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-   -   You (all) lie! (http://www.lawtalkers.com/forums/showthread.php?t=848)

Adder 03-19-2010 10:17 AM

Re: You (all) lie!
 
Quote:

Originally Posted by sebastian_dangerfield (Post 419351)
I think richer doctors is a sign of a country with its priorities in the right place. We ought to find ways to make medicine twice as lucrative for docs as it is right now, and four times more lucrative for GPs. We all have family and friends in the business who, like lawyers, tell their kids, or anyone interested in entering medicine, Don't Do It. Ever. It's a fucking headache for the money. Go into some sort of financial gig instead. That's a shame.

They need to find a way to get more talented people into medicine, and not burn out the ones in it already. The only answer I can come up with is to make it a whole lot more lucrative, and not just for specialists (a friend of mine who does dermatology makes 1.75 time my GP buddy's salary). Hell, an orthodonist in these parts can rake in $400k. A young GP's lucky to get $175k. My father's ortho guy told me a few years back he was making $150k (of course, that was because he stopped doing surgeries, where I understand all the cash is in that field).

When people who do what we do - when an ass like me who phoned in half his work - can outpace the salary of a skilled orthopedist 25 years their senior, you know our priorities are truly Perverted. When our jackass friends in finance can outpace docs by 5-20X, shit's really, really fucked up. People like to say the measure of a society is how well it treats its weakest. I think that's a flawed, naive measurement. The better measure is how well it rewards people who do its most vital work. It's time we allowed medicine to become a career that can compete with finance, brokering, or most of the other "middleman" gigs in the country, from both a QOL and $$$ perspective. Putting 30 million people who can't hope to pay shit for their services into and already overburdened system is not the answer.

Two thoughts:

1. Those figures do not make me weep for your physician friends.

2. While I most agree with you, the flaw in the system is just how much money is flowing around finance (and downstream beneficiaries of finance like us).

Tyrone Slothrop 03-19-2010 10:33 AM

Re: You (all) lie!
 
Quote:

Originally Posted by sebastian_dangerfield (Post 419351)
When our jackass friends in finance can outpace docs by 5-20X, shit's really, really fucked up.

Speaking of which, this is the best thing I've read all week.

Tyrone Slothrop 03-19-2010 10:47 AM

Re: You (all) lie!
 
Quote:

Originally Posted by Hank Chinaski (Post 419337)
so b.o. lied?

The point I keep making, and which you keep ignoring, is that health care costs will continue to go up. HCR is about slowing the rate of increase. Because costs continue to go up, many employers are cutting back on the coverage they'll pay for. This is already a fact of life. It will continue.

You have a premise -- calling it a theory would be too kind -- that HCR will cause health care costs to go up even faster than they would otherwise. Maybe someday you will try to explain why you think this, though I doubt it.

Adder 03-19-2010 11:02 AM

Re: You (all) lie!
 
Quote:

Originally Posted by Tyrone Slothrop (Post 419355)
Speaking of which, this is the best thing I've read all week.

If you like that, you should be reading http://baselinescenario.com/ and Freefall.

Cletus Miller 03-19-2010 11:16 AM

Re: You (all) lie!
 
Quote:

Originally Posted by Adder (Post 419354)
Two thoughts:

1. Those figures do not make me weep for your physician friends.

Consider that, in general, to get to that $175k number, they've been living like a student for 8 years after college. And have (likely) accrued $300k in student loans.

Adder 03-19-2010 11:29 AM

Re: You (all) lie!
 
Quote:

Originally Posted by Cletus Miller (Post 419359)
Consider that, in general, to get to that $175k number, they've been living like a student for 8 years after college. And have (likely) accrued $300k in student loans.

Understood. Still not weeping.

Cletus Miller 03-19-2010 11:43 AM

Re: You (all) lie!
 
Quote:

Originally Posted by Adder (Post 419360)
Understood. Still not weeping.

Nor am I, as I think that the good of the career still outweighs the bad, even if there were no prospect to make more than $175k, ever. But there is a basis for high-ish floor, unless we reform medical education, too.

Replaced_Texan 03-19-2010 12:14 PM

Re: You (all) lie!
 
Quote:

Originally Posted by Cletus Miller (Post 419363)
Nor am I, as I think that the good of the career still outweighs the bad, even if there were no prospect to make more than $175k, ever. But there is a basis for high-ish floor, unless we reform medical education, too.

I went to match day yesterday, and those kids are young, but I think they should be younger. There isn't really a point in sending them through three to five years of college and then med school. Throw in an extra year of basic science or phisology into the medical school cirriculum, and I think that shaving off the burden of having to pay for college on top of med school would help considerably.

I HATE the 80 hour rule, though I understand why it had to happen. Finding coverage in some programs is nearly impossible, and in my opinion, it does nothing to prepare docs for private practice.

Its no secret that I work for a med school (as well as a few other institutions). What other reforms do you think are necessary?

sebastian_dangerfield 03-19-2010 12:17 PM

Re: You (all) lie!
 
Quote:

Originally Posted by Adder (Post 419354)
Two thoughts:

1. Those figures do not make me weep for your physician friends.

2. While I most agree with you, the flaw in the system is just how much money is flowing around finance (and downstream beneficiaries of finance like us).

I didn't ask you to. I asked to you agree that it's a bit perverse for people who do important work to be paid less than people who operate in McProfessions like ours. But hey... that's the market. It awards as it'll award, and it beats having nuts like me, or politicians, pick who should receive what.

On the second point, I agree with you. Copy the last sentence of my first paragraph here.

Cletus Miller 03-19-2010 12:19 PM

Re: You (all) lie!
 
Quote:

Originally Posted by Replaced_Texan (Post 419364)
I went to match day yesterday, and those kids are young, but I think they should be younger. There isn't really a point in sending them through three to five years of college and then med school. Throw in an extra year of basic science or phisology into the medical school cirriculum, and I think that shaving off the burden of having to pay for college on top of med school would help considerably.

I HATE the 80 hour rule, though I understand why it had to happen. Finding coverage in some programs is nearly impossible, and in my opinion, it does nothing to prepare docs for private practice.

Its no secret that I work for a med school (as well as a few other institutions). What other reforms do you think are necessary?

I meant only in the context of reducing "base" compensation--if training to be a GP takes college + 8 years and costs $300k, there needs to be fairly high baseline compensation to get smart kids to decide that's what they want to do. My familiarity with the details of medical education is remote enough that I can't be much more specific w/o stepping in something.

sebastian_dangerfield 03-19-2010 12:21 PM

Re: You (all) lie!
 
Quote:

Originally Posted by Replaced_Texan (Post 419364)
I went to match day yesterday, and those kids are young, but I think they should be younger. There isn't really a point in sending them through three to five years of college and then med school. Throw in an extra year of basic science or phisology into the medical school cirriculum, and I think that shaving off the burden of having to pay for college on top of med school would help considerably.

I HATE the 80 hour rule, though I understand why it had to happen. Finding coverage in some programs is nearly impossible, and in my opinion, it does nothing to prepare docs for private practice.

Its no secret that I work for a med school (as well as a few other institutions). What other reforms do you think are necessary?

Or chop a year off medical school and let college kids enter it in their senior year. Why finish four years of college with a pre-med emphasis? Do three and then move into a three year med school program.

Tyrone Slothrop 03-19-2010 12:34 PM

Re: You (all) lie!
 
Interesting column by Bruce Bartlett in Forbes, of which this is some:

Quote:

...[N]o matter how one slices the data, the Tea Party crowd appears to believe that federal taxes are very considerably higher than they actually are, whether referring to total taxes as a share of GDP or in terms of the taxes paid by a typical family.

Tea Partyers also seem to have a very distorted view of the direction of federal taxes. They were asked whether they are higher, lower or the same as when Barack Obama was inaugurated last year. More than two-thirds thought that taxes are higher today, and only 4% thought they were lower; the rest said they are the same.

As noted earlier, federal taxes are very considerably lower by every measure since Obama became president. And given the economic circumstances, it's hard to imagine that a tax increase would have been enacted last year. In fact, 40% of Obama's stimulus package involved tax cuts. These include the Making Work Pay Credit, which reduces federal taxes for all taxpayers with incomes below $75,000 by between $400 and $800.

According to the JCT, last year's $787 billion stimulus bill, enacted with no Republican support, reduced federal taxes by almost $100 billion in 2009 and another $222 billion this year. The Tax Policy Center, a private research group, estimates that close to 90% of all taxpayers got a tax cut last year and almost 100% of those in the $50,000 income range. For those making between $40,000 and $50,000, the average tax cut was $472; for those making between $50,000 and $75,000, the tax cut averaged $522. No taxpayer anywhere in the country had his or her taxes increased as a consequence of Obama's policies.

It's hard to explain this divergence between perception and reality. Perhaps these people haven't calculated their tax returns for 2009 yet and simply don't know what they owe. Or perhaps they just assume that because a Democrat is president that taxes must have gone up, because that's what Republicans say that Democrats always do. In fact, there hasn't been a federal tax increase of any significance in this country since 1993.

One other possibility is that taxpayers are operating on the basis of a sophisticated economic theory called "Ricardian Equivalence." According to this theory, budget deficits have no stimulative effect on the economy because taxpayers implicitly discount the future tax increase that will be necessary to pay off the additional debt. People increase their savings now, the theory posits, in order to prepare for this future tax increase, thus offsetting all of the stimulative effect of the deficits with an equal and contractionary increase in saving.

While Ricardian Equivalence is a legitimate economic theory that economists continue to debate, one often hears a variation of it on talk radio shows and such, where it is said that deficits are a tax on the economy. The problem is that many people conclude from this arguably true statement that raising taxes to reduce the deficit would in effect constitute a double tax. We're being taxed once by the deficit, people think, so why should they have their taxes raised to reduce it?

Of course, this is a non sequitur. People can't be taxed twice by the expectation of a tax and again by the actual tax itself. But more important, the underlying assumption of Ricardian Equivalence--that taxes will eventually rise to pay off the debt--is now seriously in doubt. Perhaps once it was true when people genuinely cared about a balanced budget. But today's Republicans and Tea Party members oppose all tax increases for any reason, no matter how big the deficit is. I really believe that many would rather default on the debt than raise taxes by a single penny. If this is true, then Ricardian Equivalence is a dead letter--to the extent that it ever existed at all.

Probably the simplest motivation the Tea Partyers have is the one that Howard Beale (actor Peter Finch) gave in the 1976 movie Network. "I'm mad as hell, and I'm not gonna take it any more!" he said to cheering crowds. In other words, tea parties just represent unfocused anger at current economic conditions. Those who feel this way have latched on to the Tea Party movement not because they really believe that their taxes are too high, that taxes are rising or that taxes are at the root of our economic problem. Rather, they have joined because it's the only game in town; the only organized force with at least the potential of bringing about change that might make things better.

In this sense, the tea parties are simply the latest manifestation of populism, which has arisen periodically throughout American history. . . ."

Replaced_Texan 03-19-2010 12:43 PM

Re: You (all) lie!
 
Quote:

Originally Posted by sebastian_dangerfield (Post 419368)
Or chop a year off medical school and let college kids enter it in their senior year. Why finish four years of college with a pre-med emphasis? Do three and then move into a three year med school program.

I don't see the point in doing college at all, really. They don't send their docs to get bachelor's first in a lot of other countries. Rice and Cornell have done a pretty good job with their architecture programs demonstrating that a five year undergraduate professional degree is as good as if not better than a post-graduate degree. Cheaper in the long run, too.

I do MSIII orientation, and there's no way in hell I'd send those students off to be docs a year later. Most of them haven't seen patients yet at all, and they have very vague notions about what all the disciplines within internal medicine are, much less if they want to do something quai surgical like uroloy or ENT or go all the way with surgery. Sure, you have the occassional med student that thinks that he wants to be a cardiologist from day one, and maybe you can send him for that last year doing echos and caths, but I've seen more than one med student change course at the end of the third year.

Three year med school would make July an even more hellish month than usual.

Greedy,Greedy,Greedy 03-19-2010 12:43 PM

Re: You (all) lie!
 
Quote:

Originally Posted by Replaced_Texan (Post 419364)
I went to match day yesterday, and those kids are young, but I think they should be younger. There isn't really a point in sending them through three to five years of college and then med school. Throw in an extra year of basic science or phisology into the medical school cirriculum, and I think that shaving off the burden of having to pay for college on top of med school would help considerably.

This is a horrible idea, and I am astonished it comes from you.

What most kids going into medical school need is to be forced to read some novels, look at some art, maybe fix a car or two, and stop traveling nonstop from lab to bar to bed. Making them even bigger science geeks is not a good idea.

The broad liberal education is one of the best things about the US. It's part of what makes us so creative. This is not something to get screwed with.

I remember when one of my in-laws was applying to Med school as a dual English/Chem major, and got all kinds of negative comments on "wasting" her time with the English major. Screw that. Life about more than the blood and guts.

As to 80 hour rule, all I can say is what a bunch of wimps this generation is.

sebastian_dangerfield 03-19-2010 12:47 PM

Re: You (all) lie!
 
Quote:

Originally Posted by Tyrone Slothrop (Post 419355)
Speaking of which, this is the best thing I've read all week.

I think he sees an illusory value crisis on the part of govt. Govt's not valuing Wall St above "the productive sector." Wall St has the govt handcuffed because Wall St IS the productive sector. As goes Wall St goes the pension holding and retirement savings of 3/4 of the country. People talk about too big to fail architecture emerging from Sandy Weill's unwinding of Glass Steagall. The truth is, too big too fail started a long time before that. When Main Street's retirement futures became the exclusive wards of Wall Street, which started decades ago - that was the start of too big to fail.

Also, his description of Wall St types as "mediocre" is astute. But that mediocrity has served them well. Where we chose a field divorced by layers from money, they took the simplest route to the cash - working where it was kept.


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