I wonder if there is a niche to ameliorate this sort of thing by offering payday loans on insurance payouts.
The incentives are pro-social: insurance companies have an incentive to delay payouts, because their profits come from interest (they pay out more money than they take in) so the longer they can hold onto money the better. But that's reversed for this hypothetical loan issuer - they want to make the payout as fast as possible in order to earn as much interest as possible as quickly as possible.
And if there's a systematic tendency for medicaid advantage plans to deny claims that eventually get approved, and if you could predict which ones will get approved 'just' by really understanding what medicaid would approve, then this might be self-sustaining or even profitable?
The solution is disallow private insurance being the middle man between medicare and the patient.
What possible benefit to the patient is having a whole bureaucracy sit between the gov't insurance and the person in need of medical care? It only exists to make money off the backs of the people they are harming.
Now, if you don't know why people sign up for them, you don't understand what they are doing. My mom, like many others, was on a fixed income. If you sign up for a medicare advantage plan, they will do things like give you an extra $100 a month to you directly. Why would insurance be willing to PAY you? Because they make all their money billing medicare and denying you coverage.
18 billion in profits last year running a middle man between patients and medicare
Network effects. They outsource all the medical billing and management to the big insurance racket companies. Protip: go with a PPO Medicare plan and medigap supplemental plan if you want your loved ones to see any specialists and go to any hospital. I switched mine off the HMO advantage plans to BCBS PPO cause HMO Medicare advantage plans deny everything by default fighting tooth and nail.
Wikipedia says the government introduced intermediaries to cut costs (i.e. create a scapegoat people can blame for denying claims or reducing payments to providers and not have the finger point at the government).
> The act had a five-year savings goal and a ten-year savings goal following its enactment in 1997. The five-year savings goal was $116.4 billion which would be achieved by limiting growth rates in payments to hospitals and physicians under fee-for-service arrangements.[7]
>This plan also involved the change of the methods of payment made to rehabilitation hospitals, home health agencies, skilled nursing facilities, and outpatient service agencies as well as the reduction of payments to Medicare managed care plans and the slowing of growth rates of these same care plans.[7]
>The ten-year savings goal was $393.8 billion using the same savings methods as the five-year goal to achieve the savings in 2007.[7]
Is it just me or does this sound like a terrible bill? I've gone through the page and it just sounds like it was trying to save money by making healthcare beneficiaries worse off.
I haven't researched how all these came to exist but I assume it is the typical conservative talking point about the free market being more efficient so why wouldn't we want this. It will save us all money. And no, I don't believe any of that BS.
Or, I don’t know, maybe we do what every other Western nation has done and just present a public option for healthcare coverage to the average person?
Nah, better to have millionaires lying to the sick and dying about the company not having the money to pay for the coverage that the sick person paid a hefty monthly premium to provide.
Nice, a hyper capitalistic solution to a problem which only exists because of a hyper capitalistic system. Why not add another middleman with a financial incentive to a system overburdened by middlemen with financial incentives?
The solution would be to remove useless leeches providing no value or benefit to anyone other than shareholders, not add more of them.
And what do you know, most of the rest of the developed world has managed to do that. And even the parts that have private healthcare have managed to put strict rules controlling it, and costs and outcomes are much better.
But is this actually true, or just something that declining economic sentiment in the newspapers has led us to believe? People are consuming more food, more education, more square feet of house, more travel. My sense is that is surprisingly hard to find a quantitative signal that purchasing power has collapsed.
Maybe it is just that positional goods (access to the best neighborhood in the best city) get harder to obtain as the population grows?
It's important to note that calories and food consumption aren't necessarily the same. We have seen a lot of no-calorie or low-calorie sweeteners and stuff. Diet sodas seemed to be a big deal around that timeframe, as did "low fat" foods (some of which were just lower fat than before or where heavily processed to remove fats).
I mean, real wages have stagnated or declined over the past 50 years.
Sure, we're eating more food, but it's increasingly garbage. Yes, we have more education, but the quality has gone down and is really only a response to the barriers to entry that have increased for most professions. It does seem travel has increased and new houses are bigger, but these seemed to be aligned to a particular class of person. I doubt the middle class is doing much of that. Perhaps the increase in income in equality is reflected by a larger upper class skewing those metrics.
If you want to argue that real wages have stagnated, you need to argue that real GDP has stagnated.
> Yes, we have more education, but the quality has gone down and is really only a response to the barriers to entry that have increased for most professions.
Yes, that is a problem. See 'The Case against Education' by Bryan Caplan.
> I doubt the middle class is doing much of that.
What's your definition of the middle class in this context? Have you checked any statistics?
> Perhaps the increase in income in equality is reflected by a larger upper class skewing those metrics.
The first few decades after the second world war were really rough. But fortunately, global equality has massively improved in the last few decades.
Numerically, that's mostly due to China (but also India and recently Africa) first falling behind and then starting to catch up.
There was probably never a time since at least the Industrial Revolution when global consumption was as equal as today, and the situation is set to keep improving.
"If you want to argue that real wages have stagnated, you need to argue that real GDP has stagnated."
What I can argue is that median real wage has stagnated. Distribution matters, unless you truly believe in strict trickle down economics. The vast majority of the increase has gone to high earners.
"Have you checked any statistics?"
Plenty of stats out there if you want to look. One easy one is that median home income requirements exceed that of median household income by more that 25%. Most new houses are significantly above the median in cost and size, pricing out the middle class even farther.
"There was probably never a time since at least the Industrial Revolution when global consumption was as equal as today, and the situation is set to keep improving."
I'm talking about the US domestically, as were most of your comments. There's still massive per capita consumption differences between the US and most other countries (fuel, food, etc).
> Distribution matters, unless you truly believe in strict trickle down economics.
Nice straw man!
> Most new houses are significantly above the median in cost and size [...]
New houses have almost always been better than existing houses, and have predominately bought by rich people. That's how come the housing stock of 2024 is better and more luxurious than the hovels people used to live in around eg 1800.
When someone build some new luxury homes, a rich person doesn't just magically pop into existence to move in. That rich person used to live somewhere else before, and that other house is now available for someone slightly less rich to move into. There's a whole chain of moves happening.
And I do agree that the US is not building enough for various reasons.
> I'm talking about the US domestically, as were most of your comments. There's still massive per capita consumption differences between the US and most other countries (fuel, food, etc).
Yes, the US is still one of the richer countries. But the gap has started to narrow. And not in the bad way, ie the US falling behind, but in a good way, other people catching up.
Not strawmanning, some people actually belive this. In some limited scenarios or with a limited differences, it can work. Providing there are controls in place to correct any runaway effects.
" and have predominately bought by rich people."
I wouldn't say predominantly. There were times in the recent past when middle class people were the primary builders/buyers of new homes.
"It's the overall quantity of new housing being build that's important."
I understand filtering, but it does have limits. If you have too many rich people building houses that they don't need to sell, or want to keep as investments or vacations homes, them you can end up with problems. Likewise, if the percentage of rich people goes down significantly, many of the larger homes may not be economical for middle class people to live in depending on things like tax or utility costs.
"And I do agree that the US is not building enough for various reasons."
It's not just that they aren't building enough. Population distribution and vacancies are huge problems. Who or what type of entities owns properties, especially in higher percentages in a given area is a problem. But even when they do build, there is still a problem of the new single family housing being almost exclusively larger. There are very few affordable units in most markets for starter or empty nester homes.
> Not strawmanning, some people actually belive this. In some limited scenarios or with a limited differences, it can work. Providing there are controls in place to correct any runaway effects.
Maybe, but they don't call it 'trickle down' economics. That's only ever used as a slur.
> I understand filtering, but it does have limits. If you have too many rich people building houses that they don't need to sell, or want to keep as investments or vacations homes, them you can end up with problems.
Land value tax would be your friend here. Though I don't see the problems: as long as they are building enough, that's great. If rich people want to have a few extra houses, that's fine. Just keep building more, as long as they want to pay for it.
Houses are (or should be) a manufactured product. We can make more of them.
> Likewise, if the percentage of rich people goes down significantly, many of the larger homes may not be economical for middle class people to live in depending on things like tax or utility costs.
Most taxes on houses should drop, if their value drops. Eg that's the case for property taxes.
Utilities don't drop automatically, yes. But you can eg not run the heated pool, or you can retrofit insulation etc.
In any case, capital costs are often the major source of housing costs. Ie that's either what you (or your landlord) pay for the mortgage, or otherwise the opportunity cost of the equity you have in your house.
But those costs can drop a lot just by virtue of the market value of the house dropping. If necessary, they can drop all the way to zero, if the price of the house drops to zero.
So there's an enormous buffer before utility costs by themselves become a limiting factor.
You can also subdivide homes.
> It's not just that they aren't building enough.
No, that is exactly the problem. Another related problem is that it is hard to get approval for anything but a single family home in large parts of the US. So density is illegal.
Vacancies aren't much of a problem.
I don't know what you mean by 'affordable units'? I mentioned already that quantity of units on the market is what matters. If you add a new unit at the top of the market, filtering will make sure that we get another affordable unit at the bottom automatically. Building explicitly shitty (sorry, affordable) housing for poor is a bad move. Requiring developers to do so by law is worse.
I do agree that a land value tax would be an excellent way to raise revenue (without impacting the economy), and then those pesky rich people, and especially rich foreigners, bidding up home prices would just be straight up tax revenue, instead of an ideological war.
"If rich people want to have a few extra houses, that's fine. Just keep building more, as long as they want to pay for it."
Not really. You can't have them taking up land and services for houses rather sit empty. If they aren't used, they aren't helping to alleviate the constraints. Just like all the vacant rental units.
"Most taxes on houses should drop, if their value drops. Eg that's the case for property taxes."
Yes and no. The municipality and schools have costs they need to cover. They can only drop so much, especially when we're talking about the top 10-20% houses.
"Utilities don't drop automatically, yes. But you can eg not run the heated pool, or you can retrofit insulation etc."
The retrofits are major capital expenses that my mention later on. They get more expensive the bigger the house is. You still have larger costs on things like a new roof or flooring since there's simply more of it. Yes, they themselves generally wouldn't become a limiting cost. But neither would the property cost nothing.
There are multiple problems - corporate owned vacancy, building sizes, and even distribution are factors. The root problem is not lack of building new homes, as you claim. It is a distribution and utilization problem at its core. About 10% of the housing stock in the nation is vacant. If you more evenly distributed population and didn't hold units off the market, you'd fix the issue. It would be better for the nation to increase investment (jobs and infrastructure) in moderate or smaller sized cities in depressed areas with higher vacancies. Otherwise you end up with a vicious cycle consolidating people in a dozen or so major cities with people paying exorbitant amounts of money. One often overlooked aspect is that people have preferences towards single family homes. Simply allowing more density isn't going to fix that preference.
Agglomeration effects are real. And you are better off building space for people in highly productive cities like NYC and San Francisco, then to force them to toil in obscurity in Appalachia.
They wouldn't be paying exorbitant amounts of money to stay in NYC or SF. They haven't in the past, before America stopped building. The distribution of rents used to be fairly 'flat', without the crazy spikes in productive cities we see today. See eg https://kevinerdmann.substack.com/p/the-consumption-basket-w...
Yes, many people have a preference for single family homes. If the people who are ok with density were legally allowed to enjoy that density, then there would be more space (even relatively close to city centres), left over for the people who prefer single family homes on large plots.
That also applies for your concerns about rich people taking up land: legalise density and building taller.
> The retrofits are major capital expenses that my mention later on. They get more expensive the bigger the house is. You still have larger costs on things like a new roof or flooring since there's simply more of it. Yes, they themselves generally wouldn't become a limiting cost. But neither would the property cost nothing.
Maybe, but you'd expect homes meant for rich people to have nicer than average roofs and flooring already. So your concern is a bit weird.
In any case, even with your much higher estimate of 10% it's not a big deal. Even if you magically went from 10% to 0% vacancies overnight, you'd still only increased the effective housing supply by about 11%. The shortfall in building is much larger than that.
Riker's island is very poorly designed. A big part of the problem is that it is quite inaccessible from the rest of the city. This has a ton of knock-on effects:
1. There's a severe shortage of guards. Anything that could make working in the jails more attractive will help, and a 2-hour commute is not attractive.
2. Getting medical service, prisoners with court dates, lawyers, etc. on and off the island is really really slow.
3. The jail has insourced a lot of services (for example they run a large bakery). These get staffed by corrections officers. This both makes staffing harder, and the existence of these plum positions has weird effects on the politics of the corrections union (people with power in the union are not actually working as guards and are out of touch with the reality of the jail)
Moving to a model like the Tombs, with the jail directly above the courthouse, makes way more sense.
In addition, the buildings on the island need a serious revamp (e.g. there is no automatic access control, so every major door needs a guard physically standing there to let people through and climate control is broken). As long as you need to seriously renovate anyway, might as well just build a new jail where it should have been put in the first place.
Corrections staff at Riker's island get unlimited, unauthenticated sick leave, which may partly explain the large number here, along with their employment as clerks, bakers, door control, etc.
Incidentally this is what I meant above, about the union being out of touch: unlimited sick leave makes staffing unpredictable, which makes work unpredictable and frankly dangerous, which makes guards take more sick leave in a vicious cycle. The union has weaker-than-expected motivations to fix this, because everyone with seniority does not actually work in the housing blocks.
> A 1972 study on visitation that followed 843 people on parole from California prisons found that those who had no visitors during their incarceration were six times more likely to be reincarcerated than people with three or more visitors.
That's almost certainly correlation and not causation. Most families will probably visit you the first time you end up in prison, by the 5th time they will have written you off.
You should read the article; that's addressed by using prisons that ended in-person visitation and saw changes as a result.
> In Travis County, Texas, there was an escalation of violence and contraband after that jail switched from offering both video calls and visitation for a few years, to banning in-person visitation altogether.
There are also behavioral changes generated by a pending visit:
> According to one study, misconduct tended to decrease in the three weeks before a visit. This may explain why more frequent visits lead to more consistent good behavior, better overall outcomes and post-release success.
You'd probably be surprised then. Familial attachments can be quite strong and most people will eventually end up out of prison and reunited with family.
"designed" is a bit generous... It's a hodge-podge of facilities built over time as need arose with little consideration of long-term planning or a comprehensive strategy for the complex.
I've heard it called a "non-central example". That has a negative connotation though, I wish there was a more neutral term. The statement "all natural numbers are greater than 1" is false, and it's not helpful to object that 0 and 1 are noncentral examples.
(It's not a motte-and-bailey, that's about a particular sort of shifting goalposts)
Sure, but then they just send you a letter correcting your mistake, you OK it if it looks right, and either they send you a check or you send them a check. You don't have to pay a fine and you don't get audited.
(I am not a tax lawyer nor an accountant, but I have done this 4 out of the last 6 years.)
Ignorant question: is Israel literally an ally of the US? I know they are not in NATO or 5 Eyes, and I don't think they have some other close agreement, like US and Japan.
Despite not being in 5 eyes, Israel does get special treatment in the form of raw intelligence data from the US.
>The National Security Agency routinely shares raw intelligence data with Israel without first sifting it to remove information about US citizens, a top-secret document provided to the Guardian by whistleblower Edward Snowden reveals.
>According to the agreement, the intelligence being shared would not be filtered in advance by NSA analysts to remove US communications.
>While NSA documents tout the mutually beneficial relationship of Sigint sharing, another report, marked top secret and dated September 2007, states that the relationship, while central to US strategy, has become overwhelmingly one-sided in favor of Israel.
They have had consecutive Memorandi of Understanding that promise security collaboration and funding. The current one is a 20 year treaty that promises $38B in spending and expires in 2036.
It's the second one. This kerfluffle was started by Blackrock moving into real estate. Blackrock is a retail investment-management company that everyone from the middle class up invests with.
So, it's not really "you will own nothing and be happy about it", but rather "you will own 0.1% of 1000 houses rather than 100% of 1 house, and be happy about it."
So, it's not really "you will own nothing and be happy about it", but rather "you will own 0.1% of 1000 houses rather than 100% of 1 house, and be happy about it."
If only that were actually literally true. If I could buy shares in a housing cooperative that allowed me the right to live in any house owned by the cooperative, and when I owned shares equivalent to the market value of a house I could trade those in for full ownership of one house, that would actually be pretty interesting.
