It’s amazing what America could do with the money the rich hide overseas

[Independent voter]

1. Feed the poor, $80 billion

2. Pay the troops, $116 billion

3. Send every kid to preschool $90 billion

4. Give working families cash $6 billion a year

[Deleted]

Change America to World

[Skroe]

THis is somewhat disingenuous (the Washington post graph, not you Hubcap)

If $124 billion annually is hiding over sees in unpaid taxes is a drop in the bucket versus the primary drivers in budget growth, which is Medicare (mostly) and Medicaid (less, but more than Social Security or anything else).



Like I appreciate what point you're trying to make, but with all due respect, it's same kind of political chaff as "going after pork" or "going after government waste particularly at the EPA" or silly things like that.

In the end, you save tens, maybe a hundred billion dollars. Meanwhile the big three will have grown by $200 billion in the 5 years it took you to get that reform passed.

The typical retort is "every little bit helps". Well no. Not in this case. Not when Healthcare squeezes out a larger percentage of government spending every two years than any amount of reform of other parts of government saves. No amount of "every little bit" adds up to the monster of Medicare.

Medicare costs need to be tackled head on. Talking about anything else - taxes (which would merely excuse paying ever-growing sums), defense, discretionary spending - is just putting off the fact that one day, there must be a reckoning on the cost curve of health care costs insofar as what government pays.

The problem is no politician wants to tell grandma that their pills are squeezing out other things the government is supposed to be doing.

This is why I harp on about Japan's model. Japan has 127 million people. It's national healthcare service has the government cover 70% of costs while patients cover 30% of costs (with a monthly cap relative to your income so as to not ruin you). For 127 million people, it costs $2873 per capital, 8.5% of GDP and about $310 million per year. Scaled to the US with similar numbers, the US would spend about $1 trillion on Health Care in its federal budget for 320 million people at about $3000 per capita.

But here's the rub... it would replace Medicare, most of Medicaid, and state-level spending on healthcare as well. Put together, the country spends $1.5 trillion per year on Healthcare.

http://www.usgovernmentspending.com/...ending_10.html



And there you have it, adopt a Japanese style system, and I just got you $500 billion a year to play with. And I fixed the cost curve because in Japan, the government sets the rates and they are low.

Sure, let's go after tax evaders. And while we're at it, let's zero all deductions and simplify the tax code. But let's be clear: what the government to do more? Slay the dragon that is Medicare and Medicaid. We solve that, this country can do so much more without raising taxes a dime.

[shadowmouse]

It isn't OP's fault, but I get a bit honked with these stories. It is increasingly a nightmare for expats to prove they aren't in possession of fat secret bank accounts and hidden income.

http://www.investopedia.com/articles...nk-account.asp
http://www.theguardian.com/money/201...-bank-accounts
http://www.ibtimes.com/americans-abr...s-play-1517032

In the meantime, a breakout of why there seem to be comparatively few Americans in the Panama Papers points out that it is easy for America's wealthy to hide their wealth in similar setups within the US using Delaware and Nevada as a base.

http://www.theatlantic.com/national/...nevada/476994/
http://www.bbc.com/news/world-us-canada-35966612

[Auxora]

The problem there is that this oversimplifies medical costs in the US compared to the rest of the world on an individual service basis. For example, the cost of an MRI in the US on average is $1145, in Australia it's only $345, and in Switzerland $138. A c-section is about 4x more in the US compared to these countries. A heart bypass or angioplasty is over *5x* more in the US than the Netherlands. Way too many people assume high overall healthcare costs in the US are just due to people being out of shape which isn't the real cause and shifts blame to the victims. The true cause that doctors, hospitals, pharmaceutical companies (and lawyers) don't want to admit is medical costs being way, way, higher in the US than they should be. The answer isn't cutting Medicaid and Medicare for poor and elderly people, that's wrong on way too many levels to even consider. The answer is fixing healthcare costs and bringing them in-line with the rest of the world.

But, that's the problem which comes down to greed. You've got medical malpractice lawyers and huge attorney's lobbyists groups that fight any change in laws to reduce or cap malpractice awards. In some states doctors spend half their income on malpractice insurance. And guess where those costs all get passed down to either for massive malpractice awards or malpractice insurance. Same for pharma companies charging insane pill prices that go way beyond r+d costs. And same for healthcare insurance companies. All get their piece of the pie, and they all act innocent...but all of that combined is why relatively common procedures cost 3-5x+ more in the US than in other countries. Until that changes that piece of the pie is just going to keep getting bigger since pouring more money into Healthcare doesn't solve the underlying causes. Other countries have caps on lawsuit awards and things to prevent the ambulance chasing monster that's been created.

[Easo]

Change America to World

This.
And the Panama leak just enforced that a lot.

[Vayshan]

No more brainless uninformed comments that money spent on scientific experiments should be used to feed the starving children instead. Because spending money on science is a waste, apparently.

[Skroe]

The problem there is that this oversimplifies medical costs in the US compared to the rest of the world on an individual service basis. For example, the cost of an MRI in the US on average is $1145, in Australia it's only $345, and in Switzerland $138. A c-section is about 4x more in the US compared to these countries. A heart bypass or angioplasty is over *5x* more in the US than the Netherlands. Way too many people assume high overall healthcare costs in the US are just due to people being out of shape which isn't the real cause and shifts blame to the victims. The true cause that doctors, hospitals, pharmaceutical companies (and lawyers) don't want to admit is medical costs being way, way, higher in the US than they should be. The answer isn't cutting Medicaid and Medicare for poor and elderly people, that's wrong on way too many levels to even consider. The answer is fixing healthcare costs and bringing them in-line with the rest of the world.

But, that's the problem which comes down to greed. You've got medical malpractice lawyers and huge attorney's lobbyists groups that fight any change in laws to reduce or cap malpractice awards. In some states doctors spend half their income on malpractice insurance. And guess where those costs all get passed down to either for massive malpractice awards or malpractice insurance. Same for pharma companies charging insane pill prices that go way beyond r+d costs. And same for healthcare insurance companies. All get their piece of the pie, and they all act innocent...but all of that combined is why relatively common procedures cost 3-5x+ more in the US than in other countries. Until that changes that piece of the pie is just going to keep getting bigger since pouring more money into Healthcare doesn't solve the underlying causes. Other countries have caps on lawsuit awards and things to prevent the ambulance chasing monster that's been created.

I actually directly mentioned government mandating cost of services. That simply has to happen. I agree with you. However if there is truly cradle-to-the-grave universal Healthcare in this country for all citizens, Medicare and Medicaid as we know them become obsolete. They'd be replaced by a 'National Health Service.'

I certainly don't want to deny healthcare to the old or poor. But in a reformed healthcare system, they shouldn't have a special program. It would be unnecessary (to a degree, those who couldn't pay their 30% share because of near-zero income would need assistance).

Costs of services, as you say, are 100% the problem. And Japan's non-market based solution is the correct answer. Our problem is that we keep rationalizing the same failed approach because we're being intrinsically dishonest about the failure of the market to control costs in this case. Apparently market forces working merely 99 times out of 100 isn't acceptable in our perfect philosophical universe or something.

I mean Japan's is the model:
- All healthcare providers run as non-profits, managed by doctors
- Government covers 70% of cost, patients 30% of costs, with monthly premium scaled to annual income.
- Government sets the rates every 2 years. If providers get caught cheating, rates are cut even further.
- Supplementary private health insurance only to cover the co-payments or non-covered costs


But no. Instead we engage in contortions and one day will treat Universal Healthcare like some great human achievement like going to the Moon, when really we're just going to be collecting our 87th place Ribbon of Participation award.

[Felya]

The problem there is that this oversimplifies medical costs in the US compared to the rest of the world on an individual service basis. For example, the cost of an MRI in the US on average is $1145, in Australia it's only $345, and in Switzerland $138. A c-section is about 4x more in the US compared to these countries. A heart bypass or angioplasty is over *5x* more in the US than the Netherlands. Way too many people assume high overall healthcare costs in the US are just due to people being out of shape which isn't the real cause and shifts blame to the victims. The true cause that doctors, hospitals, pharmaceutical companies (and lawyers) don't want to admit is medical costs being way, way, higher in the US than they should be. The answer isn't cutting Medicaid and Medicare for poor and elderly people, that's wrong on way too many levels to even consider. The answer is fixing healthcare costs and bringing them in-line with the rest of the world.

But, that's the problem which comes down to greed. You've got medical malpractice lawyers and huge attorney's lobbyists groups that fight any change in laws to reduce or cap malpractice awards. In some states doctors spend half their income on malpractice insurance. And guess where those costs all get passed down to either for massive malpractice awards or malpractice insurance. Same for pharma companies charging insane pill prices that go way beyond r+d costs. And same for healthcare insurance companies. All get their piece of the pie, and they all act innocent...but all of that combined is why relatively common procedures cost 3-5x+ more in the US than in other countries. Until that changes that piece of the pie is just going to keep getting bigger since pouring more money into Healthcare doesn't solve the underlying causes. Other countries have caps on lawsuit awards and things to prevent the ambulance chasing monster that's been created.

The issue with Medicare and Medicaid is actually very simple. They cover the highest risk pools, which result in highest cost. Most first world countries have those costs balanced by low risk pools, making price nagotions on per patient basis a far lower avarage. In US, our low risk pools are the exclusive property of insurance companies. This means that in per patient basis, government simply cannot afford the same prices as the rest of the world.

Then it gets complicated. Other than some issues you mentioned, there is also strange patents. I forget the name of the procedure, but every single birth in U.S. has to pay an added cost to a patent related to it. The procedure it self is now out dated, but our courts have a stablished that modern technique wouldn't exist if not for the idea that preceded it. As a result, we pay extra for a technique that is no longer practiced.

In the end, government's cost and laws that surround it, are pretty much a snake eating it's own tail. There has never been a government healthcare plan voted on that didn't double down on this idea. Our systems or rhetoric discouraged preventative care. It's fear of government discourages bringing lower risk pools to current Medicare. Our fear that logical patent association would discourage inovation.

It's depression and disheartening, because the current U.S. culture has confined it self into a corner and there is nothing we can do about it. If you tackle one issue at a time, like ACA tried with mandating insurance to get everyone insured, the other problems end up ruining it. Everyone on insurance is great as an idea, but it compounds the problem with high risk pools. You tackle patents, the odds are prices wouldn't drop because insurance companies have no incentive to drop them. Much like current oil price drop having no impact on general cost of goods. You tackle preventative care, without significant cap on insurance profits and administrative costs like advertising, you end up with an immidiete price spike, because future gains are irrelevant to insurance company quarterly earnings reports.

Until people realize that universal coverage or single payer are a good thing, not because it's just socialist or the idea of it being free, but because unmitigated healthcare is nothing, but extortion. Nothing will change... We can continue making small steps, but those will only make other areas problematic. We are stuck in a loop where the sort of change needed simply does not have government or people's support, while relatively small steps make other issues far more visible. You end up playing whack a mole...

[Shadowferal]

It's depression and disheartening, because the current U.S. culture has confined it self into a corner and there is nothing we can do about it. If you tackle one issue at a time, like ACA tried with mandating insurance to get everyone insured, the other problems end up ruining it. Everyone on insurance is great as an idea, but it compounds the problem with high risk pools. You tackle patents, the odds are prices wouldn't drop because insurance companies have no incentive to drop them. Much like current oil price drop having no impact on general cost of goods. You tackle preventative care, without significant cap on insurance profits and administrative costs like advertising, you end up with an immidiete price spike, because future gains are irrelevant to insurance company quarterly earnings reports.

Until people realize that universal coverage or single payer are a good thing, not because it's just socialist or the idea of it being free, but because unmitigated healthcare is nothing, but extortion. Nothing will change... We can continue making small steps, but those will only make other areas problematic. We are stuck in a loop where the sort of change needed simply does not have government or people's support, while relatively small steps make other issues far more visible. You end up playing whack a mole...

We do agree on this...
The ACA would have made more sense if a Single Payer Option was part of it. But since Insurance companies did help write that shit...it comes across smelling just what it is; shit.

[ranzino]

Dont be silly, you can still evade US taxes by moving to another country and apply for citizenship there. And the very rich will just do that.

[Shadowferal]

Dont be silly, you can still evade US taxes by moving to another country and apply for citizenship there. And the very rich will just do that.

Until they find out that the taxes they have to pay out are far higher..

On another note, dual citizenship is no protection here in the US, where all of your assets can be legally seized just for that fact alone.

[Independent voter]

US taxes are low in comparison to other Western nations. That fact that some of our citizens hide their money away even then shows that they are ingrates.

In Nevada where I live it is easy to create a corporation and the annual fees are low, I'm sure Delaware is the same. I've heard that you can start a business in Delaware over the phone from anywhere in the world if you have a credit card, takes about an hour.

[Skroe]

US taxes are low in comparison to other Western nations. That fact that some of our citizens hide their money away even then shows that they are ingrates.

In Nevada where I live it is easy to create a corporation and the annual fees are low, I'm sure Delaware is the same. I've heard that you can start a business in Delaware over the phone from anywhere in the world if you have a credit card, takes about an hour.

I started my first business when I was 17 with a couple of documents and a $200 check. In Massachusetts.

It *should* be that easy. Putting up more regulation and barriers will strike against the entrepreneurial spirit that allows a teenager to start a company. If that means tax evasion as a downside by abusers of the system, small price to pay in my opinion. We should be a country that has low barriers to encourage people to be entrepreneurial, not one that fortifies systems the protect against the relatively few that are malicious.