5166

This seems like exactly the right way to provision health care to me. Unless your kid has special medical needs, a PA is more than qualified to perform an annual checkup. It seems obvious to me that we should use lower cost providers when they have the necessary training to perform the task.

5167

Unexpected inflation is a tax on certain types of assets. Who exactly that hits depends on the distribution of asset types. I’ve heard many times that the really rich often have primary assets in terms of property or stock that wouldn’t be hurt by unexpected inflation. I remember Brad complaining that they don’t show much income, and they finance spending by taking out low-interest loans against their giant assets. So they might be mildly helped by unexpected inflation.

A big category that would be hurt by unexpected inflation is people who rely on fixed-value pensions. Also pensions that are indexed might have a hard time as IIRC, they invest a lot in stuff like bonds that would lose a lot of value from unexpected inflation. I guess Social Security is in that boat as well.

5168

I thought the point was more that most Americans barely save any money at all, so they wouldn’t be impacted by any of their assets depreciating to begin with.

5169

I think there is a significant fraction getting fixed pensions, and of course a large number relying on Social Security.

5170

Isn’t Social Security indexed to inflation?

5171

I think that is true, yes. Are the bonds it holds indexed? Basically my thinking is that the gains to the government finances from an unexpected inflation spike would be watered down since it would just accelerate SS running out of savings.

Overall, I think using unexpected inflation as a way to soak the rich is a really poor option. It’s more a shotgun where a scalpel would be more appropriate.

5172

Or a national razor.

5173

I generally agree, though I’d say that the Fed’s insistence on keeping inflation under 2% is entirely a sop to the wealthy.

5174

Sounds about right

5175

To bring the healthcare discussion back into the bigger topic of the thread, the Dem’s are going to campaign on meaningful health care reform, with meaningful arguments within the Dem camp on how to deliver reform. The GOP on the other hand… The GOP in the House appear to be planning to campaign in 2020 on repealing Obamacare (and they seem to have given up on replacing it) which is laughable at this point. The bigger issue is Trump, who appears primed to campaign on “healthcare reform” which I’ve put in quotes b/c every single thing I’ve seen mentioned is either outright lies / fantasy or tiny minimalist crap which we should have been doing 10 years ago.

So that leads into the campaign itself: healthcare is an area where there is going to be substantive reform offered by the Dems and lies/fantasy by Trump. What’s F’ed up is that’s not necessarily a great scenario for the Dems (as it should be) due to the apparent idiocy of so much of the electorate and the fact that 98% of the media is for shit when it comes to explaining real substance like health care reform.

I think my hot take at this point is that the intra-Dem fight over single-payer versus public option is a waste of time. Public option is the clear electoral winner (and in my view roughly equal in terms of long term policy) and the sooner the leading candidates pick a flavor of public option, the sooner they can get into preparing for Trump’s lies and fantasies. This in particular applies to my pick, Warren, who needs to stop wasting time jousting with Bernie on single-payer-purity, put forth a solid reasonable public option plan, and proceed to beating Joe then Donnie. (which is my fantasy of course.)

5176

Most doctors are in fact employees these days.

5177

So the lowest paid person on that list who is actually a doctor who would have incurred the full cost of medical school is the Pediatrician who makes $230k/yr. Since I very comfortably live in a high cost city on somewhat less than half of that amount, I think it’s reasonable to say that your typical GP could probably pay their medical school costs down in less than 5 years if they tailor their lifestyle to that of an upper middle class person rather than a wealthy person. After 5 years, they can go all the way rich.

5178

Tort insurance (I am misremembering the name; apologies) is also a very significant and relatively doctor-unique cost. Probably not $100,000/year level, but it’s not insignificant, thanks to our insane litigious culture here in the US.

5179

I’m not at all sure that is true, but would be happy to look at a citation. This source indicates that 46% of doctors are owners of their practice, 47% are employees, and 7% are independent contractors. Ownership rates tend to be lowest among the youngest doctors (26%) and highest among the oldest doctors (54%), which makes sense.

5180

Yes, exactly.

5181

It’s a bit of a problem when you’re in a car accident and the closest ER is around 100 miles away. No hospital can run on just an ER department and nothing else and remain open. Hell often the ER departments are overrun trying to provide basic car and not emergencies at all. This is very expensive for not expensive issues; it’s also not long-term sustainable or preventable care for people that need it. These systems serve their communities, and what those communities actually need can vary by quite a bit, depending on which groups are in that community.

You seem to be under the mistaken belief that all health systems just rake in profits. That is simply not true.

5182

Re: Healthcare - I’m not sure if I buy the idea that overpaid doctors is the primary cause of costs going out of control in the US system.

I do agree it’s a problem, but it seems to me that the main issue that is that medical admin costs are out of control, eating up 25% of all healthcare costs, nearing almost $500B annually. Keeping the status quo with lower paid doctors will only do so much - the entire system needs a big jolt to advocate for a more cost effective model.

5183

So by your document 54% of doctors are contract or employees, and defines ‘own their own business’ as being partial owners.

Those who ‘own their own practice’ often work in a huge employee owned group where they are < 1% owners that is in effect an employed position. Like the nationwide ER group I worked for. It is doctor owned, but its a 1000 doctor business and i was an employee far more than i was an owner. same with the large multispecialty groups. sure, doctors own it, you even ostensibly are a very tiny owner, but there are executives and HR and you are hired and work as an employee despite it being owned by you. The independent doctor who runs a one doctor shop is fleetingly rare these days in my experience. Nobody ive kept up with from med school has their own practice in the old style.

5184

Yeah its not one thing only. Costs all over are whacked. Devices, medication, admin, malpractice, concierge style servicing, private rooms, luxury fountains and decoration (often vanity projects sponsored by high rolling donors who are in it for the prestige/ tax write off), excess testing, overmedication, etc all play a role.

No one area is responsible alone, and no solution can exist that doesn’t address multiple of them.

5185

Indeed it is. If only there were some way to keep hospitals and ERs open in rural areas. Something to do with public funding?