Where would you like your tax dollars to go?

[vorlon13]

As long as the Department of Redundancy Department and the Ministry of Silly Walks and the Department of Administrative Affairs are fully funded, you all can gut the rest of the budget as much as you want.

[The Industrial Atheist]

As I said, I agree that cuts alone won't fix the US debt.  We need increased revenue.  Sadly, that does not seem likely for at least 4 years.  Our debt is only going to continue to get worse.

According to republican math tax cuts = increased revenue though economic growth. While history does show lower taxes often leads to faster growth, more often than not it also shows that the growth is not enough to increase revenue by the predicted amount.

---

Not only that, but tax cuts and deregulation tend to cause a boom and bust cycle. See the Great Depression or the Great recession when Bush Jr was president.

[downbeatplumb]

As I said, I agree that cuts alone won't fix the US debt.  We need increased revenue.  Sadly, that does not seem likely for at least 4 years.  Our debt is only going to continue to get worse.

According to republican math tax cuts = increased revenue though economic growth. While history does show lower taxes often leads to faster growth, more often than not it also shows that the growth is not enough to increase revenue by the predicted amount.

---

Properly fund health care through a tax on everyone, none of this insurance shit.

Implementing a single payer healthcare system in the US is probably harder than balancing the budget.

How would you do it?

Find out how much it would cost to provide reasonable health care for people and set a tax to cover the cost making sure that the wealthy actually pais and didn't mamage to weasel out of it.

[popeyespappy]

Implementing a single payer healthcare system in the US is probably harder than balancing the budget.

How would you do it?

Find out how much it would cost to provide reasonable health care for people and set a tax to cover the cost making sure that the wealthy actually pais and didn't mamage to weasel out of it.

According to the article I just read America spent $3.35 trillion on healthcare in 2016. According to them that's $10,335 per person. That's $3.35 trillion divided by everybody so it includes a bunch of people that needed reasonable healthcare, but didn't get it because they couldn't afford it. If they had gotten care the bottom line would have been larger. The article also said we could expect a 4.8% inflation rate for healthcare. Tie that to a 0.7% population growth rate and by 2050 we are looking at $20.9 trillion total and $50,886 each per year not including the percentage of people that don't get healthcare today. That is unsustainable so I guess we'd be safe calling it unreasonable.

So how do you determine what it would take to provide reasonable care for people? A large percentage of the cost is driven by care for old and dying people. A few years back we lost my 95 year old uncle. The bill for his healthcare the last for weeks of his life was probably more than the cost for the previous 95 years. Is that reasonable? Do we just tell our parents and grand parents sorry we can't afford you so just go home and die?

Do we just set an arbitrary number? Do we just say healthcare in Germany costs half of what it does here so we are going to set medicare taxes to raise $1.675 trillion (a huge fucking increase) and call it good? The revenue target might be reasonable, but I don't know if many of our healthcare providers could survive if we cut their revenues in half. I was at the smaller of our two local hospitals last Friday. While there I walked through the doctor's parking area. I was surprised by the large percentage of old Buicks and worn old Toyotas I saw. Our doctors and hospitals have to carry huge amounts of liability insurance to protect them. Many of the doctors graduate college with a medical degree and hundreds of thousands of dollars worth of debt that most doctors in Germany don't have. How do we insure they make enough revenue to survive? Many healthcare providers, especially the young ones don't make so much money that they can afford to see their income cut in half. How do we protect them?

It's a complex problem. There is no easy way to implement a sustainable single payer system in the US without putting the health of our healthcare system at risk. It can be done, but it is going to require some fundamental changes in other areas such as education and tort reform. Changes like that take time and careful planning. I have my doubts whether or not our elected government is up to task even if they had the will.

[John V]

FIFY
Um, I still pay taxes.  My money is still being spent. Is this also about where other people's taxes are spent? I guess we discussed it both ways, how taxes as a whole should be spent, and how we would prefer our own personal taxes are spent. 

By acting like we are only discussing other people's money, you are completely strawmanning.  As if we all don't get a say in a democracy.  As if it were selfish to desire everyone to pay a fair share. That is what your strawman incorrectly implies.

Nope, it's still other.

What you're not getting is that, if government only does the things that it absolutely has to (and while there's not perfect agreement on what those things are, there's reasonably broad agreement), then you get to keep more of your own money - and you can do with it as you please, rather than debating about it with other people.

Instead of saying what you'd like done with your tax dollars, you'd simply be saying what you'd like done with your own dollars - and then you could just do it.

Simple example: if government cuts funding for the arts and reduces taxes accordingly, you could give your tax reduction to the arts if you like. Or to scientific research. Or to feed the hungry. Or just blow it on yourself. No need to reach agreement with other people.

The only reason not to prefer such a system is that you don't think people as individuals will give enough to causes you like - in other words, because you want to spend other people's money.

FTR, I'd like to see higher taxes on the rich. I don't have a problem spending other people's money. The difference is that I'm honest about what's actually happening.

[pocaracas]

In Portugal, every medical procedure is on a table together with its cost. This cost is, of course, agreed with the medical order, but the table is set by the government and those costs cannot be unreasonable as they are used for the annual health budget on public hospitals and clinics.

From what you say, pappy, it seems to me that these procedures are somewhat more expensive in the US than elsewhere.
What's the reason for such an extra cost?
From my uninformed POV, I think it has to do with the fact that American hospitals are private for-profit companies. Couple that with the existence of insurance and the hospitals end up charging almost whatever they want.... regardless of the actual cost of each procedure. The insured patient only has to worry about having that particular procedure covered.
Who is insured? mostly workers that have insurance as part of their income... and rich people...


With a table set by the government, for use in public hospitals, you get to apply only reasonable prices to the required procedures.
This cost is mostly covered by our Social Security budget.
It's not a perfect system, but it helps regulate healthcare prices.

I don't know how that could be translated to the US reality... but I do believe that it would require a massive restructuring of healthcare... do you guys have public hospitals at all?

[dyresand]

i would like my tax dollars to go here not in any specific order

Healthcare
NASA
Education / free college
Infrastructure
Fire/Police

[downbeatplumb]

According to the article I just read America spent $3.35 trillion on healthcare in 2016. According to them that's $10,335 per person. That's $3.35 trillion divided by everybody so it includes a bunch of people that needed reasonable healthcare, but didn't get it because they couldn't afford it. If they had gotten care the bottom line would have been larger. The article also said we could expect a 4.8% inflation rate for healthcare. Tie that to a 0.7% population growth rate and by 2050 we are looking at $20.9 trillion total and $50,886 each per year not including the percentage of people that don't get healthcare today. That is unsustainable so I guess we'd be safe calling it unreasonable.

So how do you determine what it would take to provide reasonable care for people? A large percentage of the cost is driven by care for old and dying people. A few years back we lost my 95 year old uncle. The bill for his healthcare the last for weeks of his life was probably more than the cost for the previous 95 years. Is that reasonable? Do we just tell our parents and grand parents sorry we can't afford you so just go home and die?

That is because America has managed to make the most expensive but least effective healthcare system in the world.

The rest of the world seems to have been able to manage it but the US seems to think it is an insoluble problem.

The NHS isn't perfect, but I have had one operation. My eldest son has metal rods in his arm and my middle son has spent months in traction. My mother had cancer treatment as did my granddad and all of this at zero cost to my family. Ifthis had been America it would have ruined me but all we had to face was the trauma of the illness without the additional burden of debt.

I fail to see how the US tolerates its system

Do we just set an arbitrary number? Do we just say healthcare in Germany costs half of what it does here so we are going to set medicare taxes to raise $1.675 trillion (a huge fucking increase) and call it good? The revenue target might be reasonable, but I don't know if many of our healthcare providers could survive if we cut their revenues in half. I was at the smaller of our two local hospitals last Friday. While there I walked through the doctor's parking area. I was surprised by the large percentage of old Buicks and worn old Toyotas I saw. Our doctors and hospitals have to carry huge amounts of liability insurance to protect them. Many of the doctors graduate college with a medical degree and hundreds of thousands of dollars worth of debt that most doctors in Germany don't have. How do we insure they make enough revenue to survive? Many healthcare providers, especially the young ones don't make so much money that they can afford to see their income cut in half. How do we protect them?

It costs more in the US because it has been allowed to become a business and not a service, the Doctors may not be the ones that benefit but sure as shit the money is being syphoned off somewhere.

It's a complex problem. There is no easy way to implement a sustainable single payer system in the US without putting the health of our healthcare system at risk. It can be done, but it is going to require some fundamental changes in other areas such as education and tort reform. Changes like that take time and careful planning. I have my doubts whether or not our elected government is up to task even if they had the will.

Find out how much it costs and get that back in tax, preferably from the extremely wealthy.

[popeyespappy]

In Portugal, every medical procedure is on a table together with its cost. This cost is, of course, agreed with the medical order, but the table is set by the government and those costs cannot be unreasonable as they are used for the annual health budget on public hospitals and clinics.

From what you say, pappy, it seems to me that these procedures are somewhat more expensive in the US than elsewhere.
What's the reason for such an extra cost?
From my uninformed POV, I think it has to do with the fact that American hospitals are private for-profit companies. Couple that with the existence of insurance and the hospitals end up charging almost whatever they want.... regardless of the actual cost of each procedure. The insured patient only has to worry about having that particular procedure covered.
Who is insured? mostly workers that have insurance as part of their income... and rich people...


With a table set by the government, for use in public hospitals, you get to apply only reasonable prices to the required procedures.
This cost is mostly covered by our Social Security budget.
It's not a perfect system, but it helps regulate healthcare prices.

I don't know how that could be translated to the US reality... but I do believe that it would require a massive restructuring of healthcare... do you guys have public hospitals at all?

I've already mentioned a couple of the big additional cost drivers in liability insurance and education costs.

Profits of health insurance and health providers are of course another target for cost reduction. But those profits are probably not as big a portion of the overall cost as many assume. For one thing only 18% of American Hospitals operate as for profit enterprises. 20% are government facilities, and 62% of American hospitals operate as non-profits. So in 82% of our hospitals there are no profit margins to cut. The 18% that do operate as for profits average a little less than a 9% margin. That means the most savings you could see cutting the profits of hospitals would be 1.62% of the total. Reality is it would be a lot less than that because hospital revenue doesn't account for 100% of the total cost.

Insurance companies operate at a lower margin than hospitals. According to some sources as low as 3.3%. But once again health insurance revenues aren't even close to 100% of the total so zeroing out those margins altogether might save another 1.6% of the total. Best case scenario we'd probably be looking at a 3% savings by getting rid of hospital and health insurance profits. Maybe none at all if the government can't manage billing and payments at least as efficiently as the for profits.

Drug company margins are another cost reduction target. One that could pay some substantial dividends since US pharmaceutical companies averaged a 23.5% margin last year. But once again drug costs account for less than 10% of total healthcare expenditures so at the most we'd be looking at a 2.35% savings off the bottom line. Add all those profits together and we'd be looking at a maximum savings of maybe 6%. That would have brought last years per capita healthcare expansive down from $10,335 to $9,715. It is something but not nearly enough to supply healthcare to Americans that don't currently get any without raising the overall cost.

[Thumpalumpacus]

Hookers and blow, hell yeah.