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05 November 2019

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Jack

Ray Dalio penned a recent note that is worth a read as it discusses the issues that lead to the arguments of people like AOC.

https://www.linkedin.com/pulse/world-has-gone-mad-system-broken-ray-dalio

”...those who have the obligations to deliver the money to pay these pensions are unlikely to have enough money to meet their obligations. Those who are recipients of these benefits and expecting these commitments to be adhered to are typically teachers and other government employees who are also being squeezed by budget cuts. They are unlikely to quietly accept having their benefits cut. While pension obligations at least have some funding, most healthcare obligations are funded on a pay-as-you-go basis, and because of the shifting demographics in which fewer earners are having to support a larger population of baby boomers needing healthcare, there isn’t enough money to fund these obligations either. Since there isn’t enough money to fund these pension and healthcare obligations, there will likely be an ugly battle to determine how much of the gap will be bridged by 1) cutting benefits, 2) raising taxes, and 3) printing money (which would have to be done at the federal level and pass to those at the state level who need it). This will exacerbate the wealth gap battle. While none of these three paths are good, printing money is the easiest path because it is the most hidden way of creating a wealth transfer and it tends to make asset prices rise. After all, debt and other financial obligations that are denominated in the amount of money owed only require the debtors to deliver money; because there are no limitations made on the amounts of money that can be printed or the value of that money, it is the easiest path. The big risk of this path is that it threatens the viability of the three major world reserve currencies as viable storeholds of wealth. At the same time, if policy makers can’t monetize these obligations, then the rich/poor battle over how much expenses should be cut and how much taxes should be raised will be much worse. As a result rich capitalists will increasingly move to places in which the wealth gaps and conflicts are less severe and government officials in those losing these big tax payers will increasingly try to find ways to trap them.”
Factotum

Welcome to California.

Factotum

Virginia is now nothing more than a majority Wash DC bedroom community, filled with Beltway insiders. Going blue is no surprise - it is what government workers do these days.

turcopolier

factotum

Too simple. There is also the I-95 corridor to the south along which masses of New Virginians are distributed in great numbers plus the native minority population.

blue peacock

English Outsider

MMT is the sophistry required to provide cover for the monetization of government debt. And also the debt of the favored classes. The ECB is already monetizing the debt of politically well connected zombie companies.

As Ray Dalio points out in the link that Jack provided below, the pressure to greatly increase the scale of monetization will only grow. AOC and her ilk are arguing why just money printing to benefit the 0.01%. Naturally the other politically well connected classes like the public sector unions that back her will want a piece of the action too. And as seen in other epochs this will continue until psychology (confidence) breaks.

Your fellow countryman Sir John Bagot Glubb's Spenglerian essay "The Fate of Empires" and philosopher Auguste Comte's work on the development of advanced civilizations provide some guide posts for thought.

Factotum

Treatment, aggressive treatment on demand in the last six months of life can often be deemed futile and is often administered to comfort the relative who demand doctors "do everything".

Futility of treatment is a hot topic in bioethics today. Futility of care during the last six months of life is never in question and is always available. This is handled by rationing and death panels in other "socialized medicine" countries. Both topic must be clarified in today's US discussion of "health care". Turning these topics into unfounded blame and shame agendas is why we should not be signing up at this time for an ill-defined new "health care" delivery system.

Pays to know the difference between these two states of "health care" (futility of treatment vs futility of care) and not conflate the two- the line is obviously not bright, but that is also why you don't write a mindless blank check for "free health care" until you adequately define what it is, what can be and what it can never be outcomes of "health care"..

blue peacock

It would be interesting if there are studies on the distribution of medical service consumption. What is consumed - by frequency, by quantity, by dollars, by whom?

To understand all this better we need answers to questions on - what is the unit cost on medical services that are consumed the most; how does it compare with other countries; what are the treatment/outcome profiles of the top 20% of services that consume the most spend; etc.

The healthcare industry would likely have no interest in folks digging into all this as they would not like to give up their growing share of spend and would prefer the debate to be around abstract issues on keep your doctor and so on.

From my friends in the medical profession I hear issues around - the AMA suppressing the quantity of doctors through placing medical education constraints; concentration of market power in a few hospital systems in each major urban area leading to monopoly style behavior; the lack of any pricing transparency; systemic incentives to increase consumption with fee-for-service, the restriction on competition, etc. Then add in the factors that you have brought up.

It seems that this is a product of our times, similar to defense procurement with all kinds of costs embedded that the value of defense expenditures is substantially diluted. There's no bang for the buck as the bloat has to be fed.

catherine

''Why does no one ever talk about how much healthcare insurance in the US is delivered by not-for-profit companies like Blue Cross/Blue Shield? How do those ubiquitous companies fit into the socialist sound bite model of greedy "bloated" companies raping the poor citizen?''


Let me ask you...with no insult intended....what exactly are your qualifications, professional or personal experience with health care and insurers to speak on the subject?

I ask because you are behind the times in your comment on BC/BS.....they are all now 'licensees' most of which began to convert to 'for profit' decades ago. Its 'conversion' path to for profit is a beautiful story of greed and politics.

Have you had any experience with 'socialized' health care?
I have. My cousin and her husband, who was a Rhodes scholarship fellow, were living in London when he was diagnosed with stomach cancer. He got the best of treatment---both my aunt and uncle and his parents went to London and had oncologists at Mayo in the US looking at the treatments Jim was getting and talking to his doctors....Mayo told them they could do no better than was being done, that it was exactly what they would do and they concurred with the London doctors.

Everything you 'hear' about health care abroad is not necessarily true.

catherine

''We spend more on health care because we choose to.''

LOL.....Big Pharma sends you their thanks.

When I was in London 4 years ago I need a inhaler for my 'rainy weather' bronchitis. Got a script and bought a 120 uses Advair inhaler for the 'retail' price of $67. Go buy one tomorrow at your friendly US pharmacy at the 'retail' price of $320.
The cost of the most widely used critical drugs have gone up 300% in the US since 1999.

Americans are such suckers.

different clue

What would be wrong with electing Gabbard through the back door? Electing her through the front door would be nicer, but if the back door is the only door there is, wouldn't the back door be better than no door at all?

She has already shown that she is ready, willing, able and eager to carry the battle to the heart of the Clinton.

Patrick Armstrong

Very interesting essay. Thanks for bringing it to my attention. Chrystalises a suspicion that we in the West are simply too gummed up to get anything done. In 2 years Russia built the longest bridge in Europe and in ten China built a stunning amount of high speed railway lines. How long would it take our systems to get that local bridge repaired?

jd hawkins

Seems the Neo-Jacobins are on our tails.

annamissed

Yes, and they also re-instated the Bush tax cuts.

Norbert M Salamon

Fred:
The $10700.00 has nothing to do with any individual in USA it is a RATIO: total cost of health care in the country [approx. 3.5 Trillion] DIVIDED BY population of the Country [ some 320 million +]
The Swiss, the Canadian and all other 200+ per capita costs for various countries are similar RATIO numbers expressed in PPP based US $ terms.

Factotum

Medical malpractice liability plays a very large part in US health care costs - doctors practicing "defensive medicine" and admitting you get sued for what you don't do; not what you do.

So they practice over-kill defensive medicine as well as eagely padding numbers of procedures to improve bottom line, with no independent corroboration as to necessity or efficacy. When comparing health care systems and outcomes, it is necessary to also compare legal liabilities and internal practices and procedures for similar situations.

How many other countries routinely demand CAT scans when an elderly patient comes in to the ER with flu systems from a senior care institution?

Most cynically in the US, the medical industrial complex will find a disease and diagnosis that matches your insurance policy limits. And government employees get the best insurance policies of all - which in turn become the drivers for costs and standards of care.

ER flu patient's CAT scan was covered by retired government employee insurance. Basically a blank check written to the health industry. Entire ER out patient flu observation totaled $10.000. He was sent home for bed rest. he could have had a 2 month cruise for the same cost.

James Doleman

Guilty as charged.

But, I hope, always respectfully

blue peacock

Here's an example of relative costs of some specific drugs & procedures in a recent Deutsche Bank research report packaged up by Zero Hedge.

https://www.zerohedge.com/personal-finance/us-healthcare-costs-are-exploding-heres-why

The above post shows a comparison chart of hospital & physician cost for an appendectomy in 2015. The US at $16,000; UK at $8,000; Australia at $4,000.

https://www.zerohedge.com/s3/files/inline-images/appendecctomy.jpg?itok=dH9IgZNL

Price comparison for the pharmaceutical drug Xarelto in 2015. US at $290; UK at $125; Switzerland at $100.

https://www.zerohedge.com/s3/files/inline-images/price%20of%20xarelto.jpg?itok=zy6hoIyd

The big question: Does the US patient of an appendectomy have a substantially better outcome compared to the Aussie, where it costs a quarter of what it costs in the USA?

different clue

Several years ago we had a Canadian-citizen co-worker where I work. That subject came up and she complained that she had to come to the US for certain treatment which she needed but could not get in Canada. I asked her who paid and she said that of course her Canadian-taxpayer-funded CanadaCare paid for it.

If she properly understood my question and I properly understood her reply, the CanadaCare system knew it couldn't give her the treatment she needed when she needed it, and in line with their coverage of Canadian CanadaCare taxpayers, they covered her just the same. If that is true for all those Canadian citizens getting must-have treatment here in America, and if CanadaCare is paying for that must-have treatment for those Canadians getting it here in America, then the CanadaCare authorities understand the problem and are solving it. And so if these Canadians are covered regardless, then CanadaCare is working for them, it seems to me.

Jim Ticehurst

Colonel..As you also Point out in your List..The "People in the Democrat Party.."and Corruption..The Corrupt Quids who get there Money..The PROS..who will Milk any Cow..any Where..Any Sex..Through Money Laundering...(Foundations) of Influence Peddeling..Like Old..Sleazy..Slidin Joe Beiden.. The PRO...who took his QUID..Hunter Beiden..to the Ukraine and China...to look for QUO...Ah That's DOUGH n English.Looks like Oldy Joe is Happier to Keep the Discussion on The Ukraine Deal...So The Media can Bring it up and He Immeditely Can SCHIFFT that Ball Back onto Donald Trump..Yup..No Joe Quid Pro Quo..Just Business as Usual...

Well...I have been Looking at the China Deal..All done with and Through Communist Chinese Front Corporations...All Military...and The BANK OF CHINA..

So these Clever Wise Guy American and Chinese Partners fixed up a way to set up an Cross Border Private Equity Fund...through Hunter Biden and Chris Heinz..called BOHAI HARVEST RSTPartners..and signed the Deal on November 2013...Then the Bank of China in the Meantime..gathered up One to Two Billion dollars...so that Hunter and BOHAI Harvest could start buying what ever their Chinese Partner...Avation Industry Corp of China..and Subsidiary of Chinese Aerospace and Defense Conglomerate....directed them to Purchase....And what did the Chinese Want to Purchase...A High Tech American Company called...Henniges Automotive..that Specislizes in Anti Vibration Technology and other technology that has all Type of Military ..A..Ship and Submarine and Aerospace,,,Applications..Not only that But Henniges Automotive...has its own Factorys..and Research Centers all over the United States...Mexico..South America...Africa..Europe..and Now Big Operations in China..23 Locations the Chinese can legally Use..and Hunters Company BOHAI Harvest..Ah..Those clever Minds...There is a BOHAI Harbor in China..Since its Deals with The Bidens..2013 to Now..The Chinese built a New Shipyard at BONAI Harbor that can Produce six Steath Submarines at a Time..You Can see the Sattelite views..must have new Anti Vibration Technology...Maybe in their Space and Aero Space..and Missle Areas Too...Oh and the Russians...They are rapidly building..Fast..Manuverable.. New Smaller..more Manuverable Stealths Submarines with Advance Propulsions Systems. ...Its Name...??BOREI...you can see the SATS on that one too..LBSHIC..
I think someone...somewhere could Sound The Bugle..Dust off an Old Battle Flag..Find Their Boots...Anyone..?

Fred

Jim,

Henniges is an automotive supplier. Senator Grassley's letter from August is four years to late, assuming there is an actual military equipment concern. Consolidation of ownership of the automotive industry supply base or it's disruption by China is a bigger threat. Grassley should have raised those concerns when Clinton was letting communist China into the WTO.

Jim Ticehurst

Fred...Henniges Automotive is a very High Tech Company that has world class expertise in many areas that can be Applied to Military Use..They are Leaders in the Process of Window/Glass Encapluation and Window Sealing..for example.As in Cockpits''and any other Military use..like the J20..or any other Purpose The Chinese Military can use..They now have access to ALL Henniges Technology..Contractors Technology..R and D..and The Chinese Spys and Military can go to any Factory world Wide..As Far as Senator Grassleys Finding..Investigation through the Finance Committee..and Treasury..about this Matter..It shows there was a Betrayal of United States national Security by President Obama and Vice President Biden...through another Loop Hole called CIFUS.".The Committee on Foreign Investment in the United States.."....which President Obamas Administration controlled....All Political. This is not a Minor Matter..It gave Communist China and its Military Access to American Technology they should never had gotten...What was the Obama/Biden Quid PRO QUO exchange for that Deal...? ts

English Outsider

Thanks. I looked up the essay you referred to.

My guess is that the Toynbeean style essay Glubb produces is only ostensibly concerned with the life cycles of civilisations. That's merely a peg upon which he hangs a sermon of his times. It's a sermon of prophetic insight -

"Men are interminably different, and
intellectual arguments rarely lead to
agreement. Thus public affairs drift from bad
to worse, amid an unceasing cacophony of
argument. But this constant dedication to
discussion seems to destroy the power of
action. Amid a Babel of talk, the ship drifts
on to the rocks."

He finds Parliament hard to take as well -

"Britain has been governed by an elected
parliament for many centuries. In former
years, however, the rival parties observed
many unwritten laws. Neither party wished
to eliminate the other. All the members
referred to one another as honourable
gentlemen. But such courtesies have now
lapsed. Booing, shouting and loud noises
have undermined the dignity of the House,
and angry exchanges are more frequent. "

Almost as if Glubb had been looking over one's shoulder at some of the recent Parliamentary antics on TV.  Then I look at the date of publication.  1977.

For some, especially in Glubb's milieu, that was a time of crisis. It was around the time retired Brigadiers were talking in corners of the need for a coup.  There were rumours of paratroopers being paraded in Aldershot and told they might be required to shoot civilians.  More rumours of the Queen Mother being asked to head the coup.  Not long before a British prime Minister had been suspected of being a Russian fellow traveller and fear of a Socialist takeover was still around.

All that was loose gossip that most of us only picked up far later, rumours few of which found their way into print. Soon afterwards in any case Mrs Thatcher came in. She beat up the miners to a degree that would have pleased the most savage of the Greek Colonels so such talk died away.  Why worry about the Red Peril when Mrs Thatcher was hell bent on suppressing Peasant Revolts wherever she could find them?

But there was that atmosphere of threat around in the late seventies and it was, I suspect, influenced by that atmosphere that Glubb wrote his essay.  And also, figuratively speaking, he was returning from arduous duty in Jordan to the childish decadence of the London scene of the '70's. It must have been like travelling from open countryside straight into a juvenile Sodom and Gomorrah.

He goes deeper. He is conscious of, always swerving back to it as he shapes his thesis, of a decline in integrity. Anyone who today watches a House Committee Hearing or a Bundestag debate, or our own Parliamentary debates, knows that little truth lies in the bottom of those wells and no point searching for it there. That catastrophic decline in our public life Glubb sensed back then and he would have watched its later progress with no surprise -

"Alternatively, there are ‘political’ schools of
history, slanted to discredit the actions of
our past leaders, in order to support modern
political movements. In all these cases,
history is not an attempt to ascertain the
truth, but a system of propaganda, devoted
to the furtherance of modern projects, or the
gratification of national vanity."

It's a fine essay.  I don't at all agree with his categorisations - I don't believe one can class the British Empire with the great civilisational empires of the past.  We all have our different Englands and in this essay Glubb's England is the England of lost Empire.  I see Empire as a superficial and transient phase in our history so for me that is a false England, though one can still feel the power of the myth.

For me that disables the argument of the essay. The peg's not stout enough. It's a fine essay for all that because Glubb was a fine and perceptive man.  And he saw truly the process of decay that was starting even then - a decay that not only left Glubb's England buried in the wreckage of history, but now bids fair to leave all our Englands buried too.

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