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Old 02-04-2011, 03:19 PM   #41
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Exercise: Identify the countries with the lowest level of government intrusion or involvement in the economy, social life, and health care.

What is the GDP per capita in each, compared to the US?
That was a bit of a trick question. Sorry about that.

Hong Kong as a choice is an interesting one. The HK government represents about 17% of GDP (2008 estimate), a good bit less than the US at 34.6% (2008, aggregate of federal, state, and local budgets), but they don't have much in the way of a Department of Defense budget for some reason... GDP per capita is $45,600 (CIA World Book 2010), compared to the US at $47,400 (CIA World Book 2010). Hong Kong has the second highest health care costs in the world, after the United States (We're #1, We're #1...) They have the same mashup of employer-provided and individual health plans. They do provide some welfare services.

A couple of other data points might have been interesting. The correlation turns out to be nonlinear.

The kicker for ERD50's hypothesis that smaller government as a fraction of GDP helps the overall GDP per capita is the lower end limit case, of essentially no government economic activity. That case suppresses economic growth because the mechanisms to enforce contracts, protect property, and develop a common infrastructure are missing or inoperative.

There has to be some government spending for the successful operation of rule of law. Relying on the population and other businesses to be good Objectivists that still respect the freedoms of others in the absence of government is a path to failure.

There's something in economics called the Rahn Curve, which says that there is a level of government spending which maximizes economic growth. The curve suggests that there is an optimal level of government spending very roughly around 20% of GDP.

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Old 02-04-2011, 04:34 PM   #42
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Hong Kong as a choice is an interesting one. .... Hong Kong has the second highest health care costs in the world, after the United States...
Do you have a link for that? It isn't adding up with my source (after converting from GDP to per capita) and I'm having trouble finding data since HK is not an OECD.

My source was saying HK total spending on HC as % of GDP was less than half the US (6% vs 16% of GDP). And your numbers indicate GDP per capita to be pretty close. So that doesn't seem to match.

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The HK government represents about 17% of GDP (2008 estimate), a good bit less than the US at 34.6% (2008, aggregate of federal, state, and local budgets), but they don't have much in the way of a Department of Defense budget for some reason... GDP per capita is $45,600 (CIA World Book 2010), compared to the US at $47,400 (CIA World Book 2010).
OK, but US Defense is about ( corrected: 20%) 4.7% of GDP, so even if we compensated for the whole thing HK would spend 4.7% more than they do now, so the 17% of GDP would go to (corrected: ) 17.8% ( third edit... arghhh - or do we add now, so 17% plus 4.7% = 21.7%), still far less than 34.6% of the US.



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The kicker for ERD50's hypothesis that smaller government as a fraction of GDP helps the overall GDP per capita is the lower end limit case, of essentially no government economic activity. That case suppresses economic growth because the mechanisms to enforce contracts, protect property, and develop a common infrastructure are missing or inoperative.

...

There's something in economics called the Rahn Curve, which says that there is a level of government spending which maximizes economic growth. The curve suggests that there is an optimal level of government spending very roughly around 20% of GDP.
I'm not sure what you are trying to say here. I wouldn't think you would claim that I think govt spending should be near zero (but that's what I'm getting). I certainly agree we need govt to provide infrastructure and law and order.

I can't say whether 20% spending is any kind of appropriate benchmark - all of us LBYMers know that there is spending and there is spending. Do all companies with a 10% R&D budget have similar success?

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Old 02-04-2011, 04:49 PM   #43
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OK, but US Defense is about 20% of GDP, so even if we compensated for the whole thing HK would spend 20% more than they do now, so the 17% of GDP would go to 20.4%, still far less than 34.6% of the US.
In 2010, all the spending by DoD accounted for 4.7% of GDP. If we add in veterans pensions AND the VA it comes to about 5.5% of GDP. And, remember that a big chunk of the "defense" spending is actually . . health care (active duty personnel, their families, retirees and families, VA spending largely on service-connected disabilities and indigent veterans, etc).

And, if total government spending of 20% of GDP is about right, then we've got some real cutting to do since we're above 40% now (federal>20%, state and local >20%).
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Old 02-04-2011, 04:55 PM   #44
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In 2010, all the spending by DoD accounted for 4.7% of GDP.
Thanks, my mistake. I was looking at % of Federal spending. Good point that a portion of that would be health care. - ERD50
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Old 02-04-2011, 05:07 PM   #45
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In 2010, all the spending by DoD accounted for 4.7% of GDP. If we add in veterans pensions AND the VA it comes to about 5.5% of GDP. And, remember that a big chunk of the "defense" spending is actually . . health care (active duty personnel, their families, retirees and families, VA spending largely on service-connected disabilities and indigent veterans, etc).
And we read all the time about some defense projects went way over-cost and got cancelled with nothing to show for it after billions being spent. And these are billion dollar projects, not little programs for a few hundred Ks.

DoD spending is no model of efficiency, yet it is still a small percentage of GDP. Makes one shudder to think of the other 95.3%.
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Old 02-04-2011, 05:23 PM   #46
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DoD spending is no model of efficiency, yet it is still a small percentage of Fed spending.
Yep, the DoD budget, VA, retiree benefits, plus the "Overseas contingency funds" to fight the wars in AFG and Iraq amounts to about 1/4th of what the US government spends.
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Old 02-04-2011, 06:14 PM   #47
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Do you have a link for that? It isn't adding up with my source (after converting from GDP to per capita) and I'm having trouble finding data since HK is not an OECD.

My source was saying HK total spending on HC as % of GDP was less than half the US (6% vs 16% of GDP). And your numbers indicate GDP per capita to be pretty close. So that doesn't seem to match.
Hong Kong isn't an OECD member and doesn't choose to publish much data. I got my information from an Allianze Global document that covered their results from providing coverage in various locations. Hong Kong uses a Beveridge model, where many of the clinics and hospitals are owned by the government, as a leftover from British rule, with a newer layer of private care. The two tiers may be leading to your discrepancy, depending on exactly what the data set you are looking at is trying to examine.

It's not cheap for a foreigner. Matilda, Canossa, and Sanatorium are three private hospitals, here compared with the US data:
GP Consultation

  • Matilda: $64 - $102
  • Canossa: $115
  • Sanatorium: $153
  • USA Federal Average: $100
Private Room / 1 day

  • Matilda: $761
  • Canossa: $328
  • Sanatorium: $682
  • USA Federal Average: $400
Maternity - Routine 3 day delivery

  • Matilda: $8,500
  • Canossa: $7,794
  • Sanatorium: $7,179
  • USA Federal Average: $7,600

I'm still not sure why Hong Kong is of such interest. Indigent locals there are pretty much in a system like the British NHS. I can't imagine any of the more cost-conscious posters in this topic actually wanting an NHS style system inside US borders. It does have the advantage of simply providing care, without all the odd carve-outs that the several states and Federal government put into Medicaid. However, it is of course Socialism, and likely to kill Grandma.
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Old 02-04-2011, 06:27 PM   #48
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And we read all the time about some defense projects went way over-cost and got cancelled with nothing to show for it after billions being spent. And these are billion dollar projects, not little programs for a few hundred Ks.

DoD spending is no model of efficiency, yet it is still a small percentage of Fed spending. Makes one shudder to think of the other 95.3%.
Am I interpreting the figures wrong? The DOD budget is 4.7 percent of the GDP, not 4.7 percent of total Fed spending. (From previous posts, it looks like total Fed spending including DOD is 20 percent of the GDP, so the DOD is about 1/4 of total Fed spending).
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Old 02-04-2011, 06:29 PM   #49
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Yes, I spotted my error and corrected it at the same time you made the post to point that out.

By the way, being no economist, I still suspect that in the civilian side, there is much of the GDP that is also "wasted". I don't know how economic activities and outputs are measured, but all those empty or unfinished construction projects due to the housing bubble burst couldn't be all that good. Do all those get subtracted out of the past GDP at all if they revised the numbers?

And all those guys I encountered at megacorps who acted just like the characters in Dilbert cartoons could not have contributed to the "real" GDP either.

But I digress... What I was thinking is that contrary to my libertarian personal friends who believe in a total laissez-faire political system, I do not trust the commercial or civilian side to be able to do all the "good stuff". The problem is of course how and where we draw the balance.
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Old 02-04-2011, 07:03 PM   #50
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It's interesting looking at the different health care systems around the world, and how they do or don't handle the indigent.

There are the Beveridge model tax-funded government run systems like the British National Health Service, found in Great Britain, Spain, Scandinavia, New Zealand, as one tier in Hong Kong, and Cuba.

There's the Bismarck Model, with an insurance system that has to cover everybody, paid by employees, employers, and premiums from the self-employed, run as a non-profit, and used to pay expenses in private facilities. There are usually a bunch of insurers, offering add-ons to the basic mandated coverage. Think of it as Obamacare, only applied to everyone, replacing Medicare/Medicaid/Tricare, etc. Places using the Bismarck model include parts of Latin America, France, Belgium, Switzerland, the Netherlands, Japan, and Germany.

There's the National Health Insurance Model, which uses a Beveridge model single insurer collecting premiums or taxes, but where the medical providers are private, rather than government owned. This setup, a 'single payer' model, gives the insurer considerable power to negotiate pricing, as well as cost control by limiting services. Yes, this is obviously the Canadian system. Taiwan and South Korea, among others, also have similar systems.

Much of the world uses the Out-of-Pocket model, wherein one directly negotiates with the medical provider for care in exchange for money, poultry, goat's milk, child care, or whatever else they may have to offer. Persons with nothing to offer simply do not receive medical care. Under this system, in general the rich get medical care, and the poor stay sick without cluttering up the waiting room.

The United States is unique, from what I can tell, in that we routinely see all four models in use within our country.
  • Veteran's care is provided on the Beveridge Model
  • Medicare/Medicaid patients are on the National Health Insurance Model, eh?
  • Working Americans with job related insurance are on the Bismarck Model
  • The rest of us are on the Out-of-Pocket Model, with the wealthy buying insurance or self-insuring, and and the others scratching to trade for medical care
If you're on the Out-of-Pocket Model, be glad to have some wealth tucked away, or you could be living that Burkina Faso lifestyle.
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Old 02-04-2011, 09:36 PM   #51
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Hong Kong isn't an OECD member and doesn't choose to publish much data. I got my information from an Allianze Global document that covered their results from providing coverage in various locations.


... It's not cheap for a foreigner.
I'm not sure that what they charge foreigners has much bearing on what it costs to cover their own citizens on average. But I haven't found any numbers outside of what was in that link, and he had no refs.

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Old 02-04-2011, 10:33 PM   #52
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This is probably un-related, but if the USA quit being the "world's policeman" and help out every country in the world with millions if not billions in military aid, and had every other country pay their fair share, we would have enough money to pay for Obamacare for the next 500 years......
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Old 02-04-2011, 11:33 PM   #53
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This is probably un-related, but if the USA quit being the "world's policeman" and help out every country in the world with millions if not billions in military aid, and had every other country pay their fair share, we would have enough money to pay for Obamacare for the next 500 years......
- We've disengaged from the world before. It didn't prove to be a moneysaver.
- This whole national defense and foreign affairs thing does have the virtue of at least being mentioned in the Constitution as a legitimate role of the federal government.
- I don't know what we're counting as "Obamacare", but if we took the entire annual expenditures for the defense budget, cost of the war in AFG, cost of the war in Iraq, all military retiree pay, and all foreign aid we couldn't pay for present US government health care (Medicare and Medicaid) for "500 years." More like 1 year. And, again, some of that "defense" spending is really health care spending.

If we look at the bigger picture, we now spend approx 6% of our GDP on all these defense/foreign aid things. We spend 16% of GDP on health care today. Does anybody think that the new legislation, mandating more medical care for more people, is going to reduce that cost? If not, then we can see that, once the government health care assimilation is complete, all our defense and foreign aid for the entire year will pay for about 4 months of PPACA-care.

Obviously you were just making a point with the "500 years" thing, but a lot of people overestimate what we spend on defense relative to other budget areas. And we're intent on adding new budget areas all the time.
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Old 02-05-2011, 01:18 AM   #54
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It seems to me whenever the topic of health care comes up someone says or implies "we can't cover everyone, it would cost too much".
Really? It doesn't seem that way to me at all. I think this is a (perhaps unintentional) straw-man.(snip)

-ERD50
I should have chosen my words more carefully. It would have been more accurate to say that whenever the subject of health care comes up, cost-based objections are raised. Here's one from this thread:

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(snip)We spend 16% of GDP on health care today. Does anybody think that the new legislation, mandating more medical care for more people, is going to reduce that cost? (snip)
It may be that the objections I recall are aimed at a specific proposal, as is samclem's, and not at the idea of American system of universal health coverage in general. I can't off the top of my head recall a health care thread where cost objections weren't raised, but that may be because many if not most of the threads are dealing with the recently passed health care act, and commenters raise the same objection because they are talking about the same proposal.

The five countries prove by example that in fact more care can be provided for more people at a reduced cost a smaller percentage of a lower per capita GDP. The three common features show how to do it. Why is there such resistance? What exactly is the barrier that is preventing the US from getting this done?
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Old 02-05-2011, 01:41 AM   #55
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Here we have 5 countries where there is greater government intrusion ("involvement") in all aspects of the economy, social life, and health care than is the case in the US. All of them have lower GDP per capita than the US. Cause/effect/coincidence? It's just possible that greater government involvement in health care and other issues is inconsistent with maintaining the GDP per capita we have today. That lower GDP is more than a number--it translates into better quality of life, more individual choices, better options for our kids, and even better health and medical care. There's a lot more to life than medical care. Having a higher GDP per capita doesn't guarantee good medical care for all (witness our current situation), but it certainly establishes a better foundation for it than does a lower GDP.
Thank you, that makes your meaning clearer.
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Old 02-05-2011, 08:16 AM   #56
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I should have chosen my words more carefully. It would have been more accurate to say that whenever the subject of health care comes up, cost-based objections are raised. Here's one from this thread:

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Originally Posted by samclem
(snip)We spend 16% of GDP on health care today. Does anybody think that the new legislation, mandating more medical care for more people, is going to reduce that cost? (snip)

... I can't off the top of my head recall a health care thread where cost objections weren't raised, ...
OK, but I think it is coming from a different angle than how you are taking it.

Read samclem's statement again - it does not say we shouldn't provide care for all - it only says that we shouldn't expect costs to decrease. Recall that leading up to this legislation, we constantly heard how health care costs in the US are increasing at "unsustainable" rates. Yet, the legislation does next to nothing about cost controls.

So we object to it being 'sold' on a false premise. And yet, we hear people say "we had to do something - costs keep going up", it doesn't make sense to hold up this bill as a solution to cost control.

It's why I keep bringing up the costs/results of public education in those other countries. It isn't the "public mandate" that makes things cheaper and better there, we have that too. Something is different in the way the US is dealing with these problems, or we just have a different situation to deal with. Going public, in and of itself isn't going to solve the cost problem.

And since there are clearly better solutions than this bill, it is indeed frustrating that something better was not done. We are going to spin our wheels for years with this, when we could have been making serious progress.

-ERD50.
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Old 02-05-2011, 08:36 AM   #57
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And since there are clearly better solutions than this bill, it is indeed frustrating that something better was not done. We are going to spin our wheels for years with this, when we could have been making serious progress.

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Old 02-05-2011, 08:50 AM   #58
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Further to my post to kyounge1956 -
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But I fall on the side of continuing with the experiment we have embarked on (and which may indeed fail) rather than returning to the experiment we were embarked on and that has already demonstrably failed.
I just can't understand this approach. Health Care is such a big and important issue, doesn't it deserve better than to accept a clearly flawed bill and take a 'wait and see' approach to it. Can't we do much better? Won't we just fall further behind?

And it isn't the binary situation you imply donheff. It isn't a choice between this bill and doing nothing. How about a better bill?

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Old 02-05-2011, 09:19 AM   #59
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And it isn't the binary situation you imply donheff. It isn't a choice between this bill and doing nothing. How about a better bill?

-ERD50
I have no problem with a better bill. In fact I am very much in favor of changes. I just don't want to repeal the current bill before going there. If the current legislation is reversed I firmly believe it will be decades before we reform the system. In the meantime (probably most of my life) we will be back facing the potential to lose coverage at the whim of carriers in many (most?) states.

A significant part of my concern is my personal situation. My daughter has a pre-existing condition. That is as much my problem as hers if she ends up uninsured. Should she encounter devastating HC costs because of a catastrophic illness I would end up cutting my ER lifestyle to the bone to help her before I would toss her under the bus. With mandatory coverage the scenario is much more rosy. As long as she is covered by insurance catastrophic HC costs won't bankrupt me. Even if she becomes disabled I could easily afford to support her in my home or elsewhere. But I couldn't afford endless medical costs. I wouldn't face those costs in most other developed countries and I don't want to face them here.

While the concerns I expressed are personal I see similar concerns regularly expressed on this board. Lots of potential retirees are afraid to leave work because they fear they could lose coverage due to pre-existing conditions. In my opinion, the current unsatisfactory situation is far preferable to the previous worse situation - it is as simple as that. Change, sure. A return to the previous status, horrible.
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Old 02-05-2011, 09:29 AM   #60
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I remember that plan and it made a lot of sense to me at the time. I doubt it will be considered if "Obamacare" ends up scrapped since, if I remember correctly, it too required everyone to pay into the plan.
IIRC, while the Wyden/Bennett plan required everyone to pay into it, it was through the tax system, so there were no individual mandates like the type that are currently being challenged in the courts. Everyone with earned income pays into Medicare, and to the best of my knowledge, it has never seriously been challenged in the courts.
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