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PaperclipPerfector  1yr ago (text post)   29582 thread views

Culture War Roundup for the week of October 2, 2023

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What should we cut? If you don’t want to cut Ukraine spending I presume it isn’t defense. Social security is reckoned separately from the rest of the budget. Everything else is a rounding error.

Everything else is a rounding error.

Nonsense. Here's a tool that's easy to tinker with and see what the options are. Given how many federal programs I think are negative net value, my preferred policies would result in nearly budgets within a couple of years through simple drawdowns to things like SNAP, education, and healthcare spending. I recognize the difficulty of large immediate cuts due to system shocks, but in the longer term, I see no need for federal education spending, federal "nutrition" spending, the ATF, HUD, and numerous other programs. Hell, just federal food spending is nearly $200 billion, which is not a rounding error.

That's a cool tool, but it takes far too many clicks to zero out programs.

Just like in the real Congress.

We went from sub 21.5% federal spending on gdp last decade to slightly over 24% since COVID. So that 2.5%. Ukraine spending might be .3% of that increase.

I agree that artificially restricted supply has a lot to do with spiraling medical costs, but I'd really prefer the order of operations to be

Remove supply restrictions -> Price goes down -> Slash programs that were helping people afford the high prices,

instead of

Slash programs that are helping people afford the high prices -> A few politicians promise to lower the prices -> Oh, wait, they didn't -> Fuck.

One of the reasons supply is restricted within medical care is because MMS helps fund residency slots and have historically capped their funding at '96 levels, keeping supply of doctors lower than it could be. Only in 2022 have we started to fix this and raise the residency slot funding. Cutting MMS funding would be moving backwards on doctor supply.

Most of the rest of the supply restrictions are state level like Con and COPA laws. Cutting MMS funding won't do anything to fix those problems.

Yeah, and if you cut Medicare’s budget, the bureaucrats running it will take it out of the actually useful fraction.

My point that it's an oversimplication to describe federal spending as "just subsidizing a good that has a restricted supply because of over regulation." Just as easily a lack of funding can be the root cause of a dearth of supply.

Administrative excess should be culled everywhere, but I'm unconvinced that "the rest of [the budget] is bloat". From this graph on their budget it looks like a reasonable 5-10% is administration while the overwhelming majority is compensation for services, 50% for hospital care, 25% for physician services, and the remainder broken between prescription drugs, and smaller categories like equipment and nursing homes.

I'm unconvinced the future is bleak either. The largest growing category in spending has been prescription drugs and the IRA should arrest that trend substantially. You've likely also read the recent headlines that our projections have wildly overestimated growth in Medicare spending, which has leveled off significantly per beneficiary for the past decade.

The problem is that the government restricts the supply of people allowed to practice medicine through regulations

This is like saying the government restricts the supply of tanks or something. There's no regulation artificially restraining something that would be in more abundance on the free market, the subsidy just isn't big enough. There is no law restricting resident doctors, which hospitals can have as many of as they want, there just isn't extra public funding to have more of them, so hospitals make up funding shortfalls out of pocket, from state governments, or philanthropy. Cutting government would ofc result in less residency slots, not more.

There are lots of regulations that genuinely do restrict the supply of medicine via laws that shield hospitals from anti-trust and prevent new competitors from emerging. But these are mostly on the state level. Even the lengths of residencies themselves are usually required by state-level licensing rules. If there's anything federal scale that's as significant as CON/COPA laws, I'm more than interested to hear about it though, that's why I asked.

I get that these are at the state level but since there are more or less similar requirements in every state I don't see that it matters all that much.

It matters because if your plan is that we should cut spending because costs are inflated by supply restrictions, but you have no plan or authority to address those supply restrictions, then you're in a worse place than before. @guesswho put it much more succinctly than I could.

Access to medication is gated behind prescriptions. Even if you know exactly what is wrong with you and exactly what medicine you need, you have to go to a doctor to access it. I guess this is more inflating demand rather that restricting supply, but the result is the same

Cutting MMS funding would be moving backwards on doctor supply.

As with so much government spending, I am told that we need government spending due to the onerous government regulation that creates a need for government spending. There is, of course, another option available.

I'm all for cutting unhelpful regulations, but which federal regulation would substantially reduce healthcare costs? The largest increases in costs have been from physicians and hospitals becoming increasingly consolidated monopolies, and this has much less to do with federal law than state-level rent seeking.

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