Health Care Reform: Giving Virginia a “Wedgy”

The Virginia Institute for Public Policy has published a must-read analysis of the impact of proposed health care reform on Virginia. Far from bringing the cost of health care under control, as its advocates assert it will, “reform” based on President Barack Obama’s principles will drive medical price inflation 5.2% above what it otherwise would be by 2019. Higher medical costs will run up both federal and state spending, costing every man, woman and child in Virginia $4,176 in net present value.

The study, “The Prognosis for National Health Insurance: A Virginia Perspective,” is co-authored by Donna Arduin, a partner with Arduin, Laffer & Moore Econometrics. The Laffer in the firm is none other than Arthur Laffer, of “Laffer curve” fame.

Now, people can argue numbers all day long, so I recognize that those predisposed to support Obama’s plans will dispute the study’s numbers while those predisposed to criticize Obama will defend them. I won’t waste your time describing the methodology. What I thought interesting, though, was the explanation of why Obama’s version of health care is doomed to fail: It fundamentally misdiagnoses the problem.

The study contends that the grievous flaw in the American health care system is the “wedge” between consumers (patients) and suppliers of health care services. Medicare, Medicaid and private insurance are structured so that patients have been paying a steadily declining percentage of their health costs out of pocket over the past 40 years. When consumers don’t pay for their treatment, they don’t care what it costs. (Indeed, we have reached a point where most consumers don’t even know what their treatments cost.) When patients fail to apply consumer pressure on medical providers, all manner of inefficiencies enter the health care system.

On the consumer side of the market, the wedge diminishes consumers’ incentives to monitor costs; after all, consumers bear only a fraction of the costs from any additional health care service. On the supplier side, doctors and other medical providers receive no incentive to provide higher quality services for less cost. No positive benefit accrues to those who do so. … The [system] removes competition and patient feedback that drives innovation.

The Obama administration reverses the cause-and-effect relationship between the number of uninsured and the cost of health care. Obama suggests that the growing number of uninsured is pushing up the cost of health care, and that the way to curtail out-of-control spending is to make sure everyone has insurance. The causality, writes Arduin, actually runs the other way. Out-of-control health care costs (along with counter-productive government regulation) make medical insurance increasingly unaffordable for a growing number of Americans.

If you’re tired of hearing proponents of a bigger government role in health care blaming the failure of “free markets” for U.S. health care woes today, this study is well worth a read. There is no such thing as a “free market” in U.S. health care. In our bastardized system, a nominally private sector operates within a regulatory framework dictated by government. Increasing the wedge — transferring power and responsibility from patients and doctors to politicians and bureaucrats — will make the problem even worse.

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89 responses to “Health Care Reform: Giving Virginia a “Wedgy””

  1. Gooze Views Avatar
    Gooze Views

    Jim,
    You mean "Laffer" as in "trickle down" and "Supply side"?
    You've stacked the deck already.Boy can you pick 'em!
    PG

  2. Gooze Views Avatar
    Gooze Views

    Jim,
    Yipes! The "wedge" between consumers and providers means that consumers don't care what their health costs because they don't know what it costs.
    Well, No "s–t, Sherlock!
    Of course, they can't know what health care costs. COnsider this front page stopry from Sunday's Virginian-Pilot:

    By Carolyn Shapiro
    The Virginian-Pilot
    © September 20, 2009
    In June, Lisa McCarty's husband had a routine check-up with his doctor and received a bill for his services.

    For a basic office visit, Sentara Medical Group's internal medicine practice charged $104. But the pricing of health care is never that simple.

    Another section of the bill showed an "adjustment" of $24.47 by the insurance company. The amount paid to the doctor's office was actually $79.53, or 23.5 percent less than the doctor's charge.

    That $24.47 disappears. Neither insurance nor the McCartys pay it. The doctor doesn't collect it or write it off. It only existed on paper. As in much of health care, the cost is not really the cost.

    It's not like buying a pair of shoes at a store, where the tag on the sole shows shoppers the price they'll pay. Or taking a car in for repairs, when a mechanic tells a customer what is owed, even breaking it down between labor and parts.

    "I wouldn't have them come clean my carpets without asking how much it was," Lisa McCarty said.

    Peter Galuszka

  3. " Well, No "s–t, Sherlock!"

    well not only do we not know how much something costs but even if we cared.. what could we do about it?

    I have a government plan and folks it's ain't the gold plate that some think it is.

    I have a substantial outlay on some costs – and I have absolutely no way of controlling those costs.

    If I have to pay a co-pay, believe me, I'd go looking for the lower cost alternative if I could – but I can't.

    How many of you folks reading this can go out and 'shop' for the best quality at the lowest price?

    You can drive a better bargain getting a Camry than you can a
    Colonoscopy.

    the last time I went to the Doc, I complained about a recurring indigestion problem.

    He suggested a nuclear stress test.

    Now I already had the lesser version of the stress test with the ECG and the echowhatzit…and I was ashamed at how much that cost.

    So I asked him..how much it would cost and do you know what he said?

    He said: "what do you care, you've got insurance"?

    and folks that's not the first time.

    Okay.. so I'll cut to the chase.

    I've seen enough reports of how Obama's plan will fail…

    goody for them…

    sorry to say.. I see no plan B that the loyal opposition is marshaling behind.

    everyone has their own ideas and no one is signing on to anyone else's ideas.

    and this has been going on for how many years? 8, 12, 16?

    I'm ready for SOMETHING to happen even if it turns out to be a disaster because I don't see anything else any better on the horizon.

    Like I said.. I've got one of those famous Govmint plans and I'm afraid to go back to the Doctor right now for fear he'll order up one of those Nuke Stress Tests.

    You know the situation would be comical for many if it were not so truly sad….

    no where else in the civilized world – do we watch folks die from treatable illnesses like diabetes because it's not our fault that they don't have insurance.

    I'm disgusted with the opposition.

  4. "In our bastardized system, a nominally private sector operates within a regulatory framework dictated by government."

    I think you need to modify that to clarify that it's a bastardized system dictated by a government which is bought and paid for by the healtcare and insurance industry.

    All the big money healthcare corporations are doing is politicizing the process and then using their hired guns, in this case politicians or a state commissioner, to game the system to their advantage.

    You are 100% correct…we do not have a free market or competition in healthcare. That's because the providers don't want one!

    Take for example, VA's COPN (Certificate of Public Need) requirement;

    http://www.vdh.state.va.us/OLC/COPN/

    How is this type of regulation good for a free market?

    Hell, in Virginia you can't open a charity hospital near a for-profit hospital w/o a COPN….IT'S AGAINST THE LAW!

  5. I've already made my views about Obama and pretty much anything that he proposes evident. Like they say, if you think health care is expensive now, wait till it's 'free' via the government.

    That said, to Larry G, look it up, lots of folks in Canada and Britain die while they wait for an operation that they normally get in this country in less than a week. In these socialized countries people wait up to 18 weeks (or longer) for procedures like gall bladder surgery or to see a specialist for cancer

    "Marrion Barnes of London, Ontario was high on the priority list. Her primary physician found cancerous cells after running several tests, which catapulted her to the acute category. The quickest she could see an oncologist, by referral of her physician, was six weeks. Although she'd hoped to get in sooner, she felt fortunate not to wait as long as other patients she knew. "I was one of those lucky ones who got in pretty quick," she says."

    Yeah, that's what I want.

    The link to the story is

    http://www.iparentingcanada.com/articles/nutrition-and-health/the-waiting-game-2355/

  6. James A. Bacon Avatar
    James A. Bacon

    Peter, Yes, I mean Arthur Laffer as in "Mr. Supply Side Economics." I knew his involvement would be controversial, that's why I pointed it out. But that doesn't let you off the hook. Simply applying a label and sneering doesn't constitute an argument. Tell me why he's wrong.

    As for the V-P story, it reinforces my point. There is no price transparency in medical markets. Why would that be? Is that an inherent flaw in free-market economics — in which price transparency exists in every other industry — or might it have something to do with the omnipresence of government regulations and incentives?

    Larry, the reason you can't look for a lower-cost alternative is that there is no free market to offer any alternatives. Again, ask yourself, why is health care different than EVERY OTHER INDUSTRY! Is the reason that doctors and insurance companies are greedier than everyone else in the universe? Or perhaps because there's more government intrusion?

    RBV, I largely agree with you. Many of the regulations we have are due to the lobbying of various health care special interests. So, let's say we pass Obamacare. Will the special interests stop lobbying? When health care subsides into the background and the next story-du-jour dominates the attention of the media and the public, will the medical lobbies stop lobbying, or will they be working behind the scenes to stack the deck in their favor?

    If you answered, yes, the special interests work around the clock, 24/7, ask yourself why. Could it be because Congress and state legislatures have intruded in the health care marketplace where they have no friggin' business? Once an industry is politicized, I would suggest, it's very hard to de-politicize it.

  7. Accurate – what about this:

    " Sandra Giustina is a 61-year-old uninsured American. For three years she saved her money in hopes of affording heart surgery to correct her atrial fibrillation. "They [U.S. hospitals] told me it would be about $175,000, and there was just no way could I come up with that," Giustina said.

    So, with a little digging online, she found several high quality hospitals vying for her business, at a fraction of the U.S. cost. Within a month, she was on a plane from her home in Las Vegas, Nevada, to New Delhi, India. Surgeons at Max Hospital fixed her heart for "under $10,000 total, including travel."

    http://www.cnn.com/2009/HEALTH/03/27/india.medical.travel/index.html

    so is it better to be on a waiting list or no list?

    so we have folks dying because they can't even get that appointment and you point out folks who can get one but have to wait.

    we have folks over here that wait forever to get that appointment because they simply die without ever getting an appointment but we say this is a superior system to systems where they have to wait "too long".

    looks like to me that "too long" also applies to a lot of Americans, no?

  8. Anonymous Avatar

    The grievous flaw in the American health care system is the fact taht insurers can decline to insure your heart because of a pre-exixting foot condition, they can take back retroactively insurance they agreed to supply and which you have piad for, they can refuse to pay for promised coverage, and for th emost part it is only available if you are healthy enough and fortunate enough to have a job with a major employer.

    Other than that, I love my health care, when I can get it.

    There is not a lot of price elasticity in healthcare, even if I know what it costs, I'm probbly too sick to complain about that $10 aspirin, or the $15 urinal.

    Obama's health care plan is going to die a slow and painful death, along with a lot of Americans, and the GOP will be the grim reaper.

    RH

  9. re: " there is no free market to offer any alternatives. "

    agree… and all these folks like Accurate that are opposed to what Obama is offering.. their alternative to it is what?

    None. They defend the current status quo essentially.

    right?

    the last 10 years saw NO increase in salaries because all of it ALL OF IT was sucked up by health care costs.

    The next 10 years promises another doubling of those costs plus twice as many people who lose their insurance.

    yet.. we are so focused on opposing Obamas Plan that we have no alternative.

    and at the end of 4 years what will the folks who oppose changes right now do?

    They will blame Obama for not fixing the problem.

    Where are the "free market" alternatives that are coming from those opposed to Obama's plan?

    I've yet to see or hear a cogent alternative offered.

    The "Republican Alternative" is what?

    I don't think I've ever seen so many people standing around grousing about Obama who have virtually nothing to offer on their own as a better path and in fact, actually favor doing nothing… apparently because, simply stated – if hey really thought there was a problem – they'd have an alternate.

    a good number of us are apparently just fine without a competitive system..

  10. Anonymous Avatar

    "Canada, which has universal single-payer health insurance, is often criticized for waiting times for surgery that are longer than those in the United States. We compared waiting times for orthopedic consultations and knee-replacement surgery and patients' acceptance of them in the United States and in the province of Ontario, Canada.

    Results: The median waiting time for an initial orthopedic consultation was two weeks in the United States and four weeks in Ontario. The median waiting time for knee replacement after the operation had been planned was three weeks in the United States and eight weeks in Canada. In the United States, 95 percent of patients in the national sample considered their waiting time for surgery acceptable, as compared with 85.1 percent in Ontario. Overall satisfaction with surgery ("very or somewhat satisfied") was 85.3 percent for all U.S. respondents and 83.5 percent for Canadian respondents.

    Conclusions Waiting times for initial orthopedic consultation and for knee-replacement surgery were longer in Ontario than in the United States, but overall satisfaction with surgery was similar. "

    New England Journal of Medicine.

    RH

  11. Anonymous Avatar

    "Definitions
    A "waiting list" is a list that patients are enrolled in once they opt to pursue an elective
    procedure, assuming that they cannot get this procedure performed immediately. In Canada,
    waiting lists do NOT exist for emergency procedures. It is a myth that Canadians with serious,
    life-threatening illnesses are enrolled on a waiting list before they can receive life-saving
    therapies.

    "Waiting time" or “wait time” is more difficult to define. A common definition is the
    length of time between when a patient is enrolled on a waiting list and when the service is
    received [1]. However, different provinces and organizations define waiting times differently
    (e.g. time from seeing GP to treatment, time from seeing specialist to treatment, time from being
    enrolled on hospital waiting list to treatment, etc.). These differences can result in dramatically
    different measurements of waiting times. Waiting times are a part of every healthcare system;
    indeed, there are often significant waiting times for elective procedures in American hospitals as
    well. The difference between countries, of course, is the magnitude of the waiting time."

    Waiting Lists in Canada: Reality or Hype?
    American Medical Student Association
    Prepared by Kao-Ping Chua, AMSA Jack Rutledge Fellow 2005-2006

    Those who oppose the Canadian single-payer system, including
    the American health insurance industry, have long used long waiting lists as an argument against
    single-payer health insurance, citing anecdotal evidence, various surveys, and media reports.
    Despite this, an objective look at the issue reveals that the evidence for waiting lists is
    inconclusive. Indeed, while waiting lists certainly do exist for certain non-emergent
    procedures, it is not at all clear that the "waiting list crisis" that is so often talked about by
    the media and opponents of single payer actually exists.

    RH

  12. "So, let's say we pass Obamacare."

    Given all the amendments being added to the bill(s) it's hard to tell what we will end up with. I haven't jumped ship yet but my life vest is on.

    However, I really feel that the problem we have today with our "system" is much more insurance related than health care related.

    If I get sick I can get to a doctor and get treated….the ultimate question is what does it cost and who is paying for it?

    If your poor and broke it's the govn't. If your rich it's your insurance policy and your own money. If your a working stiff….well all you can do is cross your fingers and fight the good fight.

    It seems like the sole mission of most health insurance companies is to find ways to deny you care for a product that you have already paid for, particularly as your health gets worse….that's fundamentally wrong.

    But, look at it from an insurance companies point-of-view…how much should they pay for a certain procedure…how much is to much….who decides what it costs….how are the costs determined? I don't know the answer.

    I think at the end of the day everyone involved will need to give up something in order for everyone to gain.

    Patients will need to pay more out of pocket expenses.

    Health care professionals, including doctors, drug reps, hospital administrators etc., may need to accept the fact that they may not be able to buy that second home until after they are 40.

    Finally, insurance companies and health care providers may need to face the fact that competition is part of our economic system.

  13. Anonymous Avatar

    Let me put it this way, I know several foreign born expats living in the U.S.

    None of them has American health insurance. They pay for routine stuff out of pocket, but if they ever have a serious issue,their plan is to get on a plane back to Ireland or wherever, and "get on the list".

    The airplane flight is a lot cheaper and less hazardous then facing any substantive American health care costs.

    RH

  14. Anonymous Avatar

    "I don't think I've ever seen so many people standing around grousing about Obama who have virtually nothing to offer on their own as a better path and in fact, actually favor doing nothing"

    Yep, the party of NO is living up to its reputation big time on this one, and I suspect they will eventually pay dearly for it.

    The domographics and the facts of health are not in their favor.

    RH

  15. Anonymous Avatar

    No one has made any credible proposals to drive out costs from the provision of medical services. Of course that will gore an awful lot of oxen.

    The concept of government cutting costs is an oxymoron. Government is only good at increasing costs. So if the feds cannot reduce costs and its adds a lot more people to coverage and also subsidizes the costs for many others, tell me again how we have fixed anything?

    The idea that the insurance companies face competition seems just about as laughable.

    Laser eye surgery and other elective, non-insurance-covered medical procedures have seen prices drop because of competition, by doctors and by other uses for money. The concept would work elsewhere, except most people don't have the money to fund their own health care.

    It strikes me that reform requires some transfer of responsibility from insurance companies to individuals, a way to share risks so that individuals don't go broke, and either a whole lot fewer people working in health care (including plaintiffs' and health care lawyers) or reduced compensation.

    Does anything come close? Whose ox should be gored first?

    TMT

  16. Gooze Views Avatar
    Gooze Views

    Bacon,
    Your precious article from your usual stable of neocons seems to state that Americans demand care, cost be damned, because they don't know what it costs. Therein: the "wedge".
    The Pilot story shows that American's can't know what the real cost is. They are helpless to shop. There is no market (and this is non-socialized medical care). A one carrier system perhaps the government might change that. I know plenty of doctors who say they wish there WERE a more socialized system because at least they'd get paid without having to
    spend hours and tons of money fighting for-profit insurance companies over payments, whatever they are.
    SO what is your, and their, point, exactly?
    Also, regarding the rather tired arguments about how bad it is in Canada, ask yourself how bad it is in the U.S. where many people don't have medical insurance because they can't afford it?
    Regarding Laffer, it might be better if you went after some sensible economists rather than try to make a splash with people like this.

    Peter Galuszka

  17. I think there is a basic difference in the way that you and I view the government. You seem to have the mindset that the government is separate from us, but it shouldn't be that way, and has the responsibility of protecting us. The people of America make up the government, not some outside force.

    Top Health Stories

    Thanks for sharing this 🙂

  18. i don't think about obama's plain but honestly i enjoyed your blog..

  19. re: "the wait" is mostly a myth – more obfuscation from those that defend the status quo.

    For instance, if you look at cancer mortality – the true measure of whether or not wait times "hurt", Canada fares better than the US:

    http://en.wikipedia.org/wiki/Comparison_of_Canadian_and_American_health_care_systems

    and again.. why do we exclude the "wait times" for folks who don't have insurance in this country and only compare the folks who do have insurance?

    that kind of comparison seeks to evade the crux of the issue – that we have folks who cannot get affordable health care – no matter how long they "wait".

    and you cannot have a healthcare system that 'works' when the guy who has diabetes spends the last few months of his life in ER rooms with heroic and expensive efforts to save his devastated cardiovascular organ systems.

    In a word – it's DUMB.

    The insurance companies don't care. they put those costs right back on top of the premiums (that why they double) and they kick out even more folks to keep their profitability.

    Why anyone would defend this system is "better" – explains to me a lot of things about what some folks "think" in this country to start with.

    They don't think.

    They have the myth view of this country and how it does business and it just does not measure up to the realities.

    Having the "best health care system in the world" when we have substantial numbers of people who get last resort health care in the ER – that'sa joke – not something to be proud of.

    Having the "best healthcare" system in the world while we have our own people flying to India for healthcare is another joke.

    What we have is "the best healthcare system in the world" for the folks who have it and if you have it and you are a conservative – then your attitude about the "problem" is dramatically different than those with less conservative attitudes.

    Those will less money in our country – would be among the FIRST to shop around and find the lower prices – if they COULD.

    Our health care system is designed and operated like a lottery.

    If you're lucky, you're covered.

    If you're not – too bad.

    It's a caste system.

  20. here's another thing I observe.

    When we do talk about wait times, the opposition INVARIABLY will bring up anecdotal examples not a definitive study.

    the studies do not support the assertion that we have lower wait times at all.

    "How does the United States compare with other countries on patient-reported access problems, continuity of care, and waiting times?"

    here is the truth:

    " In a 2005 survey of sicker patients conducted in six developed countries, the United States ranked last on four measures of continuity of care and access problems reported by patients. The U.S. patients reported relatively longer waiting times for doctor appointments when they were sick, but relatively shorter waiting times to be seen at the emergency department, see a specialist, and have elective surgery."

    "The U.S. ranked last among these six nations on four measures of access and continuity of care. Specifically:

    U.S. patients were less likely than patients in the other five countries to have a regular doctor (84% v. 92%–97%). Among those with a regular doctor, U.S. patients were less likely to have continuity with the same doctor for five years or more (50% v. 61%–78%).
    U.S. patients were more likely than patients in the other five countries to report not filling a prescription, not visiting a doctor when sick, and/or not getting a test or follow-up care recommended by a doctor because of cost in the past two years (51% v. 13%–38%).
    U.S. patients were more likely than patients in four other countries (except Australia) to report that it was very difficult to get care on nights, weekends, or holidays without going to the emergency department (39% v. 11%–29%) (Schoen et al. 2005)"

    http://tinyurl.com/y92qnmd

    and this is true even with people who do have insurance in this country.

    but none of this matters to the folks who are adamant that the govmint not "do health care" – despite the fact that the GOVMINT runs the freaking ERs (requires everyone to be seen) , the SCHIP program for kids, medicaid and medicare, tricare for the military, and VA care for the veterans.

    If we did not have these programs, we'd have kids, elderly, veterans and soldiers dependents without health care.

    the most ironic thing about this mess is that many of the folks who ARE ON Government Plans oppose govt healthcare for others…

    that's bizarre..

    to see folks who are obviously old enough to be on Medicare – out parading around with signs and shouting in Town Halls saying "No Obamacare" is just how crazy things have gotten.

  21. I could leave lots of links to the alternatives that the republicans have put forth, but you're as able to look it up on google as I am.

    Let's talk about the problems with health care and some solutions (if possible).

    1) Heath care is not portable (in most cases). If you lose your job typically you lose your insurance. If you've been buying your own insurance then there is the distinct probability that you will drop your insurance because without a job you can't afford to pay the premiums. I don't really see Obama's plan dealing with the lose your job, can't pay for health insurance (government plan or otherwise) problem.

    2) States mandate all sorts of extras to plans that employers offer. In Oregon if an employer wants to offer a health care plan it must include pre-natal care. It must include 'the pill' and Viagra. Stupid with a capital S, I'm way past having kids why should my premiums be driven up to help cover those costs that I won't/will never use? If I want Viagra I should pay for it myself or have the option of adding it to my health insurance, not having it forced on me. Obama's bill doesn't really address this problem of state mandates. Maybe there should be a base line of insurance that all states have to have and any person, any insurance company can come in and offer that basic package. If people wish to buy options, they could – this would bring the free market back into the picture.

    3) Tort reform. If this isn't addressed in a real way then this whole thing has been an exercise in stupidity and futility. In Texas they did pass a form of tort reform and Texas has more doctors locating to the state than are leaving the state (the opposite is true in Oklahoma).

    4) Illegal aliens. My hope is that what I'm hearing ISN'T what is about to happen. Rumor has it that after the health reform passes, that Obama will make all illegal aliens suddenly legal (or some spin that amounts to that). Thereby getting around his "no illegal aliens will be covered" promise. No, instead we should allow medical coverage at the hospitals like we do, but you need to show you are a citizen. If you are not a citizen you are treated and immediately (as soon as medically allowed) deported back to your country of origin – afterall, don't all those 'other' countries already have that free health care for all their citizens?

    Finally, for all those who point to people who fly out of this country to get medical care else where; there are many, many people who come here for medical care. In some provinces in Canada private care clinics are springing up … because there is a need. In England, private hospitals are doing fine, because the care in public ones is bad. How many foreign heads of state come to the USA to get treatment for some disease? The list is very, very long. How many heads of state go to … Europe or Canada to get treatment? The list is very, very short.

    There are alternatives to the health care bills that have been presented, but the democrats have been the true party of "NO" as in, 'No, we don't want to talk about it, we don't want to include your ideas in it.' That to me is the party of no. The new mantra seems to be, if you don't agree with us then shut up, oh and you're a racist.

    Thanks for listening.

  22. Gooze Views Avatar
    Gooze Views

    Accurate,
    There are rumors that Obama will make illegals legal. But a more likely and credible rumor says he'll push more of a "guest worker" concept. Whether that includes health care, I don't know.
    Peter Galuszka

  23. Anonymous Avatar

    "I could leave lots of links to the alternatives that the republicans have put forth,…."

    Well, then theyare doingan abysmal job of PR. Why should I have to google the GOPs suggestions on THE major piece of legislation this year?

    The only one that I know of is the sggestion for health care co-ops, which I think is a good idea. No reason why goups of farmers or small busnesses should not be able to buy insurance on te same basis as big business.

    On the other hand, why should it take legislation to make tht happen? If th einsurors wanted that, why couldn't they have offered it?

    I think this is a good idea, but of limited practical use, the adminsitrative and start up barriers are not trivial. If I wanted to start a health co-op for Fauquier farmers, I can see a lot of work just to contact these folks. for one thing, the landowners are usually not the farmers.

    Other than that, what have the Republicans suggested? Tear down the artificial state borders for buying insurance? Kiind of an odd position for th estates rights praty, no?

    RH

  24. Anonymous Avatar

    "I don't really see Obama's plan dealing with the lose your job, can't pay for health insurance (government plan or otherwise) problem."

    Universal government paid free health cae would do that. What is the GOP's plan?

    RH

  25. Anonymous Avatar

    "Tort reform. If this isn't addressed in a real way then this whole thing has been an exercise in stupidity and futility."

    I'll buy that tort reform is a rela issue. But studies have shown that this is a drop in the bucket in health care costs – one or two percent at most.

    It makes for a nice political argument, but the GOP cannot credibly propose this as a real finacial solution, and anyway the Dems have agreed to include this in the package.

    RH

  26. Anonymous Avatar

    "Rumor has it that after the health reform passes, that Obama will make all illegal aliens suddenly legal "

    Well, tht is just brilliant. Lets do NOTHING on all of health care, based on some (preposterous) rumor sabout what might happen.

    ——————————–

    Aside from that, more aliens may be a real solution to the social security propblem. We need them here, we need them working, we probably need a lot more of them. So, if they are a drag on the system and cost us a fortune, why not make them part of the system and pay their full tax load, like the rest of us?

    Where is the GOP plan to raise the billions it willtake to export all these people and keep them out? Small business is going to love the GOP if they actually pull that one off.

    I don;t see the GOP jumping up and down suggesting we actually enforce rules against businesses that hire illegals.

    RH

  27. Anonymous Avatar

    "…afterall, don't all those 'other' countries already have that free health care for all their citizens?"

    No. Only the developed and industrialized countries have that: you know, the ones that are smart and successful.

    Bad argumentation, we can do better than that.

    RH

  28. Anonymous Avatar

    "Stupid with a capital S, I'm way past having kids why should my premiums be driven up to help cover those costs that I won't/will never use? "

    That sentence is stupid with a capital S.

    I'm healthy, why should I buy any health care? I've never had an aut accident, why should I buy any insurance? I never use that road, why should I help pay for it?

    We need to learn to divorce social commentary from health care. We may not like, or need certain health services, but that doesn't mean they are not legitimate services for some people.

    You'd have to be a real prick to deny someone else his Viagra, even if it is one way to save money on the pill.

    Universal health care is going to have to mean universal service as wll as universal access. The GOP is raising the specter of death committes picking and choosing what services will be provided, and yet here you are doing exactly that: presiding over what services "should" be provided.

    RH

  29. Anonymous Avatar

    "U.S. patients were less likely to have continuity with the same doctor for five years or more (50% v. 61%–78%)."

    I don't think this is an indictment of health care, so musch as job security. those figures seem to pretty much match these.

    RH

  30. Blaming the Laffer Curve for much of anything is like blaming gravity for the fire bombing of Dresden. Without gravity – the bombs wouldn't have fallen, right? Blaming the man who articulated the Laffer Curver (he certainly didn't invent the concept) is like blaming Isaac Newton for the fire bombing of Dresden. Without Newton – gravity wouldn't have been "invented" and the bombs couldn't have fallen.

    Arthur Laffer might be a great economist or he might be a terrible economist. However, the curve which bears his name is a matter of accepted fact.

    "A simplified view of the theory is that tax revenues would be zero if tax rates were either 0% or 100%, and somewhere in between 0% and 100% is a tax rate which maximizes total revenue. Laffer's postulate was that the tax rate that maximizes revenue was at a much lower level than previously believed: so low that current tax rates were above the level where revenue is maximized.". Wikipedia.

    Please note the difference between the curve and Laffer's postulate. The curve is a matter of fact, his postulate is a matter of opinion. I would be happy to hear the Obama Administration's specific estimate of where, along the curve, revenue is maximized. We could then call that point "Barry's Law" or the "Geitner Quotient". Either way – it would be a matter of opinion about a curve which is observably true.

  31. Anonymous Avatar

    "In some provinces in Canada private care clinics are springing up …"

    It was my understanding that private care is illegal in Canada: they view it as non-egalitarian, a way for the wealthy to jump thw queue. Inthe UK however, that is not true, it is legal to go buy services privately.

    This helps keep the governemtn sytem on its toes, just as it is proposed a government insurance option would keep private insurance on its toes.

    RH

  32. I have been in Spain all week. Since health care is a matter of great debate in the United States it was a frequent topic of conversation here in Spain. All of the Spainards with whom I spoke loved their government-run health care system. Many had lived in the US at one time or another. All of those people felt that the US system was clearly inferior to the US system. All of the people with whom I spoke are employed and relatively affluent. All of them are in relatively high tax brackets. While the trans-national economics of health care remain hazy at best, the Spainards with whom I spoke generally acknowledged that they are probably paying more in health care related taxes (and, in some cases, supplamental insurance premiums) than they would pay if employed in the United States. However, they are in full agreement that the product they receive is of far higher quality than the helath care in the US. In two cases, the Spanish folks had received medical treatment in the US (directly or for one of their family members) while living in the US. In both cases the health care process in the US was a shambles compared to what they get in Spain. While the medical treatment itself was perceived to be first-rate, the process was considered laughable. It was convoluted, confused and inefficient.

    I am a fiscal conservative and have little regard for government-run businesses. However, facts are facts. The modern Spanish medical system was created by statute in 1986. It seems that government – run health care is working well in Spain.

    As a final note I'd ask the anti-Obama health plan crowd a question:

    If I held a pistol to your head and told you that I'd only let you live if you found a pilot in the top 10% of all pilots – where would you go? I'd call the US Air Force. While there are many good pilots employed outside of the US government those employed by the US military are high quality men and women. What would make the same structure impossible with regard to doctors?

    I leave for England tomorrow. I'll be there most of next week. I'll try to find time to provide "up front and personal" coverage of the English health care system – directly from real Englishmen and Englishwomen.

    On a final note – the Spanish seem to have a much more positive view of their government officials than the view held by most Americans. While they know that certain politicians are corrupt they do not believe that there is a systematic failure of their government to properly represent the people. They do not believe that the government, as a whole, has been coopted by special interests. I believe that the special interests in the United States have corrupted all levels of government to the point that reasonable proposals, such as more government involvement in health care, are dismissed "out of hand" by many Americans. The people who quickly dismiss these proposals are not dim witted, they are not racists. They just don't trust our government. Sad to say – I generally count myself among that group.

  33. Anonymous Avatar

    People who fly out to get health care are those who get it free at home, or go someplace much cheaper than here.

    Of those from other countries who leave home for care, some of them come here, and many more go to places that are cheaper than here.

    Just because some people come here for care is no indication that our health care sytem doesn't need a total overhaul – including whatever useful (as opposed to obstructive) suggestions the GOP come up with.

    RH

  34. Anonymous Avatar

    "Arthur Laffer might be a great economist or he might be a terrible economist. However, the curve which bears his name is a matter of accepted fact."

    I don't think there is any disagreement about that. what we do not know, however, is the SHAPe of the curve.

    It is usually represented as a bell curve, such that taxes above 50% result in decreasing revenue to the government.

    Cosnservatives see it as steeply skewed to the left: I have heard some claim that any taxes above 8% lead to decreasing revenues for government.

    The best evidence we have is that it is slightly skewed to the right: really high tax rates, like above 60% do in fact result in lower revenues to government, not to mention the people.

    RH

  35. Anonymous Avatar

    " Either way – it would be a matter of opinion about a curve which is observably true."

    Not really, we can create a curve relating total tax bills among various nations with their GDP per capita.

    Such a curve does not support Laffer's postulate. Somewhere i have a paper that shows how Laffers curve is a natural result of and can be derived from the usual supply and demand curves or cost benefit curves.

    Under that derivation, part of the shape of the curve is the result of the relative value (or rate of return) on labor and capital.

    Therefore, the shape of the curve is not fixed, but depends on varying economic conditions.

    RH

  36. Anonymous Avatar

    Good notes on Spanish health care. I think there is a lot of scare mongering going on, using fabricated facts that are difficult for most Americans to check, but easy to believe.

    Nice to have one data point of direct observation.

    RH

  37. Gooze Views Avatar
    Gooze Views

    Groveton,
    How come you get to do all the traveling and why don't you take us with you?

    Peter Galuszka

  38. Anonymous Avatar

    First, we found "Anon RH's" points on health care useful and positive.

    Now if he would just apply that level of understanding to settlement patterns.

    Second, health care is a governemnt (Dr. Risse would say Agency) responsibility (health, safety and welfare). Government has done a terrible job of seeing to it that there is a functional system.

    To yap about health care being 'a private sector responsibility' or that the private sector (Enterprise) can provide a fair and equitable healt care system is to fair to understand why Enterprises exist.

    Perhaps this is a fourth area in need of Fundamental Transforamtion if society in the US of A is to achieve a sustainable trajectory.

  39. life insurance broker Toronto Avatar
    life insurance broker Toronto

    Hello. Being Canadian I would like to clarify some points. It is true that we have to wait a few weeks longer for a surgery, but not in the case of emergency. Besides that there is a 100% insurance coverage in Canada while more than 15% of the American population is not covered at all. While the US spend more than 15% of their GDP on health insurance, in Cadana it is not more than 10%!

    Wishing all the best,

    Lorne

  40. Laffer first famously drew "his" curve on a napkin in a 1974 meeting with Cheney, Rumsfeld, et al. Laffer was trying to explain his opoosition to a tax HIKE being pushed by REPUBLICAN President Gerald R. Ford. It is based on consistent thinking from a 14th century Arab philosopher to John Keynes.

    "Somewhere i have a paper that shows how Laffers curve is a natural result of and can be derived from the usual supply and demand curves or cost benefit curves.".

    I think it's a bit more like the Economic Order Quantity curves but you're on the right track. It's an idea so simple that it has to be true – there is a diminishing return (in revenue to the government) of increasing taxation. The easiest way to understand the curve is to think about the endpoints. At a 0% tax rate there is, by definition, no government revenue from taxes. At a 100% tax rate nobody would voluntarily work so there is (again) no revenue for the government. In between there is a trade – off. Laffer's drawing on a napkin simply defined what should have been obvious to Cheney, Rumsfeld, et al. It's unclear to me whether the neo-cons (emphasis on the con) really mis-understood Laffer or thought "his" curve represented good anti-tax hike propoganda. Either way, poor Arthur Laffer became a hero or a goat depending on your viewpoint. Let this be a lesson to you – be careful what you write on a napkin when in the presence of idealogues. In fairness, Laffer really did think taxes were to ohigh but he never claimed a mathmatical proof of that opinion.

    Here is what REPUBLICAN David Stockman wrote in his book, The Triumph of Politics:

    "[T]he whole California gang had taken [the Laffer curve] literally (and primitively). The way they talked, they seemed to expect that once the supply-side tax cut was in effect, additional revenue would start to fall, manna-like, from the heavens. Since January, I had been explaining that there is no literal Laffer curve.".

    Bingo, baby!

  41. Anonymous Avatar

    "First, we found "Anon RH's" points on health care useful and positive.

    Now if he would just apply that level of understanding to settlement patterns."

    Thank you. The logic I use is the same.

    1) Is this statement factually true, partially true, or is it distorted either statistically or emotionally.

    2) Does it make any difference?

    3) Supposing it does make a difference, is the cost to repair higher than the cost of damage.

    4) Assuming the cost of repair is worth the effort, is the effort shared equitably, or is someone being stolen from?

    I don't think we are actually all that far apart as to what we believe about functional settlemtn patterns, but I think you fail miserably and cosistently in tests one through four.

    If you insist on supporting some position with a statement that sounds like "Every right thinking American knows that cows only fly in heaven" well, you position isn;t getting any support from me. not only tht, but I figure if that is the best you can do, the rest of your argument must be truly awful.

    I don't have any particular problem with what I think it is you are trying to say abut settlemnt patterns, but you can never sell it to me the way you go about it.

    I don't think you can sell it to any rational person that way. fortunately for you, most people don't fit that description. For them, any old diatribe will work as well as another. And, you can easily recognize them because they all pick up on the same unthinking catch phrases, as if repetition was the same as truth.

    I also think there is a kind of Laffer curve as to the shape of functional development, and we disagree on the shape. Ten persons per acre may be fine for some forms of habitation, but it takes a lot more than that to support those people, and under present rules, they are not paying anything like what their true social costs are.

    And like the Laffer curve, that shape is going to change with different economic conditions, like energy costs. If we are going to attempt to design a functional settlement pattern then we had best design it to be as flexible as possible and follow the least rigid rules.

    That means giving people maximum freedom, and one way to accomplish that is to make it a LOT easier and a LOT cheaper to transfer ownership of homes and property. We made it a lot easier for employers to transfer, eliminate, or replace jobs, but then we didn't follow up on the georaphic considerations that such freedom for employers implied.

    RH

  42. Gooze:

    Travel was exciting when I was in my 20s. I can still remember my first trip to London thinking, "this is great".

    It was still interesting when I was in my 30s. I started going to Asia and thought, "this is fascinating".

    By my 40s I was more subdued in my enthusiasm. I started getting to developing countries. I began thinking much more seriously about economics.

    Now I am in my 50s. My old body just doesn't take the hits so easily anymore. I don't think so much about the beautiful places where I travel (like Spain). Instead, I sit in my hotel room reading and writing blog entries about Virginia (in advance of a typically late stating Spanish dinner). Sometimes you have to go a long way away before you really know what home means.

    Aside from that – I have trips scheduled to Australia and India over the next two months (in addition to a lot of domestic travel). Let's go to India. You'll love the Vindaloo. It's the only (properly prepared) dish I have ever ordered that was too spicy for me to eat (at least the first time). Turns out it was the crazy Portugese who dreamed it up (they colonized Goa). Indians, being invererate "spice heads", couldn't find anything too spicy so they took to the dish like ducks to water. Now, the dish is theirs. I have learned to love it too. However, it can only be eaten along with gallons of ice cold Kingfisher beer. And ice cold Kingfisher is ALMOST as good as ice cold Pabst Blue Ribbon. But there's no PBR is Spain so I'll have to "slum it" with a couple of San Miguels.

  43. Anonymous Avatar

    "…we have to wait a few weeks longer for a surgery, but not in the case of emergency. "

    Thank you Lorne, for verifying the reports I posted above.

    Unfortunately, the GOP is going to continue to make claims that are verifiably untrue, and they are going to destroy whatever other credibility they have in the process.

    RH

  44. Anonymous Avatar

    What's with the misuse of the term "neo con." Neo Cons are former liberals, who support the active use of American military and economic power in the world. Many (but certainly not all) of these people are still quite comfortable with the modern welfare state, as opposed to more traditional conservatives, many (but certainly not all) oppose big government.

    We need to be careful or we'll descend to the level of some of the clowns who blog at the Post.

    Moving on, I think Groveton's point about "lack of trust" in the government explains a lot of the opposition to some of the health care bills meandering through Congress. I also think that the seeds for such distrust have been sown and nurtured by both Parties.

    TMT

  45. Anonymous Avatar

    In between there is a trade off.
    Yes, the Neo-Cons seem to have forgotten that revenue goes up on one side of the curve and down on the other. They seem to think it is always down.

    RH

  46. BACON!?!

    GOOZE!?!

    Creigh Deeds all but guaranteed that he'd raise taxes for transportation (in writing in the Washington Post) and you guys don't mention it?

    Holy Smoke!

    http://www.washingtonpost.com/wp-dyn/content/article/2009/09/22/AR2009092202643.html

    I say "good for Crazy Creigh". Maybe the guy is better than I thought. At least he's starting to hit the real issues in a meaningful way.

    I want to be on the blue ribbon transportation commission if Deeds is elected. I'll work for free on the blue ribbon commission as long as they supply free blue ribbon beer. And you think Virginia has a deficit problem now…

  47. RH –

    You have not heard about the republican plans? Why? Because you get your information from the same place that failed to inform you that some of the canadian providences ARE allowing private health care clinics? Did you know that the Supreme Court (in Canada) found that the Quebec provincial ban on private health insurance was unconstitutional?

    Here is a link to the story:
    http://www.nytimes.com/2006/02/28/international/americas/28canada.html

    You said, "You'd have to be a real prick to deny someone else his Viagra, even if it is one way to save money on the pill."

    I didn't say I wanted to deny him his pill, I just don't want to pay for it. Where do we stop? Do we allow breast augmentation to be included? If not, why not? Breast augmentation is not necessary to lead a healthy life, neither is Viagra. Do we allow sex change operations? Sorry, it was you who made the not-so-smart argument out of this one.

    You said, "Universal government paid free health cae would do that." (taking care of health insurance if you lose your job). Funny, all the bills that I've seen have the 'people' paying for insurance either to the government or an insurance company. I have yet to see one that says you will just be walking in, free and clear and get what you need/want. No, the bills in congress don't take care of that problem, they just FORCE you to pay for something (pay or get fined) no matter if you can afford it or not.

    (end of part one)

  48. (part two)

    You said, "I'll buy that tort reform is a rela issue. But studies have shown that this is a drop in the bucket in health care costs – one or two percent at most." Interesting that you didn't site any evidence backing up your assertion. However, I counter with the fact that tort claims add to a doctor's costs not only in the malpractice insurance that he is forced to carry but in the additional, expensive tests that he feels he has to carry out so that if he is sued he has done his best to CYA. No, it's not a drop in the bucket and MUST be dealt with.

    Regarding other countries with health care, you said – "No. Only the developed and industrialized countries have that: you know, the ones that are smart and successful." Hmmm, seems Mexico does have universal health care, do you consider Mexico to be "smart and successful"? Personally I don't – oh, it also seems that while there is universal public care, there are also private care for those who can afford it AND there is a special system for government workers. Gee, if it's a good universal system why the disparancy? Oh, and a link

    http://en.wikipedia.org/wiki/Health_care_in_Mexico

    To all those who commented that emergency surgery in Canada has no waiting time; please note I never said it did. Also please note, it doesn't in the USA either. However, I did have gall bladder surgery many years ago. At the time it wasn't life threatening, although had it burst it would have been. In Canada, since it wasn't life threatening, I would have been put on a waiting list (and the pain is something to behold); in the USA I had surgery the next day.

    The illegal alien problem is just that … a problem. It is a problem that none of the presidents have had the guts to deal with; and I don't think of granting amnesty as dealing with the problem. Yes they are and will be a problem for the social security system, we don't need them to help compound our health care costs.

    The federal government has done an absolutely crap-tas-tic job on entities that it has overtaken. Post Office only survives on subsidies. Amtrak only survives on subsidies. 99% of the time if something is running poorly it runs even worse and costs more when the government takes it over. We see what the government has done with the money 'set aside' for social security and medicare; they are both forecast to be insolvent within 12 years or less. So with those kinds of track records we want to put this big pot of money called health care in front of them?? I'll pass on that, thank you.

    Yes, our health care system can use an overhaul. My ideas were far from perfect, but even they were better than what the democrats have come up with.

    Oh, and because you (RH) apparently don't see or hear media beyond MSM and left wing blogs here are some links to the various republican plans that have been put forth and summarily rejected by the democrats.

    http://www.gop.gov/solutions/healthcare

    http://www.washingtonexaminer.com/politics/Democrats-stifle-Republican-health-care-plans-8224780-58644807.html

  49. "You'd have to be a real prick to deny someone else his Viagra…".

    Priceless.

  50. "You'd have to be a real prick to deny someone else his Viagra…"

    Yes, I would like a bumper sticker, please!

  51. Anonymous Avatar

    Groveton – you've haven't been spending enough time on the road lately or you've been talking with the business clowns in Fairfax County way too much. Neither Deeds nor McDonnell can fix transportation in VA.

    There isn't enough money in the state to fix it because we need to fix out-of-control real estate development first. And both guys have been spotted in the State Church on the Sabbath.

    For example, take a look at Fairfax County's Strawman II for Tysons Corner. It includes a laundry list of road improvements that would be needed to let Tysons Corner grow, but no where near what the landowners want. And a couple of good sources suggest that today's costs for building those road and bridges would be somewhere in the area of $2 billion. That's nine zeros.

    So spend all of these billions, plus the billions more for Dulles Rail and eliminate all free parking at Tysons and build to just 84 million square feet — less than 20 million square feet larger than Tysons is today and experience transportation failure. All of the major roads and highways around Tysons become literally gridlocked. Traffic cannot move. Now that's a fine return to the taxpayers! And the landowners want to grow by as much as 175 million square feet — not just 20 million!

    This is just like burning billions of tax dollars. It's not fixing or even improving transportation. It's putting someone else's money into the collection basket.

    That's the big example, but toss in every other development project around the state. What will they cost? And what will actually get better?

    The only chance we have to ever make improvements in transportation, with or without tax and fee increase, is to stop giving property rights in dirt more value and privilege than other property rights. I don't think either candidate will even propose disestablishment of the State Church.

    Taxpayers should be given tangible assurance that any increased revenues for transportation will actually provide measurable and lasting (over some reasonable period of time) improvement in safety or reduction in travel time before they pay any more.

    Again, it's all about trust.

    TMT

  52. here is what is amusing to me.

    If we did not have Medicare – what would happen to our families?

    How would you take care of your parents if they could not get insurance?

    I think we are hypocrites.

    Our moral compass seems to be that if you are 65 or older you deserve health care but if you are younger than 65 and have a pre-existing condition or lose your job – you don't.

    Here's the bad thing about Medicare.

    Because it exists, it allows many of us to pretend that health care is not a problem that deserves the govt involvement.

  53. TMT:

    I've seen a lot of worthwhile road construction projects in my neck of the woods. Gallows Rd, Rt 28, the Mixing Bowl, Wilson Bridge. I just don't buy the belief that expanding the roads is impossible or futile.

    I agree with your position on Adequate Public Facilities. I agree that the large landowners hold too much sway over local government. I even agree with the Bacon – Risse alliance on human settlement patterns. I just don't think you can stop growing while you reset society. And I definitely feel a NIMBY breeze blowing through the anti-Tyson's rhetoric sometimes.

    The Commonwealth of Vorginia spends about $34B per year. If it were a company it would rank around #70 on the Fortune 500 – ahead of DuPont, Northrup Grumman and American Express. About the same size as Cisco Systems. The idea that Virginia can't afford billions per year in road construction is just wrong. The companies at its peer level spend billions and billions every year on the facilities necessary for growth.

  54. Anonymous Avatar

    There isn't enough money in the state to fix it (transportation) because we have been sitting on our hands since 1987.

    RH

  55. Anonymous Avatar

    Interesting that you didn't site any evidence backing up your assertion. However, I counter with "the fact that tort claims add to a doctor's costs not only in the malpractice insurance that he is forced to carry but in the additional, expensive tests that he feels he has to carry out so that if he is sued he has done his best to CYA. No, it's not a drop in the bucket and MUST be dealt with."

    I'll try to follow up with the studies. The one or two percent includes the extra costs for defensive medicine.

    It is still a lot of money, but fixing the medical system cannot rely on also fixing the court sytem first.

    RH

  56. Anonymous Avatar

    Route 28 is a success because it didn't follow the usual formula. Fairfax and Loudoun Counties went to the commercial landowners and asked them whether they wanted to pay 80% of the costs for upgrading the Route 28. They knew what they were getting (including protection against downzoning) and what it would cost them. They have profited and transportation on Route 78 is better and getting even better.

    Contrast Tysons. According to Fairfax County's traffic study, just to get to build beyond today's 45 million square feet, the following improvements need to be made:

    1) Neighborhood bus routes; circulator bus routes serving Metrorail stations; express bus routes on I-66 and I-95/I-495

    2) Sidewalks to provide connections to developments within walking distance of rail stations

    3) Widen Rt 7 to 8 lanes from the Dulles Toll Road (DTR) to I-495

    4)Widen I-495 from 8 to 12 lanes to provide 4 HOT lanes between the
    Springfield Interchange and the American Legion Bridge (in process today)

    5) HOT ramp connecting to Jones Branch Drive (will happen)

    6) HOT ramp connecting to the Westpark Bridge (will happen)

    7) Application of aggressive TDM measures (whatever that means).

    Where does the money come from? Should taxes/fees be increased to pay all or part of these costs? How about applying the Route 28 model?

    Next I'll turn to what is required to move to 60 million square feet.

    TMT

  57. Anonymous Avatar

    Now to move to 60 million square feet, Fairfax County transportation staff say the following must occur.

    1) Completion of Metrorail Line from Wiehle Avenue to West of
    Dulles Airport with three stations in Fairfax County (in progress_

    2) Further improvements to neighborhood bus routes; circulator bus
    routes serving Metrorail stations; express bus routes on I-66 and I-
    95/I-495

    3) Sections of the grid of streets

    4) Ramp connecting Greensboro Dr. extension to westbound DTR

    5) Collector – distributor roads along the Dulles Toll Road from
    Greensboro Drive extension to Hunter Mill Rd. (There is not sufficient right of way to build those lanes. Take a look at a Google or Yahoo map of the DTR. What will be needed for right-of-way. Pay special attention to Wolf Trap Park.)

    6) Ramp connecting Jones Branch Drive to Scotts Crossing Road

    7) Application of aggressive TDM measures

    Same questions. 84 million next.

    TMT

  58. Anonymous Avatar

    Last one. In order to get to 84 million square feet, the following must occur.

    1) Further improvements to neighborhood bus routes; circulator bus routes serving Metrorail stations; BRT routes on I-66 and I-95/I-495

    2) Substantial sections of the grid of streets

    3) Widen Rte 7 from 4 -6 lanes between 495 & City of Falls Church

    4) Widen International Dr. from 4-6 lanes between VA 123 and Rte 7

    5) Widen VA 123 from 4-6 lanes between Rte 7 & Old Courthouse Rd

    6) Improve and enhance the safety of Old Courthouse Road from the
    Town of Vienna to Gosnell Road

    7) Widen Gallows Road from 4-6 lanes from Rt 7 to I-495

    8) Widen Magarity Rd. from 2-4 lanes from Great Falls St. to Rte 7

    9) Widen VA 123 to 8 lanes from Rte 7 to 495

    10) Widen Spring Hill Rd to 4 lanes from International Dr to Rte 7 (in progress)

    11) Extend Greensboro Dr from Spring Hill Rd to Rte 7

    12) Extend Boone Blvd to Northern Neck Dr

    13) Widen/Improve Kennedy Dr from Rte 7 to Old Meadow Rd

    14) Widen/Improve Holly Ridge Dr from Rte 7 to Old Meadow Rd

    15) Interchange Improvements Rte 7 at the Dulles Toll Road

    16) 495 crossing connecting Tysons Corner Center area to Old Meadow
    (limited to transit, pedestrians and bicyclists)

    17) Ramps connecting Boone Blvd. extension to westbound DTR &
    eastbound DTR to Boone Blvd. extension

    18) Ramps connecting Jones Branch Dr to westbound DTR & eastbound
    DTR to Jones Branch Dr

    19) Widen 495 (Outer Loop) between Rte 7 & I-66 by one lane (Again look at a map, where is the right-of-way for this additional lane beyond the HOT lanes?)

    20) Application of aggressive TDM measures (whatever that means)

    And when this is all built and Tysons hits 84 million square feet all of the roadways fail during busy hours.

    Same questions. And how about the rest of the state? This isn't NIMBYism, this is rational thought.

    TMT

  59. "Route 28 is a success because it didn't follow the usual formula. Fairfax and Loudoun Counties went to the commercial landowners and asked them whether they wanted to pay 80% of the costs for upgrading the Route 28. They knew what they were getting (including protection against downzoning) and what it would cost them. They have profited and transportation on Route 78 is better and getting even better.".

    I agree with that.

    "And when this is all built and Tysons hits 84 million square feet all of the roadways fail during busy hours.".

    I am not so sure of that. There have been alot of generalized arguments about this (Tyson's doesn't have grid streets, "edge cities never improve" etc). However, I have yet to see a specific traffic model that demonstrates that the planned expansion won't work.

    How many dollars (per year) of additional taxes are generated by another 40 million sq ft of office space? You have to count the real estate for the offices, the addition income taxes for the added job holders, the additional sales taxes, the "ripple effect" of the new job holders needing doctors, wanting hamburgers, etc.

    This is why I sense NIMBYism – each and every plan is fatally flawed. The only answer is …

    "And how about the rest of the state?".

    That's pure Nimby – Talk, no?

  60. Anonymous Avatar

    suppose we give the GOP a blank check on co-ops and tort reform.

    How many votes would that get us?

    I sugget it would get you zero votes, which suggests that those issues are straw men.

    On the other hand, if you put up a bill tht says there are to be no changes in health care except tort reform, you would get every GOP vote but one – Snow form Maine.

    There are what 458 amendments to the Senate bill? Wouldn't that suggest that maybe we just need to start over, and consider real changes?

    RH

  61. Anonymous Avatar

    Tysons (and the rest of Vienna) doesn't have grid streets primarily because of geographic features like stream beds that are off limits.

    Each of th emain quadrants of Tysons is relatively grid like, but not too long ago I waited over a half hour to make a right turn out of a side street.

    When the main light was green, there was no getting out, and when it turned red traffic immediately backed up past ths side street, so nowhere to go unless someone took pity on you.

    Pity is in short supply during Tysons rush hour.

    I think they have done a good job on Rte 28: inspite of majore new office buildings, traffic flows BETTER there than it did fifteen years ago.

    It is still congested, but not AS congested and more people can get where they are going.

    But I don;t see ANY similarity between that and Tysons. Rte 28 may have as much office space as proposed for Tysons, but it has what, 10 or 20 times the total area towork with?

    Otherwise, I agree with your observation that there will be a lot of benefits that are being totally discounted by the NIMBY's.

    And why shouldn;t they, since THEY recieve almost none of them?

    That's why I think development rights should be distributed amonst all citizens, and then let developers buy them. If the NIMBYs don;t want to sell theirs, well no one is forcing them too, and it just makes the price higher for those that will sell.

    Put money on the table and THEN see what the NIMBY's have to say. right now they get to holer NO, an no cost, but if they say yes, they get no benefit. What other result can you expect from them, under those conditions?

    RH

  62. "And why shouldn;t they, since THEY recieve almost none of them?".

    Why did Pat Tillman walk away from a $3.5M NFL contract to volunteer for the Army?

    I see a lot of greed in America. Oddly, the corporations get most of the grief. But corporations are supposed to be greedy. That's free enterprise. And government is supposed to regulate and tax corporations. I think the real problem isn't the fact that there are too mant greedy corporations – it's that there are too many greedy citizens.

    1. People who want to use federal tax money to turn Rt 15 into a permanent barrier to development in western Loudoun County. They don't care whether people have jobs. They already made their millions. Everybody else can just go pound sand. Nothing but greed.

    2. People who don't want electrical lines to go through their county. The lines may be unsightly but they are not a health risk. These people just don't want to see their views harmed. Nothing but greed.

    3. People who don't want to pay any more gas tax despite the fact that the cost of road construction and maintenance has risen while the gas tax (in cents per gallon) has not. For over 20 years. They say things like "we should implement user pays" but that never seems to apply to their own streets and roads. Pure greed.

    4. People who reject every plan for economic development. They have lots of excuses but, in the end, they just don't want to put their lifestyle at risk for the sake of more jobs for the people who need them. They've got theirs – everybody else can go pound salt. Greed.

    5. People who think they should get all of the entitlements ever discussed by the clown-show in Congress whether it costs our kids and grandchildren their futures. They pretend that these entitlements are somehow enshrined in the US Constitution as rights rather than just being the products of an incompetent president named Roosevelt. Greed, nothing but greed.

    This country is dying on the back of the greed of its citizens.

  63. but Groveton.. I though "greed" was a good thing and the basic essence of entrepreneurship and corporate excellence?

    Would you not call the top 20 businesses in the U.S. as "greedy"?

    I think "greed" is one of those bomb-throwing words…in some respects…

    for instance, are our health care problems due to the "greed" of those for-profit insurance companies or to the "greed" of those with pre-existing conditions who feel entitled to insurance?

    or "greed" is the bonuses executives of the banks that would have gone belly up without govt bailouts while "greed" is also the bailouts for the auto companies union members?

    "greed" is another one of those sound-bite concepts that rile up many of those who are too lazy to understand more about what is going on…

    present-company excepted of course…

  64. Anonymous Avatar

    Greed (also called avarice) in psychology is an excessive desire to acquire or possess more than what one needs or deserves, especially with respect to material wealth.

    —————————-

    Which leaves us with the problem of what to do when someone actually earns and deserves great wealth, despite that it is far more than he needs.

    ——————————-

    Greed is the excessive or rapacious desire and pursuit of money, wealth, power. It is generally considered a vice, and is one of the seven deadly sins in Catholicism.

    ——————————-

    "Buddhists believe greed is based on incorrectly- connecting material wealth with happiness. This is caused by a view that exaggerates the positive aspects of an object; that is, acquiring material objects has less impact than we imagine on our feelings of happiness. This view has been corroborated by studies in the field of happiness economics, which confirm that beyond the provision of a basic level of material comfort, more wealth does not increase happiness."

    That's easy for those of us without great wealth to say.

    ——————————–

    RH

  65. Anonymous Avatar

    Our 20 year-old son, a college sophomore, asked tonight at dinner why the Republican Party kept "spiraling down" into more lies and actions that damaged the public interest. My husband suggested "greed" and a desire to maintain power at all costs. I said that they were too short-sighted to recognize that they were among those who would be injured by the policies that such deceptions were meant to advance.

    The bottom line, however, is that our son, who is really still a kid, could readily see that the Republicans denied reality, and that, whether based on lies or self-delusions, their positions were delf-defeating and destructive; i.e., that rational people wouldn't act in such a manner. Moreover, neither I nor my husband could do more than guess as why seemingly intelligent people (we leave out Beck and Limbaugh) would indulge in such behavior.

    So that's the Republican Party: sinking their own boat, and ours, for reasons that nobody can figure out. Meanwhile, the ice melts, the atmosphere becomes more toxic, and people die due to lack of health care.

    Maybe they're all just nuts?

  66. Anonymous Avatar

    9:14. Did you explain to your son how the U.S. government works? The Democratic Party controls the Senate, House and presidency. With the last minute rule change in Massachusetts, the Party again has a filabuster-proof majority in the Senate.

    So how are the Republicans stopping health care reform? That is just a foolish statement.

    Health insurance reform is a complicated subject. Many good Democrats in Congress don't believe that what has been proposed will do more good than harm.

    Perhaps, you should tell your son that you really don't understand much about American government or what is going on with health care reform.

  67. " Moreover, neither I nor my husband could do more than guess as why seemingly intelligent people (we leave out Beck and Limbaugh) would indulge in such behavior."

    " So how are the Republicans stopping health care reform? That is just a foolish statement."

    How about they killed it under Clinton then spent the next 8 years doing absolutely nothing about it when they could have and instead passed Part D as a taxpayer giveaway to the pharmaceuticals by forbidding the govt to do exactly what the VA is allowed to do.

    The Republican party has become infested with ideologues and folks like Limbaugh, Beck and Hannity and even folks that used to be perceived as intelligent – like Chuck Grassley and Orin Hatch have gone off the deep end.

    The Republicans have had 16 years and 8 months to do something besides fear mongering and obfuscation… and the truth is that even those normally clueless about these things are starting to notice also.

    I don't think this really needs to be "explained" to anyone – it's pretty obvious to even the normally clueless what is going on.

  68. Anonymous Avatar

    "Many good Democrats in Congress don't believe that what has been proposed will do more good than harm. "

    And According to Groveton, those good Democrats might learn a lot from the Spaniards, who have actually tried such a system.

    Perhaps Anon 9:41 can share with us what changes he thinks might do more good than harm.

    RH

  69. Anonymous Avatar

    "In the United States today, we give you all the care you can afford, whether or not you need it, as opposed to all the care you need, whether or not you can afford it."

    From a WAPO article

  70. MEDICARE has had the effect of sidetracking meaningful debate on health care because we would be having a very different conversation if most of us were also struggling with the fact that our parents could not get medical insurance.

    I wonder how many people – if confronted with trying to get insurance not only for themselves and their children – but also their parents might have a different view of the govt being involved?

    Medicare Part D is the perfect example of how the govt could have helped people instead of the pharmaceutical company profits by using the same rules that the VA and TRICARE and all other industrialized countries do.

    And instead, we made Medicare Part D work the same way that most private sector insurance works – and the result is that we pay twice as much for drugs and medical care as the rest of the industrialized world pays.

  71. Anonymous Avatar

    " the govt could have helped people instead of the pharmaceutical company profits by using the same rules that the VA and TRICARE and all other industrialized countries do."

    Exactly. at one time, when I was uninsued and I was taking some very expensive medication, I actually calculated that I could fly to switzerland, ski for two weeks, and come home with a yers worth of medicine, and do it cheaper than I could buy the medicine here.

    RH

  72. Anonymous Avatar

    Anon 9:41's sparkling suggestions for useful and constructive changes are an eerie echo of the deafening silence coming from the GOP on this subject.

    RH

  73. Anonymous Avatar

    Two 15-8 votes in the Senate Finance Committee to kill government option. Looks to me as if there are Democrats who don't like what's on the table. But Larry will think that is somehow the GOP's fault.

  74. Anonymous Avatar

    The Sept. 23 front-page article “For French, U.S. Health Debate Hard to Imagine” cited the longer life expectancy of the French compared with Americans as an indicator of superior health-care quality.

    Broad population metrics, such as life expectancy, are affected by behavior. Our lower life expectancy is not attributable to poor U.S. health care. It stems from the higher U.S. rate of homicides and the death rate from transportation accidents.

    In their book “The Business of Health,” Robert Ohsfeldt and John Schneider explain that the U.S. homicide rate of 7.3 per 100,000 population is eight times the rate in France. The U.S. death rate from transportation accidents is also higher than in other countries. When life expectancy data are adjusted for differences in homicide and transportation death rates, U.S. life expectancy is slightly higher than for all other countries.

    U.S. health-care expenditures per capita are much higher than in France, but that spending results in access to high-quality care and the latest medical advances. In terms of quality indicators, such as five-year age-adjusted survival rates for almost all cancers, the United States has significantly higher survival rates than France.

    KEN McLENNAN

    Williamsburg

    Quoted fromantoher blog

    RH

  75. Anonymous Avatar

    "But Larry will think that is somehow the GOP's fault."

    So do I.

    A few people vigourously howling and wailing at public meetings and loudly repeating patent falshoods have poisoned the diet of rational argument.

    RH

  76. Anonymous Avatar

    Now it's OK for Democrats to run scare campaigns on Medicare & Social Security, election after election. But it's wrong for Republicans to do it.
    9:41

  77. " U.S. health-care expenditures per capita are much higher than in France, but that spending results in access to high-quality care and the latest medical advances."

    this is simply not true. The health care of the other industrialized countries is equal to or better than the typical health care that most in this country receive.

    what you're talking about is the health care that people of "means" can buy "up to" and that's true worldwide.

    If you have money and don't want to wait – whether you are in the USA or France -you can go buy better/faster health care.

    The difference is in France, if you are even at the lower end of the economic scale – you get basic care – which can save your life even if you have to wait – and in this country – you don't get the care – period and you essentially wait while you die.

    you folks who think our health care is superior are living in the same dream world that you exist in for other realities that you cannot seem to accept – so you build your own little world of the things you want to believe…

    " In terms of quality indicators, such as five-year age-adjusted survival rates for almost all cancers, the United States has significantly higher survival rates than France."

    the ultimate quality indicator is life expectancy for the population…

    so yes.. perhaps someone who actually has expensive health care in this country might live longer by paying a whole lot more money – but they still die of cancer….

    In exchange for paying for heroic efforts to extend life for days, or weeks – we choose to let others not have access to insurance at all – and we let them die without even basic care.

    That's what is wrong with this debate.

    We have the "haves" bragging about how good their health care is – and as a country – they don't count the folks that don't have even basic health care – as part of the statistics.

    It's really a selfish and self-centered way to think about something as basic and fundamental as access to basic health care.

    Absolutely no one is saying that in a universal care system that you could not buy your way up to faster/better care.

    People make this choice in all the other industrialized countries and you will always have that choice if you make more money and want to spend more.

    What this is about is a basic safety net similar to the way that Medicare works.

    If you are on Medicare – you can ALWAYS buy your way to better/faster care if you want to but the reason Medicare exists in the first place is to provide basic health care at an affordable price to everyone and my bet is that many of the sanctimonious are secretly glad that their parents are on Medicare and are not the financial responsibility of the sons & daughters – who are out parading around chanting stupid stuff about the keeping the govt's hands off of their health care.

    and isn't it a proud moment when the gray-haired folks with their single-payer public option guaranteed health care spout off in these town hall meetings about "giving" free health care to what amounts to their own sons and daughters…

    really good stuff.

  78. Democratic "scare tactics".

    ha ha ha ha bahahahaha…

    yes.. this is what passes these days as "discourse"

    The Republicans run a fear machine for months and when the Dems try to deal with some of the lies and misinformation -they, then get accused of doing the same tactics that the Republicans are using..

    that's rich.

  79. Anonymous Avatar
    Anonymous

    "Taxpayers should be given tangible assurance that any increased revenues for transportation will actually provide measurable and lasting (over some reasonable period of time) improvement in safety or reduction in travel time before they pay any more. "

    Does a reduction in therate of increase of travel time count? That is all you are likely to get, according to the Texas Transportation Studies. It seems to me that you are setting an impossible success goal, for the purpose of preventing what it is you don't want anyway.

    It is an eqully unbelievable position as that taken by a builder who says "my little development won't have any impact."

    Improvements will do some good, and developments wil ldo some bad, now lets put real numbers in the blank spaces.

    RH

  80. Anonymous Avatar
    Anonymous

    Ray, there are many small projects, fixing bad intersections, adding to turn lanes, etc. that every county and city in VA could do that would make tangible improvements in travel time or improve safety. But there is nothing in these projects that would help some land speculator.

    If the land speculator wants a big new road, let him use the Route 28 model. Everyone agrees its been a big success.

    But sooner or later, we come back to Til Hazel's infamous statement: "I build things; taxpayers are here to pay for the infrastructure necessary to support what I build."

    I don't accept that approach, and neither do many others.

    TMT

  81. Anonymous Avatar
    Anonymous

    "Now it's OK for Democrats to run scare campaigns on Medicare & Social Security, election after election. But it's wrong for Republicans to do it.
    9:41"

    The Dem's scare campaign is that the GOP would eliminate these benefits if they could, which is probably true, at least given the rhetoric.

    The GOP's scare campaign is that this will turn into a giant government run helath program that people will have to pay for, which is also true, at least the pay for part.

    How giant it becomes is an issue. Republicans claim 88 million will sign up (for omething they allegedly don't want), and the Dems claim only 11 million will sign up, because the GOP is right, most people are happy with their health care.

    This is beyond crazy on the part of both parties. Neither party is focused on the result, and only whether their view prevails, and they retain power.

    If this keeps up, both parties will expire as a result of pre-exsting conditions.

    It isn't a question of whether it is right or wrong to run a scare campaign. It is a question of whether the numbers are real or not.

    If EITHER party is correct, then we OUGHT to be scared.

    RH

  82. Anonymous Avatar
    Anonymous

    "But there is nothing in these projects that would help some land speculator."

    Of course there is, it is only a question of degree.

    But the improvements also help other people, not speculators, but road users, and that is a question of degree also.

    Suppose that local government becomes responsible for road improvements. By dint of years of effort Fauquier has succeded in having substantial development jump over Fauquier to the next county west and south.

    What incentive has Fauquier got to fix roads in Warrenton that are jammed up as a result of commuters from Culpeper? (Especially those that might otherwise have preferred to live in Warrenton?)

    Yes, the route 28 model is a success, apparently. Are the developers paying 100% of what those improvements cost, or is it 90% or 80%. If it is 100% then they got suckered.

    What I'm arguing for is equal payment for equal value received AND equal protection for property owned. It is a hard thing to measure, but not impossible.

    RH

  83. Anonymous Avatar
    Anonymous

    "Because you get your information from the same place that failed to inform you that some of the canadian providences ARE allowing private health care clinics?"

    I don't claim to have all knowledge. The basic Canadian plan is a single provider plan. If some provinces are looking the other way aor are allowed to pass different rules, that is news to me.

    If they are moving to to a two arty sytem, good, more competition, just as Obama suggests.

    But my knowledge of Canadian politics does NOT come from the same sources as my knowledge or domestic politics. I watch the conservative news shows and I don; see them offering ANY constructive plans other than "anything other than what the dems want."

    Sorry, there may be something out there, but I have not seen it. I just got a robo-call from McDonnell, and the only thing it said was we would fight whatever the democrats wanted.

    Not a single suggestion of his own.
    All I can figure from that call is the man is a non-creative dimwit. My suggestion to him is to stop making such calls: he is losing more than he gains.

    You say I don't know what the republican plans are, but you don't point to any. I don't know what they are because I have not seen any except those I commented on. They are good ideas, but minor ones: GOP is not addressing the problem, as I see it, and you haven't told me where to look.

    ————————-

    RE Viagra, We difffer: I'm willing to pay for someone else's pill providing they pay for mine if I ever need it. The whole point is for everyone to be able to have the OPPORTUNITY to live the best life available. What we ae paying for here is the OPPORTUNITY to have our own needs met someday, not someone else's pill. Same with roads, we pay for roads so we will have the OPPORTUNITY for a road trip someday.

    That isn't the point I was making though. My point was that GOP was making big scare noises about someone else (death committees) making decisions about your health care, then it turns out that (some of them) think it is OK for other people to make decisions aobut your health care, provided they can put an ethical, social, or religious spin on it.

    I don't see the difference between what they are against and what they propose, in this case. If that is the argument, it is intellectually weak. At least the (present) insurance companies are honest enough to discrimiate on cost and not religion.

    Yours is not an argument against rationing health care: it is an argument on what basis.

    RH

  84. Anonymous Avatar
    Anonymous

    http://www.gop.gov/solutions/healthcare

    OK. I see six bullets, all of which are included in the present plan or easily could be.

    Preexisting conditions, portability, tort reform, Insurance across state lines (what happened to states rights), coops, incentives for wellness, and assistance to the really poor.

    Ok then, I'll sign up to ALL of those. What are we fighting about? The public option?

    Hey, wake up, it is an OPTION. You don't have to use it. You WON'T us it unless it turns out to be a much BETTER option than the private plans.

    THAT is what GOP is scared of. The Government MIGHT be able to do something better than their business cronies can, if they don't have to support outrageous profits (which I am happy to share in the form of my United Healthcare stock). Groveton's example of aircraft pilots applies well, I think: the best ones are government pilots, and I'm damn glad of it, myself.

    —————————

    There is one hooker in the five bullets. Incentives for wellness.

    The best incentive is that if you are well, young, and healthy, you don't have to buy insurance. And that is a big part of the problem we have now.

    The other part of the problem is that even if you buy insurance when you are young well and healthy, you may not have it when you need it, as my own experience shows.

    The only way this works is if it is universal, portable, affordable, and sufficient.

    RH

  85. Anonymous Avatar
    Anonymous

    A public option is an open invitation to become a black hole for tax dollars. Medicare is darn near broke and Congress still cannot make any reforms. A government funding program, once created, never stops consuming tax dollars — even when everyone agrees changes can and must be made.

    This is true with the military, social programs and everything else.

    I would not object to a public option that could not be backed by a single tax dollar beyond premium payments.

    TMT

  86. Would you mind viewing the following videos about the laffer curve? Care to comment for all to see on your blog? your opinion is greatly appreciated.

    http://www.freedomandprosperity.org/videos/laffercurve1-3/laffercurve1-3.shtml

  87. James A. Bacon Avatar
    James A. Bacon

    Orphe, I think there's a lot to be said for the Laffer Curve. It is a very useful tool for analyzing the impact of taxes on economic activity and government revenue. However, I believe it is widely misapplied.

    Many Republicans seem to believe that the Laffer Curve means that cutting taxes will yield more revenue *in all cases.* The Laffer Curve does not say that at all. The impact of tax cuts (or tax hikes) all depend where you are on the curve. It is totally consistent with Laffer's theory that in some cases cutting taxes also means losing tax revenue.

    A related point is that different taxes have different curves. Investors' willingness to take capital gains, for instance, is highly sensitive to tax rates because selling and asset and taking a gain is a discretionary act. If you don't want to pay the tax, don't sell the asset. The income tax is very different. People have no discretion about declaring their income. They do have some choice about how many hours they work, or whether both spouses work, or whether to retire earlier or later, so the tax rate does matter some. But it's still very different from capital gains.

    My sense is that we're close to the optimal point (from an income tax collection perspective) on the Laffer Curve. Raising taxes will encourage tax-avoiding behavior and put a crimp in tax collections. Likewise, cutting taxes will be counter-productive (from a tax-collection standpoint).

    Those are my observations as a non-economist.

  88. limo hire Avatar
    limo hire

    Public option is like a open invitation…..and that so important also.

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