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.
I had chronic strep and had mine removed at the recommendation of my MD Aunt and Uncle who both practice in Germany. I flew in and immediately got sick at their house. The flight must have wrecked havoc on my immune system. I could feel myself getting progressively sicker during the flight but I was completely fine at the start.
You literally imply there is one and describe it in the sibling comment reply.
Interestingly you present the possibility of a falsifiable hypothesis. Unfortunately due to the highly variable accuracy of diagnosis and propensity to treat (source: I was on The path to surgical training and now routinely diagnose appendicitis in my role as an emergency doctor) depending on health system capacity and availability to acute care the existing retrospective data doesn’t provide a satisfying result - what it does suggest is illuminating however; with a suggestion of a decrease in rate of incidence over the second half of the 20th century in industrialised countries, and a suggestion of increase in some developing countries. This would be more in keeping with an improvement in diagnostic capacity in both industrialised (less false positives) and developing (more false negatives) countries.
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.
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.
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.
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%.