PeterMP

The inside wall is ply wood. The outside is clearly some sort of laminate that chips away and at least looks like wood underneath. It isn't any sort of siding I'm used to seeing. It is applied vertically on the surface in strips that are about 1 ft. wide so that the surface is smooth. There's no over lapping or horizontal ridges like with what you see with most sidings.

I have two old sheds. They are peelling, especially along the bottom. But isn't just the paint that is coming off so I can't just scrape/sand them and repaint. The outer surface must be some sort of laminate so that when the paint comes off, it is bringing off the top surface of the wood. Anybody have any suggestions?

1. It depends on how the healthcare/money is given to the poor. If it is given to them and then they are "pushed" into a free market system, then the end result is no different. If you start putting limits and controls on it (like we sort of talked about with respect to food stamps), then you don't really have those people in a free market and people can complain the reforms didn't work because of the restrictions that weren't free market in nature. You simply give them money or some sort of credit, like we do with food stamps, and they are going to make bad decisions. You will get the healthcare equivalent of obesity from picking bad food choices. 2. If your picking an advisor for anything essentially at random, then you are likely then simply getting random advice. The end result, with respect to a free market, isn't any better. If there was any real way to ensure that doctors in "general" were actually good or if people had any actual way to properly evaluate their doctors, this issue would go away. I've posted in other threads issues with doctors and their knowledge. There is actually a study out there that shows that doctors are more influenced by Pharma advertising then the general public. And realistically, it isn't easy for them. They are busy people trying to work, but the information underlying what they are doing is constantly changing and not changing in simple manners in most cases. Frequently, we start out w/ X is good or bad, and then it turns into well X is good under these cases for these people, but it can actually be bad in these cases. And in the intermerdiate (i.e. going from X being good or bad to the more nuanced position) time, there is lot of seemingly contradictory information out there. And most doctors aren't at all prepared to deal with something a little bit out of the norm. This is my own true story. I have two young kids. We got two cats. After having the cats for about a month they were diagnosed with common cat worms. According to the web and our vet, it is very common for kittens to have worms. Even if you treat them, the treatment only works if the worms are in the right stage of their life cycle. Okay, it was easy to get the cats cleared up. About a month later, my youngest daughter comes down with a multiday unexplained fever. This is about the right time frame for her to actually show infections from worms from the cats (generally this has been thought to be extremely rare, but in fact a study done in the last decade or so shows that ~10% of the population has antibodies to cat worms, in most cases though they aren't known to be an issue). We've already talked to the peditricians office about the issue over the phone when we found out the cats got the worms because we worried about the kids and at a regular check up for her before she even got the fever. Then a few days into the fever we take her in and they do a routine check for strep, ear infection, sinus infection, etc and she has none of these. After a few more days, the fever doesn't go away and so this is actually a sympton of a human having cat worms so we make an appointment to take her in where we've now told them over the phone to make the appointment that we are worried that she has worms from the cat. Now, my wife and I are both PhD biochemists and have read up on this, and she even works with parasites and knows several parasitologists and has talked to them. She takes my daughter in and says we'd like to do a test to she if she has cat worms. They say sure, and order a test to look at my daughter's feces (which works great if you are a human infected with human worms or a cat infected with cat worms, but not if you are a human infected with cat worms). My wife knows this and tells them you can't look at the feces you have to do a blood test to see if she has the antibodies to the cat worms. The doctor (a different doctor then we normally see and that we had talked to before, but still you think this would all be in her "chart" somewhere) looks in a red book and says 'No, this is what the red book says we should do.' My wife isn't like me. She's not a very pushy person and she's there with a sick kid that has a fever so she just leaves and calls me. Before they get home, she calls me. I call the doctor and end up talking to a nurse, and I tell them I'm looking at the CDC web page that says for cat worms in human you can't look at the feces you have to do this blood based test. The doctor calls me back, not bothering to look at the CDC page, and tells me the book says to look at the feces. I tell her the CDC says the worms won't come out in the feces and therefore looking at the feces won't matter and you have to do the blood based test, and I'm looking at the CDC page and I can e-mail her the link if she likes. We sort of go around and she seems to understand. But then she ends up back at if my daughter has worms the fact that she has vomitted (which she'd done once in what at this point in time was a 1 week fever) suggests their in her intestines, and then they should be in the feces. At this point time, I'm yelling in the phone, I'm looking at the CDC web page. Do you really think the CDC is wrong? Finally, she agrees to call the testing company and ask them what test to do, and the next day we get a form to do the right test. Turns out my daughter didn't have worms. Now, remember research shows that about 10% of people have these worms and while they aren't known to be an issue for most people (in most cases, the larva get "lost" in our system, can't find their way back to the intestines to end up in the feces and end up just encysting somewhere in your body and not causing you any issues as far as we know, unless they end up somewhere like your eye in which case you can lose your vision). We'd generally told the practice that we had cats that had worms and showed up with a kid that was showing symptoms of having worms and they didn't put it together, and then even after we told them we wanted a specific test done, they still couldn't get it together right. If we were 80% of the population, even if we went in and told them we wanted the test done for worms, we would have had the wrong test done. We've talked about switching peditricians, but several parasitologists have told us unless you are dealing with an infectious disease specialists your not going to find a pediatrician that doesn't have that issue. You walk into essentially any peditrician office and tell them I think my toddler got worms from my cat, and they are going to tell, we'll check the stools. Now, we knew this wasn't right because we understood the difference between Toxocara cati (the cat form) and other forms of Toxocara. And these are people we have been going to for over 5 years and up and until this point people we were happy with. But I don't think you realistically expect most people to get to that point. And we actually have to FEW doctors. It appears that we might have to find away for the people that aren't making the cut off to become doctors to keep up w/ healthcare demands. That doesn't give me a lot of help the popluation of doctors is going to improve. And because of how malpractice claims and cases are counducted and frequently settled out of court as part of confidential agreemtns, it is at least very difficult to even know if your doctor is REALLY REALLY bad and made several major mistakes. ---------- Post added July-25th-2012 at 01:27 AM ---------- CBO is predicting LOWER costs based on the Supreme Court ruling because some states won't expand Medicaid. http://money.cnn.com/2012/07/23/news/economy/health-reform/index.htm?hpt=hp_t2

The people is one of the parties I was talking about. Party A is the government. They will make bad decisions, but if it is a universal system, then they will do so w/ reduced costs. Party B is the people. They will make bad decisions and it will cost us more because of fragmentation in the system that causes more costs in terms over head. **EDIT** It doesn't make sense to blindly believe in free markets. There is no reason to believe that will ALWAYS work. For free markets to work, it requires that it is possible to actually make good decisions. If people are essentially making random (or worse) decisions, a free market will fail. There are reasons w/ respect to healthcare we may have reached that point. Free markets do have real limits.

Okay, point taken. The mandate "tax" is much less than getting insurance and Roberts sees that has an important differentiation.

There is and much of it is mixed http://onlinelibrary.wiley.com/doi/10.1002/hec.1757/abstract;jsessionid=CD3951F89608FD4A4C00ED6DFB42657D.d01t01?deniedAccessCustomisedMessage=&userIsAuthenticated=false "Overall, introduction of HDHP had no impact on health-care costs, positive impact on the number of outpatient visits and mixed impacts on the inpatient and emergency room visit counts. The QDID estimates suggest HDHP introduction generally impacted subjects in upper percentiles (50th, 75th and 90th)." "HDHPs may be most effective at reducing health-care spending among individuals with moderate health-care consumption. Specifically, our QDID results indicate that individuals between the 50th and 75th percentiles of spending, or $1400–$4500 at baseline, experience the largest relative decreases in spending post-HDHP enrollment." And even more provides essentially no infromation on the point that you were trying to make like the study you posted.

I'm sorry, but those two things are not equal. If the penalty is about the same as the costs of buying insurance, then it gives you choices. The Roberts statement certainly doesn't suggest that it is small with respect to the insurance costs.

I think your study shows that people that are healthy and don't have very high healthcare costs sign up for HSA. ---------- Post added July-23rd-2012 at 02:30 PM ---------- I'm sure the faculty at Stanford would love to take in every highly qualified candidate and leave all the other's to other med schools. I don't think there is any evidence that there is a large number of people that could pass the boards and get resident positions that aren't able to go to med school. The other day I even saw a Carribean Med School that was advertising for students w/o an MCAT, which would suggest to me that they are hurting for qualified students. What do you want the government to do that wouldn't be getting away from a free market. We have state run med schools, non-profits, for profits, and even ones in the Carribean. Costs are still going up.

If party A is going to make bad decisions and party B is going to make bad decisions, then I need to consider other factors in making my deicion than the quality of the decision made. If party A can make bad decisions AND cost less money, then that gives party A an advantage over paty B. If you don't have insurance companies, then you no longer have to keep track of who has what insurance. All those records and details are extra over head. The associated costs simply go away. Not to mention duplication of the efforts by individual insurance companies can be eliminated. As well as things like advertisement and recruiting customers. The associated costs are eliminated not transferred (or at least transferred to non-medical related costs. You might see them show up in things like the price you pay for cable tv). ---------- Post added July-23rd-2012 at 11:37 AM ---------- Actually, over the last decade or so there has been an effort to increase the number of med schools and therefore med students. Med school spots are going up, but the real problem is actually residencies. https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html One of the thoughts is to try and focus resident slots into primary care (and therefore force more people into primary care). http://www.aafp.org/online/en/home/publications/news/news-now/resident-student-focus/20101201hcreform-gmeredistrib.html I'll also point out that the healthcare law's changes in loans and such is focused on those in primary care so again an effort to shif the population of doctors. ---------- Post added July-23rd-2012 at 11:45 AM ---------- I don't think this is likely, and there certainly is no evidence for it as far as I know. The uninsured don't currently use the ER more than the privatly insured and use it less than people on Medicaid. Might their behavior shift to using it even less if they have insurance, maybe, but I doubt it. In addition, there are real limits on access to non-ER healthcare for the poor. There is a reason that many of the poor end up in the ER and that is because they can't find "normal" healthcare that will take their insurance and see them in a timley manner (i.e. medicaid). People aren't rushing to start primary care offices or other for profit healthcare businesses in poor areas based on what Medicaid and the non-insured are paying. By putting more people on Medicaid, you are only going to stress that system more. I have heard people argue that the best way to really lower costs (especially with respect to the federal government) would have been to give block grants to the states and non-profits to open "no fee"/"no insurance" clinics in the poor areas. These clinics would operate without worrying about billing and therefore have reduced over head. You'd give people places to go rather than the ER. And since we are already paying anyway and these clinics would be less expensive and operate with less overhead (as they wouldn't bill and worry about insurance records), you'd actually save money. Of course, you still have a lot of people out there w/ no insurance and if they get really sick and are beyond the point these clinics can help, they'd still have issues. ---------- Post added July-23rd-2012 at 12:05 PM ---------- I don't think Obama has changed the food stamp program laws. That seems like it would have made the news. And certainly since issues related to obesity and malnutrition amongst the poor pre-date him, it is irrelevant to my point. Do you think that healthcare support for the poor should be given with duration limits on it?

Again, the medicaid population is different than the population that is non-insured. The uninsured population is mostly young and healthy. They don't go to the ER because they don't need to.

1. I never said that healthcare costs will be lowered. 2. Why do you think there will be more ER use?

The majority of the things aren't going to take 10 years to take effect. In fact, I don't know of anything that is going to take effect: http://www.healthcare.gov/law/timeline/ Now, with the court issues, there will be delays on things, but that still isn't going to give you 10 years. Origianally, specifically the mandate would start to go in place in 2014 and will essentially be fully in place by 2016. **EDIT**http://healthreform.kff.org/the-basics/Requirement-to-buy-coverage-flowchart.aspx** That was going to be my original point, but I thought MAYBE you were saying that was what the predicted taxes were going to be over 10 years. I don't know where you've been getting your information, but you might want to consider getting it from some new sources. You seem to have been lied to. ---------- Post added July-22nd-2012 at 10:38 PM ---------- It doesn't matter. If they have low enough incomes to get subsidies, they will get health insurance, or they will pay a penalty. If they are low enough that they will go into a program like Medicaid, they will still have insurance (i.e. Medicaid). They will not be showing up to an ER uninsured. Again, either way you are paying.

But the number of uninsured will drop, OR they will be paying the penalty. Fewer uninsured mean fewer people going to the ER w/o insurance, or if they are paying the penalty, then that means more income for the federal government, which should offset increases in taxes to us. There's no way under this plan that the number of uninsured can't drop w/o a substantial increase in federal revenue with respect to health care costs.

What do you think about the food stamp program? Generally, it seems to have produced a system of obesity and still pretty large undernourishment in this country yet it has mantained the semblence of a free market system (i.e. people on food stamps are free to choose what goods and brands they buy)? Do you think that the food industry (and giving them access to it in a pretty unregulated manner via food stamps) has been good for the poor in this country? Does that affect how you consider how to deal with people in the context of healthcare? Where are they going NOW? ---------- Post added July-22nd-2012 at 09:59 PM ---------- How? Assuming your taxes go up (I'm not going to ask you to actually back that up w/ some evidence), does it matter if you pay through the federal government or via increased hospitials costs, which means increased insurance costs? The fact of the matter is you are paying, does it really matter how or to whom you pay?

Your already paying for these people. Obamacare doesn't really change that one way or another.

The law doesn't say it isn't a tax, and in fact, I believe the lawyers that were supporting it in fact argued that they didn't think it was a tax, but if it should be considered a tax it should be Constitutional. So the Supreme Court didn't change it from a mandate to tax. The law is vague, and they exercised judicial power with respect to it. They decieded it was tax and given the Constitutional power of the government to tax, therefore constitutional. But healthcare is inter-state commerce. And Congress has the power to tax. We have a Republic, which isn't a democracy. I'm making the point that a free market health care system will fail because people don't even have the necessary basic information to know if they are making good decisions. 1. I never said that government can make better decisions than people. In fact, I expect them to make bad decisions. 2. That centerally managed healthcare systems have lower overhead, and therefore reduced costs, is not a matter of my opinion. It is a based on several different studies that look at over head costs in different medical systems. 3. That people make poor decisions in complex situations, especially with respect to things like healthcare, again, is not my opinion. It is backed up by multiple studies. If you want some reading you can start with this: http://www.rwjf.org/files/research/71844.pdf Why do you expect that a free market health care will do fine? Why do you expect that centerally controlled systems will fail? The NHS in Britain is over 50 years old and while it is undergone modifications, I don't see any reason to think it is going to fail any time soon.

The Constitution doesn't use the word interpert, but it clearly states: "The judicial power shall extend to all cases, in law and equity, arising under this Constitution" The Obama healthcare law is a law arising under this Constitution. But it doesn't state that the powers excplitially delegated are the States or people's write, and in some cases it broadly grants power to the federal government with respect to the ability to tax and regulate inter-state commerce. And the US was not established as a free market (there would be no need to do things like regulate interstate commerce in a free market or tax things like whiskey) or a democracy. Try learning some history. I think you said before people that don't know history are bound to repeat it. What happens to people that think they know history, but don't really? I'll ask again, why? What evidence or information do you have that suggests that your doctors are "good"? Do you have any real information at all about the long term survival or health rate of their patients? And of course I haven't said that, which only shows me the problems you have with reading comprehension. I actually think people on average do a pretty poor job of picking their doctors and their elected representatives. My whole point is with respect to healthcare there are advantages to a centeralized system with respect to reducing over head costs. In addition, there are good reasons to believe that a free market will fail (i.e. people can't make good decisions with respect to complex issues like healthcare). If given two choices, one of which might fail (a centeralized system), but will have lower over head costs vs. a system that we expect will fail (a free market), doesn't it make sense to choose the one that will give you some "benefit"? Given the choice of two options, doesn't the one that seems less bad seem superior? Free markets give you people that make poor and uninformed decisions AND high over head costs. Centeralized healthcare might give you poor decisions, but at least you can control your over head costs. Add to that despite your claim of knowing people where there is a centeralized system don't like them, that a large number of polls show in general the majority of the people in those systems actually do like their healthcare, I certainly don't see the reason to reject the idea out right. It has nothing to do with baby sitting anybody. It has to do with doing what makes sense.

1. Do you not believe the Constitution is correct with respect to the Supreme Court being the interpert of the Constitution? 2. States have always had to "bear" things that they opposed: http://www.pbs.org/wgbh/amex/duel/peopleevents/pande22.html 3. Are you really claiming that a socialist/democratic system isn't possible? That the French, Swiss, and Canadians are headed towards a Soviet or Nazi style government? Do you have any reason to believe that you are making good decisions with respect to your healthcare? Do you have any actual data that your doctor is a good doctor? Do you have any data that indicates that his patients long term have "positive" out comes, especially in an economical manner? **EDIT** Your argument essentially requires that people can't do a good job of electing their representative (and if people are doing a good job of that, then it raises the issue of all the problems you say the government has actually problems), BUT that people can do a good job of making decisions with respect to their healthcare. That seems unlikely to me.

It doesn't really matter with respect to the point. And there is plenty of evidence that people don't in complex situations like healthcare. You must know a non-average population of Canadians. Multiple polls show they are in general happy with their healthcare system and prefer their healthcare system to a "free market" approach. And generally want healthcare delivered through a non-profit manner: http://www.huffingtonpost.ca/2012/06/29/canadians-mixed-system-health-care_n_1636796.html This is older, but 63% of the British say that they think their health care system is a good value. http://www.ipsos-mori.com/researchpublications/researcharchive/poll.aspx?oItemId=2048 So now going to a more federally regulated healthcare system is going to lead to the Third Reich? Or cause government leaders to use nuclear weapons?

double post

I have to go and have a PSA test done. Let's assume that I have prostate cancer. They catch the cancer, treat it, and I don't die of prostate cancer. Good, right? No. I'm going to die of something some day and almost no matter what I die of there will be associated costs. There is no reason to believe that me dying from prostate cancer will be cheaper than me dying from whatever else I'll die from. And in fact if I live to get a disease or a point where I need long term care, it'll almost certainly end up costing more than if I had died younger of prostate cancer. And that doesn't even get into all of the people that you do PSAs on that don't have prostate cancer (essentially wasted money) and false positive PSA tests. In terms of costs, it is cheaper if you keel over at 50 of cancer or some heart disease than if you live until you are 80, have associated problems (hip replacement, etc) and tests done over the course of your life, and end up dying of dementia or some other disease normally related to the oldest population. But don't take my word for it: http://www.politifact.com/truth-o-meter/statements/2012/feb/10/barack-obama/barack-obama-says-preventive-care-saves-money/ Barack Obama says preventive care 'saves money' rated false Or if you like the CBO: "In yet more disappointing news for Democrats pushing for health care reform, Douglas W. Elmendorf, director of the Congressional Budget Office, offered a skeptical view Friday of the cost savings that could result from preventive care — an area that President Obama and congressional Democrats repeatedly had emphasized as a way health care reform would be less expensive in the long term. Obviously successful preventive care can make Americans healthier and save lives. But, Elmendorf wrote, it may not save money as Democrats had been arguing. "Although different types of preventive care have different effects on spending, the evidence suggests that for most preventive services, expanded utilization leads to higher, not lower, medical spending overall," Elmendorf wrote. "That result may seem counterintuitive."" http://abcnews.go.com/blogs/politics/2009/08/congressional-budget-expert-says-preventive-care-will-raise-not-cut-costs/ **EDIT** Now, I think if you conducted very selective preventative care, you essentially didn't do broad tests like we do in many cases, you could probably make preventative care save you money. I go get blood work done every year or 2 where they do a whole bunch of tests. But realistically most of them are a waste of money. Doing them is "standard", but realistically most of them aren't affecting my health or the majority of people's health that are getting them. Especially when you start taking into account costs.

Come on. You know enough that cherry picking a few things, especially programs that were changed after the original projection, doesn't amount for evidence of much of any thing. Much less that something is systematically biased in one way. **EDIT** Other than maybe a systematic bias in the person that put together the cherry picked/miss leading list.

Is there any actual evidence this is true? That the CBO DOES systemmatically underestimate the costs of bills?

For a free market to work, it requires several things. First and for most that people can make good decisions. There are many countries that have a more socialized health care system than us that at least appear to be paying less than us- most notably by reducing over head costs. Do you really want to claim that "corruption" doesn't happen in private industry? Let's say, that people don't embezzle money from their employer? ---------- Post added July-20th-2012 at 01:27 PM ---------- But the government isn't really JUST saving money. The money is coming IN too (e.g. the "tax" from the mandate). That is the "savings" are driven by more earnings (w/ respect to the federal government), but those earning realistically are healthcare costs to the person paying the penalty. The net sum is no real savings in health care costs. As a private person, I'm not going to start collecting more money from anybody after ACA to pay for my healthcare.

The CBO, as far as I know, isn't talking about real health care costs. It is talking about government costs. There is a difference.