The Trump Crime Family

[sambuca]

By the way have you ever look at the amount of immigrants or son of immigrants in the list if self made millionnaires and billionnaires Many! You wont find Trump tho haha The problem I am trying to point out is you cannot count on them to have a great society. They and will always remain a minority. The inequities is what is killing America right now. I will say it again... No free education and no free healthcare in a country like the US is absurd. And it will gt worse.

Free education and free healthcare are very good goals, but of course the devil is in the details. Just the declaration sounds too much like Bernie Sanders. Everyone might have idealistic views of what this means. A University Chancellor might think it means he can charge whatever he wants and the government will underwrite a student's expenses. Rosbos' example points out the flaw in what Rand Paul calls enslaving doctors and other healthcare providers in a single-payer system. Either way there will be some sort of rationing which isn't always a bad thing. The rich will always get excellent healthcare and excellent educations. This probably pisses off the far left. We would almost have to adopt communism to stop the rich from getting better healthcare and education than the average person.

Income inequality exists in the U.S and it is at historically high levels. It's happened before in history. Democracies are incredibly adaptable. I am confident they will ameliorate the negative effects of income inequality. Like Rosbos, I am also optimistic about technological advancements. We shouldn't fear accelerating productivity. Productivity is what made people comfortable and rich in advanced societies.

 

[sambuca]

Communism reorders the hierarchy. And I think we are all saying the new rich under communism, the Communist party leaders, get better healthcare and educations. I don't think Nicholas Romanov II felt like he received good healthcare under Communism.

My broader point is that if the government tries to control all healthcare and outcomes people with money will get on a plane and get treatment somewhere else unless you restrict their freedom. Just to try to close off this tangent, China is not communist although party leaders do very well.

 

[sambuca]

I agree with you Sam21 and Jalimon that the U.S. needs some type of Universal healthcare program. Obamacare was a step in that direction, but I think some technocrats got a hold of it and made it unduly complicated and punitive to the healthy, uninsured middle class. The words "free healthcare" are dangerously in the category of be careful for what you wish. We can learn from Canada, but many Americans are use to having more freedom of choice. I've believe employers large and small would love to get out from under this quasi-obligation. The belief employers like to use healthcare as a way to compete for talent is a load of crap. They would much rather get out of this administrative burden and just compete for talent with good old-fashion salary, bonus, etc. I still like a system where people have some skin in the game (i.e. copays) with their healthcare.

We can go on and on about Big Pharma's pricing and Big Insurance's large middleman cut which I think any real reform will need to also address.

 

[Sol Tee Nutz]

I have read the last couple of pages, it does not matter if you are left or right you all must agree that our governments cost us too much to afford " free " education and healthcare. I know the Americans are lower in taxes but the average Canadian pays 56% of their wages in some tax be it income or housing or gas etc. Looking at Denmark all this free stuff does have drawbacks, long term students, people on the border of working or not.. too much free stuff to need to work, students taking courses that will not get them a job in the future just to get the benefits. Free stuff also invites freeloaders who look for " free " stuff, look at the illegals ( sorry, irregulars ) coming into Canada. Jaliman mentioned the many who became millionaires or billionaires (I would like to see proof of that number but ) look at all the parasites who plan to abuse the system, will all their counrtypeople pay their way? No taxpayers pay for it. I have also read some reports that " free "education should only be given to those making less than $125K... fuck the over $125K are the ones paying the major portion.
If you do not earn it you do not respect it.

 

[sambuca]

I'm not sure any of us Conservatives would disagree with you Sam21. One of the arguments against expanding government is that it is always leads to inefficiencies and prone to manipulation. Conservatives typically like or tolerate defense spending, but I'm sure most of us would admit the inherent graft and redundancies.

 

[EagerBeaver]

I disagree , if our governments and asshole politicians, be it left or right stopped paying back to all the crooked lobbyists and special interest groups that got them elected then there would be sufficient funds for free or at least an affordable health care and education system.
Unfortunately it is a viscous circle where only the scum rises to the top.

The problem is politicians are the scum of the earth and they will sell their soul to get elected and they are not concerned about the people they are supposed to be working for.
It is all about power, ego and money.

Your point about vicious circle is especially true. The Repulicans in the USA Congress who all scream and stomp for tax cuts and cuts in government spending all know that if they do not bring federal money into their Congressional District, their asses are not getting reelected. So very quietly they bring in that federal money in subsidies, defense spending in many cases, federal jobs with government contractors, etc. and the culture of spending is perpetuated, even by the hypocritical Republicans.

Healthcare has come to the forefront because we have an aging population, which is not working and is requiring extrardinary sums be expended on their healthcare. Back when our Great-Grandparents were alive, people lived to age 65, and worked all their lives. Now people are living to 90, not working after 65-70 and spending the rest of their lives racking up medical bills, in some cases with a very good quality of life and in some cases not. Families are experiencing increasing strife over the costs and management of the healthcare of older relatives. One of my buddies, a US federal employee ironically, is watching in horror as his wife battles with her family over caring for inlaws in their late 80s, one of whom had a stroke and requires skilled care, the other with congestive heart disease. These people probably should be in assisted living but they do not want to go ("I am gonna die in my house!!!!!!!!!!") and the family rages over who should do what, who should pay, and where they should be. Unfortunately I am, at the moment, dealing with similar issues in my own family. These are difficult issues and ones that we as a society simply have not figured out, and IMHO none of the politicians seems to be trying. It's too hard, too messy, too complicated.

 

[Sol Tee Nutz]

I disagree , if our governments and asshole politicians, be it left or right stopped paying back to all the crooked lobbyists and special interest groups that got them elected then there would be sufficient funds.

Disagree? Same as I said but worded different, expensive government, the cost to be the boss.

 

[sambuca]

Sol Tee Nuts, you always bring a Conservative view with a lot of gusto. I don't always agree with your arguments. I think the U.S. has a lot of free healthcare and free education. We don't manage the crazy quilt work of direct programs and tax subsidies very well. Our health care system is fragmented and overly complex with more uninsured than other developed countries. I'm pretty sure the Republicans don't want the govt. programs to work better. The Dems just want to throw more money at them. Libertarians fantasize about their demise. Socialists dream about it all being free for everyone perhaps even anyone who can get their ass across the border.

I like to compare countries in terms of % of GDP. While it's a bit simplistic, it can give you a decent idea how things are working in each country. I don't know about your 56% tax rate, but I've read from a few sources that Canada's govt. spends about 40% of GDP (seems a bit light). The U.S. govt. spends 36% of GDP.

If Canada spends 10% of GDP and healthcare and the U.S. spends 18% of GDP, that seems like a giant fail for the United States. Health outcomes don't seem all that different even when comparing the two countries' middle class populations.

The U.S. spends 2.5% of GDP more than Canada on defense spending so disregarding that I'm estimating that govt. spending as a % of GDP is 7-10% higher in Canada. This differential covers all or most your healthcare which seems to be far more efficient than the U.S. The U.S. combined governments spend almost 7% of GDP on healthcare. Private parties are paying over 11% of GDP for healthcare. Again, our healthcare system doesn't seem to be working.

 

[rumpleforeskiin]

The difference between communism and capitalism? Communism is the exploitation of man by man. Capitalism is the reverse.

 

[EagerBeaver]

If Canada spends 10% of GDP and healthcare and the U.S. spends 18% of GDP, that seems like a giant fail for the United States. Health outcomes don't seem all that different even when comparing the two countries' middle class populations.

Look at the 60 year trend on USA % of GDP spent on healthcare. It's not pretty:

https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/

More like 20% projected by CMS by 2025:

https://www.advisory.com/daily-briefing/2017/02/16/spending-growth

 

[Sol Tee Nutz]

. I think the U.S. has a lot of free healthcare and free education. .

I am not too up on the US healthcare and education, from what I understand the US is the same as Canada until high school is over, included in your taxes, your quality universities are a lot more expensive, not sure about college. My daughter asked me last week if she can take university away from Quebec, I said it is not a problem but she will have to pay the costs that would be higher than Quebec as I would pay for all here. After some Googling for cost difference by her she decided to stay in Quebec. As for healthcare, there must be hospitals that treat people who do not have healthcare in the US, has to be. Anyways, I have friends in the states who say they get insurance through their companies as perks, even without the insurance cost is not that expensive if you take a higher deductible. Pretty sure if we were given back in taxes what the government charges us we would have enough for decent insurance. Critics of Canada's single-payer health-care system call it a "cautionary tale," one that's "failing." It's universal and affordable, sure, but the quality isn't high. And the waits for procedures can be unnecessarily long: As Forbes points out, "In 2013, the average wait time for an MRI was over two months, while Canadians needing a CT scan waited for almost a month." I have friends that since they could afford it travel to the US for operations that could not be done in Canada, life saving operations.
The Obama plan would have been way to expensive for the average family within 5 years if it lasted longer. Trump had no real replacement plan, just an idea.
Still think that Trump was a better choice for working Americans over HRC.

 

[sambuca]

As for healthcare, there must be hospitals that treat people who do not have healthcare in the US, has to be. Anyways, I have friends in the states who say they get insurance through their companies as perks, even without the insurance cost is not that expensive if you take a higher deductible.

Conservative Republicans naively cling to your belief "there must be hospitals that treat people who do not have healthcare." It's never been a given and its changed rapidly as the number of non-profit hospitals have declined. The number of Catholic and Lutheran run hospitals have declined significantly. Many poor, uninsured people show up at emergency rooms. Unless it's an immediate life threatening situation, many hospitals will try to shuffle the uninsured off to another hospital. There are some state and local government hospitals, but they are patchwork across the country. If a non-government hospital treats the uninsured, they try to pass the cost along to the insured patients. Insurance companies have pushed back on these pass-ons over the years.

I'm not going to wax here about how proper preventative care reduces healthcare costs, because I don't think that has been demonstrated.

Most of us get good insurance through our employer, but that doesn't mean it isn't expensive. Someone is paying for it and it's increasing faster than inflation. That's why the portion of GDP expended is an interesting vantage point to look at the success of a nation's healthcare system. I realize some Canadians pursue private healthcare, but it isn't anywhere near the 8% of GDP that the United States spends more than Canada. Besides the inevitable criticisms of your health system, Canadians' life expectancy seems to be increasing and is almost three years longer than Americans.

I don't think Americans want the entire Canadian system and the lack of freedom, but we probably need a Federal solution to provide more access instead of shuffling costs around like a shell game. We also need to find non-market ways to try to drive down costs and inefficiencies. Healthcare providers and health insurance are extremely resistant to market forces unless you take draconian measures that basically have people pay for their own healthcare and ignore the sick and families without resources.

Don't forget that both U.S. political parties are deeply influenced by the Pharma and Insurance industry lobbies. It's easy to understand how Pharma companies make huge margins. What's lesser understood is how big health insurers earn far too generous margins acting basically as a middleman. We now realize in the U.S. that consolidation of health insurers has not increased efficiency nor lower costs to premium payers.

 

[EagerBeaver]

Sambuca is correct and unlike many of you I am at the frontlines of trying to get medical treatment for clients and others who don’t have healthcare insurance. Had a client a few years ago who had no insurance and not Medicaid eligible. She was a legal resident of the USA who came on a student visa, graduated from college and couldn’t get a job. This was in part due to the fact that she had a worthless liberal arts degree and partly due to her accent. Green card status lasts for 6 months after graduation and if you don’t have a job by then you are illegal. So here it was that she had no insurance, no job, no green card and she needed a very serious surgery. The only reason that the hospital accepted her as a patient is that a neurosurgeon authored a report saying the surgery had to be done on an emergency basis or she would become a cripple.

For every client like that there are 10 who don’t have the opinion that the treatment is needed on an emergency basis even though people need surgery and other medical treatment. So it’s basically false to think that you can show up and get needed treatment. The Republican Plan is for only the rich and the insured to get medical treatment and everyone else goes out in the street.

 

[anon_vlad]

Glaring Conflict of Interest

Last week, the Trump organization received a loan https://www.vox.com/2018/5/21/17375900/trump-trade-lido-city-indonedia , in effect, from the Chinese government. By an amazing coincidence, Trump has backed off the trade war with China and, in particular, eased sanctions against a Chinese company which had done business with Iran. Fox and Breitbart didn't even bother trying to spin this, opting to ignore it.

Conservative or liberal, it should concern all that U.S. foreign policy is conducted for the benefit of the family pocketbook.

 

[sambuca]

Last week, the Trump organization received a loan https://www.vox.com/2018/5/21/17375900/trump-trade-lido-city-indonedia , in effect, from the Chinese government. By an amazing coincidence, Trump has backed off the trade war with China and, in particular, eased sanctions against a Chinese company which had done business with Iran. Fox and Breitbart didn't even bother trying to spin this, opting to ignore it.

Conservative or liberal, it should concern all that U.S. foreign policy is conducted for the benefit of the family pocketbook.

An overly simplistic analysis given he's the first President to push back hard on China and one of his top economic advisors resigned over this fight. Trump's Treasury Secretary (former investment banker) also wants a quick compromise.

This type of analysis misses the full complexity of international relations. Trump is trying to negotiate trade with China while he's also trying to get China to apply pressure to North Korea. I've always suspected that China tolerated a misbehaving North Korea because it was an excellent bargaining chip with the U.S., South Korea and Japan.

 

[sambuca]

Do not get confused by employer provided coverage in the U.S. The number of employers offering health insurance was steadily declining before Obamacare. Employer provided heath insurance is very much a non-taxed employee benefit for many in the the middle and upper classes in the United States. Some of the working class have it provided, but many of this group are in unions.

 

[anon_vlad]

An overly simplistic analysis given he's the first President to push back hard on China and one of his top economic advisors resigned over this fight. Trump's Treasury Secretary (former investment banker) also wants a quick compromise.

Obviously, any decision in the realm of international relations is complex as it requires balancing the interests of multiple players. The point is that it is difficult even for the best of us to make a decision in the best interests of our country when offered a $500 million loan by one of the interested parties. Even Trump himself recognized that when he promised at the beginning of his term that his company would not enter into any new foreign deals. He dropped his pledge when he realized (and publically stated) he could get away with breaking it.

In Canada, it is customary for ministers (including the prime minister) to puts their assets in a blind trust while in office and recuse themselves from decisions if an appearance of conflict of interest could be perceived. The imposition of sanctions on Qatar after a loan was refused by them to his son in law is another example of a decision which is hard to perceive as only motivated by the best interests of the US.

Yes, it is simplistic to suggest that a conflict of interest led to a dishonest decision. However, given Trump's reputation, I doubt if even the majority of his supporters imagine that, when faced with a choice of what is best for his country and what is best for his pocketbook, that the former would trump the latter.

 

[jalimon]

Anon_vlad Trump did not release his taxes filling. One day we will discover why the russian played such a big part in this election. Trump has no clue what a conflict of interest is. For him its routine business. He lied 11 times last Sunday morning in a burst of tweet. Lying until the lie becomes the truth... In the US everything is about cash. This is the country of "la fin justifie les moyens".

Cheers,

 

[Carmine Falcone]

Sambuca is correct and unlike many of you I am at the frontlines of trying to get medical treatment for clients and others who don’t have healthcare insurance. Had a client a few years ago who had no insurance and not Medicaid eligible. She was a legal resident of the USA who came on a student visa, graduated from college and couldn’t get a job. This was in part due to the fact that she had a worthless liberal arts degree and partly due to her accent. Green card status lasts for 6 months after graduation and if you don’t have a job by then you are illegal. So here it was that she had no insurance, no job, no green card and she needed a very serious surgery. The only reason that the hospital accepted her as a patient is that a neurosurgeon authored a report saying the surgery had to be done on an emergency basis or she would become a cripple.

I work for a hospital. Your client could have gone to the ED and hospitals are prohibited from turning her away under EMTLA. You're a lawyer so you obviously know more about the law than I do if that would have worked. Hospitals are as much a part of the healthcare problem. The number one reason for personal bankruptcy in the US is medical bills.

As an aside, when Sambuca says things like he can't vouch for preventative care because it has not been demonstrated to reduce costs only illustrates why it's best to let people believe what they want to (and not argue) even in the face of overwhelming evidence to the contrary.

To pick one easy example, diabetes and high blood pressure caught early can be controlled with relatively cheap medication. Intractable diabetes and high blood pressure due to failure to catch it early leads to dialysis (from kidney failure). Dialysis costs anywhere from $50,000-$75,000 per year but it's covered in part by Medicare. You pay the rest (20%). If you're lucky enough to get a kidney transplant, cost of surgery is over $200,000. And then there are the immunosuppressive drugs you have to take forever to maintain your graft (even if you're a perfect match to your donor); that only costs about $15,000 per annum. Some of the surgery and post-transplant drugs will be offset by insurance, but you'll be mistaken if you think that you won't be paying a lot of money even with insurance. On the other hand if the ailment had been corralled earlier, it's pennies compared to the scenario I just posed. A generic diuretic for high blood pressure costs $10 for for a 90 day supply without insurance. I deal with countless patients in the scenario I laid out above. Preventative care saves money and lives. As a rule, I can't think of a single situation not related to healthcare where the solution costs the same even when the problem has worsened. And that's exactly what happens when health problems aren't handled early: they get worse.

 

[EagerBeaver]

I work for a hospital. Your client could have gone to the ED and hospitals are prohibited from turning her away under EMTLA. You're a lawyer so you obviously know more about the law than I do if that would have worked. Hospitals are as much a part of the healthcare problem. The number one reason for personal bankruptcy in the US is medical bills.

It would not have worked in this case, as simple as you describe, although what ended up happening was sort of the situation you describe. Generally under these facts, you can't show up at an ER, snap your fingers and ask for a lumbar fusion surgery to be performed because you are in pain. First of all you need a neurosurgeon skilled to perform the surgery and there may not be one on duty. Secondly the hospital has to hire a nerve damage monitoring team because a major complication of the surgery is permanent "battered root syndrome", meaning the trauma of surgery damages your nerves so that you have paresthesias and pain in the lower extremities (shooting pain and numbness from the ass down through your legs) the rest of your life. There are other complexities to that surgery that are beyond the scope of this discussion.

Although it has been a few years now, my recollection is the client had been pre-approved for surgery. The neurosurgeon authored a report saying why the surgery had to be done on an emergency basis, and the hospital approved the client despite the fact she had no health insurance and was ineligible for Medicaid. No date had been set for the surgery, however. The client then reported to the ER in excruciating pain on a Tuesday. She was submitted for pre surgical testing that day, and had the surgery on a Wednesday. This was possible only because the neurosurgeon had just returned from a vacation and was actually in town and on call. The client had some routine complications, and was released on a Saturday. The total bill was $165,000 which did not include anesthesiologist or nerve damage monitoring team or the neurosurgeon's bill. When those were lumped in it was just under $200,000.00.

Had the client not been pre-approved for surgery and had the neurosurgeon still been away on vacation, I do not know what would have happened. My guess is she would have waited days before another neurosurgeon got lined up, while she got pre-approved. Had the surgery not been needed on an emergency basis, who knows how long she would have waited.