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Author Topic: rouse the silver beast: the proposition for entirely replacing Medicare appears
Samprimary
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http://online.wsj.com/article/SB10001424052748703806304576240751124518520.html?mod=ITP_pageone_0

Guess how many elderly sick people will be able to get coverage for under $15,000 a year on the private market.

quote:
Conservative activists who are familiar with the Ryan plan said they expect it to call for a fundamental overhaul of the tax system, with a 25% top rate for both individuals and corporations, compared to the current 35% top rate. It is expected to raise about the same amount of money as the current system, however. Lawmakers already are considering ways to accomplish that by reducing or eliminating some deductions and other tax breaks.

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Destineer
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A 25% top bracket tax rate???
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rivka
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Moving farther away from a government-pay healthcare. BAH! [Razz]
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kmbboots
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And taking it out of the poor and elderly. Excellent! Anyone know where I can find a nice ice floe?
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BlackBlade
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quote:
Originally posted by kmbboots:
And taking it out of the poor and elderly. Excellent! Anyone know where I can find a nice ice floe?

Not on the government's dime. I've heard Iceland likes its elderly though.
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Mucus
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"... if you seek conservatism, come here to this bridge. Mr. Obama, close this bridge. Mr. Obama, Mr. Obama, build up this wall!"
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The Rabbit
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It seems conservatives really are hell bent on making America a 3rd world country. Why??
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kmbboots
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It is this weird relationship they imagine between prosperity and virtue. They are less outraged by someone starving then they are by someone getting something he doesn't "deserve". It is built into our national psyche. We tend to believe that we ourselves are deserving of course.
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Rakeesh
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Well in their (meager, I feel) defense, they don't actually think that more people are going to starve when more people get what they 'deserve', kmbboots. I realize that's an outlook that appeals to...well, I'm not sure I'd call it your vanity, but it demonizes your enemies whom you obviously (with some justification) dislike pretty strongly.

Anyway, in the kind of worldview that designs a plan like this, fewer people will starve if more people have what they 'deserve' taken from them by the government. Thus ensuring fewer people get what they don't deserve leads to fewer people starving, a laudable end goal to aim for, surely. A pretty tenuous chain of reasoning, I think...but then many of us believe in things that, from without, look pretty flimsy indeed, kmbboots.

Anyway, I think the plan is terrible and dangerous, and I very much hope it won't be passed. I guess I just don't see much point in castigating these guys for being so antagonistic to people getting what they don't deserve without examining why they feel that way. One of those reasons, though not I think the primary reason, is that it ends up being better for everyone as a whole-fewer people starving.

You can't fight `em if you don't understand `em.

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King of Men
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quote:
Guess how many elderly sick people will be able to get coverage for under $15,000 a year on the private market.
You are looking at a huge change in the way the market works, and assuming only the changes you dislike will happen. If there were actual large-scale competition for customers in the private market, as opposed to the current system of supplying services for a few weirdos without a job, prices would fall drastically. What's more, if Medicare costs the government 15000 per customer, why shouldn't individual customers be able to buy insurance at that average price? Presumably the insurance companies are making a profit at that level.
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kmbboots
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Rakeesh, I am talking about a "real" belief. If you look at prosperity theology, for example, or even Calvinism, acquiring wealth upon wealth is seen as a sign of grace- a sign of God's predestined favour. It came over on the boat with the Puritans. It undermines the fact that the gap between rich and poor is growing and will only get worse on this trajectory. It props up the absurd notion that if we leave things alone, it will all work out. It is a big part of why people think that everyone would be better off without help.

http://feedingamerica.org/newsroom/press-release-archive/49-million-at-risk.aspx

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CT
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kmboots, I wonder if the idea of "trickle-down economics" is coupled with Calvinism in this. That is, the wealthy get wealthy because they make the right choices, are disciplined, are virtuous, etc. -- and when they do well, the benefit to them also gets slowly and gradually dispersed down to those who have less. Sort of like the tide rising all boats, as the saying goes.

Of course, there are problems with both of those basic assumptions. There is no reliable tie between virtue and prosperity, certainly not to the level where either entails the other. And wealth has been getting more and more concentrated in the US, not dispersing downwards.

---

Added: Every time this topic comes up, I am reminded of how damn lucky I have been. There were so many points at which being able to ask for a recommendation from someone who already had status, or being able to ask for a small loan over a period of a few months, etc., made the difference between making it through to where I am now and having to give up and stay where I was.

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Rakeesh
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I know that's a real belief, or at least prosperity theology is. But that's not quite what you were saying. You said 'They are less outraged by someone starving then they are by someone getting something he doesn't "deserve".'

I don't feel that's true. They believe that someone getting what they don't deserve causes more people to starve in the long run, so it's pretty inaccurate to say they're less outraged by people starving. They think the two things are linked. I think that's a pretty flawed belief, as I've said. One of the reasons I think that way is because of the things CT mentioned-it's sometimes who, not what, you know and people often have little choice in who they know.

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mr_porteiro_head
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quote:
Originally posted by kmbboots:
It is this weird relationship they [Conservatives] imagine between prosperity and virtue. They are less outraged by someone starving then they are by someone getting something he doesn't "deserve". It is built into our national psyche. We tend to believe that we ourselves are deserving of course.

Boots, you have a habit of picking a single odious (and usually over-the-top) motivation for for everybody who holds a certain view that you disagree with.
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kmbboots
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Rakeesh, according to a not insignificant portion of adherents to the aforementioned philosophy, people going hungry (more accurate than "starving"?) is consistent with God's plan. Messing with the presumed Divine Order is worse. So yes, more outraged.

Which belief in particular (if any) would you like to defend, mph?

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Rakeesh
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That link doesn't have anything to do with what we're talking about, kmbboots. Which is whether or not some conservatives want people to starve more than they want people not to get what they don't deserve (you know what I mean).

I've already agreed, repeatedly, that the plan is stupid and dangerous, so I'm really not sure who you're trying to persuade about that.

Anyway, I'm not even sure which 'they' we're talking about anymore. Calvinists? And even in prosperity theology, I think if we actually, y'know, asked someone who believed in it they would say something like, "Enacting this plan would lead, ultimately, to fewer people starving." That's generally how conservative economic philosophy works: tough love. But if it makes you feel better, they're cold-hearted (even evil) bastards who think God wants more people to starve, and are willing to work to make sure that happens.

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mr_porteiro_head
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Boots: somebody shouldn't have to get up and defend a belief for you to not make sweeping and untrue statements about those who hold it.
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Lyrhawn
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Some of the numbers here are staggering.

quote:
The federal government expects to spend about $275 billion in 2011 on Medicaid, the program that provides medical care to the poor and disabled, up from $117.9 billion in 2000.
quote:
Medicare cost $396.5 billion in 2010 and is projected to rise to $502.8 billion in 2016. At that pace, spending on the program would have doubled between 2002 and 2016.
Is there a book or comprehensive study out there that can explain why these insane increases in spending have occurred? What is the justification for health costs spiraling out of control at such an incredibly rapid rate?

And how much do you want to bet one of the deductions they try to eliminate is the home mortgage interest deduction, which, unless they merely cap it, will affect the poor far disproportionately to the wealthy. I'm not saying I even particularly like that deduction, but it's a huge boon to a lot of families come tax time, and removing it without some replacement or time to adjust could screw a lot of people over.

And furthermore, if Medicare services 48 million people, and they'll all get an average of $15,000 in premium payments, doesn't that equal dramatically more money than we currently spend on Medicare?

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mr_porteiro_head
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quote:
What is the justification for health costs spiraling out of control at such an incredibly rapid rate?
Two obvious reasons are the aging baby boomers and the constant invention and development of new (and usually more expensive) techniques, procedures, and equipment.
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Darth_Mauve
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KOM--if average fee for Medicare to cover one person is $15,500/hear then a $15,000 seems to fit.

But its not that simple, since what we are dealing with are averages v.s. specifics. For an average cost to be $15,500, then there are people who's insurance will cost less, and people who's insurance cost's more.

The insurance companies will strive to pick up all the people who cost less.

They will refuse to service those who cost more without that fee being covered.

So for Aunt Mildred, her cost may be $20,000. That leaves $5,000 that she has to cover to get insurance. If she is living off of Social Security because some financial hiccup ate all her savings--that gives her a choice--pay the $5,000 for health care coverage--or buy food.

An average is not a safety net.

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kmbboots
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Rakeesh, the link was to make the point that people in this country actual are at least "food insecure".

I am talking less about individual well-defined individual religious beliefs than I am a pervasive thread of belief that is woven into the foundations of the US. We were founded by people who held this belief. Look at Benjamin Franklin, for example. It isn't a matter of individual evil; it is part of what we breathe. We don't even notice it but it colours the way we, as a country, think about the poor.

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Mucus
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quote:
Originally posted by Lyrhawn:
And how much do you want to bet one of the deductions they try to eliminate is the home mortgage interest deduction, which, unless they merely cap it, will affect the poor far disproportionately to the wealthy.

Shouldn't that be the other way around? The majority of that tax benefit should go the rich. And it also is a subsidy from renters who tend to be less wealthy toward home-owners who tend to be more wealthy.
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Lyrhawn
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quote:
Originally posted by mr_porteiro_head:
quote:
What is the justification for health costs spiraling out of control at such an incredibly rapid rate?
Two obvious reasons are the aging baby boomers and the constant invention and development of new (and usually more expensive) techniques, procedures, and equipment.
I'd like to see something more specific. For example, how many new people are using Medicare every year? How many die and leave Medicare? In other words, what's the net increase year over year.

And what is the increase in cost to coverage the average Medicare recipient over this time period?

For Medicaid, to what degree has the current economic problem contributed to an increase in costs? In other words, have a dramatic number of new poor people signed onto Medicaid?

How much of these costs are inflated?

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mr_porteiro_head
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quote:
We were founded by people who held this belief. Look at Benjamin Franklin, for example.
Are you claiming that Benjamin Franklin thought, to use your words, that it's better for somebody to starve than for them to receive something they didn't "deserve"?
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hef
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I was actually telephone surveyed about this around a week ago. The number I was quoted wasn't 15K, but 11K. It was an incredibly biased survey that had many assumptions I found quite objectionable. The last question I was asked was if I considered myself a member of the Tea Party.

I don't think that aging baby boomers describes why the cost of health-care has gone up so precipitously. I have two friends who work for non-profit hospitals. One (in Atlanta) is in charge of giving away the excess money to various charities so the hospital can remain non-profit. The other (in Chattanooga) mentions the continuous brick-and-mortar projects his hospital engages in to remain non-profit. The conclusion I reach is that in non-profit settings, they simply charge too much money. In for profit hospitals, I can only assume that this money lines the pockets of the corporation.

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mr_porteiro_head
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Lyrhawn -- I don't have anything specific. Like I said, those were obvious reasons.

Another obvious reason is that the better we get at prolonging life, the longer those people are going to be receiving expensive. medical care.

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fugu13
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quote:
I am talking less about individual well-defined individual religious beliefs than I am a pervasive thread of belief that is woven into the foundations of the US. We were founded by people who held this belief. Look at Benjamin Franklin, for example. It isn't a matter of individual evil; it is part of what we breathe. We don't even notice it but it colours the way we, as a country, think about the poor.
Ah, so people don't disagree with you because they have legitimate differences of opinion, but because they haven't yet worked their way past clouding influences like you have. That's horrible.

Take a look at Benjamin Franklin yourself -- his stated position is that he wants reduced welfare because he thinks it will lead to people being better off, but you've recast him as wanting welfare because he thinks poor people "deserve" to be poor, when quite the contrary, he talks about how removing welfare will lead to those same poor people not being poor (incompatible with what you've talked about the position being). Stop being dishonest about the positions of others.

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Lyrhawn
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quote:
Originally posted by Mucus:
quote:
Originally posted by Lyrhawn:
And how much do you want to bet one of the deductions they try to eliminate is the home mortgage interest deduction, which, unless they merely cap it, will affect the poor far disproportionately to the wealthy.

Shouldn't that be the other way around? The majority of that tax benefit should go the rich. And it also is a subsidy from renters who tend to be less wealthy toward home-owners who tend to be more wealthy.
Read what I said again. It will affect the poor/middle class more than the wealthy. A thousand dollars (random number) means a lot more to a family of four making the median national average for household income than it does to someone living in a half million dollar house making multiple six-figures.

And you're right about the second part, which is one reason why I said I'm not exactly tickled by what the deduction does.

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MattP
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quote:
What's more, if Medicare costs the government 15000 per customer, why shouldn't individual customers be able to buy insurance at that average price? Presumably the insurance companies are making a profit at that level.
Medicare stands out for both the high level of customer satisfaction and its low administrative costs. Unless people are actually getting less services or some remarkably competitive market (of the sort that we've yet to see in private healthcare) emerges, then we should expect the same care to cost more money under this plan.
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Mucus
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Lyrhawn: That doesn't sound right.

Normally with tax brackets, if the family of four gets a thousand dollars (which would be a bit odd, here they pretty much wouldn't be taxed on a return*) then the person living in a half million dollar house will get much more than a thousand dollars.

*
quote:
Because the MID is available only to the one third of taxpayers who itemize their deductions. These are mainly in the top half of households by income, with the highest percentage of itemizers in the top income tax bracket. Moreover, the MID is more valuable to itemizing taxpayers in the highest tax bracket than to middle-income taxpayers in lower tax brackets.
http://blogs.forbes.com/greatspeculations/2011/03/25/heretic-reality-mortgage-interest-deduction-needs-to-be-slashed/

Since that family on the median income is much more likely to take advantage of social services, they're much better off with a slightly better funded government without the deduction than a slightly poorer government with the deduction.

Edit to add: In other words, eliminating the deduction would be a pretty progressive thing to do, which is why I suspect it won't happen.

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The Rabbit
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quote:
Originally posted by mr_porteiro_head:
quote:
What is the justification for health costs spiraling out of control at such an incredibly rapid rate?
Two obvious reasons are the aging baby boomers and the constant invention and development of new (and usually more expensive) techniques, procedures, and equipment.
None of this explains why the cost of medical has risen faster in the US than it has in any other developed country. The average age of people in Japan and Europe is higher than it is the US and the life expectancy is longer. And yet, they spend about half as much per capita on health care as the US. In fact US health care is so much more expensive than any where else that Americans pay more in taxes for medical care than do the citizens of countries like the UK, Canada and France, even though our taxes only cover a small portion of the populations and theirs cover everyone.
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kmbboots
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quote:
Originally posted by mr_porteiro_head:
quote:
We were founded by people who held this belief. Look at Benjamin Franklin, for example.
Are you claiming that Benjamin Franklin thought, to use your words, that it's better for somebody to starve than for them to receive something they didn't "deserve"?
No. I am claiming that Benjamin Franklin thought - or at least wrote - that virtuous people would be prosperous.
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mr_porteiro_head
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Ah. I'm glad that we agree that there is a difference between the two beliefs.
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kmbboots
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quote:
Originally posted by fugu13:
quote:
I am talking less about individual well-defined individual religious beliefs than I am a pervasive thread of belief that is woven into the foundations of the US. We were founded by people who held this belief. Look at Benjamin Franklin, for example. It isn't a matter of individual evil; it is part of what we breathe. We don't even notice it but it colours the way we, as a country, think about the poor.
Ah, so people don't disagree with you because they have legitimate differences of opinion, but because they haven't yet worked their way past clouding influences like you have. That's horrible.

Take a look at Benjamin Franklin yourself -- his stated position is that he wants reduced welfare because he thinks it will lead to people being better off, but you've recast him as wanting welfare because he thinks poor people "deserve" to be poor, when quite the contrary, he talks about how removing welfare will lead to those same poor people not being poor (incompatible with what you've talked about the position being). Stop being dishonest about the positions of others.

And why would Franklin think that the removal of assistance would make a poor person better off? How does taking something away from a poor person make them less poor?
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fugu13
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quote:
They are less outraged by someone starving then they are by someone getting something he doesn't "deserve". It is built into our national psyche.
This is the position you say is grounded in Ben Franklin. Where are his statements in there, and where in there is what you just wrote?

quote:
No. I am claiming that Benjamin Franklin thought - or at least wrote - that virtuous people would be prosperous.

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kmbboots
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quote:
Originally posted by mr_porteiro_head:
Ah. I'm glad that we agree that there is a difference between the two beliefs.

Do you understand how the one belief - that virtuous people are prosperous - could also encourage the belief that people who are not prosperous are also not virtuous?
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mr_porteiro_head
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"Could encourage" is a far cry from "always causes" or "is synonymous with". And even that is a faaaaaaaar cry from your original statement.

quote:
And why would Franklin think that the removal of assistance would make a poor person better off? How does taking something away from a poor person make them less poor?
There's an important difference between not giving something and taking it away.
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kmbboots
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Okay. How do we help a poor person be less poor by stopping the help he was getting?
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fugu13
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quote:
Okay. How do we help a poor person be less poor by stopping the help he was getting?
Ben Franklin thought it was because people who are supported without working are less likely to work, as he said. I'm not saying you have to agree with him, but being dishonest about what he said is no good.

And, whatever one thinks the most moral way is, he was demonstrably right that removing benefits could lead to people being less poor. For instance, the number of people leaving unemployment skyrockets just before unemployment benefits are up, no matter how the duration of unemployment benefits changes. That's pretty dramatic proof that removing the help people are getting induces, in many cases, a person to be less poor.

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kmbboots
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So you take away that support thus making more likely to make someone work - and thus more virtuous. Work being considered a virtue. Can't you see how it all ties together? Why, we even have a special designation for those exceptional poor who are "deserving" poor the assumption being that most - or at least some - are undeserving.
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The Rabbit
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quote:
And, whatever one thinks the most moral way is, he was demonstrably right that removing benefits could lead to people being less poor. For instance, the number of people leaving unemployment skyrockets just before unemployment benefits are up, no matter how the duration of unemployment benefits changes. That's pretty dramatic proof that removing the help people are getting induces, in many cases, a person to be less poor.
This is very far from "proof" of the claim for two key reasons.

1. People leave unemployment when they stop looking for a job, not when they find a job.

2. The closer people are to loosing their unemployment benefits, the more likely they are to accept a lower paying job for which they are over qualified. Over the long run, people are often better off continuing to search for a job than accepting whatever is available now.

3. Unemployment benefits are a percentage of the pay from your previous job. If you accept a job that pays less than your last one, you may end up poorer than you were accepting unemployment even in the short term.

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scholarette
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The unemployment decrease right before the benefits run out seems likely to be desperation. When I have a little cushion, I will invest my time in good jobs vs say McDs, but when that cushion is gone, I'll take the crap job. Perhaps if I was still searching for a good job, a month later, I would have ended up better off, but instead I was working at McDs, so now I end up worse off over the long term. Even that supposedly straightforward and dramatic proof of taking away helping people may not be proof, without looking at income levels. I have not looked at that info enough to say for certain which way it goes.


ETA- or what Rabbit said.

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Ace of Spades
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Can't you work at McD's at night or on the weekend, while still looking for a "better" job?
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scholarette
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Ace- nope the only shift they had open was 9-5. Also, assume no internet access at home (that costs money and you are broke) and no laptop so you can't hang out somewhere with wireless access which makes filling out job apps much more difficult.
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Rakeesh
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I agree with fugu's point that removal of unemployment benefits is an excellent way to ensure people get back to good, long-term secure work.
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Rakeesh
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Wait a second...
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The Rabbit
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quote:
Originally posted by Ace of Spades:
Can't you work at McD's at night or on the weekend, while still looking for a "better" job?

Let's assume that you had a job earning $40,000 per year. You are a frugal individual, so you only need $20,000 of that income to pay all your basic bills (mortgage, utilities, transportation, food). That's typically what you are allowed to collect in unemployment. To make half your previous earning (after payroll taxes) at a minimum wage job you'd need to be work 50 - 60 hours per week.
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fugu13
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quote:
I agree with fugu's point that removal of unemployment benefits is an excellent way to ensure people get back to good, long-term secure work.
My point was a little weaker than that: that the removal of unemployment benefits frequently (not necessarily in most cases, just many cases) leads to people returning to good, long-term secure work.

Additionally, that for people who return to such work it is better than having been on unemployment (both for themselves and for society).

This was in response to a statement that seemed to be implying that it was impossible for removing welfare benefits to improve someone's life.

What's especially relevant is, we aren't really talking about the remarkably good cash benefit program that is unemployment (not that it couldn't be improved), we're talking about the welfare programs in Franklin's day (insofar as we're talking about Franklin's positions), which were rather . . . less good.

quote:
So you take away that support thus making more likely to make someone work - and thus more virtuous. Work being considered a virtue. Can't you see how it all ties together? Why, we even have a special designation for those exceptional poor who are "deserving" poor the assumption being that most - or at least some - are undeserving.
Wow. You can't talk about this at all without saying that people who disagree with you really mean something they most definitely haven't said (and are in some cases explicit about not meaning). That's awful.

Look at Ben Franklin's actual words instead of this fantasy you seem to imagine of them:

quote:
I am for doing good to the poor, but I differ in opinion of the means. I think the best way of doing good to the poor, is not making them easy in poverty, but leading or driving them out of it. In my youth I traveled much, and I observed in different countries, that the more public provisions were made for the poor, the less they provided for themselves, and of course became poorer. And, on the contrary, the less was done for them, the more they did for themselves, and became richer.
quote:
Repeal that [welfare] law, and you will soon see a change in their manners. St. Monday and St. Tuesday, will soon cease to be holidays. Six days shalt thou labor, though one of the old commandments long treated as out of date, will again be looked upon as a respectable precept; industry will increase, and with it plenty among the lower people; their circumstances will mend, and more will be done for their happiness by inuring them to provide for themselves, than could be done by dividing all your estates among them.
He is quite clear that he believes many people on welfare are perfectly capable of being better off, but that the existence of the welfare systems he saw was what was leading their lives to be worse off. That is his position, and you don't get to tell him it wasn't really his position, but that he thought the recipients of welfare were less virtuous. He explicitly states that he feels people will, as a whole, be better off without the welfare systems, not that people will be worse off but that's okay because the ones who are worse off aren't virtuous, as you've been repeatedly attributing to him. Stop being dishonest about the stated positions of others.
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Rakeesh
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I'm right there with you actually, fugu (I can't tell if you're playin' along with me, heh). I only ever thought you were saying what you actually said: that the impending removal of benefits will in many cases be a solid motivator towards employment-JUST employment, mind, I was being over-the-top sarcastic with the type of employment (I point that out for kmbboots and AoS).

I'm really not sure WHAT I'd be accused of having believed if I hadn't stated explicately, recently, I thought this plan was bad.

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kmbboots
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And I am saying that it is a reflection of the Protestant work ethic to care whether someone took made Monday a holiday, whether they were industrious. It took Calvin to even make working for a living even respectable or Capitalism (investing money to make money) a way of life.
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