Obamacare

ObamaCare's Dangerous Device Tax

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Congressional Democrats got the Congressional Budget Office to score ObamaCare's trillion dollars in new spending as a net deficit reducer by trimming approximately $500 billion in planned spending out of Medicare and by raising the rest in new tax revenue.

But inevitably there are costs to extracting that sort of revenue from the economy. As Ramesh Ponnuru points out in his Bloomberg column, the medical device industry, which faces a major new tax under the law, is already blaming the law for layoffs and decisions to move its operations overseas:

In November, citing the new tax, Stryker Corp. (SYK), whose products include artificial hips and knees, announced that it would let go about 1,000 of its workers. Earlier last year, Covidien Plc (COV), maker of surgical instruments, said it would lay off 200 workers in the U.S. and move production to Costa Rica and Mexico. It, too, cited the tax.

Other companies in the field have announced similar measures—or plans to expand production overseas but not in the U.S.—without mentioning the tax. The sluggish economy is clearly part of the explanation, but the medical-devices industry had been a relative bright spot within U.S. manufacturing, losing only 1.1 percent of its employees during 2007-2008 while manufacturing as a whole lost 4.8 percent. A study done for AdvaMed, a trade association for the industry, claims the tax could ultimately cost more than 45,000 jobs.

Medical-device companies employ more than 400,000 Americans. Their wages are higher than the national average. The U.S. is a net exporter of medical devices.

The tax will change these numbers for the worse. It will be levied at 2.3 percent of sales; on average, profits make up less than 4 percent of sales in the industry. The AdvaMed study concludes, "The new 2.3 percent excise tax will roughly double their total tax bill and raise the average effective corporate income tax rate to one of the highest effective tax rates faced by any industry in the world."

Why go after the device industry? The plan was for a big chunk of the law's new revenue to come from various fees and taxes and the health care industry itself on the theory that expanding health insurance coverage to 30-some million people would provide new business to health providers. There's a certain circularity to this argument: Essentially, the idea was to tax health providers in order to pay for millions of new customers for those same health providers. And now it seems that instead of generating extra business for the device industry, ObamaCare may end up slowing it down.

Somehow, though, I doubt that outcome was on the minds of any of the Congress critters who voted to fund ObamaCare using provisions like this. Indeed, the grab-bag of pay fors they relied on to nab a favorable CBO score has proved exceedingly troublesome; the 1099 tax reporting requirement for small businesses, which was designed to raise $17 billion in new revenue, had to be ditched after it became clear that compliance would be a giant pain in the neck. 

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  1. In November, citing the new tax, Stryker Corp. (SYK), whose products include artificial hips and knees, announced that it would let go about 1,000 of its workers. Earlier last year, Covidien Plc (COV), maker of surgical instruments, said it would lay off 200 workers in the U.S. and move production to Costa Rica and Mexico. It, too, cited the tax.

    Utter nonsense….if government pens regulation it alters reality. This is sour grapes from the private sector…nothing else.

    1. What is this penis regulation you speak of?
      OBAMA HAS GONE TOO FAR!

    2. Re: Tony the Candid,

      This is sour grapes from the private sector

      And now we know that Tony has never worked in the private sector.

      Like a priest handling advice on sex, Tony here pretends to opine on why people make business decisions.

      idiot.

      1. This isn’t Tony.

        1. rather was repeating the same content as our Tony above on the exact same topic in the A.M. links thread.

          Hmm. Could rather’s secret identity be that of a leftist, homosexual man who trolls Reason Hit & Run?

          1. Tony and rather’s styles are so different, I can’t see them being the same person. Or maybe you were kidding?

        2. It’s difficult to say these days… How can you tell?

          1. Utter nonsense….if government pens regulation it alters reality. This is sour grapes from the private sector…nothing else.

            Would it have been clearer had I said; Utter nonsense….if government pens regulation it alters reality rips asunder the very fabric of perceived reality. This is sour grapes from the private sector…nothing else.

    3. Tony, how does a surtax on medical devices, which is a very strong export category in the U.S., benefit anybody?

    4. “if government pens regulation it alters reality”

      That really should have been a dead giveaway.

      1. Almost.

    5. “Sour grapes” doesn’t mean what people think it means:

      When the fox found he could not reach the grapes, he rationalized it by thinking they would have been sour even if he could have reached them.

      Read your fucking Aesop, yo.

  2. Why go after the device industry? ….Essentially, the idea was to tax health providers in order to pay for millions of new customers for those same health providers. And now it seems that instead of generating extra business for the device industry, ObamaCare may end up slowing it down.

    I disagree strongly.

    The Obama Administration saw money spent on R&D for new medical devices as a drain on the system. The Obama Administration wants healthcare providers to stop using their resources on new and better treatments and start using their resources to provide more standard care to more people.

    In other words, the Obama Administration saw this as a feature rather than a bug. They think that the more they discourage healthcare providers from spending on new equipment and new devices, the more it will encourage healthcare providers to spend that money on giving more people access to the hospital.

    It’s very much in line with the Obama Administration’s severe tax on “Cadillac Insurance Plans”, where they hit you with an enormous tax if your company’s health insurance plan is especially generous. The Obama Administration sees high quality healthcare as part of the problem–and discouraging people from getting it as part of the solution.

    They wanted everyone to get a minimum amount of healthcare with a minimum level of quality–and anything above and beyond those minimum levels they saw as part of the problem.

    1. Equality means the lowest common denominator.

    2. It seems a cold attitude, but it actually makes sense in a way. One of the biggest drivers of medical costs is new technology and new drugs.

      It’s much cheaper to tell someone “sorry, there’s nothing we can do” than to marshal a highly expensive glistening piece of technology into service. If we banned every medical innovation since 1960 our health care costs would plummet.

      1. It doesn’t “seem” a cold attitide, it is both cold and inhuman. Which is exactly why the left’s belief in the political right’s heartlessness is sheer projection. Freezing technological progress in the name of equality ensures that some will suffer and die needlessly. All to the good, according to progressive social engineers.

        1. No, DEM, it’s cold and inhumane to let sick people pay doctors or nurses to treat them to help them get better. Even if they are rich and have plenty of money to pay.

          It’s also cold and inhumane to pay for someone else (like poor people) to go to a doctor, or to run a private charity hospital.

          Single payer is quite possibly one of the most insidious and evil inventions of liberals, although I’d rank their obsession with choo-choo trains a close second.

      2. Re: Tulpa,

        It seems a cold attitude, but it actually makes sense in a way. One of the biggest drivers of medical costs is new technology and new drugs.

        Sure, like one of the main drivers of the escalating cost of new computers is advancement in processor speed… no?

        Please use your head, Tulpa. The MAIN reason for the escalating costs of healthcare is a lack of supply. THAT’S IT.

        1. Precisely. New technology and innovation doesn’t cause prices to go up in any industry except health care and defense. What do those two have in common?

          1. We see huge price declines in healthcare that isn’t generally covered by government programs, too.

            Laser eye surgery is pretty cheap these days, but it didn’t start out that way.

            1. Fake tits, too!

            2. Individual instances of technology get cheaper as they age.

              Technology as a whole does not.

              1. That’s absurd.

                Technology as a whole doesn’t become cheaper over time?

                Technology doesn’t make things cheaper over time?

                What are you talking about?

                1. The technology people expected to have in 1960 cost as much then as the technology people expect to have in 2012 costs now.

                  Your argument is that the technology people expected to have in 1960 is dirt cheap now. I agree. But people aren’t satisfied with that level of technology anymore.

          2. The average person spends a lot more on computers now than they did in 1960.

            1. Yes, and because of that we no longer have to mail letters across the country. Or pay armies of secretaries to do typing and filing. Etc. Are you arguing that computers have increased the net costs of doing business?

              1. But for the average person (not business), all of the new tech toys probably don’t increase productivity enough to offset the expense (a lot of them probably reduce productivity). I don’t think that buying a new computer every few years, paying a cable bill, a cell phone bill, an internet bill, etc. are making you richer.
                You absolutely have the right to value what you want to and you owe no one your full potential for productivity, but that doesn’t mean that everything about computers increases productivity or reduces costs.

              2. How much mailing and typing and filing did the average person do in 1960?

            2. Re: Tulpa,

              The average person spends a lot more on computers now than they did in 1960.

              That undermines your argument. Did you notice it?

              1. No, perhaps you could explain how?

                1. I got it. You couldn’t afford a computer in the 60’s.

                  I recall seeing photos from I guess the 40’s where there were rows of desks of people manually calculating.

                  Today, I use a computer for more than replacing mail. Photography and other hobbies are still valuable, even if not strictly necessary. And there are a lot of things we could get rid of if mere productivity is the goal. Why have a big flat screen tv when a 13″ will do? Why have more than 4 channels?

                  1. I only get 2 channels. 4 is just extravagant.

                  2. Starving college students can afford to walk around with computers in their pockets that would fill a room back in the ’70s.

                    The reason we spend so much on pharmaceuticals in this country? Is in large part because they’re the cheaper alternative to a medical procedure and hospital stay.

                    Even if you take the unpleasantness of bypass surgery out of the equation–if I can treat your hypertension and heart problems with some pills, how much cheaper is that than heart surgery?

                    A whole lot.

                    The more we can swap pills and medical devices for procedures, the cheaper treatment becomes–innovation is the key…to freakin’ everything.

                    1. Unlimited demand sponsored by inefficient government spending with terrible oversight also drives prices up. This applies to health care as well as education. The more the federal govt makes both “affordable”, the more expensive they become. Root cause = people are more willing to spend other peoples money than they are their own.

                    2. Then howzabout your Team AND their Team, stop spending our money inefficiently?

                      And since when are you against spending other peoples money?

                2. Re: Tulpa,

                  My pleasure:
                  “One of the biggest drivers of medical costs is new technology and new drugs.”

                  Undermined by:
                  “The average person spends a lot more on computers now than they did in 1960.”

                  The reason is because computers are much cheaper. So TECHNLOGY is not a cost driver, it is a cost CUTTER.

                  Q.E.D.

                  1. Computers are certainly not cheaper than empty spaces where computers would otherwise be.

                    1. So the solution to the non-problem of people having more choices than they used to is rationing?

                      Stopping the proliferation of choices?

                    2. Re: Tulpa,

                      Computers are certainly not cheaper than empty spaces where computers would otherwise be.

                      You’re being an absolute ass, Tulpa. People buy computers because it improves their lives, just like they would buy medicine or orthopedic devices. That is what makes us WEALTHY.

                    3. Not to mention that the computer did some kind of work. If you remove it, what will do the work? The air in the space the computer once sat???? I doubt it. You would need to hire hundreds, possibly thousands of people to manually calculate everything using a pencil and calculator. I am pretty sure the computer was cheaper.

                    4. Most people in 1960 didn’t have teams of slide rule wielding drones working for them. The calculations they needed to do could be easily done by hand (and as a result they were much better with numbers than the current generation, I might add).

                    5. People buy computers because it improves their lives, just like they would buy medicine or orthopedic devices.

                      Hospitals do this with medical equipment, too.

                      Hospitals buy new medical equipment because they they think the benefit to their bottom lines is greater than the cost.

                      Why are we second guessing the choices economic actors are making for themselves?

        2. I thought it was the third party payer system.

        3. You’re misunderstanding my point.

          Yes, any particular technology will get cheaper over time. That much is undeniable. But it’s always more expensive than not purchasing the technology at all.

          As a thought experiment, consider that the average family spent $0.00 on computers and cell phones in 1960, but today they spend much more.

          1. Yes, any particular technology will get cheaper over time.

            Not if the government is paying for it. The initial price is a baseline, and from there it only goes up.

          2. “But it’s always more expensive than not purchasing the technology at all.”

            Umm, no it’s not. Computers have made many tasks much cheaper- mail, filing, etc.

            Same case in healthcare. Consider a pacemaker. If the pacemaker didn’t exist, a husband and employee with heart disease would likely die in his 50s. But with the pacemaker, he can live for another 25 years or whatever. During that time, he can be a productive employee, provide for his family, etc. You can’t consider the cost of the particular technology in isolation from its benefits.

            1. But he can also retire for 10 years and spend all the money he saved and have nothing to pass on to his children. Living longer past retirement is purely an expense. One that I hope I can enjoy some day, but I don’t think you can argue that extending lifespan saves a lot of money (until people are willing to raise the retirement age anyway).

            2. The government can, because they arent receiving the benefits (except in the form of taxes).

              For this one rare instance, Tulpa isnt arguing as a douche, as he doesnt actually support this, he is just explaining it from a government beancounters POV.

              Of course, Tulpa didnt explain it well.

              1. Uh, thanks. I think?

          3. As a thought experiment, consider that the average carpenter spent $0.00 on air nailers and sliding miter boxes in 1960, but today they spend much more.

            Technological advance takes place, and in fact, is only possible, because it yields a net positive in terms of production, and that is the entire context within which one can even consider the question of something being expensive.

            1. It’s not clear at all that new med tech is increasing productivity. Human physical fitness affects only a minor part of our economy today.

              1. Demand to be treated with 1960s tech next time you are in the hospital then.

                1. If I could get 1960s tech at 1960s prices, that would be good enough for me. And for more than a few other folk who are getting priced out of a non-free market.

              2. @Tulpa: “It’s not clear at all that new med tech is increasing productivity.”

                Bullcrap. You have never spent any time in a busy E.R. then. Digital X-Ray ALONE has saved tens of thousands of lives by reducing diagnostic time. If you want to put it in plain cold-hearted “productivity” terms, a single E.R. team can handle many more cases than the “old” days when a trauma case had to wait for films to come back before being able to proceed.

                Obamacare was DESIGNED to kill innovation. Innovation cost money up front, even though the new tech ALWAYS gets cheaper later on, and saves lives going forward.

        4. There is a lot that freer markets could do to lower healthcare costs. But the increase in medical technology and people living longer will still raise the total cost.

          A better computer analogy would be that 10 years ago, you might have bought a new laptop and been pretty happy with that. Now you might also want a smartphone, a tablet, a new Xbox, a tivo and any number of other small computers that no one would have thought of even 10 years ago. Computers are cheaper, but people want lots of them and spend more on technology than they did 10 years ago.

          1. This is what I was trying to say. Well put.

          2. So what? Does that imply that we should get rid of cars, trains, paved roads, heated houses, indoor plumbing, etc. because that technology didn’t exist 150 years ago? All of those things have made life much better for all of us, but the people living in 1862 probably didn’t miss them because they couldn’t conceive of such things. Of course technologies have costs, but they also have benefits. In a free market system, the people that are receiving the benefits have to weigh them against the costs, and where the benefits are not sufficient for the costs, they generally forego the technology. The problem in healthcare, then, is not that technologies cost a lot, but that the payment system means that no one weighs the costs against the benefits.

            1. I agree with you on the big picture, I’m just saying that from a strictly monetary (as opposed to QOL) cost-benefit perspective we’d be better off without new technology.

              Health care is in many ways inherently difficult to cost-benefit analysis anyway. Even in a world without insurance it would be hard for people to say that this new expensive treatment that would keep Mom alive for three more months is just not worth it, even if it really isn’t.

              1. cost-benefit perspective we’d be better off without new technology.

                So your argument is that, economically, we’d be better off if the sick and wounded just died? Because that’s the result of reducing health care technology to some minimal-care baseline. Perhaps you’d like to advocate euthanizing crippled or disabled children at birth, as well?

                I don’t think your argument holds water, anyway, even from the most utilitarian standpoint. You’re failing to consider how better medical tech mitigates productivity losses in the working population due to sickness or injury. Sick or injured people more fully recover, more quickly, keeping productivity in the economy.

                1. Perhaps you’d like to advocate euthanizing crippled or disabled children at birth, as well?

                  We would save a lot of money by doing that, which is the only perspective I’m considering here.

                  You’re failing to consider how better medical tech mitigates productivity losses in the working population due to sickness or injury.

                  Most of the medical technology is used on people who will never be productive (ie, disabled persons and last-6-months care). And frankly, physical production by humans is no longer a significant part of our economy. Our economy is almost entirely based on mechanization, knowledge and skill, emotional labor, and putting up with drudgery. Physical strength has little to do with most work in the US.

                  1. “Physical strength has little to do with most work in the US.”

                    Said the fat, pasty office man.

                    1. Sorry buddy, but there aren’t that many of you left. Longshoremen have been largely replaced with machines.

              2. Of course, no person makes cost-benefit trade-offs from a strictly monetary perspective, and that particularly wouldn’t be true in the case of health care. But the mere fact that I can’t put a dollar figure on a benefit doesn’t mean it is worthless. No doubt the decision to pay $100,000 to keep Mom alive for an extra three months would be tough, but there are really only two solutions here (once the unlimited government gravy train ends)- either the family makes that decision or the government says it won’t pay based on some monetary cost/benefit formula.

              3. Even in a world without insurance it would be hard for people to say that this new expensive treatment that would keep Mom alive for three more months is just not worth it, even if it really isn’t.

                _____________________

                Baloney. The reason why costs are escalating so fast is that government is insulating consumers from precisely these sorts of stark choices. If sons were told that their 89 year old mothers could be kept alive for 5 more mionths at a cost of $250k, there would be many decisions made to forego treatment. As it is, the sons are told that the additional treatments are free to them and their family as they are foisted off on medicare/medicaid. And who’d have thunk it, demand is almost infinite when the effective price is zero.

                1. If those $250K treatments were simply unavailable, you’d see an even greater decrease in their use.

                  This is my point. I’m not defending Obamacare or the status quo, just pointing out where the money is going.

                  1. Except that the $250k treatment might actually make sense for some situations/people and not for others. Your approach of denying the treatment altogether, by simply not developing the technology, ensures that no one will get it, not just grandma.

                  2. I acknowledge that consumers won’t buy what does not exist. The issue is why they are spending so much for what does exist. The answer is that they (largely) aren’t the ones paying for it. Once you suggest removing the option as a way to control the price you are very much in the Obama camp.

              4. “…I’m just saying that from a strictly monetary (as opposed to QOL) cost-benefit perspective we’d be better off without new technology.”

                In what universe is it a proper cost-benefit analysis to only consider the cost and ignore the benefits?

            2. Also note that the belief in an afterlife is a very cheap way to make end-of-life decisions easier and more financially sensible.

              We don’t really have that anymore either, as our society is mostly populated by practical atheists.

              1. “as our society is mostly populated by practical atheists.”

                Try again, Tulpa.

                Christianity Remains Dominant Religion in the United States.

                This Christmas season, 78% of American adults identify with some form of Christian religion. Less than 2% are Jewish, less than 1% are Muslim, and 15% do not have a religious identity. This means that 95% of all Americans who have a religious identity are Christians.

                A new Gallup poll.

                http://www.gallup.com/poll/151…..tates.aspx

                1. Checking a box on a questionnaire does not make one a Christian.

                  Most people in the US live as if there is no God. Hence the “practical” qualifier.

            3. Sew buttons! Look, I’m not trying to make any point about what should be done or what people should value. Why do people have such a hard time distinguishing a description of what is from a prescription of what should be done?

          3. There is a lot that freer markets could do to lower healthcare costs. But the increase in medical technology and people living longer will still raise the total cost.

            You’re talking about quality of life issues.

            The perfect example is Viagra.

            People didn’t spend much money on erectile dysfunction treatment before–because there wasn’t any treatment. You got over a certain age, and then women laughed at you.

            Erectile dysfunction treatments have not more expensive since Viagra first came on the market in the ’90s; however, the cost of treatment for erectile function plummeted the moment treatment became available.

            Before Viagra–there wasn’t anyone in the world who could afford effective erectile dysfunction treatment. Bill Gates could have spent every last one of his 35 billion dollars on erectile dysfunction treatment–and he still couldn’t afford the treatment.

            Nowadays? Just about anybody can afford effective erectile dysfunction treatment–that doesn’t mean the cost of treatment has gone up. That means the cost of treatment has come down.

            Unless you’re trying to say that the government should stop people from seeking effective medical treatments for whatever ails them–like the Obama Administration is essentially doing–then there’s no point in pointing out that people buying things that didn’t exist before creates new markets, new industries and new demand. …as if that were a problem somehow?

            There’s no effective vaccine for HIV or a cure or treatment for Alzheimer’s, which is another way of saying that no one on God’s green earth can afford the cost of effective treatment. When those treatments are discovered and become available and eventually affordable to the average person, anybody who bemoans that the cost for that treatment has gone up–because there’s a cure now–is completely missing the point.

        5. Wasn’t there an article here a few weeks ago that said it was Medicare that started the price increases in health care? Another unintended consequence.

      3. There are people like Obama who see things that way.

        I’ve made the point before–I remember when it used to cost $600 or more to buy a 15″ color monitor. It wasn’t that long ago. And it was a huge, bulky thing. The monitor was so huge it would take up your whole desk.

        I just checked, and now I can get a flat screen LCD, 23″, 5ms, with an unbelievable contrast ratio–for $119 with free shipping!

        The Obama Administration has a very static view of how the economy works. It’s all a zero-sum game with them. But the fact is that one of the reasons companies buy technological innovations is because they often lower people’s costs over time. They think the efficiency or what they pay, in other words, will more than make up for the extra cost of buying the new innovation.

        That’s always been my biggest beef with the Obama Administration–they have no idea what makes economies grow. Actually, it’s worse than that. The things that actually make economies grow? The Obama Administration thinks are part of the problem…

        Investment is one of the things that makes the economy grow–yet look at the Obama Administration’s war on banking and heaping of regulation on the investment industry.

        Technological innovation is one of the the things that makes economies grow, too! Technology drives productivity gains and efficiency gains–and that’s the stuff economic growth is made of. This really is the heart of what’s wrong with the Obama Administration–their static, zero-sum view of the economy.

        They think that if we just got rid of the R&D, that healthcare would be cheaper, but that isn’t true. As we get rid of the technological innovation, the healthcare of the future will be much more expensive than it would have been otherwise.

        Laser eye surgery is affordable to a lot more people now because of technological innovation. Laser eye surgery may eventually become less expensive than a lifetime of contacts or glasses. There are thousands of products out there that would eventually provide cheap solutions for hundreds of conditions like that. And the Obama Administration is trying to strangle them all in the cradle–on purpose for our own good!

        1. I think I’d modify that a little- they realize that technology can lead to efficiencies (see their support for electronic medical records)- they just think that they have the crystal ball that allows them to figure out which technologies will lead to efficiencies.

        2. The things that actually make economies grow? The Obama Administration thinks are part of the problem…

          But, but, but he can’t be that fucking stupid. He edited a law review. They know how to use Bluebook citations and shit.

          oh wait, Obama is that fucking stupid…. Nevermind.

        3. ‘ve made the point before–I remember when it used to cost $600 or more to buy a 15″ color monitor. It wasn’t that long ago. And it was a huge, bulky thing. The monitor was so huge it would take up your whole desk.

          I just checked, and now I can get a flat screen LCD, 23″, 5ms, with an unbelievable contrast ratio–for $119 with free shipping!

          I also remember when you could get a 13″ CRT TV for the kitchen for $40. Also only a few years ago.

          Now? You’re paying at least $100 for that size LCD TV, and the CRT’s are nearly impossible to find.

          Particular instances of technology get cheaper as they age. The latest and greatest technology sometimes do and sometimes don’t. And it’s always cheaper to do without.

          1. CRT’s are nearly impossible to find.

            Craig’s List.

            or

            Ive got one for free if you want to pick it up.

            1. Craigslist would be fine if I want a used TV with someone else’s cum stains on it.

              1. The Hell are you DOING in your kitchen, anyway? Sounds… Unsanitary.

                1. I have a unique recipe for fettucine alfredo.

                  1. How the hell did semen get under the stove??

          2. “And it’s always cheaper to do without.”

            My god that’s dumb. So I guess you’re going to walk to work today, since it’s much cheaper to do without automotive technology?

            1. I have very wisely resisted equipping my home with the fancy new technology called electricity. Way cheaper to investment my funds in a huge supply of candles and timber to fuel the wood-burning stove.

              1. I can’t believe that you’re wasting so much money on candles and a wood burning stove. It would be much cheaper to simply sit in the dark and be cold.

                1. That’s what we’re aiming for, prole.

                  Well… for average dirtbag humans, that is. Our Leaders… that’s another story.

          3. I also remember when you could get a 13″ CRT TV for the kitchen for $40.

            Not in HD, with Dolby surround, on a swivel base, with HDMI, S-cable, and other multiple input ports, that takes up 1/3 the counter space of a CRT and looks nice in a modern kitchen and matches with other modern appliances.

            1. HDMI and Dolby surround for a 13″ TV?

              Why?

              But you see what I’m saying. Technology as a whole can get more expensive because people EXPECT ever more advanced stuff that they used to do without.

        4. I would say laser eye surgery is affordable because it is rarely covered by insurance – so normal market forces worked to bring the price down to affordable levels so that more people to have access to this technology.

          1. Right.

            Market forces drove more people into the industry. They kept fighting to be more cost competitive relative to the substitutes–glasses and contacts. Different medical device manufacturers who made the laser equipment continually competed with each other to make better, more efficient equipment…

            When laser eye surgery first came out, they couldn’t treat people with astigmatism, etc. Market forces were the solution to that.

            Giving people new options in a system where people choose for themselves doesn’t increase their costs. People can and do go on using substitutes, wearing glasses or contacts, instead.

            The ideal situation are situations like this, where people aren’t generally being forced to pay for each other’s choices. We may not be able to go from the system we have overnight (where there is no private option, we’re all forced to pay for each other somehow) but the closer we get to system where we’re all free to make our own choices, like with laser eye surgery, the better off we’ll be.

            1. But right now, I can’t afford Lasik. That’s why I would prefer you pick up some of the tab, Ken. That way we both can afford Lasik. Win-win!

            2. The problem is the third party payer system.

              If laser eye surgery were covered by insurance you can bet it would cost a lot more than it does now.

              The fact that the customer pays the provider directly, instead of the bill being paid by a third party, the customer actually cares about the price and might shop around. Thus competition kicks in and prices drop.
              If they paid a co-pay and let the insurance company pick up the difference, they’re much less likely to shop around. No competition means prices can be much higher than market value because a third party payer system distorts the price mechanism.

        5. That’s always been my biggest beef with the Obama Administration–they have no idea what makes economies grow. Actually, it’s worse than that. The things that actually make economies grow? The Obama Administration thinks are part of the problem…

          Yep.

          Paul should do a series of commercials around that.

      4. One of the biggest drivers of medical costs is new technology and new drugs.

        Piffle. The biggest driver of medical costs is first-dollar/low-deductible/low copay insurance laden with mandated benefits. IOW, what ObamaCare tries to give us much, much more of.

        1. The biggest driver of overall costs is the last six months of life and the last ditch, spare no effort, attempts at prolonging life by just a little bit. A practice which benefits the hospitals and the nursing homes tremendously. The biggest driver of insurance costs is mandated benefits.

          1. The biggest driver of overall costs is the last six months of life and the last ditch, spare no effort, attempts at prolonging life by just a little bit.

            ….which disproportionately use new treatments and new technology.

            1. True, but the government and insurance companies are paying for most of it. If families had to shoulder more of the burden, I guarantee that more economical solutions would be found.

              1. And this is the ultimate point. Remove government from the health care picture entirely and the cost/benefit analysis becomes an individual decision and these discussions are moot.

                Much like my argument that 99% of all “school issues” that come up can be solved via separation of school and state.

            2. And the reason so many resources are spent on new treatments and technology in the last six months is because of . . .

              first-dollar/low-deductible/low copay insurance laden with mandated benefits.

              Trust me, I know from face-to-face experience that people will only say “do everything for Granny!” when they are sure it won’t cost them a nickel.

              1. So you have face-to-face experience of people pulling the plug on granny if they have to pay for treatments?

                1. I think he’s a doctor.

                  1. No, he’s a hospital lawyer.

                2. I have face to face experience with people stating that they want us to do everything for Granny only after receiving assurances that it won’t cost them a goddam nickel.

                  They are deciding on whether to have a do-not-resuscitate/palliative/hospice approach, or a throw-the-kitchen-sink-at-granny approach. So this is a real decision for them, one where they could go either way. And only after asking whether it will cost them anything and being told no, do they opt for the kitchen sink.

                  1. Is hospice care covered under insurance/Medicare?

                  2. Ah, but you’re not certain they wouldn’t have chosen some middle path between DNR and kitchen-sink if they had to pay. You’re just confirming that people like free stuff.

                    1. Ah, but you’re not certain they wouldn’t have chosen some middle path between DNR and kitchen-sink if they had to pay.

                      No, I’m certain they would take the lowest-cost option (which is always DNR/hospice) if they had to pay anything at all.

                      Regardless, my point was that zero financial responsibility by patients/families drives costs. Your point, Tulpa, seems to be that if they had financial responsibility, they wouldn’t choose the high-cost option. Which is, when you think about it, my point.

        2. And what are those insurance dollars mostly spent on?

    3. I am intrigued with your ideas and would like to subscribe to your newsletter.

    4. See, this is why certain industries resort to requiring employees to carry unlicensed nuclear accelerators on their backs.

      1. What about the penis regulations?

  3. Shake that booty, Michael J Fox.

  4. who trolls a libertarian website all day.

  5. Striker, listen, and you listen close: flying a plane is no different than riding a bicycle, just a lot harder to put baseball cards in the spokes.

  6. In other words, the Obama Administration saw this as a feature rather than a bug. They think that the more they discourage healthcare providers from spending on new equipment and new devices, the more it will encourage healthcare providers to spend that money on giving more people access to the hospital.

    I can believe this. Liberals seem to be uttler fucking clueless about… well everything. But in this context, they are clueless about incentives, particularly incentives that motivate businesses. Assuming this meme is true, it just goes to show to epitominze how stupid this dumb fuck president really is and proof that he has never engaged in real world business.

  7. personally, I would like to see every single person whose fingerprints are anywhere on obamacare hanged. In public. on tv. primetime. with no drop.

  8. Is the Flux Capacitor an anti-diarrhea device?

    1. No. It is a santorum filtering device.

      1. I’d pay for that

    2. The side effects of the flux capacitor are many and unknown.

      1. Only your Doctor can tell you if flux capacitation is right for you.

    3. OOPS.

      It’s an anti-constipation device.

      Sorry about that, guys.

      You can clean up in the shower.

  9. Maybe Obama will take this tariff before the WTO to stop Obama from enforcing it.

    Wow. This is beyond stupid. Tariffing your own exporters. Fucking stooooooopet.

  10. Just remember this thread next November….

    Tomorrow RP will get about 0% of the Caucus vote, rounding up the numbers of course.

    Just remember, it’s all about your precious ‘true libertarian’ feelings, not about moving the country in less statist direction.

    Sure, ObamaCare is awful, but Newt/Mitt/Bachmann/Santorum et. al., why they’ve done some weird Christian stuff in their personal life. Even though that has no bearing on how they’ll govern, I’ll choose more statism. Gotta be cool, remember?

    1. Re: Wholly Holy Cowpie for brain,

      Tomorrow RP will get about 0% of the Caucus vote, rounding up the numbers of course.

      You’ve got yourself a bet.

      1. I wonder if this isn’t a spoof of Holy Cow. He/She is not usually this fucking stupid.

    2. Even though that has no bearing on how they’ll govern

      I’ll cover that bet.

  11. FYI, the Dangerous Device tax is $200. payable via tax stamps you can get from the ATF.

    1. Sadly, you can’t just buy the tax stamps up front anymore. And it’s “Destructive Device.”

      1. But still, LOL.

  12. The tax will change these numbers for the worse.

    Nonsense. They can just raise their prices, see?

    1. Not without permission from the Pricing Commission.

      1. Not quite, but I wouldn’t be surprised if that HHS harpy Sebelius sends them threatening letters for blaming price increases on Obamacare. Like she did with insurers.

  13. O/T: MC Kruggs skoolz all y’alls on how bitches be owin’ money.

    http://www.nytimes.com/2012/01…..ef=general

    1. First, families have to pay back their debt. Governments don’t ? all they need to do is ensure that debt grows more slowly than their tax base. The debt from World War II was never repaid; it just became increasingly irrelevant as the U.S. economy grew, and with it the income subject to taxation.

      Let’s see, we’ll spend all that money and then we’ll tax the living shit out of them and inflate the currency because there won’t be any other choice but to do so. That won’t have any negative consequences at all. Can’t be worrying about those people who actually saved money or are on a fixed income.

      Krugabe is showing his true colors here.

      1. Krugabe is showing his true colors here.

        And sociopaths like Krugman are the reason why I say that anyone who voluntarily loans money to the government today is a complete idiot. Because as he openly admits right here, they’re not going to get paid back!

      2. I discussed this article yesterday in one of the threads.

        What he’s saying about the govt debt is true in the sense that the govt can continually refinance it, rather than actually paying it down. This is done by paying old creditors with money borrowed from new creditors and using the tax base only to make interest payments.

        Of course, what he misses is that this system collapses when/if creditors don’t want to lend you any more money. Also he neglects the fact that the family can also pile mortgage on top of mortgage under the same conditions (income increasing with debt, willing creditors), so there’s no problem with the analogy there.

        1. It’s true in the same sense that if I kill my father I’ll probably get my inheritance sooner.

        2. It also misses the fact that as we continue borrowing the interest costs eventually become prohibitively expensive. Even now a moderate rise in rates would jack up interest payments to a huge proportion of discretionary spending. So it’s not just that they’ll stop lending altogether, it’s that the market will eventually demand a return commensurate with the risk. Italy is bascially there now. We, on the other hand, have no ECB to bail us out.

          1. Yeah, that’s how it works in practice.

            I guess you could say both conditions are the same, since creditors being less willing to lend means that you have to pay higher interest payments, which your tax base probably can’t grow to match.

        3. Collapses? But why would people ever stop buying tulips, when they stand to earn a nice profit funded by future tulip buyers?

          Err, I mean “government bond buyers”. Strange slip, that…

        4. “What he’s saying about the govt debt is true in the sense that the govt can continually refinance it, rather than actually paying it down. This is done by paying old creditors with money borrowed from new creditors and using the tax base only to make interest payments.”

          Fucking. Brilliant!

      3. First, families have to pay back their debt.

        Actually, they don’t. Its called bankruptcy. Or dying. Either one results in the forgiveness (effectively) of debt.

        Applying his claim that the US never paid off its debt from WWII because we’ve had debt since WWII means that there are many, many families in the US that will never repay their debts, because they will never be out of debt.

        What a moron.

    2. I also liked how the only problem with increasing taxes he cited was increased tax avoidance (eg offshoring money, under the table employment). No concern or awareness whatsoever for the discouraging of production.

      Sometimes I think Kruggy is just writing columns to help NYT-reading rich liberals feel good about their politics. That shot at the Heritage Foundation would seem to confirm.

  14. Do you know what this means?! It means….that this stupid thing doesn’t work at all!

  15. So in other words, these serfs don’t get the nice treatments that can ease their suffering and help them live longer, more producitive lives.

    Nope, that privilige belongs to Comdrade Obama and members of the Presidium that wisely exercise their authority as the “Right People” to manage our lives.

    1. ASM you do realize that they are “Top Men”.

  16. I strongly suspect Obama has a personal vendetta against me.

    1. Don’t worry.

      The paranoids will come for you first.

  17. “Get this thing out of my operating room!” The colon stapling device exploded into pieces when I hurled it against the operating room wall. I was fed up with its failure to work as advertised by the manufacturer. The stapler had probably cost less than $100 to make. The hospital paid $300 for it (and then billed the patient, or insurance company, $1,200). Now the thing didn’t even work.

    I do not react well to imperfection inside the operating room. I cannot tolerate it in the tools I use, the staff assisting me, or myself. Defective devices?I can have them replaced. Unmotivated staff?I can have them removed from the operating room. I haven’t quite figured out yet what to do with myself.

    http://online.wsj.com/article/…..stpop_read

  18. With Occupy Wall Street’s “redistribution” rhetoric running rampant, perhaps another way to illustrate the enormity of America’s trillions of new debt is this: even if the government were to confiscate the net worth of the entire Forbes 400 list of richest Americans?people who create hundreds of thousands of jobs, as well as spin-off jobs and businesses?their combined $1.5 trillion of wealth would barely cover the forthcoming $1.2 trillion debt-ceiling increase.

    Still, despite the vastness of the nation’s debt crisis, as recently as this morning, New York Times columnist Paul Krugman dismissed “debt worriers” as being unduly influenced by “people who get their economic analysis from the likes of the Heritage Foundation.”

  19. Redistributing jobs to third world. Foreseen…not unintended…something something.

  20. I would purely love to see an analysis of what the debt service will look like when we return to the historical average interest rates for US debt.

    Its a complicated question, what with rolling over existing debt to new rates, etc. Assume that “out-year” spending reductions don’t happen (they won’t), we revert to the norm in, say, three years, and debt as it rolls over will do so at the average rate, etc.

    Ms. de Rugy? This sounds like something for you. It has “frightening graph” tattooed all over it.

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