Road to 350: What Does the US Navy Do Anyway?

[Randy Daytona]

$40T in debt and counting... I'm thinking government business and bonds aren't great places to be for long-term planning.

The Brits overcame debt at 260% of their GDP after the Napoleonic wars, but it took a century and an industrial revolution, and they still never got back to where they were before.

Some good charts in here:

US debt hits $40 trillion: Who does Washington owe and why does it matter?

Heavy borrowing, increased spending and tax cuts by Democratic and Republican administrations have long raised concern.

www.aljazeera.com

Saw another report from the CATO Institute arguing to let Social Security go broke to force the government to cut benefits by 22%. Unbelievable.

 

[Spekkio]

Wrong. Minimum wage is $7.25/hr, and has been since 2009.

Only 13 states abide by the federal min wage by statute, with an additional 7 who have lower min wage signed into law.

The raw average state minimum wage is $12 / hr and gets up to about $15 / hr if we weight by population.

 

[Spekkio]

Some good charts in here:

US debt hits $40 trillion: Who does Washington owe and why does it matter?

Heavy borrowing, increased spending and tax cuts by Democratic and Republican administrations have long raised concern.

www.aljazeera.com

Saw another report from the CATO Institute arguing to let Social Security go broke to force the government to cut benefits by 22%. Unbelievable.

SS has nothing to do with the deficit (sort of... it does account for intra governmental debt because the Treasury isn't allowed to keep excess tax receipts, so the SSA loaned the surplus... but in layman's terms this is just accounting wizardry).

The ACA is going to bankrupt the country. The CBO estimates its cost is $33 trillion over the next 10 years, eventually eclipsing over 50% of federal spending without a change in statute. And health insurance companies are laughing to the bank as they buy up providers to establish regional healthcare monopolies. That allows them to control the billing schedule and become a proverbial self licking ice cream cone of profit off of limitless government spending.

At least there are some bipartisan discussions happening to craft federal legislation to stop them from doing that.

 

[123412131]

The ACA is going to bankrupt the country. The CBO estimates its cost is $33 trillion over the next 10 years, eventually eclipsing over 50% of federal spending without a change in statute.

I don't think the ACA is the problem

 

[ChuckMK23]

SS has nothing to do with the deficit (sort of... it does account for intra governmental debt because the Treasury isn't allowed to keep excess tax receipts, so the SSA loaned the surplus... but in layman's terms this is just accounting wizardry).

The ACA is going to bankrupt the country. The CBO estimates its cost is $33 trillion over the next 10 years, eventually eclipsing over 50% of federal spending without a change in statute. And health insurance companies are laughing to the bank as they buy up providers to establish regional healthcare monopolies. That allows them to control the billing schedule and become a proverbial self licking ice cream cone of profit off of limitless government spending.

At least there are some bipartisan discussions happening to craft federal legislation to stop them from doing that.

Facts.

So, either true single-payer or... or bi-partisan legislation to force pre-service price transparency (you know exactly your bill before service is rendered) and let health care organizations compete on price and quality.

On the flip side, health care debt is a joke - its not reportable from a credit worthiness standpoint.

The uninsured/poorly insured bear the brunt of healthcare costs. I still believe insurance is s good thing - but desperately needs reforming and needs to be a required tax on young people. Oh and we need strong federal and state incentive for young people to have children.

But all this is moot as long as money = free speech.

 

[Spekkio]

View attachment 46062View attachment 46061
I don't think the ACA is the problem

SS and Medicare are separate taxes. Medicare is a net surplus (albeit small one) and SS just started operating at a deficit, which is okay until 2032 or so due to the aforementioned intra-governmental debt that the US Treasury owes the SSA.

Those IOUs run out in less than 10 years.

So any discussion about medicare and SS has little to nothing to do with the deficit, which is the fact that non-medicare / SS spending eclipses federal taxes (other than FICA) by over $1 trillion.

Morbidly, the only way we're going to substantially cut medicare costs is to tell people over 80 that we're just going to let you die. Over 60% of the costs are from the last 6 months of life. Or we can accept that it is what it is and move on.

Medicaid spending is a large part of the ACA.

Yes, healthcare is roughly 25% of GDP. We spend more government dollars on healthcare than every other industrialized nation.

 

[Spekkio]

On the flip side, health care debt is a joke - its not reportable from a credit worthiness standpoint.

The unspoken actual goal of Obamacare was to stop the ubiquitous 6-figure hospital bill that proves the old adage "if you owe someone $100, you have a problem... if you owe someone $1,000,000, they have a problem." The goal wasn't to make healthcare cheaper.

In doing so, it created a ponzi scheme that is slowly but surely resulting in healthcare conglomerates and monopolies.

The irony is they mostly operate out of blue states and exceed the economic size of entire countries, so Democrat voters will be waiting a very long time for their elected officials to bite the hand that feeds them.

The uninsured/poorly insured bear the brunt of healthcare costs.

This is no longer true. It was a rallying cry justification for the ACA in the first place. Today, fewer than 10% of Americans are without health insurance. The majority are under 30 and they normally abstain from using healthcare, which creates some unknown / not easily measured healthcare cost increase when they have health insurance later in life.

This ties heavily into abortion. Lower income single women have to suddenly emergency save for the procedure, which often takes longer than the first trimester... which then doubles to triples the price.

 

[123412131]

Medicare is a net surplus (albeit small one)

We take almost 600 billion dollars a year from other areas of the government in the form of general revenues to prop Parts B and D up because it's legally required. We haven't operated a general revenues surplus in 25 years.

 

[Spekkio]

View attachment 46067
We take almost 600 billion dollars a year from other areas of the government in the form of general revenues to prop Parts B and D up because it's legally required. We haven't operated a general revenues surplus in 25 years.

Thanks for that.

So it looks like I had been reading specifically about part A (hospital visits), which gets all the attention about solvency issues, whereas part B (doctors) and D (prescriptions) are funded by general tax dollars. I would say that while your graph helped me look into it, it also smashes together two entirely separate funding streams (HI trust fund vs SMI trust fund).

Which means that a lot of the structural issues with the ACA that drive up general healthcare costs also impact medicare patients. There are people making a LOT of money off of Medicare part B / D expenditures.

 

[exNavyOffRec]

SS and Medicare are separate taxes. Medicare is a net surplus (albeit small one) and SS just started operating at a deficit, which is okay until 2032 or so due to the aforementioned intra-governmental debt that the US Treasury owes the SSA.

Those IOUs run out in less than 10 years.

So any discussion about medicare and SS has little to nothing to do with the deficit, which is the fact that non-medicare / SS spending eclipses federal taxes (other than FICA) by over $1 trillion.

Morbidly, the only way we're going to substantially cut medicare costs is to tell people over 80 that we're just going to let you die. Over 60% of the costs are from the last 6 months of life. Or we can accept that it is what it is and move on.

Medicaid spending is a large part of the ACA.

Yes, healthcare is roughly 25% of GDP. We spend more government dollars on healthcare than every other industrialized nation.

I am generally pleased with the level of care I get, what frustrates me is the time it takes to get to the point where they can actually fix the issue.

If health insurance companies listened to doctors and stopped trying to delay needed test or medications I would venture that cost overall would go down.

My own experience, I have had back issues, mostly lower back issues for a very long time, I go to the doctor, I get x-rays and nothing is visible, the doc would like to send me to a specialist and have an MRI but before insurance will approve that I need to go to physical therapy as it "could be" a muscle issue, 4-5 months later with little improvement I am finally allowed to get an MRI which shows a nerve issue that physically therapy would never correct, finally 18 months after I see the doc a fix is done.

Second issue I have is that instead of prescribing medications that could prevent an issue from getting worse they say "nope, not unless you have had these other issues". In my case my weight climbed in part due to back, knee, shoulder issue restricting my workout, that all caused my BP and other things to go where the doc was concerned. I eventually get put on GLP-1 which reduced my weight and everything is almost normal, then my civilian insurance says no more, only prescribed if you have had heart attack, stroke or other significant medical emergency, thankfully Tricare is picking it up. I am pretty sure a shot or pill to help people avoid those bad life events would be cheaper than paying for GLP-1, not sure how much an ER hospitalization for a heart attack actually cost but I am sure it is a big amount.

 

[sevenhelmet]

This is thread-split worthy.

Our healthcare system is completely bonkers. I am not sure what I’ll do when I’m old- after watching my parents and grandparents try to navigate things, moving to another country has crossed my mind.

 

[exNavyOffRec]

This is thread-split worthy.

Our healthcare system is completely bonkers. I am not sure what I’ll do when I’m old- after watching my and grandparents try to navigate things, moving to another country has crossed my mind.

While I have issues with the way the insurance handles our healthcare, having friends who do or have lived in other countries ours is still better overall than where they have lived. I am specifically talking about places like the UK, Canada, and Sweden.

In the UK the wife of a guy I grew up with is a nurse, their system is a mess, even as a nurse it was/is a nightmare for them.

In Sweden my old coworkers daughter married a Swedish guy and they moved and still live in Sweden, when my coworkers husband was diagnosed with cancer her son in law flat out said, if he was in Sweden due to his age he would probably be waiting to get into treatment, since he was here he started treatment in less than 8 weeks.

I live close to Canada, I have many Canadian friends and they have no problems with minor medical issues, but when it comes to major ones several will come down to the US for specialized treatment or I have heard some go to Mexico, a friend's dad from several years ago moved to the US to practice medicine due to the state of the Canadian health care system and there were several others she knew as well. I also have had several candidates for roles I have hired for from Canada and one of the reasons they look at US jobs is to get healthcare in the US. CNBC did a report several years ago about the state of their healthcare in regards to specialized medicine the people they interviewed didn't have good experiences.

I have heard good things about Singapore, and my friends daughter lives in France with her husband, but I haven't asked her how she likes it.

 

[Swanee]

While I have issues with the way the insurance handles our healthcare, having friends who do or have lived in other countries ours is still better overall than where they have lived. I am specifically talking about places like the UK, Canada, and Sweden.

In the UK the wife of a guy I grew up with is a nurse, their system is a mess, even as a nurse it was/is a nightmare for them.

In Sweden my old coworkers daughter married a Swedish guy and they moved and still live in Sweden, when my coworkers husband was diagnosed with cancer her son in law flat out said, if he was in Sweden due to his age he would probably be waiting to get into treatment, since he was here he started treatment in less than 8 weeks.

I live close to Canada, I have many Canadian friends and they have no problems with minor medical issues, but when it comes to major ones several will come down to the US for specialized treatment or I have heard some go to Mexico, a friend's dad from several years ago moved to the US to practice medicine due to the state of the Canadian health care system and there were several others she knew as well. I also have had several candidates for roles I have hired for from Canada and one of the reasons they look at US jobs is to get healthcare in the US. CNBC did a report several years ago about the state of their healthcare in regards to specialized medicine the people they interviewed didn't have good experiences.

I have heard good things about Singapore, and my friends daughter lives in France with her husband, but I haven't asked her how she likes it.

I have some hockey referee buddies who have very mixed reviews for the Canadian healthcare system. One of them has a kid who has a pretty rare genetic disorder. They regularly travel to Mayo in Minnesota on the Canadian Government's healthcare dime to get the care he needs. I also know one guy who had a pretty bad on ice injury. The treatment plan took a longer time than it would here because of the availability of specialized care.

It should be noted that Yuma is a huge place for both Americans and Canadians to do healthcare tourism. They go across the border to Los Algodones for much cheaper prescription drugs, (many they can get without an Rx) medical care, and dental work.

 

[BigRed389]

While I have issues with the way the insurance handles our healthcare, having friends who do or have lived in other countries ours is still better overall than where they have lived. I am specifically talking about places like the UK, Canada, and Sweden.

In the UK the wife of a guy I grew up with is a nurse, their system is a mess, even as a nurse it was/is a nightmare for them.

In Sweden my old coworkers daughter married a Swedish guy and they moved and still live in Sweden, when my coworkers husband was diagnosed with cancer her son in law flat out said, if he was in Sweden due to his age he would probably be waiting to get into treatment, since he was here he started treatment in less than 8 weeks.

I live close to Canada, I have many Canadian friends and they have no problems with minor medical issues, but when it comes to major ones several will come down to the US for specialized treatment or I have heard some go to Mexico, a friend's dad from several years ago moved to the US to practice medicine due to the state of the Canadian health care system and there were several others she knew as well. I also have had several candidates for roles I have hired for from Canada and one of the reasons they look at US jobs is to get healthcare in the US. CNBC did a report several years ago about the state of their healthcare in regards to specialized medicine the people they interviewed didn't have good experiences.

I have heard good things about Singapore, and my friends daughter lives in France with her husband, but I haven't asked her how she likes it.

Lived in Australia for a few years.
I still think their system is far better than than ours.

Primary care lead times were a few days, so people get to issues much earlier than here.

When I saw the bills. Imaging tests like MRIs cost about a tenth what they do here. And the lead times were again, within a few days, not like a month plus which seems to be the norm I’ve heard/seen in multiple CONUS states.

Orthopedic surgery and other specialist wait times were within a week for initial consult.

They all pay for their Medicare through taxes, which is really just basic, preventative, and ER care. But most people have employer heath insurance that will pick up stuff their Medicare for all won’t like orthopedics.

 

[Spekkio]

I am generally pleased with the level of care I get, what frustrates me is the time it takes to get to the point where they can actually fix the issue.

If health insurance companies listened to doctors and stopped trying to delay needed test or medications I would venture that cost overall would go down.

My own experience, I have had back issues, mostly lower back issues for a very long time, I go to the doctor, I get x-rays and nothing is visible, the doc would like to send me to a specialist and have an MRI but before insurance will approve that I need to go to physical therapy as it "could be" a muscle issue, 4-5 months later with little improvement I am finally allowed to get an MRI which shows a nerve issue that physically therapy would never correct, finally 18 months after I see the doc a fix is done.

Second issue I have is that instead of prescribing medications that could prevent an issue from getting worse they say "nope, not unless you have had these other issues". In my case my weight climbed in part due to back, knee, shoulder issue restricting my workout, that all caused my BP and other things to go where the doc was concerned. I eventually get put on GLP-1 which reduced my weight and everything is almost normal, then my civilian insurance says no more, only prescribed if you have had heart attack, stroke or other significant medical emergency, thankfully Tricare is picking it up. I am pretty sure a shot or pill to help people avoid those bad life events would be cheaper than paying for GLP-1, not sure how much an ER hospitalization for a heart attack actually cost but I am sure it is a big amount.

Are you referring to Tricare, VA, or Medicare?

The going reputation for Medicare among providers is that although it pays less, it's the easiest insurance to deal with for approvals. The government almost never challenges claims.

Tricare is supposedly the worst of both worlds, which is why almost no one takes it. And there isn't the largest cohort of healthcare consumers on it like Medicare.

Private insurance battles are slowly going away as they buy up providers and expand to regional networks. Private practices are an endangered species. The same people are getting a cut of the procedure and insurance payout, so the more the doc runs up the bill, the richer the C-suite gets. This is removing almost all cost reduction pressure from healthcare.

If you go to an UC clinic or ER and ask for the bottom line cash price to get seen for an acute illness, they wouldn't be able to tell you. That's a huge problem. That fear among the public is driving healthcare policy.