Fun Friday: Revisiting Default

Two weeks ago, in a fun friday that many derided as "no fun" we established that a minority of this community, but a sizeable one, thought that the US would default in its debt obligations as a result of an inability to find common ground in the latest budget fight.

Sep 27 fun friday

I would like to redo that poll to see where the community has come in the past two weeks, most of which has been during the government shutdown (a misnomer if there ever was one as most of the government is still operating) and a political showdown in Washington. So here is the same question, slightly reworded:

My view is that we are not going to default on our obligations this year and I voted that way.

The emergence of the Ryan plan (and Paul Ryan) strikes me as exactly what we need to get ourselves out of this mess. I would like to see Obama engage in serious negotiations to further cut the deficit by attacking Medicare and Medigap spending and I would like to see the GOP agree to modest revenue increases to go along with those cuts.

We've made a lot of progress over the course of the Obama administration in reducing the god awful deficits that the Bush Administration and the Stimulus Plan left us with. Obama may have been brought to all of these budgetary moves kicking and screaming by his Republican opposition, but we have gotten them done. And it looks like we might get even more now.

The way this is going, we might have a balanced budget by the end of the Obama administration. Who would have thought that Obama's twin legacies would be a health care system where everyone is covered and a balanced budget. Truth is always stranger than fiction it seems.


Comments (Archived):

  1. Tom Labus

    The long view of history usually uncovers a part of the truth hidden by politics and media.I’d also toss in that the Obama Administration may also see us very close to being energy independent and wow does that change the economic landscape for everybody.

    1. fredwilson

      energy independence is hugebut we still have a global warming problem brought on by our relentless use of carbon based energy

      1. kidmercury






        1. ShanaC

          Garbage fuel would make space easier

        2. kidmercury

          the biofuel stuff doens’t work, takes more energy to create than it yields

        3. Glen Hellman

          Easy for Robot Dino to say when extinct organic dino fuel our economy.

      4. andyswan

        $10,000 wager that Earth temps in 2025 are cooler than they were in 2000?

        1. ErikSchwartz

          It will be a 50% bet because of the small sample size. The real bet is will the average temps between 2025 and 2035 be higher or lower than the average temps between 1990 and 2000.

        2. fredwilson

          maybe we should wager if there is any polar cap left by 2025

          1. sigmaalgebra

            In winter: -80 F, 80 MPH winds. Yup, an ice cap.In summer: Due to winds and currents, the iceblows around and piles up different places indifferent years. So, an ice cap will come andgo in the summers.The only evidence of a problem with temperaturein the Arctic is pictures of polar bears, and thosepictures are meaningless.In ‘global warming’ and ‘climate change’, thescience, e.g., Ramaswamy’s ‘radiative forcing’not to be found elsewhere in science, is justwindow dressing. The whole movement is aflim-flam, fraud, scam to get money and powerfor Al Guru, people who want to feed at theFederal slop bucket, and politicians who wantkick backs, a.k.a. campaign contributions.The interest in ‘climate change’ is from a memothat went out once the predicted ‘global warming’didn’t happen.It’s a morality play about human ‘sin’ from ‘filthy’carbon. So take something people will do anyway,e.g., sex, and restrict it and make it otherwisea ‘sin’ from which can get money and power.Sounds like something could be dreamed upby someone who spent time in a divinity school,right?It’s very much the Mayan charlatans who saidto kill people and pour their blood on a rock tokeep the sun moving across the sky.It’s very much like the pool table in ‘The MusicMan’ where the real goal was to get money andtake the next train out of town.

        3. lonnylot

          That is a bet on weather not climate. They are two different things.

          1. andyswan

            OK then let me know what measurement we can use to evaluate “climate change” decisively, and what the value would be in 2025 to prove that it is 1) occurring, 2) caused by human activity and 3) detrimental to humans I want to know how to measure this…because it’s cooler now than 15 years ago, the arctic ice is at record levels, and marxist are still calling for a global climate tax.

          2. lonnylot

            I’m not a climate scientist and I don’t have a succinct answer. If you’re interested in the logic behind the statements regarding climate change you can read the latest IPCC report: http://www.climatechange201

          3. SubstrateUndertow

            Are those the old fashion, 19th century, central planning marxists!Or the new, cyclical-organic-interdependency aware, distributive network marxists?Isn’t it getting a little late in the game to be running the old capitalist vs marxist, left vs right, polemic ?Maybe it time to focus on a serious capitalist/marxist dialectic sublation effort.Maybe its time to cut Karl a little slack on his mistakenly simplistic knee-jerk solutions to 19th century economic social injustice and focus more on some of his core insights about cyclical social/economic interdependencies?___________________________Sublation from the german word AufhebenA term used by Hegel to explain what happens when a thesis and its antithesis interact in a productive mental clash in such a way as to generate, through integrative synthesis, a new improved thesis. That new improved thesis is a synthesis of the best elements distilled via constructive mental arm wrestling between the original thesis and its original antithesis. Key terms and concepts is both the thesis and antithesis are both preserved and changed through their dialectical interplay. Key terms and concepts is both the thesis and antithesis are SUBLATED, subjugated and subsumed into the newly evolved thesis. The new thesis generates a new antithesis and the process of thesis-antithesis SUBLATION spirals off into the endless void of historical evolution.Sublation is far more productive than his evil twin brother Mr. Polemic, who often masquerades as his brother!

          4. lonnylot

            I replied to this yesterday – are links filtered here?

          5. ShanaC

            often they are.

      5. pointsnfigures

        agree it’s huge, disagree on global warming. big massive fan of fracking, nat gas and nuclear.

    2. jason wright

      the Lawrence Livermore Lab made a step forward with fusion power last month.ITER will take a different independence may not balance the books. the petrodollar is a *big* earner for the US Treasury.

    3. Richard

      Almost no one predicted the shale oil boom. Give credit where credit is due.

  2. pointsnfigures

    We won’t default. Both parties are stupid, but they aren’t that stupid.Much of Bush’s deficit was the result of spending on new agencies out of the Patriot Act(which I don’t support). Ironically, the dumb wars he started in Iraq weren’t statistically significant in monetary terms, but they were in other costs-especially human which is the highest cost of all.The Stimulus wasn’t Bush-but was one of the first acts of Obama’s. It didn’t work. Obamacare will be a disaster too.I don’t think history will be kind to either Bush, or Obama.

    1. fredwilson

      the stimulus plan was BObamaboth administrations had a hand in itand Geithner was in both administrationsit was hatched by Paulson and completed by Obama

    2. Tom Labus

      The first of the stimulus programs was done by Paulson/Bush when they knew the economy tanked. Paulson talks about in depth in his book.

      1. pointsnfigures

        Paulson/Bush never did a stimulus like the Democratically controlled Congress did in 2009. Recall, they passed an almost trillion dollar stimulus package in March of 2009.Paulson/Bush did engage in a series of programs to bail out the banks. The financial crisis first manifested itself in August of 2007. I recall because I lost a chunk of change that day. Right around August 17 I think.The Federal Reserve began quietly pumping money into the banking system. They knew there was going to be a problem, and they were trying to head it off at the pass.In August of 2008, the financial bomb blew up and the house of cards began to fall. To be honest, I am not sure we are out of the woods yet. There is a massive opportunity cost to 0% interest rates. I shudder to think what will happen when we have a gigantic pool of money, and velocity starts to grab hold of the economy again. Currently, there is no velocity of money and it’s not turning over.If you want to trade and make money, learn how to trade currencies and interest rate futures. They will explode when the Fed moves off 0.

        1. Tom Labus

          That was $300B in Jan 08 pre Bear funds tanking. It went all over the economy. The repercussions of the 08 depression will be with us for a full generation but we are also entering the early stages a major economic run.

          1. pointsnfigures

            $787 Billion.…Those of us that believe in classical economics think that the multiplier effect of government spending is equal to 0.Keynesian economists, especially those schooled by Tobin believe that government spending is the answer to growing GDP.So far, the classical economists have been proven correct in the past several years. BTW, Bush was no fan of classical economics.

  3. Ed Freyfogle

    The problem is the precedent that using the threat of default to force negotiation on an issue sets. This year it may be healthcare, what will it be next year? Will this happen on every controversial issue? That’s dysfunctional in the extreme. Giving in just feeds that monster. That would be the worst legacy ever.

  4. matthewmclean

    Did Fidelity just shed all government bonds coming due ?

    1. pointsnfigures

      Yes, and PIMCO bought them.

    2. kidmercury

      i thought it was just bonds of a certain duration, not all. but maybe i’m wrong.

      1. pointsnfigures

        Fidelity unloaded all their short term paper. Not a wise move. Risk averse fund manager……

  5. chrisdorr

    Of course, the reason the Republicans are finally changing their minds and coming to the table to talk is very simple. The NBC/Wall St. Journal poll shows that the public blames them for the shutdown and the debt ceiling debacle. Obama has been right to stand up to their threats and the public agrees–both Obamacare and Obama himself have become more popular this past week and the Republicans have sunk like a rock according to the poll. Obama is smart enough not to rub it in their faces, but that is why the Republicans are finally conceding. It was a bold move by him and in the end one of the smartest of his presidency. No matter how you slice it, the right wing has been beaten by the will of the majority.

    1. andyswan

      Popularity goes to the highest bidder, and no one can spend other people’s money quite like a “compassionate” liberal. The country has tipped, and the gimmie gimmie crowd has control…until its logical conclusion. That’s why the 2nd amendment is so important.

      1. chrisdorr

        Actually the “highest bidder” in the US are the companies and wealthy individuals who pay for the lobbyists surrounding Congress. That spending has grown larger in the last 20 plus years. I hardly think that affordable access to health care that is run by private insurance companies is “gimmie, gimmie”. It is just sane public policy that frees people to pursue their happiness and not be forced into bankruptcy by medical problems.

        1. FAKE GRIMLOCK


          1. chrisdorr

            I actually think that all people are fundamentally just like me (and you as well).

          2. andyswan

            So $640,000,000 for a website that doesn’t work “benefitted people not like me” how exactly?Cute phrase though.

          3. Jeffrey Hartmann

            It is actually a miracle that the website was done for that little based on normal Government IT practices. Go take a look at the ‘IRS Business Systems Modernization’ program. It took 18 f’ing years to just get it off the ‘high risk’ list. Multiple billions of dollars. Look at the Army email debacle, and I can probably find dozens of crap projects for you. The way the Government does IT is just CRAZY, but this website is just a normal extension of the crap IT decisions the Government makes. I actually wrote a post on JLM’s website last night you should go read. The problem with Government IT is they want to pre-plan everything because if we write any code that is not needed that would be ‘wasteful’. They also pretty much force the entities big enough to get these contracts to get their effective hourly rate down to insane low rates (sometimes as low as $40/hr). That means they will always hire Jr. developers and not commit their senior folks who are seasoned to these projects, or massively outsource to India and other body shops. The Government also doesn’t have two clues on what they want, and the workers who have the knowledge that needs to be put into the system is afraid to give that over because they are afraid it puts their jobs at risk if the computer can do their job for them. Having worked in this sort of consulting before (slightly related, but never federal which is the worst), its a miracle the website was launched on time and it works for anyone. I hear many of these federal projects have triplicate forms you need to fill out to commit to source control. What do you think something like that does to programmer productivity?

        2. Kirsten Lambertsen

          Move To Amend.

        3. Dave W Baldwin

          Yes, but knocking someone who is full time with benefit to part time and now they have to pay for it will lead to problems. You will end up with bad health in and good health paying penalty and staying out.

          1. chrisdorr

            Is the new health law perfect? Absolutely not. Every piece of major legislation that has been passed in this country has had to be improved. ACA needs to be improved, not junked. But pushing to a future where everyone has access to affordable health care is essential to our citizens and our economy. The republicans just need to get on board. I think they will come in eventually, as they did for Social Security and Medicare. And then they will moderate their agenda and we will all be better off. Sooner is of course, better than later.

          2. Dave W Baldwin

            Agree. My fear is what we do with all of those that are in the pot we need to “improve”?

        4. andyswan

          $ says we still have a massive pool of uninsured, along with tons of medical bankruptcy stories supporting a push to single payer within the next 5 years.

          1. chrisdorr

            And in your mind, this is good, bad or indifferent?

          2. andyswan

            It’s the end of the most innovative healthcare system in the world.

          3. ErikSchwartz

            A lot of medical innovation does not positively effect outcomes. It just costs more.If you’ve just got high cholesterol statins do not lower your risk of a heart attack or stroke.We do a ton of cardiac stents in this country every year, well over 90% of them do not improve the endpoint outcomes (death or heart attack).We do MRIs for back pain when the outcome for the patient is the same if they get a back x-ray (at 10% of the cost) instead.

          4. andyswan

            The technology is there because of a highly innovative, highly profitable environment. It is abused or misused because of a highly litigious environment.But if you think about it, the most amazing advancements in health care have come in the sectors that government doesn’t mandate or pay for at all: Plastics, LASIK, etc….. lower and lower costs for better and better outcomes are the direct result of direct-to-consumer product/service creation. Government will kill medical advancement if given the choice. It will opt for splitting up the current pie.

          5. ErikSchwartz

            It is misused because it is very profitable to misuse it. As long as compensation is procedure based rather than outcome based hospitals will continue to do the stuff that leads to more profit rather than better outcomes.

          6. andyswan

            Exactly right. The further you obfuscate the purchase decision away from the end-user, the more likely you are to have fraud, abuse, misuse and high prices. Almost every example you’ll give me is driven by Medicare as the payer.

          7. ErikSchwartz

            The problem is the doctor makes a very convincing salesman for the hospital and the sick patient is a very vulnerable customer.The most important thing going on in healthcare right now is not the ACA, it is the emergence of ACOs (accountable care organizations).

          8. andyswan

            We can start to agree here.

          9. Anne Libby

            Even a healthy patient might take on an unneeded treatment or diagnostic procedure, when the doctor recommends it and it is covered.Earlier in the century when I had a blue chip insurance policy, an in-network doctor at a major teaching hospital suggested that I have a vaccine that was completely inappropriate for me. When I asked her if she was kidding me, she mumbled something about “the research.” (I found another doctor.)

          10. Elia Freedman

            Uneducated. The customer is completely ignorant and relying on a third-party, who may or may not have the patient’s interests in mind, to make decisions for him/her.

          11. ErikSchwartz

            It’s worse than “may or may not have the patient’s interests in mind”. The doctor works for a for-profit entity whose profits are tied to doing more procedures and are not punished for doing unnecessary procedures.

          12. chrisdorr

            You call our system innovative? It produces the worst overall outcomes at the highest prices for any advanced industrialized country in the world. We pay more and as a people we get less.

          13. andyswan

            We subsidize the world’s innovation in healthcare, there is no doubt about it.But yes, it is amazingly innovative. I don’t know how you can argue that. Children are being repaired in the womb for conditions that would have killed them or scarred them for life after-birth. MRI’s, outpatient heart stints, pacemakers, CAT scans… knee surgery where I was jogging 5 weeks later and there is no longer so much as a scar. Pills that lower your risks significantly. Holy crap it’s amazing. Let them innovate!

          14. ErikSchwartz

            For many of the amazing innovations you have listed randomized trials show no improvement in outcomes.

          15. andyswan

            Then feel free to decline and not pay for them. This doesn’t need to be a system-wide decision, that’s my point.

          16. SubstrateUndertow

            You’ve changed your mind again already ?I’m surprised you have suddenly become so fickle πŸ™‚

          17. kidmercury


          18. Elia Freedman

            That depends on who wins the spinning. If Rep win the spin games, it will mean the dismantling of ACA. If Dems win, it will mean universal.

          19. SubstrateUndertow

            I knew you would finally see the light !Welcome comrade πŸ™‚

        5. Richard

          There is an insurance policy known as major medical catastrophic coverage that has been around for quite some time. This would provide essentially the same bankruptcy protection as ACA at 1/10th the cost.

          1. andyswan

            That’s all we “need”. Agree 100% Rich. Bet you never thought you’d see that.

          2. Richard

            The crisis we have in this country is an escalating cocktail of mandacity and ignorance. Its time for strong independents to come together. P.S. Awesome startup concept.

  6. Salt Shaker

    We won’t default, not cause our fearless leaders necessarily see the value in its prevention, but rather cause the GOP isn’t foolish enough to play high stakes poker heading into an election. That’s right, like most decisions made in Washington these days, everything is politically motivated, and even more infuriating, is that our country is continually brought to its knees by a minority within a minority. Not to suggest deficit reduction isn’t a worthy pursuit, it clearly is, but a dysfunctional process driven by a bunch of rogue legislators is undermining the system. After it became law, the GOP has tried to defund or kill Obamacare 45+ times. Can you ever imagine any of your employees or colleagues engaging in similar behavior w/ out dire consequences for their jobs? They’d be drop kicked out the door. The reset button in Washington needs to be hit in a big way w/ greater accountability and perhaps term limits. Enough is enough !

    1. fredwilson

      i agree with you but in my mind the ends justify the means. if Obama is pushed to balance the budget by the tea party, then we will have accomplished something very important

      1. awaldstein

        Yes…what matter is what results.The political process just does painfully suck though.

      2. Salt Shaker

        The end doesn’t always justify the means, Fred. There has to be a saner, more intelligent and less divisive way of getting there. The current legislative process is ridiculously ineffective and inefficient. People need to be held accountable for their actions.

        1. brianfrumberg

          Since healthcare was passed without one single Republican vote, the discord has been so great that our entire legislative process has ground to a pathetic halt. And within that environment, there has not yet proven to be “a saner, more intelligent and less divisive way of getting there,” and we can only hope that the legislative wheels of progress start turning again with the next administration, whichever party wins. And until that happens, I agree with Fred wholeheartedly that the mission of budget balance and debt reduction, putting our entire economy, for us and future generations, on firmer footing, is worthy of whatever tactics are needed to get us there today. Especially when the tactics are born out of a political climate that I believe began with the hammering of Obamacare through congress without a single Republican vote.

      3. Scott Barnett

        I’m shocked to hear you say this Fred. You don’t think Obama could have been convinced to balance the budget without all this ridiculous posturing and waste of time? What frustrates me the most is the shutdown is impacting the people who can least afford it. Innocent bystanders shouldn’t have to get hurt – that doesn’t justify the means in my mind, not at all.And I don’t buy the FUD that the Tea Party keeps throwing around. A stopped watch is right 2x/day – that’s my feeling of the Tea Party right now.

        1. pointsnfigures

          You don’t understand the Tea Party. The Tea Party started under Bush. It voted Democratic in 2006. The Tea Party wants small government and no deficits.Legacy Republicans hate the Tea Party because it would ruin their lobbying jobs.

          1. Scott Barnett

            I think 2008-9 is more like it –…I actually have no problems with some of the Tea Party’s stances. I too would like to see balanced budgets and less spending. What I’m totally opposed to is their methods. They leave no room for compromise or to appreciate other points of view. Unfortunately, these debates are not black and white – there are so many shades of gray. But they lock into a single position and don’t budge. That’s why I don’t feel the ends justify the means in this case.

          2. pointsnfigures

            I don’t disagree with the no compromise part. Change happens slowly. I encourage everyone to read the book America 3.0. It is a really thoughtful plan that would ally classical liberals in the Democratic party and the Tea Party part of the Republican party. It’s based on history, and isn’t an anti-Obama rant. They mention the President exactly one time in the entire book.

        2. dtroup

          “You don’t think Obama could have been convinced to balance the budget without all this ridiculous posturing and waste of time?” Haha, you’re not serious, are you? Perhaps you’d like to look at his deficits and lack of a budget passed under his Presidency by the Senate. (and no, CR’s aren’t a passed budget)

          1. Scott Barnett

            yep, I’m serious. I’m frankly tired of all the finger pointing, on both sides. Obama lowered the deficit much more than Bush, but nobody talks about that. The lack of a passed budget is due to gridlock in Congress – you can blame Obama as their “leader” for not leading well enough, but you can’t blame him for not trying.This shouldn’t be a blame game anyway – but that’s what it’s all been reduced to. Meanwhile, people suffer and our economy has not gotten stronger. That is the real shame.

          2. fredwilson

            that’s what i said in my post. it will be his legacy. but the tea party should get some credit for holding his feet to the fire.

          3. dtroup

            When Obama was sworn into office, the debt was $10.6 trillion. This week, it hit $16.7 trillion – an increase of 57%. In the same time frame under Bush, the debt rose 38% – under Clinton it rose 32%.But its not about Obama, its about DC.Spend, spend, spend. Thats all this government knows.

          4. fredwilson

            yup. we have to cut spending and the deficits. i think some tax increases could be helpful too. but i am not in favor of solving the problem with tax increases.

          5. dtroup

            @Fred – Exactly. Before another dime is given to .gov, they need to get spending in line, but that will NEVER happen given that the largest spend is social.

          6. pointsnfigures

            especially the ones on carried interest and cap gains ; )

          7. mterenzio

            If you want to get in shape, you don’t just stop eating. You eat less and exercise more. ; )

        3. fredwilson

          no, i do not. he does not really care about deficits. and he would have done it with tax increases and not touched entitlements. compromises are good.

          1. Scott Barnett

            just like he has pressure on the Republican side, Obama has pressure from Democrats on entitlements. Perhaps I am naive, but I truly believe if the Republicans were able to show any amount of good faith in negotiating (vs. putting a gun to his head) that Obama would try to return the favor by discussing entitlements. It’s a sensitive subject – I agree it needs to be addressed – and it only gets done with some careful discussion and honest negotiation and compromise. None of that exists in Washington today.

      4. walker

        Clinton ran budget surpluses and what happened? Bush slashed taxes for the rich because the surplus belonged to β€œthe people.” Balancing the budget is isn’t a legacy – at least in the way that we normally think of that word – as long as it can also be an excuse for Republicans to cut taxes on the wealthy.

  7. Hershberg

    The ACA offers a number of important advances, but it’s inaccurate to say it’s a health care system that covers everyone. There are an estimated 8 million people, mostly African-Americans and single mothers in the Deep South, who are too poor to qualify for ACA subsidies. The only system that would truly cover everyone is single-payer. And because it would be as easy to run as Social Security, single-payer would have the added benefit of saving hundreds of billions of dollars in administrative fees every year, which would go a long way towards reducing the deficit.

    1. kidmercury

      single payer is disastrous, though that is the world we are headed towards for sure

      1. Elia Freedman

        I’m not convinced that single payer and universal are tied at the hip. I believe we can come up it had at to get everyone insured (and not by companies) while also keeping a multi-payer system.

      2. SubstrateUndertow

        Its a fundamental social infrastructure, needed by all, just like water, sewers, military and police. Its a quintessential natural monopoly!Single payer has worked well for us here in Canada where outcome metrics are better than the US!Canada 11.?% GDP vs USA 17.?% GDP

        1. kidmercury

          it is not a natural monopoly, because the idea of proper health varies drastically from individual to individual. just ask a doctor to define what healthy is. they probably will struggle to provide a good answer…..and certainly not answer that holistic practitioners are likely to agree with.

          1. SubstrateUndertow

            That is a weak semantic augment and such variances can easily be let on the table for profit-based extended-healthcare offerings.

          2. kidmercury

            that is not a semantic argument — it is a very real one. medical doctors view the body as incapable of healing itself and thus have a prescription heavy approach. it is this approach that constitutes and defines “healthcare” under obamacare.the option to simply pay for it as one pleases will be hindered greatly under obamacare. being wealthy is no longer an option to buy what you want, in many instances you will still have to get in an impossibly long line and experience life-threatening delays. customers have less freedom to shop as they please and doctors have less freedom to practice as they please.

        2. Jim Ritchie

          I know personally many patients and doctors who have fled Canada to the USA to get away from your system.Outcomes, such as life expectancy, are loosely coupled to the amount of money spent on healthcare for the following two reasons:1) Eating less/better and sleeping/exercising more is a huge factor in outcomes and not factored in to healthcare costs.2) A large percentage of healthcare costs are spent in the last days/weeks of your life with really no meaningful effect.I believe we should pay for all normal health care (prescriptions, checkups, routine Dr. visits) out of pocket except catastrophic. The best way to control costs is to get the consumer back in the picture so they can manage their costs directly. This would also eliminate the middleman for most health related transactions. People are smart enough to make these decision themselves.

          1. JLM

            .Your comment is so wise as to make me suspicious.I agree more with you than you could possibly agree with yourself.Well played.JLM.

      3. mcbeese

        *Every* developed country with a single payer option is doing a better job of delivering health care to it’s citizen’s–at less cost–than we are. We do a better job than most of developing pharma and medical technology, and we must not lose that edge. There is no simple solution and I’m certainly no expert, but there is a hugely obvious need to do better than we are. That’s all an entrepreneurial problem solver needs to hear.

      4. Pete Griffiths


    2. Anne Libby

      (Gah, my comment just got eaten.)My hope is that as ACA is implemented — which it now clearly will be — we’ll fix what doesn’t work.Build it. Iterate.

      1. mcbeese

        Exactly. Implement and iterate. It’s the only way forward that makes sense.

    3. fredwilson

      good critique peter. i guess my view is once we get almost everyone covered, we will find the will and a way to get the rest covered. that’s the optimist and the pragmatist in my coming out.

      1. Pete Griffiths

        But even if we get everyone covered we will have elected to do so by with a system that will cost us approx 3X / head the cost of single payer in most industrialized countries.

        1. sigmaalgebra

          The US is not Switzerland in waysthat mean that the US doesn’t knowhow to do single payer well.

          1. Pete Griffiths

            We’re not just talking about Switzerland. We’re talking about Canada, the UK, France, Spain, Italy, Japan…Surely we can figure out how to do something that all these countries can do?And if we can’t, why not?

          2. sigmaalgebra

            Good. Progress.Of course we can (I am NOT borrowingan Obama campaign quote) “figure outsomething”.But Obamacare is not it, and was notintended to be. Obamacare was neverabout the actual US health care system.Instead Obamacare was an effort toestablish, by one important example,that the US will have big government thatwill be big brother to everyone and providecradle to the grave security for everyone.The health care system and delivery aspectswere left to nonsense, incompetent, dangerousnonsense. E.g., all the old US ‘health caresystems analysis economics research’, communitye.g., Karen Davis, rubbed their hands withglee that finally they were going to be thebig dictators over all of the US healthcare industry that would be essentiallynationalized. And Pelosi was thrilled,as if she had been named headcheerleader in high school, that herdreams of big socialism were on theway.But the actual planning for the US healthcare system was a disaster, left tobe worked out, much like Lenin andhis Communism.Pelosi, Barney Frank, etc., got whatthey wanted, a big statement that forhealth care, and then more, the USwas moving to big socialism. Thedetails for health care she would leaveto others.But the details matter, as we saw ina $600 million Web site that doesn’twork. Yes, eventually it will sort ofwork, but it will be wasteful.But the US does have a health caresystem, including for poor people –Hill-Burton, Medicaid, Medicare,charity, etc. We can improve thatsystem. But Obamacare is notan improvement, is not really evenhealth care but just a political statementto drag the US into socialism with thedetails not seriously worked out yet.Pelosi, Frank, etc. want Lenin stylesocialism. So, with their ACA, theyhave the legal power they want overall of US health care, but, again, thedetails have not yet been worked outand what is in the law is incompetentand dangerous and will kill lots of peopleand cost lots of money.We should junk Obamacare and dosomething effective and responsible,forgetting about Lenin, Pelosi, andFrank. And, of course, first cut,we should have a small trial firstand not do the first test on allof the US health care system for allthe US population.Since we are not doing small scaletrials, it’s not about health care butabout big socialism.

          3. Pete Griffiths

            Obamacare may have many problems but this…”Obamacare was neverabout the actual US health care system.Instead Obamacare was an effort toestablish, by one important example,that the US will have big government thatwill be big brother to everyone and providecradle to the grave security for everyone.”I just don’t buy it for an instant. But I don’t think this is the kind of thing that can be usefully discussed. Go in peace.

          4. sigmaalgebra

            I can’t give all the important information heresince there is no space and I’m short on timeto write such essays. So, you will have to digout the information for yourself.Read the American College of Surgeonsstatement, I gave a link, and look up thecontext where Obama shot his mouth off at ahealth care town hall. See that town hallwhich started with a woman with a preexistingcondition claiming that she could not getinsurance or health care — nonsense. All shehad to do was to move to a state with communityrating, and there’s plenty of charity healthcare in the US for patients with serious needs.In that town hall, Obama knew next to nothingabout health care. He wasn’t interested inhealth care. So, what was he interested in?At least politics. More likely just socialism.For that, look at some of his other campaignefforts. Barney Frank admitted, there’s avideo clip, that one goal is just single payer.Again, not health care but getting centralized,socialistic power.And read the bill. The draft I read early onwas not too difficult to read in the earlysections. There the theme is not health carebut centralized control, so much control thatthe US health care industry is not justnationalized but effectively stolen from theowners. How? There’s a Commissioner, and heis a dictator who can just set prices and clawback profits. So, he can drive the marketcapitalization of any company in US health careright to $0.00 with a stroke of a pen. It’spower, centralized socialistic power.Other things to do with that power are to havebirth through college Federal professionalnannies for all babies at risk, Federal takeover of parenting.Clearly Pelosi doesn’t know anything abouthealth care and doesn’t care. The wholeeffort, goal, and accomplishment of Pelosi waspower, to get centralized socialistic controlof all of US health care, the whole industry,including tight control of treatment options.Pelosi joked that have to pass to bill to seewhat’s in it, and basically that was correct.Much of why is that most of what happens willbe left to the Commissioner who will havedictatorial control. So, Pelosi was aboutpower, centralized socialistic control, nothealth care, and she left the health care tothe Commissioner.Obamacare doesn’t just have some “problems”.Instead, so far mostly it doesn’t even existyet as a health care system and is waiting onthe Commissioner and staff to write regulationsdefining all new US health care.If you believe that Obamacare currently existsas a health care system and just has someproblems, then you are way, far away fromreality. Again, Obamacare so far is just acentralized socialistic power grab and nothinglike a health care system. We will see what its as a health care system as the Commissionerdefines it, with whatever is left of the law bythen.But, now all Obamacare is is just a power grabfor centralized socialistic control with theactual health care parts left to the future(“have to pass the bill to see what’s in it”,that is, what the Commissioner will do and whathealth care system we will have) and notdefined yet.You just bought a pig in a poke, gave a blankcheck, signed up and started paying for aservice that so far is undefined.When the Commissar, uh, Commissioner gets towork, the results will have to be much like inRussia.Bluntly for a lot of reasons, social, ethnic,economic, political, unique to the US, the USdoes not know how to do a good job runningsocialized medicine.The US can run national health insurance, butObamacare wants essentially community ratingfor the whole country, but it has long been thecase that only the richest states have beenwilling to accept the cost. People in most ofthe US wouldn’t and still won’t pay forcommunity rating. That cost increase alonepromises to sink Obamacare.As people find out “what’s in it”, it will berolled back. In the meanwhile there will be alot of damage and dead people.You need to wake up: It’s not just subsidizedhealth insurance. Instead it’s a power grabintended later quite broadly across US society.Just like I said.The above is a very short argument, You willneed to look into much more, but I’m short oftime, The bill is likely still on-line, and Ihave an early draft.

          5. Pete Griffiths

            Wow. Sounds a bit tin foil hat to me. I don’t dispute for a moment that the Bill is riddled with flaws but the socialist conspiracy theory leaves me a bit cold.

          6. sigmaalgebra

            I don’t even know what a “tin foil hat” is.To heck with the flaws in the bill having actuallyto do with health care.Instead just pay attention to the power of theCommissioner. Again, he’s a dictator over allof the US health care industry.For the flaws in the bill actually having todo with health care, the Commissionerwill have plenty power to make the situations with the flaws better or worse.The Commissioner shows that the billis a power grab, not health care.The main problem is just the old onegoing back to Lenin, etc.: A dictator.Dictators mostly don’t work well forlong. From the 4000+ page or whateverof the bill, that’s about all you need toknow.Back to my old movie.

          7. sigmaalgebra

            While watching an old movie I saw the relevant:”I can certainly understand why you findtheir promises of new order in old chaosvery appealing. But I must warn you youmay find the price of all this good orderand discipline a rather high one.”It’s an old story, uh, scam:(1) Find a problem or at least make one up.(2) Make a big stink about the problem.(3) Claim that if we all come together and singKumbayah then our power will certainly be enough tosolve the problem and all together we will all bemuch happier and more secure.(4) Then for the actual execution, we will find someexperts and turn everything over to them.(5) Then we will all enjoy the problem solved withefficiency, equanimity, equality, and a better lifefor all.Notice that the steps in this scam are generic, thatis have nothing to do specifically with health careand can also apply to global warming, uh, climatechange, the ozone layer, the whole economy of anation, etc.So, the steps are just generic for the problem butreally just a political power grab.Yup, each 50-100 years, need to fall for this scamonce again and learn the lesson again.Again if the real goal is actually a better healthcare system, then we will concentrate on the detailsof a better system and try it with a well evaluatedpilot project, on a small scale, say, just in DC.For a pilot project, try it in, say, DC SE where,say, Michelle Rhee did so well with Federal moneywith the schools.Since we want to roll out the big change for thewhole country all at once, the real goal cannot be abetter health care system but what is happening — apower grab.Given human nature, a power grab is much moreattractive and, thus, more likely than working onthe details of a better health care system.Uh, in venture capital, a guy comes in with aproject to make $100 billion, so, sure, for a nice100:1 payoff fund him with a tiny $1 billion. Hmm…. We an ask Fred about how often that happens.In fact, we start with maybe $100,000, then $1million, then $10 million, then $50 million.But in health care for the whole country, we want totry to do it all in one stroke with no pilotprograms, etc., and where their $600 million Website doesn’t work.Are we learning yet?

      2. sigmaalgebra

        That’s part of the whole theme that heavilyObamacare is about: Pass it first and thensee what’s in it and fix it over time. Pelosi’sbig goal and ‘accomplishment’ was not toimprove the US health care system directlybut, even at the cost of serious harm tothat system, at least for a while, to have theUS go for socialized medicine run in finedetail from DC.’Socialized medicine’? Yes, as Barney Franksaid, Obamacare is intended to be a step tosingle payer. ‘Run from DC’? Yes, the lastversion of the bill I read has a Commissionerwho has essentially dictatorial powers overessentially all of US health care, e.g., can goto a supplier of, say, bed pans, bandages,or drugs, decree and declare that they madetoo much money and/or that their prices aretoo high, and claw back the profits and/orreduce the prices, all just by fiat. Dictatorialpowers. A big part is to have a physiciando a diagnosis, click on some radio buttons,and then be TOLD what procedures he canuse, and all this is supposed to come fromsome applied math of a bunch of data –great way to kill a lot of people. It goeson and on and is set up to kill a lot ofpeople.Pelosi’s idea is to assume that somehow theproblems will get fixed over time. This goesback to Lenin — establish Communism and thenfix it over time. Well, over 70 years, it didn’tget fixed, killed a lot of people, and finally gotjunked, which for a while killed a lot morepeople.Obamacare is bad medicine; everybodyknows it’s bad medicine; Pelosi, etc. justwant socialized medicine, they just wantit, they believe in it, at whatever costs,due to their emotions much like supportedLenin, i.e., a feeling of security frommembership in a group; then Pelosi, etc.,assume that, with all the power in theirhands, like Lenin, dictatorship of thesocialistic, they will be able to will thatthe problems will get fixed. No, Pelosi,etc. will wreck the system, good peoplewill leave, and the system will be morethings like their $600 million Web sitethat doesn’t work. That Lenin-Pelosistuff just doesn’t work. Being willingto move to such socialism withouta solid plan to make it successful willlead just to disasters. Want somesocialism that works? Fine: TVA,Hoover Dam, CDC, NIH, NSF, andsome more, but each of these hasa reason it works. Obamacare?Again, everyone knows it won’t worknow but just assumes that it willwork in the future — I just hope mystartup is in good shape before Ihave to depend on Obamacare.I predict: Obamacare will make amess out of US health care (Ibelieve that Pelosi, Obama, Frank,etc. know this); some years willpass with lots of people dying;finally Obamacare will be junked.There will be long term damageto US health care.Then one more time humans fall forthe Lenin scam. Apparently eachgeneration needs to learn againfor themselves that that stuffLenin was selling doesn’t work.

    4. ShanaC

      wouldn’t medicaid cover – or is because taking on medicaid subsidies is a states prerogative that they won’t be. if that is the case, shame

      1. Matt Zagaja

        If I understand correctly in states that accepted the medicaid expansion proposal there isn’t any gap, but the ones that declined to expand medicaid still have that gaping hole in their system. Disappointing for sure.

    5. sigmaalgebra

      A standard statement, e.g., of Barney Frank,is that Obamacare is intended to lead tosingle payer.But the analogy with Social Security is profoundlyand dangerously flawed: Social Security has nosay over how people spend the money for theservices they get, but Obamacare will havean iron grip on every aspect of our health caresystem and, thus, the health care service itself.

      1. Hershberg

        I didn’t draw an analogy between Social Security and the ACA, just the costs associated with running them. There’s no question that it costs far less to administer a single program like S.S. (and, for that matter, Medicare) than it does to run 50 separate exchanges, each of which offers a variety of health plans from a multitude of private insurers.

        1. sigmaalgebra

          Administrative costs are not thebig deal for either SS or ACA. Thebig deal for ACA is that it is designedto be a total takeover of essentiallyeverything in US healthcare, bedpans to brain surgery. That is,ACA is deep into delivery of servicesto the people while SS is not.

    6. Salt Shaker

      I’m a strong proponent of ACA. Access to affordable healthcare for the masses is long overdue. That said, I’m a bit concerned whether the medical system and infrastructure can handle the increased demand for care. It’s not like the number of MD’s, clinics and hospitals will increase commensurate with the increase in demand for medical care. Yes, healthcare will be more affordable, but my concern is whether the quality of care–given the sheer numbers involved–will decline. I’ve heard horror stories from relatives in Canada about long delays and backlogs on some fairly basic medical testing. Hopefully, that won’t be the case here.

  8. Anthony Serina

    I believe we need to make significant cuts to our budget and significant increases to our tax basis. But with everything in America, we face serious institutional problems. If a decent plan is put together, a new administration will just come in a couple of years after and scrap it. It is just a mess.Maybe it is being a millennial but I do not value the current system very highly and see it as an organization that underserves the people it was created to help. I am more for changing the the framework the government operates within by revamping the systems and processes.

    1. brianfrumberg

      “If a decent plan is put together, a new administration will just come in a couple of years after and scrap it. It is just a mess.” Reminds me of what everyone in NY tech fears DeBlasio will do to all the great work Bloomberg has done.

      1. Anthony Serina

        Yes. That is how I feel about DeBlasio. I feel like Bloomberg did a solid job but the institutions limit how much a competent person can even accomplish. Everything just takes so long and that time is really expensive. It costs come in the sacrifice of education, health, transportation etc. We just live in a world where it is accepted for something to take 5 years as if there is no other alternative. It makes me sick to my stomach.

  9. dtroup

    The poll question is flawed since the debt ceiling doesn’t keep the US from PAYING its current debt obligations, rather is keeps the US from making ADDITIONAL debt. So, the only correct answer is “no”. Perhaps the question should have been “Will the idiots in D.C. agree on increasing the debt spending limits as currently set by law before we hit the ceiling?”

    1. leapy

      I may be wrong, but I think the argument is that the US is borrowing to cover debt interest and therefore hitting the debt ceiling does indeed stop the US from paying its current debt obligations.

      1. dtroup

        While they may be borrowing to cover debt interest, this does NOT keep the debt/interest from being paid if the debt ceiling is hit. The payments of debt is mandated in LAW, and is not subject to the ability of the government to borrow money or increase debt limits, as such, the premise of the question is flawed.

  10. LIAD

    A default is M.A.D.Both sides know it. This whole thing is just theatre.To make it a more interesting spectator sport though, perhaps they could implement a version of Buffett’s – – “I could end the deficit in 5 minutes, you just pass a law that says that anytime there is a deficit of more than 3% of GDP, all sitting members of Congress are ineligible for re-election.”

    1. fredwilson


    2. JLM

      .For too long we have allowed a lack of accountability to prevail in Washington.Would you continue to employ a CEO who could neither balance a budget nor manage a credit card?There is plenty of blame to go around.It is outrageous that the Congress would pass a health care law and exempt themselves from its application.This is not a kingdom and the Congress is not royalty and the President is not a King.You, my friend, however are a prince.JLM.

      1. Pete Griffiths

        What do you mean exactly by ‘exempt themselves from its application?’

        1. JamesHRH

          They get CDN healthcare – full coverage.

          1. Pete Griffiths

            Ah yes – thanks. Good point.

    3. sigmaalgebra

      Cruel, cruel, how could you be so CRUEL!!!!!I mean, I mean, I mean, Members of Congress,esteemed, dedicated public servants!!!!

      1. JamesHRH

        A PB post Siggy.

    4. Pete Griffiths

      You say ‘both sides’ but there are more than 2 sides. The Republican Party, for example, has at least 2 sides of its own, and one of them most certainly does not know that ‘a default is M.A.D.’ There are those who truly believe we should burn down the system to cure it.

    5. JamesHRH

      What is wrong about this is that people laugh it off.Constitutional change that modernizes the accountability of the Congress is required.

  11. kidmercury

    “We’ve made a lot of progress over the course of the Obama administration in reducing the god awful deficits that the Bush Administration and the Stimulus Plan left us with.”here’s a chart, for some perspective.http://www.exponentialimpro…the last paragraph is truly hilarious though…….ryan plan, obama plan, or pretty much anyone from the establishment will not come anywhere near balancing the budget. they might propose a plan that they suggests will balance the budget years in the future, but this plan will almost certainly be based on deulsional math.obamacare isn’t going to provide healthcare for everyone, simply because declaring everyone is covered does not actually magically mass produce additional resources for creating healthcare. so you will have what amounts to rationing. government intervention is why costs are so high and more intervention is only going to make things worse.the healthcare system is so bizarre that it is the one place where no one has any idea how much anything costs. doctors are frustrated because they don’t know how much they will get paid. customers and insurance providers are frustrated because they don’t know how much they will have to pay. pharmaceutical companies and government officials love it though!

    1. Anne Libby

      Well, and our health care system isn’t actually providing “health.”

      1. pointsnfigures

        Ironically, investors and venture funds are avoiding investing in healthcare. If you are in an investor meeting and say the words “healthcare” they will not invest in your fund. Except, this is the exact time to be investing in healthcare companies.Healthcare was going to change radically with or without Obamacare. There aren’t enough medical personnel at any level to take care of all the baby boomers throughout the world that will consume increasing amounts of care.Additionally, as the middle class rises in BRIC countries, they will want access to good medical care. Only way to do it is through technology. Only way to get it is innovation/investment.But, most VCs, and investors in their funds run for the hills when the words health and care appear in a prospectus.

        1. Anne Libby

          If I had more time today, I could go on and on.Doctors don’t tell people to avoid sugar and stop drinking soda. So we have a diabetes epidemic. That we’re all paying for.And doctors send asymptomatic people off for expensive tests when they reach a certain age.Don’t get me started on not being able to leave a loved one alone in the hospital — preferably with a medical professional — without some kind of horror story about the “care” they did or did not get. I’ve got one for a family member and top suburban Chicago hospital.That is not health care.

          1. pointsnfigures

            No, it’s more like Cover Your Ass from attorney care….Steve Burrill put it this way. Eventually health care companies are going to have to figure out a way to provide all services for free (like Google) and monetize an ecosystem around the free services.

          2. Anne Libby

            Yes, and yet not completely, since nobody gets their backside sued for not giving basic nutritional advice.

          3. ShanaC

            not sure. maybe for general care, but speciality care?

  12. robert levitan

    The Founding Fathers knew there would have to be political compromising when they set up a government with three branches and with checks and balances. This was viewed as a complicated governing structure at the time. I am sure many doubted it would last 200 plus years. That said, it was expected that in the Senate, where states with small populations would have the same voting power as larger states, is where a vocal minority could muck things up. In the end, of course, they did believe that they had set up a governing structure in which the majority would prevail. Perhaps we will have a good outcome from all this political bickering but let’s hope we do not damage the concept of a constitutional democracy where the will of the voters and the law of the land are respected and enforced.

  13. andyswan

    Our startup’s healthcare costs are going up by 110-130% as a direct result of Obamacare.Edit: Love people downvoting a simple fact. Shows the mentality well.

    1. Anne Libby

      My costs will go down by the same factor.

      1. andyswan

        You win, I lose. How quaint.

        1. Anne Libby

          Haha, well played.

      2. Dan T

        that’s awesome. I’ve never heard of anyone’s cost going down over 100%.

        1. Anne Libby

          Ask people you know in really tiny businesses. In NY, at least…Point is, Andy is N =1. Anne is N=1. It remains to be seen what will really happen.

    2. Kirsten Lambertsen

      How many people does your startup employ?

      1. andyswan


        1. Kirsten Lambertsen

          So, your company isn’t required to offer insurance under ACA. How is it directly responsible for the increase you cite?

          1. andyswan

            We pay employee premiums and some of deductibles.Obamacare declared the policies we have now illegal, despite our happiness with them. The replacement coverage is over 2x as expensive and has higher deductibles. Unreal.

          2. Kirsten Lambertsen

            Does that increase include the 35-50% tax credit you’ll get?

          3. andyswan

            We do not qualify for a tax credit, as far our CPA can tell.It also doesn’t include the massive tax increases we will be paying on cap gains and dividends should our venture become as successful as we believe it will be.

          4. fredwilson

            i have paid close to a hundred million in taxes over the past decade Andy. i am proud to say that. all the whining about paying taxes perplexes me.

          5. andyswan

            Fred they spent $640,000,000 to build a website that doesn’t work. Billions to blow up Iraqis and Libyans. Billions to spy on you and me. Billions to use the IRS to frustrate political opponents.I’m glad you enjoy writing checks to the Federal Government. If you’d like to, you can forgo all deductions and make that your charity of choice. If you’d like me to donate to the Federal Government instead of Donor’s Choose, I will do so just as willingly as I do each year as you make your drive. I’m proud to support the efforts that you choose to promote.I prefer to spend and help locally, with people I know and trust as the managers of the money I put to use voluntarily.I am also a proud taxpayer, but now that less than half of that money goes to functions that the Federal Government is actually tasked with doing in the Constitution, I will be less than enthusiastic about the checks that I write.

          6. LE

            Paying taxes is necessary. Inherent in a system that you don’t have the time to get involved in (and even if you did is so large you could never make a difference) is that there is going to be waste and there will be money spent on things that you wouldn’t spend money on.In the end you just hope to make enough money that it doesn’t make a difference and things are good for you personally.Or you can waste time getting aggravated and upset about things that you can’t change.Curious if you are so concerned about the government spending 640m on a website that doesn’t work if you see a way to get the, um, “smart” people that could do better to work for the federal government instead of some sexy startup?

          7. Dave W Baldwin

            Don’t forget what’s going on at the NSA http://www.thefiscaltimes.c…”For a country that prides itself on being a technology leader, not knowing the electrical capacity requirements for a system as large as this is inexcusable. Within the last 13 months, at least 10 electric surges have each cost about $100,000 in damages, according to documents obtained by the Wall Street Journal.”

          8. Anne Libby

            Whining entrepreneurs?

          9. pointsnfigures

            Why do I have to carry insurance against pregnancy, autistic children and other dumb stuff in Illinois at my age?

    3. Dan T

      Are your costs GOING to go up, or are going up? I am not sure I understand. My company, with about 400 employees, is breathing a sigh of relief that the employer mandate was put off . .for now. Most of our employees make less than $15/hour. I would guess that about 80% of our clients believe EVERYONE should get healthcare. Unfortunately, that same 80% does not believe THEY – the clients – should pay for it πŸ™‚ go figure. They also don’t believe it is ethical for the employer (me) to reduce employee pay or hours to pay for it. We are faced with a 5-8% cost increase that our clients do not want to pay – in a service industry with an average 10% margin.

      1. LE

        in a service industry with an average 10% marginIn businesses where it’s not possible to increase your pricing you have to either a) cut costs and find more efficiencies b) build more volume c) turn the employees (like McDonalds does they don’t want you to stick around so they have to pay you more). d) cut corners on the service you are offeringCurious what you are going to do here. I feel your pain having been involved in the past in businesses where you can’t really increase the price of the thing you are selling.

    4. fredwilson

      can you provide the details Andy? i would like to understand how this is happening. in NY, the exchanges are driving down the cost of coverage. maybe its where you live that is the problem.

      1. andyswan

        Sure. I will use my personal policy to avoid any disclosure problems.My policy was a family policy with a $7,000 deductible. 0% coverage until $7k, 100% of everything after that.It cost $302/month for this coverage from Anthem.Then I got this letter: policy would no longer be offered starting in Dec 2014 because of Obamacare.So they invited me to check out policies to replace it. Here is the best-priced “bronze” policy: you can see, I went from $302 with a $7k deductible to $600’s for a higher deductible.I’m sure the new policy covers some bullshit we don’t want and would never buy.Turns out other local people who were responsible enough to buy their own insurance are also getting hit, some worse than me:

        1. fredwilson

          that sounds like a shitty outcome for you. i would be curious what is covered under the new policy but was not covered under the old policy. the idea of a family policy, even a high deductible policy, for $300 is shocking to mewe pay over $2400/month for a high deductible family policy for my family here in NYC

          1. andyswan

            I’m curious about that too. Probably insurance against known costs aka not insurance.$4k/mo blows my mind. To me, that’s a testament to the MASSIVE differences between states and locales, and just another reason why 536 idiots in D.C. shouldn’t be in charge of everything.

          2. LE

            To me, that’s a testament to the MASSIVE differences between states and localesThere is a reason for the pay disparity between people who work in the health care system in certain locations. Not just because of cost of living but because of desirability of the location. (Who wants to work in the middle of nowhere? Have you ever seen the recruiting ads for docs trying to get them to some of these communities?)Physician typically have to be lured to areas that are less desirable with larger pay packages or more time off or other benefits. Also a physician, nurse or even admin work in NYC is almost certainly going to have to paid more money than if the same person worked in Lancaster PA. Assuming they even want to work there.Edit: I realize I am mixing two points here. NYC is just an outlier in terms of cost of living.

          3. Richard

            My entrepreurial sister left nursing and pays a whopping $1600 a month for her coverage (she is a juvinile diabetic). Her premiums will go down but so may her coverage to the best insulin and insulin pumps. Until she knows for sure that these things won’t be denied, she will continue to stay with her current plan. Bottom line – insurance is like coding, you really can’t get a feel for it until you hack a little.

        2. ShanaC

          that plan was extremely high deductible, almost nervewrecking. Most of the people probably who bought that plan can’t afford the high deductible….

        3. LE

          My policy was a family policy with a $7,000 deductible. 0% coverage until $7k, 100% of everything after that. It cost $302/month for this coverage from Anthem.So your total costs per year would not exceed $833 per month (7000 + 300×12)/12. And only that much if you actually use it.That’s actually cheap for family coverage. (So you seemed to be underpaying if I understand the numbers you have presented.)Your new plan calculates out to $1600 per month. But has the chance of costing less if you don’t use up the deductible.This seems to penalize someone who has more family members on the plan.Which actually is a inverse pet peeve of mine.The fact that a family plan costs the same if you have 1 child or 7 children.Why is that?How in the world can you price insurance for a large family the same as a small family?Sounds like something that has its roots in the same place as Sunday blue laws.

      2. Richard

        Fred, there are winners and loosers here. You can’t Talk about Premiums without talking about Deductables.

        1. andyswan

          Both went up massively. Guess I’m in the “losers” camp of this legislation.Who would have thought… a piece of gov’t legislation that puts responsible people doing the right thing into the “losers” column. LOL

    5. CJ

      A friend saved 90% and my mom can actually afford health insurance now. My company will have to pay a tax on our healthcare plan. Individually, your results may vary. As a whole, I think this is good for the nation.

  14. Dave W Baldwin

    I’m sure most replies will be how great the President is. I just have to call your hand on the any means to an end. We are setting up the ultimate Have vs. Have Not.The biggest supporters of ACA are “those not affected” and those that believe they will get a free lunch. Unfortunately that is a big group because in health insurance, most think they pay $10 and get $100. Doesn’t work. Add to that, sweeping comments that confuse things more, like saying all of the problems in the sloppy coding in the web site is no problem because you have until March (the penalty starts in January), another from the right where they say just let those who want in go in and everyone else get a year waiver (all pre existing in and all healthy stay out)…. I can go on and on.Those who are the Haves can sit around and make sweeping statements. People like me just have to ignore them, since we’re busy working.

  15. Kirsten Lambertsen

    Why Medicare in particular?

    1. fredwilson

      because it is going to bankrupt the US if we don’t get it under control

      1. Kirsten Lambertsen

        You probably know what I’m thinking… πŸ™‚

      2. ErikSchwartz

        It’s a health insurance plan that only covers old people, sick people, and dying people of course it’s going broke.The way to fix it is to increase the actuarial pool so that healthy people are covered too, thus improving the average.If only we had a program like that…End of the day ACA (or something similar) is the only way to save Medicare and EMTALA. FWIW Reagan was the on who “socialized” medicine in this country with EMTALA, most HC reform since then has been trying to make EMTALA less ridiculously inefficient.

        1. LE

          The way to fix it is toPart of the problem is also that we are able to maintain life in people who are abusing their bodies with activities and eating habits that are dangerous].People who would have died off a long time ago if not for advances in the past 30 years.So in other words food and eating habits have changed and medicine has advanced to the point where we can keep people who make the wrong choices alive.

  16. Kirsten Lambertsen

    I’m trying to remember…. who was the last president to balance the budget?

    1. Dave W Baldwin

      Stating this from middle, but who was the congress?

    2. pointsnfigures

      Someone else in this thread asked if you really believe govt numbers. Clinton balanced the budget on an accounting basis. But, the cruel reality is that if any President added in all the costs that they have off budget, and accurately accounted for future liabilities, no budget has been close to balancing for a real long time.For example, in Illinois, the government accounts for future pension liabilities and say it’s XX billion. However, if you applied a real discount rate to those liabilities, the real projected liability would be XXX billion. Illinois conveniently uses an 8% implied rate of return on current investment, instead of a practical 4%.Government accounting by any political party is judgement with pretty large bias.

    3. fredwilson

      Bill Clinton

      1. kidmercury

        when the social security ponzi scheme runs out, people will realize clinton didn’t balance the budget, but just stole money from the SS fund to create the illusion of balancing the budget.

      2. JLM

        .Not really. When one uses the term “budget” you have to know that it does not include inter- and intra-governments transfers.if Clinton had in fact balanced the budget then the National Debt would have either not changed or gone down.Check it out, it went up indicating that the US was a net borrower and ran a government deficit.I think Eisenhower might have been the last guy to actually balance the budget as he did for 8 straight years.JLM.

        1. ErikSchwartz

          What was the top income tax bracket under Ike?

          1. JLM

            .320%?Why not take everything and just give it all to Obama?JLM.

  17. William Mougayar

    It’s still no fun watching you all discuss this, but it’s a good discussion that’s getting both sides of the arguments aired.

    1. Kirsten Lambertsen

      I think these should be called “Fight Club Friday” instead of “Fun Friday.”

      1. fredwilson

        good idea

        1. William Mougayar

          Easy. Pick polarized issues, and it spurs a passionate debate. Android vs. iPhones, Rep vs. Dem. etc.

      2. William Mougayar

        I think Fred said in his past birthday post that he wants to have a little more fun on this blog.

      3. kidmercury

        #upvotedlove that movie!

      4. ShanaC

        yeah, maybe.

    2. Anne Libby

      Not even a little fun?(I’m still hoping for “most memorable meal.” Or maybe something “bucket list” related…)

      1. William Mougayar

        un po, si

  18. Matt A. Myers

    Default this year? Next year isn’t far away.

  19. baba12

    It is always interesting to read the comments here. Most who read and comment here seem to be fiscally conservative folks who tend to believe that there are only a few things they need the government to do for society and for everything else, they believe private enterprise is the best suited to maximize profits and minimize costs when it comes to delivering a product or service.I wonder if anyone here has taken a look at the fortune 1000 companies and checked to see what percentage of their revenues comes from selling products and services to the federal, state and local governments. Granted that private enterprise is better at delivering profits and lowering their costs. But they deliver those profits to a few just as they have done in the ages before the revolutionary war.I guess the wealthy folks like Fred and many who aspire to be like Fred tend to think that they can live well only if they get to have lower income and corporate taxes.Before 1963 the top wealth creators paid over 50% in taxes and did not feel it was wrong or un justified. For all those who believe in free markets free of regulations that stymie growth or wealth creation, I’d suggest the Government in Somalia and Sudan is more than happy to have you open your business there and operate in free for all markets.I doubt The Goldman Sachs or any number of individuals move there. I know for sure the Koch brothers will not be moving their operations there anytime soon.I am flummoxed by those who feel that it is tough luck if you the individual were born in an environment that does not help you be able to perform to your best abilities. I guess not much has changed in human evolution to want fairness in the system that we choose to abide by. I must be naive to think and want that.I should be more about greed and as Gordon Gekko says about Greed, follow through on that at all costs including killing my conscience.So for all the naysayers who oppose single payer systems, regulations, higher taxes, less government, propose a fair system that accounts for people not starting out at the same time or at the same starting point and allows for the individuals to have mechanisms that gives them the same set of tools that the next person has.Since we don’t live in that world and assuming believe that the system is loaded then I’d like to see a fairer system than what we have that allows you the rich to keep your wealth while letting others get to where you are at as well. I don’t see that is how it gets played out.

    1. LE

      I wonder if anyone here has taken a look at the fortune 1000 companies and checked to see what percentage of their revenues comes from selling products and services to the federal, state and local governments. A good point for sure. My similar thought is to ask how many people who oppose war and military spending realize the good that actually comes out of war and military spending.Before 1963 the top wealth creators paid over 50% in taxes and did not feel it was wrong or un justified.Is there a survey or data to back up that statement?I am flummoxed by those who feel that it is tough luck if you the individual were born in an environment that does not help you be able to perform to your best abilities.You really can’t talk about that without talking about the issue of birth control and people in that “environment” having babies at a young age that they can’t come even close to affording to support or have grow up in a good environment. That is really the core of the problem from my perspective.I saw a mother interviewed on the nightly news – might have been last week. She was perhaps 19 years old and said she was a single mom and didn’t have the government money to buy the formula for her baby and couldn’t work because she had to stay at home and take care of the baby. “What am I supposed to do now!!” she said. Or something like that. Wouldn’t be surprised if she has another baby and the man that gives it to her doesn’t have a job or doesn’t stick around. Like the first one.I have of course no data to back up any of this up. No studies nothing written by a Harvard academic to support my point.But I also have no data to back up my thought that there is a high probability that an attractive woman walking by a construction site will get the attention of the men working there either. But I know it to be true.

      1. baba12

        Yes there is data to back it up check this out for the second part wherein you write about single mother of 19 etc, here is the issue: You rarely hear of stories of single young women under the age of 20 having children and they happen to be in the 1 to 5% income earners or come from families in those income brackets.The women you write about had to begin with a family structure that was not healthy, had public education systems fail them and had to grow up very early in life. This is true in developed wealthy nations or poor developing nations.So to address the issue at hand question is are willing as a society to try and provide for a fairer system. So far everything we are doing in the last 40 years in the U.S. tends to be so energy intensive that at times I wonder why we even bother. Passing laws that make the system fairer takes a lot more energy today than it did 50 years ago. By energy I mean the amount of work done to get the message across, be it gay rights or equal pay for equal work or passing a debt limit increase.I believe we are a nation full of nincompoops with a small group of smart folks who seem t have lost their conscience to see how much they can squeeze out of the system. I would not be surprised that in 15-20 years if things continue the way they have we wont have a bloody revolution like they had in

        1. LE

          Oh come on.You give me a 46 page pdf with charts in order to back up that statement?Give me the page on which it says in plain english the conclusion that you have reached about this? (I would never dump a load of paper on someone expecting them to just figure “well sure it must be there”). Of course I would dump a load of paper on someone if I felt they weren’t going to call me out on it. It’s actually an excellent technique in certain situations to take advantage of the fact that many people don’t want to call bullshit.The women you write about had to begin with a family structure that was not healthy, had public education systems fail them and had to grow up very early in life. This is true in developed wealthy nations or poor developing nations.I just find this an incredibly difficult equation to solve. Because by giving people a crutch and help as you would desire you also enable them to continue the same behavior patterns.

  20. Rob Underwood

    Implicit in Fred’s post, but missing from most of the sports-like coverage of the government shutdown / debt limit debate, is that by doing a clean CR the sequester spending levels would continue, albeit temporarily until an actual budget is passed and signed (don’t hold your breath). The spending levels are near the levels of the dreaded (by the left) proposed Ryan budget, and as Princeton professor Alan Blinder points out in this morning’s WSJ, a “win”, with each month they continue, for the Republicans. By refusing to do a “clean CR” that continues current spending levels, Republicans are snatching defeat from the jaws of victory, at least so far as deficit reduction is concerned.

    1. pointsnfigures

      There was a great post on the sequester from a govt employee ( that is a fiscal conservative. He didn’t like the sequester, not because of the decreased spending and the limiting of his budget, but because it was a failure to lead. Instead of making the tough choices, picking and choosing what to cut and what not to cut, it cut everything both good and bad.Even if you hate the House, they passed a budget. The Senate doesn’t. That’s a leadership failure-worse, it’s a deliberate strategy. Budgets show what a person believes in.Would anyone invest in a startup that doesn’t have at least a skeleton budget??

        1. pointsnfigures

          only took them over 1000 days, but they passed it 50-49!

  21. Nathan Lipson

    Hi Fred. This post reminded me of a post you wrote about our meeting, back in October 2008, when I asked you if you think the US is still a triple-A economy:

  22. andyswan

    BTW 1:20 PM ET today on Fox Business you can learn a little more about Swans’ latest venture πŸ˜‰ We won’t be on but our company will be discussed, hopefully positively haha.Could be more fun than listening to me bitch about Obamacare…just maybe.

    1. Aaron Klein

      I will just go on record now and say that I would be glad to build a working version of the Obamacare site for only $534,000,000.I will also provide a 50% money back guarantee if it doesn’t work.

      1. F U

        If Obamacare works as well as Riskalyze god help us all.

    2. William Mougayar

      that’s your other company, besides Voomly? Cool. you are are serial and parallel entrepreneur.

      1. andyswan

        Yes. We’ll probably merge the two soon….I don’t like parallel and LF is taking off.

    3. awaldstein

      Cool–share it later on Twitter and I”ll watch it end of the day!

      1. andyswan


  23. Kirsten Lambertsen

    In all this talk about debt and spending and taxes, why do we never talk about the enormous tax revenue we have lost over the last 10+ years thanks to our giant corporations moving their headquarters to post office boxes offshore? They get corporate welfare *and* they don’t pay their taxes.

  24. Tom Labus

    I don’t know what’s worse: Defaulting or the Giants at 0-6.

  25. ShanaC

    i just want a week were the politics all get along

  26. JLM

    .”The way this is going, we might have a balanced budget by the end of the Obama administration.”Really?Fred, as the owner of the bar know that it cuts into margins to drink all of it by yourself.I am just now pulling together an intervention but I will make sure it is fun. Nice restaurant environment somewhere. Maybe a massage therapist or two.The Obama administration is not capable of balancing a budget because they do not submit budgets.This is the most financially inept administration in the history of the US.JLM.

  27. JLM

    .Default is a meaningless bugaboo that means absolutely nothing.The US will pay every single penny of interest and principal and has more than enough current tax revenue to do that right now.What may be at risk is discretionary payments.The administration will engage in a plethora of scare tactics such as refusing to pay the death benefit to fallen soldiers — the absolute depth of cynical depravity.A soldier dies for us and our administration — having funded the DoD, mind you — tells their families they will not pay the death benefit.To put a face on this, this is a $15K payment to be made upon arrival of the body at Dover. This is a chickenshit amount of money at its core and we have lost less than 20 men since this stupidity started.This is the soul of this administration. Pissing on the bodies of our fallen warriors at $15K per man as part of a cynical political calculation.These guys are ghouls.JLM.

    1. andyswan

      “Make it hurt” is the Alinsky way at every turn. This is what they do.

  28. JLM

    .Only in the eyes of the Obama administration could a call for responsible deficit reduction, reducing the cost of entitlements, whispering about a balanced budget, reducing waste, eliminating fraud be considered radical.Count me as a radical as I want the government to balance its revenue and expenses and to finally deal with the cost of entitlements.Entitlement reform was the quid pro quo for the elimination of the Bush tax cuts for the top earners. WTF ever happened to that?Sheep. We are sheep and yet every State in the Union has a Governor who can balance the budget — Texas for 2 years at a time.It is the quality of the leadership. Nothing more.Fiscal responsibility is not a radical political notion. It is normal. It is real. It is attainable.LeadershipJLM.

  29. CAinley

    The possibility of a default is nil. The Koch Brothers called off their dogs Wednesday night when they sent a press release declaring they are neutral on using the shutdown to defund ObamaCare (see Politico). That’s why the market was so strong on Thursday. The Brothers’ Cabal had been defeated (see Sunday NYTimes). Now the market is back to worrying about the strength of Q3 earnings.Understanding the Politics of this is critical. The crisis was never about fiscal discipline.The years-old plan was to precipitate a crisis and either 1) get a feckless President to cave on his signature legislative victory or 2) create an opportunity for the Ryan/Cantor “Can-Do” Fiscal–Conservatives-Who-Can-Compromise to ride in on their White Horses – the opening salvo in their bid to unseat Queen Hilary. Polls indicate that the plan has seriously backfired mostly because the feckless Republican leadership refused to stand up to their fractious right-wing.All of which has created a wonderful political opportunity for Obama. For his late second term legislative agenda, he can effect the significant Entitlement Reductions that he knows are sine qua non for our economic survival – and blame the politically unpopular cuts on the Republicans. I think people seriously underestimate Politican Obama.

  30. David Silver

    Obamacare scares me, but nonetheless, if the president leaves having accomplished universal healthcare and a balanced budget, that would be an impressive run.

    1. JLM

      .If the President leaves with the Obamacare websites working and a balanced budget (really, look for lobotomy scars), I will buy you a steak every Friday night for the rest of your life.JLM.

  31. matthughes

    I voted that we won’t default.A deal — slippery as it might be — will be struck.Related: I got the official notice from my insurance provider this week that my family’s health care premium will be increasing 3x.

  32. sigmaalgebra

    The debt ceiling and default? Just politicaltheater so that all sides in the debate can gettheir own headlines before something simple isdone.Obama’s ‘legacy’?I believe that an essentially necessary resultof Obama’s central political strategy is thathe won’t have a significant ‘legacy’.Basically his strategy is to keep up his pollnumbers by appearing to want to do some thingsbut actually doing next to nothing and, thus,avoiding blame.On a big issue, when 60+% of the voters reallywant something, maybe he will then courageouslystep out in front and ‘lead’ just by appearingto support the effort and then promptly handoff the actual work to others so that he can’tbe blamed for failure in execution.I explained my views on Obama here on AVC in…For US health care, it has at various times inmy life saved my hearing, my left hand (wellenough not to hurt my progress with violin), myright eye, my Achilles tendons, my life atleast three times, and more. The people whohelped me were just excellent, the cream of USsociety. At various times my family and/or Ipaid from full price down to nothing.While our health care system can use someimprovements, there is no way, none, zip,zilch, zero, the grotesquely incompetent,unwashed hands of the old Senator Kennedyhealth care staff, Pelosi, Reid, and Obama canimprove on our health care system. In healthcare, grotesquely incompetent, unwashed handsare very ugly things that will kill childrenand adults or leave them seriously injured forlife.As in…we have a taste of Obamacare with the$634,320,919million Web site development that apparentlywent live without testing and full of bugs.”If you think health care is expensive now,just wait until it’s free.”Of course with Obamacare the quality of healthcare will decline, especially for poorpatients, but, you have to remember, the totalcost will be much higher.If Obamacare remains, then we will have a twotier system: In the first tier will be theworld’s best health care but at prices maybeonly 20% of the population can pay. In thesecond tier will be everyone else, and thesystem will be so bad no one will want to gofor health care no matter how sick they are.We’ll be talking mold on the walls with thepaint peeling off, the equipment old, dirty,and rusty, the refrigeration and computingchronically broken, grotesque medicaldisasters, deaths and injuries for no goodreasons, basically the unwashed hands of 19thcentury medicine with a little 21st centurymedicine around the edges. And Obamacare willthrottle the progress of 21st century medicine.Did I mention, in health care, grotesquelyincompetent, unwashed hands are very uglythings that will kill children and adults orleave them seriously injured for life?For Pelosi, she is just a spoiled, ignorant,irresponsible child who dreams of everyoneholding hands and singing Kumbayah and BigDaddy Big Government taking care of everyonewith the rich 1% paying for it. She would havereally liked Lenin, apparently still does. Asa child, her Daddy could never tell her “No” nomatter what absurdity boiled up from heroveractive, little girl emotions, and she tookthat situation as reality so that now she won’taccept “No” from anyone.For Obama, he has to know that Obamacare is adisaster but is just using it as a politicalwave to ride while he can. He wants thedisasters to be delayed until he is out ofoffice. E.g., after he shot his mouth off withincompetent nonsense, the American College ofSurgeons slapped him down hard with…and then he just shut up about Obamacare. LikeSyria, he wants to say a lot of stuff but inthe end weasel out and avoid blame for himselfno matter what happens.Obama is leaving the decisions on Obamacare tosome 60+% of the voters who will eventually seethe horrible health care, have a lot ofchildren die for no good reason, and finallytell Congress to junk it.But Obamacare will neither come nor go.Instead it will be eaten away around the edgesuntil there is next to nothing to it but justits shadow. Then it will be forgotten.Hopefully some responsible people in Congresswill sufficiently throttle Obamacare before itkills too many people. How many thousands ofUS children have to die before Congress willjunk Pelosi’s irresponsible, incompetent,deadly dreams?

    1. JLM

      .It is gratifying to see you come out of your shell. Of course, I agree with everything you say more than you do yourself.We will look back on Obamacare and shake our heads a few years from today.JLM.

  33. JLM

    .Threatening default is like when you went on a road trip and your Mother said: “Do you want your Father to come back there and smack the sequester out of you brats?”It is baloney.Even if the US were to miss a timely payment or two — Hell, we’re good for it.This is pure baloney which is being trotted out to scare the masses and will amount to nothing.The Congress — a co-equal branch of government in our system and not required to eat shit just because that is what they’re serving at the White House — has a legitimate duty to oversee and discipline spending. Every spending bill must originate in the House for goodness sake.We have had 17 shutdowns under 5 President — quick name the Presidents and the Speaker of the House for each one. See, ya’ll, it didn’t even impact any President’s legacy and nobody even remembers who the freakin’ Speaker was (except for Newton).Presidents are the leaders of our system. To lead, you have to talk. Talking is negotiating. It is what leaders do.Chatting with your wife about her credit card limits will not prevent you from having an erection. It does not undermine your manliness, even if you do not have any to start with.Hell, negotiating is leading.JLM.

  34. george

    The Economist Magazine stated it best, “This is no way to run a Country.” We need political innovation and a new approach to drive a more effective process.

  35. Alex Urevick-Ackelsberg

    Fred, I find your focus on the debt to be almost tragically comic, and its surely an illustration of the compartmentalization of your business and political “brains”.You state as a fact (as if it’s obvious) that we need to cut the deficit and “balance the budget”, which indicates that you believe that our debt is somehow out-of-control. In fact, our nation has owed money since the day we were founded, often much greater relative to GDP (which is the measure that matters, since GDP = the taxable base of income for the government). Here’s a chart of our national debt since our founding:…I’ll prefice this with the standard IANAE (e for economist), but I think your biggest error is that you seem to be leaving GDP out of your equations for evaluating debt and deficits, getting obsessed with the big numbers (which are big, and getting bigger), instead of the debt-to-GDP ratio (which has remained pretty constant). The way that the US has dealt with its debts in the past, for example those huge WWII debts, has been to grow out of them, both via GDP growth and inflation. Just to look at a 15 year period, from 1960-1975, GDP more than tripled (from ~$520B to ~$1.6T), while inflation took ~1/2 the value out of 1960 dollars ($7.87 vs. $4.35 in today’s dollars). So, over that period, the value of the debt halved, while income tripled, making the debt much smaller in relative terms. Obviously we kept on borrowing, which is why our debt continued to grow in absolute terms during that period, but the debt-to-GDP ratio shrank.I’ll let professor & Nobel Laureate Krugman (who I’m guessing you dismiss despite his pretty stellar record) explain: “to make the debt look scary, you have to dismiss the post-World -War II experience, even though it turns out that the 50s offer a quite good lesson; assume that in the future the federal government will have to amortize debt over a quite short period, even though it never had to in the past; compare this inflated debt burden with a narrow piece of the federal tax base; and ignore the likely growth in the tax base over the next decade.”http://krugman.blogs.nytime…I’m also sure you mean well by talking about “the Ryan plan”, but this “plan” is nothing more than wishful thinking mixed in with a good dose of poor math and a dash of blatant lying. Again, I know you think Krugman is biased (aren’t we all), but you should consider what he says about the Ryan “plan”: “…over the first decade all of the alleged deficit reduction comes from revenue and spending numbers that are simply asserted, not the result of any policies actually described in the β€œplan”””Ryan basically proposes three big things: slashing Medicaid, cutting taxes on corporations and high-income people, and replacing Medicare with a drastically less well funded voucher system. These concrete proposals would, taken together, actually increase the deficit for the first decade and beyond.”http://krugman.blogs.nytime…I wonder, given that you are firmly in the 1%, and Ryan’s plan would help only you and your fellow filthy rich folks, could it be class bias that’s leading to your foggy thinking on these matters?

    1. Jim Ritchie

      Krugman is such a self serving political hack that he has lost what little credibility he once had. The fact he is a nobel laureate adds about as much credence to his ideas as does the fact that Obama was awarded the Nobel Peace Prize (or that other peace loving individual Yasser Arafat).Debt in absolute dollars does matter, especially as we ultimately must increase our historically low interest rates. You said “debt-to-GDP ratio (which has remained pretty constant)”, unfortunately the debt to GDP ratio has not stayed even close to constant as just in the last decade the ratio has more than doubled. In addition, there is now way more “off balance sheet” debt such as government interdepartmental loans. Finally, how GDP is actually measured overtime has been fraught with inconsistencies and outright fraud.Bottom line is we need to reduce the absolute size of the federal government and the amount of money we are printing as both ultimately lead to long term wealth reduction to the average citizen.

      1. Alex Urevick-Ackelsberg

        Krugman is a hack, because Jim Ritchie says so (I’m sure Keynes was a hack for the same reason)! The fact that he’s been right so often must mean nothing. The funny thing is you end your post with a statement that proves that you either ignore reality you don’t like or you’re acting like just the political hack you claim Krugman to be (whom is he hacking for, btw?). If what you stated about printing money leading to “wealth reduction to the average citizen” was true, then the huge expansion of the monetary base we just experienced would be creating runaway inflation (the only way it could actually lower the “wealth” of average citizens, unless by average you mean the top 1%). But of course, reality has a well known liberal/Krugman bias:…Your statement about the “explosion” of US national debt must include the money the government owes itself, since privately held debt has, like I said, remained relatively stable (… ), and yes, money we owe others is far different from debt to ourselves. Obviously, we are still going through one of the worst recessions/depressions since the Great one, so you’d expect that ratio to go up both because of spending on safety net at the same time that taxes are going down (because of lower GDP + the Bush tax cuts, mostly for the ultra wealthy), but that’s a feature of the safety net, not a bug.We do not need to reduce the overall size of federal government, we need to reduce the size of the military and lower our overall medical costs (the later of which the ACA has already helped to do). If you look at the 2013 budget you’ll note that Social Security more than pays for itself, so we certainly don’t need less of that, and the only other huge items are defense and CMS, both of which need to be dealt with (the former through shrinkage, which may never be politically possible, the later through direct intervention in our out-of-control health care system, which the ACA is helping to deal with).And, btw, government has shrunken since Obama was elected more than during any other president of the past 30 years, a drop most sane people see as both “off the charts” and counter productive (in that it lowers GDP at a time of low GDP growth, when the government should be acting as the employer/spender of last resort)…

        1. Jim Ritchie

          Krugman is a political hack of the highest order. My saying this does not make it true, but certainly his obvious political biases do.…Anyway, we do need to reduce the size of the federal government across the board including entitlements. I favor a system of government that is as small and as decentralized as possible. It seems you may favor a completely different system. I also prefer to keep as much as my hard earned dollars as possible as I believe I am a better judge of how such money should be spent than some bureaucrat 3,000 miles away.I’m glad that federal spending as percentage of GDP has shrunk under Obama. I hope he keeps up the good work! I expect much of this is in fact due to the unwinding of our wasteful wars in Iraq/Afghanistan. I really don’t care about the comparison with W., as he was a complete failure in reducing federal spending. Here is some other data on our federal spending from “across the aisle”.…- In 1963, defense spending was 9 percent of GDP and mandatory spending on entitlement programs was 6.1 percent of GDP, one-third lower.- In 2013, spending on defense is at about 4 percent of GDP and falling, while mandatory spending (including net interest) is reaching 14.5 percent of GDP and growing.Seems like lots of room for improvement to me.

  36. Daniel Chait

    “Who would have thought that Obama’s twin legacies would be a health care system where everyone is covered and a balanced budge” <– the majority of Americans, myself included, who voted for him. Twice!

  37. locksmithtampa

    Great post

  38. Druce

    Wait, we talking about the same Ryan who campaigned with Romney promising not to touch current seniors’ Medicare, but to end it for everyone under 55 (turn it into a block grant/voucher system)? (And then Romney said Obama won because of ‘gifts.’) Same Ryan who just voted with the Tea Party against raising the debt ceiling and for default? Must be a different Ryan, the one I know is a dim, empty, soulless vessel.

  39. andyswan

    Just one more $640,000,000 404-error away from utopia

  40. JLM

    .Any reasonable person would love to conquer the health care dilemma in the US which is hugely bigger than just the debate about ACA.On the other hand, there is the reality of things like this — reality being that bitch who never seems to fail to deliver the bad news just when I have convinced myself that everything is going to be all right.…The marketplace — Goddess Capitalism who folks worship — and the folks (not the ones with the Obamaphones, the ones with the brains) hate it.ACA is going to be a very tough slog and almost nothing promised — keep you plan, my man; keep your doctor, madame; will reduce costs, bean counters; will not kill jobs, business persons — is going to be delivered.When it smells like a turd……JLM.

  41. sigmaalgebra

    Sorry, Charlie, I wish you were correct.Sure, I’d take the health care in, say,Switzerland, but the US is very differentfrom Switzerland in ways that mean thathere in the US single payer won’t workand, instead, will kill people, a lot ofpeople, and wreck the US health caresystem.

  42. pointsnfigures

    actually, insurance premiums are only going down in states in the upper northeast.…

  43. kidmercury

    all the people who hate on carbon energy should stop using it, or suggest a viable solution and a plan for getting there.or, they could at least try addressing some of the following (though as we know they won’t, they will just keep preaching their carbon religion):1. the IPCC continues to falsify data and has been caught doing so:…2. global warming stopped, like in a scientific, recordable, measurable way, 16 years ago:…and of course, what is the “solution” to global warming? why, a carbon tax, of course!!!! hahahahahaha

  44. kidmercury

    i’ll never understand how people who are otherwise perfectly adept at basic math and street smart valuation analysis when it comes to their affairs in business can look at government numbers and propositions and be like “yeah that makes total sense” lol wtf

  45. panterosa,

    My lack of bandwidth on politics is due to the fact I find politics depressing and the latest scenario embarrassing. If I thought about it too much, I’d end up in tears. At 12, my daughter is more mature than this.

  46. fredwilson

    when you know stuff, you have an obligation to speak.

  47. CJ

    Ditto. Ugh.

  48. Dave W Baldwin

    I understand your point, but then you have politics determine everything staying with envy driving polls.. and the Haves won’t be affected.

  49. Dan Epstein

    What was the argument/case against single payer?

  50. kidmercury

    you modeled it at the state level. i’ll take your word the economics were as you the federal level there is a snowball’s chance in hell of working the way you describe. in reality, premiums are going to skyrocket. the economic impact will be is a good article that goes into more details.

  51. ShanaC

    wow – do you have the numbers

  52. Pete Griffiths

    absolutelyit’s a no brainer.

  53. Mark Essel

    I think we’ll see a lot more <49 person companies out there, that aren’t required to supply health care.

  54. MickSavant

    Every government project has a “modeled” cost which turns into a more expensive “muddled” cost that offers worse service than the private sector. What was the modeled cost of the Big Dig? California rail? Insurance premiums under Romneycare?

  55. fredwilson

    i am a fiscal conservative but i am also a human and have a conscience. it is immoral to live in a society as wealthy as ours where we don’t take care of the most basic thing as healthcare. i am 100% in favor of everyone being covered one way or another. i prefer that those that can cover themselves be required to do so and those that truly cannot be covered by the rest of us.

  56. Nick Ambrose

    Well, somehow the entire rest of the developed world that has almost exclusively “single payer” (or roughly equivalent health care) manages to cover 100% of their populations for around half per person what we spend here and have generally comparable or better outcomes/life expectancySo I am not sure what numbers you are looking at.The sad thing now in England is that the government seems hell bent on crushing the NHS into uselessness just so they can point their finger and say “Look, it’s so broken, obviously the only way is to get private industry in here just like in the US”, conveniently “forgetting” that they were the ones that broke it.

  57. CJ

    You’ve yet to offer up any math that says why it’s so bad. Show me the money Kid.

  58. andyswan

    It covered us fine. It was a plan that covered 0% until $7,000 then 100% after the deductible was hit. Max outlay of approx $10,500 per employee (Min $4,000 if no illness/injury). Now we are looking at a minimum outlay of $7500 and maximum of over $20,000 per employee, which our business cannot sustain. It’s the employees that get hurt here.

  59. kidmercury

    i dislike moral arguments and use them only when absolutely necessary. i prefer economic arguments. we all want more healthcare. in fact, i personally want more wealth for everyone. 99 out of 100 times, the free market does a better job of reaching this goal. the problems with healthcare currently are because of government intervention. further intervention will only exacerbate the problem.

  60. bernardlunn

    I live in Switzerland where the healthcare system is what Romney modeled on and then Obama modeled on. Works quite well, cheaper than when I was in America and better incentivized to preventative. Better than uk universal IMO

  61. JLM

    .The big question is whether the government is the right driver of healthcare and what is the real nature of healthcare insurance?As a CEO for 33 years, I never struggled to provide health, dental, vision and life insurance and a wellness program and a cafeteria 125 program to all of my employees.I did not receive any government assistance other than it was a legitimate business expense and therefore I was using “before tax” dollars.As to the insurance itself, it often is expected to pay for the first dollar of expenditure unlike auto insurance which requires the insured to pay for routine maintenance (repairs, tires, oil, gas, cleaning).Health insurance should require a similar relationship wherein the insured pays for routine care and the policy protects the insured from catastrophic losses.The solution is out there and it is really very simple. It does not require the kind of ham handed and overbearing approach that ACA takes.Know this — ACA will accelerate and exacerbate rate increases, costs and the cost of administration will make insurance companies look like a walk in the park.ACA is going to be thundering failure.JLM.

  62. John Revay

    Nicely stated

  63. sigmaalgebra

    That’s a socialistic, political philosophy dreamthat ignores health care and will wreck UShealth care and kill a lot of people.Now everyone is covered one way or another, e.g., Hill-Burton, Medicaid,Medicare, charity programs, communityrating, etc. We might improve it.But the main driver of Obamacare is justthe ‘political emotion’ you described,and that is essentially what the supportersof Lenin had in mind. I just doesn’t work.Much of why is that Obamacare is notjust a tweak of insurance programs buta deliberate move to single payer anda Commissioner in DC that turns physicians into robots in what theycan do when treating patients. It’s ahuge power grab, like Lenin did –get the power first and then try tomake good use of it, which after 70years they never did.

  64. sigmaalgebra

    We’re not that wealthy: Only a few ofthe richest states have community rating,and the rest thought that it was too expensive.Obamacare will try to bring communityrating to the whole country, in one stroke.Then there will have to be Federal subsidies.So, now NY and MA can pay for communityrating for themselves, but with Obamacarethey will have to pay for community ratingfor the poor states, too.Then to save money Obamacare will usecrackpot applied math to specify whattreatments a physician can use, and thuswill kill people.Then to save more money, Obamacarewill fix prices and profits for everythingthe Federal money buys in heath care –the Commissioner will decide on pricesand profits. Then capital and peoplewill leave the health care industry,which then will be about 20% of the wholeUS economy.The US health care will be junk care, withlots of dead people, with the industry sickand good people gone.This is all little Pelosi’s deadly, dangeroussocialistic dream.Net, Obamacare is not health care buta socialistic power grab.

  65. MickSavant

    The problem with that comment is, what do you mean by “healthcare”? The very best and most recent advances? The best and most expensive hospitals? I think everyone should have food, shelter, clothing, and healthcare. I think everyone should provide this for themselves in an open marketplace that uses the pricing mechanism to allocate scarce resources. If we are going to help the unproductive and unlucky via redistribution we should do itwith a negative income tax, not an in kind contribution of healthcare services or food stamps or housing.

  66. andyswan

    I’m sure there are vast differences across this great land of ours….part of the reason I am so against a centralized federal “solution”.

  67. Richard

    SIngle Payer == Single Denier of Coverage

  68. kidmercury

    solar absolutely, without question, is not viable AT, wind, geothermal, and excess heat COMBINED account for 1.4% of total energy production. source:… this is with all the economically unviable is also not renewable. solar energy requires copper and rare earths, among other minerals. are they renewable? or are economically viable deposits becoming scarce? take a guess…..

  69. kidmercury

    there is no free market present, but we’ll see what ACA does. guaranteed deficits explode until the whole system collapses.

  70. Nick Ambrose

    You simply dont get it. In a single payer system, the concept of “premiums skyrocket” is completely alien …. there aren’t premiums, or “claims” in any meaningfully comparable way to the US system…. yes, there are co-pays for prescriptions but the whole concept is completely different ….

  71. SubstrateUndertow

    Without a single payer system you are probably right, as the market-place will game the system to death.

  72. Jeffrey Hartmann

    Totally agree here, I think if I remember right we are both very pro-nuclear energy. That is where it is at, and it can really move the needle. People do not seem to understand that solar is very diffuse, so it will never be able to produce enough for base load. And as you point out, the materials that are input for solar are not renewable. They are also HIGHLY toxic, there are some ‘dead zones’ in China where materials needed for making ‘renewable’ solar energy were dumped. Way nastier than CO^2, and not biodegradable.I don’t agree with you on Carbon and Global Warming though, I think it is a HUGE problem but completely solvable in a generation if we just took some of those untold billion of dollars we waste on wars and Government IT and made good and advanced Nuclear reactors a priority. We had the tech in the 60’s and 70’s, we just didn’t finish development cause it was crappy for bombs.

  73. SubstrateUndertow

    OK – we’ve got a long way to go for sure but we’re not at the end of history on this alternative energy stuff !

  74. kidmercury

    the cost is going to be more, whatever term you want to use and however that is masked. probably in the form of a greater tax burden, payable now or by future generations.

  75. kidmercury

    even if CO2-driven global warming is real, i think the solution is nuclear. because CO2 emissions come primarily from fossil fuels, and they are increasingly becoming cost prohibitive. we need to get off fossil fuels for economic reasons, which in turn will reduce CO2 emissions.

  76. ErikSchwartz

    If you look at countries with single payer systems that have outcomes comparable or better than the US they spend much less on healthcare per capita than we do in theUS.

  77. Nick Ambrose

    For all other countries (virtually) that simply is not true.Go an do some real (unbiased) research (not simply linking opinion articles from people with a point to make)Then come back and have the discussion. In countries with single-payer systems, the TOTAL cost is around 40-60% of the US and *everyone* has coverage ….. Yes, that comes out of taxes generally but …. you then aren’t paying those premiums to insurance companiesSo at that point it would simply be a non-thinking knee-jerk ideological aversion to “higher taxes” or “someone is making me pay for SOMEONE ELSEs healthcare” or “I’m being forced to pay for MATERNITY care but I am a MAN and dont need it …”Now, you may say that our government is incapable of enacting and enforcing what virtually every other developed nations government has been able to do ….. but in that case, I’d argue that the blame lies with the people that put the current people into government ….

  78. SubstrateUndertow

    “probably in the form of a greater tax burden”Well yes, there is no free launch, you may pay more from the left tax-pocket but the aggregate right/left total out of pocket costs are less under a single payer systems.

  79. bernardlunn

    The tax rate in uk is about same as USA and no – zero – health insurance premiums unless you choose to pay privately. Its like school, tax funded unless you choose to go private

  80. kidmercury

    compare the increase in taxes to the cost of premiums wait times, and illnesses impacted significantly by wait times. prostate cancer recovery before obamacare in the US? 91%. in the UK where you have to wait weeks because of hte bureaucracy? 53%.everyone may have “coverage,” but we are redefining “coverage” so that it is a lower standard of healthcare.

  81. kidmercury

    outcomes comparable or better is dependent upon how we are defining better. the US does do some things better. prostate cancer is one example i cited elsewhere for money, i’ll take your word others spend less per capita. but the cost will go up here, regardless of that. i don’t think quality will go up correspondingly. just the price.

  82. ErikSchwartz

    Basically all men get prostate cancer. Very few of them die of it. Those that do die of it likely die of it whether it is treated or not. Lots of men are treated for it who would NOT have died of it but end up with a wide variety of unpleasant side effects of the treatment.There are many widespread randomized trials to support this. Poke around pubmed and you’ll find them.

  83. Pete Griffiths

    we don’t do prostate cancer better actuallyfor the millions with no healthcare guess what, they don’t get diagnosed in time

  84. SubstrateUndertow

    That is simply not the case as demonstrated by the fact that nearly every other western system of nationalized healthcare around the world has better outcomes at a much lower % of GDP than does the USA.Your usual iconoclastic tendencies are failing you as regards this healthcare-industrial-complex propaganda!The citizenries basic healthcare need not be a profit center.Healthcare is a natural monopoly.It is the 1 in 100 outlier.Morality dosen’t enter into it !

  85. mcbeese

    Healthcare is not a free market, it’s a captive market. Big difference. The inability to ‘walk away’ from health care when you need it is why it has become an imbalanced seller’s market. ‘Choice’, including the choice to walk away, is a fundamental component of an effective free market. We’re missing that ingredient with health care and we need to understand that and figure out how to deal with it.

  86. kidmercury

    better is subjective, and GDP is dependent upon many other factors. country to country comparison deals with too many other factors to control for, and as such i prefer pre/post obamacare comparisons in the united states.1. cost will go up, for sure. 2. medical privacy? less of it. 3. rationing of healthcare will occur (as it does in other countries)4. under current regulations, if medical care is denied by Medicare, then a patient is not allowed to pay cash to a Medicare-contracted practice

  87. SubstrateUndertow

    Granted, there is some truth to your points.But in the aggregate they are at best semantic rationalizations and at worst healthcare-industry propaganda!

  88. bernardlunn

    Come on Kid, if you want to go after waste and deficits (as we all should) how about military spending?

  89. Igor

    All of these were happening regardless. I don’t see ACA changing the trajectory of these changes much.

  90. Pete Griffiths

    That’s a little too slippery for my taste. You may or may not like the single payer universal healthcare of most other industrialized countries but the evidence is pretty clear that it is MUCH cheaper. Admin costs alone are way lower. And rational discussions about the necessity of rationing make it socially more acceptable. And, in countries like the UK, there is nothing to stop you going private if you want so you absolutely have a choice if you can afford it. Which, by the way, is the only way we have a choice in the US.

  91. Mark Essel

    4 sounds messed up.

  92. Richard

    Until we understand the physician education and training practice and the role that residents play in healthcare delivery, no real change will take place.

  93. SubstrateUndertow

    The FREE-MARKET is not and infallible God!It is simply a very effective and well proven methodological option available to democratic societies.The FREE-MARKET needs guidelines and limits to protect against monopoly and corruption.Government, with all its flaws, is the necessary evil that mediates that oversight process.Neither FREE-MARKET or GOVERNMENTALLY-ADMIISTRATED functions are sacrosanct.They both need constant monitoring and restructuring as informed by new technological, environmental change and social circumstances.That constant monitoring and restructuring is where clever new social-networking Apps can provide more distributive, evidence-based, input into a more effective democratic process.Organic capitalism in the end, more likely than not, will turn out to be a somewhat free-market/socialist dialectic integration ?One way or the other modern free-market capitalism will need to accommodate massive network-driven social dependencies or become irrelevant.

  94. ErikSchwartz

    The problem with the free market in healthcare is to work the free market requires an educated consumer. The level of specialized education required to make smart health care decisions is beyond what most people have or can sensibly obtain.The other issue is that these are often emotional decisions and emotional stress does not make for a wise consumer.

  95. kidmercury

    i agree, i am not calling for total anarchy, only acknowledgment that government intervention in healthcare to the degree and manner currently is disadvantageous, and is the root of the perceived healthcare problems.

  96. MickSavant

    Monopoly is not a function of a free market. Monopolies can only exist as a result of government interference in the free market. Government and regulation create monopolies.

  97. kidmercury

    you guys still think the federal government is honest and capable of performing efficiently. the entire course of human history suggests otherwise, though i know you will still go on believing what you wish — and when the problems are not fixed the only solution put forth will be greater nationalization…..

  98. SubstrateUndertow

    up voted for brevity πŸ™‚

  99. kidmercury

    no, it is scientific truth. natural doctors with ND certification are not accepted by insurance companies and so are essentially priced out of the government controlled market. so everyone goes to the pharmaceutically endorsed MDs.

  100. SubstrateUndertow

    I don’t think there is a lot of appetite for NATIOANIZATION here !But every rule has exceptions.Or should you free-market the US military too?oooh. . . wait

  101. Richard

    Reforming how we pay for healthcare is not reforming healthcare.

  102. kidmercury

    they won’t be. it will cost more in aggregate. this will be proven time.

  103. kidmercury

    sure, but that’s not what we’re talking about today.

  104. MickSavant

    Red herring. Plenty of waste in defense spending. If anything this line of argument only augments his case.

  105. kidmercury

    i don’t mind free marketing armed forces, and am generally a fan of corporations adopting the role of the state. they already have in many ways, i simply favor a more honest and more competitive approach.

  106. SubstrateUndertow

    i don’t mind free marketing armed forcesI’m pretty sure you see the fly in that ointment !STOP DIGGING πŸ™‚

  107. ErikSchwartz

    In the UK life expectancy is two years longer than in the US. Yet the UK spends 40% of what the US spends on healthcare on a per capita basis.Not really sure how spending less than half as much to get an increased life expectancy can be considered a bad thing.

  108. kidmercury

    UK tax rates are higher (…, but that ignores all the hidden taxes, the least of which is certainly not inflation, so a hard comparison like that takes serious number crunching.

  109. CJ

    No Natural doctors? Good. I prefer patients get actual treatment rather than scammed.

  110. Pete Griffiths

    Kidthis is badly informed.what has to be estimated is the cost of healthcare to the nation as a whole as a percentage of GDPit’s nothing to do with taxes or premiums or nonsense like that, they are simply mediums by which the above costs are realizedand the evidence is incontrovertible – it is cheaper, admin alone is so much cheaper it’s ridiculous. Compare the amount of paperwork you suffer to get anything done in the US with walking in with a card to show you’re eligible in most countries – that’s it, no paperwork.As for outcomes, you are not comparing like with like. Wait times in the US for who? What are the wait times for the uninsured? What is the cost incurred by no care translating into serious conditions dealt with in emergency rooms etc etcThere is no lower standard of healthcare than none and that is what millions of americans have had.And if you want world class healthcare with no waiting and can afford it, most other countries have a parallel private system for the wealthy.Newsflash, no country can afford world class healthcare for all members of its society with no waiting. Rationing is inevitable, so do a good job of it.

  111. kidmercury

    medical doctors still can’t figure out what causes cancer and heart attacks. maybe more drug research will help…..

  112. kidmercury

    employers won’t be required to offer health insurance until 2015, so those folks will be eligible for subsidies paid courtesy of the taxpayer and future generations that will pay for the borrowing of it. $60 billion in subsidies.

  113. CJ

    Science has figured out that it’s not psychic energy though!

  114. Pete Griffiths

    Natural doctors rock. Check out this brilliant video of an emergency room staffed by NDs…

  115. CJ

    The mandate suspension was a concession to the opponents of the bill, so had they not fought against it, that wouldn’t be happening. Blame those who share your viewpoint, even if this is true.

  116. SubstrateUndertow

    Sure we probably need nuclear as a short term bridging technology but that doesn’t mean we should slow are efforts at developing renewables !

  117. kidmercury

    and what would happen to employers who had to foot the bill? would they ahve kept employing people at the same rate? would they have had resources for expansion and hiring more people?there is no free lunch. the bill is going up. the quality of service will go down. pharmaceutical companies and lobbyists will, however, enjoy greater prosperity.

  118. kidmercury

    perhaps we can get closer to the right track if we understand renewables are not renewable.

  119. kidmercury

    dr. bruce lipton, MD, graduate of stanford university, would beg to differ. as would many other scientists who are less credentialed. lipton’s book the biology of belief shows, in a scientific way, how psychic energy impacts our health and our ability recuperate. attitude is everything. well maybe not everything, but quite a bit.placebo medicine has a 33% success rate……

  120. kidmercury

    that’s not what i’m talking about. the solution to cancer is removing animal products from one’s diet. no doctor is going to tell you that, though. better to chop off body parts and prescribe drugs instead, that’s far more lucrative. obamacare will ensure that those types of doctors and that type of medical thinking is what gets rewarded financially.

  121. Jim Ritchie

    Comparing what works in Switzerland to what could work in the USA is not a valid comparison because of size, history, and many other demographics.

  122. sigmaalgebra

    I wish that Obamacare was as goodas what Switzerland has. Alas, that isnot what Obamacare is.

  123. James Ferguson @kWIQly

    Bernard – I am also Swiss based.I think it works well for a large proportion of the population.Weaknesses are:a) poorer people avoid the minimal costs of regular checkups (My sister is a UK Dr. and says the basic NHS support is better in that respect though otherwise it sucks)b) Dental is not included at lower levels – increasing poor dental care is being seen as a precursor to many diseases ( low level inflammation is a huge long term burden)So yes the Swiss collection system is far ahead of the UK / US model (and I love that the insurance/implementation is privatised – but it is still not ideal

  124. JamesHRH

    It does seem as if the ACA is a classic lose-lose compromise.If you gave companies a tax break that was 3x your insurance costs, you’d likely be alright.If you just socialized the whole system and took the insurance companies out of the equation, you would also be alright.This looks like a cluster of firetrucks with 3 vowels & 4 consonants missing.

  125. Mark Essel

    First, you’re exceptional. As much as I would like to hold all CEOs and companies to your standard, it’s too restrictive.”Health insurance should require a similar relationship wherein the insured pays for routine care and the policy protects the insured from catastrophic losses.”Hell yeah.

  126. PhilipSugar

    I agree with you more than you do yourself. I too have paid a ton of health insurance premiums for employeesIt does need to be like auto insurance. Catastrophic only.Now people with argue, if you have preventative care it will make it cheaper in the long run.I disagree.1. Go into an emergency room and see how many people are there because they have nothing better to do for a small cold. I would never consider because I hate going there but I have to if a child takes a fall etc, but if you have nothing better to do?2. See how many people take a drug for something that they could work on by exercise, diet, etc.3. If you go down the road we pay for everything then you get forced into a corner of trying to dictate lifestyle choices for people. I.e. no Big Gulps in NYC.And the other very unpopular thing to discuss is end of life issues. I watched another friend take a loved one through hospice. That is the hard choice. The easy choice is simply delegate the care to a hospital which will run up Mr. Big Bill because they make money. No different than watching a 90 year old get double knee replacements because they are “fully covered” We all know that isn’t going to work out, but the doctor certainly got their money.

  127. Richard

    Yep, reforming how we choose and pay for insurance does not reform healthcare.

  128. sigmaalgebra

    Last version of the Obamacare billI read has a Commissioner. Wait untilyou get a load of this guy — he’s adictator over all of the health care partof the US economy. E.g., he fixes pricesand limits profits.Then wait until you see what happensbetween you and your physician. So,your physician will do an examinationand then will have to click on radio buttonsto be told what procedures he can follow.These procedures will be determined bysome ‘health care statisticians’ in DC –bummer. Kill people. So, Obamacarebelieves in robot medicine — that won’twork yet.Pelosi, etc. wanted a big power grab,move to DC power over essentiallyeverything in US health care. BasicallyPelosi has the same dreams as thefollowers of Lenin. It doesn’t work, andtheir $600 million Web site is anexample. TVA works. Hoover Damworks. Last I heard, BonnevillePower worked. NIH and NSF work.DARPA has or mostly has worked.The CDC works. Obamacare won’twork — just can’t run US health care,in fine detail from big office buildingsaround the DC beltway. Run anational health insurance programthis way? Doable just from the pointof view of being able to move thepaper. Actually run health care?Nope.

  129. iggyfanlo

    yes, i’ve always believed that health insurance shold be like car insurance… but another interesting take is SIngapore where the health outcomes are arguably as good as ours, but at 4% of GDP, not 18%… feels like a cite Singapore as the best solution for virtually every governement program…

  130. sigmaalgebra

    Not all businesses can offer theiremployees what you did.The key problem is, if, once theinsurance funding has been handled,health care is a ‘free good’, then itwill be over used. So, what’s neededis some ‘rationing’. We have a lotof rationing now, and that’s basicallyhow the system can offer care toeveryone who has a serious needwithout regard for ability to pay andwithout costing too much.Obamacare is about socialism, that is,the dream that we will all be equal,no one rich, no one poor, everyonejust the same. Problem is, socialismhas one heck of a bad track record.Improve US health care? Okay: Dosome carefully monitored pilot programs.Make some progress on nuisance malpractice law suits. Since that’snot what Obamacare is doing, Obamacareis not about health care but just a powergrab following the ‘principle’ of centralizedsocialism.Obamacare won’t start tobe about actual health care until theCommissioner publishes whatever,100,000 pages?, of regulations.I don’t want to be political: I likeTVA, Hoover Dam, NSF, NIH, CDC,FDA, and more. If could actuallyrun a good health care system frombig office buildings around the DCbeltway, at reasonable cost, then finewith me — but I don’t believe it.We do need to improve our healthcare system, but Obamacare isso far not about health care but justa centralized socialistic power grab,one that for a while at least promisesto kill people.

  131. CJ

    And if that was true, everyone would do it and no one would have cancer. I’ve yet to see any evidence that Obamacare will kill the economy and result in huge amounts of debt aside from ‘it doesn’t fit with my worldview’.

  132. CJ

    Placebo medicine is just a code for ‘the body healed itself but we have no idea why’. Which just means that we don’t understand everything about medical science yet. But we do understand what things don’t work and the things that we don’t understand that do work become…medicine. Aspirin, from the bark for a tree to a pill. It’s not alternative medicine because it’s been proven to work, so now it’s just medicine.

  133. CJ

    So sayeth those who I agree with. Might as well put that at the end because you still have nothing to back up your view but supposition and speculation.

  134. kidmercury

    Lol, no, whole foods, walmart, papa John’s are just few of the corporaations that have altered hiring plans because of obaamacare. It is not so much ky opinion that when a xompany has less money they will spend less; it is basically an exobomic fact, a law of sorts.

  135. kidmercury

    You can ignore the facts if you’d like. I already presented the 60 billion number. Look up employers who have cut hiring plans because of obamacare. This is already documented, you can ignore it if youd like.

  136. kidmercury

    At the root of this disagreement is that you guys actually believe the government when they put out numbers sayung it will cost less. Well know within 5 years for sure. I am absolutely certain it will cost more and yield less.

  137. Pete Griffiths

    The question under discussion in this case was not the cost of ACA but the relative cheapness of single payer. And whilst I totally agree that many/most/all governments are not to be trusted I think the relatively low cost per capita of single payer compared with our appalling hybrid system is well established.

  138. kidmercury

    Its not established, because single payer hasnt been implemented yet. When it is, youll see what im talking about.

  139. James Ferguson @kWIQly

    Please give any reasoning.The Swiss system is highly localised at the implementation level (handles four distinct native languages) and regards history – that`s what is being made. It is not a constraint but an experience,

  140. Pete Griffiths

    What do you mean it hasn’t been implemented?How else would you otherwise describe, for example, the UK Health Service?

  141. kidmercury

    i mean it hasn’t been implemented in the US. as i’ve noted i’m less interested in a comparison to foreign countries in this regard because there are too many other variables to account for.

  142. Pete Griffiths

    Why are there ‘too many other variables to account for?’What sort of variables do you have in mind?

  143. bernardlunn

    I am not being argumentative, I really don’t know what the differences are. The differences between America and Switzerland are massive, so maybe the model won’t work so well – only time will tell. But I really don’t understand what differences you are referring to. Methinks if you did a feature comparison chart of Romneycare, Obamacare and Swiss Healthcare they would look pretty similar.

  144. bernardlunn

    I thought the subject was default which must be due to too much debt. In which case, defense spending has to be top of agenda.

  145. sigmaalgebra

    The US is not Switzerland, Singapore, etc. Obvious.So, what are the differences meaningful forObamacare?The US has some problems — social, economic,ethnic, etc. — unique to the US. I would like toput this delicately and clearly, but there is no wayto do that; I did put it delicately but not clearly.The US has long deliberately imported people toserve as an identifiable lower class, and we arecontinuing that. Over some generations, some ofthese people have risen out of the lower classes,and some have not.So, for the people who have not risen out, the UShas a big stomach ache of guilt. Then the US triesto have some ‘social principles and values’, e.g.,Fred’s liberalism. Or look at Melinda Gates –smiles, is totally sincere, has her husbanddedicated and devoted to applying his considerableabilities, has the money of Bill and Warren, and isout to save the world, very much along the lines ofthe ‘principles and values’ of the nuns who taughther in school. The woman is a dream, for anyonewith $20+ billion. And in part she is trying tosolve the problem of the US lower classes that won’t’melt’ by pushing more in education, even KhanAcademy (I know calculus — don’t try to learncalculus at Khan Academy).So, with all these problems, there is a big guiltdriven movement in the US to solve the problems.We’ve tried a lot, none of which has worked well.Well, when a country has a big problem, say, Russiain 1900, Germany in 1933, China in 1949, Cuba in1960, etc., the main approach of a solution is tograb all the power in the central government and usethe power just to push through a solution. Doesn’twork very well. The US in 1933 did not do this but,really, didn’t solve the problem until peoplestarted shooting at us at which time everyone whocould work had three jobs if they wanted; that is,once the bullets started flying, we were willing toimplement a solution. And, right the solution, with’war mobilization’, did involve a lot of centralizedpower.It really is possible to solve problems withoutestablishing a dictatorship, conceptually moreinvolved but nearly always better than adictatorship even if don’t solve the problem. Righta dictatorship is a cure worse than the disease.Well, the US, in its effort to get the ‘pot tomelt’, keeps trying and mostly failing.Then Obamacare: That’s a dictatorship (“theCommissioner”) aimed at health care, but Obamacareis not just about health care but is part of themuch larger effort to get the pot to melt and to doso by centralizing power and applying the rusty,broken tools of socialism.Really, the US deliberately created dependent lowerclasses and now is stuck with the results. I’meager enough to have the US continue to try to rightthat serious wrong, which we are continuing withdaily, as long as we don’t wreck our country trying.Obamacare would wreck our health care system, to be20% of our economy, mostly in an effort to get thepot to melt mostly from some social and politicalphilosophy and a gullibility about the efficacy ofcentralized power.There is no end to the intended reach of thephilosophy, and it would take us back to Lenin ASAP– cure worse than the disease.For the importing of people, there is anotherphilosophy: The people are fine, maybe on averagebetter than the people in the US now, and just needthe ‘great, wonderful US’ to flourish. So, let theflood gates open. Meanwhile get grass cut at lowerprices. Given the lower prices, that philosophy iseasy to take.

  146. MickSavant

    Life expectancy is impacted by a lot more than healthcare. You are cherry picking statistics to try to demonstrate a causal relationship.

  147. SubstrateUndertow

    History says otherwise !Blaming all monopolies on government regulation is by and large a corporate mythic-mind-control propaganda strategy.

  148. MickSavant

    Have you any examples of monopoly not brought about by government?

  149. MickSavant

    A cynic might point out that the history of our ills with healthcare have been caused by government regulation that subsequently have been used as justification for further regulation. Much like the ACA is transparently a stepping stone to single payer.