There must be a pony in here somewhere.

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Taktix®
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Re: There must be a pony in here somewhere.

Post by Taktix® » 30 Jul 2013, 16:51

fyodor wrote:Sentence two: well sometimes the right hand doesn't know what the left hand is doing. It's not like one uber-brain wrote and planned out this whole thing. (Jason has had some good metaphors for how law gets written that I won't try to duplicate now.) Sure, it may very well be the case that those who wrote it planned to make the mandate look unenforceable at first knowing it would change, but it's just as likely it was mishmashed result of the political process. Anyway, I agree that it won't long be as easy to avoid as simply not having a tax refund cause there's just no way that would be sustainable.
I have every confidence that, down the road, when the left and the right hands finally do come together, that the American public will be in the middle getting squished...
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Re: There must be a pony in here somewhere.

Post by fyodor » 30 Jul 2013, 16:53

Mo wrote:
fyodor wrote:
Taktix® wrote: and if enough people don't pay it, there will be calls for stricter enforcement
I hate to agree with the paranoid contingent, but this. If it's really easy enough to avoid paying that all you have to do is make sure you owe more taxes than you paid during the year, then that clearly won't last. I would assume at the least it would get lumped in with tax evasion. So even if they get to continue to say it's not a new or separate crime in and of itself, it's still going to at least have the same enforcement that not paying the rest of your income taxes currently has.

That said, if your total tax bill doesn't cover the mandate tax or whatever it is, then I can see you might get off (to the degree your total tax bill falls short). Some people would grouse about it of course, some very loudly, but Middle America does have a bit of hard time with the idea of squeezing blood from turnips, at least if they have to see it done directly. So the very poor might yet escape.
I could totally see this being like the Medicare doc fix. Some dumb policy that doesn't get changed because neither party could be arsed to do something about it for fear of the blowback. Don't worry, Uncle Sugar has got this one, baby.
I think the Medicare doc fix (if you're talking about what I think you're talking about) is a conspiracy between Reds who don't wanna lay out more money and Dems who think docs shouldn't have to be paid more (that's greeeeeeed) to go along with the system. It's a slow bleeding. I suppose the mandate only being collectable via tax rebates thing could be slow if people are really stupid enough to not catch on. Anyway, yeah maybe that's a possibility, but I wouldn't want to count on it! You seem to be saying oh don't worry there's no enforcement. Well, maybe, but at least as likely that'll change. If you're defending the mandate on the ground that there's no enforcement, I would still say that's very thin ice, even if I see the possibility that it could stay that way. Make sense?
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fyodor
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Re: There must be a pony in here somewhere.

Post by fyodor » 30 Jul 2013, 16:55

Taktix® wrote:
fyodor wrote:Sentence two: well sometimes the right hand doesn't know what the left hand is doing. It's not like one uber-brain wrote and planned out this whole thing. (Jason has had some good metaphors for how law gets written that I won't try to duplicate now.) Sure, it may very well be the case that those who wrote it planned to make the mandate look unenforceable at first knowing it would change, but it's just as likely it was mishmashed result of the political process. Anyway, I agree that it won't long be as easy to avoid as simply not having a tax refund cause there's just no way that would be sustainable.
I have every confidence that, down the road, when the left and the right hands finally do come together, that the American public will be in the middle getting squished...
Well, who am I to argue with a colorful analogy? :P
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Re: There must be a pony in here somewhere.

Post by JasonL » 30 Jul 2013, 17:10

dhex wrote:
The fundamental problem with ACA has always been that 75% of americans really like their employer sponsored coverage. No lie. Really really like it.
i don't know if the figure is that high. would go with "can tolerate" but there's an element of "because they have no other option" in there.
Yeah, this is that thing where when polled about "do you like your health plan" you get 52% saying "I guess" but if you ask about each element - cost they see vs total cost, choice of providers, quality of care received over past 12 months, etc. - you get 75% strong approval.

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Re: There must be a pony in here somewhere.

Post by JasonL » 30 Jul 2013, 17:17

Hugh Akston wrote:
JasonL wrote:I am not at all convinced that state exchanges will make any sense and that is where everyone is going to have to buy insurance.
I have never seen anything about requiring individuals to buy insurance from the exchanges. I have seen things about insurers telling states to piss up a rope, and states telling the Fed to do the same.
Well, yeah. What I meant is that the exchanges are the places where pooling will happen for individuals that isn't happening now - in theory. You would be able to buy outside the exchange, but unless you were part of some kind of pool you woulndn't have favorable pricing - in theory. Truth is nobody has any idea in the world what is going to happen to prices in the exchanges.

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Re: There must be a pony in here somewhere.

Post by Painboy » 30 Jul 2013, 17:36

JasonL wrote:Truth is nobody has any idea in the world what is going to happen to prices in the exchanges.
Image

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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 30 Jul 2013, 18:23

Taktix® wrote:
Mo wrote:Unless you let ERs leave people dying in their waiting rooms if they don't have insurance (which is inhuman to about 80% of people), people can get free coverage. Mandates solve this problem.
I disagree. That 80% figure is waaaaaay too high...
I suspect it's conservatively low. Okay, so you might not get four out of five people saying the gangbanger with a GSW or the revolving door addict is morally entitled to ER care, but start mentioning children and I doubt one in a hundred people would want to live in a society that refused them any medical care at all.

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Re: There must be a pony in here somewhere.

Post by Taktix® » 30 Jul 2013, 19:44

fyodor wrote:
Taktix® wrote:
fyodor wrote:Sentence two: well sometimes the right hand doesn't know what the left hand is doing. It's not like one uber-brain wrote and planned out this whole thing. (Jason has had some good metaphors for how law gets written that I won't try to duplicate now.) Sure, it may very well be the case that those who wrote it planned to make the mandate look unenforceable at first knowing it would change, but it's just as likely it was mishmashed result of the political process. Anyway, I agree that it won't long be as easy to avoid as simply not having a tax refund cause there's just no way that would be sustainable.
I have every confidence that, down the road, when the left and the right hands finally do come together, that the American public will be in the middle getting squished...
Well, who am I to argue with a colorful analogy? :P
Sorry, but at this point I gotta take 'em where I can get 'em! :D

In all seriousness, though, it's true. Maybe the disparate left and right hands didn't get together on this, but they will eventually. In fact, there is a far greater chance of unintended consequences when the two sides end up making compromises to settle the law's differences.

Let me be more specific.

Once they have the power to enforce this, which the SCOTUS gave them already, it's only a matter of time before they use it. If anyone thinks the government asked for the power to enforce the individual mandate without any intention of using it, they need only to look at every other encroachment upon liberties in the past.

The PATRIOT act is a great example. They swore up and down that the powers would only be used to fight "terror" but it took a very short time before those powers were used for drug cases and TSA screenings and whatever else they wanted. PRISM would not exist without the Patriot act, and the government is having trouble pointing out how PRISM has anything to do with terrorism (see the Setec Astro thread).

*SWAT teams were created for hostage situations and riots and shit, and look how they'rte being used now*

PA residents still pay the Johnston Flood tax, ferchrissakes. Fuck, the whole concept of tax withholding was supposed to be temporary!

Every time we give government a new tool, they use it... eventually. In the case of the ACA, perhaps they don't want to scare people as the implementation begins, but don't kid yourself, one day, there will be someone put behind bars for failing to pay it, and the best part is, no one will notice because it will look like mere tax evasion.

To say "this time will be different" through yet another sore, bleeding fat lip is just wishful thinking...
D.A. Ridgely wrote:
Taktix® wrote:
Mo wrote:Unless you let ERs leave people dying in their waiting rooms if they don't have insurance (which is inhuman to about 80% of people), people can get free coverage. Mandates solve this problem.
I disagree. That 80% figure is waaaaaay too high...
I suspect it's conservatively low. Okay, so you might not get four out of five people saying the gangbanger with a GSW or the revolving door addict is morally entitled to ER care, but start mentioning children and I doubt one in a hundred people would want to live in a society that refused them any medical care at all.
Sorry, that should have carried a "facetious" warning. But if we want to walk down that road, there has to be a better solution than forcing every American to purchase "insurance" which is really prepaid healthcare at this point.

What about a 3-strikes rule? We treat anybody without a pre-paid plan the first two times, giving them a warning to sign up each time, and then fucking put 'em out when they OD for the third time. I just came up with that off the top of my head, so I haven't worked out every angle, but it's far more moral than forcing every person to pay a living tax...

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Re: There must be a pony in here somewhere.

Post by Jadagul » 31 Jul 2013, 01:15

JasonL wrote:jad - that is wishful thinking. I don't disagree that the employer tied coverage aspect of our current system is among the worst parts of it, but that issue was never on the table to be addressed in ACA. Never. This situation with deferring the employer mandate has nothing to do with getting us closer to severing that link and everything to do with oh crap if we impose it now employers will purge and we dont know where people will get insurance after telling them we would not destroy the coverage they currently have.

The fundamental problem with ACA has always been that 75% of americans really like their employer sponsored coverage. No lie. Really really like it.
I certainly don't think this was the intent. I think if they keep pushing back the employer mandate it might be what happens. And I'm okay with that.
nicole wrote:
Jadagul wrote: But ideally the new risk-pooling makes it easier to get health insurance attached to your self and not your job, and the whole "employer-provided health care" thing melts away.
You did say "ideally," but I think one thing that's pretty horrible is that I really think the opposite will happen here. There are so many factors to drive up costs in the individual market--unless you are already old and sick--that it's hard to imagine any young person would rather sign up for individual coverage than hope for benefits at work. I used to be in the individual market with a plan that I loved that was a great deal--just over $100/month for a high-deductible plan with plenty of reasonable things included (even unreasonable things like fucking prenatal care, fuck you CT). Plans like that will not exist anymore, and the plans that replace them are certain to be more expensive for young, healthy people. Those are the very people I would hope would start tying insurance to themselves instead of to their jobs, and those are exactly the people who will be worst off in the individual market. The employer-provided health care thing won't melt away if only older, sicker people are getting a decent deal in the individual market.
Nicole: that's literally exactly the justification for an individual mandate. If you implemented the exact same policy but without the mandate then all the young healthy people would refuse to get insurance. So you mandate they get insurance and then they can't. That's sort of the point.

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Re: There must be a pony in here somewhere.

Post by nicole » 31 Jul 2013, 09:20

Jadagul wrote:
nicole wrote:
Jadagul wrote: But ideally the new risk-pooling makes it easier to get health insurance attached to your self and not your job, and the whole "employer-provided health care" thing melts away.
You did say "ideally," but I think one thing that's pretty horrible is that I really think the opposite will happen here. There are so many factors to drive up costs in the individual market--unless you are already old and sick--that it's hard to imagine any young person would rather sign up for individual coverage than hope for benefits at work. I used to be in the individual market with a plan that I loved that was a great deal--just over $100/month for a high-deductible plan with plenty of reasonable things included (even unreasonable things like fucking prenatal care, fuck you CT). Plans like that will not exist anymore, and the plans that replace them are certain to be more expensive for young, healthy people. Those are the very people I would hope would start tying insurance to themselves instead of to their jobs, and those are exactly the people who will be worst off in the individual market. The employer-provided health care thing won't melt away if only older, sicker people are getting a decent deal in the individual market.
Nicole: that's literally exactly the justification for an individual mandate. If you implemented the exact same policy but without the mandate then all the young healthy people would refuse to get insurance. So you mandate they get insurance and then they can't. That's sort of the point.
But my point is, the individual market was more attractive to these people before the mandate. Even the mandate itself doesn't make the individual market more attractive than it was before--the increased price of premiums will make the penaltax worth paying, at least for several years. Why would we think more people would sign up for the more sensible idea of an individual-market health plan when it makes them worse off than it did before? The best parts of the individual market will disappear, and employer-provided health insurance will be even more attractive by comparison than it has been up to now (especially since things like tax breaks for employer-provided insurance premiums aren't going away).
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Re: There must be a pony in here somewhere.

Post by dhex » 31 Jul 2013, 09:36

JasonL wrote:
dhex wrote:
The fundamental problem with ACA has always been that 75% of americans really like their employer sponsored coverage. No lie. Really really like it.
i don't know if the figure is that high. would go with "can tolerate" but there's an element of "because they have no other option" in there.
Yeah, this is that thing where when polled about "do you like your health plan" you get 52% saying "I guess" but if you ask about each element - cost they see vs total cost, choice of providers, quality of care received over past 12 months, etc. - you get 75% strong approval.
that's interesting, as it runs counter to the general narrative of the research on managed care i'd been seeing as part of the runup to the health system becoming an insurance provider in the next 12 months. however, they may have been focusing on institutional concerns, etc, as well, and i didn't get to see the polling construction, only the answers.
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Re: There must be a pony in here somewhere.

Post by JasonL » 31 Jul 2013, 10:01

I see it from the benefits offering side in the public sector, so it could be biased the other way, but what they would tell you is that polling about satisfaction with health plans stated just like that hangs out at 50 something pecent persistently, but they don't think that tells you very much. They like to focus on outcomes of coverage, where people actually feel like they get the doctor they want, can get an appointment when they want one, and get quality care and don't pay through the nose for it in the context of total cost.

You get wild variances on polling about cost if people do vs. do not know how much of the cost is covered by the company. Ford retirees were famously up in arms when they had to pay $7.00 / month for health care even though the company was still paying 98% of total cost.

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Re: There must be a pony in here somewhere.

Post by Mo » 31 Jul 2013, 10:06

JasonL wrote:I see it from the benefits offering side in the public sector, so it could be biased the other way, but what they would tell you is that polling about satisfaction with health plans stated just like that hangs out at 50 something pecent persistently, but they don't think that tells you very much. They like to focus on outcomes of coverage, where people actually feel like they get the doctor they want, can get an appointment when they want one, and get quality care and don't pay through the nose for it in the context of total cost.
I agree. Many people are happy with their coverage for the everyday stuff, it's the second they have to do something out of the ordinary that's the real indicator.
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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 31 Jul 2013, 11:37

Mo wrote:
JasonL wrote:I see it from the benefits offering side in the public sector, so it could be biased the other way, but what they would tell you is that polling about satisfaction with health plans stated just like that hangs out at 50 something pecent persistently, but they don't think that tells you very much. They like to focus on outcomes of coverage, where people actually feel like they get the doctor they want, can get an appointment when they want one, and get quality care and don't pay through the nose for it in the context of total cost.
I agree. Many people are happy with their coverage for the everyday stuff, it's the second they have to do something out of the ordinary that's the real indicator.
Like pay more than a $20 co-payment.

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Re: There must be a pony in here somewhere.

Post by Jadagul » 31 Jul 2013, 14:30

nicole wrote:
Jadagul wrote:
nicole wrote:
Jadagul wrote: But ideally the new risk-pooling makes it easier to get health insurance attached to your self and not your job, and the whole "employer-provided health care" thing melts away.
You did say "ideally," but I think one thing that's pretty horrible is that I really think the opposite will happen here. There are so many factors to drive up costs in the individual market--unless you are already old and sick--that it's hard to imagine any young person would rather sign up for individual coverage than hope for benefits at work. I used to be in the individual market with a plan that I loved that was a great deal--just over $100/month for a high-deductible plan with plenty of reasonable things included (even unreasonable things like fucking prenatal care, fuck you CT). Plans like that will not exist anymore, and the plans that replace them are certain to be more expensive for young, healthy people. Those are the very people I would hope would start tying insurance to themselves instead of to their jobs, and those are exactly the people who will be worst off in the individual market. The employer-provided health care thing won't melt away if only older, sicker people are getting a decent deal in the individual market.
Nicole: that's literally exactly the justification for an individual mandate. If you implemented the exact same policy but without the mandate then all the young healthy people would refuse to get insurance. So you mandate they get insurance and then they can't. That's sort of the point.
But my point is, the individual market was more attractive to these people before the mandate. Even the mandate itself doesn't make the individual market more attractive than it was before--the increased price of premiums will make the penaltax worth paying, at least for several years. Why would we think more people would sign up for the more sensible idea of an individual-market health plan when it makes them worse off than it did before? The best parts of the individual market will disappear, and employer-provided health insurance will be even more attractive by comparison than it has been up to now (especially since things like tax breaks for employer-provided insurance premiums aren't going away).
The idea isn't to make the market attractive to the young and healthy. The individual insurance market will never be attractive to the young and healthy, and it especially won't be if you have guaranteed-issue and they can go get insurance if they wind up being sick. The point is to force the young and healthy into the market to subsidize the less healthy, which is the actual point of this policy. (If you have guaranteed-issue and community rating but no mandate--as in NY until recently--then the pool of insured gets really sick and insurance gets really expensive. So you make everyone stay in to hold the costs to semi-reasonable).

This makes no sense if you think of insurance as being something I personally get to insure against the possibility that I personally will become sick. It makes perfect sense if you think of the insurance as being insurance against the possibility that I happen to be the sort of person who will tend to be sick a lot.

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Re: There must be a pony in here somewhere.

Post by lunchstealer » 31 Jul 2013, 21:53

Jadagul wrote:This makes no sense if you think of insurance as being something I personally get to insure against the possibility that I personally will become sick. It makes perfect sense if you think of the insurance as being insurance against the possibility that I happen to be the sort of person who will tend to be sick a lot.
That's the best explanation of the current health 'insurance' system I've seen yet.
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Re: There must be a pony in here somewhere.

Post by Jadagul » 31 Jul 2013, 22:03

lunchstealer wrote:
Jadagul wrote:This makes no sense if you think of insurance as being something I personally get to insure against the possibility that I personally will become sick. It makes perfect sense if you think of the insurance as being insurance against the possibility that I happen to be the sort of person who will tend to be sick a lot.
That's the best explanation of the current health 'insurance' system I've seen yet.
Got it from Yglesias, actually. Obviously, he supports the idea. But whether you like the idea or not I think that's the right framework for understanding what's going on.

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Re: There must be a pony in here somewhere.

Post by Jennifer » 01 Aug 2013, 12:05

In an America where people in their 20s have worse job prospects, lower wages and higher student-loan debts compared to older generations, PLUS the requirement to pay huge tax bills to fund plush public pensions they'll never qualify for themselves, clearly the chief problem with our economy is, "Those freeloading twentysomethings aren't doing enough to subsidize people older and richer than they are; we must change the law to force them to do more."
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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 01 Aug 2013, 12:21

Except, um, you know, whether you like the fact or not, your generation and Jadagul's IS going to pay for my generation's medical care, so the argument should really be about what the sanest way to do that may be. Maybe that makes it a least of all evils discussion, but them be the facts.

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Re: There must be a pony in here somewhere.

Post by Jennifer » 01 Aug 2013, 12:27

D.A. Ridgely wrote:Except, um, you know, whether you like the fact or not, your generation and Jadagul's IS going to pay for my generation's medical care, so the argument should really be about what the sanest way to do that may be. Maybe that makes it a least of all evils discussion, but them be the facts.
Granted, but in such cases -- where the government/taxpayers are going to be on the hook for people's medical costs anyway -- I'd just as soon do away with the "individual mandate" and have it paid out of general tax funds rather than an individual mandate that will, in time, give American law enforcement yet ANOTHER excuse to punish people. As things stand now, we'll have taxpayers on the hook for medical costs AND private insurance company profits AND the cost of imprisoning people* for the crime of not having health insurance.

*Yes, I know, at this exact moment in time compliance is voluntary, and as a patriotic American who was apparently born yesterday, I am obligated to believe that will never change: of all the government programs forcing people to do things for their own good, THIS will be the one that doesn't end up hurting the people it's supposed to help. Turning lack of insurance into a criminal matter will surely prove every bit as helpful and humane as turning drug addiction into a criminal matter has been.
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Re: There must be a pony in here somewhere.

Post by Aresen » 01 Aug 2013, 12:31

Jennifer wrote:In an America where people in their 20s have worse job prospects, lower wages and higher student-loan debts compared to older generations, PLUS the requirement to pay huge tax bills to fund plush public pensions they'll never qualify for themselves, clearly the chief problem with our economy is, "Those freeloading twentysomethings aren't doing enough to subsidize people older and richer than they are; we must change the law to force them to do more."
The first time I heard the "this generation has no chance of having it as well as their parents" was in the 1970s. I heard it again in the 1990s. This is the 3rd time around for my lifetime.

I suppose it will eventually be true of some generation, but I'd put my money on "they will make it through, somehow".
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Re: There must be a pony in here somewhere.

Post by Jennifer » 01 Aug 2013, 12:35

Aresen wrote:
Jennifer wrote:In an America where people in their 20s have worse job prospects, lower wages and higher student-loan debts compared to older generations, PLUS the requirement to pay huge tax bills to fund plush public pensions they'll never qualify for themselves, clearly the chief problem with our economy is, "Those freeloading twentysomethings aren't doing enough to subsidize people older and richer than they are; we must change the law to force them to do more."
The first time I heard the "this generation has no chance of having it as well as their parents" was in the 1970s. I heard it again in the 1990s. This is the 3rd time around for my lifetime.

I suppose it will eventually be true of some generation, but I'd put my money on "they will make it through, somehow".
Speaking as someone who was a young adult in the 90s, though, I'd say it's true. Compare college costs for me as opposed to my parents' generation: I paid a lot more in real dollars, and today's kids pay a lot more than I did. Compare housing costs: my generation paid more. Medical insurance costs: fuckballs more. My generation had better technology than my parents did, of course, and today's kids have better tech than I did. But looking at the non-technological economy -- what does shelter cost, what does education cost if you want a professional job -- yeah, I'd say there's a drop there. Unemployment rates are higher as well.
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Re: There must be a pony in here somewhere.

Post by Jennifer » 01 Aug 2013, 12:40

Jennifer wrote:
Aresen wrote:
Jennifer wrote:In an America where people in their 20s have worse job prospects, lower wages and higher student-loan debts compared to older generations, PLUS the requirement to pay huge tax bills to fund plush public pensions they'll never qualify for themselves, clearly the chief problem with our economy is, "Those freeloading twentysomethings aren't doing enough to subsidize people older and richer than they are; we must change the law to force them to do more."
The first time I heard the "this generation has no chance of having it as well as their parents" was in the 1970s. I heard it again in the 1990s. This is the 3rd time around for my lifetime.

I suppose it will eventually be true of some generation, but I'd put my money on "they will make it through, somehow".
Speaking as someone who was a young adult in the 90s, though, I'd say it's true. Compare college costs for me as opposed to my parents' generation: I paid a lot more in real dollars, and today's kids pay a lot more than I did. Compare housing costs: my generation paid more. Medical insurance costs: fuckballs more. My generation had better technology than my parents did, of course, and today's kids have better tech than I did. But looking at the non-technological economy -- what does shelter cost, what does education cost if you want a professional job -- yeah, I'd say there's a drop there. Unemployment rates are higher as well.
Having said that: I don't want to derail this into a side-argument about whether you can truly, honestly call somebody "poor" if they own a cell phone with MP3 player and a thousand songs on it, and have a working refrigerator in their apartment. I'm just saying, I can definitely sympathize with today's 20-something Americans who look around and think "Things aren't as good as they were for the older people." And I do think this individual mandate is just one more fuck-you to the younger generation.
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Re: There must be a pony in here somewhere.

Post by fyodor » 01 Aug 2013, 12:42

Aresen wrote:
Jennifer wrote:In an America where people in their 20s have worse job prospects, lower wages and higher student-loan debts compared to older generations, PLUS the requirement to pay huge tax bills to fund plush public pensions they'll never qualify for themselves, clearly the chief problem with our economy is, "Those freeloading twentysomethings aren't doing enough to subsidize people older and richer than they are; we must change the law to force them to do more."
The first time I heard the "this generation has no chance of having it as well as their parents" was in the 1970s. I heard it again in the 1990s. This is the 3rd time around for my lifetime.

I suppose it will eventually be true of some generation, but I'd put my money on "they will make it through, somehow".
If they would all just get off my lawn, it would be so much easier....
Your optimism just confuses and enrages me. - Timothy

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D.A. Ridgely
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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 01 Aug 2013, 12:45

I can sympathize with them, too, because I was one of the young people in the 70s who felt exactly the same way. That doesn't mean I was or they or you are correct in such pessimism. And, as has exhaustively been explained on numerous occasions, the facts on the ground don't justify such a prediction now.

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