leh-nerd skin-erd

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As would this one. Folks availing themselves of the elite level services are asked/compelled to contribute at a higher proportionate level than those who cannot afford such extravagances. It’s quite progressive. I’m not suggesting a country club surcharged to fund health care, it’s literally in the same family of services. You’ve got a lot yet to give but don’t seem to want to participate. I’ll put you down for “you’ll miss it”.

It wasn't my suggestion, it was a conversation with Red that lead to this discussion. I was just taking it through to its natural conclusion based on our conversation. Let's see that through. Much of your discussion deals with you...how things impact you...how you earned what you did...how you paid what you did...and what you want to do moving forward. Over the last two posts, you've talked about what you did in the past, and frankly that's irrelevant to the future. Thank you, of course, though as you were contributing so were the collective we--each doing our part--but beyond that we need to deal with the now. You should stop thinking "I" and focus on "We". Assuming you're 65 or so, the SS actuarial charts suggest a typical male is expected to live another 17.4 years. Beyond that, you've been financially successful, seem to be in good health and so it's reasonable to assume your actual results will vary. Let's assume 25 years for Doc Ferg. Between the upfront costs (Red suggests 15% of your income as tax), let's say $25k, the $720 from you, the $720 from the Doc the numbers add up very quickly--like a million-two. Would you miss it, Fergs?

Ironically, I have seen you complain about tax breaks for the rich in the big bill, and then acknowledge you aren't willing to anything beyond the minimum for the greater good unless mandated by law. This would be one of those compulsory requirements from you (the rich) to help those less fortunate. You paid at the highest rate over your working life because you were economically privileged, and in this case, the money came directly from the people we're looking to protect with the new program. There are some (let's call them socialists) who might feel your wealth was stolen from those in need of your services, but I don't see it that way. You studied, worked, produced and offered a service people wanted and needed, no diff than an electrician, plumber or bridge welder. You should pay more because you can, as evidenced by your fancy concierge doctor arrangement. The subscription payment (and revenue to the doctor) obviously fall outside the traditional model, and the opportunity cost is substantial when considering the blossoming popularity of boutique medicine with high net worth Americans. I do not imagine it would be much-Would you be comfortable paying the $80 per month for service, plus a $60/month surcharge matched by your fancy concierge doctor? That's literally $2/day each. Maybe don't think of it as "paying more", consider it "contributing at a higher level".

Agreed. This is simply human nature. I agree they won’t stop it, but the govt can certainly develop a surcharge or tax on the service to level the playing field. Reddog suggested that partakers in elite-level-access services pay a health insurance tax (15% of income as a suggestion) prior/along with whatever the law they want to do. If the goal is to level the playing field and fair share the deal, that makes sense.

I’ll start with the end in mind and work backwards…I agree that the current model is inefficient (and a reminder, it’s exactly what the govt planned it to be), and to be completely candid have no idea if it’s over-priced or not. Who can tell? It’s a highly regulated industry with generations of political fingerprints all over it, the well-intentioned, the apathetic and monetarily influenced alike. Much is made of ins cos lobbying, but let’s be fair and acknowledge the medical industry (docs, hospitals, clinics, phlebotomists, device manufacturers et al) is dollars deep in directing and controlling and virtually all want as large a slice of the pie as they can get. My preferred options would be a continuation of the govt-private industry model with an eye toward sensible regulation, sensible cost-control and all stakeholders thriving especially patients. My biggest issue with the govt model is that politicians seek political answers to math problems time and time again. Back when ACA was being pimped, substantial hubbub arose over coverage for “pre-existing conditions”. While there were abuses in the regulatory side (quick reminder, the state/federal government established the rules to follow there), there were many individuals who actively and intentionally forewent health insurance to save premium, only to seek it out when they needed it. That’s sad, but avoidable on a personal level. Bottom line, all these programs can work if the math is right, but the math never works out to free (and I understand that’s not your suggestion here). So, govt-private alliance, the bureaucrats working out sensible rules and guidelines, sensible cost controls for routine procedures, private companies seeking out new and efficient ways to offer services on a national level. Healthier people should earn better premiums, higher risk individuals should expect a higher commensurate premium with limitations on premium changes once a health issue occurs. As always, a safety net should be in place with tight regulation and stiff penalties for those who abuse the system.

Yes, I agree that cost has increased and also that this was the outcome planned by Obama and the architects of the ACA, at least for most working Americans. We do that now…those who contribute help fund those that don’t. Those that are in good health subsidize those that aren’t. Private subsidizes Medicaid and Medicare. I appreciate the guess at 15%, but you’re suggesting 15% on top of federal and state income tax already in existence, plus all the other tax we pay already? Property…sakes…excise etc? Ah, ok. A wealthy guy like Fergie kicks in his full 15%, but then funds his concierge service over and above. Interesting. I think that putting removing the private CO’s from the market is an absolute recipe for disaster, and would result in substantially higher costs and drastically reduced options….but if you’re going down ragtag path, I’d agree with this with maybe an additional surcharge on the concierge service. Maybe like a grand , two or three above and beyond.

Many lawyers don’t care about “those with nothing to hide” and make a career out of winning as priority #1. It’s the reason attorneys suggest keeping your mouth shut and not cooperating as the best course of action. Anyway, thanks for chatting. ✌️

I really have no idea how what I said is spin, it seems pretty factual to me. But, on we go!

We went nearly 250 years before we saw an armed raid on the house of a former President…and we might end up seeing 2 in 5 years! And, if they can loop in the Clintons it would be 3 with a Popular Vote Almost President thrown in for good measure. I think this is why you don’t knock down guardrails.

See, I don't think it's cowardice at all. I see it as political posturing, ugly though it may be. Let's be fair Mup--it's quite obvious the Russiagate fiasco was nearly 100% political posturing in the Joseph McCarthy mode. Had Obama had any sense of decency or desire for unity, he could have quickly and efficiently dispelled the Clinton narrative by stating that the Clinton team was working with a foreign national to sow discontent about the safety and security of our elections. It blossomed from there of course, but we know this to be true: Obama was a typical politician, as was HRC, John Brennan and the like--they manipulated the emotions of a certain number of American voters just jonesing for a great Russian crime drama knowing full well they would buy it hook, line and sinker. I don't think that was cowardice at all. It was a coordinated attempt to overturn the results of a free and fair election. That's why Trump launched Stop the Steal, it made perfect sense to do so. The Obama/Clinton approach worked very, very well to cause anger, frustration and discontent amongst the populace. Trump simply followed suit with his own unique spin on it. Both coordinated smears sucked, both drove a wedge between people if they allowed it to, but really---what would we expect?

Just wondering, with regard to "everyone made to pay more"...what, if anything, should the average American be asked to pay to contribute to the system in terms of annual cost, co-pays and/or deductibles, prescription meds and the like? Oh--and as Fergie points out, there is a growing field where physicians offer concierge services for a fee, catering to wealthier clients and discriminating against those less fortunate, and ironically, often most in need. In the new medicare for all scenario outlined above--does the government allow this sort of program to exist where the axis tips toward the elites and draws money away from the system that is fair and right for everyone else? I think the reality is that most members of the medical profession enter into the profession to help people, but at the same time, but often possess the same prey drive for profit as any other business owner. In that regard, they look out for number one (as Fergie has stated numerous times), and that can come into conflict with what is right and just for a patient treatment plan and the greater good. How do we balance that in the new system without setting guardrails in place that protect everyone?

But in fairness, Mup, the statement shared is 100% on point regarding transparency and the abject failure (or complicit behavior) on the coverage of Biden’s decline and cover-up in real time. Is it cowardice or political posturing?

I know this is a hot button issue for you, Red, and I can certainly appreciate that. The Jet use/cost is a fair argument, as is the use of Zoom to eliminate cost. I have no idea what other scheduled meetings or travel coincided with that trip, the importance of the trip etc, but let’s assume you’re right—it was a 1.5 hour business trip that could have been handled with a phone call. Fair criticism. We each decide where it falls in our outrage meter and vote accordingly. The carbon footprint hypocrisy is aligned with the other side, not this one.

That’s a ridiculous premise. Coverage and premiums are highly regulated under the ACA, and nothing happens outside the watchful eyes of government regulators. The system is designed by the government, and you treat it as if it isn’t. What you’re advocating for is for the designers of the system to develop another system most likely to suck worse.

That’s the thing with government programs…they make sense conceptually but don’t work and cannot exist without another organization/corporation doing the heavy lifting. Public employees retire at 55ish, with nice perks like low co-pays and very little out of pocket. A great program for those who are entitled to it, that cannot exist without others working to 65….no 67….no 70 to fund it. Medicare fails without private insurance, and the move to eliminate private insurance puts the govt in charge of all insurance, and of course govt gave us the Medicare system to begin with.

Weren’t you saying previously that in your practice, that Medicare is as insufficient to cover expenses absent private pay that put the benjies in the docs pocks?

Is Colbert in the lots-of-affluenza-types-will-rally-to-spend-to-save group like NPR? While it seems they like the message, they don’t seem to rally much around the product he produces.

Oh, snap—-Trump pardons/commutes sentence for GM in exchange for her rolling on high profile politically connected clients? Interesting angle, Andy. That way, we get answers straight from the source.

Circle of life. Seems like they were willing to lose a sh-t ton of money with Colbert’s anti-Trump dialogue to strengthen the very cozy and friendly relationship with the Biden/Dem admin. When things changed, they recognized significant exposure during the 60 Minutes litigation, Colbert and his failing enterprise were expendable. In other words, they partnered/protected Biden/Harris until it made sense not to. Seems like an easy call to me.

Your perspective seems badly skewed here. Your "guess" is "Epstein's best friend the president is on there proving he is a pedophile", yet this seems incompatible with the notion that JB and team had control of the documents, narrative and major media outlets for 1463 days, and for most of that time, he was the obvious frontrunner for the next 4 year span. That means for nearly 1500 days, he and his team had full possession of the intel and yet he withheld that crucial information from the American people? Is that your contention here, Ned? That JB, Garland and the crew were protecting DJT for four straight years? No, that makes zero sense. Maybe it would have helped if you and yours had pushed JB to scream about what's in the files. Instead, you stopped caring for a while (48 mos +/-) before caring again. Oh well, maybe next time.

I understand how you feel. For example, I felt the same way watching Biden and his disciples raging over Trump holding onto classified material, only to have them think to rethink how they felt about Biden pilfering classified/top secret docs over his decades in office. It's like they were outraged, then suddenly they weren't. "Rank hypocrisy" is an excellent phrase. As I said. Some people will care--you're in that group.

Exactly!

Student loan debt, too!

I think the country should hear from him regularly and routinely, it’s an insight into the Biden family mindset. He’s the smartest guy his dad knows, and his dad played handball with Albert Einstein—beat him twice!