Bernie Sanders announces he is running for President

[nimbus]

Carlos Ghosn is in a lot of trouble for trying to get American style executive compensation in Japan where it is culturally unacceptable.

Bloomberg - Are you a robot?

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[deleted50478]

Careful there. $5,000,000 and $500,000 is more or less the same to most people in this country. It’s a slippery slope.

There is a tax level for each income bracket that would disincentivize work, risk taking, etc. Of course you have to have tax rates below that level. My argument is that there is no increase in productivity between $5,000,000 and $70,000,000 per year (made up numbers but given for arguments sake), so that income can and should be taxed at very high rates.

 

[deleted480308]

There is a tax level for each income bracket that would disincentivize work, risk taking, etc. Of course you have to have tax rates below that level. My argument is that there is no increase in productivity between $5,000,000 and $70,000,000 per year (made up numbers but given for arguments sake), so that income can and should be taxed at very high rates.

The measure of appropriateness for tax should never, ever, be, “how much can I seize from this guy before they just quit”.

 

[VA Hopeful Dr]

You’ll never convince executives to pay the employees more. What you do instead is have a very high tax rate for people making over $5,000,000 per year and a very very high tax rate for people making $10,000,000. You tax extraordinarily high incomes so much that it isn’t worth it to the corporation to pay them that much. If they want to spend the money currently wasted on executives to raise wages, increase R&D, buy back stock, raise dividends, etc, it’s up to them, but any alternative is preferable to extraordinary executive pay.
I mean don’t feel sorry for them. They’ll still get $5,000,000 per year.

I would have no objection to more tax brackets at higher incomes. They shouldn't be above 50% though. Taxing over half of your income just isn't right.

That said, you'll have more luck with taxing capitals gains as income (because it is).

 

[Osminog]

You’ll never convince executives to pay the employees more. What you do instead is have a very high tax rate for people making over $5,000,000 per year and a very very high tax rate for people making $10,000,000. You tax extraordinarily high incomes so much that it isn’t worth it to the corporation to pay them that much. If they want to spend the money currently wasted on executives to raise wages, increase R&D, buy back stock, raise dividends, etc, it’s up to them, but any alternative is preferable to extraordinary executive pay.
I mean don’t feel sorry for them. They’ll still get $5,000,000 per year.

"Convince" executives to pay employees more? You know, executives don't decide on employee wages by strapping on blindfolds throwing darts. Rather, they decide on employee wages on the basis of the value of the employees' labor. When the value of employees' labor increases, the price of their labor increases accordingly and employees get paid more. When the value of employee labor decreases, the price of their labor decreases and employees get paid less.

The market for labor is comparable to the market for anything else; companies purchase the labor of employees in the same way that I purchase tomatoes. If the government were to artificially increase the price of tomatoes, I would become less interested in buying tomatoes and fewer tomatoes would be purchased by tomato consumers. Likewise, when the government artificially increases the price of labor (i.e., wages), companies become less interested in buying labor (i.e., hiring employees) and fewer people looking for jobs are hired. The end result of a higher minimum wage is mass unemployment, and mass unemployment would be the outcome of Bernie Sanders' campaign to institute a federal $15 minimum wage.

Now, on to the subject of executive compensation. Why are executives paid so much? Is it because company board of directors don't want to re-invest in the company and instead want to shovel money into the CEO's wallet? No. The reality is that it's extremely challenging to find a good CEO. It's a job with a huge amount of responsibility and with a very significant influence on a company's profitability, and it requires an individual to possess qualities that a vast majority of the population doesn't possess. Companies try to invest a lot of money into their executives because of the impact executives have on company success. When you limit companies' ability to fully compensate their executives, you stunt private sector growth (and hence economic growth) and you ultimately cause lower wages and unemployment for people in our country's lowest socioeconomic stratum. Like many socialist politicians, Bernie Sanders probably has good intentions—but his policies, if put into practice, would ultimately hurt the exact people he claims to want to help.

 

[DM27]

What do people think about wealth tax instead of higher income taxes.

Opinion | To Reduce Inequality, Tax Wealth, Not Income

 

[deleted480308]

What do people think about wealth tax instead of higher income taxes.

Opinion | To Reduce Inequality, Tax Wealth, Not Income

So now we want to punish someone for saving instead of punishing them for earning?

Unsurprisingly, I’m not a fan of either

 

[deleted162650]

There is a tax level for each income bracket that would disincentivize work, risk taking, etc. Of course you have to have tax rates below that level. My argument is that there is no increase in productivity between $5,000,000 and $70,000,000 per year (made up numbers but given for arguments sake), so that income can and should be taxed at very high rates.

Again, to the average Joe making 50k, there’s not a big difference in productivity between 200k and 500k so let’s just tax everything over 200k at 70%. You see where I’m going with this?

 

[pgg]

What do people think about wealth tax instead of higher income taxes.

Opinion | To Reduce Inequality, Tax Wealth, Not Income

I oppose wealth taxes at any level. At some point, once you've earned something, it should be YOURS and not subject to incremental annual bites from the government. Property taxes are bad enough, but at least there's some justification for them in that a person living someplace and benefiting from public services there should pay for them.

An estate tax, on the other hand ...

There ought to be a large exemption for passing wealth down to heirs. Certainly enough to cover the majority of family businesses that are continued by heirs. $10M exemption or thereabouts.

But royalty is un-American. Having 100s of millions passed down generation after generation, effectively creating an elite hereditary class is harmful to our collective ideals. A steep estate tax for very large estates is OK by me.

 

[VA Hopeful Dr]

I oppose wealth taxes at any level. At some point, once you've earned something, it should be YOURS and not subject to incremental annual bites from the government. Property taxes are bad enough, but at least there's some justification for them in that a person living someplace and benefiting from public services there should pay for them.

An estate tax, on the other hand ...

There ought to be a large exemption for passing wealth down to heirs. Certainly enough to cover the majority of family businesses that are continued by heirs. $10M exemption or thereabouts.

But royalty is un-American. Having 100s of millions passed down generation after generation, effectively creating an elite hereditary class is harmful to our collective ideals. A steep estate tax for very large estates is OK by me.

Agree completely.

You want to decrease the inequality, tax capital gains higher and have an estate tax (just make sure its got a pretty high floor).

 

[deleted480308]

I oppose wealth taxes at any level. At some point, once you've earned something, it should be YOURS and not subject to incremental annual bites from the government. Property taxes are bad enough, but at least there's some justification for them in that a person living someplace and benefiting from public services there should pay for them.

An estate tax, on the other hand ...

There ought to be a large exemption for passing wealth down to heirs. Certainly enough to cover the majority of family businesses that are continued by heirs. $10M exemption or thereabouts.

But royalty is un-American. Having 100s of millions passed down generation after generation, effectively creating an elite hereditary class is harmful to our collective ideals. A steep estate tax for very large estates is OK by me.

There isn’t anything “unamerican” about passing your wealth to your kids.

 

[Osminog]

A steep estate tax for very large estates is OK by me.

A big part of why many industrious, intelligent people try to make ground-breaking discoveries and build major companies is so that they can eventually pass along their wealth to their children. Nowadays, we like to think of people strictly as individuals, but we really live in a society that centers around the family unit. A large estate tax deters the brightest, most forward-thinking Americans from producing the valuable things that make all of our lives so much better.

 

[VA Hopeful Dr]

A big part of why many industrious, intelligent people try to make ground-breaking discoveries and build major companies is so that they can eventually pass along their wealth to their children. Nowadays, we like to think of people strictly as individuals, but we really live in a society that centers around the family unit. A large estate tax deters the brightest, most forward-thinking Americans from producing the valuable things that make all of our lives so much better.

No it doesn't.

 

[deleted480308]

No it doesn't.

When taken to a certain point, it might. Why keep going to work when I’ve accumulated enough that the govt will take all the new earnings before my kids/grandkids can have it?

But that’s irrelevant. The real reason to not have an estate tax is because that money doesn’t belong to the govt. the discincentive is just a side discussion

 

[pgg]

No money "belongs" to the government, but taxes are necessary to pay for some things. Money will be taken from people in some fashion. As a society we get to decide what methods are most in line with our collective values.

Hence my feelings on wealth vs estate taxes.

 

[VA Hopeful Dr]

When taken to a certain point, it might. Why keep going to work when I’ve accumulated enough that the govt will take all the new earnings before my kids/grandkids can have it?

But that’s irrelevant. The real reason to not have an estate tax is because that money doesn’t belong to the govt. the discincentive is just a side discussion

Nope. If you tax income highly enough, sure people might work less. But when it comes to money to pass to your kids? Nah.

 

[deleted480308]

Nope. If you tax income highly enough, sure people might work less. But when it comes to money to pass to your kids? Nah.

If I have enough to meet my intended lifetsyle for my life, the only reason to keep working is enjoyment or because I’m building something for my kids. If I get to the point where neither I, nor my descendants, will benefit by my labor I can promise you I am done

 

[deleted480308]

No money "belongs" to the government, but taxes are necessary to pay for some things. Money will be taken from people in some fashion. As a society we get to decide what methods are most in line with our collective values.

Hence my feelings on wealth vs estate taxes.

You’re just falling back to “but we can win votes with this idea, so take that”.....

 

[VA Hopeful Dr]

If I have enough to meet my intended lifetsyle for my life, the only reason to keep working is enjoyment or because I’m building something for my kids. If I get to the point where neither I, nor my descendants, will benefit by my labor I can promise you I am done

That lifestyle is pretty fluid though for 99% of people.

Plus I don't even think Comrade Sanders wants to tax anything at 100%.

 

[deleted480308]

That lifestyle is pretty fluid though for 99% of people.

Plus I don't even think Comrade Sanders wants to tax anything at 100%.

he did say 90% was just fine at one point.

 

[Osminog]

The real reason to not have an estate tax is because that money doesn’t belong to the govt.

You'll eventually discover that this line of reasoning isn't persuasive to people who don't already agree with you. Most people view government is a largely benevolent institution and consider taxes to be a necessary sacrifice for the greater good. They're not going to buy into the "taxation is theft!" and "I keep what's mine!" stuff, because their moral premises are fundamentally different from yours. That's why I try to emphasize the inherent inefficiency of government and its negative influence on economic growth and prosperity—so while my opponents can continue to view government as benevolent by design, they can at least realize that it is wasteful and harmful in practice. Once a person becomes aware of the government's inefficiencies, he becomes more willing to discuss the moral considerations that you're bringing up.

 

[deleted480308]

You'll eventually discover that this line of reasoning isn't persuasive to people who don't already agree with you. Most people view government is a largely benevolent institution and consider taxes to be a necessary sacrifice for the greater good. They're not going to buy into the "taxation is theft!" and "I keep what's mine!" stuff, because their moral premises are fundamentally different from yours. That's why I try to emphasize the inherent inefficiency of government and its negative influence on economic growth and prosperity—so while my opponents can continue to view government as benevolent by design, they can at least realize that it is wasteful and harmful in practice. Once a person becomes aware of the government's inefficiencies, he becomes more willing to discuss the moral considerations that you're bringing up.

Someone had to say slaves were people even when most didn’t agree. The introduction of the concept is important

 

[deleted50478]

"Convince" executives to pay employees more? You know, executives don't decide on employee wages by strapping on blindfolds throwing darts. Rather, they decide on employee wages on the basis of the value of the employees' labor. When the value of employees' labor increases, the price of their labor increases accordingly and employees get paid more. When the value of employee labor decreases, the price of their labor decreases and employees get paid less.

The market for labor is comparable to the market for anything else; companies purchase the labor of employees in the same way that I purchase tomatoes. If the government were to artificially increase the price of tomatoes, I would become less interested in buying tomatoes and fewer tomatoes would be purchased by tomato consumers. Likewise, when the government artificially increases the price of labor (i.e., wages), companies become less interested in buying labor (i.e., hiring employees) and fewer people looking for jobs are hired. The end result of a higher minimum wage is mass unemployment, and mass unemployment would be the outcome of Bernie Sanders' campaign to institute a federal $15 minimum wage.

Now, on to the subject of executive compensation. Why are executives paid so much? Is it because company board of directors don't want to re-invest in the company and instead want to shovel money into the CEO's wallet? No. The reality is that it's extremely challenging to find a good CEO. It's a job with a huge amount of responsibility and with a very significant influence on a company's profitability, and it requires an individual to possess qualities that a vast majority of the population doesn't possess. Companies try to invest a lot of money into their executives because of the impact executives have on company success. When you limit companies' ability to fully compensate their executives, you stunt private sector growth (and hence economic growth) and you ultimately cause lower wages and unemployment for people in our country's lowest socioeconomic stratum. Like many socialist politicians, Bernie Sanders probably has good intentions—but his policies, if put into practice, would ultimately hurt the exact people he claims to want to help.

https://www.google.com/amp/s/www.ws...pay-depends-on-boards-independence-1457544986

https://www.google.com/amp/s/www.fo...ys-excessive-ceo-pay-is-trashing-america/amp/

 

[DirtDocMD]

Some folks talk about a “social contract” that society/government’s should have with their citizens to provide certain things....

Well, that ought to go both ways. What should an able-bodied citizen have to provide their society/government??? Does sitting around, breathing air, qualify you?? Does simply “showing up” one day and saying “Here I am!!” qualify you?? (Illegal aliens)

None of us would run an anesthesia group that way, yet politicians expect taxpayers to work/pay to provide such things for non-workers and non-citizens (to help them get votes for re-election, no doubt).

What is more “unfair”?? That certain people who work hard don’t get quite as much as they deserve?? Or is it that certain people (lazy, unskilled, uninvited) DEMAND and GET free housing/food/healthcare/benefits for literally doing NOTHING, either for themselves OR society? Where do you draw the line?? At what point are taxpayers SLAVES to these sorts of folks and governments??

No one ever gives a definitive “this is too much tax” answer. Does someone have a “right” to be wealthy and prosperous, even if there are poor folks around?? The answer for some “liberals” always seems to be “that guy has more than I have, it’s not fair...”

 

[vector2]

I'll read through this later, but just skimming I can already tell that I don't like his plans. A Tobin Tax is his solution to "dealing with Wall Street"? And his opinions on social security are laughable. Raising the age to 69 would be "disastrous"? He must have been high when he wrote that opinion, or he's just delusional like I stated earlier.

A Tobin Tax is a brilliant idea in the age of high frequency trading where billion dollar hedge funds are front running all the trades and picking up a million nickels a second with their algorithms. Also, you said earlier that you don't mind medicare because people paid into it, but now you say that it's OK for social security benefits to be delayed for people who have been paying FICA tax their whole lives? You need to try a little consistency. I'm willing to compromise somewhat and make SS benefits income based, or even delay benefits depending on income level, but blanket raising the age to 69 would hurt those among us who need SS the most.

Let me be perfectly clear. I'm not completely against a universal system or welfare programs. Those policies are not mutually exclusive from expecting individuals to be personally responsible for themselves. However, in the US it is painfully obvious how individuals behave when they become part of these programs. The VA system is essentially a single-payer microcosm in the US and it is a legitimate disaster. So we're supposed to trust that the US gov, which can't even run an effective system only for its veterans is supposed to successfully run a universal system for the entire country? Are you daft or do you just have no experience with the US's already (terribly) implemented universal system?

Military and vets have a 78-81% satisfaction rating with Tricare and the VA. Medicare recipients are at 77%. Medicaid recipients are at 75%. Current/former employer/self-pay satisfaction is 65-69%. Don't get me wrong, the VA has its problems, but a blanket overarching statement implying that all of the VA is a disaster is straight out of the Faux News propaganda desk. Also bear in mind, these ratings for govt healthcare remain this high despite the Republican party trying to sabotage, defund, or privatize these programs for the last 40 years. Just imagine what we could do if these programs were actually embraced and improved.

Also, I don't "let people pay for my services with their government handouts". For now I'm forced to because I'm a resident, but after residency I do not plan on accepting Medicare (as I do not plan on treating seniors) and may very well not accept Medicaid. So your little jab there is a moot point.

You know, I really used to hate it when I would get into discussions as a student or resident and then receive a reply from someone more senior essentially saying I don't know what I'm talking about, but as a resident, you really don't know what you're talking about. Do you even have any idea how GME is funded in the United States? You are literally taking a government handout by being a resident since CMS allocates $100,000 / yr / resident to each training program/hospital to pay salary and other expenses related to GME/training. So, assuming you make ~$50k, unless you're coughing up the extra $50k on top of your resident salary to pay your program, enjoy the handout.

I don't know what your plans are after you graduate, but saying you're definitely never accepting Medicare seems laughable. Are you an anesthesia resident? I guess maybe you're doing peds? Even for those who hate adult anesthesia and have no plans to anesthetize them, good luck finding a 100% peds only job after the recent string of years with a high number of peds fellows graduating. If you are lucky enough to find a peds only job, there are maybe 5 jobs in America that would be all cash/private payor, as compared to the vast, vast majority of peds jobs which treat a lot kids who are on CHIP/medicaid. If you get some unicorn job involving general, cardiac, pain, ICU etc that is >95% cash/private payer, please PM me so I can come join you.

Did you read what I wrote? Did you read the article you posted? Because nothing in that article refutes what I said. Like I said, they're typically non-binding and in some international contexts may be legally binding but not always. While some of these MoUs seem to be legally binding your source even states "China might claim it is not legally bound by the MoU (like the US has claimed in those contexts)." So even when legally binding they may not be legally binding. Sounds rock solid to me...

I know it's difficult to think that strong daddy trump may ever be wrong, but if you actually read the article, you'd realize that trump has totally misinterpreted what an international MOU is by erroneously conflating it with a common business MOU. This is because trump doesn't really know the first thing about trade or diplomacy. MOUs are how binding trade agreements with China outside of the WTO have been done for the last 20 years. The last actual bonafide bilateral treaty we signed with them was in 1949. Since there is no hope of the US and China joining the transpacific partnership or creating a ratified free trade agreement, MOUs are all we've got, and Lighthizer is going to keep the same documents he's been working on and just change the name while complimenting the emperor's new clothes.

 

[vector2]

Here's the thing though - Boeing already pays very very well. Their intro-level jobs with no experience where they train you in what they want you to do range from $20-35/hr.

Same thing with BMW (can you tell I'm from South Carolina?) - a job right out of high school pays $16.50/hr, paid holidays, retirement, and insurance. I see a lot of these folks in my office, their insurance is top notch.

So yes, they both absolutely could pay their workers more. But they already pay them pretty well (and offer great benefits), so why should they have to pay them more?

We kind of already beat this death, but I brought Boeing up simply to demonstrate that anyone can pick among various companies with various profit margins to support their viewpoint of whether corporations should return more of their after-tax profit to workers. My ultimate point about it was to use the total corporate profit after tax figure and divide it by the number of non-govt employees in the US. Is using that average vs a median optimal? Probably not, but no matter how you ran the data on ~$8T profits/ 150 mil workers, there's a lot of extra cash there.

 

[VA Hopeful Dr]

We kind of already beat this death, but I brought Boeing up simply to demonstrate that anyone can pick among various companies with various profit margins to support their viewpoint of whether corporations should return more of their after-tax profit to workers. My ultimate point about it was to use the total corporate profit after tax figure and divide it by the number of non-govt employees in the US. Is using that average vs a median optimal? Probably not, but no matter how you ran the data on ~$8T profits/ 150 mil workers, there's a lot of extra cash there.

Yes, and no. As has been demonstrated it's true for some companies and not true for others. The average is a piss poor measure for the reasons already discussed.

 

[d9sccr]

For those arguing for higher tax rates, what evidence do you have that the government is underfunded vs bloated and inefficient? Can you point to well-run programs that come in under budget and on-time/early? It seems to me that every thing the government touches requires massively more money than "expected" and always runs late. State governments, which are much smaller, can't even complete basic projects without running into these issues.

Take the ACA, how far did it undershoot? According to Obama nothing was changing --like adding thousands of high health care consumers wouldn't change anything. The CBO estimated it would cost $940 billion which in less than two years was upped to $1.76 TRILLION.

Find Out How Much Obamacare Cost and Why It Doesn't Add to the Debt

But at least it helped control the costs of healthcare despite killing the national budget, right?

Overwhelming Evidence That Obamacare Caused Premiums To Increase Substantially

Idk how anyone in good faith can support further enlarging our government at this point. It's a large, bloated beast that serves those in power (both in private and public sectors) while largely ignoring the folks it's intended to support. As far as the social safety net, while I agree it should exist, let's not act like people were dropping like flies during the Great Depression. Neighbors helped neighbors get through one of the worst times in American history --and would again, especially if we spent less time trying to divide the people up for votes

 

[VA Hopeful Dr]

A Tobin Tax is a brilliant idea in the age of high frequency trading where billion dollar hedge funds are front running all the trades and picking up a million nickels a second with their algorithms. Also, you said earlier that you don't mind medicare because people paid into it, but now you say that it's OK for social security benefits to be delayed for people who have been paying FICA tax their whole lives? You need to try a little consistency. I'm willing to compromise somewhat and make SS benefits income based, or even delay benefits depending on income level, but blanket raising the age to 69 would hurt those among us who need SS the most.



Military and vets have a 78-81% satisfaction rating with Tricare and the VA. Medicare recipients are at 77%. Medicaid recipients are at 75%. Current/former employer/self-pay satisfaction is 65-69%. Don't get me wrong, the VA has its problems, but a blanket overarching statement implying that all of the VA is a disaster is straight out of the Faux News propaganda desk. Also bear in mind, these ratings for govt healthcare remain this high despite the Republican party trying to sabotage, defund, or privatize these programs for the last 40 years. Just imagine what we could do if these programs were actually embraced and improved.



You know, I really used to hate it when I would get into discussions as a student or resident and then receive a reply from someone more senior essentially saying I don't know what I'm talking about, but as a resident, you really don't know what you're talking about. Do you even have any idea how GME is funded in the United States? You are literally taking a government handout by being a resident since CMS allocates $100,000 / yr / resident to each training program/hospital to pay salary and other expenses related to GME/training. So, assuming you make ~$50k, unless you're coughing up the extra $50k on top of your resident salary to pay your program, enjoy the handout.

I don't know what your plans are after you graduate, but saying you're definitely never accepting Medicare seems laughable. Are you an anesthesia resident? I guess maybe you're doing peds? Even for those who hate adult anesthesia and have no plans to anesthetize them, good luck finding a 100% peds only job after the recent string of years with a high number of peds fellows graduating. If you are lucky enough to find a peds only job, there are maybe 5 jobs in America that would be all cash/private payor, as compared to the vast, vast majority of peds jobs which treat a lot kids who are on CHIP/medicaid. If you get some unicorn job involving general, cardiac, pain, ICU etc that is >95% cash/private payer, please PM me so I can come join you.



I know it's difficult to think that strong daddy trump may ever be wrong, but if you actually read the article, you'd realize that trump has totally misinterpreted what an international MOU is by erroneously conflating it with a common business MOU. This is because trump doesn't really know the first thing about trade or diplomacy. MOUs are how binding trade agreements with China outside of the WTO have been done for the last 20 years. The last actual bonafide bilateral treaty we signed with them was in 1949. Since there is no hope of the US and China joining the transpacific partnership or creating a ratified free trade agreement, MOUs are all we've got, and Lighthizer is going to keep the same documents he's been working on and just change the name while complimenting the emperor's new clothes.

Pretty sure he/she is doing psych, and I know way more psychiatrists who don't take medicare than those who do.

As for Medicare paying for residency, its not exactly a handout. First, residents can't be paid by Medicare FFS like everyone else so basically Medicare is paying for a capitated physician. Second, the government says that unlike every other profession we can't practice without a residency so it makes sense they would help us along with that.

 

[pgg]

Some folks talk about a “social contract” that society/government’s should have with their citizens to provide certain things....

Well, that ought to go both ways. What should an able-bodied citizen have to provide their society/government??? Does sitting around, breathing air, qualify you?? Does simply “showing up” one day and saying “Here I am!!” qualify you?? (Illegal aliens)

None of us would run an anesthesia group that way, yet politicians expect taxpayers to work/pay to provide such things for non-workers and non-citizens (to help them get votes for re-election, no doubt).

What is more “unfair”?? That certain people who work hard don’t get quite as much as they deserve?? Or is it that certain people (lazy, unskilled, uninvited) DEMAND and GET free housing/food/healthcare/benefits for literally doing NOTHING, either for themselves OR society? Where do you draw the line?? At what point are taxpayers SLAVES to these sorts of folks and governments??

No one ever gives a definitive “this is too much tax” answer. Does someone have a “right” to be wealthy and prosperous, even if there are poor folks around?? The answer for some “liberals” always seems to be “that guy has more than I have, it’s not fair...”

The producers are always going to be stuck paying for the the lazy/willful nonproducers. It has always been so. Thus ever it shall be.

The salient question is how should we choose to pay?

We could pretend that we don't have to pay anything, because it's not fair. Then a large subset of the nonproducers become antiproducers who turn to crime that damages the producers or their property. The producers pay for those losses. And then maybe then the producers will pay for security to keep the antiproducers away from themselves and their stuff. At some point a subset of the antiproducers will commit enough crimes harming the producers that there will be a need to pay to incarcerate them. Now the producers are paying to house, clothe, feed, and provide healthcare, rehabilitation, education, training, and even entertainment for the antiproducers.

A lot of the producers will need to choose (or get drafted into) a profession as a soldier or cop (salary paid by other producers) and carry guns (also paid for by other producers) in order to discourage others who covet their goods from taking them by force.


Or maybe producers would be wiser to pay in an unfair tax scheme, where the nonproducers pay no taxes (or get a handout), the low producers pay almost no taxes, and the rest of the producers pay high taxes. Such a progressive income tax scheme could throw the nonproducers enough bones so that only the absolute worst of them become antiproducers. Even though it's unfair.

Maybe the path with the least friction and risk for the producers is to pay to keep as many nonproducers docile as possible. Yes, at its core it's a protection racket. Maybe we could give it a more palatable name, like "social contract" ...

Even the Ayn Randiest of my fellow libertarians ought to consider that perhaps the least unpleasant option is to get extorted a little in exchange for not getting knifed or having our stuff stolen. There is a silver lining - some of the protection money we cough up will go to help those who can't produce because they're children, or sick, or injured, or victims of another kind. Personally, I choose to be happy about that, rather than eternally pissed off that some worthless crackhead might be living large off my back.

 

[deleted480308]

The producers are always going to be stuck paying for the the lazy/willful nonproducers. It has always been so. Thus ever it shall be.

The salient question is how should we choose to pay?

We could pretend that we don't have to pay anything, because it's not fair. Then a large subset of the nonproducers become antiproducers who turn to crime that damages the producers or their property. The producers pay for those losses. And then maybe then the producers will pay for security to keep the antiproducers away from themselves and their stuff. At some point a subset of the antiproducers will commit enough crimes harming the producers that there will be a need to pay to incarcerate them. Now the producers are paying to house, clothe, feed, and provide healthcare, rehabilitation, education, training, and even entertainment for the antiproducers.

A lot of the producers will need to choose (or get drafted into) a profession as a soldier or cop (salary paid by other producers) and carry guns (also paid for by other producers) in order to discourage others who covet their goods from taking them by force.


Or maybe producers would be wiser to pay in an unfair tax scheme, where the nonproducers pay no taxes (or get a handout), the low producers pay almost no taxes, and the rest of the producers pay high taxes. Such a progressive income tax scheme could throw the nonproducers enough bones so that only the absolute worst of them become antiproducers. Even though it's unfair.

Maybe the path with the least friction and risk for the producers is to pay to keep as many nonproducers docile as possible. Yes, at its core it's a protection racket. Maybe we could give it a more palatable name, like "social contract" ...

Even the Ayn Randiest of my fellow libertarians ought to consider that perhaps the least unpleasant option is to get extorted a little in exchange for not getting knifed or having our stuff stolen. There is a silver lining - some of the protection money we cough up will go to help those who can't produce because they're children, or sick, or injured, or victims of another kind. Personally, I choose to be happy about that, rather than eternally pissed off that some worthless crackhead might be living large off my back.

not "might be". Is.

 

[Stagg737]

I don't even know why I'm responding anymore, because it's clear to me that either your reading comprehension of my posts is poor or you're just cherry-picking statements and changing contexts. Since I've got some downtime, why not feed the troll though.

A Tobin Tax is a brilliant idea in the age of high frequency trading where billion dollar hedge funds are front running all the trades and picking up a million nickels a second with their algorithms. Also, you said earlier that you don't mind medicare because people paid into it, but now you say that it's OK for social security benefits to be delayed for people who have been paying FICA tax their whole lives? You need to try a little consistency. I'm willing to compromise somewhat and make SS benefits income based, or even delay benefits depending on income level, but blanket raising the age to 69 would hurt those among us who need SS the most.

No, Tobin tax is still a crap idea. We can agree to disagree on this one because I don't feel like arguing in circles here.

You're taking my medicare and SS comments out of context. I'll clarify further (again) since you've continued to make assumptions about my statements which are false. I never said I don't mind medicare because people pay into it. I said I'm not opposed to a universal system or welfare programs. I believe a certain level of safety net is, unfortunately, necessary to help those incapable of providing for themselves through no fault of their own in order to survive. I never said anything about approving of them because people pay into them. Period. My statements aren't inconsistent, only the assumptions you're making about them.

Additionally, SS is a broken system in it's current state. When it was implemented in 1935 the average lifespan of an individual was ~61 and today it's ~76. The average number of years people lived past 65 (for those who made it to 65) has increased from ~12 years in 1935 (see first link from SSA) to ~20.5 years in 2017 (see second link from OECD). So the average person will collect 8.5 more years of social security today than in 1935 when the policy was enacted, but we haven't changed the age at which someone can apply for full benefits at all. At some point that will have to be adjusted and many people will have to deal with the consequences. It sucks, but that's reality. Also, what are your thoughts on changing benefits based on income level?

Social Security History
Health status - Life expectancy at 65 - OECD Data

Military and vets have a 78-81% satisfaction rating with Tricare and the VA. Medicare recipients are at 77%. Medicaid recipients are at 75%. Current/former employer/self-pay satisfaction is 65-69%. Don't get me wrong, the VA has its problems, but a blanket overarching statement implying that all of the VA is a disaster is straight out of the Faux News propaganda desk. Also bear in mind, these ratings for govt healthcare remain this high despite the Republican party trying to sabotage, defund, or privatize these programs for the last 40 years. Just imagine what we could do if these programs were actually embraced and improved.

Have you ever worked in a VA or been treated in one? Do you know the metrics by which those survey results are measured? Have you ever seen a "5 star" VA hospital as rated by patients? I can say yes to all and have become completely appalled by the deception within the VA system. I have literally seen people die at VA hospitals because of inefficiencies in the system or blatant lack of essential resources (how a hospital doesn't have trach/intubation equipment readily available or in the hospital at all still baffles me). I've seen co-workers break down because their patients suffered unnecessarily and family members threaten to sue over cases they would very likely win at a community or academic hospital be told by administration "good luck suing the federal government" (once in those exact words). I've worked in 3 different VA hospitals and seen major issues which should not exist in all of them. I have family who have worked in 2-3 other VA hospitals/clinics and they've said the same things. So yes, I will say that the VA system is a disaster because I've seen it first hand at multiple institutions. Before med school I actually wanted to work for the VA so I could work with veterans (almost accepted an HPSP scholarship). 5 years later after working in the system, that has changed significantly.

Completely agree with your point about the VA system not receiving the (right) attention it needs. However, I'm pessimistic that more attention would do much as the few major changes made to try and improve the system have essentially just been adding more metrics (which have previously been shown in evidence-based research to not improve outcomes). End rant/

You know, I really used to hate it when I would get into discussions as a student or resident and then receive a reply from someone more senior essentially saying I don't know what I'm talking about, but as a resident, you really don't know what you're talking about. Do you even have any idea how GME is funded in the United States? You are literally taking a government handout by being a resident since CMS allocates $100,000 / yr / resident to each training program/hospital to pay salary and other expenses related to GME/training. So, assuming you make ~$50k, unless you're coughing up the extra $50k on top of your resident salary to pay your program, enjoy the handout.

Did you actually read my post? Did you miss the part where I said " For now I'm forced to because I'm a resident" in regards to accepting CMS funding? So yes, oh wise one, I actually do know exactly what I'm talking about in terms of how CMS funding works and that fact that I'm currently accepting it (and it does not make me happy).

I don't know what your plans are after you graduate, but saying you're definitely never accepting Medicare seems laughable. Are you an anesthesia resident? I guess maybe you're doing peds? Even for those who hate adult anesthesia and have no plans to anesthetize them, good luck finding a 100% peds only job after the recent string of years with a high number of peds fellows graduating. If you are lucky enough to find a peds only job, there are maybe 5 jobs in America that would be all cash/private payor, as compared to the vast, vast majority of peds jobs which treat a lot kids who are on CHIP/medicaid. If you get some unicorn job involving general, cardiac, pain, ICU etc that is >95% cash/private payer, please PM me so I can come join you.

I'm psychiatry, not gas. So it would be extremely easy in the current climate for me to open up a shop that doesn't accept medicare/caid tomorrow and fill my practice pretty easily. Heck, I could open up a cash only practice in my city tomorrow and have a full patient panel in under 6 months without much excess effort. A plethora of reimbursement models is a (small) part of why I chose my field. Because if worse comes to worst with our healthcare system I can still give the gov the finger and open a PP very easily and still sleep easy knowing I'm providing a desperately needed service to patients in need.

I know it's difficult to think that strong daddy trump may ever be wrong, but if you actually read the article, you'd realize that trump has totally misinterpreted what an international MOU is by erroneously conflating it with a common business MOU. This is because trump doesn't really know the first thing about trade or diplomacy. MOUs are how binding trade agreements with China outside of the WTO have been done for the last 20 years. The last actual bonafide bilateral treaty we signed with them was in 1949. Since there is no hope of the US and China joining the transpacific partnership or creating a ratified free trade agreement, MOUs are all we've got, and Lighthizer is going to keep the same documents he's been working on and just change the name while complimenting the emperor's new clothes.

Lol, more poor assumptions on your part. I'm not on the Trump train. I hate the guy I couldn't be happier if I never heard his name again. So nice assumption. You going to tell me my favorite color next?

To the MoU thing, I realize that Trump likely has no clue about the intricacies of international agreements vs. common business proceedings domestically. He's not wrong though that even on the international level they may or may not be "legally binding" agreements and that China could break them. Additionally, even on domestic agreements it's relatively common for the wording of an MoU to undergo little to no changes when being drafted into a legally binding contract. So while I do agree with you that Lighthizer is certainly more knowledgeable and this likely won't make a huge difference, Trump was still technically not wrong (which is a phrase that I don't enjoy saying).

 

[Stagg737]

The producers are always going to be stuck paying for the the lazy/willful nonproducers. It has always been so. Thus ever it shall be.

The salient question is how should we choose to pay?

We could pretend that we don't have to pay anything, because it's not fair. Then a large subset of the nonproducers become antiproducers who turn to crime that damages the producers or their property. The producers pay for those losses. And then maybe then the producers will pay for security to keep the antiproducers away from themselves and their stuff. At some point a subset of the antiproducers will commit enough crimes harming the producers that there will be a need to pay to incarcerate them. Now the producers are paying to house, clothe, feed, and provide healthcare, rehabilitation, education, training, and even entertainment for the antiproducers.

A lot of the producers will need to choose (or get drafted into) a profession as a soldier or cop (salary paid by other producers) and carry guns (also paid for by other producers) in order to discourage others who covet their goods from taking them by force.


Or maybe producers would be wiser to pay in an unfair tax scheme, where the nonproducers pay no taxes (or get a handout), the low producers pay almost no taxes, and the rest of the producers pay high taxes. Such a progressive income tax scheme could throw the nonproducers enough bones so that only the absolute worst of them become antiproducers. Even though it's unfair.

Maybe the path with the least friction and risk for the producers is to pay to keep as many nonproducers docile as possible. Yes, at its core it's a protection racket. Maybe we could give it a more palatable name, like "social contract" ...

Even the Ayn Randiest of my fellow libertarians ought to consider that perhaps the least unpleasant option is to get extorted a little in exchange for not getting knifed or having our stuff stolen. There is a silver lining - some of the protection money we cough up will go to help those who can't produce because they're children, or sick, or injured, or victims of another kind. Personally, I choose to be happy about that, rather than eternally pissed off that some worthless crackhead might be living large off my back.

I mean, we could always just implement capital punishment for petty crimes like Singapore. Seems to help them function at an incredibly efficient level. /sarcasm

 

[vector2]

I don't even know why I'm responding anymore, because it's clear to me that either your reading comprehension of my posts is poor or you're just cherry-picking statements and changing contexts. Since I've got some downtime, why not feed the troll though.

Back at ya. Let me know when you have actually contributed anything useful to the anesthesia subforum before you start slinging accusations about who's trolling here.

No, Tobin tax is still a crap idea. We can agree to disagree on this one because I don't feel like arguing in circles here.

Whatever you say. I'm not necessarily down with a tobin tax at the percentages Bernie has suggested (0.5% of the total value of a stock transaction), but if you don't think it's a good idea to tax high frequency traders and other investment firms which honestly provide no real economic productivity, but rather just skim of hundreds of millions off of a bunch of 2 millisecond transactions, I don't know what to tell you.

You're taking my medicare and SS comments out of context. I'll clarify further (again) since you've continued to make assumptions about my statements which are false. I never said I don't mind medicare because people pay into it. I said I'm not opposed to a universal system or welfare programs. I believe a certain level of safety net is, unfortunately, necessary to help those incapable of providing for themselves through no fault of their own in order to survive. I never said anything about approving of them because people pay into them. Period. My statements aren't inconsistent, only the assumptions you're making about them.


Additionally, SS is a broken system in it's current state. When it was implemented in 1935 the average lifespan of an individual was ~61 and today it's ~76. The average number of years people lived past 65 (for those who made it to 65) has increased from ~12 years in 1935 (see first link from SSA) to ~20.5 years in 2017 (see second link from OECD). So the average person will collect 8.5 more years of social security today than in 1935 when the policy was enacted, but we haven't changed the age at which someone can apply for full benefits at all. At some point that will have to be adjusted and many people will have to deal with the consequences. It sucks, but that's reality. Also, what are your thoughts on changing benefits based on income level?

Social Security History
Health status - Life expectancy at 65 - OECD Data

Anyone honestly reading your posts in a vacuum would absolutely come to the conclusion that yes, you are opposed to a universal system or welfare programs. If you want to talk about how much you hate most aspects of social programs and then state that you still think they're necessary, I guess that's your prerogative. It does pique my curiosity as to where your vote comes down in regard to supporting these kind of programs when choosing people/policies at the ballot box.

As far as SS, it's only broken in any capacity because of where payroll taxes are marginally capped. If high wage earners and those who make multimillions from capital gains actually had to contribute a fair share to FICA, it would be a different story. In regard to life expectancy, it's pretty damn disingenuous to use OECD data. Life expectancy in the United States is 78.6 years, which is a lot less than the 20.5 years past 65yo that you just tried to claim. What's worse, life expectancy is very closely correlated (or causal, even) with poverty. The gap between life expectancy between the richest and poorest American men is 14 years. I stand by my statement that a blanket raise of the SS age punishes the neediest among us.

Have you ever worked in a VA or been treated in one? Do you know the metrics by which those survey results are measured? Have you ever seen a "5 star" VA hospital as rated by patients? I can say yes to all and have become completely appalled by the deception within the VA system. I have literally seen people die at VA hospitals because of inefficiencies in the system or blatant lack of essential resources (how a hospital doesn't have trach/intubation equipment readily available or in the hospital at all still baffles me). I've seen co-workers break down because their patients suffered unnecessarily and family members threaten to sue over cases they would very likely win at a community or academic hospital be told by administration "good luck suing the federal government" (once in those exact words). I've worked in 3 different VA hospitals and seen major issues which should not exist in all of them. I have family who have worked in 2-3 other VA hospitals/clinics and they've said the same things. So yes, I will say that the VA system is a disaster because I've seen it first hand at multiple institutions. Before med school I actually wanted to work for the VA so I could work with veterans (almost accepted an HPSP scholarship). 5 years later after working in the system, that has changed significantly.

Completely agree with your point about the VA system not receiving the (right) attention it needs. However, I'm pessimistic that more attention would do much as the few major changes made to try and improve the system have essentially just been adding more metrics (which have previously been shown in evidence-based research to not improve outcomes). End rant/

I rotated at a VA back home when I was a medical student and I am staff at a university hospital which is directly across the street from a VA- a VA which my former classmates and another old colleague are anesthesia staff at. Their VA hospital is pretty new so they have access to more equipment than I could ever dream of since our department budget is not that great. That being said, the VA does have a significant amount of dysfunction in that numerous surgical specialties and critical care are not at the point they need to be at since opening and god only knows what's causing the delay at this point.

I absolutely believe that the VAs you've personally seen or that your family have seen have had that kind of dysfunction. Your experience, even though it sounds awful, unfortunately is still anecdotal when you consider there are 170 VA medical centers and another thousand outpatient sites. Similarly, my experience that the VAs I've seen have been about on par in terms of care compared to other hospitals is purely anecdotal to you. Do surveys and their methodology usually suck? They sure do. How about outcomes then?

When comparing mortality and readmission rates for VA vs non-VA in 7900 men with acute MI, HF, and PNA:


"The researchers found that mortality rates were lower in VA hospitals than non-VA hospitals for AMI (13.5 percent vs 13.7 percent) and HF (11.4 percent vs 11.9 percent), but higher for pneumonia (12.6 percent vs 12.2 percent). Hospital readmission rates were higher in VA hospitals for all 3 conditions (AMI, 17.8 percent vs 17.2 percent; HF, 24.7 percent vs 23.5 percent,; pneumonia, 19.4 percent vs 18.7 percent). In within-MSA comparisons, VA hospitals had lower mortality rates for AMI (percentage-point difference, -0.22) and HF (-0.63), and mortality rates for pneumonia were not significantly different (-0.03); however, VA hospitals had higher readmission rates for AMI (0.62), HF (0.97), or pneumonia (0.66)."

Feel free to also peruse this one , this one, and this one.

Did you actually read my post? Did you miss the part where I said " For now I'm forced to because I'm a resident" in regards to accepting CMS funding? So yes, oh wise one, I actually do know exactly what I'm talking about in terms of how CMS funding works and that fact that I'm currently accepting it (and it does not make me happy).

I'm psychiatry, not gas. So it would be extremely easy in the current climate for me to open up a shop that doesn't accept medicare/caid tomorrow and fill my practice pretty easily. Heck, I could open up a cash only practice in my city tomorrow and have a full patient panel in under 6 months without much excess effort. A plethora of reimbursement models is a (small) part of why I chose my field. Because if worse comes to worst with our healthcare system I can still give the gov the finger and open a PP very easily and still sleep easy knowing I'm providing a desperately needed service to patients in need.

No one is forcing you to do anything, chief. No one made you go to med school, pick a residency that treats medicare/caid, or accept the CMS gravy that allows us to all finish training. You are choosing to do all those things. But I guess now that you (almost) got yours, good luck with your purely cash endeavor.

Me though, I just did a case today- thoracoabdominal aneurysm repair with a questionable surgeon on a 50yo incarcerated lady who had every comorbidity under the sun including a previous TEVAR. Likely stratified as super high mortality preop. Of course, entire operation paid for completely by the taxpayers. Was pretty hairy at times, but the patient did great, and my resident had an excellent learning experience since these cases don't come along often at my shop. When I think about the case and your last post, just remember, you're not only giving the finger to the govt when you turn these kind of patients away.

Also, unrelatedly, "gas" is more of an internally used term around here and its use is actively discouraged in situations like med students saying they're applying to "gas." It would be like me saying that you are a pen & notebook resident or a zoloft resident.

So while I do agree with you that Lighthizer is certainly more knowledgeable and this likely won't make a huge difference, Trump was still technically not wrong (which is a phrase that I don't enjoy saying).

Okay, thanks for confirming that you're only arguing about this topic so you can reach the pinnacle of pedantry.

 

[BLADEMDA]

 

[BLADEMDA]

The video above is probably 35 years old. Nothing has changed. Trillions of dollars spent on social programs with nothing to show for it.

Bernie can’t save the poor. The poor need to save themselves. Bernie can provide an opportunity for the poor to educate themselves. But, he can’t fix the dysfunctional family unit which is the major issue these days.

No matter what Bernie or the left promise they can’t deliver. The cost will be enormous and the benefit marginal. The country will sink deeper into debt, taxes will go up massively but the poor will remain poor and uneducated. Sure, we can provide more Medicaid but that won’t move the needle much on life expectancy in this country.

While I recognize the GOP has failed to deliver on less govt. they are the lesser of 2 evils. The country needs real leadership and less politics. Nobody running for Presudent in 2020 will deliver anything of substance.

So, I’ll stick with the idiot Trump who will keep SCOTUS conservative and preserve my rights as the founders intended. I’ll try to keep as much of my money as possible because govt wastes a large percentage of what it takes in

We have a spending problem in this country. Taxation isn’t the main issue but will be required to pay our obligations.

I’m not optimistic long term about the US dollar. But, most of the world has similar issues to the USA in terms of debt/entitlements.

More govt isn’t the solution. It is the problem.

 

[Spikebd]

The video above is probably 35 years old. Nothing has changed. Trillions of dollars spent on social programs with nothing to show for it.

Bernie can’t save the poor. The poor need to save themselves. Bernie can provide an opportunity for the poor to educate themselves. But, he can’t fix the dysfunctional family unit which is the major issue these days.

No matter what Bernie or the left promise they can’t deliver. The cost will be enormous and the benefit marginal. The country will sink deeper into debt, taxes will go up massively but the poor will remain poor and uneducated. Sure, we can provide more Medicaid but that won’t move the needle much on life expectancy in this country.

While I recognize the GOP has failed to deliver on less govt. they are the lesser of 2 evils. The country needs real leadership and less politics. Nobody running for Presudent in 2020 will deliver anything of substance.

So, I’ll stick with the idiot Trump who will keep SCOTUS conservative and preserve my rights as the founders intended. I’ll try to keep as much of my money as possible because govt wastes a large percentage of what it takes in

We have a spending problem in this country. Taxation isn’t the main issue but will be required to pay our obligations.

I’m not optimistic long term about the US dollar. But, most of the world has similar issues to the USA in terms of debt/entitlements.

More govt isn’t the solution. It is the problem.

Amen, Blade

 

[Stagg737]

Anyone honestly reading your posts in a vacuum would absolutely come to the conclusion that yes, you are opposed to a universal system or welfare programs. If you want to talk about how much you hate most aspects of social programs and then state that you still think they're necessary, I guess that's your prerogative. It does pique my curiosity as to where your vote comes down in regard to supporting these kind of programs when choosing people/policies at the ballot box.

Completely depends on the policy. I don't fall into typical identity politics, which is probably why the assumptions you've made about me have largely been incorrect.

As far as SS, it's only broken in any capacity because of where payroll taxes are marginally capped. If high wage earners and those who make multimillions from capital gains actually had to contribute a fair share to FICA, it would be a different story. In regard to life expectancy, it's pretty damn disingenuous to use OECD data. Life expectancy in the United States is 78.6 years, which is a lot less than the 20.5 years past 65yo that you just tried to claim. What's worse, life expectancy is very closely correlated (or causal, even) with poverty. The gap between life expectancy between the richest and poorest American men is 14 years. I stand by my statement that a blanket raise of the SS age punishes the neediest among us.

If you want to use simple life expectancy the data is even worse. Life expectancy in 1935 was 61.5 years old, so on average Americans didn't collect social security. Today it's 78.6 according to you, so that's a 17.1 year difference, far worse than the 8.5 year difference I previously quoted. Also, you're once again reading my claim wrong. The stats show that for individuals who live to be 65 years old, they will on average live 20.5 more years in the US today. In 1935 those who lived to be 65 would live on average 12 more years. I was looking only at individuals who would actually live long enough to collect social security. I see what you're saying about a blanket raise affecting the needy more, but suggesting more re-distribution of wealth in addition to all the other suggestions you seem to be making only moves us farther into the direction of a nanny state which I prefer not to take. Besides, a blanket increase also means those who work and are wealthy are also "being punished" by not receiving those benefits earlier. It will universally suck for everyone, but given the significant increase in life expectancy it is a necessary and eventually inevitable outcome imo.

Regarding the VA, we'll talk past each other all day. I'm aware that there are significant differences from hospital to hospital in all sectors. For all the VAs I've worked at or rotated through though, if I were a patient that qualified for care there and it were something serious, I'd keep driving to the next hospital.

No one is forcing you to do anything, chief. No one made you go to med school, pick a residency that treats medicare/caid, or accept the CMS gravy that allows us to all finish training. You are choosing to do all those things. But I guess now that you (almost) got yours, good luck with your purely cash endeavor.

Except if you want to be a practicing physician in this country you have to finish a residency which in all but a very select few situations requires you to accept CMG funding. You know that, so your point is pretty irrelevant, chief. Also, how did this conversation even move in this direction? It went from me saying physicians accepting medicaid wasn't a handout by the physicians, to you saying if it's a handout then physicians are potentially immoral for accepting a hand out, for you basically calling me immoral for accepting it and also immoral for saying I wouldn't accept it. You want to talk about how that's hypocritical?

Me though, I just did a case today- thoracoabdominal aneurysm repair with a questionable surgeon on a 50yo incarcerated lady who had every comorbidity under the sun including a previous TEVAR. Likely stratified as super high mortality preop. Of course, entire operation paid for completely by the taxpayers. Was pretty hairy at times, but the patient did great, and my resident had an excellent learning experience since these cases don't come along often at my shop. When I think about the case and your last post, just remember, you're not only giving the finger to the govt when you turn these kind of patients away.

That's great. I'm not saying these patients don't need to receive treatment or that those cases don't have value. I'm not even saying physicians shouldn't see those patients (another thing you implied about what I said incorrectly, you're great at that). Also, I'm not giving those patients the finger. In psych, it's common to have a 6+ month waitlist for new patients and even those with great insurance or willing to pay cash can't get in. So like I said, that's not an ethical dilemma that I'm bothered by in my field as the shortage is legitimately that severe.

Also, unrelatedly, "gas" is more of an internally used term around here and its use is actively discouraged in situations like med students saying they're applying to "gas." It would be like me saying that you are a pen & notebook resident or a zoloft resident.

Lol at thinking the term "gas" is special to SDN for anesthesiologists. I've heard this term for well over a decade and I've been here much shorter than that. Feel free to call me whatever kind of resident you want though. I don't get bothered by ignorant mislabeling.

 

[radsisrad]

5. The wall. This is a federal land and power grab designed to line the pockets of some rich people with public money. That’s all it is. I can’t keep the deer or bunnies out of my vegetable garden with a fence, so what chance does a fence/wall have of keeping out drug cartels with net worths in the billions?

You're wrong. Walls work in just about every country where they're implemented. Ask the Hungarians and the Israelis.

 

[radsisrad]

By what definition is trump not ultraconservative? Xenophobic isolationism, anti foreign aid, antichoice, anti single payer, anti union, anti gay marriage, tax cut bill which really didn’t help anyone significantly other than corps and ultrarich, climate change denialism, pro school vouchers, pro 2A, anti federal civil rights legislation....am I missing something?

- "Isolationism" is an interesting description for a President who's done more to avoid war and bring peace to the Koreas than any other we've had in decades.

- Why *should* we give foreign aid? We're $22 trillion in debt, but even if we weren't - that's money that came from taxpayers' pockets. It should be spent on our own.

- Being anti-single-payer isn't "ultraconservative", unless you use that word to mean that we really strongly want the elements that out our country toward the top of the list when it comes to medical innovation.

- Trump intimated back in 2000 that he didn't really care about homosexuality. My personal view is that marriage is between man and woman, but regardless of that... Obama is lionized by the Left, but even he was hemming and hawing about the subject during his first term, waiting for political winds to shift before "evolving" on the matter. What a coward.

- Trump's tweets about climate change are meant to trigger die-hards on the Left, and it's funny to watch it work without fail. The guy really does have a sense of humor.

- The 2A is a beautiful thing.

Honestly, based on what you've written, it seems like you employ the term "ultraconservative" with glowing admiration.

 

[GravelRider]

You're wrong. Walls work in just about every country where they're implemented. Ask the Hungarians and the Israelis.

No, you’re wrong. I’m right. I’m always right.

 

[vector2]

Completely depends on the policy. I don't fall into typical identity politics, which is probably why the assumptions you've made about me have largely been incorrect.

It’s funny that those who talk about shunning any and all identity politics inevitably turn to either be far right, center right, or right wing libertarian.

If you want to use simple life expectancy the data is even worse. Life expectancy in 1935 was 61.5 years old, so on average Americans didn't collect social security. Today it's 78.6 according to you, so that's a 17.1 year difference, far worse than the 8.5 year difference I previously quoted. Also, you're once again reading my claim wrong. The stats show that for individuals who live to be 65 years old, they will on average live 20.5 more years in the US today. In 1935 those who lived to be 65 would live on average 12 more years. I was looking only at individuals who would actually live long enough to collect social security. I see what you're saying about a blanket raise affecting the needy more, but suggesting more re-distribution of wealth in addition to all the other suggestions you seem to be making only moves us farther into the direction of a nanny state which I prefer not to take. Besides, a blanket increase also means those who work and are wealthy are also "being punished" by not receiving those benefits earlier. It will universally suck for everyone, but given the significant increase in life expectancy it is a necessary and eventually inevitable outcome imo.

My mistake on the (once age hit, then x more years) interpretation. But again, the nanny state you rail against isn’t the real problem. The one you should be worried about is the one that has enabled this level of corporate welfare. I personally have a different opinion on the ethos of work than most- the idea of a society making people working 40-60 hrs a week until they’re at an age where they’re too decrepit to enjoy life is ridiculous. I work to live, not live to work. It’s perverse that we’re talking about punishing seniors when lifting the payroll cap which would solve 90% of the problem.

Except if you want to be a practicing physician in this country you have to finish a residency which in all but a very select few situations requires you to accept CMG funding. You know that, so your point is pretty irrelevant, chief.

Actually, it’s not, hoss. You’ve been talking this entire time about individual responsibility and the dangers of the nanny state and government handouts and yet you chose a profession and training where you would be the beneficiary of $200,000 over 4 yrs of sweet government loot. This doesn’t even include the possibility that you may have (like so many “individual responsibility” types in medicine) have been the recipient of federally subsidized loans instead of walking down to a Wells Fargo and taking your chances. Yes, you are required to accept the CMS funding to train, but no one is stopping you from just giving the money back to Uncle Sam when you file taxes this year since you’re so principled.

That's great. I'm not saying these patients don't need to receive treatment or that those cases don't have value. I'm not even saying physicians shouldn't see those patients (another thing you implied about what I said incorrectly, you're great at that). Also, I'm not giving those patients the finger. In psych, it's common to have a 6+ month waitlist for new patients and even those with great insurance or willing to pay cash can't get in. So like I said, that's not an ethical dilemma that I'm bothered by in my field as the shortage is legitimately that severe.

Whatever you have to tell yourself. If you are purposefully not going to accept medicare/caid/charity at all, especially in a field where poverty is so closely linked to severe disease processes and the shortages are that bad, then yes, you are giving patients the finger as well.

Lol at thinking the term "gas" is special to SDN for anesthesiologists. I've heard this term for well over a decade and I've been here much shorter than that. Feel free to call me whatever kind of resident you want though. I don't get bothered by ignorant mislabeling.

No sh1t Sherlock, I didn’t say the slang was invented here or patented. But since you didn’t understand me, I’ll clarify: casual references to the specialty as “gas” by someone who is not in the specialty is considered rude and ignorant.

 

[Stank811]

The video above is probably 35 years old. Nothing has changed. Trillions of dollars spent on social programs with nothing to show for it.

Bernie can’t save the poor. The poor need to save themselves. Bernie can provide an opportunity for the poor to educate themselves. But, he can’t fix the dysfunctional family unit which is the major issue these days.

No matter what Bernie or the left promise they can’t deliver. The cost will be enormous and the benefit marginal. The country will sink deeper into debt, taxes will go up massively but the poor will remain poor and uneducated. Sure, we can provide more Medicaid but that won’t move the needle much on life expectancy in this country.

While I recognize the GOP has failed to deliver on less govt. they are the lesser of 2 evils. The country needs real leadership and less politics. Nobody running for Presudent in 2020 will deliver anything of substance.

So, I’ll stick with the idiot Trump who will keep SCOTUS conservative and preserve my rights as the founders intended. I’ll try to keep as much of my money as possible because govt wastes a large percentage of what it takes in

We have a spending problem in this country. Taxation isn’t the main issue but will be required to pay our obligations.

I’m not optimistic long term about the US dollar. But, most of the world has similar issues to the USA in terms of debt/entitlements.

More govt isn’t the solution. It is the problem.

Agreed...pages of post on how much we should tax and who should get taxed more...how about we start talking about the billions on billions wasted each yr and how to prevent the global corruption associated with the billions in waste that is paid with our taxes

 

[vector2]

Trillions of dollars spent on social programs with nothing to show for it.

The cost of these programs is certainly up for debate, but let's not pretend that they didn't help anyone.

 

[VA Hopeful Dr]

My mistake on the (once age hit, then x more years) interpretation. But again, the nanny state you rail against isn’t the real problem. The one you should be worried about is the one that has enabled this level of corporate welfare. I personally have a different opinion on the ethos of work than most- the idea of a society making people working 40-60 hrs a week until they’re at an age where they’re too decrepit to enjoy life is ridiculous. I work to live, not live to work. It’s perverse that we’re talking about punishing seniors when lifting the payroll cap which would solve 90% of the problem.

Actually, it’s not, hoss. You’ve been talking this entire time about individual responsibility and the dangers of the nanny state and government handouts and yet you chose a profession and training where you would be the beneficiary of $200,000 over 4 yrs of sweet government loot. This doesn’t even include the possibility that you may have (like so many “individual responsibility” types in medicine) have been the recipient of federally subsidized loans instead of walking down to a Wells Fargo and taking your chances. Yes, you are required to accept the CMS funding to train, but no one is stopping you from just giving the money back to Uncle Sam when you file taxes this year since you’re so principled.

Whatever you have to tell yourself. If you are purposefully not going to accept medicare/caid/charity at all, especially in a field where poverty is so closely linked to severe disease processes and the shortages are that bad, then yes, you are giving patients the finger as well.

Most reasonable people would be fine with either increasing the cap or lifting it entirely if benefits also increased. If I'm paying extra to SS, I expect a bigger return should I live that long.

Your argument about federal money for residency training is disingenuous at best. If there is only 1 path to a career that you want to do, not agreeing with parts that path doesn't mean you shouldn't pursue that path. As for student loans, the government no longer subsidizes graduate school loans (which includes medical school) so that argument is wrong. Interestingly, I just looked and several private banks actually offer loans with potentially lower interest rates than the Federal loans do. To be honest, had I even known this was an option I would have done that when I was in school (Wells Fargo has a 5.5% rate compared to the Federal 6.6% at the moment).

As for giving patients the finger, really? So you'll be moving to an area that has a shortage of anesthesiologists? Or do you offer your services discounted/free of charge voluntarily to patients that need help? Am I also giving patients the finger (being FM) for not moving to rural BFE since they both have a significant shortage and would get more benefit from having me than my current suburban location does?

 

[vector2]

Most reasonable people would be fine with either increasing the cap or lifting it entirely if benefits also increased. If I'm paying extra to SS, I expect a bigger return should I live that long.

Paying out extra benefits based on a higher contribution totally defeats the purpose of a progressive entitlement. Assuring the solvency of SS (if that is indeed one's goal) will ultimately require that those who have already done very well in life to subsidize those who haven't. I would make FICA marginal just like income tax so that 6.6% isn't a flat (and likely unfair figure) for incomes 128k-1M.

Your argument about federal money for residency training is disingenuous at best. If there is only 1 path to a career that you want to do, not agreeing with parts that path doesn't mean you shouldn't pursue that path. As for student loans, the government no longer subsidizes graduate school loans (which includes medical school) so that argument is wrong. Interestingly, I just looked and several private banks actually offer loans with potentially lower interest rates than the Federal loans do. To be honest, had I even known this was an option I would have done that when I was in school (Wells Fargo has a 5.5% rate compared to the Federal 6.6% at the moment).

I didn't say he shouldn't pursue the path. He's absolutely entitled to pursue residency training. I just want him to realize that he's likely been recipient of numerous 'handouts' like CMS allocation along the way and recognize that railing against those 'handouts' once the shiny board-certification is in hand is hypocritical. My mistake on graduate school loans not being subsidized now, but does that absolve federal aid required by many for the undergraduate studies that are required to go to graduate school? The argument taken to its conclusion stands.

As for giving patients the finger, really? So you'll be moving to an area that has a shortage of anesthesiologists? Or do you offer your services discounted/free of charge voluntarily to patients that need help? Am I also giving patients the finger (being FM) for not moving to rural BFE since they both have a significant shortage and would get more benefit from having me than my current suburban location does?

Indeed, the argument can be reduced to an absurd monastic level like the british professor making 30k a year who pledged 1/3rd of his income to charity, for life, in light of the fact that everyone in the 1st world is a relativistic millionaire compared to all those subsisting on a dollar per day.

In some ways, we all are giving the middle finger to someone and we are all hypocrites to some extent (hell, I believe in climate change but I drive a supercharged V8), but it's up to us to determine on a personal, ethical level how much of our time, money, and sweat we want to keep for ourselves instead of giving to others. Personally, I think purposefully refusing medicare/caid if one has had the gift of being born in / living in America and having access to its medical education system is unethical and I would draw a line there, but you and others are free to disagree with this opinion.

I can sleep at night because I work at an urban, inner city, level I trauma center with a very high indigent/charity/medicare/medicaid/prisoner pt population, so yes, I frequently treat pts who are not contributing to the anesthesia department's budget. Additionally, my job doesn't pay quite as much as the other jobs in town, but I like working with residents and the pathology one sees with impoverished pts with poor prior medical care has been great for my development.

 

[deleted480308]

Paying out extra benefits based on a higher contribution totally defeats the purpose of a progressive entitlement. Assuring the solvency of SS (if that is indeed one's goal) will ultimately require that those who have already done very well in life to subsidize those who haven't. I would make FICA marginal just like income tax so that 6.6% isn't a flat (and likely unfair figure) for incomes 128k-1M.

there shouldn't be any "entitlement" at all.

I didn't say he shouldn't pursue the path. He's absolutely entitled to pursue residency training. I just want him to realize that he's likely been recipient of numerous 'handouts' like CMS allocation along the way and recognize that railing against those 'handouts' once the shiny board-certification is in hand is hypocritical. My mistake on graduate school loans not being subsidized now, but does that absolve federal aid required by many for the undergraduate studies that are required to go to graduate school? The argument taken to its conclusion stands.

.

it's not a "handout" if you are literally barred from collecting for your services by that system. Especially when the system wouldn't exist at it's current length were it not for govt interference in medical training.

I'm all for stopping all medicare funding of residencies and govt backed students loans though since you mention it, looks like we found something to agree on?

 

[vector2]

there shouldn't be any "entitlement" at all.

Yea, we did try that once until things changed in 1935 and 1965. A return to the gilded age is certainly favored by some, but I'm not especially keen on the idea of the wealthiest nation in the world just letting its indigent elderly die in the street or declare medical bankruptcy after a bout of severe pneumonia and an ICU stay.

it's not a "handout" if you are literally barred from collecting for your services by that system. Especially when the system wouldn't exist at it's current length were it not for govt interference in medical training.

I'm all for stopping all medicare funding of residencies and govt backed students loans though since you mention it, looks like we found something to agree on?

At the very least, I can applaud you for your consistency. Making residents pay 100% of their own training costs and removing any federal subsidies from higher education would certainly ensure that only those with rich parents could go to medical school.....but at least you're consistent. Unsurprisingly I don't hear a lot of right-leaning physicians and residents supporting this view, though.

 

[VA Hopeful Dr]

Paying out extra benefits based on a higher contribution totally defeats the purpose of a progressive entitlement. Assuring the solvency of SS (if that is indeed one's goal) will ultimately require that those who have already done very well in life to subsidize those who haven't. I would make FICA marginal just like income tax so that 6.6% isn't a flat (and likely unfair figure) for incomes 128k-1M.



I didn't say he shouldn't pursue the path. He's absolutely entitled to pursue residency training. I just want him to realize that he's likely been recipient of numerous 'handouts' like CMS allocation along the way and recognize that railing against those 'handouts' once the shiny board-certification is in hand is hypocritical. My mistake on graduate school loans not being subsidized now, but does that absolve federal aid required by many for the undergraduate studies that are required to go to graduate school? The argument taken to its conclusion stands.



Indeed, the argument can be reduced to an absurd monastic level like the british professor making 30k a year who pledged 1/3rd of his income to charity, for life, in light of the fact that everyone in the 1st world is a relativistic millionaire compared to all those subsisting on a dollar per day.

In some ways, we all are giving the middle finger to someone and we are all hypocrites to some extent (hell, I believe in climate change but I drive a supercharged V8), but it's up to us to determine on a personal, ethical level how much of our time, money, and sweat we want to keep for ourselves instead of giving to others. Personally, I think purposefully refusing medicare/caid if one has had the gift of being born in America and having access to its medical education system is unethical and I would draw a line there, but you and others are free to disagree with this opinion.

I can sleep at night because I work at an urban, inner city, level I trauma center with a very high indigent/charity/medicare/medicaid/prisoner pt population, so yes, I frequently treat pts who are not contributing to the anesthesia department's budget. Additionally, my job doesn't pay quite as much as the other jobs in town, but I like working with residents and the pathology one sees with impoverished pts with poor prior medical care has been great for my development.

I wouldn't say it had to be the same algorithm but there needs to be some benefit to paying more in. It could be diminished (and even more so if the rate goes down progressively at higher incomes) but it can't be the same for someone being taxed on 400k as it would be for someone at 138k (or whatever the current maximum is).

CMS is paying you to do a job, its just capitated (I feel like I've said this before) since residents can't bill Medicare. They're still doing work on Medicare patients. Let residents bill and you could easily stop the CMS payments for residents. As for loans, if he/she doesn't have undergrad loans we're in agreement that there's no handout there then?

I actually opted out of Medicare at one point, and it wasn't a money issue. The rules for Medicare are stifling - if a Medicare patient wants to pay cash for something they are forbidden from doing so. Doctors have been sued for this by the government. In my practice, I was seeing probably 80% uninsured patients (blue collar, couldn't afford insurance and everyone else in town charged way more than I did). But I couldn't see Medicare in that clinic unless I wanted to bill Medicare even when the patients wanted to just pay me. At risk of a tangent, that's why I hate Medicare - its their way or the highway with the backing of the government, no appeals, no arguing, nothing. I could go on about issues I've had besides that but its not relevant to this thread.

So you're not personally deciding to voluntarily not bill someone. Got it, you have a whole department (and likely hospital) subsidizing your salary. Noted.

 

[VA Hopeful Dr]

Yea, we did try that once until things changed in 1935 and 1965. A return to the gilded age is certainly favored by some, but I'm not especially keen on the idea of the wealthiest nation in the world just letting its indigent elderly die in the street or declare medical bankruptcy after a bout of severe pneumonia and an ICU stay.



At the very least, I can applaud you for your consistency. Making residents pay 100% of their own training costs and removing any federal subsidies from higher education would certainly ensure that only those with rich parents could go to medical school.....but at least you're consistent. Unsurprisingly I don't hear a lot of right-leaning physicians and residents supporting this view, though.

What you will hear is wanting to let residents bill for their own services. 2nd and 3rd year I can promise I would've earned more than CMS was giving my program for me.