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Interesting overview of American health care: present status, history and causes

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  • Interesting overview of American health care: present status, history and causes

    http://www.theatlantic.com/doc/200909/health-care

    Some excerpts:

    Almost two years ago, my father was killed by a hospital-borne infection in the intensive-care unit of a well-regarded nonprofit hospital in New York City. Dad had just turned 83, and he had a variety of the ailments common to men of his age. But he was still working on the day he walked into the hospital with pneumonia. Within 36 hours, he had developed sepsis. Over the next five weeks in the ICU, a wave of secondary infections, also acquired in the hospital, overwhelmed his defenses. My dad became a statistic—merely one of the roughly 100,000 Americans whose deaths are caused or influenced by infections picked up in hospitals. One hundred thousand deaths: more than double the number of people killed in car crashes, five times the number killed in homicides, 20 times the total number of our armed forces killed in Iraq and Afghanistan. Another victim in a building American tragedy.

    ...

    I’m a businessman, and in no sense a health-care expert. But the persistence of bad industry practices—from long lines at the doctor’s office to ever-rising prices to astonishing numbers of preventable deaths—seems beyond all normal logic, and must have an underlying cause. There needs to be a business reason why an industry, year in and year out, would be able to get away with poor customer service, unaffordable prices, and uneven results—a reason my father and so many others are unnecessarily killed.

    ...

    The housing bubble offers some important lessons for health-care policy. The claim that something—whether housing or health care—is an undersupplied social good is commonly used to justify government intervention, and policy makers have long striven to make housing more affordable. But by making housing investments eligible for special tax benefits and subsidized borrowing rates, the government has stimulated not only the construction of more houses but also the willingness of people to borrow and spend more on houses than they otherwise would have. The result is now tragically clear.

    ...

    Comprehensive health insurance is such an ingrained element of our thinking, we forget that its rise to dominance is relatively recent. Modern group health insurance was introduced in 1929, and employer-based insurance began to blossom during World War II, when wage freezes prompted employers to expand other benefits as a way of attracting workers. Still, as late as 1954, only a minority of Americans had health insurance. That’s when Congress passed a law making employer contributions to employee health plans tax-deductible without making the resulting benefits taxable to employees. This seemingly minor tax benefit not only encouraged the spread of catastrophic insurance, but had the accidental effect of making employer-funded health insurance the most affordable option (after taxes) for financing pretty much any type of health care. There was nothing natural or inevitable about the way our system developed: employer-based, comprehensive insurance crowded out alternative methods of paying for health-care expenses only because of a poorly considered tax benefit passed half a century ago.

    ...

    Insurance is probably the most complex, costly, and distortional method of financing any activity; that’s why it is otherwise used to fund only rare, unexpected, and large costs. Imagine sending your weekly grocery bill to an insurance clerk for review, and having the grocer reimbursed by the insurer to whom you’ve paid your share. An expensive and wasteful absurdity, no?
    Is this really a big problem for our health-care system? Well, for every two doctors in the U.S., there is now one health-insurance employee—more than 470,000 in total. In 2006, it cost almost $500 per person just to administer health insurance. Much of this enormous cost would simply disappear if we paid routine and predictable health-care expenditures the way we pay for everything else—by ourselves.

    ...

    Moral hazard has fostered an accidental collusion between providers benefiting from higher costs and patients who don’t fully bear them. In this environment, trying to control costs is awfully tough. When Medicare cut reimbursement rates in 2005 on chemotherapy and anemia drugs, for instance, it saved almost 20 percent of the previously billed costs. But Medicare’s total cancer-treatment costs actually rose almost immediately. As The New York Times reported, some physicians believed their colleagues simply performed more treatments, particularly higher-profit ones.
    Want further evidence of moral hazard? The average insured American and the average uninsured American spend very similar amounts of their own money on health care each year—$654 and $583, respectively. But they spend wildly different amounts of other people’s money—$3,809 and $1,103, respectively. Sometimes the uninsured do not get highly beneficial treatments because they cannot afford them at today’s prices—something any reform must address. But likewise, insured patients often get only marginally beneficial (or even outright unnecessary) care at mind-boggling cost. If it’s true that the insurance system leads us to focus on only our direct share of costs—rather than the total cost to society—it’s not surprising that insured families and uninsured ones would make similar decisions as to how much of their own money to spend on care, but very different decisions on the total amount to consume.

    ...

    In 2007, employer-based health insurance cost, on average, more than $12,000 per family, up 78 percent since 2001. I’ve run several companies and company divisions of various sizes over the course of my career, so I can confidently tell you that raises (and even entry-level hiring) are tightly limited by rising health-care costs. You may think your employer is paying for your health care, but in fact your company’s share of the insurance premium comes out of your potential wage increase. Where else could it come from?
    Let’s say you’re a 22-year-old single employee at my company today, starting out at a $30,000 annual salary. Let’s assume you’ll get married in six years, support two children for 20 years, retire at 65, and die at 80. Now let’s make a crazy assumption: insurance premiums, Medicare taxes and premiums, and out-of-pocket costs will grow no faster than your earnings—say, 3 percent a year. By the end of your working days, your annual salary will be up to $107,000. And over your lifetime, you and your employer together will have paid $1.77 million for your family’s health care. $1.77 million! And that’s only after assuming the taming of costs! In recent years, health-care costs have actually grown 2 to 3 percent faster than the economy. If that continues, your 22-year-old self is looking at an additional $2 million or so in expenses over your lifetime—roughly $4 million in total.

    ...

    Whatever their histories, nearly all developed countries are now struggling with rapidly rising health-care costs, including those with single-payer systems. From 2000 to 2005, per capita health-care spending in Canada grew by 33 percent, in France by 37 percent, in the U.K. by 47 percent—all comparable to the 40 percent growth experienced by the U.S. in that period. Cost control by way of bureaucratic price controls has its limits.

    ...

    Health care is an exceptionally heavily regulated industry. Health-insurance companies are regulated by states, which limits interstate competition. And many of the materials, machines, and even software programs used by health-care facilities must be licensed by state or federal authorities, or approved for use by Medicare; these requirements form large barriers to entry for both new facilities and new vendors that could equip and supply them.
    Many health-care regulations are justified as safety precautions. But many also result from attempts to redress the distortions that our system of financing health care has created. And whatever their purpose, almost all of these regulations can be shaped over time by the powerful institutions that dominate the health-care landscape, and that are often looking to protect themselves from competition.
    Take the ongoing battle between large integrated hospitals and specialty clinics (for cardiac surgery, orthopedics, maternity, etc.). The economic threat posed by these facilities is well illustrated by a recent battle in Loma Linda, California. When a group of doctors proposed a 28-bed private specialty facility, the local hospitals protested to the city council that it was unnecessary, and launched a publicity campaign to try to block it; the council backed the facility anyway. So the nonprofit Loma Linda University Medical Center simply bought the new facility for $80 million in 2008. Traditional hospitals got Congress to include an 18-month moratorium on new specialty hospitals in the 2003 Medicare law, and a second six-month ban in 2005.

    ...

    Consider the oft-quoted “statistic” that emergency-room care is the most expensive form of treatment. Has anyone who believes this ever actually been to an emergency room? My sister is an emergency-medicine physician; unlike most other specialists, ER docs usually work on scheduled shifts and are paid fixed salaries that place them in the lower ranks of physician compensation. The doctors and other workers are hardly underemployed: typically, ERs are unbelievably crowded. They have access to the facilities and equipment of the entire hospital, but require very few dedicated resources of their own. They benefit from the group buying power of the entire institution. No expensive art decorates the walls, and the waiting rooms resemble train-station waiting areas. So what exactly makes an ER more expensive than other forms of treatment?
    Perhaps it’s the accounting. Since charity care, which is often performed in the ER, is one justification for hospitals’ protected place in law and regulation, it’s in hospitals’ interest to shift costs from overhead and other parts of the hospital to the ER, so that the costs of charity care—the public service that hospitals are providing—will appear to be high. Hospitals certainly lose money on their ERs; after all, many of their customers pay nothing. But to argue that ERs are costly compared with other treatment options, hospitals need to claim expenses well beyond the marginal (or incremental) cost of serving ER patients.
    In a recent IRS survey of almost 500 nonprofit hospitals, nearly 60 percent reported providing charity care equal to less than 5 percent of their total revenue, and about 20 percent reported providing less than 2 percent. Analyzing data from the American Hospital Directory, The Wall Street Journal found that the 50 largest nonprofit hospitals or hospital systems made a combined “net income” (that is, profit) of $4.27 billion in 2006, nearly eight times their profits five years earlier.

    ...

    Here’s a wonderful example of price opacity. Advocates for the uninsured complain that hospitals charge uninsured patients, on average, 2.5 times the amount charged to insured patients. Hospitals defend themselves by contending that they earn from uninsured patients only 25 percent of the amount they do from insured ones. Both statements appear to be true!

    ...

    Ten days after my father’s death, the hospital sent my mother a copy of the bill for his five-week stay: $636,687.75. He was charged $11,590 per night for his ICU room; $7,407 per night for a semiprivate room before he was moved to the ICU; $145,432 for drugs; $41,696 for respiratory services. Even the most casual effort to compare these prices to marginal costs or to the costs of off-the-shelf components demonstrates the absurdity of these numbers, but why should my mother care? Her share of the bill was only $992; the balance, undoubtedly at some huge discount, was paid by Medicare.

  • #2
    Re: Interesting overview of American health care: present status, history and causes

    From the general to the nitty gritty:

    I'm a board certified anesthesiologist with over twenty years of experience beginning in the military. I'm now in private practice. My patients have come from a relatively healthy patient population during my military based practice to a practice consisting largely of critically injured patients suffering from multiple traumatic injuries and or multiple serious medical conditions.

    My fees are steeply discounted. I charge $70 every fifteen minutes, but I don't remember ever getting anywhere near that. My insured patients pay me around $50-55 dollars per fifteen minutes through their health insurance companies. I can bill uninsured patients for my full, non-discounted fee of $280 an hour, but I rarely collect anything at all from these patients.

    Most of my current reimbursement is based on Medicare rates. I get $19.53 for every 15 minutes of service. I think $80 per hour to care for the elderly patient who often has multiple pre-existing medical problems is a tad undervalued. Try calling a plumber to fix a broken water pipe at 3 am. I wonder what they would charge for a call like that? I'll bet it would be a lot more than $80 an hour.

    Around 20% of my patients have no insurance whatsoever. These 'self pay' patients virtually never pay me for their care, which often comes in the middle of the night. My hospital subsidizes me to the tune of around $36,000 a year to provide care to these patients.

    My malpractice liability insurance costs me around $32,000 a year. I have been sued three times. I made the mistake of agreeing to mediation on one of these cases. That one cost me $50,000 plus about $100,000 in legal fees. The surgeon paid out $3.4 million. In my opinion, the surgeon was 100% responsible for the poor outcome but I got tired of explaining why I was unable to save the patient's life. I will never settle another case out of court again. I will have a jury trial. None of these cases had anything to do with my care; they could be regarded as 'nuisance' cases. The other two cases were dismissed in my favor but only after my liability insurance carrier and I myself spent well over $100,000 on each case. Neither case went to trial; both were dismissed after years of legal manouvers, depositions, etc.

    I have 14 years of education beyond high school. I was at the top of my high school class of 800 and graduated from college and medical school with honors. Back in the day, I used to help my roomates in college with their homework. Now they are plaintiffs' attorneys getting multi-million dollar settlements from medical malpractice settlements. I'm sure they earn their 40% 'share'. Meanwhile, I gross between $200,000 and $240,000 a year. I was lucky, I graduated from med school and residency with only $45,000 in debt. Recent grads average nearly $200K in debts. I am grateful that neither of my kids chose medicine as a career. I hope the bankers and lawyers choke to death on their bailouts and bonuses.

    Comment


    • #3
      Re: Interesting overview of American health care: present status, history and causes

      Originally posted by reallife View Post
      I hope the bankers and lawyers choke to death on their bailouts and bonuses.
      Let us just hope they do not spend their last gasping moments on the operating table you're working if they do so choke.

      The last thing you need is another lawsuit, this time involving the demise of a medical malpractice attorney or his banker.
      Most folks are good; a few aren't.

      Comment


      • #4
        Re: Interesting overview of American health care: present status, history and causes

        Go out into your yard (if you have one, or the city park if no yard) and find an ant hill. Take a twig and brush off the top of the mound, and watch those little mothers erupt. How much do you think one on those ants might know about the world in which it lives? Damned little would be my guess, if an answer could be derived.

        Though it seems that many of us have opinions one way or another about what is good, bad with the US healthcare system, I strongly suspect that most of our individual range of knowledge of the problems is best likened to that of an ant in the above paragraph. Basically most of us do not know jack-shit.

        Damned I hate long articles and reading books, but the article you put up, clue, is a worthwhile bit of information and should broaden any reader's scope in appreciating the magnitude of the problem in which this country finds itself with just the single problem of health care.

        Perhaps the answers to the problem suggested by Goldhill have some merit, but for sure if they do, any evolution toward them will take a long time.

        Several things seem near certainties to me. Something must change, and for the politicians to be out discussing this with mostly ignorant citizens is a waste of time that will result in nothing substantive in the way of productive change. Whatever changes, it likely will leave a whole to be desired in actually changing the current problems with health care.

        If you have a long attention span, the article is worth reading.
        Last edited by Jim Nickerson; September 01, 2009, 11:08 PM.
        Jim 69 y/o

        "...Texans...the lowest form of white man there is." Robert Duvall, as Al Sieber, in "Geronimo." (see "Location" for examples.)

        Dedicated to the idea that all people deserve a chance for a healthy productive life. B&M Gates Fdn.

        Good judgement comes from experience; experience comes from bad judgement. Unknown.

        Comment


        • #5
          Re: Interesting overview of American health care: present status, history and causes

          Originally posted by Jim Nickerson View Post
          If you have a long attention span, the article is worth reading.
          Thanks for the poke. I had skipped over the article before, but am reading it now.

          Good stuff.

          It's not just the FIRE economy that needs to have its game board tipped over and started afresh. There are some more obese globs of putrid bloat about, including the health-care, bigAg, defense contractors, intelligence (!), political and newsmedia domains.

          Power corrupts. The United States is the most powerful nation in the history of civilization, thanks to our forefathers getting some things profoundly right, thanks to an abundance of natural wealth from sea to shining sea and thanks to the sweat, wisdom and bravery of many who have gone before us.

          Nothing lasts forever.
          Most folks are good; a few aren't.

          Comment


          • #6
            Re: Interesting overview of American health care: present status, history and causes

            Originally posted by Jim Nickerson View Post
            Go out into your yard (if you have one, or the city park if no yard) and find an ant hill. Take a twig and brush off the top of the mound, and watch those little mothers erupt. How much do think one on those ants might know about the world in which it lives? Damned little would be my guess, if an answer could be derived.

            Though it seems that many of us have opinions one way or another about what is good, bad with the US healthcare system, I strongly suspect that most of our individual range of knowledge of the problems is best likened to that of an ant in the above paragraph. Basically most of us do not know jack-shit.

            Damned I hate long articles and reading books, but the article you put up, clue, is a worthwhile bit of information and should broaden any reader's scope in appreciating the magnitude of the problem in which this country finds itself with just the single problem of health care.

            Perhaps the answers to the problem suggested by Goldhill have some merit, but for sure if they do, any evolution toward them will take a long time.

            Several things seem near certainties to me. Something must change, and for the politicians to be out discussing this with mostly ignorant citizens is a waste of time that will result in nothing substantive in the way of productive change. Whatever changes, it likely will leave a whole to be desired in actually changing the current problems with health care.






            If you have a long attention span, the article is worth reading.

            Damn well said. We need knowledgeable people deciding this stuff. Instead we have a Town Hall Dog and Pony show starring people on both sides who don't have a clue. I've always said that I don't know the answer, but I do know something ain't right and some real thought needs to be put into this. But this is America, and we don't seem to do that anymore. At least not in politics.

            Comment


            • #7
              Re: Interesting overview of American health care: present status, history and causes

              Originally posted by ThePythonicCow View Post
              Let us just hope they do not spend their last gasping moments on the operating table you're working if they do so choke.

              The last thing you need is another lawsuit, this time involving the demise of a medical malpractice attorney or his banker.
              LOL....My point is that the likelihood of getting sued has little to do with the care provided. In one case, I was guilty of walking into the OR about 15 minutes after a surgeon put a screw into someone's spinal cord by mistake. I gave the anesthesiologist doing the case a break while the surgeons figured out what they could do to ameliorate the problem. My name was on the chart, the patient had a devastating injury...BINGO! Everyone must pay!

              I actually have a great reputation with the local legal community and have had quite a few requests to provide anesthesia care for attorneys and their families. I give all my patients, regardless of their occupation or ability to pay, the very best care that I can provide (and I am a very good anesthesiologist).

              Comment


              • #8
                Re: Interesting overview of American health care: present status, history and causes

                Federal and state courts are subsidized by the government. Mediation is all out of pocket and in general, the costs are much more expensive. Judges cost more, rooms cost more, filing costs more, etc, etc. Someone has to pay for their marketing and executive compensation. I don't understand why there are no libertarian cries to privatize the judicial system.

                Comment


                • #9
                  Re: Interesting overview of American health care: present status, history and causes

                  holy cow... lots of soapbox potential here...

                  I will say that

                  1) the premise of insurance covering regular care is indeed flawed
                  2) society seems to concede that insurance for major and unusual medical events should be 'universal'... i dont know if I agree.
                  3) from personal experience, insurance is a funnel through which the medical industry is overcompensated, though I concede that it is unevenly and unjustly distributed among the community.
                  4) the number one thing I learned in my early legal practice was that I should have gone to med school -- most defense lawyers were making under $50k, billing insurers at $150 per hour at best, plaintiffs lawyers uneven but most even less, often not getting anything; yet no matter what happened in the case, the treating doctors were paid through health insurance or workmens comp, other doctors were paid $500 per hour to testify or review, and any unpaid medical bill that didnt fall under one of those funnels was paid out of the settlement or verdict. Usually the ONLY person making good off of a personal injury suit was not the plaintff, certainly not the defendant, and neither lawyer, but every doctor involved made a killing.

                  As far as med mal lawsuits go, in most states in the last 10 years, a plaintiff or lawyer really cant make money suing doctors, except very rare cases, most of which certainly justify large awards.

                  I moved on and upwards from that beat many years ago, but those dynamics remain today.

                  5) Insurance is by definition a leach on society, and when overutilized grows far out of proportion; however, the medical field would see its overall income drop substantially without it (though I would say the fair and appropriate allocation of the income would improve).

                  6) in terms of leaches/wasted productivity I'd have to rate government as number 1, insurance as 2, finance industry gamesmanship 3, and excessive and unnecessary tax related law and accounting as number 4, scale these back to rationality and devote this brainpower and productivity into engineering and science and you have a rennaisance; a fairly core Itulip concept and one that I have held for a very long time and attracted me here.

                  7) dont ever, ever let anything do away with the jury trial system; it is the last and only bastion of fair and equitable governance on the planet. It should be used much more broadly than just civil disputes and criminal charges; serving on a jury is YOUR **ONLY** opportunity to inflict rationality and justice on the world (Voting in the US now being a complete joke except occasionally at the local level). If you have not served on a jury you have no right to comment on anything the legal system does.

                  8) the only way to reform the US begins with rationalizing jury *selection* and voter qualification.

                  OK, I'm done...

                  Comment


                  • #10
                    Re: Interesting overview of American health care: present status, history and causes

                    It would be nice to see some discussion on how to avoid having to go to a hospital in the first place.

                    If we don't fix the root cause - bad diet and little exercise - the health care problem will only get worse.

                    Fix the root cause and the problem goes away....


                    "Plenty of factors contribute to your life expectancy, including your family medical history, habits (ahem—smokers), and even your race. But no matter how you stack up in other categories, if you don’t keep your weight in check, you’re setting yourself up for a host of life-threatening ailments. Want proof? The numbers below tell a scary story: The states with highest percentages of obese adults—including Alabama (31.2%), Louisiana (28.9%) and Mississippi (32.5%)—have some of the lowest life expectancies in the country—74.6, 74.4, and 73.7 years, respectively. Compare those states to Colorado—where only 18.9 percent of adults are obese and the life expectancy is 78.4 years. Where your state falls on the fit-to-fat spectrum shouldn’t be your only health concern, but it’s certainly worth keeping tabs on."

                    http://www.womansday.com/Articles/He...our-State.html


                    "Americans now spend more money on fast food than they do on higher education, personal computers, software or new cars. They spend more on fast food than on movies, books, magazines, newspapers, videos and recorded music - combined."

                    http://www.mcspotlight.org/media/pre...ingstone1.html




                    "Regular exercise is a critical part of staying healthy. People who are active live longer and feel better. Exercise can help you maintain a healthy weight. It can delay or prevent diabetes, some cancers and heart problems."

                    http://www.nlm.nih.gov/medlineplus/e...alfitness.html


                    "Obesity not only impacts lifestyle but can also lead to lower self-esteem, cause depression and discomfort in social situations, and significantly diminish quality of life. Obesity also increases a person's risk for developing serious obesity-related health conditions such as diabetes, heart disease , hypertension, metabolic syndrome, and poly cystic ovary syndrome.

                    Statistically,
                    * 58 Million Overweight; 40 Million Obese; 3 Million morbidly Obese
                    * Eight out of 10 over 25's Overweight
                    * 78% of American's not meeting basic activity level recommendations
                    * 25% completely Sedentary
                    * 76% increase in Type II diabetes in adults 30-40 yrs. old since 1990
                    Childhood obesity in the United States has more than tripled in the past two decades.
                    -- According to the U.S. Surgeon General report obesity is responsible for 300,000 deaths every year."

                    http://www.merchantcircle.com/blogs/...ortions/336525
                    Last edited by bobola; August 21, 2009, 11:19 AM. Reason: addition

                    Comment


                    • #11
                      Re: Interesting overview of American health care: present status, history and causes

                      Originally posted by cbr View Post
                      holy cow... lots of soapbox potential here...

                      I will say that

                      1) the premise of insurance covering regular care is indeed flawed
                      2) society seems to concede that insurance for major and unusual medical events should be 'universal'... i dont know if I agree.
                      3) from personal experience, insurance is a funnel through which the medical industry is overcompensated, though I concede that it is unevenly and unjustly distributed among the community.
                      4) the number one thing I learned in my early legal practice was that I should have gone to med school -- most defense lawyers were making under $50k, billing insurers at $150 per hour at best, plaintiffs lawyers uneven but most even less, often not getting anything; yet no matter what happened in the case, the treating doctors were paid through health insurance or workmens comp, other doctors were paid $500 per hour to testify or review, and any unpaid medical bill that didnt fall under one of those funnels was paid out of the settlement or verdict. Usually the ONLY person making good off of a personal injury suit was not the plaintff, certainly not the defendant, and neither lawyer, but every doctor involved made a killing.

                      As far as med mal lawsuits go, in most states in the last 10 years, a plaintiff or lawyer really cant make money suing doctors, except very rare cases, most of which certainly justify large awards.

                      I moved on and upwards from that beat many years ago, but those dynamics remain today.

                      5) Insurance is by definition a leach on society, and when overutilized grows far out of proportion; however, the medical field would see its overall income drop substantially without it (though I would say the fair and appropriate allocation of the income would improve).

                      6) in terms of leaches/wasted productivity I'd have to rate government as number 1, insurance as 2, finance industry gamesmanship 3, and excessive and unnecessary tax related law and accounting as number 4, scale these back to rationality and devote this brainpower and productivity into engineering and science and you have a rennaisance; a fairly core Itulip concept and one that I have held for a very long time and attracted me here.

                      7) dont ever, ever let anything do away with the jury trial system; it is the last and only bastion of fair and equitable governance on the planet. It should be used much more broadly than just civil disputes and criminal charges; serving on a jury is YOUR **ONLY** opportunity to inflict rationality and justice on the world (Voting in the US now being a complete joke except occasionally at the local level). If you have not served on a jury you have no right to comment on anything the legal system does.

                      8) the only way to reform the US begins with rationalizing jury *selection* and voter qualification.

                      OK, I'm done...
                      cbr, it's is nice when posters care enough to identify their backgrounds, it adds something to credibility.

                      It matters little that I agree with most of your observations, but I would appreciate your troubles to expand on what you mean with your number 8). "Rationalize" according to Webster: to bring into accord with reason or cause something to seem reasonable. There is a vast difference between the two phrases on either side of the "or."

                      I hope you'll get back to us on this.
                      Jim 69 y/o

                      "...Texans...the lowest form of white man there is." Robert Duvall, as Al Sieber, in "Geronimo." (see "Location" for examples.)

                      Dedicated to the idea that all people deserve a chance for a healthy productive life. B&M Gates Fdn.

                      Good judgement comes from experience; experience comes from bad judgement. Unknown.

                      Comment


                      • #12
                        Re: Interesting overview of American health care: present status, history and causes

                        Originally posted by cbr View Post
                        If you have not served on a jury you have no right to comment on anything the legal system does.
                        If you have not served on the board of directors you have no right to comment on anything Goldman Sachs does.

                        Comment


                        • #13
                          Re: Interesting overview of American health care: present status, history and causes

                          Originally posted by reallife View Post
                          I gross between $200,000 and $240,000 a year. I was lucky, I graduated from med school and residency with only $45,000 in debt. Recent grads average nearly $200K in debts. I am grateful that neither of my kids chose medicine as a career. I hope the bankers and lawyers choke to death on their bailouts and bonuses.
                          I agree with your sentiment about bankers and lawyers.

                          On the other hand, the average income in the US is around $32,000 year (last time I checked). Your gross income is $200K to $240K. That's about 7 times the average salary. Not too bad . . . .
                          raja
                          Boycott Big Banks • Vote Out Incumbents

                          Comment


                          • #14
                            Re: Interesting overview of American health care: present status, history and causes

                            Originally posted by raja View Post
                            I agree with your sentiment about bankers and lawyers.

                            On the other hand, the average income in the US is around $32,000 year (last time I checked). Your gross income is $200K to $240K. That's about 7 times the average salary. Not too bad . . . .
                            I'm not complaining. The average $32,000 wage earner has much less education (and missed opportunity costs while obtaining that education) than I do. New grads have educational loans that must be repaid. I've heard of monthly loan payments that are larger than many mortgage payments. I was just providing some relevant insight for our readers. I do work 60-65 hours a week so my income would be considerably lower if I was able to work less. I would work a lot fewer hours if I could but there is a real shortage of anesthesiologists and the demand on my time is largely out of my control. It is difficult and very expensive to recruit additional staff.

                            Comment


                            • #15
                              Re: Interesting overview of American health care: present status, history and causes

                              my #8 is of course a value opinion, but one on which I am at least familiar with the consequences...

                              Jury selection varies slightly across jurisdictions, but generally speaking (and being a bit glib), anyone with a drivers license gets called...and anyone with a business or a solid career gets released without serving.

                              Some Juries are drawn from voter pools rather than driver pools, but still, most educated hard working people get off of jury duty up front.

                              Those that are not summarily released are often struck 'for cause' as it is called, based on some characteristic that one or the other side does not like.

                              Judges have immense discretion in how jurors are stuck 'for cause'.

                              I think you want a selection system that favors rather than excludes intelligent, diligent, fairly well educated people with some life experience serving on juries.

                              I have some ideas but dont have time right now to discuss.

                              Same with voters. As much of a personal rights and freedom kind of guy as I am, I can't fathom why *everyone* should be able to vote, nor why a direct vote doesnt count at the presidential level in this day and age, and why information available to voters is controlled by candidates themselves and media which are both subject to influence by well financed special interests.

                              Short version, IMO, in order to have a vote, you should be able to demonstrate some level of education generally, a fair level of education about real actual substantive issues (not emotional sideshows and soundbites), some depth of knowledge of candidate backgrounds and intentions (identifying a name and party does not count), and past or current contribution to society, whether it is by gainful employment (self or otherwise), government service, military service, or volunteerism.

                              I realize there are difficulties with implementing these ideas without other inroads for corruption, should by some miracle a consensus form that they are needed, but it would not be impossible.



                              Fire away!

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