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ACA Repeal/Replace: Progressives Face Moral Dilemma
#41
(01-16-2017, 03:09 AM)Classic-Xer Wrote: It would be nice if those developed nations weren't so reliant upon us for their national security and so forth. How many large global commitments and defense agreements does the government France or any of the other developed nations have tied to them financially?

You might have done better citing the Germans. The French, and the Brits, pay their own way.  Even more to the point, the Swedes, who are neutral, spend more as a percentage of GDP than we do, but they seem to be able to fund entitlements just fine.
Intelligence is not knowledge and knowledge is not wisdom, but they all play well together.
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#42
(01-15-2017, 10:58 PM)Warren Dew Wrote: Expecting welfare and entitlement recipients to have respect for taxpayers is like expecting slaveowners to have respect for their slaves.
That is a very strong statement. I personally find it offensive to have taxpayers compared to slaves and welfare and entitlement recipients compared to slaveowners. Most people on welfare want to work, want to get off of welfare. And comparing taxpayers to slaves? Really???

I had to respond.
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#43
(01-16-2017, 01:10 PM)David Horn Wrote:
(01-16-2017, 03:09 AM)Classic-Xer Wrote: It would be nice if those developed nations weren't so reliant upon us for their national security and so forth. How many large global commitments and defense agreements does the government France or any of the other developed nations have tied to them financially?

You might have done better citing the Germans. The French, and the Brits, pay their own way.  Even more to the point, the Swedes, who are neutral, spend more as a percentage of GDP than we do, but they seem to be able to fund entitlements just fine.

I think we need to shut down the MIC and redirect the funds myself.  And here's a good one.  Here's a list of Senators who've whored themselves out to Big Pharma.

http://www.cnbc.com/2017/01/13/bernie-sa...ntary.html

For the people


Grouped By Vote Position
YEAs ---46
Baldwin (D-WI)
Blumenthal (D-CT)
Boozman (R-AR)
Brown (D-OH)
Cardin (D-MD)
Collins (R-ME)
Cortez Masto (D-NV)
Cruz (R-TX)
Duckworth (D-IL)
Durbin (D-IL)
Flake (R-AZ)
Franken (D-MN)
Gillibrand (D-NY)
Grassley (R-IA)
Harris (D-CA)
Hassan (D-NH)
Heller (R-NV)
Hirono (D-HI)
Kaine (D-VA)
Kennedy (R-LA)
King (I-ME)
Klobuchar (D-MN)
Leahy (D-VT)
Lee (R-UT)
Manchin (D-WV)
Markey (D-MA)
McCain (R-AZ)
McCaskill (D-MO)
Merkley (D-OR)
Murkowski (R-AK)
Murphy (D-CT)
Nelson (D-FL)
Paul (R-KY)
Peters (D-MI)
Reed (D-RI)
Sanders (I-VT)
Schatz (D-HI)
Schumer (D-NY)
Shaheen (D-NH)
Stabenow (D-MI)
Thune (R-SD)
Udall (D-NM)
Van Hollen (D-MD)
Warren (D-MA)
Whitehouse (D-RI)
Wyden (D-OR)
-----------------------------------------------------------------------------
Big Phama Whores

NAYs ---52
Alexander (R-TN)
Barrasso (R-WY)
Bennet (D-CO)
Blunt (R-MO)
Booker (D-NJ)
Burr (R-NC)
Cantwell (D-WA)
Capito (R-WV)
Carper (D-DE)
Casey (D-PA)
Cassidy (R-LA)
Cochran (R-MS)
Coons (D-DE)
Corker (R-TN)
Cornyn (R-TX)
Cotton (R-AR)
Crapo (R-ID)
Daines (R-MT)
Donnelly (D-IN)
Enzi (R-WY)
Ernst (R-IA)
Fischer (R-NE)
Gardner (R-CO)
Graham (R-SC)
Hatch (R-UT)
Heinrich (D-NM)
Heitkamp (D-ND)
Hoeven (R-ND)
Inhofe (R-OK)
Isakson (R-GA)
Johnson (R-WI)
Lankford (R-OK)
McConnell (R-KY)
Menendez (D-NJ)
Moran (R-KS)
Murray (D-WA)
Perdue (R-GA)
Portman (R-OH)
Risch (R-ID)
Roberts (R-KS)
Rounds (R-SD)
Rubio (R-FL)
Sasse (R-NE)
Scott (R-SC)
Shelby (R-AL)
Sullivan (R-AK)
Tester (D-MT)
Tillis (R-NC)
Toomey (R-PA)
Warner (D-VA)
Wicker (R-MS)
Young (R-IN)

Not Voting - 2
Feinstein (D-CA)
Sessions (R-AL)


* Cotton is just an overall fuckwad
* Booker just flushed his future away
* Both my Senators are overall fuckwads
---Value Added Cool
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#44
(01-16-2017, 03:31 PM)The Wonkette Wrote:
(01-15-2017, 10:58 PM)Warren Dew Wrote: Expecting welfare and entitlement recipients to have respect for taxpayers is like expecting slaveowners to have respect for their slaves.
That is a very strong statement.  I personally find it offensive to have taxpayers compared to slaves and welfare and entitlement recipients compared to slaveowners.  Most people on welfare want to work, want to get off of welfare.  And comparing taxpayers to slaves?  Really???

I had to respond.

It's an accurate statement and comparison to make with another conservative. You must not notice the strong feeling *fake sense* of entitlement that exists on your side. I'm sure you hear that a lot but you probably don't see it happening a lot. I've seen/been around enough poverty to form a strong impression that it has become a fairly comfortable lifestyle for most in suburban and rural areas.
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#45
Typical phony resentment by trickle-downers and libertarian economics believers. The dog whistle of "dependency" and individual responsibility. It's killing us; it's reprehensible. And there's little more that can be said about it that hasn't been said a million times.
"I close my eyes, and I can see a better day" -- Justin Bieber

Keep the spirit alive;
Eric M
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#46
Shame on Booker. Remember I have downgraded his horoscope rating; I don't give him any chance at the presidency.
"I close my eyes, and I can see a better day" -- Justin Bieber

Keep the spirit alive;
Eric M
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#47
(01-16-2017, 05:19 PM)Ragnarök_62 Wrote:
(01-16-2017, 01:10 PM)David Horn Wrote:
(01-16-2017, 03:09 AM)Classic-Xer Wrote: It would be nice if those developed nations weren't so reliant upon us for their national security and so forth. How many large global commitments and defense agreements does the government France or any of the other developed nations have tied to them financially?

You might have done better citing the Germans. The French, and the Brits, pay their own way.  Even more to the point, the Swedes, who are neutral, spend more as a percentage of GDP than we do, but they seem to be able to fund entitlements just fine.

I think we need to shut down the MIC and redirect the funds myself.  And here's a good one.  Here's a list of Senators who've whored themselves out to Big Pharma.

http://www.cnbc.com/2017/01/13/bernie-sa...ntary.html

For the people


Grouped By Vote Position
YEAs ---46
Baldwin (D-WI)
Blumenthal (D-CT)
Boozman (R-AR)
Brown (D-OH)
Cardin (D-MD)
Collins (R-ME)
Cortez Masto (D-NV)
Cruz (R-TX)
Duckworth (D-IL)
Durbin (D-IL)
Flake (R-AZ)
Franken (D-MN)
Gillibrand (D-NY)
Grassley (R-IA)
Harris (D-CA)
Hassan (D-NH)
Heller (R-NV)
Hirono (D-HI)
Kaine (D-VA)
Kennedy (R-LA)
King (I-ME)
Klobuchar (D-MN)
Leahy (D-VT)
Lee (R-UT)
Manchin (D-WV)
Markey (D-MA)
McCain (R-AZ)
McCaskill (D-MO)
Merkley (D-OR)
Murkowski (R-AK)
Murphy (D-CT)
Nelson (D-FL)
Paul (R-KY)
Peters (D-MI)
Reed (D-RI)
Sanders (I-VT)
Schatz (D-HI)
Schumer (D-NY)
Shaheen (D-NH)
Stabenow (D-MI)
Thune (R-SD)
Udall (D-NM)
Van Hollen (D-MD)
Warren (D-MA)
Whitehouse (D-RI)
Wyden (D-OR)
-----------------------------------------------------------------------------
Big Phama Whores

NAYs ---52
Alexander (R-TN)
Barrasso (R-WY)
Bennet (D-CO)
Blunt (R-MO)
Booker (D-NJ)
Burr (R-NC)
Cantwell (D-WA)
Capito (R-WV)
Carper (D-DE)
Casey (D-PA)
Cassidy (R-LA)
Cochran (R-MS)
Coons (D-DE)
Corker (R-TN)
Cornyn (R-TX)
Cotton (R-AR)
Crapo (R-ID)
Daines (R-MT)
Donnelly (D-IN)
Enzi (R-WY)
Ernst (R-IA)
Fischer (R-NE)
Gardner (R-CO)
Graham (R-SC)
Hatch (R-UT)
Heinrich (D-NM)
Heitkamp (D-ND)
Hoeven (R-ND)
Inhofe (R-OK)
Isakson (R-GA)
Johnson (R-WI)
Lankford (R-OK)
McConnell (R-KY)
Menendez (D-NJ)
Moran (R-KS)
Murray (D-WA)
Perdue (R-GA)
Portman (R-OH)
Risch (R-ID)
Roberts (R-KS)
Rounds (R-SD)
Rubio (R-FL)
Sasse (R-NE)
Scott (R-SC)
Shelby (R-AL)
Sullivan (R-AK)
Tester (D-MT)
Tillis (R-NC)
Toomey (R-PA)
Warner (D-VA)
Wicker (R-MS)
Young (R-IN)

Not Voting - 2
Feinstein (D-CA)
Sessions (R-AL)


* Cotton is just an overall fuckwad
* Booker just flushed his future away
* Both my Senators are overall fuckwads


--- Booker the  BigPharma Hooker sure screwed himself ovah this time. Not even standing up for John Lewis could turn his Pharmass around
Heart  Bernie/Tulsi 2020    Heart
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#48
(01-16-2017, 03:09 AM)Classic-Xer Wrote: It would be nice if those developed nations weren't so reliant upon us for their national security and so forth. How many large global commitments and defense agreements does the government France or any of the other developed nations have tied to them financially?

France actually interferes with its former colonies quite a bit.

More importantly, though, the security that we provide, they pay us for.

The fact that the US is "the world's policeman" is closely related to the fact that the US dollar is the world's reserve currency. That means total reserves of US dollars held by other nations are much larger than reserves of other currencies held by the US.

Inflation of the US dollar is effectively a tax on dollar holdings, including those dollar reserves held by other countries. Last I checked, a few years ago, a 2% inflation rate "tax" on foreign net reserves of US dollars a good fraction of the US defense budget.

I think that's a reasonable deal. The way I think of it is that we use our Navy to keep trade routes open and safe for everyone and they pay for our Navy.
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#49
(01-17-2017, 01:01 AM)Marypoza Wrote: <snip>

--- Booker the  BigPharma Hooker sure screwed himself ovah this time. Not even standing up for John Lewis could turn his Pharmass around

Yeah, I can see any opponent using that line [Booker, the Big Pharma Hooker. ] Cool Big Grin

Now, as for my 2 yahoo Senators of the Republican persuasion, the question I pose is this:

As proponents of free markets and deregulation, why are you supporting this ban on free drug trade and REGULATIONS that forbid folks from getting cheaper drugs [a free market benefit? no????] and do not allow Medicare to have a bidding process to get the best deal? Hmmmmmmmmmmmmmmmmmmmmmmm??????????!!!!!!

:: Rags taps toes ::
---Value Added Cool
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#50
(01-17-2017, 12:42 AM)Eric the Green Wrote: Typical phony resentment by trickle-downers and libertarian economics believers. The dog whistle of "dependency" and individual responsibility. It's killing us; it's reprehensible. And there's little more that can be said about it that hasn't been said a million times.
It's serious resentment that exists. Internal resentment that exists within the democratic. Why am I more aware of its existence than you are? I assume that you don't hangout with the working class as much as me.
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#51
(01-16-2017, 09:50 AM)SomeGuy Wrote:
Quote:Third, if we're going to have a major revamp of the system, why not move to a genuinely free market system, or at least closer to it?

I'd be curious to see what you had in mind.  Not that I am necessarily opposed, mind you.

In an ideal world, the government - or the federal government, at least - would just get out of medical care entirely, limiting its role to safety regulations.

The big problem with our present system is the economic distortion introduced when the beneficiary of a product is different from the payer of the product.  That's a recipe for overconsumption and overcharging - or at least overpricing - and is what causes health care expenses to keep going up and up.  And we have that distortion both with government provided medicare and with employer provided health insurance, which together include the vast majority of the market.

What that means is that we spend too much on medical care, and that takes away from the money we could be spending for things like a higher quality diet that would be a more cost effective path to good health.

Return the money and control to the people, and we'll see a more rational health care system and better health.  And yes, people will likely start paying for doctors' visits and drugs out of pocket and medical insurance will likely be limited to relatively inexpensive policies that only cover catastrophic needs.

Realistically, any transition would need to be gradual.  Realistically, the best that can likely be done in the near term is to put individually purchased insurance on the same tax footing as employer provided insurance.  Then the market will gradually shift from employers paying for health insurance to employers paying that money in wages, and individuals using it for health care as appropriate.  Of course we would get rid of the current blatant interventions like Obamacare, and perhaps permit interstate competition and facilitate competition in other ways.  I'm open to keeping the "kids on the policy until 26" rule and the requirement to continue covering conditions that develop while covered by insurance, at least in the near term, but those should be viewed as insurance regulation - similar to the regulations that require life insurers to retain the reserves necessary actually to pay out on death - and not as health regulation.

Now, I'm not unsympathetic to David's argument about having paid into the Medicare system for a lifetime and deserving some return on that.  If we take literally David's argument that intergenerational transfer is legitimate, of course, then it's legitimate to say, "okay, the GIs got the benefits but didn't pay in, and the boomers are going to pay in but not get the benefit".  But from an individual fairness perspective, it's fair to give boomers Medicare coverage commensurate with what they (we) paid into the system, if not the current levels which amount to much more than they (we) paid into the system.

In order to limit costs to a reasonable level, it would probably be best to shift as many Medicare customers as possible over to Medicare Advantage type plans, where the customer gets a voucher to use toward traditional health insurance.  These plans could then get less traditional, for example paying for certain beneficial supplements and possibly even for a healthier diet and lifestyle.  The key is that the amount paid should be fixed, adjusted for inflation but not for "average" health care costs, and perhaps scaled to years in the system.  You paid in a certain amount; you get out a certain amount.

If we wanted to keep a traditional form of Medicare as well, then costs on traditional Medicare would have to be limited to the same as that for the Medicare Advantage type plans.  For example, we could seriously enforce the payment limits.  Customers would then have to choose between using low end doctors and facilities, or making up the difference themselves.
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#52
(01-16-2017, 03:31 PM)The Wonkette Wrote:
(01-15-2017, 10:58 PM)Warren Dew Wrote: Expecting welfare and entitlement recipients to have respect for taxpayers is like expecting slaveowners to have respect for their slaves.
That is a very strong statement.  I personally find it offensive to have taxpayers compared to slaves and welfare and entitlement recipients compared to slaveowners.  Most people on welfare want to work, want to get off of welfare.  And comparing taxpayers to slaves?  Really???

Lets see, if someone should refuse to pay taxes then people with guns show up and take what they want.  In effect by taking the earnings and property of another then  the taxpayer in question is working for someone they would rather not.  If the slave does not work then he is subject violence.  Its a little more roundabout being one of the tax livestock but the results are much the same which is some form of involuntary servitude.
Democracy is the theory that the common people know what they want, and deserve to get it good and hard. -- H.L. Mencken

If one rejects laissez faire on account of man's fallibility and moral weakness, one must for the same reason also reject every kind of government action.   -- Ludwig von Mises
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#53
Progressives really don't have to do anything at all. ObamaCare is going to die all on it's own once the remaining insurance providers can't keep up with the cost of providing coverage. One of them has dropped out already citing bankruptcy, and the biggest of the tax increases that will hit everybody is this year, right after Obozo has left office, just as we knew it would.
Knowledge doesn't equal Understanding, and the Truth is the Truth no matter what you think of it.
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#54
(01-17-2017, 02:51 AM)Warren Dew Wrote:
(01-16-2017, 09:50 AM)SomeGuy Wrote:
Quote:Third, if we're going to have a major revamp of the system, why not move to a genuinely free market system, or at least closer to it?

I'd be curious to see what you had in mind.  Not that I am necessarily opposed, mind you.

In an ideal world, the government - or the federal government, at least - would just get out of medical care entirely, limiting its role to safety regulations.

The big problem with our present system is the economic distortion introduced when the beneficiary of a product is different from the payer of the product.  That's a recipe for overconsumption and overcharging - or at least overpricing - and is what causes health care expenses to keep going up and up.  And we have that distortion both with government provided medicare and with employer provided health insurance, which together include the vast majority of the market.

What that means is that we spend too much on medical care, and that takes away from the money we could be spending for things like a higher quality diet that would be a more cost effective path to good health.

Return the money and control to the people, and we'll see a more rational health care system and better health.  And yes, people will likely start paying for doctors' visits and drugs out of pocket and medical insurance will likely be limited to relatively inexpensive policies that only cover catastrophic needs.

Realistically, any transition would need to be gradual.  Realistically, the best that can likely be done in the near term is to put individually purchased insurance on the same tax footing as employer provided insurance.  Then the market will gradually shift from employers paying for health insurance to employers paying that money in wages, and individuals using it for health care as appropriate.  Of course we would get rid of the current blatant interventions like Obamacare, and perhaps permit interstate competition and facilitate competition in other ways.  I'm open to keeping the "kids on the policy until 26" rule and the requirement to continue covering conditions that develop while covered by insurance, at least in the near term, but those should be viewed as insurance regulation - similar to the regulations that require life insurers to retain the reserves necessary actually to pay out on death - and not as health regulation.

Now, I'm not unsympathetic to David's argument about having paid into the Medicare system for a lifetime and deserving some return on that.  If we take literally David's argument that intergenerational transfer is legitimate, of course, then it's legitimate to say, "okay, the GIs got the benefits but didn't pay in, and the boomers are going to pay in but not get the benefit".  But from an individual fairness perspective, it's fair to give boomers Medicare coverage commensurate with what they (we) paid into the system, if not the current levels which amount to much more than they (we) paid into the system.

In order to limit costs to a reasonable level, it would probably be best to shift as many Medicare customers as possible over to Medicare Advantage type plans, where the customer gets a voucher to use toward traditional health insurance.  These plans could then get less traditional, for example paying for certain beneficial supplements and possibly even for a healthier diet and lifestyle.  The key is that the amount paid should be fixed, adjusted for inflation but not for "average" health care costs, and perhaps scaled to years in the system.  You paid in a certain amount; you get out a certain amount.

If we wanted to keep a traditional form of Medicare as well, then costs on traditional Medicare would have to be limited to the same as that for the Medicare Advantage type plans.  For example, we could seriously enforce the payment limits.  Customers would then have to choose between using low end doctors and facilities, or making up the difference themselves.

Am largely in agreement.  I am not sure that it is politically feasible, though a "Medicare for all" option would probably look a lot more like Medicare Advantage for all once people actually grasp with the cost.  Is largely what I meant earlier.

I mean, there are the equity issues that are politically powerful, and certain issues with health care versus other types of goods/services (that Dave touched on before), but it is still a rival, excludable good/service, and so it should be primarily handled by the private sector.
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#55
(01-16-2017, 02:20 AM)Warren Dew Wrote: First, perhaps the main reason they are cheaper is that alll the drug research is paid for by us, and they only pay the costs of manufacture. 
We charge Americans boku for drugs because people like you are willing to accept it.  I make bulk drugs.  The cost of all of our drugs is about 1.5% of sales.  Formulate costs a bit more so total cost is maybe 5-6% of sales.  R&D is about 14%.  The rest is administration, sales, profit, and merger/acquisition/restructuring charges.

If Medicare bargained for Japanese-style prices, and private insurers followed, then we would adopt life-cycle pricing.  We would continue to develop more drugs but  spend a lot less on advertising and administration.  For example, after Pfizer swallowed us, the closed down a pile of R&D facilities, Skokie Il. Kalamazoo MI, Ann Arbor MI, Sandwich England, and some of the legacy Pfizer facilities.  They nuked a bunch of production facilities, closing maybe 40 plants.  But they kept our old corporate HQ.  So now we have two huge sites filled with administrators.  One of these would likely have to go with life-cycle pricing.

Quote:Second, their systems aren't like Medicare.  The most successful of the European systems, which is questionably more cost effective than our private insurance system after adjusting for drug prices mentioned above, essentially has the government paying for private insurance selected by the individual
It's not just drug prices.  Most elements of our health care are significantly more pricey that elsewhere.  The Japanese get more cat scans and MRI than we do, but pay less for them, because the price is much lower.  Japan gets the best deals because they are the largest single buyer, so like Walmart they can demand low prices.  Their health administrator negotiates the price of everything, and all the many private insurers pay the same price for the services they cover. The national service also sets the premium they can charge.  So there is no price-based competition, the completion is all over quality.  All the companies offer the same basic plan at the same cost, but there are things they offer that are not part of the basic plan.   An efficient firm that can process claims for less, has extra resources to offer goodies than attract for customers.  The competition is intense, but it is all over the extra nice-to-have but not have-to-have things.

Quote:Third, if we're going to have a major revamp of the system, why not move to a genuinely free market system
Because it doesn't work.  Lots of poor countries have free market insurance. When or if they become developed, they switch to a universal system.  For example, Taiwan in 1994.  Even Switzerland, a bastion of free-capitalism, went to a universal system in the 1990's.  A country like ours would typically have gone to a universal system in the 1940's, when it would have been easy to do.  And it was proposed by the Truman administration and would have passed except for opposition by Southern Democrats.  Under the proposed national system, all folks, black and white would have access to medical facilities, that is, it would mandate race-mixing, and that doomed the plan.  America probably could have gotten national health care, were it restricted to whites as significant portions of the New Deal programs were.  But Truman wouldn't go there.
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#56
(01-17-2017, 03:37 AM)Galen Wrote: see, if someone should refuse to pay taxes then people with guns show up and take what they want.  In effect by taking the earnings and property of another then  the taxpayer in question is working for someone they would rather not.  If the slave does not work then he is subject violence.  Its a little more roundabout being one of the tax livestock but the results are much the same which is some form of involuntary servitude.

And if tenant farmer doesn't pay his rent, men with guns show up and deprive him of his livelihood.  What's your point?
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#57
(01-16-2017, 03:09 AM)Classic-Xer Wrote: It would be nice if those developed nations weren't so reliant upon us for their national security and so forth.

Are they?  We like to insist they are getting a benefit for US military spending.  Do they agree?  I think not.  Trump is right, NATO is obsolete and has been since 1999.  So is our security guarantee to South Korea and Japan.  Hell we could eliminate three quarters of our military expenditures and probably be safer than we are now.  Americans are just patsies.  We pay way too much for defense just like we do for health care.
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#58
(01-17-2017, 07:47 AM)Mikebert Wrote:
(01-16-2017, 03:09 AM)Classic-Xer Wrote: It would be nice if those developed nations weren't so reliant upon us for their national security and so forth.

Are they?  We like to insist they are getting a benefit for US military spending.  Do they agree?  I think not.  Trump is right, NATO is obsolete and has been since 1999.  So is our security guarantee to South Korea and Japan.  Hell we could eliminate three quarters of our military expenditures and probably be safer than we are now.  Americans are just patsies.  We pay way too much for defense just like we do for health care.

Considering how much they request US military intervention, yes they are.  Even France was calling for "US leadership" when Libya started falling apart.  Poland has been asking for a US military presence ever since Russia invaded Ukraine.  Japan would be in a tough spot without US nuclear protection because they need it to balance North Korea but large proportions of their population are allergic to having nuclear weapons themselves.

There has been a rise in piracy over the Obama years after the US stopped worldwide patrols in the wake of the sequester.  Nations like South Korea, India, and China have cobbled together forces to hold the line, but it's not as effective.  And it costs them money to maintain a blue water navy that they might not otherwise need.
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#59
(01-17-2017, 12:47 AM)Eric the Green Wrote: Shame on Booker. Remember I have downgraded his horoscope rating; I don't give him any chance at the presidency.
Regarding Booker (and Menendez), when I visit my sister in northwestern New Jersey, I pass the Merck headquarters. New Jersey and Delaware have lots of pharmaceuticals located in their states. Where you sit is where you stand.
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#60
(01-17-2017, 02:51 AM)Warren Dew Wrote: In an ideal world, the government - or the federal government, at least - would just get out of medical care entirely, limiting its role to safety regulations.

The big problem with our present system is the economic distortion introduced when the beneficiary of a product is different from the payer of the product.  That's a recipe for overconsumption and overcharging - or at least overpricing - and is what causes health care expenses to keep going up and up.  And we have that distortion both with government provided medicare and with employer provided health insurance, which together include the vast majority of the market.

What that means is that we spend too much on medical care, and that takes away from the money we could be spending for things like a higher quality diet that would be a more cost effective path to good health.

Return the money and control to the people, and we'll see a more rational health care system and better health.  And yes, people will likely start paying for doctors' visits and drugs out of pocket and medical insurance will likely be limited to relatively inexpensive policies that only cover catastrophic needs.
How do you handle the affordability issue? Most Americans don't have a couple grand lying around that they can use to procure routine preventive care such as colonoscopies or managing chronic conditions such as diabetes or asthma, common medical emergencies such as broken legs or pregnancy. (I'm assuming that the catastrophic coverage would cover things such as heart attacks, strokes, cancer, and postnatal care for preemies.) And do you really want people having to pay out of pocket for public good items like vaccinations?
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