Rad Onc Twitter

  • Thread starter Thread starter deleted1002574
  • Start date Start date
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
what solvent means
I agree with your basic point. Medicare and SS are not in trouble. These are matters of will, not ledgers. Nobody is not going to fund the best thing that the gvt does for the general public, which is to provide a low baseline income to avoid catastrophic poverty in the elderly (common before SS) and healthcare for the elderly. (I think GWB attempted some reform at SS and got hammered years back. Red county America loves SS.)

Money is mostly make believe.
 
The USA is in terrible, terrible financial shape right now, the magnitude of which I don't believe most Americans understand. We have not only $30 trillion in debt, but a total of $170 trillion of unfunded obligations. As long as we remain the world's reserve currency we have a better shot at being ok, but that is by no means guaranteed. If we lose our status as the world's reserve, then we likely would go into a sovereign debt crisis, at which point we would be truly in very bad shape.

Medicare and Social Security both need to be means-tested. I realize it's counter to what was promised to The Boomers, but that in and of itself would pay for both programs. If you can pay for your Medicare, we're going to need you to do that. If you don't need Social Security, you're not going to be able to take it. You could also simply raise the age at which you collect both of those to 70-75, and that would also do the trick.

However, given how often older Americans vote, I cannot imagine these reforms would ever pass, and as a result I am pessimistic about the financial health of our country over the next 10-15 years.
 
Last edited:
I agree with your basic point. Medicare and SS are not in trouble. These are matters of will, not ledgers. Nobody is not going to fund the best thing that the gvt does for the general public, which is to provide a low baseline income to avoid catastrophic poverty in the elderly (common before SS) and healthcare for the elderly. (I think GWB attempted some reform at SS and got hammered years back. Red county America loves SS.)

Money is mostly make believe.

I don’t disagree. I think @OTN making a very valid point - this was not the goal of the program and some sort of skin in the game for high earners is not unreasonable.
 
All I know is that when the CEO of United Healthcare is making 17 million a year and that’s considered “low”compared to others, we have serious issues.


Don’t get me started on hospital CEO’s, Pharmaceuticals, Banks, etc.
 
I don’t disagree. I think @OTN making a very valid point - this was not the goal of the program and some sort of skin in the game for high earners is not unreasonable.

I assure you that there's no one walking around without any skin in the game. We all have skin in the game as high earners. whether they are our parents now or us in the future, we all benefit. we live in a society.

the goal of the program was to ensure basic standards for ever American, full stop.

means testing is just another step of taking a basic right and making it something only the 'poor' get, creating further division and opening the door to get rid of it completely.
 
We have 8.5% yoy inflation for reasons like Medicare solvency.

They get you coming or they get you going. Can't print your way to total happiness.
 
The USA is in terrible, terrible financial shape right now, the magnitude of which I don't believe most Americans understand. We have not only $30 trillion in debt, but a total of $170 trillion of unfunded obligations. As long as we remain the world's reserve currency we have a better shot at being ok, but that is by no means guaranteed. If we lose our status as the world's reserve, then we likely would go into a sovereign debt crisis, at which point we would be truly in very bad shape.


If this happens, there will be much bigger fish to fry, like probably war.

until that happens, there's not a lot of real reason to worry about it too much, other than the fact that it makes for a nice infographic for folks who want to pretend that the USA economy is like a household's.

but there are more clear and present solutions to balancing things than 'let's cut basic necessities'
 
It's a government program in need of additional funding. The government runs at an ever increasing deficit. It prints money that will never be repaid to cover this deficit. Inflation happens.

It's obviously no the only program contributing to this issue. Not in the least. And it's one of the most beneficial programs to do so. There's fat to be trimmed everywhere.
 
  • Like
Reactions: OTN
another thing I would like to add is that this conversation has devolved into being about the 'poor' and 'rich' - but the insurance system is absolutely, royally ****ed, even for all us rich people with 'great' insurance plans.

The only reason most of us don't know or care is we haven't had to navigate the health care system or gotten ridiculous amounts of bills for made up things like 'out of network' when we get taken to the hospital via ambulance and have to stay in an ICU.

THAT should be our focus, IMO. the system is designed to NOT work.

 
another thing I would like to add is that this conversation has devolved into being about the 'poor' and 'rich' - but the insurance system is absolutely, royally ****ed, even for all us rich people with 'great' insurance plans.

The only reason most of us don't know or care is we haven't had to navigate the health care system or gotten ridiculous amounts of bills for made up things like 'out of network' when we get taken to the hospital via ambulance and have to stay in an ICU.

THAT should be our focus, IMO. the system is designed to NOT work.
No doubt about it.
 
If this happens, there will be much bigger fish to fry, like probably war.

until that happens, there's not a lot of real reason to worry about it too much, other than the fact that it makes for a nice infographic for folks who want to pretend that the USA economy is like a household's.

but there are more clear and present solutions to balancing things than 'let's cut basic necessities'

What would you like to cut? Keep in mind that as the debt grows and interest rates rise the percentage of the national budget that will go to service that debt will continue to increase.
 
What would you like to cut? Keep in mind that as the debt grows and interest rates rise the percentage of the national budget that will go to service that debt will continue to increase.
cut defense budget, increase capture from the ultra-rich, cut health care costs (ie, get to the root of the evil, rather than making the average American have to pay more and more and more)

@RickyScott has posted in detail about the fact that under the current system, insurance companies have no desire to cut costs.
 
I don’t make @OTN or @medgator money, but we’d all probably think it’s reasonable for us to pay some proportion of our Medicare premiums when we age. The country and healthcare and life has been good to us.
 
I don’t make @OTN or @medgator money, but we’d all probably think it’s reasonable for us to pay some proportion of our Medicare premiums when we age. The country and healthcare and life has been good to us.

I mean - medicare is not free. theoretically you are supposed to pay. and if you want to pay less of your costs, you pay premiums in a medicare adv plan.

so yes we are paying.
 
I don’t make @OTN or @medgator money, but we’d all probably think it’s reasonable for us to pay some proportion of our Medicare premiums when we age. The country and healthcare and life has been good to us.
Tell OTN and medgator to pay their fair share! No reason I should be sharing a tax bracket with these rich folks!
 
Mostly the gvt creates wealth for already rich people by printing cash. The easy cash and low interest rates of the past 15 years probably contributed greatly to wealth disparity. Debt/GDP for US still far off many global north countries. Debt can go away. Whole countries can default and walk away from debt and what happens? Other countries figure out how to get something when renegotiating terms of debt and allowing for credit to again be established. (In 2008 many fairly well to do folks just defaulted on properties etc. cause it was the best thing to do if they didn't need lots of credit going forward).

I agree it's the prices stupid with healthcare. This is not a mystery. There are some uniquely American problems where solutions have been found elsewhere. Yes, docs will make less.

We don't need people to work longer or harder. Among the myths that are becoming obvious is the myth of productivity. We have long moved past a notion of objective value (the work you put in ) for setting prices. The add revenue from a stupid podcast recapping Office episodes would dwarf all of all salaries. Objective value is limited to a few things (food, housing, healthcare, transportation, sustainability) with most of our economy predicated on totally subjective things. We don't need 68 y/o remote workers.

We do need young people. Open those flood gates to the immigrants!
 
cut defense budget, increase capture from the ultra-rich, cut health care costs (ie, get to the root of the evil, rather than making the average American have to pay more and more and more)

@RickyScott has posted in detail about the fact that under the current system, insurance companies have no desire to cut costs.
cut the defense budget and/or raise taxes on the rich are the tells of someone who has never actually looked at federal government obligations/revenue and what it would take to make it solvent.
 
  • Like
Reactions: OTN
cut the defense budget and/or raise taxes on the rich are the tells of someone who has never actually looked at federal government obligations/revenue and what it would take to make it solvent.

Like I said above, the goal for 'solvency' is made up.

but defense does make up a quite healthy portion.
 
Tell OTN and medgator to pay their fair share! No reason I should be sharing a tax bracket with these rich folks!
Effective tax rates for higher income w-2 earners are among the highest in the country....i assure you I'm paying my fair share.

That being said... Plenty of fat to go after: Real estate giveaways thanks to the last guy, carried interest loophole for the hedge fund whales etc. And just simple enforcement of the tax laws that are already on the books.
 
Last edited:
cut the defense budget and/or raise taxes on the rich are the tells of someone who has never actually looked at federal government obligations/revenue and what it would take to make it solvent.
Really? The F35 is the poster child of what is wrong with defense spending


 
Last edited:
Effective tax rates for high wage w-2 earners are the highest in the country....i assure you I'm paying my fair share. Plenty of fat to go after.... Real estate giveaways thanks to the last guy, carried interest loophole for the hedge fund whales etc

yeah the medgators of the world or any of us W2 folks aren't really the target.
 
Really?

There's fat everywhere in the government. But say cut it to zero (including the VA bennies?). Will it balance the budget? Surely the rest of the world will follow suit and we can all sing imagine or kumbaya or some such as everyone hugs it out. We're not living in a Francis Fukuyama end of history fairy tale.
 
There's fat everywhere in the government. But say cut it to zero (including the VA bennies?). Will it balance the budget? Surely the rest of the world will follow suit and we can all sing imagine or kumbaya or some such as everyone hugs it out. We're not living in a Francis Fukuyama end of history fairy tale.
Sure, but where is value based metrics when it comes to defense spending? What are we getting for the trillions that are behind dumped in? The F35 was ****ing atrocious
 
Medicare is a societal good and important social safety net, but let’s not it it twisted. It’s also a massive corporate bailout that allows private insurers the ability to not even think about the highest utilizers of health care during the most expensive time of utilization. It allows these insurers to ream the lower utilizing young.

Privatization of profits and socialization of risk and all.
 
Medicare is a societal good and important social safety net, but let’s not it it twisted. It’s also a massive corporate bailout that allows private insurers the ability to not even think about the highest utilizers of health care during the most expensive time of utilization. It allows these insurers to team the lower utilizing young.

Privatization of profits and socialization of risk and all.

sounds like a fantastic argument for single payer system!
 
Sure, but where is value based metrics when it comes to defense spending? What are we getting for the trillions that are behind dumped in? The F35 was ****ing atrocious
No doubt. LCS a disaster. Low intensity conflicts of dubious value across a range of countries (most of which not authorized by congress). The list goes on. All for reorganization and realignment. Given all that, what makes anyone think that a government involvement in healthcare or retirement would be any less full of boondoggles and scandal and waste is beyond me.
 
I’m definitely not opposed at this point.
I've come full circle to it.... M4A may be the best compromise since we couldn't get RomneyCare to work.

Evilcore, healthcare CEOs etc are all profiting off the current racket. We literally employ 3-4 fte in the practice to fight with insurance companies and do prior auth. How is m4a worse? Medicare is the easiest payor we deal with by a mile
 
Last edited:
what makes anyone think that a government involvement in healthcare
Lets do the thought experiment...a truly free market health care system. Hell, lets go full Milton Friedman and get rid of credentialing.

First, can the patients tell good value? NO. They're not waiting around to see who has the most 90 year old primary care patients or comparing lumpectomy scars.

Second, could small scale practitioners compete? NO. Consolidation would be even more rampant. Rare ownership physicians with mostly ownership bankers/private equity types selling lowest cost, plausible to the public health care. Huge advertising budgets. Lots of chiropractors, alternative medicine and snake oils. MDACC name would be on everything.

Direct markets just aren't for this sort of thing. Market forces already making our lives as docs more miserable.

If I worked in a free market this is what I would do.

1. Fire 70% of the staff.
2. Bill what I could but less than the competition. Use the cheapest machine possible while promoting it as the best.
3. Market brand name products left and right. "Gators alligator skin cream".
4. Spend lots of time on local TV/radio.
 
Mostly the gvt creates wealth for already rich people by printing cash. The easy cash and low interest rates of the past 15 years probably contributed greatly to wealth disparity. Debt/GDP for US still far off many global north countries. Debt can go away. Whole countries can default and walk away from debt and what happens? Other countries figure out how to get something when renegotiating terms of debt and allowing for credit to again be established. (In 2008 many fairly well to do folks just defaulted on properties etc. cause it was the best thing to do if they didn't need lots of credit going forward).

I agree it's the prices stupid with healthcare. This is not a mystery. There are some uniquely American problems where solutions have been found elsewhere. Yes, docs will make less.

We don't need people to work longer or harder. Among the myths that are becoming obvious is the myth of productivity. We have long moved past a notion of objective value (the work you put in ) for setting prices. The add revenue from a stupid podcast recapping Office episodes would dwarf all of all salaries. Objective value is limited to a few things (food, housing, healthcare, transportation, sustainability) with most of our economy predicated on totally subjective things. We don't need 68 y/o remote workers.

We do need young people. Open those flood gates to the immigrants!

There is no "myth of productivity." Productivity is everything in an economy, especially as it relates to trading with other economies. The value of the dollar is directly related to the productivity of the citizens of the United States, and as as result developing that productivity and allowing it to support the dollar is mission critical. Allowing the US to default on its debt would be catastrophic for at least a generation, if not permanently. What would the interest rate on T bills be if that happened? How much of the US budget would need to be put towards debt servicing, given the extraordinarily high interest rates that would be needed to get anyone to invest in a country who recently defaulted? What would those interest rates mean to consumer borrowing in the economy? The answers to those questions are not pretty.

Prices have never been related to "a notion of objective value" or whatever that means. The price is what the market will bear. You could put an enormous amount of work into a product, but if no one wants to buy it, then the value is zero.

IF we create a monopsony on purpose in the healthcare industry (which single-payer healthcare is designed to do), it will, by design, underpay providers, requiring them to accept below-market value for their services. I'm all for universal care, I just want a multitude of payers in order to protect both patients and providers.

Finally, if recent world events haven't convinced anyone that defense spending isn't necessarily wasteful, then I'm not sure what more can be said. If the F35 is so bad, then what is Germany doing?
 
Lets do the thought experiment...a truly free market health care system. Hell, lets go full Milton Friedman and get rid of credentialing.

First, can the patients tell good value? NO. They're not waiting around to see who has the most 90 year old primary care patients or comparing lumpectomy scars.

Second, could small scale practitioners compete? NO. Consolidation would be even more rampant. Rare ownership physicians with mostly ownership bankers/private equity types selling lowest cost, plausible to the public health care. Huge advertising budgets. Lots of chiropractors, alternative medicine and snake oils. MDACC name would be on everything.

Direct markets just aren't for this sort of thing. Market forces already making our lives as docs more miserable.

If I worked in a free market this is what I would do.

1. Fire 70% of the staff.
2. Bill what I could but less than the competition. Use the cheapest machine possible while promoting it as the best.
3. Market brand name products left and right. "Gators alligator skin cream".
4. Spend lots of time on local TV/radio.

No one is seriously arguing (except for maybe Peter Schiff) for a completely unregulated market, in healthcare or any industry.
 
absolutely
There is no "myth of productivity." Productivity is everything in an economy, especially as it relates to trading with other economies. The value of the dollar is directly related to the productivity of the citizens of the United States, and as as result developing that productivity and allowing it to support the dollar is mission critical. Allowing the US to default on its debt would be catastrophic for at least a generation, if not permanently. What would the interest rate on T bills be if that happened? How much of the US budget would need to be put towards debt servicing, given the extraordinarily high interest rates that would be needed to get anyone to invest in a country who recently defaulted? What would those interest rates mean to consumer borrowing in the economy? The answers to those questions are not pretty.

Prices have never been related to "a notion of objective value" or whatever that means. The price is what the market will bear. You could put an enormous amount of work into a product, but if no one wants to buy it, then the value is zero.

IF we create a monopsony on purpose in the healthcare industry (which single-payer healthcare is designed to do), it will, by design, underpay providers, requiring them to accept below-market value for their services. I'm all for universal care, I just want a multitude of payers in order to protect both patients and providers.

Finally, if recent world events haven't convinced anyone that defense spending isn't necessarily wasteful, then I'm not sure what more can be said. If the F35 is so bad, then what is Germany doing?
Logical and well thought out.
 
, then I'm not sure what more can be said. If the F35 is so bad, then what is Germany doing?
Buying yesterday's tech.


Meanwhile, China has already beat us to hypersonic missiles with a fraction of the budget. Value-based warfare. No different than healthcare.

 
Lets do the thought experiment...a truly free market health care system. Hell, lets go full Milton Friedman and get rid of credentialing.

First, can the patients tell good value? NO. They're not waiting around to see who has the most 90 year old primary care patients or comparing lumpectomy scars.

Second, could small scale practitioners compete? NO. Consolidation would be even more rampant. Rare ownership physicians with mostly ownership bankers/private equity types selling lowest cost, plausible to the public health care. Huge advertising budgets. Lots of chiropractors, alternative medicine and snake oils. MDACC name would be on everything.

Direct markets just aren't for this sort of thing. Market forces already making our lives as docs more miserable.

If I worked in a free market this is what I would do.

1. Fire 70% of the staff.
2. Bill what I could but less than the competition. Use the cheapest machine possible while promoting it as the best.
3. Market brand name products left and right. "Gators alligator skin cream".
4. Spend lots of time on local TV/radio.
Quick question... how is this different from the current reality of massive (though not UK etc) levels government involvement? Think you're pinning the tail on the wrong donkey. Maybe need to watch more Uncle Milton videos.
 
Buying yesterday's tech.


Meanwhile, China has already beat us to hypersonic missiles with a fraction of the budget. Value-based warfare. No different than healthcare.


I'm fine with increasing the defense budget to catch up in hypersonic missile tech, no problem there.
 
"myth of productivity."
I didn't mean that productivity isn't a thing. There are things (and ideas and ad revenue) produced. What I meant is the myth of personal productivity, or in other words, that there is a strong correlate between labor and productivity. (This is what all old school economists presumed). This is decoupled more and more and more and more....in other words, an equal (or greater amount) of productivity can occur with less labor. You can tell what employment markets are absolutely booming, because they are the rare jobs where this decoupling is next to impossible. (elder care, nursing, direct service jobs). We could produce plenty (maybe even more) with less employment. It may be more sustainable (less travel, less consumption). I'm thinking UBI baby! It is interesting to me that there seems to be good hiring for soft information based jobs as well?

Allowing the US to default on its debt would be catastrophic for at least a generation
I agree, but I'm also not sure that this is even possible. We have foreign and domestic debt. None of our lenders are interested in us defaulting. Just pointing out that the debt is just contractual of course, and can disappear (or be renegotiated). Might want to check out Japan's debt/GDP ratio. Nobody wants them to default either. Canada's is not far from hours. Russia's is very low.

IF we create a monopsony on purpose in the healthcare industry (which single-payer healthcare is designed to do), it will, by design, underpay providers, requiring them to accept below-market value for their services.
Market value... who the hell knows. More docs, less market value. More linacs, less market value. Less fractions, less market value. What is the real cost of a fraction of appropriately QA'd XRT? More importantly, how cheaply could MDACC administer such a thing? The market value with unregulated providers would undoubtedly be lower than presently negotiated insurance rates and even medicare.

Finally, if recent world events haven't convinced anyone that defense spending isn't necessarily wasteful, then I'm not sure what more can be said.
I'm fine with defense spending being high (although I'm sure it can be cut in half just like health care spending). Research budget could be much higher.
 
I'm fine with increasing the defense budget to catch up in hypersonic missile tech, no problem there.
I'm fine with increasing the defense budget if Lockheed and Raytheon can show me they aren't dumping more down a rabbit hole. As much as people complain about wasteful healthcare spending, wasteful defense spending gets a free pass quite often. How much defense spending is going towards cyber these days?

Probably another stale and bloated industry ripe for disruption, Elon musk style (he's crushing the entrenched auto and space industry players)
 
Last edited:
Lock him up…I mean make him pay!

Sorry, I digress but for real, companies like Halliburton, Merck, United Healthcare are all able to capitalize big and it’s not like the govt is trying to help. I’m not saying we need to shut down capitalism but there is such a huge gap between the 1% and the 0.1%, much less the bottom 99%. People like Musk, Gates, OTN, and medgator need to give more!
 
Last edited:
Check his private email server while you’re at it
 
Lock him up…I mean make him pay!

Sorry, I digress but for real, companies like Halliburton, Merck, United Healthcare are all able to capitalize big and it’s not like the govt is trying to help. I’m not saying we need to shut down capitalism but there is such a huge gap between the 1% and the 0.1%, much less the bottom 99%. People like Musk, Gates, OTN, and medgator need to give more!
Hahah. No! No! No! I’m just kidding !
 
Math was never my best subject. I have no concept in regards to value. To me, 1,000 is the same as 100 billion.
 
Buying yesterday's tech.


Meanwhile, China has already beat us to hypersonic missiles with a fraction of the budget. Value-based warfare. No different than healthcare.


The problem is I don't believe China. So much fraud when it comes to this stuff.

Also, in general, they replicate tech that we developed and just use cheaper parts.

Look at Russia right now, they have quite a bit of equipment that doesn't work. They supposedly spend a lot on military budget.
 
  • Like
Reactions: OTN
The problem is I don't believe China. So much fraud when it comes to this stuff.

Also, in general, they replicate tech that we developed and just use cheaper parts.

Look at Russia right now, they have quite a bit of equipment that doesn't work. They supposedly spend a lot on military budget.
Russia has already used them in Ukraine... No reason to doubt China in that regard.

My point is that for all the commentary regarding healthcare expenditures and cost effectiveness/QALY etc, no such accountability is applied to the defense budget (or the aerospace one for that matter for years. Look at how much we spent on NASA and the space shuttle over the years vs what SpaceX is charging now).

Considering we spend more on our military than the next several countries combined, why weren't we the first with a hypersonic missile? Why is China taking the lead on things like railguns etc
 
Last edited:
Top