Is Obamacare making the mass abuse of ERs worse?

[Starlight]

I also don't know where you're getting this crap about supply and demand in American healthcare that you prattled on about in your first several paragraphs, but as the saying goes, that which is presented without evidence can be dismissed without evidence.

All right, let's go back to the movie theatre line analogy, because I think it works well and will help you understand the situation.

Currently, in America, you have lots and lots of people selling 'movie tickets' (ie healthcare). There are enough of them, that anyone who can afford it, can go to one of these people, immediately purchase their 'movie ticket' and go into the theatre. That's basically the current situation for non-urgent care - anyone who can afford it gets it immediately, whereas those who can't afford it don't get it (excluding medicaid and medicare for a moment).

Now, let's say that a new queue opened at the movie theatre. This would be a line for free tickets, but the employee would only give out 1 ticket per hour. For some people, the wait would be worth the gain, so they would go to that line instead of paying for the ticket like they would have previously. And it would encourage more people who otherwise wouldn't have seen a movie to come in off the street and go in that queue. That's what an extremely terrible public healthcare system would be like - in a sense it's still better than not having one because it adds an extra queue and doesn't detract from the existing system and gives people more freedom to choose which line they go in.

Now imagine that that free line moves faster, instead of issuing a ticket per hour, that line gives out one ticket per minute. As a result, a lot of people would stop buying the costly tickets, and would instead crowd into the 'free' line. More people would come in off the street and join the 'free' line. As a result the free line would get very very long, and some people would get bored of waiting and go back outside, while others would give up waiting in line and go and buy one of the more expensive tickets and go into the movie theatre.

So, depending on how fast the 'free' line gave out tickets to people in the queue, the number of people waiting in the free line would be a different length, and the number of people who give up waiting in line and duck out to pay for it themselves and go straight into the theatre would change. If the 'free' line was giving out free tickets at an extremely rapid pace, then nearly everyone would use this line, whereas if it was going slowly and the line was long, a high number of people would choose to pay for immediate entry. Basically, different political parties dial up or down the rate at which the free line is being processed, thereby affecting the wait-times in the free line and subsequently affecting the number of people who choose to pay for it themselves versus wait in the free line. In the UK and NZ, the free line is currently set to a speed that means about 90% of people choose to use the free line, while 10% of the people choose to pay to get into the theatre immediately.

America, by contrast, has effectively put a giant 'closed' sign across the free line, thus forcing people to buy tickets from the other lines. In a weird way, medicare and medicaid give some people the choice to use the free line. Unsurprisingly, medicare users seem to love it.

[Truthseeker]

Starlight, waiting to get "free" stuff or service is itself a cost.

[Cow Poke]

All right, let's go back to the movie theatre line analogy,

Movies aren't free, either. And, by the time you add the horribly overpriced popcorn and soft drink, it's like $50 or $60 a couple!

[Starlight]

only because you're clueless about how that works.

It appears to be an American term that distinguishes between taxes paid on an employee's salary by the employer, as compared to taxes paid on the employee's salary by the employee. I am slightly confused as to what Americans think they are gaining by distinguishing those two, or by even having employers paying tax on behalf of their employees which seems convoluted.

The term used here is simply "income tax". We have no payroll tax here. Our tax system is pretty simple, and the vast majority of people do not file tax returns as income tax is automatically deducted from their salaries at the correct rate without requiring any action on their part.

(It always confuses me when I see Americans talking about 'big government', because I see a huge distinction between "government providing a lot of free things for you" and "government interfering in your life and choices", and Americans often seem to confuse the two of those things. Our government here does a lot more for us than the US government does for Americans - eg provides free healthcare for everyone. But we seem to interact personally with out government a lot less than Americans seem to interact with theirs - eg I often see Americans whining about tax returns... most New Zealanders don't do tax returns. The average New Zealander would have no reason to ever personally directly interact with the government in the average year - they don't ever need to ring up any government department, fill out any government form, or anything like that - but instead the government is simply at work behind the scenes providing roads, water, hospitals, police etc that everyone just uses whenever they need it. So when I see Americans talk about "big government" I'm never quite sure what they're getting at. They seem to want less of the general services list (ie roads, water, hospitals, police etc) on the grounds that if the government does more of those things then it is somehow "cOnTroLLinG YoUr LiVeS!" in some sort of Orwellian way. Yet our government provides far more in that respect than America's does and is vastly less ominously present and interactive than the US government seems to be. When I think "government" I basically think "organization that exists to efficiently provide services for everyone", whereas it seems like that when Americans think "government" they basically think "giant inefficient and corrupt bureaucratic nightmare that is out to get me and steal my money".)

[Starlight]

Starlight, waiting to get "free" stuff or service is itself a cost.

If you're literally waiting in line for a movie ticket like in the analogy, then yes it's a waste of time. But in reality with healthcare if you're on a "waiting list" for a non-urgent operation in one month's time, then ideally there's no cost involved - there's no time wasted in that scenario because you're not actually physically waiting anywhere.

Obviously if the condition is impacting quality of life or ability to work, then yes, being on a waiting list starts to be a cost. Mum has pointed out to me more than once that one of the problems with the current way the system is set up here is that the social-security budget is separate to the healthcare budget, so the bean counters think they're "saving" money by slowing down the rate at which free healthcare is dished out, but the result of that is people who are unable to work due to waiting for operations and thus costing money out of the social security budget (as well as taxes that would have been collected on their wages had they been working), whereas if the budgets were combined the bean counters would realize that they could save money by turning the rate of free healthcare up to maximum and reducing waiting times to nearly zero. This is one of several reasons I think free healthcare should be being dispensed at a higher rate than it currently is in my country, and why I have some swearwords directed at the current right-wing government who has held the healthcare budget constant (thus cutting it at the rate of inflation).

[Cow Poke]

It appears to be an American term that distinguishes between taxes paid on an employee's salary by the employer, as compared to taxes paid on the employee's salary by the employee. I am slightly confused as to what Americans think they are gaining by distinguishing those two, or by even having employers paying tax on behalf of their employees which seems convoluted.

[Cow Poke]

(It always confuses me

This seems to be a constant state.

when I see Americans talking about 'big government', because I see a huge distinction between "government providing a lot of free things for you"...

Ummm... the government has no money. They simply take it from some of us and give to others. There is nothing free.

[Starlight]

I said that earlier ("any employer is going to account for it when they choose your salary anyway.")
And you responded by laughing. I'm confused as to why you laughed at me for making the exact same point that you say is important.

[Cow Poke]

I said that earlier ("any employer is going to account for it when they choose your salary anyway.")

Yes, and you're still wrong.

And you responded by laughing.

Yes, but I'm over it now.

I'm confused as to why you laughed at me for making the exact same point that you say is important.

Um..... I'm pointing out that an increase in payroll taxes causes a decrease in --- perhaps you'll grasp this term --- "take home pay".

The notion that you think that an employer just smiles and increases the employee's salary to offset the increase in payroll tax is laughable.

[Starlight]

Ummm... the government has no money.

Given they literally print the money, and define what even is money, they actually literally have as much money as they like.

They usually choose to source most of their money through taxes.

However there's totally no reason they actually need to do that. The government could equally have shares in a number of businesses and source all their activities through the dividends from the businesses they own. The New Zealand government owns quite a number of businesses (called State Owned Enterprises or SOEs) and gets decent income from them. Likewise the city I live in owns shares in the local airport, port and electricity companies and as a result the taxes it levies on local residents have historically been very very low because it gets a huge amount of income from its stock portfolio. The Norwegian government is famously ridiculously rich and bathing in cash and has a massive stock portfolio consisting of 1% of all stocks worldwide, on which it earns market returns each year. I understand this has created political issues in Norway along the lines of "well, we don't actually need to tax people to run the government. So why are we taxing people?"

So government is not inherently simply a redistribution of wealth, it's simply the case that most governments have been run that way. It's a choice on the part of everyone involved for them to run that way. I am personally in favor of governments having large stock portfolios and having a strong source of revenue from those.

They simply take it from some of us and give to others.

Obviously some of what most modern governments do is direct wealth redistribution. Literally they take from the rich and give to the poor like Robin Hood, to try and limit wealth inequality. But most of what most governments do is provide centralized services that benefit everyone. eg Police, army, roads, schools, clean water, sewerage treatment, ensuring clean air, courts, etc. When I think of government, I think primarily of all the services it provides to me and everyone else in society, and the fact that it does a bit of Robin Hood on the side is secondary, although I would personally like to see the amount of Robin Hood it does dialed up a bit as even though that would cost me personally financially I think it would be to the benefit of society in general.

[Starlight]

The notion that you think that an employer just smiles and increases the employee's salary to offset the increase in payroll tax is laughable.

Ah, there's your problem. I was saying they decrease the employee's salary to compensate for the taxes.

[Cow Poke]

Ah, there's your problem.

No, not my problem, Fred.

I was saying they decrease the employee's salary to compensate for the taxes.

No, here's what you said.... (bolding mine)

Yes, because "payroll tax" is not a term I'm familiar with, and having just googled it, the differences between it and an income tax seem minor and the whole notion of a payroll tax strikes me as pointless bureaucracy since any employer is going to account for it when they choose your salary anyway.

You didn't say "decrease", you simply said "account for it", which could give the impression that they'd somehow make up the difference. Perhaps the confusion came from your awkward way of wording the "choose your salary".

An employer hires a person at X salary --- the higher the payroll taxes go, the lower the take home pay ends up, with no other action needed by the employer.

[Abigail]

When I think of government, I think primarily of all the services it provides to me and everyone else in society, and the fact that it does a bit of Robin Hood on the side is secondary, although I would personally like to see the amount of Robin Hood it does dialed up a bit as even though that would cost me personally financially I think it would be to the benefit of society in general.

Nothing to stop you giving away your money. Put your money where your mouth is.

[Starlight]

Nothing to stop you giving away your money. Put your money where your mouth is.

What I was saying was essentially that I would like to see is the half-a-million poorest people in my country have more money, and the 100,000 richest people have less, because I think a society that was a bit more equal would overall be a better society (because the evidence suggests so). While I can help a handful of people by donating my own money, that is not going to be relevant with regard to affecting my society in general. To achieve results that affect the dynamics of society as a whole it needs to be done on a large scale.

[Joel]

I'm 62 years old and my entire health regimen is a baby aspirin every morning. That costs me about $17.32 a YEAR! And you want to DOUBLE my payroll tax and make me pay VAT taxes?

I imagine you would jump at the chance if what you got was all healthcare in the remainder of your life for free.

Let's suppose for a moment that, if offered the choice, I would consider it a good deal and would take the deal.
But if the same 'deal' is forced on me with the threat of physical force (e.g. prison), I would object on principle (and would be morally justified in fighting back in defense). Likewise I would object to forcing all my neighbors into the 'deal.'

If the deal is really as good as you think--if virtually everyone would voluntarily "jump at the chance" to take the deal, then you would be better off actually making the deal a voluntary offer, and to force nobody into it (including the taxes). And then all the objections to your system would vanish. The fact that you need to force everyone into the deal seriously undermines your argument that it's a good deal.

Likewise with all the other programs you favor. If they are really such great deals, then there's no reason to make them compulsory. Make them all voluntary. (In which case government would become superfluous.)

1. Everyone who can pay has the option of getting things done privately immediately. Adding a public healthcare system doesn't decrease your options, it increases them.

To reach that conclusion you are looking only at the one side of things, and ignoring the other side: the payment taken by force in the form of taxation. The latter certainly is a decrease in the person's options.

Consider your movie ticket analogy. Suppose you take $15 from someone named Alice (without Alice's consent) and then offer her a "free" movie ticket. You then proclaim that you have increased Alice's options, because now she has the option of accepting a "free" movie ticket, in addition to all the other options she has. But that's absurd. All you have done is to decrease Alice's options from (a) all the things she could have done with $15 to (b) accept a "free" movie ticket from you.

(And it does detract from the private system. It decreases Alice's ability to afford the private system. And has a 'crowding out' effect due to there being a competitor that gives tickets out for 'free'. Certainly all the Alice's will be more likely to accept your ticket than go to the 'private' line, but that would be zero evidence that any of them would choose the whole deal if given the choice.)

America, by contrast, has effectively put a giant 'closed' sign across the free line, thus forcing people to buy tickets from the other lines.

Because you look at only the one side of it, you come to such bizarre uses of the word "force". In your thinking, by not taking the $15 from Alice, you would be "forcing" her to decide for herself how her money should be spent.

(It always confuses me when I see Americans talking about 'big government', because I see a huge distinction between "government providing a lot of free things for you" and "government interfering in your life and choices",

Again, that's because you are ignoring that providing the 'free' ticket only decreases Alice's options from (a) all the things she could have done with $15 to (b) accept a "free" movie ticket from you. That decrease in Alice's options is the government "government interfering in [Alice's] life and choices".

They usually choose to source most of their money through taxes.

However there's totally no reason they actually need to do that. The government could equally have shares in a number of businesses and source all their activities through the dividends from the businesses they own.

But then why would a government need to be involved at all? Why wouldn't the people who want these activities to be done get together to purchase the shares in the businesses and use the dividends to fund those activities? It would all be voluntary, consensual human interaction, with no state involvement (which is inherently coercive).