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coboardhead



Joined: 26 Oct 2009
Posts: 1960

PostPosted: Wed Nov 10, 2010 8:43 pm    Post subject: Reply with quote

Mac - Your comment regarding light rail not reducing carbon emmissions is an interesting planning quandary.

Density does not increase unless transportation frastructure can support it and infrastructure will not be cost effective unless density increases.

This is the "chicken and egg" question for city planners.

Short term, these type of invesments seem like boondoggles, however, it is still workwhile to begin the process of acquiring real estate for the eventual need for mass transit systems. Routing of future lines will allow appropriate development and density to ultimately support those systems.
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MULLDE102f



Joined: 15 Jun 1997
Posts: 90

PostPosted: Wed Nov 10, 2010 8:50 pm    Post subject: Reply with quote

"Clinical insomnia. That's how that sucker gets in thousands of hours sailing each season. Whoda thought."

All while suffering with a taxpayer subsidized "disability".
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coboardhead



Joined: 26 Oct 2009
Posts: 1960

PostPosted: Wed Nov 10, 2010 9:04 pm    Post subject: Reply with quote

Keycocker said

Quote:
What exactly do you disagree with?"
Nothing in the intent of the law. It was also intended to reduce costs with the public option.This was the essential idea at one time- to reduce spiraling costs with competition. They dropped that key feature already. That gives me the sense that this could work out like Medicare.It was also a great idea to reduce the costs of health care. Now that the cost cutting features of Medicare are defunct, we are try to fix that ,too.
Will we have some more laws later on to fix the Health Care Bill?
Then some laws to fix that law as the whole thing gets bogged down and costs spiral out of control?
Tell me your favorite big program/law that has shown how successful our Gov. is at big programs? Highways maybe?
Seen all those guys standing around out there?


I am personally relieved to see the public option out of the bill. The government's cost cutting methods for Medicare are to cut fees to providers (basically that's it). This is not effective, because it will cause rationing - already does for some seniors. The Medicare program has been a dismal failure in actually reducing the amount, and therefore the expense, of care. Payment is disproportionally high for surgical and "bit work" and low for preventative care, clinics and primary care. Some primary care physicians are going out of business due to Medicare underpayments.

Expanding this system with a public option is a bad idea.

The best cost cutting measures are being developed by the large insurer/hmo's who have a vested interest in keeping costs low, providers happy and consumers in their plans. The health care law, really, gives these types of operations the tools they need.


Last edited by coboardhead on Wed Nov 10, 2010 9:06 pm; edited 1 time in total
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mac



Joined: 07 Mar 1999
Posts: 5337

PostPosted: Wed Nov 10, 2010 9:05 pm    Post subject: Reply with quote

coboardhead--I like that you are thinking. We are talking here about high speed rail. In some areas the rail may stimulate enough density to make it work environmentally. In California, I know enough of the players to know that it is unlikely, and the game has largely been played as a public slush fund. Their projections have been challenged in court, and by independent auditors, and found to be overblown if not actually invented to try to justify the project. Some sleazy folks working on it. There are some pretty good critiques of high speed rail from some pretty reputable, somewhat libertarian outfits. Those folks are doing the cutting edge thinking on transportation, and proposing things like congestion pricing in tolls and parking that have a lot of promise to utilize the infrastructure we already have. I attended some of the pretty prestigious conferences, like the annual air quality conference in California that is invitation only, while I was still working in transportation and they were pretty good. From what I remember, only the eastern seaboard between Boston and DC has the density to make sense.

Light rail is another matter entirely. Great systems in a lot of places, eliminates trips, encourages density. Even worked pretty well in a low density place like San Diego. Like them, worth the investment as a general rule. Much cheaper because they go faster and through areas with lots of passengers. Even then boondoggles creep in for political reasons--the airport connector for BART here in Oakland is just plain stupid. The one to SFO is pretty much a loser as well, and SFO has about 2 1/2 times the traffic. Influence peddling on big projects, both for construction and consulting, attracts corruption among Democrats too.
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coboardhead



Joined: 26 Oct 2009
Posts: 1960

PostPosted: Wed Nov 10, 2010 9:17 pm    Post subject: Reply with quote

I guess I didn't read the post carefully re: high speed rail. That's a completely different issue and probably really does not affect urban planning.
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keycocker



Joined: 10 Jul 2005
Posts: 3438

PostPosted: Wed Nov 10, 2010 9:41 pm    Post subject: Reply with quote

Co boardhead
So if there were changes in the bill to improve it ,what would you suggest?
I thought the idea of the public option was to reduce the big jump in rates and profits that seemed to raise everyones cost lately.
Some think there is collusion among ins co of the type that oil companies use to raise consumer costs.You raise- we raise- no one speaks to each other about it so it is legal.
Another thought is a that the companies simply operate equally profitable and inefficient so we pay more that it actually might cost.
Wasn't the public option supposed to give a benchmark that private cos pricing could only exceed by risking the loss of clients.
All my life it has been obvious that I could cut my costs by spending more on primary care, so my family always has, but out of pocket. Like most world citizens we mostly have had no ins unless the law insists, or my new wife does. We have enough rental houses to pool the risk so none have insurance
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coboardhead



Joined: 26 Oct 2009
Posts: 1960

PostPosted: Wed Nov 10, 2010 9:59 pm    Post subject: Reply with quote

Keycocker

I don't, honestly, believe that the government can run a health insurance company more efficiently than the private sector. If they started one, and it was subsidized by taxpayer dollars, then it would provid artificially low prices and unfair competition.

What is important, is that insurance reforms (enacted) get everyone in the system to avoid the cost shifting that now occurs.

I suppose it is possible that the insurance companies will try and increase profits and blame the increase on the health care plan. That should be monitored by the government.

I believe the plan is weak on the implementation of electronic medical records. Right now, there are dozens of systems out there and they don't all mesh. The gov. should contract this out and provide the software to providers to reduce this upfront cost. The incentives in the plan are minimal and many practices will not convert due to the high costs.

The definitions of required insurance coverage is also weak, in my view.

Medicare is still the elephant in the room and will require real work by the government to keep costs in control. See how they do with that vs the private insurance sector. I'm betting on the private sector.
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keycocker



Joined: 10 Jul 2005
Posts: 3438

PostPosted: Wed Nov 10, 2010 10:07 pm    Post subject: Reply with quote

If the gov. can do anything better than private I don't know what that would be.
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coboardhead



Joined: 26 Oct 2009
Posts: 1960

PostPosted: Wed Nov 10, 2010 10:22 pm    Post subject: Reply with quote

In all fairness to the government.

Many of the problems with Medicare are politically motivated.

To make Medicare solvent we need to address some major issues with the way care is delivered. These choices are politically unpaletable so are ignored:

End of life care
Clinic treatment vs seeing your own doctor
Overutilization of care

Talk about reducing an entitlement and you are out of office!
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jpbassking



Joined: 19 May 1998
Posts: 2385
Location: Leo

PostPosted: Thu Nov 11, 2010 10:55 am    Post subject: Reply with quote

keycocker wrote:
If the gov. can do anything better than private I don't know what that would be.


wage war..

_________________
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