actually, the problem is that Congress continues to LOWER physician reimbursement, but RAISE hospital reimbursement. When I became a surgeon in 2002, medicare paid $600 for me to take out a gallbladder. I had to pay my overhead (50%) so my take-home was $300. Today, in 2024, after price reductions, medicare pays $600.
That is why I have to be employed. I guarantee that after 22 years, office expenditures (rent, salaries, supplies, health insurance) would eat up the remaining $300. So taking care of Medicare patients would be charity. Medicare is 60% of my practice. Private insurance is 25%. Medicaid is 10% and unfunded is 5%.
surgeon here. before Obamacare insurance companies denied payments if they deemed the issue pre-existing and were not told about it in the patient's application. I was in private practice for 10 years and now employed surgeon for 12 bc insurance companies notoriously deny payments for no legitimate reason. One time I saw a patient with an inguinal hernia and then fixed it. We were denied payment because my initial consultation said, 'presents with hernia he's had for 2 years, but now increasing in size and causing discomfort'. Their reason for denial was that he only had coverage for a year and had not told them about the hernia. From then on, my notes were very brief. 'Patient presents with symptomatic hernia'
Before Obamacare, some policies had lifetime limits, which could affect expensive treatments like cancer.
We celebrated the fact that now medicare can negotiate 10 drug prices. It should negotiate all drugs. The organization that gets the lowest prices is the VA. Congress could easily pass a law saying medicare will only pay that much and it would not cost much to implement.
The USA tax code potentiates this. First $12m tax free, step up basis allow tremendous wealth to be bequeathed without financial penalty.
Trusts, when set up correctly, can do so as well.
Once inherited, the first $90,000 (married couple) of qualified dividend income is tax free. Plus, standard $29,000 (married couple) deduction means that the first $119,000 of investment income can be tax free. You will see the wealthy either try and start a company or not work. Why work a job where about 30% of your income is taxed when you can stay home and not work. If you inherit your parents' home, you can easily live without working.
Current safe dividend yields are about 6% so all it takes is inheriting $1.5m. There are 24 million millionaires in the USA so there may be quite a few that take advantage of this. When the wealthy start giving their children their inheritance while they are still alive ........
Currently, you can give your children up to a total of $12m combined in your lifetime, before taxes have to be taken out.
surgeon here:
antibiotic treatment works great as long as there's no peritonitis and/or no appendicolith seen on CT. However, statistics show that 30% of successfully treated patients go on to get appendicitis again within 1 year.
Anyway, I offer my patients a choice. Most choose surgery. Those conscientious enough without insurance usually choose nonoperative management because it's much cheaper.
rich people make their money either investing for others or investing for themselves and are rewarded with paying less taxes on that income than people that work.
I grew up in the 80s going to the Cary Mall. It was awesome. I used to converge at the arcade where my dad would occasionally give me $.50 to play 2 games......Mostly I would watch. Anyway, it's great to see my hometown have Epic and SAS as headquarters as this usually leads to good paying middle class and above jobs ..........
The libertarian leaning policies of the USA have already started to create a low birth rate. The first affected generation doesn't have time to realize that they will be worse off than their parents, and so has 2-3 children without realizing that they will be unable to afford to educate or provide healthcare.
Those children then grow up seeing the hardships and stress of their parents, who complain about how expensive they were and now they won't be able to retire and decide to either wait for things to get better before having children or not to have any at all.
Then the elder statesmen complain about low birth rates.
Until the United States creates policies so that someone who works 40 hours a week, regardless of the job, will be able to retire and afford healthcare, only the top 10% of earners ($150k+) and the extreme poor (medicaid, food stamps, subsidized housing) will have more than 1 child.
In South Carolina, where I work for a hospital, you automatically qualify for Medicaid when you’re diagnosed with cancer.
This way people don’t die from untreated cancer.
Getting diagnosed early when uninsured is where we fail as a society. Our politicians cover up this failure by giving them Medicaid so we spend $500k treating advanced disease and they still die, rather than universal coverage.
didnt realize that link was behind paywall. It won't happen again.
Gist of the story is that an amateur law student was amazingly good at predicting AAPL earnings every quarter. Graduated, and started his own hedge fund.
Publicly advocated buying options because AAPL could only go up bc profits were increasing. That's also what he did with investors' money. Options expired worthless. All $$ lost.
AAPL price did not follow increase in earnings in straight line.
Just imagine if investors in his fund had just bought the stock instead of options (calls).
Similar situation as above.
Don't invest what you can't lose. Slow and steady and living below your means wins the race.
USA tax laws favor investment income over labor income. If no wage income, first $75k of qualified dividend income is federal tax free. Most qualified dividends pay 2-4% so you need $2 million dollars to get $6k post tax dollars a month.
Senior citizens are allowed to take classes for free in North Carolina. My mother uses this to take foreign language classes. She said the older folks taking the classes take it way more seriously than the 'students' ("Who goes to class in their pajamas?")
Excellent points. Everything in this country is aligned with being wealthy. Look at how they attack 'public schools', and 'teachers unions' ruining education and want to use tax dollars to subsidize private schools. Who can go to private schools? Rich kids, and extremely smart kids.
I helped my GF do her taxes. 18K in student loan interest (most of her loans are 4-7%), of which only 2.5k was deductible. Meanwhile, I do well, have assets, and paid $28k in margin interest. ALL DEDUCTIBLE.
What type of debt is non dischargeable? education
What loans are essentially non refinanceable and much higher interest rates? education
It's as though the rich want to keep the poor, poor.
The republicans were able to push through tax reform that benefited real estate investors, and wealthy individuals that live in low / zero tax states. It's as though Donald Trump's sole goal of being elected was to make his family more money in the long run.
When most have nothing, the pitchforks will come out in the form of policies championed by the likes of AOC and Bernie Sanders (not that they're all bad).
Student loans need to be dischargeable in bankruptcy and need to be privatized. This way, there will be accountability with the university education.
People need to be able to purchase medicare policies if private insurance costs more than x% of their income.
Corporate tax needs to be super low for those corporations that provide health insurance with out of pocket expense less than x% of salary, $7k / year in retirement contributions so that they'll have incentive to reparticipate in the social contract.
Actually, without subsidies, it's around $3500 / month for a family and that's with a $5k - $10k deductible. I have a collegue that retired after inheriting a lot of money and that's what he pays for health insurance.
Most small business owners that I take care of are on their spouse's insurance.
If Americans don't think that the cost of health insurance is destroying entrepreneurship, they're idiots. For example, if you're single and want to open your own garage to fix cars, you may have to compete with the shop down the road that doesn't worry about insurance bc they're on their spouses. So that shop has $3500 a month less costs than yours.
Actually, anesthesiologists are middle of the pac in regards to malpractice. Whenever someone quotes income levels for physicians, it's usually after all expenses, including malpractice. It really doesn't matter how much a doctor pays in malpractice, it's what their net income is after. Neurosurgeons pay close to $100k / year, but make $500k+.
Anyway, anesthesia is much safer than 30 years ago
I went to Duke University from 1987 to 1991. Because I was a North Carolina Resident not using a public university, but staying in state, North Carolina paid Duke $1000 out of the $8000 tuition for me. Not sure what it is now, or if it still exists.
I take care of a lot of people who work for Fortune 500 companies that have Medicaid. My taxes, therefore, subsidize these companies' profits. Moreover, when I was in private practice, I accepted sub market fees for my services when I took care of them. This is the reason why I am a hospital employee. I get paid regardless of whether the hospital gets paid.
General surgeon in the South here. What I've seen is that uninsured individuals will prolong going to the doctor for symptoms because of cost and that sometimes costs them their lives because of the advanced presentation of their disease. On the other hand, once you get diagnosed with cancer in South Carolina, you automatically qualify for Medicaid so that you receive some treatment.
This way, you die with treatment and our system does not seem cruel. Even advanced, expensive chemotherapy is paid for, sometimes exceeding hundreds of thousands of dollars.
The Affordable Care Act provides subsidies for health insurance based on income, not assets. If you're diagnosed with cancer and lose your job (because chemo is tough), and have assets, pay the Cobra until next sign up period. Sell all assets and invest to make about $20-$30k a year. Your premiums will be low and you'll have access to quality care. Move near large academic institutions because they do medicaid / bad insurance care. This way you minimally touch assets.
Rich people hate the Affordable Care Act because they don't get subsidies on premiums, which are about $3500 / month for a family now, and they have to pay 4.8% Medicare tax on all income over $250k . So, in essence, someone that makes $1m a year pays $78k/year in health care costs.
Lastly, I take care of a Pizza Hut delivery person who gets his insurance through the Affordable Care Act and only pays $40 / month for it, because of the subsidies.
my gf just finished her nurse practitioner degree and while she increased her salary from 60k to 90k, her student loan payments, with some loans being 10% !, eat up all of her increased income. She's happier, but after all the bills, she has the same left over. So from an economic standpoint, she got an advanced degree that benefitted her school and the bank.
I'm old enough ( graduated HS 1987 ) to have had woodworking in middle school. Still have the shitty pine box I made in class. I now enjoy woodworking as a hobby, not a profession. Currently building a dresser for the bedroom. Will take me probably a year. Real wood furniture built by real craftsmen is expensive, because labor aint cheap. Most people don't want to spend / can't afford to spend anymore.
That is why I have to be employed. I guarantee that after 22 years, office expenditures (rent, salaries, supplies, health insurance) would eat up the remaining $300. So taking care of Medicare patients would be charity. Medicare is 60% of my practice. Private insurance is 25%. Medicaid is 10% and unfunded is 5%.