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Bad Choices
If two people are dying from liver disease, one 25, the other 65, and there’s only one liver available for transplant, the old one dies.
There’s one economic variable that’s highly predictable; demographics. In all of the industrial countries the aging population is now weighing on the economic outcome. Japan was the first country to go down the tubes from this phenomenon. Europe is behind Japan, but rapidly catching up.
The US has a huge headache with an aging population. The number of oldsters is big, and rapidly rising. Add to the size of the aging US population the fact that the promises made to these people are enormous. Other countries, like Canada, Russia and even China are struggling with the problem.
The USA is in now in year three of what will prove to be a twenty-year mega-trend of an aging population. These facts have been know for a long time, I’m amazed that the US has been so slow to come to grips with the implications of what is clearly in our future. Thanks to the Fiscal Cliff debate, the financial implications of the graying of America are now being discussed, and Washington is talking about “solutions”.
So what are the solutions that the deciders are zeroing in on? Simple. The proposals (and what we will get) are extensions of the ages that benefits become available. Both sides have suggested that pushing out the age for Medicare and Social Security benefits for an additional two years is appropriate. The Administration has said it would be willing to do this; John Boehner (and other big Republicans) has flat-out insisted that it happen.
At some point in the next year (I don’t think this will be part of the fiscal cliff resolution) the eligibility changes will take place. The changes will be phased in over 10-15 years. When the ink is dry on the new laws, the bean counters in Washington will declare success. The end result will be a 3-4 year extension of the lives of both the Social Security and Medicare Trust Funds.
Where does this “fix” take the country? That’s easy to forecast. Older people will be forced to stay in the workforce for years longer. The retirement age will be pushed out, the benefit checks will also be smaller on a relative basis. (There will be cuts to inflation adjustments) Once again, the deep thinkers in D.C. are “okay” with making old folks wait for a few years for benefits; the thinking is that people live longer, so make them work longer.
My fear is that the solution to one problem is going to spill over and aggravate another problem. The fix on retirement benefits will cause a long-term erosion of youth unemployment. That outcome could prove more devastating than the aging problem.
Its not hard to find evidence that these big trends are already moving the needle. Last Friday’s NFP is a case in point. Zero Hedge has the details (Link) and (Link). This chart shows what happened in November. A disaster for those 22-54, the 55-69 group were the winners.
It wasn’t just November. Consider the changes since 2009.
What does a government do when it is faced with high youth unemployment? It sends them to school with borrowed money. This won’t work much longer:
This is the worst kind of whack-a-mole problem solving. Washington will take steps to address the fiscal consequences of the aging population, but those steps will create a multi-decade drag on what is already a serious problem.
We are far from the point where rules on transplants should apply to choices on economic policy, but we’re getting closer. The policy choices that are being made today are running counter to the rules on transplants. They favor old over young. We are a long way from being balanced on this issue; longer still toward policies that actually tip the scales to the next few generations.
If you asked the question, “How do we create opportunities for younger workers?” The answer would be to lower the retirement age. Create the opportunity for upward mobility. We are on a path 180 degrees in the opposite direction.
I don’t see a way around this. Demographic changes are powerful forces. The problem is we are on the third rung of a twenty-foot steep ladder, and we’re already making bad choices.
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You all are losing sight of the real problem!
The corporation, UNITED STATES OF AMERICA, has exempted itself from all GAAP rules of fiscal management. Proper accruals and timely reporting of the true condition of our country's finances would have woken people up many years ago.
America's politicians are just like Europe's
"We all know what to do, we just don't know how to get re-elected after we have done it."
-Jean-Claude Junker
Finally, I wish Bruce would remind his readers that Obama signed the 2011 Budget Deal.
If Barry was true to his campaign promises, he would have vetoed the expiration of Bush tax cuts for the NON-wealthy.
"only "fair" way out of this mess"
Jesus fucking Christ, FAIR?!? FAIR?!?
<head asplode>
Fair? I paid into SS for 1/2 a century.. Fair? Give me back the money with the UST rate per annum and I fend for myself. That is fair. I paid in as self-employed - just give it back. the govenerment hijacked the SS Trust Fund to finance the dregs and welfare type. If you spent all your income and did not save tough shit - the govrenment can give me all the UE payments I have made and NEVER drawn a penny on - six figures being syphoned off to the liar loan crowd.
This fucked up system continues to coddle the lazy, the bankster, cronies and the welfare society it created while it continues to punish the prudent. Let some of these asshole fail -
The governemnt borrowed money from the fund and paid interest on it - give me my "deposits" plus the interest earned. THAT IS FAIR.
BTW Bruce, I have a buddy who is a carpenter in his 50s - he is now looking to game the system - worked all his life but he looks around and sees too many people getting handouts so he is gonna do it too.
The money's gone. I'll have to live with that just like Madoffs clients have...but...Madoff's in jail. I know its asking a lot but if you whiney little youngsters feel sooo strongly about evil bankers and getting the raw deal, I'll go along. I'll let you off the hook, if.....you put the assholes in jail that robbed me! That should be FAIR right. Thats what you want is fairness right. Jail the assholes. And if they are going to means test SS, then they should be forced by law to call it what it is...WELFARE. All we really can ask for is a little justice, right? Because the money is GONE. And I'm beginning to believe that all of the money is gone, not just SS but all of it. The money in the bank is starting to feel like a deposit i made from a home equity loan. Like its not really mine because I don't dare spend it yet I know it is vaporizing before my eyes. The money is gone, we are just going through reconciliation now. The accounts will balance a zero.
How can it be you've paid FICA for 50 years and haven't yet learned that life isn't FAIR? Sheesh.
It's all really too bad, dude, but the money's not there. You were robbed. Go protest or something, vote for the guy who's going to cut Medicare/SocSec or vote for the guy who's going to raise taxes to keep making those payments, but don't expect a *check.*
eggs actly... it is that simple...
Don't forget, barring unlucky accident, you are going to get old too, Bruce.
I do support means testing and pushing the ages up. Simple math - we don't have enough inflow of bucks into the entitlement systems to handle anything more, and we ARE living and staying healthy longer as a species. The older workers are paying more in than the young due to higher salaries in the first place. The downside is that older people tend to consume less, they already have what they need, so their money tends to not stimulate demand as much.
The problem of unemployment isn't truly related to this. It's just that, particularly in this crash, companies found more efficient ways to get things done and need fewer workers to get the same production, or at least enough to meet demand, on almost everything.
Many places I've worked, heck, you think this or that guy is going to be a good hire, yet after awhile, you realize that the entire place would be better off without them (not even counting their pay - I mean they not only don't produce, they waste the time of others). Guess who got cut in the crash? Finally, an excuse to cut them without so much worry about litigation in labor laws.
Just pretend you're hiring right now and see what you get. Picture perfect resumes with everything in the response matrix checked off. Then you meet the guy, and he's a total loser. I know, because I have. Or you get a younger person who knows nothing, admits it, says they are willing to work hard, but...in practice, they break more than they make, and expect 6 months of pay to be trained, whereupon they leave. Immature, entitled jerks, many of them, and not super easy to detect before you get stuck with them. And oh crap, the cost of having an employee even if they do nothing - all those payments for unemployment, disability etc etc to the state regardless of the guy's actual value, and you have to put that unemployment money back should they get cut loose - you don't even gain by stopping paying them, because you can't stop, one way or the other.
So when I run a business, as I do now, it's all (sub)contractors.
And yes, I know all too many multi-millionaires who "depend" on that SS check and medicare, who would be utterly incensed if their bennies were cut, even though they'd still be better off than the norm. Charge someone for many years to pay in, and by golly, they are "entitled" to a payback, because they bought the lie that it's their own money coming back rather than the truth that what they paid in paid for their parents - as is stated in the law of all these pay as you go "entitlements".
Comprimise: Use zoning regulation to abate school taxes and simultaneously exclude certain socially supported medical services.
"How do we create more opportunity for young people?"
By more Federal Gov't tinkering, central planning and social engineering! Because it has worked so well in the first place!
if you can also tell me how to cool the planet, you got my vote. Messiah, sir...
Nuclear winter will cool the planet short term. It will also reduce the chance of manmade emissions over the longer term.
However, as the headline above notes, this would be one of the "Bad Choices."
You cool the planet by taking money from some countries and giving it to others.
That is the U.N. solution.
Such a lovely thought for a Monday. For the next fiscal stimulus we could just give one million dollars to each taxpayer over 55 provided they pay off all their outstanding debts and quit their jobs.
Would turn out swell I'm sure.
What's this? More "scared old man" shit from Bruce? Weak. That which cannot be sustained, won't be, same as it ever was. How about asking some real tough question asshole, like why everyone CONgress and government has 5x better healthcare than everybody else. why do these congressional critters get to keep that coverage for life? When they stop "working" that shit needs to end and they need to be kicked into the same pool with everybody else.
I agree with your comment, except I am not sure why you would vomit fire upon Bruce for making everyone aware of the problems.
First, everyone with half a brain is very much "aware of the problems" (especially those of us taking care of our own parents). This is a trading site, give us something we can trade for chist sake.
Second, bruce is starting to sound like the majority of the "whining populace" out there. Wah wah wah, cry me a fucking river, everyone is foolish to believe the any man-made organization or enterprise can somehow insure your well-being in an evironment where fraud is the status quo, this is simply beyond stupid.
Here's a novel concept, prosecute the fucking fraud, restore the rule of laws and contracts, and restore real consequences for bad behavior at all levels of society and all parts of society and the vast majority of this shit fixes itself. health care is no exception, if you make bad choices regarding your health (eat shit, get fat, smoke, drink, etc.) then don't expect those of us that made good health choices to pay for the resulting costs of your healthcare down the road!!!!
There are numerous "entitlement generations" now that feel that they are entitled to all the best healthcare, despite the choices that they made. Fuck them, wake me when everyone is ready to have an adult conversation.
Agree, Hang the elite power structure high on the wall for all to see; however, I hope you are planning on a long sleep...maybe like death.
Hang just one publically and I would bet that "markets" would rally immediately. This is about true price discovery and a functioning market in all sectors (including healthcare). The only way we get back to this is by allowing true "mark to market" pricing/valuation and real consequences for bad behavior. The bad business models, bad management, and bad folks should die and suffer the consequences as this is the only way true innovation has a chance to step into the market.
Could not agree more with you that America needs to take a bank CEO head, like angelo Mozzillo, would stop bad behavior more than a "10,000" page Dodd-Frank bill. Why a conservative does not run with this cause? The kleptocracy runs deep!
In america, the justice motto should read: "Equal justice for the poor and disenfranchised, so the rich can be free to rape and pillage the system" ( A little too long, but you get the point.)
Why isn't that happening in China.They hang a banker every now, and then ?
Does work in Muslim country's though.
The difference is interest.Muslim banks cannot charge it,so are equity partners in
ventures.
Of no revelance now,but if any of us survive to plan a new system,a thought to ponder,
Greened you.
It's actually worse than you say in some regards. If the government is listing your care as a cost center, then they have a vested interest in not allowing choice of how you live as well. And they're not always right.
Example, turns out margerine is worse for you than butter, but the gov was sure it was the other way. So, given they had the power - they'd have banned real butter. And bacon. And eggs.
I support the idea of choosing how one will live their own life, which logically means I don't support others having to pay for it - because that's their money, their life, to do with as they please. If I want to kill myself young, it's my option, and I don't expect you to pay for it.
It's the entitlement mentality (along with the other things you mention) that is the problem.
And asking them(congress critters) to account for just where all that FICA money went, because it damn sure wasn't put in a lockbox.
edit: see chubbar's post elsewhere in this thread!
A guy who ran for prez not long ago was making noise about putting the FICA contributions into some kind of lockbox, but the guy we ended up wanted to cut taxes and start wars instead. It's not like we didn't know what to expect.
The other bad choice:
35% of the population will be forced out of their traditional premium healthcare plan and be forced to make a choice in what the article states as:
"If two people are dying from liver disease, one 25, the other 65, and there’s only one liver available for transplant, the old one dies."
The other people who have crappy insurance or no insurance at all who will die in this situation being that they are 25 OR 65 will now be able to make a decision on the statement:
"If two people are dying from liver disease, one 25, the other 65, and there’s only one liver available for transplant, the old one dies."
SOS............the sheeple get fucked again.
Don't you worry though, the coveted health industry will surely rectify this problem by realizing the entire problem is $30hr nurses and nothing at all to do with $10,000 MRI's and $50million a year CEO's.
I must say I have to laugh at the idiots that work in this field that seem to think they aren't vulnerable to corporate greed. It's already happening in nursing homes as some of them fired the janitors so when you're not wiping asses you can clean toilets and windows.
NO ONE IS SAFE.
The one and only solution....WAR!
All developed, most BRIC, and many emerging countries have the above problem. War kills the youth in battle and war rations for civilians will kill the weak. A majority of the weak is the old folks.
The black plague preceded the renaissance. Life springs after a forest fire. First question is the nuclear option. Could the powers keep the nuclear genie in the bottle like thet kept the gas genie in the bottle during ww II. If not, second question, once nuclear button is pushed will the ecosystem support man after the nuclear reactions stop.
Probably. But not in the manner to which he has become accustomed.
Transplantation in the case of many victims should be considered a crime. It is time to spend more resources on alternatives. The rush to transplant can push the decision. Often those who are "harvested" may be salvageable and deserve a decent death.
The ethics of giving a transplant to a victim with a self inflicted disease such has cirrhosis, against salvaging someone who is a victim of tort defies logic.
Research is now coming into focus that would allow other remedies such as organ regeneration. There has been far to little research in accident salvage.
The most remarkable "salvages" are from the many battlefield traumas that would have been KIAs. There are many connections between medicine and war.
I would be dead today if not for knowledge learned first in the Korean War.
Specifically bowel resection.
Since the beginning of time, the one with resources (Money) wins. Typically, old guy has money relative to the young guy.
Bruce-thats been tried already (lowering retirement age) in the education and public employees segment-and we are left with massive benefot and pension liabilities.
The answer tehre is to retire people earlier but with less benefits. ie--people may actualy have to save on their own for a decent retiremnet-of course you cant tell people what to do in a republic, (notwithstanding evidence to the otherwise)
I've treated some patients with liver transplants.
It's a messy, complicated affair. Any number of things could go wrong during and after the procedure, and patients need to be on powerful immunosuppresants which have all sorts of side effects and increase the chance of infection. And the grafts can fail at any time.
Thus far in medicine the only form of organ transplantation that is somewhat successful is kidney transplant. But, patients can go on dialysis for quite some time anyway, so those with kidney failure can persist for some time regardless.
There's really only one way to make an organ transplant successful, and that's to harvest a patient's stem cells and grow a new organ. But we'll never actually get that, because we'd rather spend the money on banker bailouts and foreign wars.
Personally I think organ transplantation will eventually go the way of the dodo. It isn't paid for, and like many other things in modern medicine, is unsustainable. And then when we have no resources left, good luck because you'll be on your own and good health will be the most important thing you can have.
I have no idea how you have "treated some patients with liver transplants" but your knowledge/experience appears to be minimal, to say the least.
Obviously there is a huge amount of data on transplants gathered locally/nationally/internationally so data clearly varies.
"Any number of things could go wrong during and after the procedure".
This has to be one of the most "bleeding obvious" statements I've ever heard. The alternative to the surgery is death, otherwise it wouldn't be done. Approximately 10% of patients will have post operative complications in the first 12 months and die. Medication is unique to each patient, that is something that needs a few months to be titrated. Something which you don't state is that people who require transplants (of any organ) are weakened by something in the first place. Like hepatitis C, cirrhosis, cancer, PBC etc. There are plenty of people who go on to live to normal life expectancy but others may succumb to the disease they already had. Steve Jobs is a classic example, he had cancer, he wasn't likely to live much longer anyway, and he died of cancer, not from his liver transplant. Personally I doubt he would have even made it onto a transplant waiting list in the UK.
"Thus far in medicine the only form of organ transplantation that is somewhat successful is kidney transplant. "
Completely wrong. In the UK the life expectancy of a liver tx is 22 years, a kidney tx, 12 years. Your assessment of what is "somewhat successful" seems strange to me too. Extending somebody's life by 22 years is "somewhat successful"? Patients live perfectly normal lives, they aren't bedridden or live in hospitals. Regular bloodtests would be all that's needed. Some cancer patients can have their life expectancy increased by six months, and with a poor quality of life too, to me I class that as "somewhat successful".
"The graft can fail at any time".
Once the first 12 months of a liver tx patient has been passed, the likelihood of failure reduces greatly. Also, any persons organs can fail at anytime.
"patients need to be on powerful immunosuppresants which have all sorts of side effects and increase the chance of infection"
Once again the alternative is death though there are increasing numbers of patients who are being weaned off immunosuppressants completely. There are also very few side affects although there are more in US patients than UK patients because they are much more likely to be over medicated (your big pharma at work?).
All current lifespan projections are based from the 1950s onwards when transplants became routine. Cyclosporine is being phased out in favour of tacrolimus. Organ preservation techniques have improved, surgical procedures have improved, stem cell injection to improve graft success, all sorts of things have and are improving. Livers have been grown in petri dishes, tiny little things but research is moving quickly, a great deal of it in the US but as far as I know, it isn't funded by government spending.
The future for patients requiring transplants is improving, why would they not be? Because it isn't paid for and unsustainable? I don't understand your reasoning. As long as US medical insurance exists they will surely be available. Renal transplants save money, a new kidney is cheaper than long term dialysis. Pigs hearts maybe used in future transplants.. the poor in the US will be bound to suffer. Everyday I get a Google news alert for "liver transplant" stories and everyday I read of fund raising being done to support somebody in the US who needs a transplant. So in this respect I agree with others, in the US, money matters, in the UK it isn't allowed to.
You might find this interesting:
http://www.nhs.uk/Conditions/Liver-transplant/Pages/Who-can-use-it.aspx
The new transplant will be an asprin or maybe some pain pills. I laugh and almost want to cry seeing people post ideas here on how to fix things. The herd needs to be thinned out. Sorry - maybe you voted for this.
Sorry folks but it is over. As Bruce Willis might say "Sorry Pal" It is over. We are ***ed. People voted for this. Any oldsters or baby boomers who voted muslim deserve what is coming. The rest do not.
Or as Bill Paxton would say (and I stopped watching TV or Hollywood's sh*t after 2008 - I don't need the brainwashing):
"Game over!"
http://www.youtube.com/watch?v=dsx2vdn7gpY
Like the little kid says - they come at night - mostly.
You better get some ammo, food, shelter and hard currency. You better hope your health is pretty good too.
What's sorely lacking is total commitment:
https://www.youtube.com/watch?v=N1KvgtEnABY
>>>The herd needs to be thinned out.<<<
Care to step forward and be the first to volunteer?
I know I won't miss you.
At least volunteer to take out the trash for you mommy/wife or whoever.
I would be in favor of cutting all of these congressional pensions to the bone because they leave, after fucking everything up and move on to lobbyist positions or some high paying private sector jobs AND receive generous and unneeded governement pensions and benefits.
OK, so let me see if I have the proposal here straight. Lower the retirement age so that the elderly will leave the workforce and open an opportunity for a younger person. Right?
To which I say: You must be batshit-crazy to think that's how jobs are handed from old to young. Forcing somebody old out doesn't mean that same job gets handed to a younger person. Not now. Now we replace them with 3 hamburger-flipper jobs.
Go sell crazy somewhere else. My kids are already far enough in debt from other people's promises as-is.
Which reminds me.... anybody remember the movie "Logan's Run"?
I agree with Bruce's analysis but not his conclusion. Lowering retirement ages isn't what provides young people with opportunity. What gives them opportunity is a) lowering the cost of hiring a young person; b) lowering the costs a young person is burdened with so they can accept jobs with low starting pay and still make ends meet.
Soylent Green the reality..........
Anyone that knows anything about SS knows that this notion of changing the COLA to SS is such a canard because SS recipients aren't getting anywhere near COLA adjustments. The only time in the last 4 years there was an inflation adjustment was, coincedetally I'm sure was this eleciton year. Hmmm...
Or a congressional COL raise.
I've suggested before that making Medicare available at the same age as social security ( 62) could induce many people between 62 and 65 to retire. I retired at 58 only because I could keep my employer provided healthcare plan. Had I tried to buy private health insurance at age 58 the monthly payment would probably equal my monthly income. I'm sure there are many people in my position who would like to retire but cannot because they would lose their employer provided health insurance.
I think Bruce said Medicare costs about $11,000 per year to provide. Offering medicare to people at age 55 for $1000 per month or a bit less since their healthcare costs should be less, on average, than those over 65 might be way to induce a certain percentage of those between 55 and 65 to go ahead and retire.
I think it doesn't work. Lowering age limits would add to the federal cost for Medicare/SS. At least that is what the numbers say.
Far more importantly, it would greatly decrease profits of the healthcare industry:
http://www.nationofchange.org/some-better-targets-people-who-hate-government-1355153160
This was my favorite part--
>>>They're taking a lot more of our money than Medicare does. According to the Council for Affordable Health Insurance, medical administrative costs as a percentage of claims are about three times higher for private insurance than for Medicare. The U.S. Institute of Medicine reports that the for-profit system wastes $750 billion a year on waste, fraud, and inefficiency. As a percent of GDP, we spend $1.2 trillion more than the OECD average.
That's an amount equal to the entire deficit wasted on private medical care companies. One out of every six dollars we earn goes to doctors, hospitals, drug companies, and insurance companies. All good reasons to redirect our hatred. <<<
It's all about the profit margin. Delievering health care is secondary. They might as well be producing over-priced under-performing widgets.
Too bad the true co-op model only exists in a few places.
I would join a well-run health care co-op like they have in MN before I'd pay a dollar to for profit health care greedy fucks.
It will be cheaper to save the 65 year old because you will have to sustain his or her life for 40 fewer years!
And why would they want to extend earth destroying humans any longer than necessary.
They would be terminally conflicted but for the guiding hubris.
This is America; there is no "cheaper" only, "I want..."