patrick.net

AdHominem says

But the larger the government the more lucrative it becomes for corporations to lobby and control said government.

Exactly--and if you give more power (and more money) to local, municipal and state governments, doesn't it follow that they will become even more corrupt?

SF ace says

“Doctors choose their profession because that’s what they want to do and certainly aren’t forced to do so, but the idea that an MD will be wealthy is a misperception. When you reduce his pay to an hourly rate, you’ll find that the educator that makes $60k a year makes more. ”
Wow, did I just hear that!
First, I doubt that a new MD pratitioner would start a private practice right off the bat in light of Hospitals, HMO’s private practice partnership. But for the sake of your concern, let’s say it is and I’ll just have my pediatricians to go by and see where’s the financial reward in going private. He runs a practice with at least four other MD’s (as can be seen since all the names are listed on the door), well my doctor (non-baby type so malpractice is less than 100K) probably books an appointment every 15 mins or about 30 appointments a day. Guess what, notwithstanding immune shots or special situations, the insurance bill is $185. You do that 30 time a day and (30*185) = 5,550 in fees a day and about 20 days average is 122,100 a month, four full time doctor and revenues are up to 488K a month
All that costs are leveraged with other doctors, say you have to hire 10 assistants, receptionist, billers to assist the doc and handle the paperwork and mailing @ 2,500 a month, the monthly expense is
Salary 10% 4000 = 40,000 a month

Rent = 10,000

Insurance = 50,000

Medical equipment/lease = 50,000

Other expense/overhead = 50,000
expenses 200K

revenue 488K

Equity per month 228K a month

4 partners 57,000 a month per partner or 684K equity per year per partner.
now, there are a lot of assumptions about revenues and expenses, but doctors who run their practice expertly know how to maxamize their time into $600-$800 of billable work and should easily be making $200-$300 an hour running their own practice. Afterall, this is ultimately the reason why people choose to go private over doing salary work anyway.

As someone who used to do medical office management software and medical office management consulting work I can tell you your expense numbers are way, way off to the low side. If you can hire medical coders for 2500 a month then you have found the key to great personal wealth. Open a coding business today, don't hesitate. On the revenue side, as several people have pointed out, the insurance billed amount is a meaningless number. It's just part of the game of negotiating with carriers. What is paid is always a lot less.

Doctors make damn good money, but they more than earn it. It's more than fair compensation for 12-17 years of training, including 4-8 years of residency at 100+ per hours per week, racking up student loans for 8 years, giving up 8-12 years of retirement contributions while going to medical school and residency, being on call constantly, being called into the hospital at 2 am for 4 hours then going to the office all day, making life or death decisions frequently with poor or incomplete information knowing an error or even bad luck will land them in court with a gaggle of lawyers second guessing them.

Sure there are doc's out there making 500-600k. They are the guys who went to the brutal 6-7 year residencies, followed by 2-3 years of fellowship, followed by years of developing their skills and reputations. The vast majority of doctors, the bread and butter GP's and Ped's and OB people, are making in the 100's to low 200's. Like the man said ass, gas, or grass no one rides free. You want to give up another 4-6 years of your career you can earn a lot more.

I do think the docs who own medical related business and refer to their own business are in a very serious conflict of interest situation that is probably unethical. The highest cost of medical care is in area's where a lot of these arrangements proliferate. South Texas comes to mind. The lowest cost of care is were the doc's are employed by the hospital and the hospital manages costs carefully. Read up on the Mayo or Cleveland clinic sometime. The obvious question is why health care reform isn't based on these working models.

Medical school applications are way down. If it's such easy money for an easy life then apply. Otherwise don't complain. Talk is cheap.

Why do you want to talk about Germany? Do you want to live in Germany?

Germany is a parallel trial of government policy. We can analyze what they're doing right and wrong and synthesize policy changes for our own, differing, national socioeconomic experience.

All things being equal this might be an interesting avenue for comparison. However all things are not equal. For example how can you compare a country who spends a massive portion of GDP on war and military occupation to one that spends only a tiny fraction on military? How can you compare the country where most medical advancements are made to anyone else who is riding on our coatails? How can you compare the country with the largest GDP to one with a GDP a quarter of the US? What gave US the largest GDP, perhaps lack of socialized medicine for one? How much higher would Germany's GDP be if it had lower taxes/socialism?

I find your comparison of apples and oranges to be a distraction at best. Arguing that Germany can afford their welfare state (at least for now) so we should expand ours too is asinine.

And lets not forget that Germany is a competing country. It has different form of government, offering an alternative to ours. Why would we want to copy them? There is already one Germany do we need another? People who like it should try living there. Is that what made America great, copying Europe?

AdHominem says

How can you compare the country where most medical advancements are made to anyone else who is riding on our coatails?

The coattail argument is rather bogus. Big Pharma spends 3X feeding the fat compared to R&D. Read any income statement, let's take GSK:

Topline $28B
COGS $7B
SG&A $9B
R&D $4B
Tax $2B
Shareholder profit $5.7B

Germany isn't riding on our coattails wrt drugs. We're just getting screwed sixways from Sunday.

Is that what made America great, copying Europe?

Pretty much, yes. We were burning witches and busy clearing forests while Europe had its Enlightenment. Adam Smith, Thomas Paine, and the pre-Revolutionary French milieu all had their impact on the social development of the colonies and nascent US.

It was the British Industrial Revolution we copied and accepted lock, stock, and barrel, and then built from there.

Then when things got wacky in the Gilded Age it was the Bismarckian social reforms and the British Liberal movement that inspired the Progressive era reforms of the early 20th century.

If you want to look to systems we can learn from, you've got to look at Europe state socialism, since going the otherway just results in the economic destruction of oligarchy and kleptocracy of the third world.

Middle classes can only exist where the state reigns in the predations of the upper class and provides ladders for the lower classes.

AdHominem says

And which German created drugs are on the top 100? Any in the top 200? Hmmn, their socialized medicine and overly regulated economy doesn’t exactly attract the top investors and bring the most innovation does it?

Perhaps you've heard of Bayer, or Merck, if not Boehringer Ingelheim. What do you mean by top 100? Over the counter volume? Prescription volume? Quality? New drugs?

?????

Bayer is #3 ranked worldwide.

Germany is well-respected for their engineering skills as well, some people I know prefer German products over Japanese, particularly for cars.

Oh wait I forgot USA USA USA!

AdHominem says

Are you talking about our great Federal Reserve bank and the host of welfare programs that are set to go bankrupt?

Nothing a few tax raises back to Clintonian if not Nixonian levels can't fix.

Yes, socialism excels at bringing out the best in these things. It must have been socialized medicine that enabled the Industrial Revolution right?

Your railing against teh socialism is rather content-free and on the order of paranoia or something. The UK and Germany both partially socialized their economies prior to WW I -- in response to even more radical big-S Socialists who really wanted to bring private enterprise under the heel of the State.

There are two kinds of socialism. The shitty kind like under Pol Pot and the kind that Eisenhower/Nixon-era Republicans would recognize and not necessarily oppose. The French, Germans, and the rest of the Eurosocialists operate towards the latter end of the spectrum.

Are you trying to tell me what to do? I thought this was a free country. Do you want to give me any other orders captain?

No, you're free to remain your special snowflake self. Don't ever change.

How about we look at USA pre 1913. Yes that is right Pre-Fed. It was a good time.

No it wasn't. The emergent industrial economy of the late 19th century was a continual series of monetary and economic boom/bust cycles.

Life sucked for tens of millions of Americans, and it was only thanks to the Homestead Act and the millions of productive land available for the taking that the economy grew and prospered as it did.

The problem was a great imbalance between labor and capital, what the railroad gaveth the railroad barons took away.

William Jennings Bryan was the teabagger of his day. He got pretty far until coopted by the Democratic establishment under Wilson.

But if by ladders you mean free medicine, housing, and all the other necessities of life, you should live in the mobile home park I grew up in full of families just living off your dime.

Not free, just government-run insurance and financial aid such that everyone has the resources to become and remain a productive member of society. We're an immensely productive people but anyone with a passing understanding of history realizes that free market fundamentalism is suboptimal compared to the mixed economy the US established and grew under ca. 1940-1980.

The economy ran off the rails somewhat in the 1970s thanks to Vietnam, going off the unsustainable foreign gold standard, necessity to weaken the dollar and the associated oil shocks, granted.

Vincente, don't get me wrong, the Germans can make a good product. Hey, if it wasn't for us they probably would have taken over the world. Of course we are the fourth Reich dressed up in the guise of bringing democracy to the world.

And in many ways America is not just the New England it is the New Bavaria as well (english edged out german when we voted on a national language). Politics aside of course.

Well, we agree on most things Troy, so I guess the biggest difference is that I never called you a snowflake.

Troy says

government-run insurance and financial aid such that everyone has the resources to become and remain a productive member of society.

or a freeloader

AdHominem says

And can I opt out?

Well because it's YOU.... not only no but HELL NO!

Anyone else feel like they're changing diapers here?

Nomo, you always make me laugh.

Vicente says

AdHominem says

And can I opt out?

Well because it’s YOU…. not only no but HELL NO!

Ah yes, dictatorship! Hail Vincente! King of .....

AdHominem says

Ah yes, dictatorship! Hail Vincente! King of …..

I was making a feeble attempt at Ad Hominem. Now I'm a sad panda you didn't like it.

Vincente, to properly use Ad Hominem you need to actually attack the credibility of the witness, usually because you do not want to acknowledge that you are standing on thin ice with your own warped views. Ellie and Nomo are good at it. It is their bread and butter. In fact it is just about all Ellie is good at and Nomo does it just for fun, though as he mentioned earlier we agree on 99% of things so he does it just for fun too. My response of Ad Hominem is therefore reserved for those who envoke it first.

But thanks for playing it makes you feel cool to be part of the gang puttin' down the guy who is different doesn't it?

Oh, my gawd! I knew it! You think I'm COOL!

WTF is "envoke?"

http://www.glennbeck.com/content/articles/article/198/36618/

I don't usually like Krugman, but he had a good take on GOP bait-n-switch tactics.

The conservative answer, which evolved in the late 1970s, would be dubbed “starving the beast” during the Reagan years. The idea — propounded by many members of the conservative intelligentsia, from Alan Greenspan to Irving Kristol — was basically that sympathetic politicians should engage in a game of bait and switch. Rather than proposing unpopular spending cuts, Republicans would push through popular tax cuts, with the deliberate intention of worsening the government’s fiscal position. Spending cuts could then be sold as a necessity rather than a choice, the only way to eliminate an unsustainable budget deficit.

So, lacking the political directness to tackle the SPENDING problem head-on, this misdirection has benefitted them NOW. They probably delude themselves they will be the recognized adults in the room after the crackup-boom. Most historical currency and deficit crisis though, just advance the whackiest elements not the ones who thought they'd be in position to profit.

The Bankruptcy Boys

Adhominem says: "I NEVER said raising minimum wage causes layoffs. It does however cause unemployment by reducing the amount of employees that a business will HIRE. Lower the minimum wage and I guarantee more people will have jobs."

The minimum wage has more or less been undermined by inflation to the point where few employers would bother offering jobs for less. At least to legal workers. Which makes small businesses that engage in such practices little different than chemical companies that cut back on costs by dumping asbestos and PCB"s into the river. Hey! You're saving 10 cents a can on bug spray! Quit whining!

In the beginning of change, like now, true patriots are ridiculed, hated and scorned. Career politicians and their supporters claim that criticism of government policies are dangerous to the country and label critics as subversives...even "terrorists".

Rebels, traitors and enemies of the state were terms used to describe American patriots by King George III.

It's funny Honest Abe is your nickname. After all your namesake put down a secession/rebellion by people that considered themselves "patriots" and that Washington DC was no longer their legitimate government. Lincoln seemed pretty liberal/progressive, which makes it more incongruous.

Let me repeat, in the beginning of change, TRUE PATRIOTS are ridiculed, hated and scorned. Which is what's happening now.

Honest Abe says

Career politicians and their supporters claim that criticism of government policies are dangerous to the country and label critics as subversives…even “terrorists”.

Really? What poiticians have claimed that? Or labeled critics as "terrorists"?

OK, for one, how about the "leaked" document that was all over the Internet last summer from the Dept of Homeland Security (?) that warned the police to be suspicious of anyone with a Ron Paul bumper sticker. It further stated those individuals may be 'TERRIORISTS'.

By the way, which radio and TV "personalities" today are ridiculed, hated and scorned?

Abe--

Is that the best you've got? A report saying that people with Ron Paul bumper stickers MAY be part of the radical right? That's a far cry from a politician calling people who disagree with their policies "terrorists".

You're really playing loose with the truth on this one...

You lazy, liberal, progressive, pompous commies make me laugh. Read it yourself:
http://www.reddit.com/r/politics/comments/86api/document_state_of_missouri_report_on_modern/

Honest Abe says

You lazy, liberal, progressive, pompous commies

hey man I'm not a communist.

The commie rats, of both parties, that have been in the White House and Congress, with the help of The Fed, continues to deficit spend us into bankruptcy.

They have built a rotten financial structure, made out of a house of cards, erected on a bed of sand, built over a fault line, in a known financial hurricane zone, on borrowed money, at huge degrees of leverage.

As our worthless, paper, fiat currency continues to collapse, everything will continue to increase in price due to horrible inflation caused by governments shameless expansion in the money supply.

Why do we "respect" and actually pay these people ?????????? Anyone ?

^ very nice. My general perspective on the Great Recession was that inflationary expansion was better than a deflationary collapse with mass unemployment, but we're still in the latter mode apparently.

Given that only 25% of this country can find their ass with a flashlight, should present conditions obtain in November there will be a major reversal in Congress, a la 1994.

I'm thinking of votiing Republican just out of self-preservation instinct. Let's get this over with.

^ The yuan is still at 7 now but since their minimum wage is 65c it clearly should be at parity or even 1:2.

I lack the brain to fully tease out the impact of this change.

Our foreign-held debt really isn't that bad I don't think:

http://www.ustreas.gov/tic/mfh.txt

grew 20% last year, that's not good.

Japan's economy is a fiscal mess yet they each own $6000 in t-bills. And their population is declining now so this will only get better : )

The trade imbalance with China fell a bit to $220B in 2009 but they only rolled over their treasuries, putting most of the cash in strategic investment funds I guess.

OPEC of course were the big winners in 2008 and I think a chunk of that windfall eventually ended up in the UK, which now has $300B in our bonds on their books.

Everybody's economy is f---ed to the degree capital gets tied up in its real estate sector. This only became obvious to me in late 2003, alas, but it's as plain as day to me now.

Every country's econony is messed up because every county uses its own worthless fiat currency. No country can have a sound economy until they have sound currency. fiat currency has been tried countless times thruout history and the result is always the same, without fail...the currency collapses. Can someone please name a fiat currency that has historically held its value? There are none.

Next, acting financially irresponsibly can never be a solution. Spending more than is available is a disaster, never a solution. Then one must borrow to cope. That creates additional problems, such as interest on the borrowed money which compounds the problem.

Our country borrows from the Chinese because our leaders are financially irresponsible, promise too much and spend too much. Its pretty obvious.

Our country has caused itself to be non-competitive by a blizzard of regulations, rules, laws, "codes" and the like. To compound the pain to business throw in abusive unions and crushing preditory lawsuits.
Is it any wonder american companies move offshore???

The bottom line is two wrongs don't make a right. OK, make that three wrongs: (1) Debasing our own currency can never be a solution, (2) Deficit spending due to financial irresponsibility can never be a solution (3) Countless government regulations, abusive unions and preditory lawsuits don't create competitive american companies - it does the opposite. OK, make that four wrongs: (4) Penalizing the american people who buy foreign products to help american businesses remain competitive is no solution either. It just costs the american consumer more, and doesn't make the american business any more competitive what-so-ever.

All the above is what america has been doing, its a reciept for failure, and is causing the pain most everyone is experiencing today.

The following is a quote from"Secrets of the Millionaire Mind" by T. Harv Eckler. It's appropriate and works equally well for individuals, families, businesses...even the U.S. Government..."IF YOU WANT TO GET RICH, FOCUS ON MAKING, KEEPING, AND INVESTING YOUR MONEY. IF YOU WANT TO BE POOR, FOCUS ON SPENDING YOUR MONEY"

No more hocus-pocus smoke and mirrors deficit spending worthless fiat currency leveraged to the moon non-sense. What our country needs is fiscal responsibility, sound currency and COMMON SENSE.
Thank you, and remember to vote EVERYONE out - impeach everybody.

Honest Abe says

Our country has caused itself to be non-competitive by a blizzard of regulations, rules, laws, “codes” and the like. To compound the pain to business throw in abusive unions and crushing preditory lawsuits.

That is just complete BS. Jobs move overseas because other countries have lower standards of living. End of story.

It is indeed very "competitive" if you move all your manufacturing to totalitarian countries where slave labor and deadly pollution levels are perfectly acceptable business practices. We seem to have found the ultimate version of "keep the slaves at a distance" they aren't just out of smelling range, they are WAY over there in places with no cameras allowed and dissent is crushed. USA! USA! USA!

Both of you want to argue, pretend, justify and debate why everything is just fine the way things are now. They aren't, our country has tried it "your way" and look what we have...a financial meltdown. And our "wise" leaders are trying to solve our problems by adding more of what caused the problems in the first place...which you obviously agree with...ugh.

Borrowing is not a solution. Tariffs are not the solution. More Government regulation is not the solution. Further debasing our currency is not the solution. Excess spending is not the solution. Inflation is not the solution. Expanding union power is not the solution. Socializing businesses and industries is not the solution. More taxes is not the solution. More bailouts are not the solution. The Fed's manipulation of interest rates is not the solution.... Getting government out of the way and letting businesses and consumers make their own unrestricted free choices IS a solution. But that involves freedom - which seems to drive you guys CCCRRRAAAAAZZZYYYY. Getting government out of the way and letting the economy heal itself would be like "water seeking its own level". But once again you guys are probably way too smart to comprehend something as simple as that.

I've stated there are laws of nature as well as laws of business and finance. For example: water always runs downhill. For example: if you spend more money than you have, you always experience financial difficulty.

Come on, its not that hard to understand.

Throw everyone out of office! Campaign for Liberty. Ron Paul.com

^ yup, plus until 1970 we actually, literally owned half or so of the oil in the mideast. Then the camel jockeys decided it was their oil.

Plus from 1946-1974 China was an economic black hole and not a trade competitor. Japan was more of a junior partner 1950-1980, until the strengthening yen increased their global footprint by an order of magnitude.

The rise of a middle class in India and their plugging into our economy via the internet is another dimension of this puzzle.

How can a guy with a $500,000 mortgage compete with a well-paid, for India, dude making $15,000 a year?

Japan was cleaning our clocks with the 250 yen exchange rate.

Remember, Volcker's 20% interest rates strengthened the dollar since funds wanted in for a piece of that action.

The Plaza Accord of late 1985 reversed this and restored some balance between Europe and the US at least (Japan didn't want anything from us).

http://en.wikipedia.org/wiki/Plaza_Accord

The North Sea oil coming online in the mid-late 80s tanked the price of oil, which also helped.

You asked why in the post-Reagan era things are so out of whack.

Looking at this chart it's clear to me that the Bush administration inherited an imbalanced system, and in their inimitable way did absolutely nothing to address it.

When I left the US in 1992 "Made in China" was a rarity. When I came back in 2000, it was a trend. By 2006, our entire economy was Made in China, or so it seemed.

http://www.cnn.com/2003/ALLPOLITICS/01/22/bush.boxes/

You keep jumping around. First to the japanese then the germans. Vw was the only volume car producer in germany in 1960. That means that 739,443 beetles was pretty much the entire output for all of germany for worldwide sales. How can you compare that to one model of car from one division of one american car company and say that the national auto industries were in any way shape or form comparable? That's just nonsense. American car companies sold over 6 million cars domestically alone. Japan's gdp in 1960 was 16 billion the US was 980 billion. The average japanese worker earned 10% of the average american worker in 1960. You really don't believe that Japan (and to a lesser degree Europe) was still recovering from WWII at this point? Japanese growth really took off in the 60's averaging about 10% a year, but prior to that they were struggling.

No our markets would not have been flooded with imports. The manufacturing capacity simply didn't exist overseas prior to the 1960's. That's a simple fact.

^ sure, I agree with that. The wealthy have interest earning interest earning interest now. At work a coworker was talking about how he got to pal around down in Carmel with a Johnson & Johnson fortune moneyed dude, how the dude's intergenerational wealth was simply throwing off cash too fast to humanly spend.

When 10% of the country owns 70%+ of the wealth (and more of the actual capital wealth), you're nearing the event horizon of feudalism and wage slavery.

All Clinton did was add two tax brackets to mildly redirect upper middle class and above incomes to the public sector, no Republican voted for this, and their doomsday fearmongering posturing BS did not come to pass. The opposite, in fact.

Anybody making more than $500,000/yr is making more than wages from labor. They're welcome to go Galt, in this economy somebody hungrier will be more than happy to take up the slack.