I am laid low with the worst flu I've had in years. I will return as soon as possible. Today (2/9) I dragged myself to the doc and he said I have an especially nasty strain of the flu. The boyish physician told me how this is killing people, which would please Front Page Editor, who believes we're in for something like 1918.

If this is the TV show, "The Strain," I won't insult anyone by casting him or her as Dr. Goodweather -- the CDC expert who can't identify obvious signs of a vampire. Who is the brilliant, sword-wielding evil-hunter, Professor Abraham Setrakian? Cal? Emil? Soleri?

Off to a coughing jag...

To the right is a get-well sculpture from FPE.

Comments

[INPHX]

Test

[INPHX]

Sorry to hear about the flu. As we all get older, a bad strain can lay you up for a week or more. Take care of yourself.

As far as Soleri playing Setrakian, well, I think it would cause most viewers to start cheering for the vampire/zombies (rim shot)

[soleri]

My only consolation about the Randian dystopia the hard right hopes to create in America is that INPHX might have to move to a "socialist" country if some epidemic is unleashed thanks to a gutted CDC and other public health-care systems.

That consolation is tempered by the realization that millions more will be at risk if the right succeeds in neutering Obamacare. Best wishes to Jon for a rapid recovery. We're all in the same foxhole but it's the medics among us who are the most crucial combatants in this fight.

[cal Lash]

Recommend Sonoran Desert Dry Heat and Sun.
Will be at least 80 here today. Sun is the best Vampire Slayet.
But Buckhorn Hot Springs is closed as is the house with the red porch lite.

[Rogue Columnist]

Footnote for non-regular readers: Soleri was an Army medic and I was one on the streets of Phoenix

[INPHX]

Speaking of Obamacare, I sure hope Rogue was able to use the same health plan and doctor that he used before Obamacare. You know, just like Obama promised us all.

And boy, I agree with Soleri about defunding the CDC. What kind of jackass would cut their funding? What kind of right wing zealot would even dream of cutting their funding? How CRAZY does someone have to be to temper with the health of the country?

http://www.cdc.gov/fmo/topic/Budget%20Information/appropriations_budget_form_pdf/FY2015_Budget_Request_Summary.pdf

Where's the outrage?

[Rogue Columnist]

Of course, the ACA was the conservative plan for health insurance cooked up in the Heritage Foundation and implemented by the GOP's 2012 presidential nominee in, as he always called it, "his state."

I would have preferred universal payer, of which there are many varieties, that every other advanced nations have. It was not possible politically.

[INPHX]

Rogue:

Did the debacle at the VA influence your view of "universal payer"??

As I recall, liberal icon Paul Krugman described the VA as the closest thing we have to "universal payer".

Is that what you want for the whole country?

[cal Lash]

And I was an airforce medic. (1962 -68)
No foxholes. Only saw a gun once in six years.
No ties, no hat's, no saluting,
ate in Hospital cafeteria, not mess hall
and lots of female Nurses

[Rogue Columnist]

Too sick to fight. VA was a classic case of cutting funding. As with so many instances, "conservative" tactics depend on underfunding to ensure failure to give the appearance that "government doesn't work." Don't like the VA caseload? Stop the wars.

[soleri]

It's a curiosity that sociopaths ascribe unmitigated failure to a health-care system veterans enthusiastically support while at the same time underfunding it so the wars they conjure from a witch's brew of lies stress the system even more. The Republican nihilists in Congress get gold-plated health care for themselves while lecturing the unwashed not to get sick on their dime. The good news is that they're pro-life up to and including the final sonogram they would force women to watch. Because.......morality!

[INPHX]

More good news from the VA:

http://www.denverpost.com/news/ci_27103393/contractor-kiewit-walking-away-from-va-hospital-aurora

from that article:

"We find the behavior of the VA has not comported with standards of good faith and fair dealing required by the law," the board decision said. "The agency failed to provide a design that could be constructed within the estimated construction cost at award because it did not control its designer."

Congress budgeted $600 million and completion by May 2015; VA put plans together with a budget of $1.0 billion that won't be done until May 2017.

And the recent debacle concerning patients? Funding problems? Well, no:

http://www.usatoday.com/story/news/nation/2015/02/10/va-gao-high-risk-list-scandal-healthcare-veterans/23113827/

From that article:

The number of aging or disabled veterans treated by the VA has grown to 8.9 million from 6.8 million in 2002, and Congress has increased funding by 85% during that time.

Yet problems with poor health care, delayed doctor appointments and leadership accountability and oversight persist, according to the report. The GAO said it keeps issuing audits identifying problems — eight just last year — but more than 100 areas of mismanagement remain unresolved, according to the report.

More than 20 years of not fixing mistakes:

http://cnsnews.com/mrctv-blog/tyler-mcnally/gao-has-cited-va-unnecessary-deaths-incompetence-more-20-years

And it wasn't just Aurora:

http://kdvr.com/2015/01/20/va-leaders-in-charge-of-failed-hospital-projects-take-home-bonuses/

From that article:

The last Government Accountability Office report in 2013 found the Aurora facility is not the only one behind schedule and hundreds of millions of dollars over budget. Hospitals being built in New Orleans, LA; Orlando, FL and Las Vegas, NV have faced the same problems. The Las Vegas facility opened up last year.

But at least the Vegas facility was well run:

http://archive.navytimes.com/article/20130508/BENEFITS04/305200001/New-VA-hospitals-Months-overdue-millions-over-budget

from that article:

The longest delay was in Las Vegas, where a hospital now expected to be done in June is taking more than 10 years to complete, 74 months behind schedule. Its price, now estimated at $585 million, is 80 percent over the initiative estimate.

Also from that article, citing a VA employee letting us know that all is not bad:

VA officials said they are learning lessons and doing better. They cite as an example an Orlando hospital, scheduled to be completed in June, that is 39 months behind schedule and 143 percent over cost.

Well, there's something to brag about.

Do I really need a trump card? I'll play it anyway:

http://www.politico.com/story/2014/06/white-house-report-overhaul-va-corrosive-culture-108403.html

From that article:

“A corrosive culture has led to personnel problems across the Department that are seriously impacting morale and by extension, the timeliness of health care,” the report states. “The problems inherent within an agency with an extensive field structure are exacerbated by poor management and communication structures, distrust between some VA employees and management, a history of retaliation toward employees raising issues, and a lack of accountability across all grade levels.”

This is TEXBOOK economics. When you make a service "free", it will be under-supplied and over-demanded.

Period.

Now, I know you guys knew about all these issues, didn't you? I mean, you wouldn't form opinions about the VA without knowing all of this would you? I mean, with the need for an educated citizenry, and folks engaged in the process, and all of those other dopes (mostly conservatives, of course) who generate opinions without requisite knowledge.

Soleri- you knew about the cost overruns, didn't you? The Vegas and Colorado debacles? The 85% increase in funding? The litany of GAO reports addressing issues that were never resolved? The corrosive culture?

A bright guy like you wouldn't have missed all of that, would you??

[Rogue Columnist]

INPHX,

My father and uncle were combat veterans from World War II, so, yes, I know about the VA. They swore by it (not at it).

Because economics is not settled science like, say, climate, but an ongoing argument, I would urge people to read widely...beyond a few axioms, there is no single textbook on economics that answers every question as to governing a liberal democracy.

"When you make a service 'free,' it will be under-suppled and over-demanded." I assume you are exempting police and fire protection? Or maybe not?

As to Krugman, I will let him answer for himself. After saying that I don't recall him advocating the VA for a national system but noting its low administrative costs and ability to negotiate with pharmaceutical systems.

http://www.nytimes.com/2014/06/20/opinion/the-hype-behind-the-health-care-scandal.html?_r=0

The clipjobs could go back and forth forever. I am asking you, INPHX, to draw conclusions. And try to do so for the larger audience, instead of the two of us you apparently hold in such contempt.

1. Every other advanced nation has some form of universal healthcare for all. But they are varied and some involve the private sector. Most have better outcomes than the U.S.

Do you approve of any of these other systems? Or do you believe the American system is superior to all three?

2. Most advocates of universal care here during the ACA debate wanted Medicare-for-all. Do you support Medicare? If not, what would you put in its place?

3. Are you troubled by the pricing power that large health-care providers and pharmaceutical companies have arrogated to themselves? This is one of many reasons that TEXTBOOK economics can't be applied to health care.

4. You seem like a balance-sheet type. Do you believe economics and cost-benefit should be the determinants of all decisions we make as a society?

Simple questions, asked in genuine curiosity. Show me you're not a troll.

[INPHX]

Rogue

http://www.nytimes.com/2011/11/14/opinion/krugman-vouchers-for-veterans-and-other-bad-ideas.html?

That's the article where Krugman praised the VA. At the time, Romney was advocating vouchers for veterans, which is exactly what the veterans wound up with anyway after the scandal broke. Pretty bright guy, that Romney.

On the police and fire protection, people call the fire department to get a cat out of a tree. And lord knows the cops never go out on a call that's a waste of time- do they??

Phoenix police charge homeowners something like $50.00 when they have to answer an alarm and there's no one at the house and there's nothing wrong. I know because it's happened to me.

Why?

And while we're on the firemen and the police, what should the annual cost to the taxpayers (including accrued benefits) of a cop be? $50K? $100K? $200K? What about the overtime they earn at private events? Should that matter?

Why?

On the comparisons to other countries, I find comparisons with the US on any issue very difficult. We're big, we're diverse, we're the cops to the world (like it or not), we have huge immigration problems, we have too many guns, we drive too much, we're rich, we're free, and we lead (where does the world look when there are catastrophes?? Sweden? ), we're relatively anti corrupt (we respect property rights and the rule of law),we have a screwy tax system, and we have a strong Constitution. We also have 50 states, mayors, counties, and others. The whole deal.

Believe it or not, I'm OK with almost any type of subsidy to get people into private insurance (that's the financing part of health care) But the government should be as far removed from the actual providing of the healthcare as we can tolerate. And I think people should pick their own policies and have to work at it.

What I do find amazing is the liberals want to emulate a European type model (unions, cradle to grave benefits, universal, the whole deal) at a time when if anything, Europe has significant economic headaches relative to the US.

The US system is not pretty. We have private (but massively regulated), and then all of the public (VA, Medicare, Medicaid, ACCESS type plans, etc.) programs.

Given what we've seen at the VA and the administrative bungling and arbitrary changes in Obamacare, why would anyone want to move more towards the public model?

I have said before that the part of Obamacare that I approved of was driving people to private insurance and then subsidizing the cost at checkout. I don't like the Medicare expansion because "free" is almost always a bad answer. I don't like the government expansion. People have to have some skin in the game.

In terms of the pricing power, that's part of what health insurance is for. Just in case you missed it, health insurance companies negotiate with providers of medical services and medicines. Just like Medicare and Medicaid generally do. Merck may want to charge X for a drug but United Healthcare will only pay them Y. I'm completely comfortable with that.

On the balance sheet- let me ask you a question. You like defense expenditures? Are they enough now? too much? There's a whole bunch of soldiers and hawks that will tell you they need more. And more. And MORE.

And the freakin' Pentagon can't even provide a balance sheet. Who needs bids when you have Haliburton to take care of things?

Teachers will tell you the same thing. So will solar power companies. And the banks need a bailout. And Amazon has to settle with the states on the whole sales/use tax thing. Workers need a higher minimum wage, and it won't effect jobs. Let's tax health insurance benefits. Not so fast, says the unions. Lower interest rates are good, aren't they? Well, not if Grandma was living off her CD's.

The VA needs desperately to build some new hospitals.

You in? Any cost benefit analysis needed there or how about just a blank check?

You want to bail out the Illinois pensions? If so, I guess we don't need to perform any sort of cost-benefit analysis. Just write a check.

Part of the pitch of Obamacare was that it was projected to reduce the deficit.

I guess we shouldn't have paid attention to that?

Did that matter to you? What if it had been projected to increase the deficit? Would that have mattered? How much of an increase in the deficit would you have been comfortable with? Is there a level at which you would have said- gee- it's too expensive-- it's a bad idea.

You know, in another blog, Soleri said he would be comfortable with a bail out of Detroit. He didn't even mention costs. I assume he didn't even think about them.

The mind of a liberal......

[soleri]

INPHX, Detroit is an American city. Which means, rather than being in Iraq, or Vietnam, or Syria, or Ukraine, we can and ought to spend money if it's distressed. Many of its problems are typical of rust-belt cities, and will probably be typical of Phoenix given its lack of a strong manufacturing base and high-tech economy. Does Detroit require more largesse than, say, Baghdad? No. But if it needed help, I'd sooner help it than one more neocon wet dream of a nation-building project.

All that said, I have no particular ax to grind here. I don't want to say we must absolutely commit significant resources or no. I'm merely open, as a citizen, to good arguments. I'm not an ideologue like you are.

Your health care arguments are specious and irrelevant. Remember, you don't care if 45,000 Americans die each year for a lack of health insurance. If 45,000 Americans were to die because of terrorism, you'd probably want to send in the trillions to wage war against the perpetrators. Millions more are bankrupted because of unpayable health-care bills. You don't care about them. The nation itself is saddled with a huge total bill, 18% of GDP, the highest in the world, and one that creates a competitive disadvantage against other nations in terms of trade. You don't care. What matters to you is that the rich become richer. That's it. There is no other principle here, certainly not the free market because there hasn't been a free market in American health care for decades. Oligopolies, yes.

If you want the VA to function better, you might want to talk to actual veterans instead of harebrained ideologues at The Goldwater Institute. They might be able to pinpoint where service can be improved. But you already tipped your hand: you think their demand is excessive because it's "free". Like many chickenhawks, you're more than willing to pay Blackwater or Halliburton more than need, but the veterans who do the fighting? They're "moochers". You don't mind Republicans lying this nation into a disastrous war but you do mind veterans making a claim upon the government for their injuries and illness. Maybe if they dressed up to look like Jamie Dimon you'd feel more sympathy for them.

I find people like you horrifying. You're not a patriot in any sense of the term. You love money more than your fellow Americans, the nation itself, or common decency. The spiritual emptiness of your cult is a remarkable aspect in contemporary life, a malignant celebration of egomania and cruelty.

And you vote.

[Rogue Columnist]

INPHX
Thanks for addressing the questions. We don't agree. But you're not a troll.

[INPHX]

Soleri:

The "corrosive culture" report came from the White House. The other stories came from various news stories and sources, none of which have anything to do with the Goldwater Institute.

Do you need to re-think your comment on the Goldwater Institute? If so, please edit your previous post. There is NO reference (of mine) to anything by the Goldwater Institute.

The rest of your reply is the typical Chatty Cathy, pull the cord nonsense. Rich get richer, lying us into war, cult this, Jamie Dimon, the cheap shots at Haliburton- it's kind of a laundry list of the issues from the lunatic left. Trite, boring, inaccurate, and horribly meaningless.

Any one of thousands of monkeys in front of thousands of typewrites would be embarrased by your reply.

Paul Krugman bragged about the VA as a model of what a single payer system might look like for the rest of the country. And then we found out what was behind door number 3.

"Corrosive culture" and cost overruns.

And folks like you just can't process that. You just can't learn from that. Your position doesn't change based on those revelations, cause, well, Jamie Dimon!!

Good to see you evolve a little on Detroit, though. Maybe there's some hope.

[soleri]

INPHX, May I call you Chatty Chickenhawk, since you seem to think a witless ad hominem must count as a devastating riposte?

We're having a conversation more about values than anything else here. You might think you're posting indisputable facts, but our trench warfare is not about "facts", which are convenient deflections arrayed against other less convenient "facts". We use them as shields but they're illustrate our core values. As emblems of humanitarianism, yours suck quite a bit.

May I list some of them? Magnifying income inequality. Shrinking the middle class. Taking health care away from veterans. Privatizing as much of the public sector as you can get away with. And in effect making the rich richer. You live inside a septic tank of indisputable "facts" that are as vile as anything coming from a faceless sociopath on the internet. Arizona is full of your tribesmen (hence The Goldwater Institute slur). You celebrate the free market with federally financed water projects, taxpayer-paid sporting venues, freeways paid by sales taxes, and tax policy written by K Street hired guns. You are an exceptionally well-pampered Rugged Individualist.

My favorite subject is world geography. That is, I like to see how other people do things and what the results - and problems - are. I look around the world to find the place that mirrors your dingbat value system. Finding none this side of Somalia, I look to those "laboratories of democracy" that have adopted the Full Ayn Rand like Arizona, Kansas, Alabama, and Mississippi. You know: "winner" states. And what I see there are just more 3rd-world wannabe places with a small class of the very rich, a stressed middle class and a huge underclass. That's apparently what you want for the nation as a whole. Good and hard.

At any rate, thanks for the drool-flecked verbiage. We may be monkeys flinging poo but at least yours has the imprimatur of a "think tank".

[INPHX]

Soleri:

It's not me taking anything away from healthcare for veterans.

It's the VA's "corrosive culture" and the cost overruns. Their budget increased 85% from 2002 to 2012 while the number of patients treated increased about 30%.

It's also the fact that chowderheads like you won't acknowledge it and refuse to think that just maybe there's a better answer.

This reflects the most critical (of dozens) flaw in your attempt at logic.

I want the veteran to have the best medical care available. And I think you do, too.

But because I think that the facts I've posted above just might suggest that private medicine (and vouchers)will result in better outcomes, well, you think, um, er, well, ummm, well, I guess you think that Jamie Dimon makes too much money. Oh- and comparisons between Somalia and US states have meaning.

You're lazy. You either don't or cannot process new information.

Really. Just how bad would the VA have to mess up before you'd consider other options?

Here, genius:

http://www.usatoday.com/story/news/nation/2015/02/10/va-gao-high-risk-list-scandal-healthcare-veterans/23113827/

From that article:

"Yet problems with poor health care, delayed doctor appointments and leadership accountability and oversight persist, according to the report. The GAO said it keeps issuing audits identifying problems — eight just last year — but more than 100 areas of mismanagement remain unresolved, according to the report."

How many unresolved areas of mismanagement would you need if 100 isn't enough? 500? 1,000? 10,000?

From the article:

"These risks to the timeliness, cost-effectiveness, quality and safety of veterans' health care, along with persistent weaknesses we have identified in recent years, raises serious concerns about VA's management and oversight of its health care system," the report said. "VA health care is a high-risk area."

I don't think the GAO can give them a crummier grade.

Maybe they need to create one?

And to think YOU want to send a veteran of this country into that mess....

[Jerry McKenzie]

Get well soon Rogue!

[soleri]

INPHX, I'm not going to argue with your cherry-picked "facts". Suffice it to say, there is no other advanced nation on Earth with a privatized health-care system. Even in those countries like Germany, The Netherlands, and Switzerland with private insurance carriers, the marketplace is well-regulated and coverage is guaranteed. This is the territory that you either love (Romneycare) or hate (Obamacare). The differences between the two are of minor degree, not kind. You are too partisan to simply acknowledge this so you'll fight a rearguard battle against the VA instead. Why? Because private is always better than public? Really? So, how did we end up with the world's most expensive health-care system? How did we end up with 45,000 deaths a year due to non-coverage? How did we end up Republican seniors clamoring to "keep the government's hands off" their Medicare?

Let me humor you, however. Assume the VA really is as dreadful as your selective fact-mongering would suggest. Why would you tell veterans they have to buy vouchers to get private care instead? Do you think privatizing Medicare would fix a similar "problem"? Even though the overhead for Medicare is 4% vs 14% for private carriers? Even though Medicare's reimbursement schedule is LESS than private carriers? Your silence on this matter is illuminating because it undercuts your fanciful notion that the unregulated private market solves actual problems instead of merely maximizing CEO compensation packages.

If there's something wrong with the VA system, fix it. The veterans I've talked to prefer that. Politically, I suspect you'll never get veterans on board with privatization, no more than Paul Ryan will succeed in privatizing Social Security or voucherizing Medicare. But assuming there is something permanently rotten about the VA, you could put them on Medicare instead. It's a single-payer system, which in the hysterical translation of people like you means "socialism", but it would definitely be cheaper than private care.

The reason we have a VA, however, is because of something you wouldn't know about. It is that service-related disabilities demand a level of care and specialization that the VA has traditionally delivered. This is why you can cite no veterans' groups pleading that the VA be abolished. And it's why Krugman is right and you are wrong that its delivery system is a model for all public-health care systems with team care and electronic record-keeping. A strong majority of veterans prefer its care to the private market. And those things they traditionally do gripe about such as long wait times for dental work can be solved with more resources.

A single-payer system would shave as much as 10% of total health care costs in this nation mostly due to sharply reduced administrative costs. This won't happen because private economic power easily overwhelms the public interest. So, we got the next best thing (Romneycare/Obamacare). Already, it has succeeded in taming health-care inflation. The cost-curve is finally bending down instead of up. It was something your side dreamed up before denouncing it because.....er......FREEDUMB!!!. http://politicalticker.blogs.cnn.com/2013/10/02/obamacare-fact-check-who-bent-the-cost-curve/

At any rate, our arguments are on record. I'll grant you proprietary privileges to your puffed-up outrage that a large bureaucracy often needs reform. But if saving money is your real issue, it will all end up in the compensation packages of lucky CEOs. Private always means more expensive when it comes to health care.

[INPHX]

Soleri:

You write:

"And it's why Krugman is right and you are wrong that its delivery system is a model for all public-health care systems with team care and electronic record-keeping. "

The GAO (boy, now that's some real cherry picking on my part) says:

"Yet problems with poor health care, delayed doctor appointments and leadership accountability and oversight persist, according to the report. The GAO said it keeps issuing audits identifying problems — eight just last year — but more than 100 areas of mismanagement remain unresolved, according to the report.

These risks to the timeliness, cost-effectiveness, quality and safety of veterans' health care, along with persistent weaknesses we have identified in recent years, raises serious concerns about VA's management and oversight of its health care system," the report said. "VA health care is a high-risk area."

What color is the sky in your world?

Are you so stubborn and ingrained in your stupid preconceived ideas that you just can't accept that the GAO (not me) has a better perspective than you and noted liberal Paul Krugman??

Wait.

I think that question has already been answered.

BTW, the article you posted says that 75% of the slowing in the increases in health care costs are due to the crummy economy.

Congratulations on that one.

Swell work.

[Suzanne]

"Corrosive culture" and cost overruns. I am wondering, who established the cost that the V.A. overruns?
INPHX, when you compare V.A. with non-government health care organizations the outcome is very similar. Some VA hospitals perform better or worse with patient care, just as every hospital in the nation performs better or worse than other hospitals. That is a fact. You have not provided evidence that VA is any more flawed than any other healthcare organization.

INPHX, you have complained about a janitor in Europe who earns 100k a year because he is associated with a union.

What would you say to the U.S. CEO of Aetna health insurance who earns 100k every single day?
Corrosive? Cost overruns?

[soleri]

INPHX, as I said above, if something is wrong, fix it. Don't blow it up. Don't wrap it in gift paper and give it to corporate greedheads. Don't magnify the shortcomings simply to grind your ideological axe. Fix it.

Suppose we were to apply your stringent anti-government principles to the Defense Department, the same department Republicans fall over themselves when it comes to making sure they have more than they need? How about critiquing with the same ascerbic certitude that you apply in broad brush strokes to the VA? Why not put the F-35 under that same microscope in which crony capitalists sell a dismal product at a wildly escalating price?

Few people if anyone at all would suggest that we get rid of the Defense Department because of its obvious ineptitude in weapons procurement, or in military strategy (see: Afghanistan, Iraq, Vietnam) or its coziness with the merchants of war, or the golden parachutes generals reward themselves after a couple of decades of service, including fully tax-free pensions thanks to "disabilities" that miraculously come out of nowhere. They're heroes and tend to vote Republican.

Indeed, why not get rid of the GAO since it's a government agency that finds all these problems. Shouldn't we privatize it and appoint someone like John Stossel to investigate the government like he does on Fox News? After all, you know with absolute certitude that only crony capitalists know how to fix things.

At any rate, the veterans you want to push into inadequate vouchers that will go only part way to pay for much more expensive care deserve better. As I've helpfully explained to you above and elsewhere, you don't give a fuck about them. They're moochers. They get in the way of sociopaths making ever-greater amounts of money at the expense of everyone else. That's your only real concern.

So, I'll suggest to you that the color of sky in your world is anything you want it to be. You create reality as you go along, always finding the fault with anything that helps the little guy. Because you're a winner.

Excuse me. I need to go take a shower.

[Suzanne]

BTW Rogue, I am wishing you feel better soon.

[Emil Pulsifer]

Great conversation: interesting and stimulating (except for the ad hominem).

I think we can agree that the VA has been badly mismanaged. The question is whether this illustrates the conservative talking-points argued by INPHX, or something else.

INPHX says that if something is "free" (his quote marks) it will be under-supplied and over-demanded. Yet he belies this by pointing out that from 2002 to 2012 the VA received an 85 percent funding increase while experiencing a caseload increase of only 30 percent (this in response to two wars and an aging population of older vets, no doubt).

Taking this at face value, that's neither an under-supply of funding nor an over-supply of demand for services (relative to the additional resources made available by Congress).

Of course, the article doesn't say whether this is in nominal dollars or real (inflation adjusted) dollars: it would take a 27 percent increase just to keep up with inflation from 2002 to 2012; and that's relative to the CPI as a whole, whereas healthcare costs rose MUCH faster over the same period.

The article also doesn't say whether the VA was laboring to catch up with underfunding from a previous period due to cuts under past administrations (e.g., Reagan, Bush Sr., etc.).

But just taking INPHX's own statistics at face value undermines his whole argument.

Soleri managed to halt his mudslinging long enough to point out that Medicare has both lower administrative costs and lower service reimbursement costs than the private healthcare market.

Rogue himself pointed out that in many single-payer systems whether in Canada or Europe, healthcare costs as a percentage of GDP are less than in the United States, while medical outcomes are (with atypical specialized care exceptions) better than in the United States.

No counterargument from INPHX on either point so presumably he accepts these characterizations as factual. Both points undermine his argument.

So, the real question doesn't seem to be public vs. private, so much as good vs. bad management.

The VA illustrates that public agencies are not immune from bad management. What about private companies?

It can actually be more dangerous to stay in private hospitals than to recouperate at home, due to hospital acquired infections. These are the result of poor training and supervision of staff as well as lax practices in basic procedures of decontamination, sanitation, and isolation of infection.

"Nosocomial infections are commonly transmitted when health care providers become complacent and do not practice correct hygiene regularly...Since medical staff move from patient to patient, the staff themselves serve as a means for spreading pathogens. Essentially, the staff act as vectors."

The Centers for Disease Control (CDC) estimates that 75,000 deaths a year are caused by HAIs in the United States, and that ten times as many non-fatal complicating illnesses (some with long-term effects), ranging from pneumonia to blood infections to surgical site infections are also caused by poor hospital management.

http://www.cdc.gov/HAI/surveillance/

What about the perennial problem of auto-manufacturers who knowingly keep defects secret instead of issuing systematic recalls, then attempt to cover up and conceal culpability when sued?

How about the way large, well-funded corporations from chain stores like Target to major bank chains, fail to implement a level of security basic enough to prevent the wholesale theft of tens of millions of confidential customer records (including credit card numbers)?

Perhaps we can agree that incompetence and poor management are not exclusive to either public or private bodies.

As for police and fire services, are cats stuck in trees and false alarm calls the best INPHX has to offer?

Surely he realizes that if he (and others) were forced to pay for private emergency response services on a pay-by-use basis, he'd be paying much more. Most would not be able to afford such services and many crimes would go underported. Is that an improvement?

I suggest that police and fire dispatch centers can manage complaint calls better (and the prioritizing of police and fire services) better, on average, than a private subscription system in which profit rather than public safety is the primary motive, and resources are employed to coddle wealthy neurotics concerned about the black man who passed their house while gawking at it.

Public emergency services, single payer health systems, and the like, actually function similarly to private insurance systems: the vast majority of subscribers are non-users of the services, most of the time, and these subsidize the minority who do require use of the services. That isn't socialism: that's the essence of private provider cost-sharing and the heart of all private insurance systems.

[Emil Pulsifer]

Release Date: December 19, 2012

After a cautious and rigorous analysis of national malpractice claims, Johns Hopkins patient safety researchers estimate that a surgeon in the United States leaves a foreign object such as a sponge or a towel inside a patient’s body after an operation 39 times a week, performs the wrong procedure on a patient 20 times a week and operates on the wrong body site 20 times a week.

The researchers, reporting online in the journal Surgery, say they estimate that 80,000 of these so-called "never events" occurred in American hospitals between 1990 and 2010 - and believe their estimates are likely on the low side.

http://www.hopkinsmedicine.org/news/media/releases/johns_hopkins_malpractice_study_surgical_never_events_occur_at_least_4000_times_per_year

Whoops.

[Concern Troll]

After nearly 20 years of experience in gummint my only comment about privatization is that it has a very few places that it can succeed in providing core services.

1) Any service delivered by a powerfully unionized workforce with significant featherbedding. See back east. Not here in Arizona- the unions outside of the cop shop are effectively dead.

2) Privatization will appear to succeed when the private sector will underprice the service to get the contract. See garbage collection. Once the gummint has scrapped all the equipment, and gotten rid of all of the employees- pfffft costs rise nearly exponentially to feather those executive nests. See also private prisons in Arizona. We know they cost more, but those campaign contributions grease that $70 million skid (this time!!!), and will even repress the studies about cost effectiveness.

3) Project based contracts- a place where it actually makes sense to use the private sector.

In short, privatization appears to work and actually gets a lot of hands into the taxpayer pockets that charge a ton of money for questionable returns.

But hey the Goldwater/Cato/Ducey administration will privatize a ton more of state government, to astounding cost overruns and total failures, and InPhx will lap it up like cream.

Sad really, but watch it happen over the next four years, and when I am right, you may weep over your higher taxes to fix this mess.

Because in reality, the looting has begun.

[Emil Pulsifer]

Note: a new reply to koreyel re climate change and the Pentagon has been posted in the previous thread.

[cal Lash]

Emil got it right (for Profit hospitals tried killing me twice in the last two years)
and Concern Troll nailed it.
4 years more of Charter School backers and private prison companies and their bought and paid for corrupt POL lackeys raking it in.
I am curious why some seem to have to toss around the words liberal and conservative like the words are somehow "filthy."

[INPHX]

Oh my!!

Private companies mess up!!

The horrors!!

Gee. Maybe we should let Veterans decide. Give then a voucher, or let them go to the VA. Their choice.

See-- that's called "competition". So if the VA isn't doing it's job, the veteran can make another choice. The US Treasury still takes the financial hit, but the Veteran can choose. And if he or she prefers the VA to the private provider, he or she can make that choice, too.

You know, when the you know what hit the fan at the VA, that's EXACTLY what the "short term" remedy was. Vouchers.

Choice. Competition. Pressue on the VA and the private providers to take care of their patients or lose them. And the related funding.

So.

Who could possibly object to that?

Suzanne;

A union member is almost certainly overpaid based on the artificial, legal requirement to recognize the bargaining unit. The Aetna CEO doen't belong to a union. He (or she) bargains on behalf of himself only; it's an almost perfect supply/demand process.

Unions exist to bring above market wages to their members and limit the supply of eligible workers. They only exist because of laws that require employers to recognize them, and the related political pressures brought on by their members.

Soleri:

You'll never get me to defend the processes and cronyism at the Defense Department. The important distinction (and it's true for the Defense Department and most law enforcement) is that their mandate is unique; the state mandated power to arrest or to defend the country makes a competitive model almost impossible.

The difference in the VA and the DoD is that in the case of the VA, there is a private, competitive alternative.

Why you don't see that difference, or why you can't imagine that the VA is just as messed up as the DoD, shows how narrowly you address an issue.

You know, I wish we didn't have to have this conversation. I really do. I wish the GAO report gave the VA five stars. I wish those hospitals in Aurora and elsewhere had opened on time and under budget. And the head of the VA could have cut the ribbon, thumped his chest, and watched veterans go in and receive the medical care they deserve.

And the head of the VA could defend the 85% increase in it's budget and say, well, sure, but wait times are less, outcomes are better,no one's behind schedule, no one's dying waiting for care, and no employees feel the pressure to falsify records.

And it would be something we could all be proud of.

But none of that happened.

Funny.

Most of the responders here seem to pretend it did.

[INPHX]

One other thing I thought of---

In this country, we have antitrust laws.

Why?

To avoid monopolies and promote competition. So consumers can have choices.

But not veterans.

Super.

[INPHX]

Emil:

Read the Johns Hopkins study.

Did it include or exclude incidents at the VA?

Whoops indeed.

[INPHX]

Soleri:

Speaking of DoD disabilites, the hits just keep on coming for the VA:

http://www.usatoday.com/story/news/nation/2014/07/14/va-backlog-committee-hearing-veterans/12573043/

I wish I was just making all of this up......

[INPHX]

At least they get college funding right:

Oh, wait:

http://www.usatoday.com/story/nation/2014/07/11/gi-bill-va-veterans-delay-books-housing/12539185/

[Suzanne]

INPHX, On the one hand you say it's fine if the 'free' market pays a doctor or CEO an exorbitant salary.
On the other hand, when the V.A. has cost overruns, let's just throw out the VA and go directly to the overpaid CEO through a voucher, you extol.
No! it makes no sense.

Veterans, do have a choice. Every veteran I know is covered by insurance. That is our choice.

[soleri]

INPHX, somebody fucked up, which is proof to you that the entire enterprise of civilization must be scrapped in order that your dystopian solutions jump to the head of the line. But the world is a large place and there is absolutely no evidence that handing over health care to the privateers of modern capitalism will somehow fix it. What they will do, as is always the case, is generously reward themselves at the expense of society. Absolute economic freedom for the rich must seem so magical. It's a delirious siren song of high-school sophomores, soreheads, and anarchists that only requires sweeping oversimplifications and ideological certitude, which you have in spades.

Instead of taking your airy beliefs so seriously, why not simply descend from the clouds and engage this forum. You're certain that veterans will do better with less. How do you know this? How do you know anything that has do with their special needs? How do you know that they are undeserving? For a partisan of a political cult that feverishly constructed an edifice of lies that grievously injured - and ended - countless young lives, you are rather cavalier about their fate.

Civilization costs money. To anarcho-capitalists, this is the best argument against it. Instead of paying taxes, people should be free to sleep under bridges, starve in their shanties, sicken unto death, and let the strong rule as social Darwinists think proper. We would be the only advanced nation on Earth to undertake this project that so enchants your cult. Most people have enough sense not to fall for this insanity. I wish you were among them.

The life of Ayn Rand is a telling illustration of the many pitfalls that delude purists and ideologues. She had a social worker enroll her in Social Security and Medicare when she was mortally ill. Another example would be John McCain who has lived all his life with socialized health care, yet votes to deny his lessers any care at all. Another would be Paul Ryan, who worked perhaps six months in the private sector before embarking on a career in public service that gives him gold-plated health care so that he might take away the bronze plans from less fortunate people.

What is wrong with you people? I get knicked here for using the word "sociopathic" to describe you and your tribe but it is, if anything, an understatement.

[INPHX]

So- Soleri-

Veterans shouldn't have a choice?

Check the box, genius. No need for you to blabber on about sociopaths, Ayn Rand, and all of your other pull the string Chatty Cathy inane, irrelevant, and inaccurate claims.

Suzanne:

You have a typical liberal mind set on CEO's. I really don't care what they make. I care about the product that their company sells. I have an I Phone. I don't care what Tim Cook makes. I don't drink high end coffee, but it has nothing to do with what the CEO of Starbuck makes.

So. If a veteran prefers Dignity Health to the VA, I don't care what the the CEO of Dignity Health makes.

Why would you?

[Rogue Columnist]

http://www.nytimes.com/2015/01/27/science/steven-brill-tackles-health-care-in-americas-bitter-pill.html?_r=0

http://www.dailykos.com/story/2014/05/20/1300760/-Privatizing-VA-health-care-would-be-the-greatest-tragedy-of-all#

[INPHX]

C'mon Rogue- you expect reasoned discourse form Kos? From May 2014? Before the GAO report? Before the explosion in the construction costs debacles?

Gee. Maybe I'll link an article about the the wonders of Obamacare from the Koch Institute.

Great survey from 2006, though. Hurray for that.

I'm not suggesting privatizing the VA I'm suggesting choice. I'm advocating the wonders of competition.

What are you guys afraid of? If the VA is so great, that's where the vets will all go. And then we'll KNOW.

[soleri]

Chatty Chickenhawk does know one thing: the veterans without grave illness nor combat wounds would probably love vouchers. Why wouldn't they? Free money, as it were, when they go to the doctor for a refill on Cialis. The veterans who actually fight the wars understand this stalking horse. Get vouchers in the door, and then gradually squeeze the system in order to drive as many vets out of it as possible. It's Rove 101: starve the government for resources and then point at it and say "see, they can't do anything right"

As susceptible as low-information voters are to right-wing disinformation campaigns, most react negatively to the idea of privatizing SS or voucherizing Medicare. It also points out the fallacy of the GOP divide-and-conquer strategy: it's one thing to attack Obamacare as giving free stuff to "those people". It's something else entirely to take stuff away from their base.

At any rate, I hope they try. The Republican coalition is largely composed of people who are by the GOP's own definition, "moochers". As long as they keep their eyes trained on Latino mothers and strapping young bucks buying steaks with food stamps, all is good. The moment the Dems pull back the curtain and tell the rubes what is in store for them, that magic is lost.

[cal Lash]

INPHX, might you provide me with your definitions of a liberal and a conservative "mind."
And which came first?

[wkginbham]

I’d like to shift gears slightly. I believe the administrators of the VA are deserving of all the scorn we can heap upon them, and it go at that.

One commenter mentioned the replacement aircraft for the existing Warthog; a program that is a debacle. By contrast, consider the development and deployment of the F6F Hellcat in WWII. The Hellcat was the Navy’s main carrier fighter and was designed to be a “Zero killer”. The stats:

Prototype contract: 6/30/41
1st production A/C delivered: 10/3/42
Last production A/C: 11/45
Number built: 12,275

Consider NASA. From the late 50’s to 1970 they successfully developed the Mercury, Gemini and Apollo programs.

Consider the Interstate Highway system which was largely built between 1960 and 1980.

Consider the TVA, BPA or the Arizona water projects.

Compare and contrast to the roll-out of Obama Care. No let’s not go there – how about – well I’m having a hard time of even thinking of anything the Feds have tried to accomplish (in a positive sense).

I’m trying to get my mind around the situation/problem, but a couple of things seem to stick out at this point.
First: an organization is formed with an identifiable goal. For example the VA. The goal: we have millions of returning veterans (from WWII), many with severe injuries, returning to civilian life – and keep the depression from recurring. They were remarkably successful. Since then, the performance seems to have declined.

Second: Once an (Federal) organization has been formed, it is almost impossible to kill it.

Third: How do you access the performance of an organization when you really don’t know what you want it to do?

Forth: these organizations have goals of their own; to get bigger, have larger staffs, higher pay grades etc.

Fifth: these organizations establish a constituency of their own. For example: look how hard it is to close a military base.

I might add that non-governmental organizations are much the same. They all want to get bigger, make more money and pay higher salaries – particularly to management.

I’m sorry that all of this is half-baked. It’ll take a while to think through. Even though the conversation has been about the VA, I think it points to a more pervasive situation; and one that is troubling no matter which side of the isle you sit on.

[Emil Pulsifer]

Obama uses "selfie stick": results existentially lame. First green lipstick interview, now this. May be time for a thorough physical.

[Emil Pulsifer]

P.S. The CiC seems to have taken lessons from a Vulcan on how to give the stiffest imitation of spontaneous hijinks possible. Makes Dubya look like John Stewart by comparison.

[Emil Pulsifer]

Ok INPHX, I'll play. What does "healthcare voucher" mean? Insurance voucher. How much per voucher, and what is total cost both now and in 10 years? Please do the math explicitly. This may make potential problems in your position explicit.

[INPHX]

Emil:

I'll play, too.

You do the same thing for the VA.

How much in hospital construction overruns are you going to include?

And make sure you increase the VA numbers by the amount of the vouchers they needed recently after we all found out that vouchers were the only option after the VA did such a swell job.

Imagine if there wasn't a private market to help pick up the pieces......

[Emil Pulsifer]

INPHX, your comments are increasingly more facile, less interesting. KOS story well sourced re quality of care: 2012 Rand study; New England Journal of Medicine; 2013 (not 2006) American Customer Satisfaction Index survey of vet and non-vet healthcare customers.

Admittedly, over-reliance on VA provided metrics and data could compromise this; but you have not shown that any, much less all sources suffer ffrom such weaknesses. Construction cost overruns not relevant to this or to justifications offered for vouchers.

[Emil Pulsifer]

VA budget details a matter of public record. Your voucher proposal is not. For someone who casually accuses others of intellectual laziness you are cavalier in your evasiveness. This is put up or shut up time if you want to be taken seriously.

I'll make it easier for you. How much per voucher and how many veterans gives you total cost this year. Remember that many veterans have expensive chronic problems in many cases, and expensive acute problems in many other cases, and often require long-term follow up care, all of which makes for expensive private insurance. Then give us your one-size fits all voucher amount. Or else admit you haven't thought through your position.

[cal Lash]

Jon, looks like Emil might be Professor Abraham Setrakian.
After all he is the offspring or Ben of
Hal and David, a great Hunter of evil in the Universes.
Good Posts Emil

No vampires in my desert today, too much Sun Light.

[Emil Pulsifer]

Here's what the latest GAO report (GAO-15-290, High Risk Series: An Update, February 2015) says (p.26 in the document's internal page numbering):

"For example, the total number of annual outpatient medical appointments VA provided increased by 39.9 million visits (or about 85 percent) between fiscal years 2002 and 2013. Over that same period, Congress provided steady increases in VA’s annual health care budget, with amounts more than doubling, increasing from $23.0 billion to $55.5 billion between fiscal years 2002 and 2013."

That's a bit different than the figures provided by INPHX citing USA Today. An 85 percent (not 30 percent) increase in caseload, and a nominal 141 percent increase in budget; but general CPI inflation over the period was 29.5 percent; and healthcare inflation was much higher: in 2002 the healthcare inflation rate was roughly 10 percent ANNUALLY. So it's likely that the real (inflation adjusted) budget increase was actually lower than the increase in caseload. That had probably been going on at least since the late 1990s when the "reform" was enacted, if not before.

Forbes has an easy to read graph comparing CPI general inflation against healthcare inflation over this period:

http://www.forbes.com/sites/peterubel/2013/10/02/how-good-is-the-good-news-about-healthcare-inflation/

Wiki has this to say about the "reform":

"In their major reform period of 1995–2000, the Veterans Health Administration (VHA) implemented universal primary care, closed 55% of their acute care hospital beds, increased patients treated by 24%, had a 48% increase in ambulatory care visits, and decreased staffing by 12%. By 2000, the VHA had 10,000 fewer employees than in 1995 and a 104% increase in patients treated since 1995, and had managed to maintain the same cost per patient-day, while all other facilities' costs had risen over 30% to 40% during the same period."

Though this is commonly construed to be flattering to the VA, this sounds to me like an enormous pressure to cut costs while increasing services. This combined with performance metrics that reward administrators for bottom line rather than patient outcomes no doubt explains much of the scandal.

The GAO report continues:

"Despite these substantial budget increases, for more than a decade there have been numerous reports—by GAO, VA’s Office of the Inspector General, and others—of VA facilities failing to provide timely health care. In some cases, the delays in care or VA’s failure to provide care at all have reportedly resulted in harm to veterans."

Note that this does not quantify the extent of the problem in the VA system as a whole. The phrase "numerous cases", in a system dealing with vast numbers of veterans, is an ambiguous term. Resolving this ambiguity is necessary to properly evaluate the issue.

[INPHX]

Emil writes:

Construction cost overruns not relevant to this or to justifications offered for vouchers.

That's just silly.

Every hospital was way late and way over budget. Not one, not a couple. All of them.

How much VA time, money and resources were spent trying to "manage" those messes?

The USA article used total patients. Your number from the GAO report uses only outpatient visits. I think total paitents is a better indicator that total outpatient visits, which probably reflects an ongoing trend in the medical community to keep more patients out of the hospital.

That trend is probably magnified at the VA, since new hospitals are typically billions over budget and years over budgeted time. Can't put people in new facilites that aren't built yet, can you??

I find the reforms from 1995 to 2000 irrelevant. 15 years ago is not helpful.

If you want to adjust the funding for inflation, fine. The point is that contrary to what most chowderheaded liberals think, the VA was not starved for funding. That's the classic liberal reaction when a government program fails. And it's just not true here.

They're veterans. They're entitled to the best. Just let them choose. They pick their doctor, the doctor bills the US Treasury.

Or they can stay with the VA and wait another 2 years and another $600M for that new facility in Aurora.

At best.

[INPHX]

Emil:

2014 audited financial statements for the VA:

http://www.va.gov/budget/docs/report/2014-VAparPartIII.pdf

In pages 77-83, you will see the independent auditors opinion on those statements. The opinion is long because there are a lot of problems.

Dignity Health's most recent audited financial statements:

http://www.dignityhealth.org/stellent/groups/public/@xinternet_con_sys/documents/webcontent/131805.pdf

Pages and and two are the auditors' report. It's short, becuase the financilas are clean as a whistle.

Carry On.

[INPHX]

Sorry about the typos. I was rushed.

[Emil Pulsifer]

I'll get back to the VA shortly.

INPHX wrote:

"(Unions) only exist because of laws that require employers to recognize them..."

Quite true. The same can be said about patents and copyrights. In fact, corporations themselves are "persons" courtesy of a legal fiction.

If entrepreneurs had been required to assume personal liability for all business debts, and financing was limited to piggy banks and loans secured by personal assets, the economy of the United States would be unrecognizable. Economic growth as well as the level of goods and services produced would be paltry.

"Unions exist to bring above market wages to their members and limit the supply of eligible workers."

Considering the fact that at their height, 35 percent of the employed labor force of the United States was unionized, the assertion that unions were created to limit the supply of workers is absurd on its face.

Market wages are whatever labor and capital negotiate. What you really mean is higher wages than employers would prefer to pay. Most employers, left to their own devices, would prefer to pay as little as possible.

Unions are simply labor associations, like business associations. They tend to form naturally in response to the advantage capital has by virtue of its control of employment, from which the income needed to obtain food, housing, and other necessities of existence may be derived.

Free markets require negotiations between capital and labor to determine wages and working conditions. We don't have to imagine what these would be like had unions never existed, because history tells us. Your scenario of individual worker bargaining as "an almost perfect supply and demand process" is a fatuous fantasy: I suggest you obtain a good book on labor history and settle down to a sobering reality-check.

If owners are able to dictate subsistence wages, 14 hour workdays, and hazardous working conditions, because they are able to fire those who attempt to organize or participate in labor associations, and can bus in surplus labor from impoverished rural areas or third world countries in order to discourage attempts at collective bargaining, that isn't a free market: it's wage-slavery.

Company towns where not only income and working conditions, but housing and basic retail are controlled by an employer are a form of serfdom, in which even pittance wages flow back to the employer.

[INPHX]

Emil-

Really, what are we arguing about? You view the unions as existing to pay wages and benefits above what employers would prefer to pay. And that they use volume to try to accomplish that.

I agree with you.

But clearly, a union employee enjoys better working conditions that someone not in a union, all else equal.

Why else would anyone join a union???

When businesses group together to control prices and restrict supply, that's called price fixing, and it's illegal.

When certain people do it, it's called a union. And it's encouraged.

Now, you see that as a noble goal against the horrors of capital. I see it as just another pricing distortion.

My supply and demand example was dialed in on CEO compensation (another one of the horrors of the looney left). It's a terribly efficient market; information is available; committees are involved, studies are performed. Anyone who rejects or criticizes CEO compensation has a partisan agenda that sweeps over any rational analysis of markets.

Don't lecture me about labor history. But just in case you missed, it, at least in the US, it's not 1920 anymore. Or 1950. Or 1970.

It really doesn't matter, though. Private unions will continue to shrink in this country; and with great leaders like Scott Walker and Bruce Rauner, the rubber is going to meet the road for public unions, too.

[Emil Pulsifer]

INPHX wrote:

"I find the (VA) reforms from 1995 to 2000 irrelevant."

They're not irrelevant because they formed the base conditions from which the VA's subsequent problems followed. It's no coincidence that "GAO has reported since 2000 about VA facilities' failure to provide timely health care" (see page 1):

http://www.gao.gov/products/GAO-15-290

Laying off 10,000 employees over a five year period, while adding new services like primary care and increasing the number of patients by 104 percent, is an obvious recipe for bottlenecks, delays, and poor service, as well as an incentive for managers to cook the books and discourage patient appointments in order to meet quotas and time goals. When understaffing makes the actual accomplishment of goals impossible, administrators whose careers and salaries depend on the meeting of those goals are likely to turn to fraud and chicanery. Requirements to "maintain the same cost per patient-day, while all other facilities' costs had risen over 30% to 40% during the same period" are also a strong incentive for creative accounting.

It's no coincidence that these "reforms" occurred during a period when both the House and the Senate were controlled by Republicans. Making impossible austerity demands is part of the tradition called "starving the beast", in which government programs that cannot be eliminated or privatized are overloaded and made to fail, to make a compelling case for privatization.

Construction overruns are certainly relevant to good budget management and allocation of resources. But then, I never said they weren't.

What I did say was that you were advocating healthcare vouchers because of alleged substandard medical care, not construction delays and construction cost overruns.

I'll have a look at your auditor report links.

[Emil Pulsifer]

INPHX wrote:

"But clearly, a union employee enjoys better working conditions that someone not in a union, all else equal."

And your objection is?

"When businesses group together to control prices and restrict supply, that's called price fixing, and it's illegal. When certain people do it, it's called a union. And it's encouraged."

This is a false analogy. Markets require a framework of laws created and enforced by governments in order to discourage fraud, coercion, and the kinds of monopolies, trusts, and cartels which make honest competition by small and new businesses difficult or impossible.

They also require a framework of laws created and enforced by government to insure that employers, who literally hold the power of life and death since they control the primary source of income needed for existence, don't do to workers what the big trusts would do to small business.

"Don't lecture me about labor history. But just in case you missed, it, at least in the US, it's not 1920 anymore..."

The fact that it's no longer the era of child labor, legalized wage-slavery, and the use of workers as disposable commodities in unsafe working environments, we owe entirely to unions and to the political power they used to elect progressive governments. If you don't acknowledge such an obvious fact, you need to be lectured on labor history.

Employers didn't provide eight hour days, a minimum wage, basic safety for workers, as well as wages and benefits allowing workers to share some of the wealth their labor created so that they could enjoy a bit of comfort and security too, out of a sudden religious conversion. They were forced to, dragged kicking and screaming by virtue of organized labor associations and the progressive government you revile.

[Emil Pulsifer]

P.S. Contract negotiations are not "price fixing". If individual workers can negotiate individual contracts without being accused of price fixing, labor associations employing democratically elected representatives to collectively bargain on their behalf can also be regarded as legitimate. What you really object to is that unions are able to get results that isolated individuals, pitted against powerful and entrenched commercial interests, can obtain only in unusual cases.

[INPHX]

Emil:

No decrease in funding 1994- through 2000

https://www.fas.org/sgp/crs/misc/RS22897.pdf

The guy championing the 1994 reforms was Dr. Kenneth Kizer, a Clinton appointee

[Emil Pulsifer]

INXPHX wrote:

"No decrease in funding 1994- through 2000."

Take a look a the column (in your source) headed "constant FY 2011 dollars". You'll find that in real dollars, budget authority declined slightly from 1994 through 1996 then remained nearly flat through 2000.

During this period the VA offered major new services such as primary care, increased their patient caseload by 104 percent, and cut 10,000 employees. The fact that budget authority essentially flatlined over this period shows that these EXPANDED services and caseloads went unfunded: service obligations rose dramatically while funds did not.

In private business, if I ask you to produce a whole lot more using a whole lot fewer employees, while failing to increase your budget, as a department head you have a strong motive to use fraud and chicanery to keep your job by obscuring the fact that you are floundering and falling behind.

Also note that "budget authority" and authorization funding are not the same thing.

[INPHX]

Emil writes:

What you really object to is that unions are able to get results that isolated individuals, pitted against powerful and entrenched commercial interests, can obtain only in unusual cases.

Geez.

About 80% of the employees in this country manage as isolated individuals.

What heroes they must all be

[Emil Pulsifer]

INPHX wrote:

"The guy championing the 1994 reforms was Dr. Kenneth Kizer, a Clinton appointee."

Kizer didn't control the VA budget or keep it flat while asking the VA to offer greatly expanded services, prompting massive layoffs and understaffing: a Republican controlled Congress did. Let's give credit where credit is due.

[Emil Pulsifer]

INPHX wrote:

"About 80% of the employees in this country manage as isolated individuals. What heroes they must all be."

Sure, after labor associations and the progressive governments they elected created the legal framework: eight hour standardized days with overtime pay required above that, a minimum wage that creates an income floor which doesn't just determine the wages of burger flippers but also (by setting the bottom standard) increases industry minimums for workers making more than that; and establishing legal rights and cultural standards for working conditions and safety requirements.

And in case you didn't notice, with the demise of unions, many of the gains of labor have been eroding...

[cal Lash]

Republican Teddy Roosevelt understood unbridled captalism

[Chris Thomas]

INPHX, rather than attack your motives, I'd like to ask you to further explain some of your proposals. I happen to agree in general that free markets are the best way to efficiently allocate capital. The tricky part is determining whether this efficiency can be enjoyed in any particular market. If so, then we can leave for another day the argument about whether there is some point at which maximizing market efficiency should give way to another social goal.

With regard to vouchers for veterans to use to access care at other hospitals, would these be unlimited? If so, then how would they do anything about the problem you identify about "free" goods being over-demanded? If not, then aren't you really proposing to use vouchers as a vehicle for rationing care?

We all agree that employee unions have the effect of allowing union members to obtain better working terms than an individual member could. That, as you say,s is their entire purposes. I'll grant you that, in this regard, the existence of unions is a pricing distortion versus a labor market without unions. Clearly you would prefer that this particular form of pricing distortion be eliminated.

But there are any number of other distortions in the market. Do you contend that we should strive to eliminate them all? if not, on what principled basis do we determine which should be eliminated and which can be tolerated? Minimum wage laws, mandatory overtime, and child labor laws are all pricing distortions. So are laws requiring employers not to hire those with no legal right to be in the country. Should those market distortions all be eliminated as well?

You've done an excellent job of pointing out the massive incompetence of the VA. I'm not defending that. Rather, I'd like to hear more about how your approach would be applied.

[Concern Troll]

Ha, Chris, don't bother.

You know he has nothing, and he knows he has nothing. But he so badly wants to win.

And when we finish off the VA, well, we can shift those vets to the county clinic/hospital, which will have been outsourced in operation to a for-profit.

As long as those on top get a fat rebate on their taxes for backing the winning candidate, the new spoils system will continue to get worse.

More looting, please.

The faster the entire system fails, the quicker we can get to a reset.

[INPHX]

Chris:

Thanks for a reasoned response; it's nice to engage with someone who doesn't allege that I'm a sociopath (imagine the ignorance of that allegation)

1. They're veterans. They're entitled to the best. If you're going to start a war, you better be ready to pay for it.

They make their choice, the US Treasury foots the bill.

A big part of the economic problem is that the VA basically has an "exclusive" for the medical care. Free to the vet is OK with me; the problem is that for much of what they need; there is only one "free" provider (the VA). That's always bad. (Imagine is you could only buy one cell phone).

Can't give you a bright line distinction on the other pricing distortions. But the Internet sure has changed things.

As an example, eliminate child labor laws in this country tomorrow.

Who would hire them? Imagine the first tweet or the first news story. The firm would be out of business tomorrow.

But at the margins, let the markets work things out. And choice is always a good thing.

Do you think minimum wage laws reduce overall employment?

Troll:

What would it take at the VA for you to favor vouchers (as a choice) for veterans? I mean, it looks like guys died waiting,it looks like records were "doctored" (do you know what happens when a private medical provider forges Medicare or MEdicaid documents?) it's a "corrosive culture", the cost overruns make the Obamacare roll out look like a winner, the financial statements have a qualified opinion on technology and internal controls, (kiss of death in the private sector).

Really--

What would make you change your mind?

Anything?

[Jerry McKenzie]

The VA is not always free. A know a vet that gets charged $75 for an office visit!

[Concern Troll]

What a laugh. Did you fight against Obamacare, INPHX- because that is your voucher system. Period.

Pro up dude, at least you should learn to be a better troll.

http://www.va.gov/oig/pubs/VAOIG-14-02603-178.pdf

Read how this entire system has been short of money for years, and how they have done this throughout the country for years, including throughout the 2000's when it was all done by the R party.

And then you trot out vouchers. Har.

Vets will go to the VA because they need free care- so give them a voucher?

Did you notice that it is hard to get docs to take AHCCCS and Medicare because they don't pay enough, so now you want another chronically underfunded voucher?

Solutions, not cuts masquerading as a solution.

Otherwise, you mark yourself as just another denier of reality, living in the GOP spin zone.

[Chris Thomas]

INPHX, at a minimum I'm willing to withhold judgment on whether you're a sociopath. That appears to make me your greatest ally on this thread. :)

If I read your response correctly, you've essentially said that at least for veterans your voucher proposal really is all about choice and is not a more subtle way to make cuts. So, good for you. Concern Troll's skeptical response reflects a couple of hurdles to this idea. One is the fact that it's theoretically possible that giving veterans unlimited access to private care might produce higher costs in the aggregate. Making more health care providers available is likely to produce better care overall, although picking a doctor isn't quite like finding the best price on a mattress. However, it appears that the VA system has essentially rationed/denied care in reality. introducing additional provider options into that dynamic likely will produce higher overall costs, as the effective rationing is eliminated. I'm okay with that, as you seem to be.

The second challenge is the fact that past proposals to convert programs into voucher or block grant systems have been made in bad faith -- either to weaken disfavored programs or to hide the fact that popular ones are being cut. if you are making a voucher proposal from a libertarian economic perspective -- as I gather you are -- you need to recognize that non-libertarian conservatives have given this theory a bad name.

As for the minimum wage and unemployment rates, certainly economic theory would tell us that establishing a minimum wage that is above the natural market equilibrium rate is likely to reduce overall employment. among other things, it makes employment-reducing technology somewhat more competitive. I am not sure that today's relatively ungenerous minimum wage is much above the natural market equilibrium, at least on a national basis.

Assuming that it is, then this is an example of a situation where I'd support legislation (minimum wage in addition to child labor laws, etc.) even though it would produce outcomes less efficient than letting the free market operate with its usual brutal efficiency. The argument that the minimum wage depresses overall employment and thereby reduces the chances for people to get their first job seems a bit dated to me. Too many jobs today pay minimum wage or something close to it, even to adults working full-time and trying to support a family. Nobody who is willing to work full time should be below the poverty line, even if the unfettered market would value their skills in that fashion. I might be willing to tolerate a specific sub-minimum wage for certain workers (say, 16- and 17-year-olds) if serious study suggested that it really would make more employment available to them. We do that already for workers with mental disabilities. if the reality is that the level of employment wouldn't really budge, then I'd pass on the grounds that it's merely a net negative departure from the status quo.

Your child labor comment about stigma enforcing norms in the absence of legislation is an entertaining thought experiment. I have a libertarian friend who thinks each airline should be allowed to handle its own passenger screening. his theory is that, over time, the market would drive out of business those airlines that did a lousy job and suffered bombings and hijackings. That is no doubt true, but the painful process of getting to that point demonstrates that even the markets have limits to their efficiency. that's why we have laws.

Cheers,

Chris

[INPHX]

Chris:

I understand what you're saying about the bad faith of some previous voucher/grant programs. Earlier in the thread, I stated that I really wish that none of this had happened at the VA.

So.

It's time with the VA. IMHO, they've lost there exclusive rights. By quite a margin.

What other real solution is there? More money? Firing and replacing hundreds or thousands?

There's a great program here in AZ where you can divert some of your income taxes to private schools. But it's capped in total (good), but it needs some more caps IMHO based on total tax liability (bad that it doesn't). It's not going to bankrupt a school district, but it's a tad bit of market forces and choice. And much like what I'm suggesting with the veterans, it's optional. So my choice position doesn't advocate dismantling the VA or Arizona public schools- I'd like to think it kind of puts those institutions on notice.

I'm not against a minimum wage. I just want those who favor it to acknowledge that it probably reduces overall employment and as you pointed out,it gives technology more incentive to eliminate labor. It's not free and you run afoul of fundamental economic principles at your own risk.

There is some hyper libertarian discussion about allowing people to sell their organs (only once they are dead). The thought is that it would actually increase the organs available (and it probably would). But much like child labor laws and your friend's idea about airlines, there's just no way those ideas would ever get implemented. There are limits.

I'm not an anarchist. But I think at the margins, when we are confronted with decisions about policy today, we need to think about information, technology, and markets. And that there is nothing that is free; most decisions are like teeter totters. If one side goes up, another side goes down.

Take social security. Great program when it started-total government control.

But today, you can open a securities account in about 5 minutes on a computer and there is a lifetime's worth of information about investments on the web. So- give folks an option to invest their own social security?

Why not?

Because investment advisors might make money?

Who cares, if the investment makes more?