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Preparing (FINANCIALLY) for the possibility of socialized medicine

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  • #46
    Wealth tax sounds good as long as it starts at a wealth level according to this formula: FLP Net worth+1

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    • #47
      My partner and I always joke about how many physicians would retire as soon as Medicare for all became available.  Suspect a large % of those > 50, especially as physicians will get paid less and have higher taxes.  Physician salaries are a target.

      I don't think a wealth tax is feasible, too many ways to hide/shelter it.  Suspect federal tax rates will continue to increase closer to European rates along with increasing SS max.

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      • #48




        I meant it would be highly unlikely to happen as claimed.

        I do anticipate something like this happening in future, whether it is a wealth tax, tapping 401ks, I do anticipate the government accessing “wealthy” peoples money somehow that they aren’t currently.

        Her initial proposal has to be modest and not fundamentally radical in order to seem viable and thus gain traction, then can be further radicalized to make more money for government. If she initially came out and said 2 mil and above, that would be harder to get traction than the 50 plus 1 billion
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        No one is going to touch your 401k dude. If you really think they are buy a bunch of gold coins and bury them in your backyard.

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        • #49











          From a public health perspective, having coverage is the least efficient means of ensuring proper health.  Policies that induce lifestyle changes are far more efficient. 
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          Gotta do both.
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          I don’t disagree that both should be our aim.  But do you think the best and most efficient way to achieve the former is by putting the government in charge of all medical care?
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          We have money to send our kids to distant lands to fight interminable, misguided wars. We spend money on fighter jets, cruise missiles, and foreign aid to countries. I think we can do a little less of that and guarantee medical care for all citizens, as a fundamental right as a citizen of this country. Common sense. When there’s a single payer, we can negotiate for lower prices, maybe instead of 10 different statins we’ll have one or two at an improved price, same goes for procedures and care that have not been shown to be beneficial (if you want to call that rationing then let’s ration). If, as a byproduct of this, an orthopod makes 500K instead of 600K and fatlittlepig makes 250 instead of 300 so be it.

          FLP
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          I think you're missing a handful of things here.  First, we can't afford any of those things you mention, as we are running hundreds-billions dollar deficits currently (in boom times).  These were still hundreds of billions even prior to the new tax law BTW.  So if the government wants to do something it's not a matter of affording it because politicians have consistently shown a willingness to spend without an ability to pay for it (see $21T debt).

          Second, no one has a right to anyone else's labor.  I don't have a right to yours and you don't have the right to mine.  That is a fundamental concept of the free market, capitalism, and our founding documents, constructs that have enabled you to earn your vast sums of wealth and that have benefited even the poorest among us.

          Third, it's not common sense - it's just your opinion, as these statements are mine.  If anything, common sense (IMO) would seem to be to support non-monopolistic systems sicne those systems have consistently delivered poor value for the consumer.  Competition and the free market drives value for the consumer.

          Fourth, you seem to misunderstand why drugs are priced the way they are and seem to misunderstand the nature of competition.  More drugs available are better.  More competition and options lowers cost.  You see this when trade names become generic.  What stalls this process and makes things more expensive is what the FDA allows in terms of patent protections and their criteria for what is approved as a "new drug".  Look no further than the federal government here for the source of those problems.  The other issue here is that the rest of the world has been free-riding off our system that has allowed for R&D investment and innovation.  So we are charged higher prices while other countries sit back and enjoy a cheaper ride.  If we join them then bye-bye goes innovation for the next new medical problem or a better solution to ones we have currently.  Also, how would this work exactly?  A bunch of elected and non-elected government employees are going to wave a wand and determine which statins they will or will not approve, sending 8-9 companies into turmoil and 1-2 to sustained success?

          Fifth, you grossly underestimate the effects that a single payer shift would have upon the healthcare market and your salary.  Why would a monopolistic power care to offer physicians higher than Medicare wages?  Why would they seek to even sustain those payments?  Historical evidence would speak to a desire to reduce our wages in real terms.  Do you have evidence to the contrary?  Also, what makes you think the government will not make your life more debilitating, with more onerous work with no additional pay or value for patients?  You think burnout and the poor patient care that results from burnout will get better under this system?

          And lastly, you still haven't addressed the fundamental issue of individual liberty in that you are continuing to advocate for a system whereby people are conscripted into government service/payment against their will with no power to negotiate salary.  Last time I checked individual liberty was clearly outlined as a fundamental right in our founding documents.  Healthcare was not.

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          • #50
            In the last debate Warren clobbered DeLaney on style, but he was dead right that the wealth tax is a super inefficient way to extract money from the opulent.  I think capital gains tax, higher SS wage bases (or means testing), maybe 401k contributions get phased out above a certain income, RMD's for Roth IRA's.... the list goes on.  The wealth tax will just get shot down by the current SCOTUS, or even worse turn the IRS into an even more monstrous inefficient bureaucracy.

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            • #51
              Do you know how much treasure we are spending in Afghanistan per day, or how many bundles of cash we have given Afghanistan tribal leaders— and for what? Do you know we are building a drone base in the middle of Africa (Niger)- I happen to know a physician who was deployed there. Care to imagine how much money it takes to transport, feed, house troops, then to build hospitals, and drones in the middle of literally nowhere— and for what? I reject that we cannot afford to provide healthcare to our citizens. I’ll be happy to address your other concerns when I have more time.
              FLP

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              • #52
                I think it's becoming increasingly clear to the general population that our current health insurance system is broken.  Our healthcare delivery system is also ridiculously expensive and inefficient.

                Health insurance MUST be de-linked from employment and from the location in which one lives.  Leaving a job or moving to another state shouldn't create a health insurance crisis for anybody.  It's ridiculous that it often does.  We need everyone in the health insurance pool either through all out competition and uninhibited free markets (a national market with basic guardrails from the feds) or though a single payer type situation.  This would make everyone's health insurance costs more reasonable and also everyone would be in the same boat and with the same interests which would in turn make public policy in this area much less messy.  People who work for big business and who receive fantastic health insurance through these employers are the ones who would potentially lose in this and something would have to be done to get them on board.  At the very least we need to equalize the tax treatment of health insurance costs for people who receive it as a benefit of employment vs those who have to purchase it on the "open" market.

                Physician incomes don't necessarily have to go down as part of revamping the health insurance/healthcare delivery system, but physicians would likely need much better representation in the process than they currently have in the form of entities like the AMA.

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                • #53
                  Historical review.  The 16th constitutional amendment allowed a federal income tax which originally included only the top 1% earners....a beachhead that now includes 50% of earners.  A wealth tax will similarly serve as a beachhead to include progressively lower levels of wealth.

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                  • #54
                    Docs might (or might not) make a little bit less.  But insurance company CEOs, hospital administrators, and the like stand to make millions less.  Who doesn't want to see that?

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                    • #55




                      Do you know how much treasure we are spending in Afghanistan per day, or how many bundles of cash we have given Afghanistan tribal leaders— and for what? Do you know we are building a drone base in the middle of Africa (Niger)- I happen to know a physician who was deployed there. Care to imagine how much money it takes to transport, feed, house troops, then to build hospitals, and drones in the middle of literally nowhere— and for what? I reject that we cannot afford to provide healthcare to our citizens. I’ll be happy to address your other concerns when I have more time.
                      FLP


                      The thing is that American corporations make huge money off of these deployment efforts.  That's a big part of the for what...someone is getting rich off of it.

                      When I was in Iraq the laundry was run by KBR. You would drop your sack of dirty laundry off and pick it up the next day. This was the only option where I was to get laundry done. Someone told me the rate the govt was paying KBR for each bag of laundry. It was ridiculously expensive. And I guarantee the third country nationals doing all the work were getting paid next to nothing. Of course, it was free to us, and the American taxpayer who is footing the bill never gets an itemized list and so the money just keeps draining out, just get and keep the contract and you're golden. It would have been so easy for the military (i.e. The govt) to directly run its own laundry facility for very little cost. But nope. And that's just a tiny tiny piece of the MIC pie. So many incentives that most Americans don't think about to keep it chugging along, all in the name of freedom. So gross.

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                      • #56
                        Anyone here lived in the 90's when Hillary secretly plotted a socialized healthcare for all that would severely restrict insurance and pharma companies. It was all set to go through until those lobbies fought back with Harry and Louse ads. That effectively killed it.

                        Even though the healthcare is in a much worse situation now the lobbies are still powerful. I do not think that they will allow elimination of private employer plans in favor of Medicare for all. I suspect that Medicare will be expanded and people can choose to buy into it but Medicare for all is still a decade away.

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                        • #57




                          Do you know how much treasure we are spending in Afghanistan per day, or how many bundles of cash we have given Afghanistan tribal leaders— and for what? Do you know we are building a drone base in the middle of Africa (Niger)- I happen to know a physician who was deployed there. Care to imagine how much money it takes to transport, feed, house troops, then to build hospitals, and drones in the middle of literally nowhere— and for what? I reject that we cannot afford to provide healthcare to our citizens. I’ll be happy to address your other concerns when I have more time.
                          FLP
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                          I'm not sure why you completely overlook the point I made on spending having nothing to do with this and try to ram home your off-based point again.  As for the other replies, I'll wait.

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                          • #58







                            Do you know how much treasure we are spending in Afghanistan per day, or how many bundles of cash we have given Afghanistan tribal leaders— and for what? Do you know we are building a drone base in the middle of Africa (Niger)- I happen to know a physician who was deployed there. Care to imagine how much money it takes to transport, feed, house troops, then to build hospitals, and drones in the middle of literally nowhere— and for what? I reject that we cannot afford to provide healthcare to our citizens. I’ll be happy to address your other concerns when I have more time.
                            FLP
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                            I’m not sure why you completely overlook the point I made on spending having nothing to do with this and try to ram home your off-based point again.  As for the other replies, I’ll wait.
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                            To me, it has everything to do with it...a country (which happens to be the wealthiest country) which has the resources to pursue foreign misadventures surely has the resources to provide its own citizens healthcare...

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                            • #59
                              Anne I disagree with your comment. Socialized medicine will lead to way more bloat and more useless administrators. Look how they have proliferated as we have become more and more socialistic. Socialism is what leads to useless administrators. In a nice private system trying to be efficient there is no room for them

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                              • #60
                                delete

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