2016 Postmortem
Related: About this forumAn interesting parallel between single payer and free trade agreements.
So suppose that by some miracle we get single payer. What happens then is that the private health insurance industry disappears, and the 500,000 people who work in it are out of a job. Sure, some will be rehired doing the same job for the government, but most won't, and even for the lucky few, this is going to be disruptive to their lives, and most likely will get paid less.
Of course, this will make the system more efficient (in theory), and is often brought up as a benefit by SP supporters: the people now pushing around papers for the private insurers will be able to put their talents towards work that is actually socially productive. Fair enough.
Now let's think about NAFTA. The pessimistic estimates are that NAFTA cost about 1 million jobs. Whether or not that's accurate, surely a significant number of people lost their jobs. Of course, NAFTA proponents will say that this makes the system more efficient, that those people are freed up to use their talents towards more socially productive work, rather than manufacturing things that can be made more efficiently in Mexico.
The parallel is pretty strong. With NAFTA, some people lose their jobs, but consumers get cheaper goods. With single payer, some people also lose their jobs, but consumers get cheaper healthcare.
The odd thing is, almost all single payer proponents are also opponents of NAFTA and free trade in general (e.g. Bernie Sanders). We hear over and over about the people who lost their jobs to NAFTA, but the same people don't seem to care at all about the people who would lose their jobs to SP for the sake of economic efficiency and lower consumer prices.
Why is this? Why is it bad to lose manufacturing jobs but not bad to lose jobs in healthcare administration? Or, conversely, why is it good when healthcare administrators are free to do more socially productive things, but not when manufacturers are free to do more socially productive things?
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leftofcool
(19,460 posts)Human101948
(3,457 posts)Why should we worry about those paper pushing jobs. We are so smart we can invent more productive jobs.
Seriously, you are worried about paper pushers? How do people survive in single payer systems in other countries without a huge number of paper pushers?
DanTex
(20,709 posts)Aren't we smart enough to invent more productive jobs for them also? If we can get our stuff cheaper from Mexico or China, why should we pay more to have them made here?
Human101948
(3,457 posts)Paper pushing is paper pushing. No net benefit.
http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/
https://www.washingtonpost.com/news/to-your-health/wp/2014/06/16/once-again-u-s-has-most-expensive-least-effective-health-care-system-in-survey/
DanTex
(20,709 posts)bureaucratic work. The questions are, how many manufacturers/administrators do we need, and what jobs should they be doing.
Sure, manufacturers produce things, but if the same things could be produced at a fraction of the cost somewhere else, that's obviously an inefficiency. In the same way that having too many paper pushers in the insurance industry is an inefficiency.
Human101948
(3,457 posts)Alas, that is not the case.
http://www.latimes.com/business/hiltzik/la-fi-mh-the-us-healthcare-system-20140617-column.html
http://www.theatlantic.com/health/archive/2014/06/us-healthcare-most-expensive-and-worst-performing/372828/
http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/
https://www.washingtonpost.com/news/to-your-health/wp/2014/06/16/once-again-u-s-has-most-expensive-least-effective-health-care-system-in-survey/
Your plea for the poor paper pushers is touching but not very convincing.
DanTex
(20,709 posts)(i.e. office workers) do productive work.
Manufacturing things in the US that can be made more cheaply overseas is also not efficient.
Human101948
(3,457 posts)because it is made with low, low wage workers in Malaysia who work in a sweatshop factory?
No, they do not do productive work. It is a system that is set up to slow down the healthcare system and extract inflated profits for insurance companies. (Though you could say it is productive for the top execs and stockholders, but I prefer a more expansive definition of productive.)
They would be productive if they were working to make our healthcare more efficient than all those awful "socialist" healthcare systems that are more efficient in terms of expenditures and health outcomes. However, they fail miserably.
DanTex
(20,709 posts)I'm just saying there's a parallel. Jobs lost for the sake of efficiency. It's strange that some people are extremely in favor of this when it comes to healthcare, and extremely against this when it comes to free trade.
Human101948
(3,457 posts)If we have to sacrifice them I certainly don't care. And if you speak to folks who work in those jobs they know they are doing useless, soul draining work.
DanTex
(20,709 posts)And I'm pretty sure that the people who work their care just as much about their jobs than people who work in manufacturing.
In both cases, things could be restructured to provide the same goods and services more efficiently. But that doesn't mean that the people doing things now are useless.
Human101948
(3,457 posts)You don't seem to have any backing for your assertions. Are you in the business?
Admiral Loinpresser
(3,859 posts)Chan790
(20,176 posts)(Bear with me until the end, there is a point to this.)
It basically goes like this. A shoemaker, that is, a cobbler, works in the only shoe making shop in all of Holland where he makes shoes. One day, the man that owns the shop buys a machine that makes shoes more efficiently than any cobbler could. So the cobbler prays for a miracle that will save his job...and he receives the shoe gnome. All day long the shoe gnome sits stony on a shelf. Every night after the owner leaves late at night, long after the cobbler is gone for the day, the shoe gnome comes to life and beats the ever-living shit out of the shoes made by the highly-efficient machine. It doesn't destroy the shoes because that would be counter-productive, no it merely damages them severely which impairs the net-productivity of the machine. This makes the cobbler a more valuable employee and a more highly paid one as he not only is getting paid to make shoes now but to repair the shoes made by the efficient machine and damaged by the shoe gnome. Likewise, this actually also benefits the owner enough that he really doesn't seek an explanation or care why it is happening; he is able to cite costs and scarcity as reasonable grounds that he simply must raise the price of shoes and he has no competition so the market must bear the price he will charge. So he charges substantially more than his increases in costs. If he was raising the price of shoes without a reasonable ground, he would face buyer revolt...but he has a working excuse. So, the only people suffering economic costs of the dastardly task of the shoe gnome are the consumers. They cannot live without shoes for people without shoes in Holland easily catch sickness; shoes offer the only modest hedge-protection against sickness and death. The owner continues to raise the price of shoes citing increasing expenses that he possesses no motivation to easily remedy because the inefficiency of the system benefits his purse greatly. Eventually the government says "Everybody must buy shoes" because shoes are so terribly integral to public health and because it has been bearing the brunt of the costs of people without shoes. This makes both the owner and cobbler even happier, wealthier men benefiting from the broken system. Eventually, the public begins to demand that the government intervene and set up their own shoe-manufacturing machine and provide shoes at reasonable costs where the beneficiaries of the increased efficiency are the public and the government rather than those lining their pockets from the work of the shoe gnome.
Now DanTex, I ask you, why specifically do you care about the wellbeing and employment of the shoe gnomes of our broken healthcare system?
DanTex
(20,709 posts)imported goods so that inefficiently manufactured domestic goods can remain competitive?
SonderWoman
(1,169 posts)Armstead
(47,803 posts)I suppose there's a point there, but dang if I can find it.
Bluenorthwest
(45,319 posts)payer systems of the pure sort have healthy private insurance industries providing enhanced benefits to the many who want such enhanced benefits. Because of those realities, your lack of data to support your assertion about job loss on a massive scale is understandable. It's a false assertion. The private insurance industry does not disappear, the jobs themselves remain.
So that leaves us with the moral aspect of your assertion which involves hinging the lives and deaths of children and everyone else on the need for 'paper pushing' jobs that you yourself are arguing are redundant by nature. I don't agree, but you say the jobs are so useless that the moment any improvements were made those jobs would cease to exist. And yet you say humans should have lesser health care at higher prices in order to preserve those pointless, redundant positions. I'm not very comfortable with the ethical implications of that concept.
DanTex
(20,709 posts)the private health insurance industry. Yes, SP systems still have small private healthcare industries that provide additional coverage, but there's no way the industry stays anywhere near as large as it is now.
As far as the moral aspect, single payer is far from the only way to ensure universal coverage. Plenty of other countries achieve this with public-private hybrids, some with systems that are quite similar to Obamacare.
More to the point, I'm not arguing for or against single payer here. My opinion is that pushing for single payer right now is not the right thing to do for a variety of reasons, but that has nothing to do with this OP, and the job losses in health insurance administration are not the reason I feel this way.
My point here is that increasing economic efficiencies, whether it's in the form of streamlining healthcare administration, or moving manufacturing to places where it is most cost effective, often comes with the side effect of job losses and dislocation. And it's curious to me that the dislocation associated with NAFTA gets huge amounts of attention, but the same people pay virtually no attention at all to the dislocation that would come from re-organizing our healthcare system along single payer lines.
Bluenorthwest
(45,319 posts)Your entire premise is about job loss but you offer absolutely no support for any net loss of jobs. Healthcare as an industry expands when all are covered, and all the 'paper pushing' still has to be done, on an even larger scale. I see no reason to think there would be a loss of jobs at all because I think the jobs are part of the system that delivers healthcare. You think they are excess persons doing pointless work that would not exist if reason was in charge, so you fear reason being in charge.
I think there would be a gain of jobs over all. It seems obvious.
dsc
(52,166 posts)then where does the cost savings come from?
Armstead
(47,803 posts)Private insurance could continue exist under a single payer system (depending on what specifically is adopted) forr those who choose additional supplemental coverage.
Human101948
(3,457 posts)Too Sick for Health Care
How Insurers Limit and Deny Care in the Individual Health Insurance Market
Conservatives claim that comprehensive health care reform will lead to government control and rationing of care. Yet private insurers already effectively limit and deny the health care that their policyholders can access, especially those who have to find coverage in the individual market. And make no mistake—the insurance companies are well aware that just 20 percent of patients are responsible for 80 percent of health care costs in the United States. That’s why insurers try to limit the coverage of this 20 percent, especially in the individual insurance market.
The recent testimony of former insurance company executive Wendell Potter before the Senate Commerce Committee offers insight into the practices that protect insurers’ economic interests at the expense of their policyholders’ best interests. In an effort to limit their costs, Potter explained the techniques that insurers use to try to drop sick individuals from coverage. One approach is “purging,” where the monthly costs for some individuals are significantly increased in the hopes that the individual will choose to drop coverage.
djean111
(14,255 posts)We are told we are racist (as if we would have gladly given our jobs to, say, Norwegians) or that we just need to suck it up and get trained for something else. So - now the insurance workers are special snowflakes, and the rest of us must pay through the nose for private health insurance?
Also - gee, I thought the TPP was going to bring jobs and prosperity to the US! So there should be LOTS of other jobs available.
I think that is a very lame objection to Single payer. Do you also think medicare should be privatized?
DanTex
(20,709 posts)And, now that you mention, H1-Bs might fall under this parallel as well -- an increase in overall efficiency but not all individuals end up better off.
djean111
(14,255 posts)And, again, why are insurance jobs more special than all of the other jobs? Plus, I believe Single Payer would mean a lot of those who work in the insurance industry would get hired to work for the government.
TPP and NAFTA supporters just shrug that off. The problem with your parallel is that if we do not go to something like Single Payer, prices will just keep going up and up so that insurance companies can keep increasing profits (same for hospitals and Pharma), and many people will not be able to afford actual health care. You think that is a good trade-off for keeping one certain sector of people in their jobs? I don't. In fact, that seems morally bankrupt.
portlander23
(2,078 posts)Last edited Mon Sep 21, 2015, 10:05 PM - Edit history (1)
You are correct that this would result in what recalled "dislocations" which is a very sterile term for people losing their jobs. That said, single payer would:
1. Lower costs for workers and businesses leading to increases in salaries (assuming we regulate things so that industry doesn't eat the gains). This is likely to increase jobs as well as this stokes demand.
2. More openings for people who actually deliver care. Once everyone has the means to pay for care, there will be more people with more money seeking care.
So there's a case to be made that it's a overall job program, but this is definitely a dislocation. That said, to think of it in these terms it to use the wrong frame. In the case of Free Trade, we're really talking about an industry relocating to a foreign labor pool. In this sense the jobs are going elsewhere. This is more like regulating the tobacco industry. You can make the argument, and people have, about regulating the tobacco industry.
By regulating the Tobacco industry, and intentionally shrinking the market, the government cost people's jobs. That said, those jobs resulted in people dying. When we reduce an industry like that it's not a loss.
From Michael Moore's Documentary Sicko:
The definition of a good director was
somebody who saves the company money.
(Moore) Dr. Linda Peeno
was a medical reviewer for Humana.
She left her job because she didn't like
their way of doing business.
(Dr. Peeno) I was told when I started
that I had to keep a 10% denial.
Then they were giving us reports weekly
that would have all the cases we reviewed,
the percent approved
and the percent denied.
And our actual percentage denial rate.
Then there would be another report that
compared me to all the other reviewers.
The doctor with the highest percent
of denials was gonna get a bonus.
(Moore) Really? So you, as a doctor,
working for the HMO,
if you denied more people healthcare,
you got a bonus?
(Dr. Peeno) That was how they set it up.
Any payment for a claim
is referred to as a medical loss.
So yes, on the superficial analysis, there is some parallel in as much as there's a dislocation in the market. But when we have a for-profit health insurance industry that makes money by denying care, we have a moral obligation to shrink or destroy that industry and replace it with a system that benefits people.
DanTex
(20,709 posts)With free trade, sure, some industries will suffer and jobs will move overseas. But the benefits are cheaper goods, which means consumers have more money to spend on other things, stimulating demand, and so on. In addition, the trading counterparties also drop their tariffs, giving US firms a larger market to sell to.
Both are situations where the economy as a whole is made more efficient, even though there are individuals in the economy who end up worse off.
portlander23
(2,078 posts)I would point out however that the efficiency engendered by free trade is not shared by workers. That is not the case with single payer.
Secondly, and this is the salient point, losing jobs is not a credible reason not to go to single payer. Cutting back on tobacco jobs saves lives. Losing jobs in coal mining is not a reason against moving to renewable energy.
We can discuss insurance industry job loss in relation to single payer, but it dramatically misses the point.
DanTex
(20,709 posts)How so? The workers also get cheaper appliances or cars, or whatever.
Human101948
(3,457 posts)That's a right wing meme. "They can't be poor,they have a refrigerator!"
DanTex
(20,709 posts)Bluenorthwest
(45,319 posts)From the UK about National Health Service:
"The NHS employs more than 1.6 million people, putting it in the top five of the world’s largest workforces together with the US Department of Defence, McDonalds, Walmart and the Chinese People’s Liberation Army."
DanTex
(20,709 posts)Human101948
(3,457 posts)Problem solved.
portlander23
(2,078 posts)Yes, this is the standard assumption about efficiency delivered by free trade. That said, there are two points to keep in mind.
First, not all of the reduction in cost translates to reduction in price. Most of the gains from moving jobs offshore goes directly to corporate profit.
Second, with the loss of good paying manufacturing jobs, not only do formerly manufacturing workers have to contend with lower pay, whole communities are affected by the ripple effect of less money people's pockets.
The promise of lower-priced goods has always been the justification for free-trade, but the reality of free trade over the last few decades has not resulted in increased prosperity. The indisputable track record is that free-trade results in massive profits for multinational corporations, and the decimation of the working class.
DanTex
(20,709 posts)If you've got data do back that, I'd like to see it. But in general these industries are pretty competitive. Sure, some of the gains to go profits, but most of them go to lower prices. IPhones would cost a lot more if they were fully manufactured in the US, and the same goes for a lot of things.
As for your second, there you have a point, because there are geographical areas whose economies are largely fueled by certain industries, and when those industries get moved overseas, the results can be devastating. I don't know of any region that is equally dependent on healthcare administration.
portlander23
(2,078 posts)We're getting into the weeds and off the health care topic, but the core concept here is that the price of a good is not tied directly to the cost of manufacturing a good. The price of a good is based on what the market will bear. By moving production to a lower cost country, you've done nothing to change what the market will accept for the price of the good. Thus, moving the production alone results in an increase in profit margin, not the lowering of price.
In all fairness, the details of this will change based on economic conditions, how productions are positioned (low cost competitor vs value add), etc, but that's the basic mechanic at play.
Take this article from the Atlantic which examines the cost vs price of the iPad 2:
Average U.S. manufacturing/mining/construction compensation is $32.53/hour as of December, according to the BLS. Research firm iSuppli estimates the iPad 2 costs $10 to manufacture, which - using the $1.11/hour rate - works out to about 9 hours each to complete. If assembly and manufacture took the same amount of time in the U.S. as it does in China (another possibly unrealistic assumption), the cost of making each iPad 2 comes out to $292.77!
Again, according to iSupply, the material cost for the 32gb iPad 2 WiFi + 3g - which sells for $729 - is about $325, or $335 including labor, which puts Apple's gross margin (ex shipping/handling) at 54%. Just using the simple math above, if the iPad 2 was made in the U.S it would cost $617.77, bringing Apple's gross margin down to 15.25%! Of course, Apple is not in the business of self-immolation, and given their relatively substantial pricing power, they could just make the iPad 2 more expensive, let's say, increasing the price to the point where their gross margins stayed intact, from $729 to $1,144.02!
Note the trade off here in profit margin. You could make the iPad 2 in the United States and maintain the price - the difference is the profit margin goes down because more money is flowing to labor. Apple would still make money, just less. The assumptions about "raising price" by moving manufacturing back the United States has the built-in assumption of freezing margins at the levels obtained from moving manufacturing overseas where multinationals can exploit cheap labor.
Higher profit margins and lower wages is the general result of free trade. To the extent that prices are lowered, goods are generally going to be priced in such a way that moving seas increases profit margins, or else the move wouldn't have occurred.
If Apple were unable to offshore manufacture, it's likely that price would increase, but it can't increase more than the market will bear. The increased cost of labor is taken out of the profit margin more than it is out of the price extracted from the market.
Again, this is something of a distraction with respect to health care. My point is delivering health care is not comparable to the cost and pricing of consumer goods. Delivering health care is a social good.
DanTex
(20,709 posts)There's both supply and demand, which govern the market price. Demand is a curve, there's no such thing as "what the market will accept for the price." At a higher prices there is less demand, at a lower price, there is more demand.
Sure, reducing costs increases profits (usually, at least until competitors also figure out how to reduce costs), but it also reduces prices.
portlander23
(2,078 posts)"This difference is one of the things that trip up students, in my experience in teaching economics for 30 years. Cost I think most people can directly relate to. Cost is simply what it takes, in terms of dollars or resources, to produce a particular product or service. So let's say we're looking at a restaurant meal. You look at the cost of the food that goes into that restaurant meal, the labor, maybe some piece of the building and the kitchen equipment and so forth, so basically, what the costs of the inputs are that go into making that restaurant meal. Now, price, on the other hand, some would say, 'Well, price should be the same as cost.' But not necessarily, price is simply what someone is willing to pay for that product or service. So price is really more of a demand or consumer phenomenon, whereas cost comes from the supplier. And so, for example, the price of that restaurant meal would be the price that the owner thinks that he or she can sell it at and is posted on the menu, and the owner will see if that's the right price by how many people are willing to come into the restaurant and pay for it. Now, usually price is greater than cost. That's what gives a business a profit. But it's not always the case. Sometimes price is less than cost, and we're seeing that right now in our down economy, for example. Some real estate is selling at a much lower price that what the cost of that real estate is, and that's a signal to the business to change things, to get out of that business or perhaps try to become more efficient and produce things at a lower cost."
Cost is a function of the price of the inputs to create a product. Price is based on what consumers think the value of a product is. You'd think these are directly tied, but it is not the case. All companies attempt to drive down the cost of goods, but this does not imply a drop in the price of goods. The whole point of a company is to attempt to keep margins between price and cost as high as possible. Lowering costs by moving overseas does not put downward pressure on the cost of a good unless there's a perceived loss of value in the good by consumers.
Again, this is something of a distraction with respect to health care. My point is delivering health care is not comparable to the cost and pricing of consumer goods. Delivering health care is a social good.
DanTex
(20,709 posts)to sell it for a given price. Price is based both on supply and on demand. You're trying to pretend that price only depends on demand, which is wrong.
portlander23
(2,078 posts)If the cost of the manufacture of a good increases, the price will only increase (short of the perceived value of of the good increasing) if the seller of the good is unwilling to decrease the profit margin.
This is not to say that cost plays no part in determining price, but it is not the primary determinant of price, nor is it directly related to price. Decreasing the cost of producing a good does not result in the decrease of a price of a good. It increases the profit. There may be all sorts of reasons for lower the price, but reducing the cost is not one of them.
Businesses are money making engines. The whole point is to drive cost down and margins up. Moving overseas is primarily about obtaining larger profits, not altruistically lowering prices.
On supply, you're misinterpreting the law of supply. First let's look at the law of demand, then supply.
Economics Basics: Supply and Demand
A. The Law of Demand
The law of demand states that, if all other factors remain equal, the higher the price of a good, the less people will demand that good. In other words, the higher the price, the lower the quantity demanded. The amount of a good that buyers purchase at a higher price is less because as the price of a good goes up, so does the opportunity cost of buying that good. As a result, people will naturally avoid buying a product that will force them to forgo the consumption of something else they value more. The chart below shows that the curve is a downward slope.
B. The Law of Supply
Like the law of demand, the law of supply demonstrates the quantities that will be sold at a certain price. But unlike the law of demand, the supply relationship shows an upward slope. This means that the higher the price, the higher the quantity supplied. Producers supply more at a higher price because selling a higher quantity at a higher price increases revenue.
The law of demand states that as the price of a good increases (short of the perceived value of a good increasing), the demand for for a product will drop. This is exactly what I'm talking about when I say the price of a good is a function of the perceived value of a good, not the cost of manufacture of a good.
The law of supply notes that the higher the selling price the market will bear, the more the producer of a good will produce. Why? This doesn't impact the profit margin of the good, but it does drive increased profits through selling more units at that margin.
Now this isn't to say that a business might not lower the price of a good in the pursuit of competing with other companies of the basis of price, but that's not directly related to moving manufacturing to a cheaper location. A company might also lower price by diminishing profit margin. Furthermore, not all companies compete on being the lowest cost option. Many companies (especially ones like Apple that enjoy high margins), compete on perceived value.
To reiterate, all other things being equal, lowering the cost of production of a good increases profit margin, not decreases price.
And once again, again, this is something of a distraction with respect to health care. My point is delivering health care is not comparable to the cost and pricing of consumer goods. Delivering health care is a social good. It's part of the commons. Comparing the effects of moving to single payer to consumer goods is not the best frame for crafting the best policy.
If you'd like to continue talking economics, and I assure you there are others much more qualified than I to explain this. I'd suggest you lift this conversation of the impact of free trade to its own thread where you might garner attention from more informed participants.
DanTex
(20,709 posts)demand. But cost of production is one of them. Again, you are stuck on this idea of "what price the market will bear." The market will bear a lot of prices: this is the demand curve. The higher the price, the less demand there is, and vice versa.
portlander23
(2,078 posts)It’s one of the most fundamental decisions that every business must make: What price should I charge? The right answer to that question is a company should charge “what the market will bear” — in other words, the highest price that customers will pay.
Economists are business people are stuck on this idea.
Again, again, again, this is something of a distraction with respect to health care. My point is delivering health care is not comparable to the cost and pricing of consumer goods. Delivering health care is a social good. It's part of the commons. Comparing the effects of moving to single payer to consumer goods is not the best frame for crafting the best policy.
DanTex
(20,709 posts)Manufacturing costs affect the supply curve. This is basic. This is why the price of oranges is less than the price of SUVs.
portlander23
(2,078 posts)I don't think we're going to agree on economics. My larger point is it's a mistake to view health care as merely a consumer good.
Capn Sunshine
(14,378 posts)I think the significant boom that would result in business no longer limiting their expansion decisions based upon healthcare costs would create a MUCH more positive environment for job seekers than the post depression one that came about after NAFTA.
Combined with the infrastructure boom, I think there would be places for lots of admin people.
Just how it works in boom times.
DanTex
(20,709 posts)about people who lose their jobs to free trade either.
Capn Sunshine
(14,378 posts)There's still no guarantee of either.
TheKentuckian
(25,029 posts)An awful lot of claims are processed offshore, like the lion's share that are not done by automation.
Were you crying about the decline in compensation and jobs for brokers with the "reform"or were you crying a river as most or the people who did rating got walked out due to ending preexisting conditions, bet not.
There will be some streamlining due to duplication but how much I think is quite debatable considering you still have the same volume to cope with. Who would be in trouble might be many execs and most marketing folks.
DanTex
(20,709 posts)Since this industry virtually disappears with single payer, most of those workers end up dislocated.
I'm not crying about anyone. I'm just bringing up a parallel. If people are going to cry about people who lose their jobs to NAFTA, why should those same people not cry about people losing their jobs to single payer? Or vice versa. If shedding jobs for efficiency is a good thing in the case of single payer, why is it not also a good thing when it comes to free trade?
Bluenorthwest
(45,319 posts)here's what the National Health Service says: "The NHS employs more than 1.6 million people, putting it in the top five of the world’s largest workforces together with the US Department of Defence, McDonalds, Walmart and the Chinese People’s Liberation Army."
So our NHS would be larger, perhaps by 5 times. NHS has well over 110,000 office staff positions so we might have what, 550,000 such jobs, a net gain on the current level of employment....funny how that works.
Perhaps the problem is that a few key employees will lose the jets and millions? Because yes that is likely to happen. Let them make use of the parachute d'or.
DanTex
(20,709 posts)Here's the thing: if we continued to employ all the healthcare administrators we currently have in the private sector, and paid them the same amount, then there wouldn't be much savings. People like to point to the CEOs and the private jets, but in fact most of the money spend is just paying salaries of regular workers. Yes, the CEOs make a lot, by regular person standards, but not by the standards of how much the healthcare system costs. If all they did is fire top executives, the cost savings would be minimal.
Human101948
(3,457 posts)And whether that is a good thing depends on who you talk to. If you talk to management that outsourced manufacturing they will be A-okay with it and richer for it. If you talk to management shown the door by single payer they will not be happy campers.
I assume we are talking about universal national healthcare. If so, I would rather be unemployed under that system than what we got now.
TheKentuckian
(25,029 posts)You act like Single Payer magically disappears the administration required to get providers paid. I granted some duplication but the volume isn't going anywhere so which jobs are in danger according to your estimates? How many jobs would be added if there wasn't so damned much outsourcing?
How does single payer empower multinational corporations above citizens? How does Single Payer create intellectual property rights that drive up drug costs? How does Single Payer set up corporate tribunals? How does single payer generate borderless capital and strict borders for labor? How does single payer negate nation of origin labeling? How does single payer set up a race to the bottom on wages and environmental regulations by attempting to enforce conditions where industry shops for whatever is cheapest for production while demanding the door for those goods and services be unrestricted?
How does single payer drive conditions where the poor of the world are exploited and resources and land plundered?
You have an apples to wrought iron fences comparison here to push corporate rightwingery.
DanTex
(20,709 posts)be much at all in terms of administrative savings, which is one of the big selling points of single payer.
TheKentuckian
(25,029 posts)Some folks like myself might get a haircut or be eliminated but your "point" was number of jobs so if you want to move the goalposts then so be it.
DanTex
(20,709 posts)number of layoffs, or there isn't much cost savings.
TheKentuckian
(25,029 posts)Your misunderstanding is fundemental to the point that you seem to not understand insurance in general because if you did you'd have to get that single payer is insurance and that not only does insurance pool resources but that by doing all that pooling you generate significant gravity added to the power of the purse.
That is what all the networks are about, the ability to set rates for your members.
You also over time get to have measurable opportunities to increase effeciency moving forward by doing things like having everyone on the same systems. There is quite possibky a percentage point or more of overall cost just in translation errors, IT fiascos that otherwise wouldn't happen, human error, and administration costs to identify and correct.
For that matter than how is only loss of labor opportunity is the problem with "free trade" and even if it was how is the benefit anything like comparable? How does a person assign equal value to cheap belts from Walmart with the health of our citizens and the health of the broader economy as this sector already above carrying threshold that continues cancerous and explosive growth.
You have not proven (or even marginally supported by even making a case for) your underlying assumptions. One cannot even get to your questions without accepting an assumed reality that your framing dictates be accepted as valid as stated and that just is necessarily the way it is.
Especially when you go hyperbolic as hell and damn well at least imply that 500,000 jobs go poof.
No question effeciency will take some toll so can an app or a coding update, or what have you but I'm pretty hesitant to cede equal cost to benefit ground here, your mileage may vary.
DanTex
(20,709 posts)You're right, that isn't the only reason why we pay more than the rest of the world. The actual reasons are varied and complicated, and simply switching to single payer isn't going to fix them. In fact, there are plenty of efficient systems around the world that aren't single payer, some of which resemble Obamacare (e.g. Switzerland, Netherlands).
As far as the benefits of free trade, saving money is saving money. People don't only spend money on healthcare, they also buy things like cars and TVs and refrigerators (and belts). Making those things cheaper puts more money in people's pockets. There are tradeoffs everywhere.
djean111
(14,255 posts)For me, it is getting rid of the profit motive, and price-fixing by insurance companies, hospitals and Pharms. Getting rid of the onerous co-pays and out-of-pockets that now mean that some people are forced to buy insurance, but cannot afford to use it. Things like that. I think Rangel submitted a plan that employed most of the current admin. @Wonder what the numbers would look like today.
msongs
(67,438 posts)corporate parasite managements and shareholders who lose out.
DanTex
(20,709 posts)there wouldn't be much in the way of cost savings.
Human101948
(3,457 posts)Here's an outrage that must be changed: Big Pharma has been systematically price-gouging the Medicare program for seniors and people with disabilities -- and raking in billions in excessive profits. The 11 largest global drug companies made an astonishing $711 billion in profits over the 10 years ending in 2012, and they got a turbo-charged boost when the Medicare Part D prescription drug program started in 2006, according to an analysis of corporate filings by Health Care for America Now (HCAN).
The drug companies hold the power to charge America's consumers whatever they want. Worse, Medicare -- the nation's largest purchaser of drugs -- is prohibited by law from seeking better prices. The result of this shortsighted policy is dramatic. In 2006, the first year of Medicare's prescription drug program, the combined profits of the largest drug companies soared 34 percent to $76.3 billion. And unlike other industries, such as Big Oil, drug companies get something even better than a tax subsidy -- they get a government program.
http://www.huffingtonpost.com/ethan-rome/big-pharma-pockets-711-bi_b_3034525.html
We could use this money to pay the 500,000 workers and they would each receive $1,022,000. That's insignificant?
Your assertions are just hot air.
ion_theory
(235 posts)The jobs lost in NAFTA were lost because corporations wanted to make more money, plan and simple. They did not care whatsoever about the people and families they were laying off, because in the end it increased their profit margins. With a SP healthcare system, the goals are different. Of course the purpose is still to save more money, but it to save more money for the nation as a whole and not just share-holders. I agree that people employed by insurance companies will lose their jobs, but those companies don't just go away. Much of their profit will and this is where many of those lay-offs will come from. It does cost money to run a business, but doesn't cost $5m for an executives to do his/her job either regardless of what the market says IMO.
TubbersUK
(1,439 posts)Last edited Tue Sep 22, 2015, 01:31 PM - Edit history (1)
In terms of US GDP, NAFTA is generally considered to have had no more than a slight positive impact.
Moreover, NAFTA puts pressure on US jobs, mainly in manufacturing - so any 'slight' NAFTA driven gains in GDP are offset (and then some) by the social and economic impact of job losses (1 million to date according to the OP).
However, a change of healthcare model has the potential for highly significant cost savings (e.g. the US spends 17.1% of GDP on a subset of the population, the UK spends 9.1 % for universal coverage) and those savings would be available for spending on other socially productive activities thus creating social benefits and jobs.
ETA: Based on the UK NHS experience, it's likely that some, if not all, of the private sector admin jobs lost would be off-set by admin jobs within the new system.
http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
http://www.bloomberg.com/bw/articles/2013-12-30/nafta-20-years-after-neither-miracle-nor-disaster
Garrett78
(10,721 posts)
DonCoquixote
(13,616 posts)"The odd thing is, almost all single payer proponents are also opponents of NAFTA and free trade in general (e.g. Bernie Sanders). We hear over and over about the people who lost their jobs to NAFTA, but the same people don't seem to care at all about the people who would lose their jobs to SP for the sake of economic efficiency and lower consumer prices. "
It is not that we do not care about people losing jobs, it is that the lack of affordable health care causes people to lose their LIVES. How can you compare someone losing their JOB to losing their LIFE? We have a high infant mortality rate, and , especially when you compare how much is spent, one of the worst health rates in the world. Yes, if it is a choice between someone dying and someone losing a job, life has more priority, full stop.
"Why is this? Why is it bad to lose manufacturing jobs but not bad to lose jobs in healthcare administration? Or, conversely, why is it good when healthcare administrators are free to do more socially productive things, but not when manufacturers are free to do more socially productive things?"
First, the manufacturers mixing to Mexico are not being socially productive: they are leaving behind lots of American jobs, and they are going there to pay Mexicans less. The very idea of socially productive is NOT a synonym for someone making a profit.
Second, you can get another job, but DEATH, or even maiming, cannot be fixed.
now, me personally, I would consider what most of europe has an improvement, and they have private insurance too, but the idea the the singe payer system that would save lives should be considered bad because some people would have to get a new job, is disgusting. Then again, some so called Democrats have no problem with anything that kills working class people.
DanTex
(20,709 posts)Single payer is one form of achieving universal coverage, not the only one.
And, yes, moving manufacturing to places where it is cheaper is economically efficient. It brings down prices. Smart phones, for example, would cost a lot more if they were fully manufactured in the US.
DonCoquixote
(13,616 posts)That making healthcare available to people is a matter of LIFE or DEATH, period. You cannot use a frame like cell phones or cars, because frankly, dead people have no use for those.
DanTex
(20,709 posts)healthcare readily available.
restorefreedom
(12,655 posts)Hoyt
(54,770 posts)you examine it as you have.
GeorgeGist
(25,322 posts)TubbersUK
(1,439 posts)Last edited Tue Sep 22, 2015, 04:40 PM - Edit history (5)
it distills what many consider to be the main cause of inflated healthcare costs in the US:
“There is no such thing as a legitimate price for anything in health care,” says George Halvorson, former chairman of Kaiser Permanente, the giant health maintenance organization based in California. “Prices are made up depending on who the payer is.”
In addition to "made up prices", the article cites waste & duplication, pharma gouging and rabid marketing as factors.
It also points out that buying power is critical e.g. when Medicare is paying, prices tend to be lower.
http://www.consumerreports.org/cro/magazine/2014/11/it-is-time-to-get-mad-about-the-outrageous-cost-of-health-care/index.htm
ETA: "............ everything just costs a whole lot."
http://www.huffingtonpost.com/2013/10/03/health-care-costs-_n_3998425.html
DanTex
(20,709 posts)What should be done about that is to enforce all-payer rate setting, so that everyone pays the same price.
https://en.wikipedia.org/wiki/All-payer_rate_setting
Skwmom
(12,685 posts)
ljm2002
(10,751 posts)...is that the jobs lost to NAFTA / TPP etc. aren't really eliminated, they are just moved to other countries where labor is cheaper, and then the goods manufactured in the other country are shipped back to the US for sale to us. Whereas the jobs lost to a single payer system are eliminated. That fact also explains part of the cost savings of a single payer system.
Another thing you fail to mention is that all the single payer initiatives I am aware of provide funds to retrain those who lose their jobs due to it.
Also, if we go to a Canadian style single payer system, private insurance is not totally eliminated. People can still buy insurance to cover them a little better than average, such as having private rooms and the like (although not allowing them to go to the front of the waiting list). So not all of those jobs need to be eliminated.
Yes, some jobs will be lost. But unlike manufacturing jobs, these administrative jobs do not produce anything. Yes they are necessary for administration, and as you point out, a certain percentage of them will still exist but will become government jobs instead of private jobs.
The question to ask is, what is the benefit of cheap foreign made goods, vs. the cost to society as a whole of losing those manufacturing jobs? And what is the benefit of a single payer system, vs. the cost to society as a whole of losing the administrative jobs in the private medical industry? Since one of the big benefits of a single payer system is that everyone gets health care (not health insurance, but health care), and since the overall cost of health care will be diminished, the benefits are huge. Seems to me the retraining costs are a small price to pay for those benefits. Whereas the benefits of cheap goods are immediate but short lived: yes we can all have a TV, but the money we spend goes to multinational companies who hide their profits and don't pay taxes, and the jobs are held by people in other countries so fewer and fewer of us can afford even the cheap goods.
I don't see any real contradiction here.
DanTex
(20,709 posts)But, if anything, that makes the NAFTA job losses more palatable from a global perspective. Jobs are lost here, but jobs are gained elsewhere. And the people getting the jobs are generally poorer and more in need than the people losing their jobs in the US. In fact, free trade has been one of the reasons that the global middle class has been growing and getting wealthier over the last few decades.
As far as initiatives to compensate and retrain people who lose their jobs, that also exists with free trade.
That's not true. Administrative jobs are a productive and necessary part of the economy. The fact that they don't actually produce physical things doesn't mean they aren't productive.
First of all, single payer is not the only way to ensure that everyone gets healthcare. That can be accomplished in a number of ways, including expanding Obamacare. Not all universal healthcare systems are single payer.
Also, the benefits of cheaper goods are significant. If people have to pay less for the things like TVs, cars, appliances, etc., it is easier to make ends meed. Cutting an average family's healthcare costs by $200 a month is basically the same as cutting their other expenditures by $200 a month: either way, the family gets the same stuff, but for $200 less.
ljm2002
(10,751 posts)...by multinationals in order to make their predatory practices more palatable.
The fact is that third world workers are being exploited. Their hopes of a better life are often nightmares of long hours and low pay -- the same problems that our workers fought and died to change. Factories in Bangladesh where hundreds die in a fire (a la the Shirtwaist Fire back in the day), factories in China where now there are nets so that people who jump won't die. And also, prices of goods do not always reflect the lower prices of manufacturing. I've always wondered how Nike gets away with their $100+ shoes; certainly their shoe prices did not suddenly become affordable after they moved their manufacturing overseas.
Also, I am not arguing that administrative jobs are not necessary. However, the level of administrative work required in our current Rube Goldberg contraption of medical insurance / health care system is ridiculous. You have administrators in the private insurance companies -- many of whose job is dependent on how many claims they can deny; you have hospitals and medical practices who must keep extra administrators to deal with the patchwork of different insurers, and who also must deal with denied claims as a constant issue.
Your argument about cheaper goods is the same one made by the multinationals, and it is spurious because it is short-term thinking. Once we lose the ability to support ourselves, we have lost our independence too. Sure the world is more intertwined than ever before. But we have become like third world nations in that nowadays, we ship raw materials such as lumber and fibers overseas, only to have finished goods shipped back to us. We lost our garment industry and our furniture making industry. We import steel to make our bridges (ask the people of the San Francisco Bay Area how well that has worked for them on the new Bay Bridge), and these days we even import chicken from China.
Not only that, but many of these practices are environmentally disastrous. Shipping goods around the world, raw materials in one direction and finished goods in the other direction, is hugely wasteful of resources and polluting. We need to re-think it sooner rather than later if we want to have a remote chance of reversing the ill effects we already see.
Finally, you make a fundamental mistake by equating $200 in healthcare costs to $200 in goods. Once you get past the level of simple survival, goods and healthcare are simply not the same. If I don't have $200 to spend on a new TV set, I don't get the TV set. Oh well. If I don't have $200 to spend on a medication, I don't get the medication. My condition gets worse and I may end up in the emergency room or worse. They are simply no the same thing, and the trade-offs are not the same.
DanTex
(20,709 posts)The actual fact is that global middle class wages have risen significantly over the past decades, and a lot of this is due to international trade. Yes, many people work in very poor conditions, but the main thing the US can do about that is free trade agreements with labor standards. And the same thing goes for environmental problems. The only way we can prevent other countries from polluting is via international treaties and environmental standards in free trade agreements. If you think we can just put up big tariffs and suddenly sweatshops and pollution will go away, you are fooling yourself.
And, yes, cheaper goods are a good thing, denying this is stupid. And we aren't remotely losing "the ability to support ourselves", this is a Pat Buchanan/Donald Trump argument. We import a lot of things, and we also export a lot of things, and neither of those is a problem. Who cares if some of the stuff we buy is made overseas, and some of the stuff we make goes overseas? What matters is the standard of living of people, both here and abroad.
And, yes, saving $200 on goods is basically the same as saving $200 on healthcare. This is because people don't live on healthcare alone, they also need goods. They need cars, refrigerators, food, and so on. And they spend money on all those things. If they save the $200 on other goods, that's an extra $200 that increases their standard of living, same as if they save it on healthcare. In fact, since healthcare is subsidized for low income people, a $200 reduction in the costs of other goods is likely to make more of a difference to them.
ljm2002
(10,751 posts)...I'm trying to have a discussion.
And yes, globalization is largely a ruse to mask the real agendas of the multinational corporations, which is of course all about maximizing profits to the exclusion of any other goal.
Cheaper goods is not an unalloyed good. Denying this is stupid. Yes we are remotely and not so remotely losing the ability to support ourselves. We no longer manufacture clothing or furniture in this country, except for small-scale specialized enterprises. What we do is ship our raw goods overseas -- using fossil fuels to do so -- and then import those same goods as finished products, again using fossil fuels to do so. Do you really not see the environmental costs of doing things this way?
Also, importing manufactured goods from abroad often means poorer quality. Importing pet food from China resulted in the sickness and death of pets here. I don't say this to demonize China, but rather to point out that this globalization often removes the manufacturers from seeing first hand the consequences of their shoddy practices, and therefore removes incentives to do it better.
I am not advocating against all international trade, but we really do need to re-think a lot of it based on environmental concerns as well as societal concerns -- not just for the US but for those other countries as well. Mexican farmers is just one example of the deleterious effects of so-called "free trade". There are many others.
But to get back to health care: if you truly think that $200 on consumer goods can be equated to $200 on health care then I don't think we can have a productive discussion. Your thinking is totally bottom-line and dollar-driven. My thinking is that we must consider the underlying reality: societal, environmental, human well-being.
BTW, I do agree that health care for all can be achieved in various ways. But you need to realize, that in those countries where the private sector is still a part of their universal health care, those private entities are highly regulated. In this country, we have hobbled our own government from negotiating drug prices, and we have made it illegal for our own citizens to buy their drugs out of country -- when the same drugs in this country can cost hundreds of times more. Our own government and corporations consider us citizens -- oh, excuse me, consumers -- to be a captive source of revenue, nothing more. It's just wrong.
DanTex
(20,709 posts)It doesn't mean that free trade is bad. Virtually all economists agree that free trade is a good thing, including liberal economists like Krugman. Free Trade Agreements are a different matter, because they include things that aren't related to free trade and reducing tariffs. But as far as the question of free trade versus protectionism, there isn't much doubt that free trade is better in general.
Yes, it is an unalloyed good. Certain ways of getting cheaper goods have downsides, in which case such a policy would have both costs and benefits. But cheaper goods are definitely a clear benefit. The question, in all cases, is whether the benefits outweigh the costs.
Some of the costs you cite are real, for example environmental damage. The solution to that (or a solution) is a carbon tax, to raise the cost of burning fossil fuels up to the point where it reflects the true cost including externalities. Other costs you cite are fictitious. Whether our clothes or furniture are made in the US or not makes no inherent difference.
Lower quality goods are obviously a harm. As a consumer the solution to this is to buy more expensive, higher-quality goods. And things made abroad are not always lower quality, this varies. For a long time cars made in Japan were higher quality than American cars. That was a big benefit to American consumers.
I am thinking about the underlying reality, and human well-being in particular. If a family saves $200, that's $200 of extra standard of living for that family, regardless of where it came from. Obviously, if a family saves $200 on healthcare versus $100 on other things, they would prefer the healthcare savings (and vice versa). But, to the extent that a household spends their money on a certain group of goods and services, saving money on any of those things will yield basically the same benefit to them. I don't see why this is even controversial.
I agree, the healthcare industry needs to be more heavily regulated, including better price negotiation tools. But Obamacare was a huge step forwards, and given that Single Payer is a political impossibility, a much more fruitful road at the moment is to expand on Obamacare. Too often here on DU I've read that if you're not for single payer, then you aren't for universal coverage, and you're some kind of Republican light corporate apologist.
TheKentuckian
(25,029 posts)is perhaps substantially more politically impossible with not a hair less opposition from conservative to regressive voters or "the stakeholders" they act as cannon fodder for.
We at least have done things like Social Security, Medicare, Medicaid, Tricare, and the VA this pipe dream of this huge nonprofit private sector acting under the watchful eye of a robust regulatory body able to stand the test of generations has no serious analog in this country. We flat out don't do this fairy tale in the United States that you, Max Baucus, Kent Conrad, and Barack Obama (though his pitch was slightly more honest in the hedging toward some bullshit "uniquely American" system knowing the money would keep flowing) pretend we are on the road to when in reality we did the opposite and made the for profit cartel too big to fail in full effect and then a step further guaranteed them customers and agreed to make up the difference between what could be squeezed out of them and what the cartel wishes to charge.
We maintained the weak state oversight and dumber pools, I've yet to hear a real argument for the benefits of pool fragmentation but that is a whole other can of worms.
Our problems are too deep, to far progressed beyond bandaid fixes, and widespread in the whole sector for anything less the power of the purse especially when placed in the context of our ability to sustain oversight and regulation no matter how obvious the need or importance of maintaining the hen house.
I believe from where we are that single payer is a moderate and perhaps tepid due to mass widespread Pollyannaism it is not even slightly unreasonable to believe that the only way to stop the cancerous growth and certainly to dial back costs is to go full blown NHS, it is just that far out of hand.
We don't really have a model because no one else in the world, even less than advanced countries were so insane and foolhardy to allow their systems to be as out of hand as ours.
When a Conrad tries to sell that eventually health care will be like our utilities eyes roll all across the spectrum. Only the most fortunate have much love for their local friendly neighborhood monopolies for profit that get their annual rubber stamps to squeeze what they will.
The whole proposition is damning self evidence, the example being aimed for sounds like a terrible idea once real life not fantasy island context is applied because the example is something we are fucking terrible at on multiple levels and as a country have never shown the slightest propensity to sustain even if temporarily achieved.
This is a generational rhetorical slow walk to prop up a failed status quo to a destination that we aren't even really heading toward on the map that is probably optimistic speculation or just pure salesmanship that insists on reinventing the wheel while excluding the use of circles, spheres, and tubes.
Armstead
(47,803 posts)That was too easy.
Roy Ellefson
(279 posts)any single payer plan must include a plan to train and re-employ insurance company workers.