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  • Avatar drmka26 
    Participant
    Status: Physician
    Posts: 14
    Joined: 09/11/2018

    We saw how the housing bubble crashed ~ 10-15 years ago. Lots of money was being made by execs of housing, banks, politicians etc.

    Do you guys not see the same trend w/ healthcare companies and student debt? The health insurance & pharmaceutical industry greed and people going bankrupt over minor hospitalizations is just not sustainable… how long before this bubble bursts?

    I think Physician salaries only account for about 2%? or healthcare expenses so we might be okay in the long run but isn’t the whole industry heading towards a crash?

     

    What about student loan debt? Physicians might have no issues paying them off, but what about other who earn average salaries and raking up huge sums of debt? Isn’t this also going for an eventual burst?

     

    I know politics are heavily discouraged here but anyone see any changes in 2 years when we will potentially have a ‘very different’ government in place? We have more and more younger people getting elected.

    #197085 Reply
    CordMcNally CordMcNally 
    Participant
    Status: Physician
    Posts: 1609
    Joined: 01/03/2017

    I thought this thread was going to be about the character Bubbles from Trailer Park Boys. He’s my favorite.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #197089 Reply
    SerrateAndDominate SerrateAndDominate 
    Participant
    Status: Physician
    Posts: 311
    Joined: 02/01/2018

    I thought this thread was going to be about the character Bubbles from Trailer Park Boys. He’s my favorite.

    Click to expand…

    I was actually thinking Bubbles from The Wire. Another great character in his own way

    Earn everything.

    #197090 Reply
    Liked by Zaphod, MPMD, ENT Doc, Peds
    Avatar Peds 
    Participant
    Status: Physician
    Posts: 3010
    Joined: 01/08/2016

    Bubbles from Trailer Park Boys. He’s my favorite.

    Click to expand…

    fail. Bubbles from The Wire.

    #197095 Reply
    Liked by Zaphod, MPMD
    ENT Doc ENT Doc 
    Participant
    Status: Physician
    Posts: 2675
    Joined: 01/14/2017

    We saw how the housing bubble crashed ~ 10-15 years ago. Lots of money was being made by execs of housing, banks, politicians etc.

    Do you guys not see the same trend w/ healthcare companies and student debt? The health insurance & pharmaceutical industry greed and people going bankrupt over minor hospitalizations is just not sustainable… how long before this bubble bursts?

    I think Physician salaries only account for about 2%? or healthcare expenses so we might be okay in the long run but isn’t the whole industry heading towards a crash?

     

    What about student loan debt? Physicians might have no issues paying them off, but what about other who earn average salaries and raking up huge sums of debt? Isn’t this also going for an eventual burst?

     

    I know politics are heavily discouraged here but anyone see any changes in 2 years when we will potentially have a ‘very different’ government in place? We have more and more younger people getting elected.

    Click to expand…

    Lots to unpack here.

    Healthcare spending and student debt have both outpaced inflation for decades, namely because both are propped up by our government.  This disrupts markets that traditionally don’t reward inefficiency and poor value.  Healthcare and educational inflation have been driven, in part, by a lack of transparency of value in both sectors.  The price of college may be more transparent, but is the quality of the degree (expected future income, job opportunities) from that college or major transparent?  Of course not.  Likewise, is medicine the least bit transparent in terms of value (price and quality)?  Of course not.  The market can only tolerate this sort of nonsense for so long – people will devise alternate solutions.

    The issue of medical bankruptcy is often misunderstood and sensationalized by the media.  While many bankruptcies involve someone having medical debt at the time of bankruptcy there is little evidence that this constitutes the majority of marginal bankruptcies.  Additionally, getting medical care costs money.  Why shouldn’t it?  If you don’t make good decisions with your money and get hit with a medical bill of course that’s going to put you at risk for bankruptcy.  Any marginal cost would.  Now if you want to argue that costs need to be lower then I don’t disagree, because I know that we all see a lot of non-value-added things occurring in healthcare.  But people will still go bankrupt with medical costs even in the best system.

    Don’t single out drug companies and insurance companies for being greedy.  Think hospitals aren’t?  Think some providers aren’t?  Device makers?

    I think an important issue to address is the lack of transparency overall and especially with out of network billing.  That is a ridiculous practice that no one should have to worry about when they go to the ER or get hospitalized.

    Physician salaries are more than 2% – I’ve seen estimates of 10% and even as high as the upper teens.

    If you take out lots of loans and didn’t get a meaningful degree or go to a good value school then yes those people will pay a price.  The biggest failure in that system is that the government is willing to rack up our national debt to guarantee anyone money for any school and any degree.  This incentivizes overspending and overcharging.

    The funny thing about the Medicare-for-all crowd is that none of them are willing to admit that the government has anything to do with the problem, yet we’re supposed to accept the prescription that more government is the answer.  Just absurd IMO.  This is not to say the government has no role in the two sectors.  We really don’t know what life would be like without government intervention in both systems, but I imagine you’d have a lot more transparency of price and value.  Since the government is already “dug in like an Alabama tick” in both sectors, the best thing the government could do would be to mandate measures of quality and price transparency, the former to be dictated by non-government entities such as American Academy of X and controlled for health factors that skew results.  On cost there should be published rates for any procedure/visit at any practice, depending on your insurance.  And this cost should be comprehensive of ALL expected out-of-pocket costs, including the nonsense out of network charges.  Want to take your kid to Children’s?  $40.  Clinic down the street?  $20.  Ear tube surgery?  Deductible not met – charges of $3000 at Children’s, $1500 at ASC down the street.  Things would change REAL quick.

    #197106 Reply
    Liked by octopus85
    Avatar Dont_know_mind 
    Participant
    Status: Physician
    Posts: 744
    Joined: 11/21/2017

    We saw how the housing bubble crashed ~ 10-15 years ago. Lots of money was being made by execs of housing, banks, politicians etc.

    Do you guys not see the same trend w/ healthcare companies and student debt? The health insurance & pharmaceutical industry greed and people going bankrupt over minor hospitalizations is just not sustainable… how long before this bubble bursts?

    I think Physician salaries only account for about 2%? or healthcare expenses so we might be okay in the long run but isn’t the whole industry heading towards a crash?

     

    What about student loan debt? Physicians might have no issues paying them off, but what about other who earn average salaries and raking up huge sums of debt? Isn’t this also going for an eventual burst?

     

    I know politics are heavily discouraged here but anyone see any changes in 2 years when we will potentially have a ‘very different’ government in place? We have more and more younger people getting elected.

    Click to expand…

    That’s a popular narrative. Which you are being fed, by someone.

    The term bubble is misused and used way too much.

    I wouldn’t be so confident about being able to predict the future about student loans or healthcare crashing or when.

    Yeah, sure there are imbalances, but they are well known so may well be corrected for.

    Put that with the growing unsustainable US/worldwide debt, government debt, china bubble, Japanese government bond bubble and various other “bubbles”.

    All of these are propped up by governments, so they may not be bubbles at all, depending on what government response is.

    I don’t think real estate was a bubble in 2009. If Bernanke had saved Lehman and allowed an orderly clean up of MBS, then things may have evolved quite differently.

    Real bubbles are rare. I think of bubbles as more like Bitcoin recently or internet stocks in 1999.

    Even there predicting how or when things will evolve is difficult. Predicting how politics will evolve ? Who knows. Yeah, I guess it is possible people could get so upset by student loans and healthcare that they elect a Hitler or Stalin. In the US though, in 2 years ?

    In the early 90’s, people were worried about how the current account deficit was completely unsustainable and how that would result in an economic catastrophe. It’s just not a worry now.

    Things are not always as they seem. But sometimes they are. If you could predict this stuff with accuracy, you could become a billionaire. It’s a cognitive bias, called overconfidence bias. I’m sure it happens in medicine and politics too.

    We love to listen to someone who confidently knows the answer. It becomes a bit of an echo chamber of people reinforcing our opinions.

    #197155 Reply
    Liked by jfoxcpacfp
    Avatar Dont_know_mind 
    Participant
    Status: Physician
    Posts: 744
    Joined: 11/21/2017

    We saw how the housing bubble crashed ~ 10-15 years ago. Lots of money was being made by execs of housing, banks, politicians etc.

    Do you guys not see the same trend w/ healthcare companies and student debt? The health insurance & pharmaceutical industry greed and people going bankrupt over minor hospitalizations is just not sustainable… how long before this bubble bursts?

    I think Physician salaries only account for about 2%? or healthcare expenses so we might be okay in the long run but isn’t the whole industry heading towards a crash?

     

    What about student loan debt? Physicians might have no issues paying them off, but what about other who earn average salaries and raking up huge sums of debt? Isn’t this also going for an eventual burst?

     

    I know politics are heavily discouraged here but anyone see any changes in 2 years when we will potentially have a ‘very different’ government in place? We have more and more younger people getting elected.

    Click to expand…

    Lots to unpack here.

    Healthcare spending and student debt have both outpaced inflation for decades, namely because both are propped up by our government.  This disrupts markets that traditionally don’t reward inefficiency and poor value.  Healthcare and educational inflation have been driven, in part, by a lack of transparency of value in both sectors.  The price of college may be more transparent, but is the quality of the degree (expected future income, job opportunities) from that college or major transparent?  Of course not.  Likewise, is medicine the least bit transparent in terms of value (price and quality)?  Of course not.  The market can only tolerate this sort of nonsense for so long – people will devise alternate solutions.

    The issue of medical bankruptcy is often misunderstood and sensationalized by the media.  While many bankruptcies involve someone having medical debt at the time of bankruptcy there is little evidence that this constitutes the majority of marginal bankruptcies.  Additionally, getting medical care costs money.  Why shouldn’t it?  If you don’t make good decisions with your money and get hit with a medical bill of course that’s going to put you at risk for bankruptcy.  Any marginal cost would.  Now if you want to argue that costs need to be lower then I don’t disagree, because I know that we all see a lot of non-value-added things occurring in healthcare.  But people will still go bankrupt with medical costs even in the best system.

    Don’t single out drug companies and insurance companies for being greedy.  Think hospitals aren’t?  Think some providers aren’t?  Device makers?

    I think an important issue to address is the lack of transparency overall and especially with out of network billing.  That is a ridiculous practice that no one should have to worry about when they go to the ER or get hospitalized.

    Physician salaries are more than 2% – I’ve seen estimates of 10% and even as high as the upper teens.

    If you take out lots of loans and didn’t get a meaningful degree or go to a good value school then yes those people will pay a price.  The biggest failure in that system is that the government is willing to rack up our national debt to guarantee anyone money for any school and any degree.  This incentivizes overspending and overcharging.

    The funny thing about the Medicare-for-all crowd is that none of them are willing to admit that the government has anything to do with the problem, yet we’re supposed to accept the prescription that more government is the answer.  Just absurd IMO.  This is not to say the government has no role in the two sectors.  We really don’t know what life would be like without government intervention in both systems, but I imagine you’d have a lot more transparency of price and value.  Since the government is already “dug in like an Alabama tick” in both sectors, the best thing the government could do would be to mandate measures of quality and price transparency, the former to be dictated by non-government entities such as American Academy of X and controlled for health factors that skew results.  On cost there should be published rates for any procedure/visit at any practice, depending on your insurance.  And this cost should be comprehensive of ALL expected out-of-pocket costs, including the nonsense out of network charges.  Want to take your kid to Children’s?  $40.  Clinic down the street?  $20.  Ear tube surgery?  Deductible not met – charges of $3000 at Children’s, $1500 at ASC down the street.  Things would change REAL quick.

    Click to expand…

    This happens when you take your car to the mechanic. It’s supply-demand. Little regulation, so supply meets demand and there is less excess rent for the mechanics (doctors), garages (hospitals), parts suppliers (pharma).

    I guess if the mechanic makes a mistake, you could die, but why are they paid less ?

    All the absurdity seems to me to be just rent-seeking. And why not ? Everyone is doing ok.

    I would guess the current healthcare structure will at some stage get disrupted or gradually substituted if it doesn’t reform. That may or may not be adverse to healthcare providers, depending on how profits are apportioned. How Amazon moves into healthcare will be interesting to watch. I would guess at the end of the day, structures that have the consumer as king, will tend to eventually dominate. But that is just a guess and also dependent on government regulation.

    #197157 Reply
    Liked by Zaphod
    MPMD MPMD 
    Participant
    Status: Physician
    Posts: 1967
    Joined: 05/01/2017

    I thought this thread was going to be about the character Bubbles from Trailer Park Boys. He’s my favorite.

    Click to expand…

    I was actually thinking Bubbles from The Wire. Another great character in his own way

    Click to expand…

    Bubbles from Trailer Park Boys. He’s my favorite.

    Click to expand…

    fail. Bubbles from The Wire.

    Click to expand…

    “Aint no shame hangin’ on to grief, long as you leave room for other stuff too.”

    one of the best lines from the entire show.

    #197159 Reply
    Liked by Zaphod, Peds
    Hank Hank 
    Moderator
    Status: Attorney
    Posts: 1116
    Joined: 03/27/2017

    Terribly disappointed.

    I thought this was a thread about Michael Jackson’s chimpanzee Bubbles.

    #197184 Reply
    Avatar NYCdoc 
    Participant
    Status: Physician
    Posts: 13
    Joined: 08/24/2018

    Terribly disappointed.

    I thought this was a thread about Michael Jackson’s chimpanzee Bubbles.

    Click to expand…

    I guess none of you guys has a toddler…the only thing I could think of was of the “bubble guppies” from Nickelodeon…

    #197211 Reply
    Liked by Lordosis
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 317
    Joined: 02/11/2019

    I was expecting the monkey belonging to the Lord of the world’s.
    Not really but I like this game :p

    “Never let your sense of morals prevent you from doing what is right.”

    #197215 Reply

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