Come Up with Three Specific Economic Policies

[ReaPsTA]

The problem with any political discussion is the lack of concrete policy ideas.  Especially in economics.  Saying "simplify the tax code" or "break up the big banks" sounds nice, but doesn't really mean anything.  The goal in this thread is to get people to submit three specific economic policies they would implement if they could.

1.  Fix the tax code

The only tax should be on income.  Nor business taxes or property taxes or gas taxes or whatever.  These taxes exist purely as a means to let the government profit from social engineering.  No tax deductions whatsoever. 

By doing this, Americans easily understand exactly how much they are paying in federal taxes every year.  By getting rid of business taxes, you lower the cost of transacting business in this country.

[Other stuff deleted because I'm not as smart as I think I am]

There is exactly one exception to this.

2.  Change Social Security into a Pension System

Something like this has been done before.

The biggest problem with social security is the constant influx and output of money.  Nothing has any value, which is why it will eventually go bankrupt.

The solution is simple.  It would still be mandatory to pay a retirement tax.  You could choose an amount somewhere between a minimum and a maximum.  That money would go into a personal retirement account run by a semi-private company whose sole job is to handle the public's retirement accounts.  The money would be put in low-risk (like, really low risk) accounts so it isn't lost to a stock crash.

Because of this, retirement would be completely self-funded and non-reliant on society to fund it, removing a major source of economic drain and uncertainty.  Unfortunately, I don't know how much the retirement tax amounts would be.  I'd guess the minimum tax should be 8%, and the maximum at 15% or 20%.  Anything higher and you should probably be looking at private options.

3.  Copyright reform

I still have no idea what to do about file sharing.  You can't make it illegal, because then entertainment companies would have no competition against which to price their products.  But you can't make it legal, because then entertainment companies wouldn't be able to sell their products at all.  But, we can start with a few ideas that definitely make sense:

 - Change copyright terms to 15 or 20 years.  Perpetual copyright is legalized insanity.
 - If you are the copyright holder of a product and you do not distribute the product yourself, then you have no legal authority to stop others from doing so.  I call this the "Song of the South" rule.  Either Disney puts out their own copy of the movie, or society can do it for them.  Once you release something, you shouldn't be able to unrelease it.
 - No more copyright math.  Let's say you sue somebody for file sharing 15 copies of a song.  If you sell the song on iTunes for one dollar a piece, you should only be able to ask for compensatory damages of 15 dollars plus legal fees.
 - If you can prove someone was selling pirated material for profit, you can ask for whatever punitive damages you want.  This practice should still be as illegal as humanly possible.
 - If you remix a song, you have created a new work of art that you can produce and sell for profit.  The Grey Album (a mash up of the White Album by the Beatles and the Black Album by Jay-Z, Listen to a track here) should be legal for DJ Dangermouse to profit from and produce.

That's all I've got.  What do you all have?

[rumborak]

Patent sytem
My policy suggestion would be to fix the patent system by adding two things:
- Demonstrable intent of commercialization. It can't be that there's companies whose sole purpose is to sue other companies that actually create products, only because they bought the patent on something
- Patents should be "losable", in that if a patent has become "obvious" (an actual legal term in patent law), it should no longer be enforcable.

Same-sex marriage
Also, stop marrying people through the government. Call it something else, and let churches do the marrying. That way same-sex couples can enjoy the benefits of other couples, and the government isn't in the business of issuing religiously tainted social contracts.

rumborak

[Riceball]

Does this have to be specific to the US? Sounds like fun (.......I went there) but my detailed knowledge of US economic policies is limited.

[Super Dude]

If I can just respond to the OP, I don't agree with most of the things you said, but I love what you've done with copyright law. I might increase the term to 25 years, but otherwise it sounds like an elegant solution to a complex issue.

[Scheavo]

1) Taxes - pretty much in agreement with OP. The only thing I don't exactly want to do is give an exact percentage for income tax, as I don't know how much revenue is necessary for the services the federal government needs to perform. (I'd probably go higher than you, also to pay off debt quicker)

2) Huge infrastructure investment. I'm talking rebuilding our roads, building high speed rails, expand fiber-optics and internet structure everywhere, solar power plants, new nuclear power plants, subsidize geo-thermal to greatly reduce our energy needs. Maybe some others one's I'm forgetting right now, but without doing this, anything else you do isn't going to do all that much for us right now.

3) Proper health care reform, including scrapping and redoing our food subsidization policies. We shouldn't be spending as much money on health care as we currently do, and one major reason we spend so much money is because too many people don't have preventive care. This makes the problems worse, which leads to emergency room visits, which makes it more expensive, and foots us with the bill anyways. Unless you want to say its acceptable to let someone die because they don't have money, universal health care via an expansive of medicare would make our economy more efficient.

[El Barto]

The question then is, how do you tax income?  It's easier to demonstrate than to explain.  Let's say someone makes 200,000 dollars in income during 2012.  This would mean:

$15,000 (first 15,000 you make) - Untaxed
$50,000 (the income you made between 15,000 and 65,000) - Taxed at 5%
$50,000 (income from 65,000 to 115,000) - Taxed at 10%
$85,000 (from 115,000 to 200,000) - Taxed at 15%

Overall, this person would pay $20,250 in taxes.

The problem with progressive taxation, as it currently works, is that it penalizes you for making money by increasing your overall tax rate, which is not fair.  This way, if you make 75,000 dollars in one year instead of 65,000, only the additional 10,000 is taxed more, and not the original 65,000.

It already works that way. 

[GuineaPig]

I don't know a lot about economics per se, but considering this thread is more like "come up with three policies which would have significant financial bearing upon its respective nation," I have a couple of suggestions.

1. Immediate freeze on building new electricity sources that are not renewable.  Target of ten years for phasing out all coal generation.

2. Stop the building or expansion of urban roads.  The only exception should be modification to include dedicated bike infrastructure, which should be made mandatory on every major roadway, ideally physically separated.  Further improvements to transport should come from better public transit.  Building rural roads, where necessary, is still OK.  Increase road tolls, reduce available parking in urban centres, and generally ramp up prices on driving-related activities in order to promote transit and densify urban cores.

3. Implement a carbon tax on industry.

[Super Dude]

I don't know a lot about economics per se, but considering this thread is more like "come up with three policies which would have significant financial bearing upon its respective nation," I have a couple of suggestions.

1. Immediate freeze on building new electricity sources that are not renewable.  Target of ten years for phasing out all coal generation.

2. Stop the building or expansion of urban roads.  The only exception should be modification to include dedicated bike infrastructure, which should be made mandatory on every major roadway, ideally physically separated.  Further improvements to transport should come from better public transit.  Building rural roads, where necessary, is still OK.  Increase road tolls, reduce available parking in urban centres, and generally ramp up prices on driving-related activities in order to promote transit and densify urban cores.

3. Implement a carbon tax on industry.

Your heart's in the right place but I doubt it'll work. The only thing approaching it is British Columbia, as far as I know.

[kirksnosehair]

I am not an economist so I can only talk about this in general conceptual terms, but here are some ideas that are important to me:

Leave Social Security Alone - it's been fine for 75 years and it's fully funded for until 2037 as it stands right now.  Do some minor adjustments need to be made?  Yeah, probably.  But don't do it on the backs of the middle class. 

Raise Taxes on the Rich - Simply put, Warren Buffet is right.  The rich should be paying a more equal share of their income to what the middle class currently pays.  It's absolutely ludicrous that a billionaire pays a smaller share of his overall income in taxes than his secretary who is earning .00000000001% of what he's earning.

Get Rid of Obama's Health Care Law - The Republicans eviscerated it, because they hate anything that resembles socialism.  Except already established socialism like Social Security and Medicare.   Even now they're trying to de-fund pieces of Obama's health care plan based on the fact that, you know, it's Obama's health care plan.  The way you fix this is just put everyone on Medicare.  Republicans will leave it alone because they won't have a choice if they want to survive as a party.  Just lower the eligibility age for Medicare, dump Obama care. Problem solved.  Is it perfect?  Nope.  But it won't be under constant attack, or at least, not as constant.

[Super Dude]

Nah, because over time the policy will age and people will get used to and dependent upon it, same as Medicare.

[kirksnosehair]

But the problem is, the policy sucks a mile of ass.    Republicans basically gutted it.  Medicare, with just a few tweaks, would be perfect.

[lordxizor]

1.  Fix the tax code

The only tax should be on income.  Nor business taxes or property taxes or gas taxes or whatever.

I would definitely fix and simplify the tax code, but I'd like to point out that local cities get basically all of their tax revenue from property taxes. Your code would mean all public expenditures would now need to be covered by your significantly reduced tax income. I assume you're meaning for governments to cut spending to the bone while they're at it, but this would likely be very extreme.

And I'll second El Barto in pointing out that the tax code already works in the way you described with the tiers. It's a common misconception that a person can get a raise, be bumped up a tax bracket, and actually bring home less money. it doesn't work that way.

For income tax, I would do something like this:
Everyone gets a standard deduction of $15,000. The remainder is taxed at a rate of 20% (or whatever rate is necessary, I obviously haven't done the math.) Phase out all other deductions over 5 years.

I would leave or increase the gas tax, with 100% of the revenue going to build, fix and maintain roads and fund public transportation. For electric vehicles and possibly hybrid, there would need to be an up front tax to cover the cost of maintaining the roads. This would be my strategy whenever possible, shift the tax burden to the people who are using the services it provides (essentially becoming a toll).

I'd also like to point out that the OP's Social Security reform would likely work moving forward, but what about those elderly folks who are currently drawing from SS? Do they just get screwed? There'd have to be a transition somehow.

I also agree with Rumborak's patent reform ideas. I would say the company has 50% of the length of the patent (or whatever is appropriate) to commercialize a product utilizing the patent or the patent will expire.

I would add health care reform as well. Not sure how it would get paid for, but I would do something like this:
1) Every adult gets one free wellness check annually, babies and toddlers get more.
2) Every person can have X regular doctor visits (or urgent care visits or ER) covered up to $200 each. Not sure what X should be. Likely just a couple.
3) Beyond that, everyone has a high deductible insurance plan for all other more major health issues. This will prevent people from racking up tens of thousands of dollars of medical expenses while keeping costs down since people will have to think twice about going to the doctor for every sniffle since they'll pay for it out of pocket. Employers would be encouraged to provide their employees with a flexible health spending account to cover the deductible instead of offering them insurance. Or private supplemntal insurance would be available to cover additional medical expenses.

[Chino]

1) If a US company has employees in other countries, the company pays taxes on those workers equal to what they would if the workers were American. The companies must also keep their funds in US banks.

2) Get a head start on improving infrastructure. It's going to be needed in 20 years (or less) anyway. Might as well put money in some people's pockets.

3) Mandate that every automobile created after 2025 must be able to run at least 150 miles without a drop of gasoline.

4) If you buy an appliance that is made in the US, you don't pay a sales tax on it... I think the taxes generated by operating in the US would far outway the tax lost on each sale. For example, that new television company, Element. If you buy a TV made by them, you should be out the door for whatever the sticker said and not a penny more (unless you buy a warranty or something)

5) Healthcare needs something. I don't know what, but it needs something. I think the biggest problem is that America turns to a pill for everything and has allowed the pharmacy busniess to get too big.

[rumborak]

3) Proper health care reform, including scrapping and redoing our food subsidization policies. We shouldn't be spending as much money on health care as we currently do, and one major reason we spend so much money is because too many people don't have preventive care.

Here's the rub: As a resident of Massachusetts the above statement is no longer true for me (I think), because we already have mandatory health insurance. Spreading it out on the federal level would, for me, most likely raise prices because it would reel in all the diabetic obese people in the Bible Belt. So, ever since MA got their new health care I've actually stopped pushing for Universal Healthcare. At this point my stance is, "you can do the same thing as in MA if you want; if you would be the major benefactor of universal healthcare and you still don't want it, then all the more power to you."

rumborak

[ReaPsTA]

The question then is, how do you tax income?  It's easier to demonstrate than to explain.  Let's say someone makes 200,000 dollars in income during 2012.  This would mean:

$15,000 (first 15,000 you make) - Untaxed
$50,000 (the income you made between 15,000 and 65,000) - Taxed at 5%
$50,000 (income from 65,000 to 115,000) - Taxed at 10%
$85,000 (from 115,000 to 200,000) - Taxed at 15%

Overall, this person would pay $20,250 in taxes.

The problem with progressive taxation, as it currently works, is that it penalizes you for making money by increasing your overall tax rate, which is not fair.  This way, if you make 75,000 dollars in one year instead of 65,000, only the additional 10,000 is taxed more, and not the original 65,000.

It already works that way.

I feel numb.

[Scheavo]

3) Proper health care reform, including scrapping and redoing our food subsidization policies. We shouldn't be spending as much money on health care as we currently do, and one major reason we spend so much money is because too many people don't have preventive care.

Here's the rub: As a resident of Massachusetts the above statement is no longer true for me (I think), because we already have mandatory health insurance. Spreading it out on the federal level would, for me, most likely raise prices because it would reel in all the diabetic obese people in the Bible Belt. So, ever since MA got their new health care I've actually stopped pushing for Universal Healthcare. At this point my stance is, "you can do the same thing as in MA if you want; if you would be the major benefactor of universal healthcare and you still don't want it, then all the more power to you."

rumborak

I believe the (I think) is wrong, but either way, isn't your mentality rather libertarian at this point?

Thing is, 17% is too much of our GDP going to health care. Even if you had to pay more out of pocket in taxes, technically, I'd be willing to bet that a healthier economy would mean a higher Consumer Purchasing Power for you, meaning you're better off.

[Cool Chris]

I feel numb.

I LOLed

Your thinking is in the right place. Though I’m also interested in something along the lines of taxes based on expenditures instead of income though I know that will never happen. 

3) Beyond that, everyone has a high deductible insurance plan for all other more major health issues. This will prevent people from racking up tens of thousands of dollars of medical expenses while keeping costs down since people will have to think twice about going to the doctor for every sniffle since they'll pay for it out of pocket. Employers would be encouraged to provide their employees with a flexible health spending account to cover the deductible instead of offering them insurance. Or private supplemntal insurance would be available to cover additional medical expenses.

Jesus Christ this. One of my wife’s assistants just went to the hospital because she stubbed her toe and thought she broke it.

2. Stop the building or expansion of urban roads.  The only exception should be modification to include dedicated bike infrastructure, which should be made mandatory on every major roadway, ideally physically separated.  Further improvements to transport should come from better public transit.  Building rural roads, where necessary, is still OK.  Increase road tolls, reduce available parking in urban centres, and generally ramp up prices on driving-related activities in order to promote transit and densify urban cores.

I read and respect many of your posts GP, but this one makes me shake my head. I agree with you on the public transportation angle and even tolls. But reduced (and costlier) parking in Seattle is hurting businesses as people don’t want to go to downtown any more. Bike lines on ‘every major roadway?”  Not practical at all.* And people don’t want urban cores more dense. They are already overly expensive and impractical for families. That’s why they move to the suburbs.

* Though I am all for a bike tab tax like there is for cars. If you want o ride your bike on the road, register it and pay for it, like the everyone else does.

Leave Social Security Alone[/b] - it's been fine for 75 years and it's fully funded for until 2037 as it stands right now. 

What about 2038? I’m planning on retiring around 2040 so that ‘fully funded till 2038’ argument doesn’t exactly make me feel warm and fuzzy inside. 

[lordxizor]

What about 2038? I’m planning on retiring around 2040 so that ‘fully funded till 2038’ argument doesn’t exactly make me feel warm and fuzzy inside. 

I actually wouldn't have a huge problem doing nothing either. We have 25+ years advance notice that SS will not be fully funded. All that means is that they will only be able to pay out what they bring in at that point. SS will not cease to exist, it will just pay out less. It's almost like it's phasing itself out. We all have plenty of time to save extra for retirement on our own. I'm not depending on any money from SS to help me out in retirement. If there's anything still available it will be a bonus on top of what I'm planning to provide for myself.

[GuineaPig]

2. Stop the building or expansion of urban roads.  The only exception should be modification to include dedicated bike infrastructure, which should be made mandatory on every major roadway, ideally physically separated.  Further improvements to transport should come from better public transit.  Building rural roads, where necessary, is still OK.  Increase road tolls, reduce available parking in urban centres, and generally ramp up prices on driving-related activities in order to promote transit and densify urban cores.

I read and respect many of your posts GP, but this one makes me shake my head. I agree with you on the public transportation angle and even tolls. But reduced (and costlier) parking in Seattle is hurting businesses as people don’t want to go to downtown any more. Bike lines on ‘every major roadway?”  Not practical at all.* And people don’t want urban cores more dense. They are already overly expensive and impractical for families. That’s why they move to the suburbs.

* Though I am all for a bike tab tax like there is for cars. If you want o ride your bike on the road, register it and pay for it, like the everyone else does.

Parking kills density, which kills walkability, which kills transit.  Lots of cities in the world have severe limitations on parking; for example, the most prosperous city in North America, Calgary.  Movement in urban cores should be conducted overwhelmingly by public transport or bikes. 

As for bike lanes along each major roadway, it's eminently possible.  Go to the Netherlands, or Switzerland, or Denmark, or Spain... every road has a bike lane.  Every large road has a bike lane physically separated for protection.  Every highway has a parallel route for bikes.  In large cities, 20-40% of commutes are done by bicycle.  It's the best individual method of local transportation, bar none.

[j]

3) Beyond that, everyone has a high deductible insurance plan for all other more major health issues. This will prevent people from racking up tens of thousands of dollars of medical expenses while keeping costs down since people will have to think twice about going to the doctor for every sniffle since they'll pay for it out of pocket. Employers would be encouraged to provide their employees with a flexible health spending account to cover the deductible instead of offering them insurance. Or private supplemntal insurance would be available to cover additional medical expenses.

Jesus Christ this. One of my wife’s assistants just went to the hospital because she stubbed her toe and thought she broke it.

My ER rotations were easily some of the most eye-opening in terms of being a huge facial dose of reality with regard to direct experience with some of the problems with health care in the US.  We are already providing "universal health care" through emergency rooms, it's just costing us a dickload more.  Statistically, less than 30% of ER patients pay their bills, and I shit you not, I'd estimate that less than 20% of the patients seen on a given day qualify as remotely "emergent" cases.  These doctors spend the vast majority of their shifts treating runny noses, sore throats, healthy but crying kids, <1 cm lacerations, minor bruises, anxiety, hypochondriacs, and other bullshit.

A few of the main problems I've gathered:

1) Privately funded ERs can turn patients away, but there is not much incentive to screen patients in triage.  Both the hospital and the doctors (assuming they're paid on a fee-for-service basis) make more money the more patients are seen.  Plenty of the docs I've worked with tell me that, contrary to what was historically true, they don't make most of their money seeing trauma or time-consuming sick patients who might require multiple procedures and significant workup.  Most of the money is made in the fast track part of their shifts, where they can see tons of not-sick patients rapidly.

2) Ignorance/lack of education is a massive, massive issue, definitely the primary one that is the most difficult to address.  I would estimate that 90% of the clientele these ERs see is made up of 4 types of patients.  Old (>70 y/o) sick people with long medical histories, drug-seekers or "chronic pain management" people, people with legitimate but non-emergent medical problems for which they should be seeing a specialist or primary care physician, and people who have nothing wrong with them (certainly nothing requiring emergent care).  Probably 2/3 of this last group consists of uneducated people--often poor--who either treat the ER like a free clinic (where this attitude comes from I'm not sure) or simply don't understand what constitutes a condition that might need medical attention.  It would do no good for these people to have access to "preventive care," because they would not use it or understand its value.  They do not know how to take care of themselves in the most fundamental ways at home, how can they be expected to take responsibility for another level of that?

3) Everyone is obese.

4) There is some new federal policy (I think it was a part of Obama care, but not certain) which now determines funding for hospitals in large part due to "patient satisfaction ratings."  Hospitals and other health care institutions hire these outside firms (Press Gainey is a big one) which send surveys to patients inquiring about their opinions regarding the care they received, and otherwise evaluate the physicians and other employees based on the way the patient feels about their stay.  I really can't begin to explain the problems this causes, but suffice it to say that the quality of medical care a patient receives is largely unrelated to their feelings about the visit, and they are sometimes in direct contradiction.  Doctors will order tests and medications that are not medically indicated and generally practice differently because they're worried about this stuff (they are likely to lose their jobs if their scores aren't high enough), and it does no good to the patient but adds to the costs they incur.  And that's just the tip of the iceberg.

5) Lots of middle men, insurance companies, billing companies, superfluous contract negotiators, and others skimming money off the top.

Sorry, I know this post is barely related to the topic, but I figured since it came up I'd share some of this crap.  I actually have some non-health care related policy ideas that I'll try to post after work later.

-J

[El Barto]

Good post, -J.  I typed up a bit of my suggested policies, which I'll post later, and they're also health care related.  It really doesn't matter who pays for healthcare if the product is so stupidly priced that nobody can afford it. 

[snapple]

1.) add incentive for companies to build/manufacture etc. in America. Hefty taxes if you choose to do production overseas, nice big breaks if you produce here.


I'll come back with more later.

[Cool Chris]

GP: Bike lanes may be feasible in theory and some areas, but at least in my area, they just are not. I take the bus to/from work and am all about public transport, but if I had to go solo to work, taking a bike would be ridiculous. It would take almost 2 hours each way, not accounting for getting rain dumped on my 70% of the year and time spent changing clothes. I know it is as much about mentality as it is about pragmatism, but there is no way we would get those levels of bike ridership here. It’s not a ‘if you build it, they will come’ type of situation.


Sorry for straying from topic. GP, I admire your passion about this subject but what works for one city won’t necessarily work for another. 

[rumborak]

I believe the (I think) is wrong, but either way, isn't your mentality rather libertarian at this point?

I wouldn't call it libertarian, because ideally, I would agree that universal healthcare is the solution. But when I see that the segment of the population that would benefit the most from that healthcare is the one that votes the most adamant against anything remotely resembling it, then I have to say it's not worth it.

rumborak

[Scheavo]

: J

Not much I really disagree with, but there's one assessment I think you're dead wrong on:

They do not know how to take care of themselves in the most fundamental ways at home, how can they be expected to take responsibility for another level of that?

With "preventive care," those people would have access to a primary care doctor. They would still cause issues for the system, but they wouldn't be clogging the ER rooms if they can go to a doctor they know, perhaps they trust, and whom they regularly see.

[GuineaPig]

GP: Bike lanes may be feasible in theory and some areas, but at least in my area, they just are not. I take the bus to/from work and am all about public transport, but if I had to go solo to work, taking a bike would be ridiculous. It would take almost 2 hours each way, not accounting for getting rain dumped on my 70% of the year and time spent changing clothes. I know it is as much about mentality as it is about pragmatism, but there is no way we would get those levels of bike ridership here. It’s not a ‘if you build it, they will come’ type of situation.


Sorry for straying from topic. GP, I admire your passion about this subject but what works for one city won’t necessarily work for another.

Why aren't they feasible?  Lots of people commute upwards of 30 km a day by bike.  Or lots of people combine bikes with trains, or buses, or trams, or other public transport.  Bike infrastructure allows for bikes to be easily and safely melded with other forms of transport, and given how easy and flexible bikes are to use (plus the growing number of bikeshare programs) they're ideal for local transport.

[Riceball]

Something that the US needs, and would provide a whole range of economic and social benefits, is a renewed national infrastructure development program. This doesn't have to be delivered directly by the public sector, but I am almost certain that a regieme could be developed that allows for PPPs (public private partnerships), private sector incentives and where these don't work direct public investment. Pretty much every piece on "this is how to fix America" mentions in part or is centred on infrastructure development. To me, it just makes sense.

Although practicality is the next question. How do you do it? To me, you raise taxes on those at higher income levels (where the MPC is so low that it doesn't have many welfare effects), crack down on tax havens, trusts and the like, and tweak spending on things like defense to bring about efficiencies.

Feel free to attack

[j]

: J

Not much I really disagree with, but there's one assessment I think you're dead wrong on:

They do not know how to take care of themselves in the most fundamental ways at home, how can they be expected to take responsibility for another level of that?

With "preventive care," those people would have access to a primary care doctor. They would still cause issues for the system, but they wouldn't be clogging the ER rooms if they can go to a doctor they know, perhaps they trust, and whom they regularly see.

That would be ideal, but there are a few complications.  Many of these people are not educated enough to understand the value of preventive care.  They will not see a doctor regularly, even if they have one, because their mindset is "go to the doctor when something is wrong."  If they do happen to see their doctor regularly, they'll likely only be seeing a PA or nurse practitioner, although perhaps they'll form a relationship with them.

Lack of access is a problem, but there are so many other issues.  Lots of our patients have primary care physicians, and there are limited measures in place (at least around here) to give people access who perhaps wouldn't otherwise have it.  But when you can be seen in the ER right away regardless of your complaint (as opposed to in 2 weeks at your PCP's office), have virtually all labs and radiology performed in house, and have your test results within a couple of hours (as opposed to another week or longer after your appointment), with expedited hospital admission or follow up if necessary, many of these people go to the ER with their minor complaints ANYWAY.  And you'd be surprised at how many of them are even sent by their PCPs!

Which brings up another problem: the huge shortage of primary care physicians.  There are literally no incentives for graduating medical students to go into family practice or another primary care sub specialty.  The pay is the lowest there is for an MD, there are few procedures associated, relatively little respect from peers, burnout is high...unless that's just absolutely your only passion, it's hard to argue in favor of choosing it over much else.  With some exceptions obviously, those residencies tend to go to the graduates who can't get into anything else, when the system should be doing everything it can to encourage doctors to do this stuff, because it's what society desperately needs.  It's not hard to see why a lot of them are forwarding their patients to the ER whenever possible, because they're way over capacity as it is.

-J

[Super Dude]

Something that the US needs, and would provide a whole range of economic and social benefits, is a renewed national infrastructure development program. This doesn't have to be delivered directly by the public sector, but I am almost certain that a regieme could be developed that allows for PPPs (public private partnerships), private sector incentives and where these don't work direct public investment. Pretty much every piece on "this is how to fix America" mentions in part or is centred on infrastructure development. To me, it just makes sense.

Although practicality is the next question. How do you do it? To me, you raise taxes on those at higher income levels (where the MPC is so low that it doesn't have many welfare effects), crack down on tax havens, trusts and the like, and tweak spending on things like defense to bring about efficiencies.

Feel free to attack

I'm down. Higher taxes for the nation with the lowest tax rates in the developed world are just fine in my book.

[slycordinator]

If they do happen to see their doctor regularly, they'll likely only be seeing a PA or nurse practitioner, although perhaps they'll form a relationship with them.
...

Which brings up another problem: the huge shortage of primary care physicians.  There are literally no incentives for graduating medical students to go into family practice or another primary care sub specialty.  The pay is the lowest there is for an MD, there are few procedures associated, relatively little respect from peers, burnout is high...unless that's just absolutely your only passion, it's hard to argue in favor of choosing it over much else.  With some exceptions obviously, those residencies tend to go to the graduates who can't get into anything else, when the system should be doing everything it can to encourage doctors to do this stuff, because it's what society desperately needs.  It's not hard to see why a lot of them are forwarding their patients to the ER whenever possible, because they're way over capacity as it is.

-J

1) Personally, I think the shortage is why they're churning out PA's and NP's or at least pushing people toward that, especially the latter since they already have a good number of nurses around who can take that extra training and fill the gap. Although, I get the feeling that you'd prefer them to be seeing MD's (and perhaps DO's) only.

2) With regard to the number of MD's, I think it comes into play that there's been very little put into increasing the number of graduates by creating new schools. Like I know someone from HS in a newly created medical school, but AFAIK it was the first one created in quite some time.

[Scheavo]

: J

Not much I really disagree with, but there's one assessment I think you're dead wrong on:

They do not know how to take care of themselves in the most fundamental ways at home, how can they be expected to take responsibility for another level of that?

With "preventive care," those people would have access to a primary care doctor. They would still cause issues for the system, but they wouldn't be clogging the ER rooms if they can go to a doctor they know, perhaps they trust, and whom they regularly see.

That would be ideal, but there are a few complications.  Many of these people are not educated enough to understand the value of preventive care.  They will not see a doctor regularly, even if they have one, because their mindset is "go to the doctor when something is wrong."  If they do happen to see their doctor regularly, they'll likely only be seeing a PA or nurse practitioner, although perhaps they'll form a relationship with them.

Lack of access is a problem, but there are so many other issues.  Lots of our patients have primary care physicians, and there are limited measures in place (at least around here) to give people access who perhaps wouldn't otherwise have it.  But when you can be seen in the ER right away regardless of your complaint (as opposed to in 2 weeks at your PCP's office), have virtually all labs and radiology performed in house, and have your test results within a couple of hours (as opposed to another week or longer after your appointment), with expedited hospital admission or follow up if necessary, many of these people go to the ER with their minor complaints ANYWAY.  And you'd be surprised at how many of them are even sent by their PCPs!

Which brings up another problem: the huge shortage of primary care physicians.  There are literally no incentives for graduating medical students to go into family practice or another primary care sub specialty.  The pay is the lowest there is for an MD, there are few procedures associated, relatively little respect from peers, burnout is high...unless that's just absolutely your only passion, it's hard to argue in favor of choosing it over much else.  With some exceptions obviously, those residencies tend to go to the graduates who can't get into anything else, when the system should be doing everything it can to encourage doctors to do this stuff, because it's what society desperately needs.  It's not hard to see why a lot of them are forwarding their patients to the ER whenever possible, because they're way over capacity as it is.

-J

I just wanna stress again, that I mostly agree with you. I think emergency rooms should be able to turn away anyone who isn't in a life-threatening, or ya know, emergency situation. But I think some of the problems you are addressing are can really be fixed by addressing the thoroughly for-profit system we have now. The middle men and insurance companies help spur over-testing, and doctors don't actually bill the patients. Funding and subsidizing health clinics would be a pretty simple way. I mean, they sorta work like emergency rooms anyways, but they don't have the ridiculous prices associated with them. Hell, could make it simple, and build them near current hospitals, so people don't even have to change their behavior much. Can tax health care profits tremendously, and set up non-profit health agencies with public trust funds.

I mean, other countries do it, and I just can't imagine American's are that different.

----

By the way, I felt the need to add one more economic policy: end the war on drugs. It would save a bunch of government money, local and federal, as well as redirecting money away from the black-market. Some possible sources for taxation. Also, as Portugal has shown, a decrease in overall people addicted to hard-drugs.

[snapple]

I've gone into the emergency room with a hurt tummy  because I couldn't shit. Is that life threatening? Oh, my appendix ended up rupturing.

[Nick]

1. Steal Underwear
2. ?
3. Profit!

[kirksnosehair]

What about 2038? I’m planning on retiring around 2040 so that ‘fully funded till 2038’ argument doesn’t exactly make me feel warm and fuzzy inside. 

I actually wouldn't have a huge problem doing nothing either. We have 25+ years advance notice that SS will not be fully funded. All that means is that they will only be able to pay out what they bring in at that point. SS will not cease to exist, it will just pay out less. It's almost like it's phasing itself out. We all have plenty of time to save extra for retirement on our own. I'm not depending on any money from SS to help me out in retirement. If there's anything still available it will be a bonus on top of what I'm planning to provide for myself.

Well, that's really not what I want.  I guess I probably could have expanded on my thoughts a bit more.  Here's my thinking:  Social Security has worked, and worked extremely well for 75 years, but over time things do change.  Specifically, what is changing now is the population.  So, with a higher percentage of people retiring, the system faces a larger burden to pay out what it has always paid out.  Now, personally, at 48 years old, under the most ideal of circumstances, I should be able to retire in about 17 years, which is 2029.  The system, as it stands now, is solvent until then.  So, yeah, personally (and this may be selfish, but it is what it is) I am not really too concerned about what's going to be happening with Social Security a decade after I retire.

But I will say this:  Ideally, the system would be preserved as closely to what it is today as possible.  It's far from perfect, but it does most of what it was designed to do.  And I'd like to see that continue even beyond the window of time when I will be using it.  To that end, I'd be more than happy to pay a higher tax today to help fund the benefits of current and future retirees.  I know that not everyone shares that view, but I think if you took a poll of Americans from across the political and economic spectrum, you'd probably find that a lot of people feel the same way.

I think the reality, though, even for people like me who are going to retire while the system is still solvent, is that we're going to need more than Social Security and Medicare to live.  That's why I encourage everyone to get some kind of retirement savings account going at as early an age as possible.  Now, personally, I didn't start putting anything into a 401k until about 12 years ago.  But you'd be surprised what that compounded interest can do in 12 years  !!  If you plan it carefully and aren't too aggressive and avoid unreasonable risks with those investments like I have, you'll really have a nice nest-egg saved up by the time you retire.  Between my 401k, my mortgage (which is almost paid off now) and Social Security, I should be able to maintain a relatively comfortable retirement, and perhaps even travel a bit.

[lordxizor]

Ideally I'd like to see SS remain about the same as it is today as well. However, I'd push back the age that you start receiving benefits until at least 70 if not 75. When SS started, the average person only lived to be maybe 5 years beyond the age that SS kicked in. These days, we're living on average 20 years drawing from SS. We're also healthier later in life and can probably work until 70 or 75 in a lot of cases.