I did the math with the malpractice subtracted out.
Doctors are not Wall Street types - they mostly take a salary, and it is taxable. They often hit the AMT as well. In any event, the tax rate isn't really important, is it? And I think it is close enough, depending on what state you are in. I'm using the tax rate my wife and I pay based on my state. I didn't include the local tax, or it would actually be higher.
The point is, a doctor is not a 1%er unless you start talking about the specialties. I know plenty of doctors - some of them live like kings, but most are simply comfortable and work CRAZY hours that probably put them below school teachers in per-hour compensation, especially school teachers that are 7-10 years into their pay scale. I'm not picking on school teachers, but I am pretty familiar with their compensation in our areas since my brother and sister in law are school teachers, and most people don't consider them over-compensated.
The medical occupation I would choose? Hands down, CRNA. Certified Registered Nurse Anesthetist. Really good salary - better than an internal medicine doctor - but much less effort to get there. You have to do a stint in the ICU, but that's no worse than residency and your pay will be better with much lower student loan payments.
No, it's pre-pay. I had to transfer from my old T-Mobile post-pay account. It's got a different support staff and a separate web page. I have to pay at the beginning of the cycle, and if I run out of money in my account, the phone stops making calls until I top up. The situation has changed considerably - pre-pay is cheaper than post-pay now, even for unlimited plans.
You want to give the AMA immunity from defamation, but you can't stand a little salty language? Right.
I'm still chatting with you, aren't I? You seem hung up on my suggestion that immunity be granted. Honestly, it's not that important of a detail so forget about it if it bothers you.
Your idea isn't sound, it's utter nonsense, it's not a potential for abuse, it's an outright prescription for it.
I hate to break it to you, but doctors are self-regulating right now. I'm not introducing a radical new vector for abuse. I want to maintain the patient's right to sue while also cracking down on the lottery atmosphere of medical malpractice. Medicine is NOT an exact science, human error and mistakes happen. I think there needs to be a penalty for mistakes so that people should take pains not to make them, but it also shouldn't be a career ending experience. Doctors have gotten ridiculously conservative, and we all pay for it. You seem to think that there is no malpractice problem, in which case our disagreement lay way further down the tree.
I have another, much more government-heavy scheme as well, but you probably won't like that, either, because it would also put the "expert witness" scammers out of business.
Don't forget, almost all new workers are saddled with similar student debt, and they don't have the $120,000/yr average starting salary straight out of school.
First of all, no they are not. The medical school debt positively dwarfs the undergrad debt, which still exists and has been accumulating interest as principal for 7 years or so. Second, the person who is fresh out of school has a 7 year head-start on earnings.
And malpractice insurance is a cost of doing business.
Malpractice varies a lot by location. In some places and some specialties, it can be a deal-breaker. Many OB programs are fleeing the state of PA, for instance. The cost for internal medicine is between $6k and $11k in PA. That is probably 5-10% of an entry-level salary! Some quick math: $120k salary - 10k malpractice insurance - 35% tax rate - $2500 student loan payment/month ------- 41,500 take home pay
Now don't get me wrong, lots of people would love to have that kind of take-home pay. And in 10 years the salary will be much higher and the student loans paid off. But if you are the typical young MD with a new family, much of that take-home will go away with child care costs, and you still need to live somewhere and drive something. You are also 10 years behind your peers on retirement savings, so you need to put some away for that. You are not starving, that is for sure, but you sure don't understand where people get off calling you rich, either.
The notion that malpractice costs are what's driving the price of health care is a canard. It's just not so.
While I certainly agree that the raw malpractice premiums are not a large fraction of health care costs, the cloud of malpractice makes doctors practice very, very conservative and defensive medicine. Thousands of dollars worth of tests are run to rule every possible thing out, all because the doctors are petrified of lawsuits.
Yes, but in the US it is _illegal_ LOL... we are so weird. Naturally, we are still allowed to sell them for slaughter. Because, you know, it doesn't matter that the horse is eaten, just that it cannot be eaten HERE.
If medical care is more expensive because the technology costs too much, and people aren't even allowed to access care because of the exhorbitant cost, then maybe we need a new class of physicians who are trained on the manual way of doing things.
Until people are more connected with the actual cost of care, there is no pressure to keep costs down in this way. Right now we depend on the government and the insurance companies to provide the cost pressure, which takes choice away from the consumer. For instance, during end of life care, people want "everything possible" done for their terminal loved one. If they are responsible for the costs associated with that decision, it usually changes quite quickly. Maybe dying comfortably and with dignity isn't such a bad option after all...
Or we could move to a European style healthcare system, which would make much more sense.
Which European system? There is the British system, which is mostly government run like our VA system, the French model which most resembles Medicare, and the Swiss model which most resembles Obamacare. Each have advantages and disadvantages, and now we have all three! Yay for efficiency!:)
Thanks, I didn't know that was a change in 10.3. I'll have to give a 10.3 ROM a shot. My goal is to keep this thing until around April, at which point I'll look at one of the mini Galaxies. I'm still not into the huge Samsung phones. I might even try the lower end Nokia MS phone, just for the geek value of being familiar with another OS.
Rural areas have to pay outsized salaries because, under normal circumstances, no one in their right mind would live in Roswell. The average starting salary is still around $120k, outliers included. In some crowded markets, pediatrics had dipped below $100k. I know a few docs that abandoned pediatrics in mid training because they weren't going to be able to make their loan payments after residency without stretching them to 20 years. At that point, why in the world are you wasting so much of your life on all this training?
And fuck you if you think the AMA should get immunity for that. At that point, we'd damn well know it wasn't legitimate, but was a good reason to disband that corrupt organization as the criminal enterprise it really would be at that point.
Can we keep it civil? I clearly don't have all the answers, but I think my general idea is sound. You raise a good point - of course I agree that there is the potential for abuse here - which is why I think there should be some government involvement. An arbitration or appeal process is critical. Even without that, the AMA process would have to be transparent and above-board for this to work. Defamation suits from all of these crooked docs would be expensive, but just a fraction of what doctors currently pay in malpractice suits and settlements - so even without that immunity I think it would be a huge improvement.
It's not just an Apple thing - Samsung gets good margins on their high-end stuff as well. This little Exhibit probably makes them next to nothing but does 90% of what the big Galaxies do. Actually, it does more like 100% of what they do, but more slowly:)
Mercedes has a track record as being a really nice, luxurious automobile. Apple and high-end Samsungs have the same reputation. This thing doesn't even exist yet. It might be a Yugo, it might be a Mercedes. We have no way to know yet, but it's priced like a Mercedes.
. Also it was not $200, the contract pricing included the real cost over a longer term.
Incorrect, I'm on pre-pay. I typically spend about $40-45/month with 5GB of data. I wouldn't quite call the Exhibit a Yugo, but it definitely is not up to Apple standards. That said, it is 1/3 the price and I was able to load it with Cyanogenmod 10. It definitely has Android lag and it could use more memory, but it's still a very fun toy.
I realize there is a great deal of pressure on doctors from both Big Pharma and patients
Most of the pressure they feel is time pressure and lawsuit pressure. Those extra tests are to cover their ass. We have the whole system set up to reward CYA and dissuade cost reduction, so it's hard to blame the doc for responding rationally to such incentives.
You should read Bitter Pill [time.com] (paywalled), and How Dentists Rip Us Off [go2dental.com] (pdf) if you are truly ignorant of the reckless and cavalier attitude the medical community has towards costs.
Again, this is the incentive system we have set up. If we only pay dentists a reasonable amount for x-rays, then we're going to get x-rays. And lots of 'em. They certainly aren't hard to justify, and the insurance company seems more than happy to pay for them. I have to assume that the insurance companies know about this, and that lots of x-rays are in fact cheaper than waiting for hidden cavities to cause a problem requiring anesthesia. I'm constantly fighting with my kids' dentist over x-rays. As for the piece you linked to, most of them were trying to sell him the Cadillac on the lot... not surprising given that he told them he had a blank check - again, incentives. For God's sake, don't tell someone you are buying from that you have an unlimited budget! Had he gone in there with the crappy dental HMO I have, they would have given him the $500 treatment.
I know a guy who is pretentious as hell, but overall a nice fellow. Anyway, he got a job offer at Ford, but was going to turn it down when he found out he'd be expected to drive one. I said, "You know, Ford makes Jaguar..." and his eyes went wide and he took the job the next day. Shallow, but there you go.
The employer isn't 100% responsible for whatever happened to a person before they became an employee. Many employees are damaged goods, and you only detect that when they do something wrong. If you blindly trust everyone in this world, you will be eaten alive. I worked in retail before and during college. Thank God that's over.
My wife is a doc, so we've thought a lot about malpractice.
My opinion is that the doctors are at fault in large part. They could _easily_ band together and kill these lawsuits, but they have a very individualist spirit that harms them greatly. All it would take to kill the worst malpractice suits is for the AMA and local medical boards to start yanking licenses of docs found to be making unreasonable testimony. Many (most?) of the docs testifying are being paid by the plaintiff and do this as a substantial part of their living. Start reviewing expert testimony and punishing docs who are misleading juries. Set it all up to limit conflict-of-interest and keep it above board, and say bye-bye to most frivolous or false malpractice claims.
Honestly, they wouldn't even have to yank licenses... simply publish a hit list of docs that have been making misleading testimony and let the defendant use that as evidence to discredit the expert witness. They'd be constantly fending off defamation suits, but thems the breaks. Perhaps a little government help would work in that regard - pass a law that exempts the AMA from defamation in exchange for running such a program at no cost to the government and putting some kind of appeals process together.
As for Canadian malpractice, I only know that it is lower. I know that docs get reimbursed for their liability insurance to some degree, but I do not know if this is included in their salary figure. Certainly they pay a lot more in taxes than a US doc, so it's probably a wash.
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Mixed race offspring. Tell me you are smart enough to figure this out. The fact that some people are members of races does not mean everyone is.
So something like 50% of the US can't be classified in your scientific classification system? That sounds useful. And very scientific.
Won't they be producing most of Europe's surplus children?
I did the math with the malpractice subtracted out.
Doctors are not Wall Street types - they mostly take a salary, and it is taxable. They often hit the AMT as well. In any event, the tax rate isn't really important, is it? And I think it is close enough, depending on what state you are in. I'm using the tax rate my wife and I pay based on my state. I didn't include the local tax, or it would actually be higher.
The point is, a doctor is not a 1%er unless you start talking about the specialties. I know plenty of doctors - some of them live like kings, but most are simply comfortable and work CRAZY hours that probably put them below school teachers in per-hour compensation, especially school teachers that are 7-10 years into their pay scale. I'm not picking on school teachers, but I am pretty familiar with their compensation in our areas since my brother and sister in law are school teachers, and most people don't consider them over-compensated.
The medical occupation I would choose? Hands down, CRNA. Certified Registered Nurse Anesthetist. Really good salary - better than an internal medicine doctor - but much less effort to get there. You have to do a stint in the ICU, but that's no worse than residency and your pay will be better with much lower student loan payments.
No, it's pre-pay. I had to transfer from my old T-Mobile post-pay account. It's got a different support staff and a separate web page. I have to pay at the beginning of the cycle, and if I run out of money in my account, the phone stops making calls until I top up. The situation has changed considerably - pre-pay is cheaper than post-pay now, even for unlimited plans.
Damn, I thought you had a loophole that would let us sell rat shit burgers to Canada! :)
Right, but we only prohibited it for within the US - export was just fine! Who care if those filthy outsiders get sick from our doped horses, right?
But it's fine for us to package them into steaks and sell them to other people? Huh, no that doesn't seem hypocritical at all...
You want to give the AMA immunity from defamation, but you can't stand a little salty language? Right.
I'm still chatting with you, aren't I? You seem hung up on my suggestion that immunity be granted. Honestly, it's not that important of a detail so forget about it if it bothers you.
Your idea isn't sound, it's utter nonsense, it's not a potential for abuse, it's an outright prescription for it.
I hate to break it to you, but doctors are self-regulating right now. I'm not introducing a radical new vector for abuse. I want to maintain the patient's right to sue while also cracking down on the lottery atmosphere of medical malpractice. Medicine is NOT an exact science, human error and mistakes happen. I think there needs to be a penalty for mistakes so that people should take pains not to make them, but it also shouldn't be a career ending experience. Doctors have gotten ridiculously conservative, and we all pay for it. You seem to think that there is no malpractice problem, in which case our disagreement lay way further down the tree.
I have another, much more government-heavy scheme as well, but you probably won't like that, either, because it would also put the "expert witness" scammers out of business.
It is illegal to sell it for food, according to Reuters, but if you say otherwise I certainly cannot refute as I am not up on my federal food laws :)
Don't forget, almost all new workers are saddled with similar student debt, and they don't have the $120,000/yr average starting salary straight out of school.
First of all, no they are not. The medical school debt positively dwarfs the undergrad debt, which still exists and has been accumulating interest as principal for 7 years or so. Second, the person who is fresh out of school has a 7 year head-start on earnings.
And malpractice insurance is a cost of doing business.
Malpractice varies a lot by location. In some places and some specialties, it can be a deal-breaker. Many OB programs are fleeing the state of PA, for instance. The cost for internal medicine is between $6k and $11k in PA. That is probably 5-10% of an entry-level salary! Some quick math:
$120k salary
- 10k malpractice insurance
- 35% tax rate
- $2500 student loan payment/month
-------
41,500 take home pay
Now don't get me wrong, lots of people would love to have that kind of take-home pay. And in 10 years the salary will be much higher and the student loans paid off. But if you are the typical young MD with a new family, much of that take-home will go away with child care costs, and you still need to live somewhere and drive something. You are also 10 years behind your peers on retirement savings, so you need to put some away for that. You are not starving, that is for sure, but you sure don't understand where people get off calling you rich, either.
The notion that malpractice costs are what's driving the price of health care is a canard. It's just not so.
While I certainly agree that the raw malpractice premiums are not a large fraction of health care costs, the cloud of malpractice makes doctors practice very, very conservative and defensive medicine. Thousands of dollars worth of tests are run to rule every possible thing out, all because the doctors are petrified of lawsuits.
The problem that some have here with the term "cloud" I have with "tag". I'm not sure how it differs from a "keyword".
We've slaughtered them before, but always export the meat. It is illegal to sell in the US, which makes us raving silly hypocrites.
Yes, but in the US it is _illegal_ LOL... we are so weird. Naturally, we are still allowed to sell them for slaughter. Because, you know, it doesn't matter that the horse is eaten, just that it cannot be eaten HERE.
If medical care is more expensive because the technology costs too much, and people aren't even allowed to access care because of the exhorbitant cost, then maybe we need a new class of physicians who are trained on the manual way of doing things.
Until people are more connected with the actual cost of care, there is no pressure to keep costs down in this way. Right now we depend on the government and the insurance companies to provide the cost pressure, which takes choice away from the consumer. For instance, during end of life care, people want "everything possible" done for their terminal loved one. If they are responsible for the costs associated with that decision, it usually changes quite quickly. Maybe dying comfortably and with dignity isn't such a bad option after all...
Or we could move to a European style healthcare system, which would make much more sense.
Which European system? There is the British system, which is mostly government run like our VA system, the French model which most resembles Medicare, and the Swiss model which most resembles Obamacare. Each have advantages and disadvantages, and now we have all three! Yay for efficiency! :)
I don't think 'gator is "taboo" so much as "novel". It's common either in burger or fried form at Florida tourist traps.
Thanks, I didn't know that was a change in 10.3. I'll have to give a 10.3 ROM a shot. My goal is to keep this thing until around April, at which point I'll look at one of the mini Galaxies. I'm still not into the huge Samsung phones. I might even try the lower end Nokia MS phone, just for the geek value of being familiar with another OS.
Rural areas have to pay outsized salaries because, under normal circumstances, no one in their right mind would live in Roswell. The average starting salary is still around $120k, outliers included. In some crowded markets, pediatrics had dipped below $100k. I know a few docs that abandoned pediatrics in mid training because they weren't going to be able to make their loan payments after residency without stretching them to 20 years. At that point, why in the world are you wasting so much of your life on all this training?
And fuck you if you think the AMA should get immunity for that. At that point, we'd damn well know it wasn't legitimate, but was a good reason to disband that corrupt organization as the criminal enterprise it really would be at that point.
Can we keep it civil? I clearly don't have all the answers, but I think my general idea is sound. You raise a good point - of course I agree that there is the potential for abuse here - which is why I think there should be some government involvement. An arbitration or appeal process is critical. Even without that, the AMA process would have to be transparent and above-board for this to work. Defamation suits from all of these crooked docs would be expensive, but just a fraction of what doctors currently pay in malpractice suits and settlements - so even without that immunity I think it would be a huge improvement.
With the surplus of children we have after banning airplane flights, we can afford to spare a few to feed the terrorists.
It's not just an Apple thing - Samsung gets good margins on their high-end stuff as well. This little Exhibit probably makes them next to nothing but does 90% of what the big Galaxies do. Actually, it does more like 100% of what they do, but more slowly :)
My yugo was cheaper than a mercedes.
Mercedes has a track record as being a really nice, luxurious automobile. Apple and high-end Samsungs have the same reputation. This thing doesn't even exist yet. It might be a Yugo, it might be a Mercedes. We have no way to know yet, but it's priced like a Mercedes.
. Also it was not $200, the contract pricing included the real cost over a longer term.
Incorrect, I'm on pre-pay. I typically spend about $40-45/month with 5GB of data. I wouldn't quite call the Exhibit a Yugo, but it definitely is not up to Apple standards. That said, it is 1/3 the price and I was able to load it with Cyanogenmod 10. It definitely has Android lag and it could use more memory, but it's still a very fun toy.
I realize there is a great deal of pressure on doctors from both Big Pharma and patients
Most of the pressure they feel is time pressure and lawsuit pressure. Those extra tests are to cover their ass. We have the whole system set up to reward CYA and dissuade cost reduction, so it's hard to blame the doc for responding rationally to such incentives.
You should read Bitter Pill [time.com] (paywalled), and How Dentists Rip Us Off [go2dental.com] (pdf) if you are truly ignorant of the reckless and cavalier attitude the medical community has towards costs.
Again, this is the incentive system we have set up. If we only pay dentists a reasonable amount for x-rays, then we're going to get x-rays. And lots of 'em. They certainly aren't hard to justify, and the insurance company seems more than happy to pay for them. I have to assume that the insurance companies know about this, and that lots of x-rays are in fact cheaper than waiting for hidden cavities to cause a problem requiring anesthesia. I'm constantly fighting with my kids' dentist over x-rays. As for the piece you linked to, most of them were trying to sell him the Cadillac on the lot... not surprising given that he told them he had a blank check - again, incentives. For God's sake, don't tell someone you are buying from that you have an unlimited budget! Had he gone in there with the crappy dental HMO I have, they would have given him the $500 treatment.
I know a guy who is pretentious as hell, but overall a nice fellow. Anyway, he got a job offer at Ford, but was going to turn it down when he found out he'd be expected to drive one. I said, "You know, Ford makes Jaguar..." and his eyes went wide and he took the job the next day. Shallow, but there you go.
The employer isn't 100% responsible for whatever happened to a person before they became an employee. Many employees are damaged goods, and you only detect that when they do something wrong. If you blindly trust everyone in this world, you will be eaten alive. I worked in retail before and during college. Thank God that's over.
My wife is a doc, so we've thought a lot about malpractice.
My opinion is that the doctors are at fault in large part. They could _easily_ band together and kill these lawsuits, but they have a very individualist spirit that harms them greatly. All it would take to kill the worst malpractice suits is for the AMA and local medical boards to start yanking licenses of docs found to be making unreasonable testimony. Many (most?) of the docs testifying are being paid by the plaintiff and do this as a substantial part of their living. Start reviewing expert testimony and punishing docs who are misleading juries. Set it all up to limit conflict-of-interest and keep it above board, and say bye-bye to most frivolous or false malpractice claims.
Honestly, they wouldn't even have to yank licenses... simply publish a hit list of docs that have been making misleading testimony and let the defendant use that as evidence to discredit the expert witness. They'd be constantly fending off defamation suits, but thems the breaks. Perhaps a little government help would work in that regard - pass a law that exempts the AMA from defamation in exchange for running such a program at no cost to the government and putting some kind of appeals process together.
As for Canadian malpractice, I only know that it is lower. I know that docs get reimbursed for their liability insurance to some degree, but I do not know if this is included in their salary figure. Certainly they pay a lot more in taxes than a US doc, so it's probably a wash.