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15 July 2019


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John Minehan

Well, the freight lines are private. Passenger rail is largely nationalized under AmTrak.

Prior to the 1980s, you really could say we were moving towards a "mixed economy" here, but we have largely reversed course since. More "socialized" things like AmTrak are hard to get rid of, but the general trend is away from things like that.

The "Great Recession" brought some of that back (the bank bail-outs and the Forc & Chrysler bail-outs) but I think people get the fact that those things are not really workable.

As Heinlein and Milton Friedman both said, "There ain't no such thing as a free lunch."

John Minehan

Would they be offering the Medicare rates or would it wind up being more like the Medicaid fee schedule in practice?

Twenty years ago, Medicare was cash-flow for the average practice, the rates were low but payment was net 45 days on a "clean claim."

For about the last ten years that has been less true and more docs either don't par or close their practices to new Medicare patients.

i suspect this will go nowhere, but time will tell.


A big subject.

Some brief observations. I have views that one might characterize as socialist. The key one is that I do not think that incomes as determined by the free market reflect marginal contribution to social welfare. In fact I would argue that most incomes are determined by a combination of anti-competitive practices (trade associations, cartels, and monopolies or monopsonies) or reflect pure economic rents - meaning they are unnecessary to encourage the economic activity associated with it. For example land rents.

I can see that without price signals, marginal economic activity may not take place. But I would argue that many features of our current supposedly free market are not integral to well-functioning capitalist systems.

I dont believe that substantial amounts of wealth should be inherited. I think that private property should be at least partially subordinated to the interests of the collective. We do this in war time. Why not, if the situation suggests in, in peace time.

Individuals contribute to society in many ways. They have a stake in society when they serve its military for example. Are these people adequately compensated and looked after by the existing system.

And what if productivity of capital continues to increase. If productive activity requires increasingly little human labour, would that mean that unemployed people should starve.

All economic systems should be judged by how they serve society in general. If they outcomes are poor then the system is poor. There is no natural order, save that we make ourselves.

All, of course, in my humble opinion.


Concerning the pros and Cons of socialism, I daresay that it is the same as the difference between a medicine and a poison. It mostly depends on the dosage and the means of application (application by slow evolutionary process is good, application by Soviet Bajonett is not).

Historically speaking, Capitalism worked pretty when its ruling classes where scared of some non capitalists, and thus kept the exploitation of those under them somewhat limited. One does not get this "sane capitalism" without someone scaring the capitalists into essentially sanity.

I mean, look at the military industrial complex of the united states. The capitalists running it have completely messed up everything. You have essentially one factory left that can build artillery, and apparently zero that can build new Abrams tanks on US soil (there are some that can refit tanks though). If the US capitalists felt under any kind of threat, they would not do something that stupid. The whole situation with "lets outsource everything to China" is similar. This was incredibly shortsighted rank stupidity, and it is not coincidence that it happened for real after the Soviet Unions collapse.


Barbara Ann,

“Envy yes, but I think this in turn often stems from rootless insecurity, fear caused by feelings of inadequate self-sufficiency (of all kinds) and a resentment of those more at home in their culture and the world.”

More at home, that feels true.

Thank you,


John Minehan

'[F}ederal law that requires hospitals to treat the indigent starting at the emergency room . . . ."

The "Emergency Treatment and Active Labor Act" ("EMTALA") requires a hospital (essentially something with an Emergency Room, a community hospital or Academic Medical center but not an ambulatory surgical center or other independent diagnostic & treatment facility) to "stabilize" indigent patients.

In order not to die of uncompensated care, these houses have learned to manage "diversions" and to define "stabilize" very carefully.

It is a real question, worthy of detailed empirical study, if hospitals actually gave more care to the generally indigent BEFORE EMTALA passed.

John Minehan

Have you seen if he is dual-eligible for Medicaid? Unfortunately, it sounds like he is too young for EPIC coverage. (It seems like OMH should sponsor something like EPIC, or dual-eligibility should be routine.)

John Minehan

Also, Lasik https://offers.tlcvision.com/promo/?did=GS4XY&eventid=7003&utm_medium=cpc&utm_source=google&utm_campaign=General+-+Restructure&utm_content=Lasik+-+Surgery+-+General+-+Exact&utm_term=lasik+eye+surgery&kclid=407ac732-778c-4c84-abaa-a4b16a6b7675&gclid=EAIaIQobChMInamKsuO-4wIVBZyzCh2AKQgHEAAYAiAAEgIhBfD_BwE . . . . for the most part, it can also be used for some ocular cancers which treatment is covered.

John Minehan

I think you can make a fairly strong empirical argument that there would be no big business without big government, that excessive regulations create barriers to entry that reduces competition enough to make bloated organizations economically functional, which they would not be if they had to deal with a lot of more nimble competition.

The problem is that after you have made your nut, you don't want to hear about Schumpeterian "Creative Destruction."

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