Medicaid Expansion

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anonymous_coward
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"It's also worth noting that

"It's also worth noting that there's evidence that health care for the lowest income groups costs more than for the highest groups, suggesting that factors other than paying for access drive health results."

Do you have a source? I'm not doubting the results, but I think this statement could be taken out of context and run with in different directions by some.

anonymous_coward
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@Melvin:

@Melvin:
"That's a broadly non-specific assertion.....not far off from things like "fair-share."

"Equal people aren't free; free people aren't equal."

None of these policies exist in isolation; every choice affects things more broadly....you know, the law of unintended consequences.

Give kids their parent's health policy til age 27? Hey...why get a job! Suddenly employers can't find workers...."

Sorry, I'll clarify... I'm definitely not saying people should be equal. And I do believe (as I stated above) that wealthy people should have access to better health care than poor people - in the same way that they have access to yachts and Lamborghinis.

What I am saying is that we as a nation should strive to provide the same opportunities for everyone. If you don't have access to a school with at least a basic level of education in a safe environment, then you're going to have a very difficult time becoming a doctor or lawyer.

If you can't buy food or put a roof over your children's heads because you've been bankrupted by an operation (for example, let's say you're a blue collar worker and you tear your ACL, which you need to have repaired in order to work), then your children will have a significantly reduced ability to dig themselves out of poverty.

TL;DR: I don't mind poor people being poor, what I do mind is stacking the deck against them.

The parent's health policy is supposed to help people be covered so they can go to school.... but again I would suggest this is more of a middle-class tax cut than helping the poor.

anonymous_coward
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@Economike:

@Economike:
"Matt -

How do you know that wealth is becoming increasingly concentrated?"

This is pretty well established by most measures (jini coefficient, etc.), at least in the U.S.

I think if you take a global view (including China/India/Pakistan) it might not be the case, but it's certainly the case here.

anonymous_coward
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@Economike:

@Economike:
"So let's decide. Are any changes in the distribution of wealth necessarily due to corruption? If you want to discourage corruption do you punish honest capitalists with taxes on all wealth?

What if demographics (e.g. increase in proportion of retirement-age citizens, or assortive mating) also drive concentration of wealth? Or other trends (how about increasing returns to skills?) besides government policies?

Is there a difference between policies that reward corruption and policies that reward the creation of wealth?"

Most economists would agree that the increase in wealth inequality is a result of globalization and automation. (The folks here would point to the Clinton globalist policies.)

Personally, I don't think that the globalist policies that have created wealth are a problem, but I do think that it's a mistake to think that these people have increased their wealth to astronomical levels due to ingenuity and hard work. Sure, some of their wealth is a result of smarts/luck/hard work, but there is a huge extra amount of wealth that has nothing to do with their efforts and everything to do with technological automation and cheap Asian labor.

Economike
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Here it is, anon.

Here it is, anon.

Yes, undoubtedly it could be taken out of context.

http://www.arnoldkling.com/blog/health-spending-negatively-correlated-wi...

Economike
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Anon -

Anon -

"This is well established ..etc" doesn't entirely satisfy my curiosity. Are we talking about shares of increasing wealth? Gini, as I think you meant, is an income/consumption measure, not a wealth measure per se.

My intuition, for what's little it's worth, is that wealth (in the U.S.) is increasing, with a larger proportion of the increase going to the relatively wealthy. If that's what we mean by increasing concentration, OK. But if we're talking about concentration as a zero-sum game, then we're misleading ourselves.

Of course, it's always a question what sort of effort creates wealth - hard work versus good timing. What policy preferences ensue? Tax the lucky and leave the diligent harmless?

anonymous_coward
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Fascinating. I'll definitely

Fascinating. I'll definitely dig into it more, but at first glance, it's worth noting that the source of the source (Katera) finds that overall spending is higher for poor people (a finding that by itself is counter-intuitive), and then notes that poor people are less healthy (more or less well established).

However, there's no indication of what "poor" means. It could be that poor people are those on Medicaid, and so they end up spending more because it's free (as we have found from the results of the Oregon Medicaid experiment)... or, it could mean that poor includes those that don't qualify and go to the ER.

Sadly, the original paper seems to unavailable... I tried the google docs link but it failed.

anonymous_coward
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@Economike:

@Economike:

""This is well established ..etc" doesn't entirely satisfy my curiosity. Are we talking about shares of increasing wealth? Gini, as I think you meant, is an income/consumption measure, not a wealth measure per se.

My intuition, for what's little it's worth, is that wealth (in the U.S.) is increasing, with a larger proportion of the increase going to the relatively wealthy. If that's what we mean by increasing concentration, OK. But if we're talking about concentration as a zero-sum game, then we're misleading ourselves.

Of course, it's always a question what sort of effort creates wealth - hard work versus good timing. What policy preferences ensue? Tax the lucky and leave the diligent harmless?"

Well middle and lower class wages have been pretty stagnant over the past 2 decades (worse if you account for rising health care costs), and if you just look at GINI coefficients, overall wealth allocation has skewed in favor of the wealthy as well.

(FWIW, part of latter is b/c of loose monetary policy which I think no one here really likes, but hey, could be wrong.)

It's also worth noting (but I admit just anecdotal evidence) that Trump's rise and the general revolt against globalism is largely a result of weak income/wealth growth among the lower middle class.

This group typically is responsible enough to hold a job but it's a working class job, and is generally white and lives in the middle of the country.

If this group of people were happy with their wages and wealth, we wouldn't be seeing the kind of Trumpy popularity that we have seen over the past 18 months.

You can't really say that the whole pie is growing proportionally if such a large chunk is so dissatisfied.

Economike
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A few posts ago I entered the

A few posts ago I entered the conversation to challenge an implicit notion that increasing "concentration" (in reality, increasing proportion) of wealth was prima facie evidence of corruption, or would somehow lead to corruption. My point is that tax policies aimed at discouraging wealth are not equivalent to discouraging corruption. (Quite the opposite, but that's a post for another day.)

Regarding income, I think the "stagnant wages" story is part of a dystopian narrative that explains "inequality" as a zero-sum transfer of income from the middle-class to the rich. However, I don't think one needs to agree with this to admit that wages - and, more important, income - have not "stagnated."

Regarding dissatisfaction, I think a lot of forces are in play, many of which are structural and demographic - and therefore outside of the injustice narrative that cries out for corrective government action, such as higher taxes on the rich. For better or worse (I say better) the world is changing in ways government can react to only as a dead weight. I'm thinking of phenomena like returns to skill, labor factor equalization, assortive mating (educated people marrying each other), and an aging population in the developed world. The world economy no longer insulates the American laborer as it did a couple of generations ago, and the American government has no power to legislate productivity by fiat. Note that both Trump and Sanders calculated their appeal with anti-foreign and anti-market malarkey.

There are many things to dislike about parts of the current tax bill, but the idea that its centerpiece reduction in corporate income tax is a giveaway to the rich is naive and mistaken.

Mike G
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The rich get richer and the

The rich get richer and the smart play the old and new tax code and pay less taxes than the chump.

What is humorous is didn't this whole Trump tax plan begin as tax reform and then it became a tax cut. Well in DC no one wants tax reform, but they always are willing to vote for tax cuts. NO spending cuts mind you, no politician wants that, because government has become the biggest employer in town, that gets them votes, so they have job security.

Without spending cuts, tax cuts mean nothing other than an increase in the debt that no one cares about, I mean no one. Ahh they will wax poetic about how the tax cuts will pump all this wealth into the economy and the tax revenue will increase etc. But that is all bullshit. Where has the debt gone since reagan, clinton and beyond? Always higher, to where it now takes doubling the national debt in 8 years to create a 2% gdp rate.

What do we expect from the GOP plan, because I doubt it was the Trump Plan, they got that guy on the ropes, he just goes along? three years later after this gets law, deficit 30 trillion?

It's always a sugar deal that never produces anything but more debt. Cut Spending, slash MIC spending, get rid of federal agencies? none of that is going to happen, same ole same ole

Course they always throw you some sugar to make you think its a deal.

http://www.schiffradio.com/swamp-2-people-0-episode-310-p/

Peter Schiff take on the senate GOP tax plan.

For those that don't know the Schiff name his ole man died a prisoner of the Federallies at 80 plus, with an armed guard present, because he dared to publish his truth about our monetary system and taxes.

anonymous_coward
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@Economike: "A few posts ago

@Economike: "A few posts ago I entered the conversation to challenge an implicit notion that increasing "concentration" (in reality, increasing proportion) of wealth was prima facie evidence of corruption, or would somehow lead to corruption. My point is that tax policies aimed at discouraging wealth are not equivalent to discouraging corruption. (Quite the opposite, but that's a post for another day.)"

This is a fair point.

Regarding income, I think the "stagnant wages" story is part of a dystopian narrative that explains "inequality" as a zero-sum transfer of income from the middle-class to the rich. However, I don't think one needs to agree with this to admit that wages - and, more important, income - have not "stagnated."

Well, if the overall pie is growing, and your slice isn't growing at the same rate, then it really is a zero sum game where the wealthy are stealing from you.

"Regarding dissatisfaction, I think a lot of forces are in play, many of which are structural and demographic - and therefore outside of the injustice narrative that cries out for corrective government action, such as higher taxes on the rich. For better or worse (I say better) the world is changing in ways government can react to only as a dead weight. I'm thinking of phenomena like returns to skill, labor factor equalization, assortive mating (educated people marrying each other), and an aging population in the developed world. The world economy no longer insulates the American laborer as it did a couple of generations ago, and the American government has no power to legislate productivity by fiat. Note that both Trump and Sanders calculated their appeal with anti-foreign and anti-market malarkey."

Well my argument for higher taxes on the wealthy were not so much a call for righting an injustice but rather that an increase in wealth due to structure changes is not meritocratic, and thus free to be taxed.

If you work hard and smart and take risks you should expect to be rewarded... but if you get wealthy because of structural changes and because manufacturing is now super cheap b/c of globalization, should you really expect to get rewarded?

"There are many things to dislike about parts of the current tax bill, but the idea that its centerpiece reduction in corporate income tax is a giveaway to the rich is naive and mistaken."

I never made that argument, since the burden of corporate taxes isn't necessarily shouldered by the wealthy... though how that is shouldered is highly dependent on aggregate demand. If there isn't sufficient aggregate demand to drive hiring, then wages will stay flat and it'll just increase corporate profits (which mostly benefits the wealthy).

johnw
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Corporations don't pay taxes

Corporations don't pay taxes,consumer do......

Watcher
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I just heard a view from Dan

I just heard a view from Dan Bongino who was sitting in for a talk show host. Bongino said that Liberal complains about how this "tax cut" will increase our deficit, remind them that after every tax cut in recent decades, the taxes received by the Federal government actually went up in succeeding years. The deficit was caused by continued over spending...not the tax cuts.

I have not researched this yet but will.

Economike
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"Well, if the overall pie is

"Well, if the overall pie is growing, and your slice isn't growing at the same rate, then it really is a zero sum game where the wealthy are stealing from you."

anon -

Let's step back and consider the terms we're using. Keep in mind that we're talking about proportionate distributions. (Of household wealth, or earnings, or whatever, in deciles, quintiles, etc.)

So if we're thinking about an increase in total wealth that disproportionately accrues to the wealthy, we're imagining people moving among various cohorts. Suppose, for example, that the household wealth of the Smith family increases so that the Smiths move from the fourth quintile to the fifth quintile in household wealth. Do we conclude that the Smiths stole from someone? Since they moved from fourth quintile to fifth, perhaps they stole from themselves?

Also note in our example that the Jones family might have moved from the fifth quintile to the fourth without having lost any wealth. You will readily grasp that "stealing" is inapt in this context.

"If you work hard and smart and take risks you should expect to be rewarded... but if you get wealthy because of structural changes and because manufacturing is now super cheap b/c of globalization, should you really expect to get rewarded?"

The dilemma is - How do you devise a tax policy that distinguishes between the diligent and the lucky? All wealth-creation involves some risk and, therefore, luck. How do you tell the difference between licit risk-taking and illicit risk-taking? Do you expect the IRS to question taxpayers about how hard and smart they work in order to determine their tax rates?

"I never made that argument, since the burden of corporate taxes isn't necessarily shouldered by the wealthy... though how that is shouldered is highly dependent on aggregate demand. If there isn't sufficient aggregate demand to drive hiring, then wages will stay flat and it'll just increase corporate profits (which mostly benefits the wealthy)."

Doesn't this depend on why aggregate demand is insufficient? Don't recessions (falling demand) cause corporate profits to fall and disproportionately reduce both the incomes and wealth of the more affluent?

Mike G
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" The deficit was caused by

" The deficit was caused by continued over spending...not the tax cuts. "

AND there are no spending cuts in this bill nor will there be any from the beltway in the future.

So a deficit increase, and no one, I mean no one gives one hoot about it in the beltway. Fast track to 30 trillion

anonymous_coward
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@Mike: It's like you're the

@Mike: It's like you're the only sane conservative here

anonymous_coward
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@Economike:"Also note in our

@Economike:
"Also note in our example that the Jones family might have moved from the fifth quintile to the fourth without having lost any wealth. You will readily grasp that "stealing" is inapt in this context."

Ok, so perhaps the term stealing was a bit harsh. Nonetheless, if the economy is growing and everyone stays in their same quintile, if all the new wealth in the economy goes to the top 1%... what do you call that?

The dilemma is - How do you devise a tax policy that distinguishes between the diligent and the lucky? All wealth-creation involves some risk and, therefore, luck. How do you tell the difference between licit risk-taking and illicit risk-taking? Do you expect the IRS to question taxpayers about how hard and smart they work in order to determine their tax rates?

Ok let's take a step back... you can have licit risk-taking but still be taking advantage of structural changes that favor you.

Let's say that you own a company (or you are a rich person that owns stock in a company) that moves its manufacturing to China. This is something you can do because of increase manufacturing capacity in China, as well as a more efficient global transport system and an open trade deal with China.

Your profits as a company (and thus your profits as a shareholder) go up while the average wage of your workers is stagnant or drops, because you don't need American workers to make stuff any more, you can get Chinese ones to do it for 1/10th of the price.

You as a CEO didn't work any harder or were more clever, you just had a big fat amount of money handed to you and your shareholders because of the aforementioned changes.

So you didn't steal (again, I admit that was harsh), but you certainly don't deserve the big increase in wealth.

"I never made that argument, since the burden of corporate taxes isn't necessarily shouldered by the wealthy... though how that is shouldered is highly dependent on aggregate demand. If there isn't sufficient aggregate demand to drive hiring, then wages will stay flat and it'll just increase corporate profits (which mostly benefits the wealthy)."

Doesn't this depend on why aggregate demand is insufficient? Don't recessions (falling demand) cause corporate profits to fall and disproportionately reduce both the incomes and wealth of the more affluent?"

Not necessarily - recessions often favor the wealthy because they have the resources to buy assets at deflated prices, whereas the poor often have to sell at deflated prices in order to survive.

Economike
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"Ok, so perhaps the term

"Ok, so perhaps the term stealing was a bit harsh. Nonetheless, if the economy is growing and everyone stays in their same quintile, if all the new wealth in the economy goes to the top 1%... what do you call that?"

I call that a miracle. Seriously, if the 1% gets all the new wealth then, by definition, not everyone stays in the same quintile. Remember that quintiles are proportions, not individuals.

"You as a CEO didn't work any harder or were more clever, you just had a big fat amount of money handed to you and your shareholders because of the aforementioned changes."

I disagree. The decision to move production to China was a decision among many possiblities. It was a risk, not a slam dunk. You may think that decision was somehow unethical, but it was a decision made in search of profit for shareholders. You seem to think "work harder" means "make decisions I agree with." Let me ask again, How do your ideas about good risks and bad risks translate into practicable tax policy?

"Your profits as a company (and thus your profits as a shareholder) go up while the average wage of your workers is stagnant or drops, because you don't need American workers to make stuff any more, you can get Chinese ones to do it for 1/10th of the price."

You are missing the basic benefits of trade, which trend toward greater productivity. Your reduced costs (as a producer) mean reduced costs for consumers, freeing their income for more-valued uses. As a matter of basic economics, you can't count the reduced income of your company's employees as a cost without accounting for someone else's gain. In the aggregate, Americans can purchase goods from China only by producing goods of value to offer others in international trade. Otherwise, no trade. Imagine that instead of using Chinese labor, you replaced your American workers with robots. If your profits increased, do you think that would be "a big fat amount of money handed to you" that you don't "deserve?"

"Not necessarily - recessions often favor the wealthy because they have the resources to buy assets at deflated prices, whereas the poor often have to sell at deflated prices in order to survive."

Yes, but that's beside the point that recessions tend to reduce aggregate profits and wealth in proportion to earnings.

anonymous_coward
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"I disagree. The decision to

"I disagree. The decision to move production to China was a decision among many possiblities. It was a risk, not a slam dunk. You may think that decision was somehow unethical, but it was a decision made in search of profit for shareholders. You seem to think "work harder" means "make decisions I agree with." Let me ask again, How do your ideas about good risks and bad risks translate into practicable tax policy?"

More often then not, one company takes the risk, and the rest wait to see if it works and then all follow. Most of them are profiting off the first guy's risk taking. (Generally speaking, most managers are risk averse and are there to not screw things up.)

I don't think it's possible to say, ok company A took a real risk and "deserves" its increase in wealth and company B was just taking advantage of systemic changes.

But what you can say is that *all* companies have taken advantage of automation, computerization, and offshore manufacturing, whether it be directly (in the case of a company moving its manufacturing offshore, or indirectly, by a company that buys domestically but buys from the company that did the offshoring). The ones that took additional risk received additional gains.

So it's very fair to just tax all wealthy people an additional amount, since their gains are a result of an overall increase in corporate profits across the board;.

"You are missing the basic benefits of trade, which trend toward greater productivity."
I'm not arguing against free trade, just arguing that we should help redistribute the fruits of those benefits across the 5 quintiles. Obviously historically free trade has resulted in increased wealth but without a major disruption (WW1, WW2) those fruits have historically fallen mostly into the hands of the wealthy.

Economike
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Well, this is progress. We

Well, this is progress. We agree that we really can't write tax policy that places a greater burden on "bad risk" capitalists than "good risk" capitalists.

Now we are speculating that the tax burden on wealth ought to increase, presumably in appeal to fairness, when corporate profits rise too far. Somehow, wealthy people become less deserving when luck, or globalization, or some other trend increases their share of wealth to some unspecified degree. Because they stole it (from an unspecified someone) or caused something not as harsh as stealing.

So, one asks, how does one write a tax policy to separate excessive profit from permissible profit? (Hmmm. This sounds reminiscent of the question how to separate good risk from bad risk.) Besides, in taxing the wealthy, how do we know that those tax receipts will somehow result in more wealth for others?

I also wonder, since we are speculating that the increasing concentration of wealth is a "problem," whether the "problem" is not "the wealthy have gained too much" but that "the non-wealthy haven't gained enough." In this light, we might seek political remedies that would reduces barriers to wealth-building by the non-wealthy.

I can't come up with an answer to these confusing questions. If we set out to correct the distribution of wealth, how do we first determine what the correct distribution should be? And how much of that wealth will leak out of the trough on its trip through Washington on its way to the non-wealthy?

I suppose, though, that if "we" are smart enough to "help redistribute" the benefits of free trade, "we" can also devise such a policy to "help redistribute" wealth. Who are "we" and who needs our "help?"

Bruce Libby
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All this debate about

All this debate about various economic stuff is great and shows how smart you guys are,but so far the answer to the biggest question alludes us .
How are we going to pay for it ???

Toolsmith
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If the premise that economic

If you accept the premise that economic activity has been suppressed by a high tax, then no need. Income will increase a result, as it did for the Reagan tax cuts. Lower corporate tax becomes lower prices for domestically produced goods, increasing activity and creating more jobs... which increases income taxes by moving idle workers back into the workforce and reducing benefit payments as a result.

For this to work, of course, spending has to be held in check. That's the real problem. Spending can easily erase any benefit.

Economike
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Bruce -

Bruce -

I think Toolsmith is right. This tax reform probably won't result in decreased government revenue.

But neither will this tax reform make much of a dent in the federal government's unfunded liabilities: its spending commitments.

Bruce Libby
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Ok

Ok
Now expansion in Maine is a unfunded liability.
Any Fed. contribution like wise over its' promised existence.

Given our population numbers demographics etc. how does it get paid for ( just our states share) assuming a two year budget cycle.

Economike
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Bruce -

Bruce -

That's the essential problem of medicaid expansion, isn't it?

Too bad that the referendum question didn't include a requirement for each voter that a "yes" vote had to be paid for with a cash contribution to Maine Revenue Services.

Bruce Libby
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Thank you Economike.

Thank you Economike.

Prediction, this will become the biggest " I told you so fairly soon", probably by the 2nd part FY20. !

johnw
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Wow you guys just don’t get

Wow you guys just don’t get it.The cost of Medicare expansion will be a non starter ALL of those who support it in the business community and those in the private sector are going to voluntarily cough up the extra dough needed to fund this , because it is the right thing to do,there there’s problem solved.....

Bruce Libby
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Which guys johnw ?

Which guys johnw ?

johnw
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Bruce come on I was being

Bruce come on I was being sarcastic......

Bruce Libby
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No problem just checking

No problem just checking johnw.

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