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2005 Apr 11, 5:00pm   182,906 views  117,730 comments

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204   d3   2009 Jul 16, 4:01am  

Some Guy says
You are paying
It is true a doctor maybe charge what he wants, however the insurance and medicare are only obligated to pay a certain amount. For many treatment that amount is set below what makes it profitable for many practitioners to make any money off the treatments. Sometimes they are even forced to take a loss. Why would one spend 8 years in school to be a primary care doctor when you can make more money in most fields with a 4 year education. I just feel that over regulation from medicare and the insurance companies have taken away the profitability of family practice. It is a fact family doctors are leaving the field. I just think that socializing medicine is the current root cause of the problem and adding more regulation will only make things worse
205   rdm   2009 Jul 16, 4:22am  

Regarding the $2000 Tetanus shot (even $200 seems high) A good usually quicker and cheaper alternative to emergency rooms for such medical problems are the so called "prompt" and "urgent" care facilities. One of the absurdities of the current system as referenced indirectly in the comments about "billed" costs verses what insurance companies actually pay is that uninsured people are typically charged more by hospitals and other providers and end up paying a higher amount then insured people (either private or Medicare etc.) for the same service. A small step that could help a lot of people without insurance would be a regulation that they be charged on a fee for service basis at a rate no higher then either the Medicare rates or perhaps an average of all the private insurance companies that the provider accepts. The political debate on this proposal would be interesting to observe as I am sure it would be opposed by the entire medical establishment as well as insurance companies but how can this practice be defended?
206   d3   2009 Jul 16, 4:40am  

rdm says
Regarding the $2000 Tetanus shot (even $200 seems high) A good usually quicker and cheaper alternative to emergency rooms for such medical problems are the so called “prompt” and “urgent” care facilities. One of the absurdities of the current system as referenced indirectly in the comments about “billed” costs verses what insurance companies actually pay is that uninsured people are typically charged more by hospitals and other providers and end up paying a higher amount then insured people (either private or Medicare etc.) for the same service. A small step that could help a lot of people without insurance would be a regulation that they be charged on a fee for service basis at a rate no higher then either the Medicare rates or perhaps an average of all the private insurance companies that the provider accepts. The political debate on this proposal would be interesting to observe as I am sure it would be opposed by the entire medical establishment as well as insurance companies but how can this practice be defended?
Sad to say but the urgant care near me was closed about a year ago.. I agree that people without insurance should not be forced to pay more than those with insurance, but I do not think medicare or any other entity should have the excusive right to determine what those fees should be. I do not think the goverment has the ability to fairly regulate prices. A doctor in NYC should not be forced to charge the same as a doctor in Idaho, also if all doctors had to accept the same payment what would be the point of one doctor working harder trying to be better then another. One of the great things about a free market is that you have a choice and if you work harder and make more money you are rewarded by being able to get better things. One of the problems over regulating medicine or any other company is that you end up with rules that may appear fair on paper but are not fair in reality
207   d3   2009 Jul 16, 4:48am  

Where are all the doctors http://www.cnn.com/2008/HEALTH/11/17/primary.care.doctors.study/ http://www.law.duke.edu/shell/cite.pl?69+Law+&+Contemp.+Probs.+195+(autumn+2006)+pdf http://bulletin.aarp.org/yourhealth/caregiving/articles/where_have_all_the_doctors_gone_.html
208   justme   2009 Jul 16, 4:52am  

d3, Your argument is essentially that "if doctors could charge everyone whatever they wanted, then prices would go down" mixed in with a bit of "the cost of billing software and services is what makes care expensive now". I'm not buying this argument. Not at all. It defies logic.
209   justme   2009 Jul 16, 4:54am  

TOB, right on. Let us ban rubber bands and electric scooters from medicare. These are the types of items that *would* be cheaper if we had an open an free market.
210   justme   2009 Jul 16, 4:56am  

Where are all the doctors? They have become specialists because they can then charge more. It is as simple as that. It's got nothing to do with medicare, government regulations or anything like that.
211   freddy22122   2009 Jul 16, 5:13am  

Some Guy says
d3 says
Some Guy says
d3 says
The problem is that over regulation as scared of family practitioners. If you want to get a shot you are forced to go to an emerancy room which costs both them and you more money.
Huh? What does government regulation have to do with a doctor being too busy to see you?
The relationship is fairly indirect, but it does exist. From my understanding, for Medicare a lot of specific treatments ie vaccines, there is price setting that is in effect which prevent a doctor from refusing certain treatments and charging more than a set amount for that treatment. Doctors will often have to take loses to provide certain treatments. Also depending upon the area the doctor serves he may have even greater limits to what he is allowed to charge for certain treatments.
I don’t believe that’s true. It may be true that Medicare will only reimburse the doctor for a certain amount, but that doesn’t mean he can’t charge whatever he wants. Unless you are on Medicare, the limiting factor is usually going to be your PRIVATE insurance company. The insurance company decides how much a given procedure is “worth”, and will not pay the doctor more than that amount. Sorry, but you can’t blame the evil government for that. And even then, you still haven’t explained what any of this has to do with a doctor being too busy to see you.
There are a ton of regulations on what a doctor can charge for medicare. The federal government has a cap of 15% over standard allowable rate for a doctor that does not accept assignment (although most do). In addition most states have even tighter regulations on how much a doctor can charge over assignment for medicare. The issue here is around the fact that a doctor couldn't be seen immediately. I know that the local family practice clinic I go to I can always be seen the same day, but they charge me $150 / yr for the privilege of seeing doctors at their practice. Without government interference you can start to see more models like this one. Where the government really needs to step in, is in creating transparency in pricing for medical procedures and visits.
212   mikey   2009 Jul 16, 5:40am  

I think Sarah was being facetious with that VP comment. Everyone knows that the veep is second banana but that job doesn't exactly have a bunch of appeal. Some swingers around here seem to consider her the gorilla their dreams and I'm sure they wouldn't mind monkeying with her tail if the time was ripe. Well, at least this Chiquita isn't on the Dole and doesn't act like a fruit.
213   sfbubblebuyer   2009 Jul 16, 5:43am  

Cheaper than a lapdance!
214   ch_tah2   2009 Jul 16, 5:55am  

It's not just down south: "Northern California home sales highest in three years as prices rise 3 percent" http://www.mercurynews.com/ci_12851341?source=rss For all of the talk about it being impossible to get a mortgage, there seem to be a lot of people buying. Where do they get their money?
215   Misstrial   2009 Jul 16, 6:07am  

camping: "For all of the talk about it being impossible to get a mortgage, there seem to be a lot of people buying. Where do they get their money?" I was told by my investment manager that its hedge funds and REITs buying properties that they intend to resell later for profit. Kind of like "institutional flipping".... Individuals and couples - yes them too. They are buyers who are going for State and Federal incentives ($8k, $20k in Cali if you buy a new home from a builder. Not sure if that program is still going on though). Buyers are using the incentive in lieu of a traditional down that they've saved, so we're heading straight back into the same situation as before where a buyer gets seller assisted financing or some other funny-money arrangement that allows them to bypass time-tested avenues of market entry. Sorry for my simplistic response regarding individual buyers/couple and the "incentive" monies - I read up on this several months ago and seeing the absurdity of it all I've just set it all aside in my mind as junk financing to uncredit-worthy borrowers. However, these are the folk that vote for the politicians that provide this sort of thing. Gov't wouldn't do this unless it worked. Just look at the numbers in Congress who got re-elected. Tells you something, No???
216   ch_tah2   2009 Jul 16, 6:47am  

The REITs and hedge funds part makes sense. I'm curious what percentage of the market is them though. As for individuals/couples, assuming we're only talking about non-new homes, only the $8k applies. I believe that also has an income cap of $150k (for couples). In the Bay Area, many of the homes I'm seeing go sale pending are $500k+, so $8k doesn't go very far towards your down and also if they technically can afford a $500k+ house, they should probably be over the income limit anyway. Something doesn't make sense.
217   Misstrial   2009 Jul 16, 7:05am  

"I’m curious what percentage of the market is them though." That I do not know, but what he has told me is that the hedgies and REITs are buying huge blocks of foreclosures directly from lenders, say 1000 residences at a time such as in PHX for example. Prices vary but generally are below 20 cents on the dollar. Some individual investors are doing this too: buying a property at auction for $10k and turning around and selling it for $60k. Sorry, I don't know how many of these form the percentage of RE sales. "also if they technically can afford a $500k+ house, they should probably be over the income limit anyway. Something doesn’t make sense." Yep, another problem to deconstruct.
218   angrish   2009 Jul 16, 7:13am  

Actually, understanding the math, as the market continues to contract, the median price will actually move UP, not down. Weird huh. The problem is the word "median". If 10000 houses sold last year for 200K, the median is 200K. If one house this year sells for 220K, the median is 220k, a 10% rise in prices. Now that we all know why median is a screwy statistical measure in an illiquid market, let's see why the median is actually about to move UP as house prices decline. Think of people in Jumbo territory. That market has come to a virtual halt. People can't get loans big enough to pay for the prices the delusional owners are asking for. So only the low end homes are selling. Let's say unemployment goes up a bit. The few on the border of jumbo-conforming that lose their jobs will go "Screw this, take a lil haircut, and this place will sell cos a bank'll make this loan". And then all the homes that were hiding behind the jumbo bushes come out to play. The prices will be lower than what the owners were originally asking for, but the median home price in that area will actually rise. Using economic statistics designed for functioning markets during a crisis is like driving off a cliff and looking at your speedometer to see how fast you're falling.
219   Misstrial   2009 Jul 16, 7:24am  

angrish: Yes I agree with you. As Option ARMS and Alt-A's reset, the median will go up simply because many of these properties coming on the market are mid to upper end having been purchased by buyers with better-than-subprime credit histories in mid to upper-end neighborhoods. Although I think the median will go up, eventually it will (I think) go down simply because the fundamentals in our economy are not there to support former pricing. Jumbo loans aren't being made, generally as before. So up then down.
220   angrish   2009 Jul 16, 7:27am  

Agreed. See how the media plays the first "up" move though. It'll be quite a spectacle.
221   ch_tah2   2009 Jul 16, 7:45am  

The math isn't what is confusing. What is confusing is how everyone supposedly has no money, banks aren't lending, etc. etc., yet every listing of houses that I look at has a significant number "sale pending" right now and the other part of the news article comments on the number of sales which is up by a large amount. Theory (people can't afford to buy) and reality (people are buying) are not meshing.
222   angrish   2009 Jul 16, 7:53am  

I couldn't find the LA times article on it, but I found a few others. All the rises are in "%" m-o-m. 1 sale rising to 2 is a 100% jump, so that's says nothing. It definitely doesn't say "people are buying" in any statistically significant number. And the article I found says exactly what I said above, high-end distress. I guess the "price rises" have started. And you were right the first time. People don't have money, and banks aren't lending. It's just that the numbers are so small, that everything is noise.
223   ch_tah2   2009 Jul 16, 8:03am  

From my quoted article above: "DataQuick also says 8,644 homes were sold in the region in June, the highest number in almost three years. The figure was up more than 16 percent from 7,447 in May and more than 20 percent from 7,178 in June 2008. " I'm not sure how many sales there should be in a typical market, but according to this: http://filelibrary.myaasite.com/Content/1/1403/4545338.pdf there were 10,492 in 2003 and 14,104 in 2004. Obviously, we're way off of 2004, but unless you label 2003 a down year, 8,644 isn't a huge difference from 10,492. We're certainly not talking 1 going to 2. I want to believe you are correct, it's just hard when everything I actually see tells me otherwise.
224   greatrate2008   2009 Jul 16, 8:04am  

It really depends on what listings you are looking at. It is really not shocking that all of the lower end listings are getting sold so quickly. On dqnews.com, it states that the average mortgage payment on a new loan taken out in the bay area is around $1500 per month. Thats a very low number when compared to rent in the bay area. To relate that to the purchase price of a house, $1500 a month can buy you a $225,000 house with 3% down on an FHA loan. The total payment would be slightly over $1500 a month. Someone only needs to make $3600 a month before taxes to qualify if they have no debt. Not to mention all of the investors competing for these same houses which they can cash flow right away. The median was a deceptive number on the way down and it will be a deceptive number on the way up. Based on the numbers from Data Quick, the median in the bay area is now up 21% from a low of $290,000.
225   greatrate2008   2009 Jul 16, 8:11am  

angrish says
And you were right the first time. People don’t have money, and banks aren’t lending. It’s just that the numbers are so small, that everything is noise.
These numbers are very insightful http://dqnews.com/Articles/2009/News/California/RRCA090716.aspx 44,167 sales in the state of California in June The average sales number in June dating back to 1988 is 50,698 The numbers are not small. The peak was 76,669 in 2004
226   angrish   2009 Jul 16, 8:14am  

Thanks for the numbers. There was a 3 month moratorium on foreclosures. once that finished, they got swept off the market. That number was bound to bounce. Add it up for the first half of the year. That might be less "noisy"
227   greatrate2008   2009 Jul 16, 8:20am  

angrish says
Thanks for the numbers. There was a 3 month moratorium on foreclosures. once that finished, they got swept off the market. That number was bound to bounce. Add it up for the first half of the year. That might be less “noisy”
So you are saying that the moratorium on foreclosures has caused the increase in sales? I dont follow it. It seems likely to me that sales have increased because prices have fallen...Econ 101. Your comments were that people dont have money and banks arent lending but the statistics are contrary to that. Sales are up dramatically from those lows. EIther people are getting loans to buy those houses or they have enough cash to buy them without loans
228   angrish   2009 Jul 16, 8:21am  

Haha. What's Patnet?
229   angrish   2009 Jul 16, 8:23am  

Falling prices definitely contribute to rising sales. But they're not the only factor. It's like someone holds your nose and mouth closed for 2 minutes and then lets go. The next breath is bound to be bigger than it otherwise would've been. Sure, people breathe in general, but the artificial constriction caused the larger than normal breath.
230   ch_tah2   2009 Jul 16, 8:42am  

angrish says
. Sure, people breathe in general, but the artificial constriction caused the larger than normal breath.
I'm not sure that makes sense. If there are less houses available, you would think less sales would occur. If I have 5 apples to sell, at most I sell 5. If I have 500 apples to sell, I would likely sell more than 5. I don't know much about econ, so maybe there's more to the story.
231   angrish   2009 Jul 16, 8:46am  

It's not about less sales. It's about the number of sales "in June". Say you sell 5 apples every month from Jan to June in a year. The next year, you're prevented from selling apples from Jan-May, and then sell 6 in June because people are craving apples, and since they haven't spent any money on apples all year, they have more "apple money" lying around for the month. They may be poorer in that they can no longer spend money on 5 apples for 6 months, but they can definitely spend money on 6 apples for one month. You've actually sold more in June, but the actual number of apples you sold this year are way off. And your May to June number is actually astounding. These are only m-o-m and y-o-y stats. The cumulative would be less noisy, I think.
232   angrish   2009 Jul 16, 8:48am  

Btw, I'm no econ major either. Just common sense, which is why there're probably a lot of holes in my theories.
233   ch_tah2   2009 Jul 16, 9:10am  

I see what you are saying, but I'm not sure if the moratorium had the effect you are assuming. The inventory was actually higher in Jan/Feb than it was in May/June (at least in the areas I've been watching). The moratorium was on foreclosing obviously, not purchasing, so people didn't necessarily need to hold their breath while the moratorium was in place. On top of that, CA had its own moritorium that started June 15th. I'm not sure how that would fit into your theory. We're talking absolute numbers here. 8,600+ sold in June 2009. 10,400+ sold in June 2003. These numbers are not that far off. The bottom line is that according to news article after article: banks aren't lending and people have no money...obviously banks lent to a portion of the 8,600 entities in the Bay Area which means theory/news is different from reality. Maybe it is mostly REITs and other big companies; I don't know.
234   Austinhousingbubble   2009 Jul 16, 9:12am  

EIther people are getting loans to buy those houses or they have enough cash to buy them without loans
There are a LOT of folks who are still sitting on their bubble equities. Don't omit them as a factor. If they didn't move from CA to Austin and pay for their 500K house in cash, they are likely diving back into the market there in CA. There is no big secret. Almost no one has any money right now, unless it's funny.
235   angrish   2009 Jul 16, 9:17am  

Inventory was high, but with foreclosures looming, I know if I was looking to buy a house I'd wait for the 3 months worth of foreclosures to hit the market. The moratorium that started in CA on June 15th will show up, if I'm right, as a spike in Sept sales, when the 3-months worth of foreclosures hit the market. (assuming they dont extend the moratorium). The second para though, I'd still say the same thing. To make an extreme case, 0+0+0+0+0+8600 would much less than ~10+~10+~10+~10+~10+10400. What I'm fishing for, if someone has them, are the numbers for the sales y-o-y for the last 6 months...or at least from March onwards when then moratorium began. Banks aren't lending. Even if there's any lending, it's all Fed and Treasury lending, either directly or thru Fannie/Freddie. That's why the jumbo market is frozen. Banks are only "making the loans" that they know will be taken off their books by Fannie Freddie. So they do technically "make the loan", but it's taken off by Fannie and Freddie, or ultimately, by you and me.
236   angrish   2009 Jul 16, 9:33am  

Weird, it didn't strike me PatNet was patrick.net. I guess since I've only ever clicked on links to get here, the name of the place never really sank in.
237   Patrick   2009 Jul 16, 9:39am  

Hmmm, maybe I should sell patrick.net T-shirts with catchy anti-debt slogans. So far I've resisted advice to put the ads more in the way to get clicks, since this is all kind of a personal mission rather than a business. But T-shirts seem like a fair thing to sell. Anyone know a quality maker/printer that won't take 95% of revenue? I tried Cafe Press, but gave up immediately upon complaints from buyers. And Cafe Press overcharges and keeps most of the money.
238   ch_tah2   2009 Jul 16, 9:41am  

@angrish I think the pent up demand came from the slightly higher mortgage rates which were then pushed extremely low by Fed. That makes more sense. But that's a side story. It doesn't matter who is lending, someone is lending since 8,600+ people didn't all pay cash for their homes. So the statements that people can't get loans does not appear to be true. I don't know where to fit this in, but a couple of more points to consider. The link I posted said the % of homes sold that were REOs was actually lower this month than previous months. So the argument that everyone was waiting for and is buying foreclosures may not be valid. Also, every REO I've attempted to offer on in the last few months has required at least 20% down. So any discussion of FHA 3% loans is irrelevant if the argument is that people are buying REOs (unless those requirements have changed). If 20% is required for these REOs, people have money.
239   angrish   2009 Jul 16, 11:20am  

I agree with the first statement. And you're right...people do seem to be able to get money. How much, isn't clear. But money's definitely flowing ever since the fed started it's printing press.
240   justme   2009 Jul 16, 11:49am  

>>Where the government really needs to step in, is in creating transparency in pricing for medical procedures and visits. Something we can all agree on?
241   OO   2009 Jul 16, 12:27pm  

elliemae, the physical therapy rehab facility are always keeping the seniors for the max time Medicare allows. I have never seen one senior getting discharged after 3 days even though the injury is minor. There is so many Medicare abuses that this is not even funny. I understand what you mean by Medicare reimbursing far less. But the problem is, those of us who are not on Medicare, if one day we lose our jobs along with our insurance, will have to pay sky-high prices that is not a Medicare-negotiated price. Medicare is able to compress reimbursement because WE ARE PAYING THE DAMN DIFFERENCE. Medicare is a transfer system in which We subsidize the senior's lifestyle. If we abolish Medicare altogether, first of all, the major consumers of the medical system will have to shop around and drive the price down. Now, the seniors are going to hospitals and doctors left and right because it only cost them ~$15 co-pay so they are essentially using doctors as psychologists to talk about their personal problems. If the biggest component of the medical market does NOT care about price at all, those of us who rarely use the medical product will have to suffer. And we pay for the FXXXing Medicare. That's why I said either we have universal coverage for everyone based on the principal of equity, so that those who PAY for the system get to use the system as well, or we just adopt completely private medical system and let the poor old seniors go the natural way. I am fine either way.
242   Fireballsocal   2009 Jul 16, 2:01pm  

I have had no problem getting pre-qualified. I haven't sealed the deal yet so I don't know what hoops I'll need to jump through. By the numbers though, I should have no problem. First time buyer, credit score of 714, zero debt, 10% down on a 200K loan in Southern California, conventional. There is plenty of money out there for those that qualify so I'm assuming many more qualify then we expected. No house for me though. I'm not willing to buy at todays prices. Another 12-15% drop in the Inland Empire will push me into the market. Lets see if it happens in the next few years.
243   srla   2009 Jul 16, 3:54pm  

I will say that at least this L.A. Times reporter, Peter Hong, is honest enough to admit he recently bought a house and thus stands to profit from any price uptick. Of course, this hardly makes up for his unabashed industry cheerleading and bias. The L.A. Land blog, which he now partially runs, has really gone down hill too since he took over from Peter Viles. Numerous recent comments to his blog have predicted this very type of false uptick in median prices, explaining (as DataQuick did in its press release this week) that the increase in median would reflect a SOFTENING of the mid and upper price ranges. Peter H., it seems would rather ignore this reality and instead trumpet a "home sales price surge". Apparently some people learned absolutely nothing from the abysmal reporting that fed the bubble frenzy and helped get us to this point in the first place. Sad.

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