The insurance companies aren't doing a very good job. I went to a physiatrist last year who gave me an unnecessary knee x-ray, and if I had let him he would have given me an unnecessary and dangerous cortisone shot. My insurance company didn't care.

As long as you give doctors financial incentives to do something, most of them will do it. The insurance companies gave us a song and dance starting with the managed care days about how they would impose quality standards, but they botched that up. They usually let Medicare set the standards, and follow along. If you want doctors to follow evidence-based guidelines, then put them on salary. They don't do unnecessary urine tests (and CAT scans) in the VA or in the UK NHS. If you're going to let lobbyists (like the ones at the American Academy of Orthopedic Surgeons) influence government standard-setting bodies, then of course you're going to have waste, fraud and abuse. We missed our chance with Donald Berwick.

But back to the original question, I suspect that the fraud in the food stamp program is well under the fraud in the private health insurance industry.

On the general question of redistributive programs, Paul Krugman explains it better than I can.

So what? Out of 47 million people on food stamps, you'd expect that a few of them cheat.

Those stories show that the USDA is policing the system and catching people when they do cheat. They're doing their job.

That doesn't show that a large number of people cheat the system. You need statistics for that.

I don't think the cheating on food stamps is any worse than the cheating in the private sector, and maybe less. Doctors perform unnecessary procedures, like CAT scans, and bill the private insurance companies for thousands of dollars. And I do have statistics for that.

A rich person might have taken your job away, and sent it to India or China.

The top 1% made about 24% of the income. http://www.slate.com/articles/...

So it's totally appropriate for them to pay 37% of the taxes (if they did -- I don't know if those figures don't include FICA payments, which conservatives sometimes exclude from the definition of "tax").

Paul Krugman has explained why income inequality is bad for everybody. http://www.nytimes.com/2014/03... Those American billionaires could get along perfectly well at Swedish levels of taxes, and the rest of us would be much better off. It's actually bad for everyone to have 20% or 40% of the population in poverty.

I know that right-wing talking point and I've checked it out before. Don't forget the footnote:*
_________
*Footnote: "Taxes" are defined to exclude FICA, which is the largest payment most middle-class and working people pay.

Percentagewise, the rich pay roughly 30%, the same as the middle-class, although those that can put everything into investment income like Mitt Romney pay about 15%.

That's why Warren Buffet pays less than his secretary.

Yeah, let's get rid of the freeloaders and cheaters.

From FTA:

But you can't cite any stats.

Therefore, many of us would conclude:

1. There are no statistics.

2. You're full of shit.

We're paying roughly twice as much for our health care as the Canadians do.

If we want to cut our health care costs, all we have to do is compare our system to Canada's and see what we're doing wrong.

The one I was thinking about was AZT https://en.wikipedia.org/wiki/... Government-funded researchers developed AZT, tied it up in a package, and handed it to Burroughs-Welcome. Burroughs-Welcome did have some expertise in retroviruses, but they weren't indispensable.

I'd like to know where you get that figure. And I'd like to drill down to see how much of that is new classes of drugs vs. me-too drugs that just stick on a methyl group somewhere.

There's a problem with the term "invented." Most drugs are the result of a long chain of efforts from basic research to drugstore. The drug companies contribute to parts of that, usually in the later stages of human research and industrial production.

But government agencies are quite capable of doing the human research. The VA for example has often done the best studies of drugs used in cardiology and other conditions that are common among their patient population.

And many of the drug companies now contract out their actual drug production to factories in China and India. The FDA does inspection and quality control.

Alexander Flemming discovered, or invented, penicillin in a university lab. He refused to patent it, because he wanted to give it to the world. During WWII, the British gave all their penicillin research to the U.S. government, who gave it to Pfizer, who worked out the commercial development. Pfizer, in contrast, patented everything they did and kept it to themselves.

I'd have to look that up, but AZT was developed as I described. I'll give the drug companies credit where it's deserved, but they have always been supporters of NIH funding.

Whenever the Wall Street Journal had an editorial demanding that the government shut down NIH funding and unleash the creativity of the free market in its place, even the right-wing conservative corporate executives in the pharmaceutical industry came to the NIH's defense.

The Social Security tax rate is 12.4% up to a maximum of $117,000.

If we were to eliminate the maximum, and charge everyone 12.4% of all their income, that would solve any problem the Social Security system had.

Because of the way income is distributed, people with income over $117,000 in the aggregate earn about as much as everybody else put together. So that's where the money is, and they can easily afford it.

People may be living longer now, but they also have a higher level of disability. For example, I saw in a recent issue of the Journal of the American Medical Association that 20% of people over 50 years of age have mobility problems such that they can't walk a mile. So they couldn't do a job that required walking.

Over the age of 65, peoples' abilities decline and their handicaps increase significantly. There are people who can continue working, but they're exceptional. For example, I know an actor who made a good living but he had to stop working in his 70s because he kept forgetting his lines.

Most other developed countries have a retirement age of 60-65 (sometimes younger) https://en.wikipedia.org/wiki/...

Is the American economic system so inefficient that we have to force people to work longer than they do in other developed countries -- even socialist countries?

Yes it does have to go through a public forum.

Judges will often go back to the legislative record to interpret a law. If there was no public forum, there was no legislative record.

Prosecutors have done stupider things.

I'm not a lawyer, so I don't know every possible problem that can come up with these laws, but a defense lawyer who has handled these cases could come up with objections. They should have been allowed to testify.

Laws shouldn't be easy to pass. Putting somebody in jail for 2 1/2 years shouldn't be easy.

You and I must be reading different journals.

Perspective: Asia's Ascent — Global Trends in Biomedical R&D Expenditures
January 2, 2014
N Engl J Med 2014; 370:3-6
Owing to cuts mandated by the Budget Control Act of 2011, the NIH budget for fiscal year 2013 was reduced by $1.7 billion, to $29.2 billion — a 5.5% reduction that continued a trend of declining federal funding for biomedical research that began in 2003.2
Our analysis reveals that U.S. inflation-adjusted R&D expenditures and the U.S. share of global expenditures decreased from 2007 through 2012. The decline is remarkable because the United States has provided a majority of the funding for biomedical R&D globally for the past two decades — a share that some previous analyses suggested was as high as 70 to 80%.2 Moreover, the decline was driven almost entirely by reduced investment by industry, not the public sector, between 2007 and 2012. Sequestration of NIH funding in 2013 and beyond will exacerbate this reduction by causing U.S. public-sector expenditures to decline.
Although our data set has its limitations, our findings reveal a decline in U.S. financial competitiveness in biomedical R&D and may have implications for the debate over appropriate federal policy in this area. The lack of a coordinated national biomedical R&D strategy is disappointing, at a time when mature economies such as those of Japan and Europe have maintained their level of investment in this area.

http://jama.jamanetwork.com/ar...
Funding of US biomedical research, 2003-2008.
JAMA. 2010 Jan 13;303(2):137-43. doi: 10.1001/jama.2009.1987.
Funding of US biomedical research, 2003-2008.
CONCLUSION: After a decade of doubling, the rate of increase in biomedical research funding slowed from 2003 to 2007, and after adjustment for inflation, the absolute level of funding from the National Institutes of Health and industry appears to have decreased by 2% in 2008.

Where do you think these practicing doctors get the drugs they use to treat people?

Most of the drugs they use to treat AIDS and cancer come from NIH research (although usually the pharmaceutical companies managed to squeeze in and get a patent for them).

You've been talking to the wrong doctors.

I've run into a lot of doctors who would admit that they didn't know something.

I've also run into a few doctors who admitted that they were wrong. As Carl Sagan said, it doesn't happen often but it does happen.

Of course a lot of them were research-oriented, like the guys who get NIH grants.

You ought to get better doctors.

"Entitlements" are things that people are entitled to.

If I spend 40 years working and putting a big chunk of my income into Social Security and Medicare because the deal was that I'll get it when I'm 65, I think I'm entitled to get it when I'm 65.