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From a doctor's perspective, is it better to repeal or keep healthcare reform

Discussion in 'Allopathic' started by Lysinee, Mar 1, 2012.

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  1. notbobtrustme

    notbobtrustme Crux Terminatus

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    When you are running in the red, you don't cut everything willy-nilly. You don't cut your food budget with the same vigor that you cut your Cadillac budget do you? Do you cut 25% from everything, including rent? OF course not, that's just silly. Unfortunately, that's exactly what the GOP have proposed. They would sacrifice us all on some obscene altar all in the name of "no taxes". Conservatives have portrayed the budget debate as a massive spending deficit when, in reality, it's nothing of the sort. We do need sensible cutting of the budget, but to suggest that education, research, infrastructure, social spending and the like need to be cut while taxes for the top bracket also need to be slashed is downright retarded. The fact that we've been coerced into this narrative shows how well the conservative community is able to control the debate. The GOP has lurched so far to the right that center-right positions are now "liberal." If Reagan was running today, he'd be a liberal Democrat, nevermind a Republican. Objectively, nearly every single policy action taken by Reagan would firmly place him to the left of Barack Obama today.

    The reason we are in a such a big hole is because GWB's tax cutting + spending policies during the 00s plunged us into a massive deficit. His administration combined massive tax cuts with extraordinary spending and then left office before the full effects of the mess could be seen. Without the Bush tax cuts, there would be no "budget crisis" even with today's level of spending. And now, we have GOP candidates advocating for essentially a 0% tax on the top bracket. A return to Clinton-era taxes, which are still lower than the Reagan era, is unfathomable. That's how far right the debate has gotten. People who talk about cutting without addressing the tax side of the equation might as well be from Mars. There's no sense in talking to these people because they fundamentally don't understand the question at hand.

    This is a very well sourced and written article about the current budget and tax issues. Give it a thorough read before making any conclusions.

    http://www.rollingstone.com/politics/news/how-the-gop-became-the-party-of-the-rich-20111109
  2. Dave89

    Dave89 E pluribus pluribus

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    First, I simply cannot take anything from RollingStone seriously. There are sophisticated, well-informed, and cultured publications on both the left and the right, but the profanity-laden, shamelessly partisan tripe in RS simply does not pass muster. Appealing to envy does work for oafs, but I think as medical student we should be able to have a more intellectual discussion than the emotional one which inevitably ensues of one takes seriously an article entitled "How the GOP Became the Party of THE RICH" (snarl)

    Second, I never said that taxes need to be slashed at this point (though I do believe they must be cut). But that's not the point. Regardless of tax rates, we are spending too much on education and "infrastructure." I'm sorry, but I don't agree that slashing from education (or what passes for it these days, anyway) is akin to slashing your food budget when in the red. Public schools have more than demonstrated for themselves that they are nowhere near vital for survival.
  3. Lysinee

    Lysinee

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    1) "Fluke testified that contraception can cost a law student $3,000 over three years." So, that's $1k per year, which would cover your expensive NR option. Again, we are assuming she would pick that expensive option in the first place. Plus, her first OB/GYN exam will be covered by her insurance. So, $1k per year is too much.
    http://cnsnews.com/news/article/pel...y-factual-despite-9-month-birth-control-pills

    2) If she wants a long lasting birth control, she should consider IUD which is $500 and lasts about 5 years. Also, pills, injections, patches, etc for short term.

    3) Don't go to GT Law (Catholic institution) and expect to have their insurance cover birth control. She knew this before too. Her failed attempts to change the school's policy (http://www.gulawweekly.org/news/201...control-mandate-reverses-georgetown-poli.html). She "even considered filing a sex discrimination claim against the school."
  4. ManBroDude

    ManBroDude Half man, half bearpig

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    They will cheat. They'll find a way, and they will cheat. Both teachers and students.

    If you've never seen The Wire, I suggest you check it out. Especially season 4 (it's highest rated season of the world's highest rated series, subjectively). It's excellent social commentary on Baltimore's school system which is an abyss that sucks tons of money with no good results. And then the entire community is outraged when people even think about cutting funds ("but think of the poor children!")
  5. scarshapedstar

    scarshapedstar MD c/o 2016

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    The thrust of your argument is that, at the time SS was created, it was expected that practically nobody would ever receive it, because 65 was sooooooooooooooooo old back in those dark ages. Is it not? Just trying to get this straight first. I've heard this argument before - nobody expected SS to go mainstream, so to speak - in fact it was almost a prank by FDR because only like, one or two little old ladies each year would ever collect... and now there's millions... totally unforseen because government actuaries are soooooo shortsighted! What a disaster!

    Isn't this basically what you're getting at?
    Last edited: Mar 28, 2012
  6. pupster

    pupster

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    I guess that's why Europe was (until the debt crisis) standardizing on the Euro, and the Russians and Chinese are pushing a reliance on non-dollar currencies?
  7. MiracleforMD

    MiracleforMD

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    Yes, because it gives them a chance to make back the billions of dollars they spent creating it.
    Yes, because it is the basis of capitalism.
    Yes, because it inherently drives competition and forces people to innovate and work hard thus progressing our society.
    Yes. It. Is. Right.
  8. Gut Shot

    Gut Shot

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    Except that she didn't say three years. Here is what she said: "Without insurance coverage, contraception, as you know, can cost a woman over $3,000 during law school. For a lot of students who, like me, are on public interest scholarships, that's practically an entire summer's salary. 40% of the female students at Georgetown Law reported to us that they struggle financially as a result of this policy."

    You should let her and every other female law student at Georgetown know. IUDs are incredibly hard to place in nulliparous women, BTW, but I'm sure you were aware of that.

    I would expect to attend any educational institution in the country that accepts federal funds and receive birth control coverage. Georgetown has decided to exist within the public sphere, and as such it is subject to the same rules as everybody else.

    But you're right, perhaps she should follow other great Americans, roll over, and accept the status quo.
  9. Gut Shot

    Gut Shot

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    Patents only prevent competition for a limited period of time, and they are necessary to ensure the private R&D commitment needed to bring new drugs to market. It's a flawed system, but better than the alternative.
  10. Gut Shot

    Gut Shot

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    So let's see, Jack Shephard is all indignant, Dave89 is getting compared to Glenn Beck (a lousy comparison, as Beck is just an actor), and pupster thinks he's going to get laid by offering women Botox (i.e. he's getting creepier by the minute). As for my specialty, I actually hand out toiletries in a night club men's room. I just didn't see "attendant" in the drop down menu.

    All in all I would say this thread is a resounding success.
  11. SteinUmStein

    SteinUmStein

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    I don't see any incentive for the Russians or Chinese to rely on the dollar when they're almost constantly antagonizing us/antagonized by us, even if the dollar were rock solid. Europe's got the Euro, so what? It's even less stable than the oh-so-flimsy dollar that you are all purporting with no evidence. None of these are indications for the future health of the dollar.
  12. Marcus Brody

    Marcus Brody Already has the grail.

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    Do they, though? Fluticasone/salmeterol no longer is patented, yet there are no generic alternatives, and Advair sells for $200 per 60 metered doses, the smallest quantity available. Though patents are the best example, there are other barriers that essentially bar people from getting help and from helping others, licensing and "quality standards." It takes a lot of time and money just to bring a generic drug to market due to all the legal barriers, and so even this is a form of monopolistic privilege, just more convoluted than an outright patent. These restrictions are done in the name of "public safety," but when people are legally prohibited from getting basic health necessities except through an overpriced monopoly you have to wonder if there was an ethical miscalculation somewhere in the rationale. It is interesting the people so adamant about a "right to healthcare" are so blithe and indifferent when it comes to the right to provide it.

    Essentially what you are saying is you want to, on one hand, coercively restrict the supply of these drugs and services, and on the other hand "solve" that problem by coercively forcing others to subsidize them. It's a racket on both ends that serves to perpetuate itself.

    And what about the research and development- is research on erectile dysfunction and symptom-relief for chronic disease the "commitment" you had in mind? We need different types of research right now but there are massive shortages (and not just in research, of the drugs themselves too). Patents have NOT promoted research and development overall, they have simply artificially skewed it toward more profitable areas. The effect is we have comparatively little research and development in the things that actually matter, like antibiotics.

    Patents have also prevented research on newly patented drugs by the companies making them, ie they overstimulate research prior to the drug's development, then unduly restrict it afterward. Research on "blockbuster drugs" always seems to end once they're patented even if what is brought to market is unsafe and controversial. Why bother when there is a State-protected monopoly? Adalimumab and the other TNF inhibitors for example are some of the worst and most dangerous drugs, yet they make their patent holders $5+ billion/year. Same with most of the major cash cows...ZyPREXA, Plavix, etc... Even NuvaRing has problems, but I don't see anyone trying to improve it. It's illegal.

    I don't buy this "well, it's flawed but necessary." If that is true, fix the flaw before you come looking to impose its costs on others against their will. It takes a lot of gall to propose forcing someone to help you with a problem you willfully continue to perpetuate. But what is most grotesque of all is making these arguments when one actually works in healthcare, because like Pfizer and Merck, we benefit from these problems at patients' expense.
    Last edited: Mar 29, 2012
  13. SurfingDoctor

    SurfingDoctor

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    .
    Last edited: Mar 29, 2012
  14. JackShephard MD

    JackShephard MD

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    Indignant? Not at all. I'm as peaceful as a Tibetan monk.

    I simply pointed out your childish behavior.

    I sincerely wish you well. Good luck.

    Oh, and the House passed Ryan's Medicare bill today...
    Last edited: Mar 29, 2012
  15. Gut Shot

    Gut Shot

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    tl;dr

    Perhaps I can show you to a nice soapbox somewhere else?
  16. Gut Shot

    Gut Shot

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    It doesn't look so peaceful. But you are right, indignant didn't write "Politics, where conduct, class and respect are all secondary to the day's pursuit." A haughty spirit did.

    [​IMG]

    Good. That's one step closer to the dustbin of history.
  17. SteinUmStein

    SteinUmStein

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    At its current composition the House could probably pass a bill declaring the GOP to be God's Own Party and all Democrats to be heathens who shall burn eternally in the twin fires of government overreach and runaway spending.
  18. JackShephard MD

    JackShephard MD

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    :rolleyes:

    We can stop there.

    You have a talent for bringing about dissension.

    I hope you find what you're looking for.
  19. phltz

    phltz

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    In 2010 (which is the last year I can find solid numbers for), the federal government collected less money in taxes, as a fraction of GDP, than it has since the early 1950s. Estimates for 2011 appear to be even lower. Taxes are already at historic lows for the post-WWII era. On what basis do you think they must be cut further? Do you think that taxes should always be cut, or can you imagine a situation in which you would think they were appropriate or should be raised? What would that situation have to look like?
  20. Skinceutical

    Skinceutical

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    Don't mean to side track the thread, but saw this and I felt obligated to respond.

    What are you talking about? The anti-TNF agents have single-handedly revolutionized the treatment of recalcitrant RA, psoriasis, IBD, and a whole slew of other rheumatologic diseases. They're highly effective effective, well tolerated by most, and have a safety profile comparable (if not outright superior to) many of the DMARDs that would otherwise be used for these patients.

    Moreover, the idea that there has been no further research to improve these drugs is absurd. The first anti-TNF agent, infliximab, was a murine/human chimeric antibody - some patients developed anti-chimeric antibodies leading to reduced efficacy. We now have fully human anti-TNF agents (adalimumab, golimumab, etanercept). We also have a slew of newer biologics with other targets in the immune system (ustekinumab, tocilizumab, belimumab, etc).

    Anyways - I'll let you all get back to solving the nation's health care crisis now.
  21. Gut Shot

    Gut Shot

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    I do consider myself the George Fox of SDN.

    What makes you think I haven't?
  22. Dave89

    Dave89 E pluribus pluribus

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    Of course I believe taxes should be raised in some cases. But when people say they would like taxes to be raised, they often refer foolishly to corporate taxes. Which, at a time when outsourcing is so common, will only serve to hurt our economy.

    But maybe we should raise taxes on the nearly 50% who pay no income tax at all...

    Look, raising taxes might have some merit if the revenue were being spent responsibly. But the federal government (and some state ones) act like kids with credit cards in a candy shop. At this rate, raising taxes will only cause more money to be frittered away.

    To tame the beast, we must starve it a little.
  23. phltz

    phltz

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    So your plan is to cut taxes, thereby reducing revenue and forcing the government to spend less money? That's a fine theory, which is unfortunately contradicted by the facts. People who've looked at the actual evidence, instead of just armchair theorizing, have found that cutting taxes alone actually results in _more_ demand for government spending. So your proposed course of action is actually directly at odds with the goals that you claim to want.
  24. SteinUmStein

    SteinUmStein

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    :laugh: Ah yes, our old friend STB. My second favorite, after "trickle-down economics" of course.

    http://www.forbes.com/2010/05/06/ta...arve-the-beast-columnists-bruce-bartlett.html
  25. Dave89

    Dave89 E pluribus pluribus

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    Nice try, but that's not what I said. I've said explicitly that there must be cuts as well.
  26. Dave89

    Dave89 E pluribus pluribus

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    Certainly, merely cutting spending is not enough. We must come back to the understanding that the more money government takes, the worse it is for the economy and the country. Granted, there are certain functions that, for practical reasons, can only be achieved at a federal level (e.g. our national defense). When we send our money to the bureaucracy in DC, it is used far less efficiently Like flour going through multiple sieves, some gets lost with each level it encounters.

    I assume we are all well aware of the "use it or lose it" principle. This is reality. There will always be more people to give benefits to, more trees to save, and more businesses/corporations to prop up. Just as we as medical students have to say NO to eating sushi every other night, especially since every borrowed dollar spent comes out to more than a dollar in debt, the federal government needs to live within certain means as ITS spending is borrowed with interest.

    "Starving the Beast" is insufficient to solve our problems, just as the Forbes article illustrates, and very few would claim that it, alone, is the silver bullet. What really needs to be accomplished is a national soul-searching regarding the role of government. I realize this kind of thinking is mocked widely to loud hoots and raucous laughter, but I think it's simply the cold, hard truth.
  27. SteinUmStein

    SteinUmStein

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    Ooh, are we moving to fantasy land now? Can we get giant marshmellows to nap on too?

    To keep it very brief: without a Democratic supermajority in the Senate, Republicans will always filibuster to prevent a tax increase from passing. Without a Republican supermajority in the Senate, Dems will always filibuster to prevent deep cuts to domestic programs they favor. The result? Reality, where we live right now, with no marshmellow pillows and a massive national debt that will only continue to grow until we can find some sort of compromise (don't hold your breath).
  28. Dave89

    Dave89 E pluribus pluribus

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    I'm not sure how you improved upon my statement. All you basically said (correct me if I'm wrong), is that the situation is hopeless.
  29. phltz

    phltz

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    The evidence still suggests that if you really want to shrink the size of the government, cutting taxes is somewhat counterproductive.

    For any given level of government spending, the less people are paying in taxes, the better the deal they're getting on their government services. And, like almost every good known to man, the cheaper it is, the more people will want to consume. When you cut taxes, you're providing a discount on health care, wars or foreign adventure, roads, schools, etc. People then want more of those things.

    If you really want to reduce demand for government services, you'd raise taxes, and force people to pay full price. As the price people pay for government services rises, they'll want to consume less of them.

    The only way for "starve the beast" to work would be if people behaved rationally with good long-term planning. Unfortunately, human nature being what it is, people tend to make decisions on a very short time horizon. This makes it counterproductive.

    I'm not just pulling this out of my ass, this is what the actual economic data shows. If you really want to reduce government spending, your first step should be raising taxes. I appreciate your goals, and I don't think they're bad ones. I just think that you are going about them in exactly the wrong way, and are sabotaging yourself in the process.
  30. SteinUmStein

    SteinUmStein

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    Not hopeless. Close to hopeless until we have a major change in our political atmosphere nationally. I have a gut feeling that it will take some major crisis to get us there, one larger than the Great Recession apparently. Iran getting a nuke? Israel going postal on Iran prematurely? A complete collapse of our health insurance system following a :thumbdown: Supreme Court ruling on Obamacare? Who knows. But I think it'll take a major jolt to get us moving. We're stuck pretty deep in the mud right now.
  31. Dave89

    Dave89 E pluribus pluribus

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    Where do you think the "government" gets its money from? Us! If taxes are cut and people receive the same level of government "services", they're not getting something for less, they're paying more, because then the only way government is spending that money is by borrowing it with interest.

    When politicians as a class finally realize that it is not "cheaper", we will begin to see a sharp reversal in public opinion on government spending. The TEA Party, hate 'em or love 'em, have learned this.

    :confused::confused::confused: "...force people to pay full price"? Not sure what that means. If you're going to take away the government borrowing and spending beyond its means, why not just get government out of the picture in those areas and let the free market provide the goods or services? They'd be a hell of a lot better and cheaper.

    In our situation, certain taxes should be raised. But for anyone (not accusing you personally) to ridicule me for living in a "fantasy land" by suggesting that we must change our attitude toward government spending is just wrong.
  32. Dave89

    Dave89 E pluribus pluribus

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    Whoa, whoa, whoa! Who mentioned a crisis, especially an economic one? I have a faint idea that I was mocked for suggesting such a possibility a couple days ago. :laugh::laugh::laugh:

    Yes, that's why I wrote that post before about the American people waking up to reality.

    BTW by the thumbsdown, I imagine you were referring to the possibility of it being upheld, right? :)
  33. SteinUmStein

    SteinUmStein

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    The fantasy land comment was about the difficulty of getting our political landscape to do anything productive, not about your idea that we need to change the public's understanding of debt and how to reign in spending, which is correct.

    I'm not saying there WILL be a crisis like a collapse of the dollar, which I think is probably less likely than any of the ones I just mentioned, just that it will probably take a major national change of that kind of magnitude to get us moving.

    edit: I meant a down ruling, not a "bad" one. Down as in repealed.
  34. Dave89

    Dave89 E pluribus pluribus

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    Well, it starts in places like these, where hopefully ideas can spread in a reasoned fashion. To be a Republican or conservative does not mean one is a contributing member to Stormfront, and to be a Democrat or liberal does not mean one thinks Che was a hero. It's important to flesh these realities out, because even on forums like these not everyone appears to have learned them.
  35. phltz

    phltz

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    You're supposing that people rationally consider the long-term situation. They don't. People are generally irrational, and generally focus on short term plans. If you present a deal to people wherein they'll pay less for government services, they'll think it's a great deal, even if public sector debt is accumulating. Very few people will care that in 10 or 30 or 50 years the bill will come due. Why do you think the credit card industry does so well? Why do you think the housing bubble got so out of control? Why do you think so many people have woefully undersaved for retirement? It's because, by and large, we're very bad at planning for the future.

    If we were all Vulcans, "starve the beast" might work. But we are, sadly, flawed humans. "Starve the beast" is a strategy that blunders right into some of our most profound and stubborn cognitive weaknesses. It's just not going to work.
  36. Dave89

    Dave89 E pluribus pluribus

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    It's either that or let the debt spiral even higher and make our future even bleaker.

    BTW I am not sure I agree with you on this. A good number of people have come to the realization that 16 trillion dollars of debt is a bad thing. But they're dismissed as "extremists."
  37. phltz

    phltz

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    I think that 16 trillion dollars of debt is a bad thing. And I think a great place to start dealing with it would be to return to the Clinton era tax rates of the late 1990s. That would put an enormous dent in the deficit. The economy in the 1990s was the best in recent memory, which suggests that those rates wouldn't exactly crush the lifeblood out of growth.

    As a matter of fact, the increase of tax rates in the Clinton era was actually coupled with serious cuts and restructuring on entitlement programs. Remember welfare reform? When you make citizens pay full price for the government, they're more willing to make serious efforts to make cuts and make things more efficient.

    If you are serious about cutting the deficit, step one should be raising taxes. This will provide much of the political will needed to cut and restructure inefficient government programs. _That_ is how you balance the budget and get the debt under control. Trying to start with cutting taxes just won't work.
  38. SteinUmStein

    SteinUmStein

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    I agree, that's why I hesitate to identify as a Democrat, because people think they immediately have me figured out and know my stance on every issue. It's also frustrating to not be able to support issues I feel strongly about because I'm not (usually) willing to vote R, and my stance on those issues has been named a "conservative" one. The world is too complicated and is too many shades of gray to cover every topic with two diametrically-opposed stances. Our democracy is terribly flawed, but it's the best we've got for now.
  39. Lysinee

    Lysinee

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  40. pupster

    pupster

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    Cutting entitlements would go a long way toward cutting debt.
  41. notbobtrustme

    notbobtrustme Crux Terminatus

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    and cutting your leg off goes a long way towards weight loss.
  42. notbobtrustme

    notbobtrustme Crux Terminatus

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    This is objectively false. If you look back in history, higher taxes have led to better growth and better social mobility. During the '50s and '60s, the top bracket tax was something like 70%. There were a lot of deductions, but the overall tax burden was still much higher than today. During the 80s, taxes on the top bracket (and overall) were higher than today and the US economy grew like gangbusters.

    Today, taxes are at their lowest since the income tax was established. And we are still slogging through an extremely slow recovery. And the GOP wants to slash taxes even more.
  43. auburnO5

    auburnO5

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    No. The government is WAY TOO &#*%ing big.
  44. phltz

    phltz

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    It always makes you look intelligent and in the right when someone makes a claim and backs it up with several factual pieces of supporting evidence, and then you counter their claim with capitalized letters and profanity.
  45. SteinUmStein

    SteinUmStein

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    You know the GOP and Fox & friends are doing a great job when the knee-jerk reaction to any problem among a significant portion of the population is "Nope, government's too big, slash spending (except defense) and cut taxes!"

    Lets see some data. Really, anything other than "Obummercare too big gov'mt herp derp spending my money ruining 'Murrica! Freedom!!111"
  46. JackShephard MD

    JackShephard MD

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    The benefits/consequences of taxes or size of government are peripheral issues.

    The central issue: how the government uses resources. The government has proven to be inefficient, ineffective, unable to make progress or compromise, irresponsible, wasteful and unaccountable. Does anyone trust politicians? Can congress get things done?

    I would support higher taxes/spending if the government was a well-oiled machine, but it simply isn't.

    Also, polarizing isn't helpful. We don't need a conservative/liberal war. Common sense will save the country, not partisan ideology.
    Last edited: Mar 30, 2012
  47. Dave89

    Dave89 E pluribus pluribus

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    Cutting your leg off can be a mighty fine thing when it's gangrenous and threatening the rest of the body.
  48. Dave89

    Dave89 E pluribus pluribus

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  49. phltz

    phltz

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    If someone tells me that my leg is gangrenous and needs to be cut off, I'm going to need to be thoroughly convinced that they're right before I'll agree to an amputation. Some random guys saying, "Yo, man, your leg is rubbish." isn't going to cut it. Some random guy saying "Yo, man, some of your limbs are crap, you can totally get by without a few of them," without even saying which specific limbs he thinks are gangrenous is even less credible. If you have a strong case that particular governmental programs are crap and need to be amputated, I'm all ears. If you're just going to make sweeping generalizations, I'm much less interested.
  50. Dave89

    Dave89 E pluribus pluribus

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    http://www.usgovernmentspending.com/us_20th_century_chart.html

    We are at the highest level of government spending as percent of GDP since WW2. I think that's a decent indicator that government is huge, and probably too big.

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