrat plan, it is a conservative/republican plan.  When you privatize insurance without regulations, that is exactly what happens.  It does so in a rather irregular manner, but it happens. As I said earlier, it is the heart of capitalism: if you want the procedure, you can pay for it - either by getting better insurance/supplemental insurance, or by paying for it out of pocket.

• For example, you medicare and medicaid don't pay for crystal therapy to cure brain cancer.  Why?  Because the medical community doesn't think it works. (They are correct.)
  
• It also doesn't pay for 'experimental treatments', such as face transplants.  Many people think these do work, but we don't really have enough evidence.
• But insurance also does not pay for certain things simply because they are too expensive for the benefit.  In Spain, you pay tens of thousands of dollars to get electrical implants that paralyze the nerves that cause migraines.   But Medicare and Medicaid don't offer that treatment because migraines aren't worth it.

Limiting coverage is not evil, as long as it is done based on the cost, not on the person.  If for example we choose to cover penis cancer, but not breast cancer even though penis cancer is more expensive, that's an ethical problem.   The best way to do this is to do it explicitly - have an outright cost/benefit analysis done, with what I call a "soft limit".  That is, things that are low cost, high benefit automatically get paid at full cost.  Things at or near the edge get a set payment and the user must make up the difference, while things significantly above the cost/benefit line gets no payments.

This "soft limit" method means that we pay some money even for things that are questionable, but not excessive.  Trust me when you need the treatment, you will be glad for that money, particularly if you don't have to complain to get it.

This brings us to the the best option, #3.   It requires some massive changes in our research an development.  Right now there are huge incentives to come up with more expensive treatments or cures, not cheaper ones. The only 'cheaper' option we have is generic drugs.  We don't need new expensive and slightly better treatments.   We need to change the focus of our research.


We could for example change the laws as follows:

1. Offer only a 10 year patent protection for treatments or diagnostic methods unless they fall into the 'cheaper' categories below.
2. Offer a 20 year patent protection for treatments /diagnostic methods that are at least half the cost of current methods.  If we don't have any treatment/diagnostic method yet, then the comparison cost is infinite.
3. Offer a 20 year patent protection for cures - assuming the cure costs less than 10% of the estimated current treatment for the life of the patient. 
4. Offer a 30 year patent protection for cures that are at least half the cost of the current method/treatment - but the price can not rise above that for the duration of the patent (or the patent vanishes).

 That system could theoretically radically change the focus of future research away from expensive methodologies and towards cheaper diagnostics,  treatments and cures.

Oh and there is one more thing we can do to cut costs without affecting service:  Eliminate medical mistakes.  Currently, medical mistakes are a leading cause of death - killing more people that Aids.  (Source) The current system evolved as a response to law suits, so it focuses on hiding what really happened.  We need to fix that system.

I suggest the following:   By law require all hospitals to offer 'Open Surgery'.  If the patient chooses 'Open Surgery', then they give up all right to sue for anything more than medical costs caused by the surgery, or $300,000 for death.  Put in a requirement that the doctor must be fully certified, sober,  and broke no laws (or the legal limits vanish).  In exchange, they get a full video record of the surgery, and a copy goes to the AMA, which would be instructed to create new surgical procedures based on what they find.   We still would need to find some way to discover and prevent non-surgical errors.


Finally, remember that we are probably going to have to do a mix of all three of these fixes.  One alone won't solve the problem.  But a combination of limited general tax support, reasonable limits on what we pay for and cheaper medical procedures can solve the problem.  

Senator (D) Claire McCaskill vs. Rep. (R) Todd Akin

Claire McCaskill is an incredible woman from Missouri.  She is one of the few female senators, and she presides over a republican state.  She is up for re-election in 2012, you can contribute to her campaign here.
I have talked a bit about her before.

Running against her is Todd Akin, a republican Congressman.

He said, and I quote:

"First of all, from what I understand from doctors [pregnancy from rape] is really rare.  If it's a legitimate rape, the female body has ways to try to shut that whole thing down."  On the Jaco Report, August 19th, 2012.  He left out the words in the bracket, but that's what he was talking about.

Note, even after that statement, he is polling at one point greater than Claire McCaskill.  She needs your support (see link above.)

For those of you that don't know, in an ironic way, he is right about one thing.  If a woman gets raped, then her brain cells can trigger, causing her legs to get up and walk to the nearest Planned Parenthood, where she can request an abortion.

But that's the ONLY way to that her body can 'try to shut that whole thing down'.

I'm not even going to try and touch that 'legitimate rape' comment.

But let's not talk about what he said anymore.  Let's talk about two other things.

1. Lots of us believe things that aren't true.  But most of us know when we are stating things that other people don't believe.   I don't bring up my feelings about ethical vegetarianism, because I know it's a bit radical.  What possessed this ...conservative... to state something so wildly out there?  Is he really stupid enough to not understand how it will lose him votes?  I could see being stupid enough to think that, but to state it out loud? Note the rest of the GOP knew how bad it was, they told him to quit the race.
2. The GOP thinks this is the best republican from Missouri, to take down a democratic senator in a thoroughly republican state.  By god, I weep for Missouri, if this is the best they have. 

I just talked about being wrong yesterday.  About how your opponents aren't always ignorant, stupid or evil.  But here is a reminder that sometimes they are.   I have to state here and now that Todd Akins is not evil.  He is just incredibly ignorant and stupid.   He honestly believed that there were legitimate and illegitimate rapes.


Just so you remember, that (R) they put after Todd Akin's name doesn't stand for Republican, they want him to quit.  What does it stand for?  I'll give you a hint - the next letter after the 'r' is an 'a'.

The Rebirth of America

Forbes has a fantastic article about  the rebirth of American industry.

To summarize:

China has cheap labor.
America has robots.
Robots are cheaper than the cheapest labor.

We are talking about 3D printing, laser cutting, CNC machines (computerized numerical controls), etc.  You program the machine and it builds what you want.

The article doesn't go into China's other advantage:  A willingness to accept a CRAPLOAD of pollution.   For example, they put in limits on fire retardants only in 2009.   Formaldehyde is almost everywhere - as it used for construction and the fabrication of furniture.  Note, they are getting better, but I think they will always accept more pollution than we do.  They value their economy more than their workers.

But I don't think any American is going to be upset about giving the high pollution jobs to China.  I just wish we could export our coal burning.

So, what is America going to look like in 20 years?  Well, I expect we will have some more manufacturing, but the jobs will still be service jobs - installing robots, maintaining them, fixing them, programming them and running them..


Unfortunately, this is not the entire story.  China has been expanding it's trade with other countries, and creating solid relationships and investments outside of China.  This may turn China into a financial powerhouse, capable of competing with the US.  It can't right now.  Yeah, people are scared of China, but the US still beats China on industrial output, as of 2010, even though it had 1/3 the population.  Throw in the Service industry - which includes installing, maintaining, servicing, and programming robots - and we handily beat them.

One more bit about the Obama healthcare ruling

I've heard some people (source) complain that the Obama care individual mandate 'tax' is not a tax because it is " punitive, regulatory, and intended to compel."

Apparently these idiots don't know what a tax is.   Again, I repeat, as per the US constitution (source) there four types of tax like payments government can require:

1. taxes
2. duties
3. excises
4. imposts

So, what are the differences?  (source)

A "Tax" is to specifically raise income.  It is not punitive, regulatory or intended to compel

A "Duty" is placed on things you import or export. Any international traveler knows what a 'Duty free shop' is.   For example sugar has a duty on it.  It is there specifically to prevent people from importanting sugar.  It protects American sugar manufactures.  In other words, it is a kind of tax that is PUNITIVE,  REGULATORY AND INTENDED TO COMPEL.

An "Excise" is "taxes on the manufacture, sale, or consumption of goods, or upon licenses to pursue certain occupations, or upon corporate privileges".  Note the word license to pursue certain occupations or privileges.  In other words, it is REGULATORY.

Imposts are everything else.  Including the individual mandate.  They can be punativie, regulatory and intended to compel.

Part of the problem is that people are combining the word 'tax' to include duties, excises and imposts.   Technically they are different things.  The rules that apply to an income tax do not apply to duties, excsies and impost taxes.

The fact that some people don't know about duties, excises and impost taxes are just examples of ignorance.

READ THE CONSTITION.   Otherwise you are just an idiot talking out of your hat.


P.S.  Obama said it isn't a tax earlier.  As I stated here, technically he is correct, it is a an impost, not officially a tax.

SCOTUS proves it's above politics

As I have said before, as conservative Justices go, John G. Roberts is fairly good.   He joined the liberals and kept the Individual Mandate as constitutionally legal.
 
Kennedy fell for a rather foolish argument, but Roberts came through with liberty and justice for all.

He followed the same reasoning I did - if the Government can tax you - and exempt people from a tax if they buy things, then it can fine you for failing to buy something.   They are effectively the same thing, and the Supreme Court agrees.

What does this mean for the future of US healthcare?

Well, with enough Democrats in the Senate to block a House law, Obamacare will not change.  While it is just barely within the range of possibility that Obama will not be re-elected, it is extremely unlikely that we will also lose so many Democrats in the Senate that we won't be able to block Health care revocation.

In addition, the court said that the Federal government's powers to limit Medicare spending is restricted - no threatening to take away the funding for certain things.  But that was a relatively minor move.

More importantly,  Medicare will likely have changes initiated by the GOP anyway.  It is getting very costly and unsustainable.  Someone's going to have to do something soon, and the GOP has refused to accept any Democrat led ideas for a long time.  

If they can come up with something reasonable, it will pass.

Driving Faster Reduces Accidents, Right?

Say there are fifty people in a study.   Some of them insist that driving faster is safer - as it lets them avoid other drivers.  They go at various speeds between 55 and 65 mph.  Others insist slower is faster as it gives them more reaction time.  They drive between 25 and 40 mph.

So they start driving.  Over the years, they repeatedly show that the slower drivers are right - they have less accidents.

The guys with the ninth highest accident rate realizes they have a problem.   They think it over, and realize they are doing something wrong.  They have to make a change.  So they insist that the solution must of course be to drive at 90 mph - faster than anyone else is driving.

This is the hallmark of stupidity.  Refusing to admit that your core principle is wrong, that people doing the opposite have better results.  

I am of course talking about Tennessee.  They are tied as the 9th worst teen age pregnancy state, in large part because they have a full blown case of "Abstinence Only" sex education.  (source)

So what do they do to fix it?  They pass a "no gateway sex education law'.  You see, they look at the records and realize something.  Many of the 'abstinent kids' with relationships give hand jobs and oral sex to stay abstinent.   Tennessee, instead of realizing that this release is the only way kids can put up with the incredibly moronic and stupid sex ed policy, thinks it encourages the kids to eventually break abstience.

So the 'no gateway sex ed' law makes it illegal (and allows parents to sue school teachers or organizations for it) to promote gateway sexual activity.  They left gateway sex vague - it could be hugging or holding hands claims some lawyers. (news about passing the bill, Bill summary).  Please note that the law specifically negates the 'health message' exception that people sometimes use.  So no, you can't use that excuse to explain that condoms works better than abstinence - because the human sex drive is stronger than abstinence promises but not stronger than condoms.

They think by doing even more of a clearly failed program it will finally work. It won't.

In business, they call this moronic plan to fix an issue "We'll make it up in volume".   No. You can't make it up with volume if your are losing money on each sale.  It didn't work for Karl Marx, and it won't work for Tennessee.  (Karl Marx admitted that the fewer owners an economy had, the worse the worker's life, but claimed that going all the way to 0 would instantly reverse the clear trend of getting worse and actually be better for workers.  He was wrong.  Going to 0 owners from 1 continues to make things worse the same way going from 2 to 1 did.)  More of something that doesn't work never solves the problem.

I will hereby bet anyone that posts here that that Tennessee will NOT go down beneath 15 in teen age pregnancy ranking  as long as this bill is legal.   I will bet up to $1000.  First come, first serve.  Why do I give them the chance of going as high as 15th?  Because some other states might get worse.

Patent Infringement

Patent infringement is a major problem in the US.  Part of the problem is that the electronic tech world and the biotech world have very different needs, yet both have strong lobby's.

Biotech needs very strong patents because their products take a huge amount of work and testing to discover and prove safe.  It is very difficult to find/create new medical treatments, making the invention process expensive.   Then, implementing it, you need expensive quality control checks.   The extensive testing makes sure that only working ideas get patented - otherwise you are forbidden from producing goods.

Software however is very different.  Here it is very easy to come with ideas, taking almost no effort, and quality control is practically nothing.  People can create it in a day, then patent the idea, and little or no testing - or searching for prior art is done.   Because it moves so fast, people can honestly not even be aware of prior art.

These two industries differ in many other ways, but they have a large amount of control over changes in the patent law, because they have very different needs.

But there are a couple of ways we can help the problems of patent law.

1. Outlaw Non-Disclosure agreements for patent lawsuits.  (NDAs)There are people that engage in patent trolling.  They sue for large amounts then settle for small ones.   Mainly because a patent lawsuit can cost millions of dollars to defend, but sometimes because they are guilty.   It is always the bad guy that wins by having a non-disclosure agreement.  ALWAYS.   If you win a large amount of money because the slime bag violated a real patent, then he wants to keep it secret to maintain his reputation.    If you are a patent troll who settles for tiny amounts of money, you want to keep it secret to help you get more money from your next victim.   NDA's are pretty much only wanted by the bad guys in Patent Lawsuits and should be outlawed.  Yes, this might make certain patent suits harder to settle.  But it could kill lawsuits before the courts get involved - if no patent lawsuit was filed yet, you could still get an NDA>  This would save people a lot of money on lawyers.
2. We need to treat different patents differently.   Design patents last 14 years, while general patents last 20.  No reason we can't further expand the system.  For example, a healthcare cure is the most desirable thing, but treatments that don't cure are WAY more profitable.  Grant real cures longer patents, say 30 years, while restricting treatment cures to just 10 patent years.  The software industry moves very fast and costs practically nothing to ramp up from selling one product to selling worldwide 7 billion copies in less than a month.  So reduce the duration to only 7 years.  On the other side, we could offer a special "Main Business Patent", in which a company can declare a single patent that is central their business to be the Main Active Business Patent.  This one patent and only that patent could be extended to 25 year.   Only a top level corporate entity or person could hold such a patent.  I.E.  no creating five subsidiaries and having each own 5 Main patents. 
3. Patent cases are overturned on appeal far more often than other cases.   We need patent only judges.  Patent cases involve much higher expertise on both the nature of the technology and patent law itself.   (Source)

Please note that these three ideas are generally patent neutral.  They don't help either side completely, instead giving a little bit to each of the opposing sides..

How to deal with the "pre-existing conditions' problem

If the SCOTUS removes the insurance mandate, they are very likely to eliminate the Guaranteed Issue.

Guaranteed Issue means people can't decide to refuse to cover you for a pre-existing condition - or (almost as bad) - to cover you EXCEPT for the pre-existing condition.

Currently, in the US, all health insurance sold in the small group market (usually employers of 2-50 employees) is already guaranteed issue.

I suggest a simple rule:

Give Guaranteed Issue  to anyone that has never been without insurance for a period of 2 months or less, starting at the time this rule goes into effect.

That in effect means you can't deny coverage for someone or even for a particular health issue as long as they have continuously held insurance from the law passage.  I threw in a grace period of 1 month to make sure that simple screw ups don't kill someone's insurance.

It also means that every single American will have Guaranteed issue for a period of 2 months.

Yes, it will put a strain on insurance corporations for a short time as they are forced to cover sick people, but it will also give a huge intake of healthy people getting insurance right away to make sure that they will always be eligible for coverage.

Healthcare and the Court

As we speak, the Supreme Court of the United States(SCOTUS) is reviewing the healthcare law.

They have already indicated they consider it a 'penalty', not a tax, using the argument that most people are expected to get healthcare, avoiding the penalty, so it is not an attempt to raise revenue, but an attempt to punish people.  Not set in stone yet, but the tenor of their questions indicate that is a strong possibility.

Next up is the 'legality of regulating inaction vs action'.

The government already regulates inaction.   The federal government used to arrest you for failing to register for the draft.  The states arrest you for not wearing clothing.  The states mandate vaccinations for children - before they enroll in public or private school.  As they also have laws forcing you attend school - with some minor exceptions such as home schooling.  That is a regulation against inaction, forcing you to act, with some exceptions.

The healthcare laws also have some exceptions - it doesn't force you to buy insurance if you are unemployed, for example.

Using that precedent, if the states can regulate inaction, then so can the federal government.  The question then become is health care the territory of the Federal as opposed to state, and honestly that is not challenged (hard to challenge it considering Medicare and Medicaid).


People try to act like healthcare is special - that because it applies to everyone, the government can't regulate inaction.  They claim that the scope of the action changes the rules. 

But that is irrelevant.  The question is not whether the government can force everyone to do something, even if they don't engage in commercial action.  No.  Wrong.   That is TWO questions falsely combined into one, to make it LOOK right.  Scope does not change previously established rules.  If the government can do it to one person, they can do it to ALL people.  There is no rule in the constitution that says the government can do x but only to a small number of people.

The first question is can the government force you to act and second, is the law within the scope of Constitution's mandated federal powers.   The answer to both of those separate questions is yes, as proven by previous precedent.

I fully expect SCOTUS to validate the mandate.

This should negate the sever-ability issue (whether the rest of the act can stand if the mandate falls).

Finally, there is the 'coercion' issue - can the Federal government coerce the states to abide by new Medicaid rules by threatening to take away the Federal money they already get.

This is a long standing precedent for this action.   The national 55 speed limit laws came (and went) because the federal government tied highway money to it.  Similar issues relate to driver licenses rules the federal government wants.

This type of coercion is exactly what the government does.  Nothing illegal here.

How much would getting rid of welfare COST us?

One of the major problems that conservatives make is the belief that doing nothing is free.  It isn't.  Often it is the most expensive thing to do. 

If you don't pay for a fire department, then your house can burn down.  Yes, on an individual basis, it doesn't always make sense to pay for a fire department.  For example if you lose your main job and are working overtime at the 7-11 to barely afford your mortgage, then it makes more sense to forgo the fire department.  You might not be able to pay for both the mortgage and the fire department, and the mortgage is more important. Note, there are really town where you can choose not to pay for fire department service.  Not many because...

But to society as a whole, it makes far more sense to fund the fire department.    While individuals may be willing to take the risk, with enough individuals, it ceases to become a risk and becomes a guarantee.  Worse, fires spread.  Same for the police and for ambulance care.  Which is why most governments fold these things into general taxes, not charge separately.
 
So not paying for things does in fact cost you.  Lets assume you get rid of all welfare.  How much would it cost you?

Well, as per Philip Mangano (via Politifact), George Bush's homelessness policy czar, each homeless person cost more than $35,000 a year, depending on location.  Homeless people in a warm, rural area cost loss.  In colder, cities, a lot more.  In some places, as much as $150,000 a year.   Keep in mind that these numbers are over 5 years old, they may have gone up.  Why so expensive?  Well, I don't know if you ever met a homeless guy, but some of them are not model citizens.   They get arrested, they get sick, the get addicted to alcohol.  They invade libraries who have to hire extra security to handle them.   Quite a few of them are just plain CRAZY.  So our police, ambulances, medical services, and fire departments spend a crap load of money to deal with them.  In fact, in some areas, most of what the police do is deal with the homeless.  Ask any small town cop, his duties usually involve a couple very poor troublemakers, plus kids being kids. 

Unless of course you give them housing.   You see, as per Mangano, it costs less than $25,000 a year to give them a home with minimal services.   That $25,000 a year is for the expensive, colder cities.   It's cheaper in a warmer rural climate.  I'm not talking a mansion, just a place to hang their hat - with power, water, maybe a security guard with a phone, etc.  They have a place to stay out of trouble, they have less exposure to the elements, life is a bit better (so less reason to get hooked on drugs) and less exposure to criminals, such as drug pushers.

Not to mention that it is easier to hire a single security guard for the housing area than to hire extra cops AND to hire security for all the libraries, hospitals, etc.

Paying for minimal care for the homeless is a lot cheaper than letting them roam free.  And it's not just the homeless.

Same goes for healthcare for young, employable people.  Better to give them healthcare (say insulin for example - it's one of the growing expenses) letting them keep working (as opposed to losing toes, fingers, legs etc.)

Why Insurance (of any kind) should pay for birth control

 This is not about religion o the government.  It is about why healthcare should pay for birth control.

Health insurance is not a magic pool of money - any money you get out must first come in.   If birth control costs say $30/month, then if everyone buys it through insurance, it raises the cost of insurance by say $32 - after all their are administration costs and and the insurance company needs a profit.

So, why do it through health insurance as opposed to paying for it ourselves?  It clearly costs more

Well, first of all, not everyone buys birth control but everyone benefits from it.   When we do it through insurance, it doesn't raise the women's health care cost by $32, it raises both men and women's healthcare by $16.   This is fair because the men benefit as much as the women do.   For every woman that has an unwanted child, their is a man with an unwanted child as well.

But that's not all.  If the birth control is condoms, we not only control birth but we limit the spread of deadly, incurable, EXPENSIVE diseases.   Condoms are clearly healthcare - and as anyone concerned about an epidemic would consider it worthwhile for all to use birth control.  Birth control pills have similar, though not as strong or obvious, health effects.

Also, if it is covered by insurance than that encourages people to actually use it - as they have already paid for it.  It stops idiots from having unprotected sex because of short term money issues.  Anything that stops idiots from having unprotected sex is a good idea.  We have enough idiots, we don't need them making more.

Moreover, as China has clearly demonstrated, it is in the interest of United States to limit birth.   While China is a autocratic country that uses evil methods to limit births, that does not mean a democratic country can't use legal insurance rules to encourage people to limit births.

That is, it is in the states' interest to reduce birth in the USA .   Our population is growing and excessive population growth can cause problems (just as Japan is having an issue with insufficient population growth)

As such, it is reasonable to charge everyone to control births, even if they don't want to do it.  Requiring insurance companies to offer it is a kind of indirect tax on consumers that don't want birth control.   It makes them pay for those that do.   Which is currently in the United States's national interest.

Note, if we ever have Japan's problem of insufficient births, it would then make sense to prevent insurance companies from covering birth control, and perhaps to even tax it.

Santorum's Defense vs Entitelement Spending

Recently, my favorite Second-Place (in both the primary and the general) candidate (Rick Santorum) gave two interesting statements:

1)  "When I was born, less than 10 percent of the federal budget was entitlement spending. It's now 60 percent of the budget."
 

2) "When I was born, defense spending was 60 percent of the budget.  It's now 17 percent.  (Defense source)

First of all, most of the numbers he quoted were too low.  Some in his favor, but the 1958 entitlement number is significantly not in his favor.  As per Politifact.com, he was very wrong about the entitlement % in 1958, it was 25.4% not 10%.  (Entitlement Source) 

Second, he said 'entitlement' that includes pensions for every government employee - including pensions for generals.  But that is a small portion of the entitlement plan.

Thirdly, the real point is that most of what Santorum called "entitlement" is composed of Social Security.  Social Security, despite the lies put out by the GOP, is still solvent, and with minor changes (either what I want: increase the tax to apply to all income, not just the first 106k  OR [not both] increasing retirement age by just two years,will be solvent for the foreseeable future.)  But he appears to want to cut it.

The next two big "Entitelement" programs are Medicare and Medicaid.   Now Medicare and Medicaid are in trouble, we need a better way to pay for them and/or to hold the line on costs.  They are about 24% total, split pretty much down the middle at 12% each.

But let's take a look at entitlements, excluding Social Security, Medicare, and Medicare.

Well, Social Security is about 20% of the total Federal budget and Medicare and Medicaid are each another 12%  (as per Wikipedia, so hopefully it's accurate - but the government itself has confirmed that both together are 24%) (Source).

So lets compare 1958 without social security (Santorum's birth year) to 2011 without the big three (social security, medicaid, and medicare.

When he was born, the budget was 56.8% defense, 25.4%  Entitlement.
Currently, the budget is 19.6% defense, 65.1% Entitlement, (including 20% social security, 12% medicaid, 12% medicare, plus 21.1% for other entitlements), plus another 15.3% for stuff besides defense and entitlements.

Ignoring the big three, Defense becomes 24.5%, Entitlements become 26.4%
Using the those numbers, entitlements have risen 1%, while defense has dropped about 22%.  Entitlements up 1%  not a big deal if you ask me.   The defense drop is mainly do to getting out of Vietnam and no longer doing a cold war. 

So, Santorum is complaining about Social Security, Medicare and Medicaid.   For some reason, I don't think he is going to win any friends cutting Social Security and Medicare.  He is probably smart enough know this.

So that brings us to Medicaid.  Wow, a Republican complaining about spending money on healthcare for the poor.  Sound familiar?

The costs for Medicaid (and Medicare) have risen in line with other health care costs.  The problem is not and never has been government waste.  Instead it is the simple fact that we are developing new and expensive ways to provide healthcare.

Why is it expensive?

1)  In recent years, we have been finding a lot of treatments, not that many cures.  Partly because treatments pay a steady stream for the patients life, but cures are a one shot deal.

2)  Medicine continues to be a human intensive business.  Automation is not used or trusted.  We can't (or won't) automate surgery, examination (diagnosis - think House) or nurse work. 

3)  Pharmaceutical companies pay huge amounts of money to research new drugs - then demand huge amounts of money for their use, giving the research expenses as an excuse/reason.  

Putting limits on the pharmaceutical would be difficult in a free market economic system.    But we can try to automate medicine some.  Nursing is almost as much of the problem as doctors, except instead of one person getting paid 6 figures, we have 10 people getting paid 5 figures.  Both deserve their pay, but we need to find a way to limit our need for them.

More importantly, we let research companies get away with treatment instead of cure.  I propose a simple rule - if you create an expensive treatment, your patent protection is half as long as currently.  Leave the patent for cures as is.  We want the companies to work more on cures than on treatments and they are already too expensive.

Defining Success.

In private industry it is easy to tell if you are successful or not.  If you make money - and don't go to jail - you are successful.  If you go to jail and/or fail to make a profit, you are not successful.

In government, their is not one measure, but several.   This is part of what makes government so complicated.

Here are a list of the three major possible goals (That is these are the ways some people MAY judge it, not necessarily why they created it or how they should be judged):

• Purpose: Achieve the stated purpose - such as defend the United States
• Money: Under budget and/or cheaply
• Partisan: Push the administration's world view

Now, sometimes there are obviously failures - when money is spent and zero change is done.  These are incredibly rare.  However, that CLAIM gets made an awful lot - usually by listing huge amounts of money and and cutting short the time frame.

It's sort of like saying "We have allocated $1,000,000 per child and it's been 8 months and we do't even have a child yet."

Yeah, it takes 9 months to give birth and the $1,000,000 you allocated is over 25 years, including everything you are going to pay including Medical School tuition.

Here is a list of general spending categories, including the post office.  In no particular order:

1. Social Security
2. Healthcare (Medicare/Medicaid)
3. Military
4. Agriculture
5. Education
6. Anti-Terrorism
7. Housing
8. Crime
9. Science
10. Environmental Protection
11. US Post Office.

Let's go over these things:

#1: Social Security is a huge success in achieving it's stated purpose.   Budget wise the GOP tries to call it a failure, but honestly that is debatable.  Slight changes (such as eliminating the cap on SS taxes) can handle that issue.   Old people like it, and it successfully keeps the older generation in favor of the Democrats.   From the Democrat's point of view, Social Security is hugely successful in all three measures.  Overall success = 9/10

#2.  Healthcare Medicare and Medicaid are generally liked by the people that use it.  They do their stated purpose.  Veterans health care is not as well liked, but generally accepted.   Money wise they are OVER budget and not cheap - except when compared to private insurance which is much more expensive.   Partisan wise again, the Democrats get a big push from it.   From the Democrats' point of view government healthcare is moderately successful, but the GOP tries to claim it is a big failure. But everytime the GOP tries to change Medicare, they get laughed at.   Obamacare has not yet kicked in yet, so we can't really judge it.   On the other hand, if our old healthcare did everything we wanted, we never would have made Obamacare.   Overall, 7/10

#3.  The US is the undisputed military leader of the world.  But we did lose Vietnam war and we may not have made Iraq any better.  We also spend a crap load more than anyone else and it took us a decade to kill Osama Bin Laden.  Partisan wise, it is a big GOP stronghold.   While the GOP likes to push our military as successful, honestly, our record here is mixed.  The recent cuts that will almost certainly be support the view that we spend too much, just like in healthcare.  At best, it is a 8/10.

#4.  The US is the breadbasket of the world. The programs work.  They also cost a lot of money - often spent paying people not to grow  things.  Partisan wise, no one wants to truly support it.  Rate it a 6/10.


#5 Education.  We routinely badmouth our education system.  But honestly we let the states fund them.  More importantly, our higher education is still the best in the world.   Partisan wise, it is a punching bag.   Give it a 5/10

#6.  Anti-Terrorism.  Not many attacks get through.  But the TSA overspends a huge amount.   Partisan wise it is a huge success - the GOP loves to use it as a weapon.  7/10

#7.   Housing is a failure.  We spend a ton of money and get crap for it.  Moreover it is a punching bag.   At best it gets a 2/10

#8.  Our legal and justice system is remarkably good.   Yes, we arrest 1% of our population, but at the same time we give people many rights.  While it can be expensive to participate in it, the government costs are not unreasonable - except when we pay to keep minor drug offenders in jail.  Aside from the fact that we don't always pay enough for defense - or force legal abusers to pay court courts, it does well.  Partisan wise, it's a huge success.  People love to claim to be law and order politicians.  I rate it an 8/10

#9.  We don't overpay for science.   The amount we pay for Nasa, the National Science Foundation, etc. is trivial.   We get a lot for that little bit of money.  The few problems tend to be dramatic (Challenger disaster), but are a necessary part of discovery.  But partisan wise, often people ignore the science.   Call it an 8 out of 10.

#10.  The EPA is notoriously short changed on cash.  They don't cost a lot.  But they also have a reputation for letting people get away with stuff - particularly because of Bush's 8 years of "no enforcement".   Partisan wise, it is useful to the Democrats and even the GOP doesn't want to eliminate it.  A solid 7/10.

#11.  The post office does a great job for a cheap amount of money.  Their current monetary problems are entirely due to Congress forcing them to be more conservative in their pension budgeting than any business has to be.   They don't really have a partisan function.  A solid 9/10

To me,t he surprising part is first of all how MANY government programs come out looking good.   Only Housing is a real failure (2) - although Education is not that great (5)> 


Even if you add Agriculture (6) as a 'failure', that is a 70% success rate.   Honestly, while the EPA, anti-terrorism and health-care could do better, but so could a lot of businesses.  

Start up businesses have a failure rate of 50%. 

In other words, government does a better job than most businesses does.

Health care savings account

It's that time of year again.  When millions of Americans get un-needed health care - and spend our own money on it.

Me?  I got the following, "extra care":

1. An extra doctor appointment.  Sure, I could have waited two more months for my yearly check up, but I got it early.
2. I pre-ordered some medication that I still have two months of left.
3. I bought a first aid kit
4. I bought new reading glasses
5. I am going to buy sun glasses.  Expensive ones.

Why do we do this?  Because the law encourages us.   My employer offers what is known as a "Flexible Spending Account."(FSA)   Flexible Spending Account is like a "Health Savings Account" (HSA) or a  "Health Reimbursement Account" (HRA), but unlike them you can't roll over the money.  If I don't use it this year, is forfeited to the government. Does the government end up with a lot of cash?  No. Instead we all rush out to spend it now - and decrease how much we save next year.

So at the end of the year I, like millions of other Americans, rush to spend whatever is left.

Is this money a total waste?  No.  But if we want to decrease how much we spend on healthcare each year, this is an easy cut.

Why doesn't my employer use an HSA or an HRA?


The HSA is only available if your health care counts as a "High Deductible Health Plan" - a deductible of at least $1,200 for a single person, 2,400 for a family.  The HRA is entirely funded by the business.  They pay the money, not you.    It is pretty much only used by small businesses - and then often used in place of good health care plans.

Companies with bad healthcare plans offer the HSA - and keep costs down.  Companies with good healthcare plans offer the FSA - and drive up our yearly health care costs.  HRA's are pretty rare in larger corporations.

But the end result is that anyone with an FSA is likely to waste money.  I paid extra for speedy shipping of medication - in part because I knew I would have extra money and decided why take the risk of missing a day or two of medication.   Normally I would have said the missed day or two would not matter.   I can probably make do with old, cheap sunglasses, but why not get a new, expensive pair?

After all it is MY money - I just have to spend it on healthcare this year.

You want to reform Healthcare?   Change the rules for the FSA to make it like the HSA and HRA.  Let any extra money rollover to the next year.

If that was the case, then I would probably spend about $267 less on healthcare this year.  If 5% of the US population did that, it would be $4 billion dollars.

Reform FSA accounts - let people rollover the money.  This will decrease our yearly health care costs without decreasing the quality of care.  Or you could simply let people pay the taxes they did not pay earlier in the year and get the money back.

The point of these accounts is simple - to encourage people to save for and spend money on healthcare.  Letting them rollover the money encourages them to save more money.  You don't have to worry or think about putting too much in.  Yes, the next year you may reduce your monthly contribution, but so what, you still are 'saving' for healthcare as the money you rolled over counts.