I suspect lawyers have the broadest range of all. Really more akin to just business. From $30k a year to billions.Now do the bottom of lawyers
First year salary at big firms here is $225k
Trump tells House Republicans to find a ‘fair number’ on SALT
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First year salary at big firms here is $225k
What assumptions are you talking about?
I'm referring financial results. So there aren't assumptions. The report I'm referring is one that delineates P&L by payer. They make black numbers on privately insured and red numbers on publicly insured.
OK. Do you agree that the way our system is setup that Medicare is roughly cpi +1, or ~3% annually in perpetuity?
Hmm….most that I am familiar with completed a residency in Internal Medicine or Family Practice
An eye opener to me was I had a coworker who had some money and bought a house by coconut grove. I can’t remember what it was. Not crazy expensive at all. Anyway he sold it after three years and wanted to celebrate so we went out for drinks. The profit he made on that deal was more than I made in salary the length of time he had the house. 3 years ish. And I worked from 9 to 7 or 8 every day and every Saturday.Now do the bottom of lawyers
I think that hustle mentality and opportunity is even more prevalent with the younger Gen. House flippers. Bitcoin. So much shit. Med school just seems like a lot. Not to mention the pool worth a shit at math etc to qualify
Oh yeah, I believe he completed his residency in internal medicine. But yeah don't think he has an interest in starting his own practice at this point in life.
Everything is easy in a bull market. A lot of it is blind luck.
I'm more interested in the chart than the text.
Why not compare to Germany or Netherlands.... Seems at least a closer peer.
According to this ranking system the US scores well on a lot of the metrics.... With the extreme exception being 'fiscal sustainability'
Germany: #3 in the 2024 World Index of Healthcare Innovation - FREOPP
Germany demonstrates one of the best healthcare systems in the world through an array of choices, scientific advancements, and a commitment to fiscal sustainability.freopp.org
We can and should look at whatever we can to get better results -- without a rating of 16 on fiscal sustainability.
But we need to disabuse ourselves of the notion that healthcare is a right. That's for childrens' fairytales.
GPs are useless anymore. All mine does is read the blood report. Hell, I can do that.
And if there are any issues, they just send you to a specialist. Whatever they're paying GPs, it's too much.
Not saying it would happen here, but Korea tried to force universities to take on more med students, and it resulted in a catastrophic doctor strike that is still going on to this day one year later.
Doctors are gatekeepers, and will protect the gate at all costs. Be careful what you wish for.
No shit lol. I think the gen before us had it pretty good. No tiered partnerships. No tort reform. Not saturated etc
AI is going to have a massive impact on healthcare.
The new resource allocation system our hospital has is jaw-dropping. I've gotten an in-depth demonstration of it. It's not entirely automated, but it largely is. Basically the idea is to not only pair up patients to services (and/or beds) quickly and efficiently in real time, but also to do near-term projections to assist with staffing and scheduling. And they match all this up across the entire network. There's even talk of eventually incorporating private practices where they can send overflow.
The impacts are less on the cost side of the ledger than on the revenue side of the ledger (basically the idea being that they can perform 20 CTs on a machine per day, rather than 15...and the reimbursement is the same whether a service takes 2 hours or 15 minutes). But improvements on either side are a positive.
I've had lengthy conversations with the guy who has run all of this for them. And what's clear is that they're just scratching the surface. They're just getting underway with clinical applications of AI. And he feels strongly we'll be seeing them hit quickly and impactfully.
Very interesting. Throw in telemedicine and it may be a new world after AI.
As is always the case with technology and regulated industries, the regulations will drastically slow down adoption well after the technology is ready.
The insurance is more expensive and covers less or so it at least seems. That gp is just another bill. A referral bill. Took my daughter for an mri Monday. Insurance on file. Still dinged with $700 on the spot.
Subsiding is fine. I do not recall specifically how they do it. Subsidizes need indexed somehow. Musk should receive less of a subsidy than some others.
Like selling your house. Everybody has a hand in your pocket.
Regulation (or, at least, over-regulation) really needs to start being viewed as the self-imposed millstone that it is. I'm sure you're right about this. And I'm sure the regulators will make the case that it's necessary and worth it, etc.
But is it really? I guess that's a question easier asked than answered. We tend to speak of regulation in generic terms, as if it's all created equally. And it isn't, of course. It's always been a baby/bathwater thing.
But is it too much to ask that our policymakers at least make an effort to look for the bathwater and drain it? Marc Andreessen had a good interview I watched yesterday where he discussed this -- and he brought up some really interesting points about the post-Chevron regulatory environment.
Of course, it’s a reasonable request to look at which regulations are necessary. But it’s much more complicated than that. Don’t forget to throw medical malpractice lawsuits and the cost they bring into the ecosystem into the fold also. Regulations, medical malpractice, as well as non-medical managers running institutions and physicians staying on much longer than they need to create a slow moving tortoise.
Out of deference to @mcmurtry66, we’ll just stipulate that med-mal suits are a wonderful thing that serve to protect us and that we should be nothing but thankful for….not merely a good way for lawyers to make a handsome living.
(I’m kidding, of course…I’d much rather live in a place where doctors are held accountable for their screwups than in a place where they aren’t. I usually give some exemption to MM lawyers from my tirades on trial lawyers as a group).
MM lawyers only deserve your sympathy crazed. They have it the hardest of all ambulance chasers. Obstinate Defendants with a god complex. Settlements hampered by consent to settle clauses. Obscene expenses. Layers and layers of built in defenses. Caps that make it rarely worthwhileOut of deference to @mcmurtry66, we’ll just stipulate that med-mal suits are a wonderful thing that serve to protect us and that we should be nothing but thankful for….not merely a good way for lawyers to make a handsome living.
(I’m kidding, of course…I’d much rather live in a place where doctors are held accountable for their screwups than in a place where they aren’t. I usually give some exemption to MM lawyers from my tirades on trial lawyers as a group).
They should get medals like Olympic heroes or war vets
There are no solutions, only tradeoffs.
Some value the tradeoff that would be made for universal healthcare. Others like you don't. Has nothing to do with fairytales.
You missed my point.
My point is that nothing scarce can truly be a right. We can tell ourselves that it is, but it isn’t actually. Because it doesn’t exist in abundance such that we truly possess the ability to exercise the right when we want, how we want, etc. We all recognize certain rights - and one thing they have in common is that they’re pretty much within our control and beyond anybody else’s.
Brits have a nominal right to healthcare. Go and examine the reality of their ability to exercise it.
It’s a falsehood - even if they like the NHS and wouldn’t want to change to some other model.
I’m not missing the point. We’ve discussed this before, we just disagree. You’re focusing on semantics. I’m focusing on the ideas that the phrases stand for.
“Rights” in all instances are man made. There is no metaphysical “right” without a man made construct—one doesn’t exist without public acceptance, a legal system, and a will to protect it.
What you’re doing is complaining about the wisdom and cost of recognizing that particular right. Perfectly fair. In many respects, I agree.
But you’re forgetting that it’s just a trade off based on your (and somewhat my) own values. You’ve admitted as much by your reference to the Brits. Their right might not be so great, might not be worth it, but they still have it and they can enforce it in some instances and that the public accepts it, no matter how weak it is.
I can see why you’d call this semantics. But I don’t see it as that at all. The concept of a “right” - an actual one, not one we pretend to have - is a pretty sacred thing.
Not only did our framers recognize this, the people throughout history they took inspiration from did as well. And they were very cognizant of the weight of that and other weighty verbiage they used to not only establish a new country, but to set the course for Western civilization as we know it today.
I assure you, to people like Madison, Jefferson, Paine, etal, the notion of a “right” was hardly a matter of semantics.
In fact, it’s the weight of this term that attracts people today to its use in things like healthcare policy.
Nobody on earth has a right to healthcare, even if they think they do. Even if they have guaranteed health insurance. There isn’t enough, and never will be enough, health care to fill what is demanded.
Ask the people in Vermont, they’re discovering this the same way people elsewhere have. And they’re befuddled as to why (I’m not).
If I have a legal claim to something I can’t actually access, then I don’t have a right to it.
This is where we disagree. And, again, I don't think chalking it up to a matter of semantics clears the bar Brad. I didn't agree with Justice Brennan on much, but I do think he expressed the idea of rights being recognized (and protected) by man rather than being "made" by them very well here...
Now, I realize that the Bill of Rights wasn't exhaustive. After all, they drafted the 9th amendment for a reason. I also realize that not all rights are natural rights. So it is entirely possible for a right to be man made. And that's fine as far as it goes.
But if it's a gross misnomer if a right -- be it natural or otherwise -- exists on paper but not in practice. Scalia used to love to point out that the Soviet Constitution offered a pretty remarkable collection of rights, far more expansive than our own even. He also loved to point out that they weren't worth the paper they were printed on.
They were -- like the concept of a right to healthcare or any other scarce resource -- a fairytale.
How are medical supplies and equipment priced?I sit on a hospital board and have seen the data. They're sucking wind with public insurers. They'd be insolvent if that was their only source of income -- because the privately insured subsidize the publicly insured. Given that, we ought to expect some pretty bad repercussions if CMS just pared back their reimbursement schedules.
If you took what I said to mean that doctors and nurses are waiting in bread lines, then you misread what I was saying.
Also, what you're seeing in this chart is the symptom, not the disease. The disease, if I may distill it all the way down to the nut, is the widely held notion that healthcare is a human right.
It's not. It couldn't be even if we all unanimously agreed that it should be -- it's scarce and demand will always outstrip supply.
The wise words of Thomas Sowell apply here:
Cost of manufacturing and R&D, tech involved, whether there’s competition and demand. Like other products
You mean…beyond those enumerated? Or are you just looking for those enumerated?
Any. You say it can't be a right if it's scarce, and my gut tells me that rules a lot of stuff out, so I'm curious what's left over.
So, to pick back up on the point I was trying to make, spending in healthcare is artificially high. Public reimbursement rates are set on auto thanks to administrations rubberstamping the doc lobby. This has left us paying compounding interest for 60 years.
Private reimbursement rates are set based on public reimbursement. So, if public rates are compounding at ~3% annually, private reimbursements are compounding at ~3.2%.
This explains the divergence that appears in the graph, as private fees are increasing at an increasing rate(~.2) above that of public reimbursements.
When someone makes the claim that private insurance is subsidizing public insurance, they are leaving out these facts (Or they don't understand them). Unless, the FFS schedule formulas are adjusted this will necessarily always be the case and in fact get worse.
At the heart of this matter are all the people that would like to cut government spending. This is the easiest problem to fix, and may be the most consequential.
Back to you original point. Congressional Republicans seem miles apart right now on all kinds of tax issues. Including the corporate tax rate.
The Vermont case you cited has absolutely nothing to do with an increase in the amount of people being covered. And is a terrible argument against UHC.
Are more people covered in Vermont? Are rates high and increasing? Are hospitals going broke? Are lines long? ...All, yes. Is this proof of an invisible hand, or unintended consequences? No.
The state has been trying to keep rural hospitals open. In one example, the hospital averages 1-2 admissions/day. That isn't enough volume to sustain the overhead. And because of the shape of the state, many are driving to closer facilities across state lines to receive more convenient, and perceived better care. Trying to cover this overhead is why costs are going up and hospitals are going broke. Those lines aren't long enough.
The long lines are only referencing specialists, which as @twenty02 referenced is a problem the entire country is facing due to quotas/limits. The reason stated for Vermont's exacerbated problem with availability of specialists is housing/lifestyle and the struggle with getting specialists to move into rural areas in general.
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