I've decided to expend my energy in the real world with real people using their their real names. Too much at stake to waste my time here this election cycle. Y'all have fun!
I've decided to expend my energy in the real world with real people using their their real names. Too much at stake to waste my time here this election cycle. Y'all have fun!
Too much at stake to not waste time in a music or fitful prognostication thread though. Yin/yang, you know. lol
I've decided to expend my energy in the real world with real people using their their real names. Too much at stake to waste my time here this election cycle. Y'all have fun!
I've decided to expend my energy in the real world with real people using their their real names. Too much at stake to waste my time here this election cycle. Y'all have fun!
I believe this comment is what sparked this discussion. To your reasonable questions...I'm generally in line with the belief that the top few % could throw more into the bucket.
I dont think a proposal to tax unrealized gains is realistic (for various reasons) and that there are better ways at getting that share.
We are generally in agreement. I also don't think this will come to fruition, but for different reasons. To me, this is a lot like the 95% tax brackets in the 50's. No one paid it, or at least not very much. If you have this much money rolling in, it's better to put it to work than to give it to the government. So what the wealthy did was invest the money in new factories, new technologies, paying their employees a wage that allowed a single earner to have a family with a house in a nice suburb... All things that are not being done today as the ultra wealthy horde their piles of gold in a mountain.
Money only works when it's in motion (it's value is in our agreement of it's worth for exchange), it's not a trophy to show off. This is just a way to force that money into motion, which is exactly what government should be doing - ensuring the smooth operation of the economy.
I know some really high net worth individuals. Through my work I've met some at the very top. I interviewed for a family foundation position with one of the world's wealthiest people (you all know his name). After months of process I didn't make it (they actually canceled the project I was hoping to work on), but I never got to sit down with them personally. Through all of this I might have actually met 1 or possibly 2 of the people that would be impacted by this tax. They wouldn't remember talking to me. The idea that this is a broad impact is laughable. The idea that this is what would cause them to 'flee the country' is absurd (they do what they want regardless).
nah.. JS is criticising the Democrat media team more than KH here. And the YouTube guy is trying to stretch this into a criticism of her personality (or lack of it).. pretty unconvincingly IMO.
She's got the credentials.
...
People should not have to spend their retirement calculating healthcare receipts. There has to be a better way, but those who benefit from the current system are going to hold on tight, and no group of politicians are going to fix it without a mandate from the vast majority of Americans. When 1 in 6 works in healthcare...everyone knows someone who would suffer from a streamlined medical system. It's the same for tax reform. Far too many people make a living helping others navigate the complexity. TurboTax could be nationalized and billions would be saved...but nobody will do it. Bush got close...and then Intuit wriggled off the hook.
I know we disagree on almost everything here...but I don't think it's in the goals. It's in the delivery. You feel that companies should be allowed to fix a lot of these problems and that the government should be smaller. Having spent time in the 3rd most valuable company on the planet (when I joined), I think the notion that companies truly want to fix things is preposterous. They only want to make money....and use the "American Dream" as a cloak to hide their greed and mixed motivations. In the end, I think government has to run programs that effect all citizens, but they need to do so efficiently and effectively.
Not sure if Government should run all, but definitely regulations are a necessity. Corporations (People?) and their Money (Speech?) is an abomination.
They can bill for whatever they want but Medicare has a set fee that they pay to everybody and it is has to accepted by the provider, if you want to be an official Medicare provider. The patient is only liable for their copay.
...
Total billing is $15,202.90 The Clinic gets $2,219.60 and writes off -$13,094.92 14.59%
My cardiologist was billed at $423 for the visit, MC paid $23.22 and I had a $40. copay 14.89%
My pulmonologist was billed at $624. for a hi, how ya doin ? MC paid $52.82 and I had a $40 copay. 14.9%
....We did our own filing for Social Security Disability and succeeded on the first attempt for both of us. We managed all the hoops properly. Most people seem to need attorneys to do it, from watching TV.
Sigh.
So I noticed a trend in reading your itemized list... the providers are recovering roughly 15%. The amount of aggravation, abuse, and error now built into the system is diabolical. Healthcare is roughly 18% of GDP and 14% of employment in the US. A lot of people make a living on the inefficiency. If you could snap your fingers and fix everything tomorrow, you'd be blamed for widespread unemployment and the drop in GDP.
People should not have to spend their retirement calculating healthcare receipts. There has to be a better way, but those who benefit from the current system are going to hold on tight, and no group of politicians are going to fix it without a mandate from the vast majority of Americans. When 1 in 6 works in healthcare...everyone knows someone who would suffer from a streamlined medical system. It's the same for tax reform. Far too many people make a living helping others navigate the complexity. TurboTax could be nationalized and billions would be saved...but nobody will do it. Bush got close...and then Intuit wriggled off the hook.
I know we disagree on almost everything here...but I don't think it's in the goals. It's in the delivery. You feel that companies should be allowed to fix a lot of these problems and that the government should be smaller. Having spent time in the 3rd most valuable company on the planet (when I joined), I think the notion that companies truly want to fix things is preposterous. They only want to make money....and use the "American Dream" as a cloak to hide their greed and mixed motivations. In the end, I think government has to run programs that effect all citizens, but they need to do so efficiently and effectively.
But I think we agree all of this is insane, and nobody before us is really up to the task of fixing this.
PS - I can't imagine lawyers (or anyone) running ads suggesting they aren't needed.
I worked on a data project recently for a start-up healthcare tech company, and their billing rates for Medicare were 4X the private insurers...because it can be. Medicare and Medicaid should pay the lowest price negotiated by anyone else.
They can bill for whatever they want but Medicare has a set fee that they pay to everybody and it is has to accepted by the provider, if you want to be an official Medicare provider. The patient is only liable for their copay.
Here's the breakdown on my IVIG for example:
Total billing is $15,202.90
The Clinic gets $2,219.60 and writes off -$13,094.92
My copay is $493.83 which I pay until my out of pocket expenses reach $5,500 for the year. My LLS grant will take care of $4,000 of that. This does not include out of pocket for ordinary pharmacy purchases. I have a PPO Advantage plan, same one for at least 7 years going forward.
Since my first round in April, the cost of the actual medication stayed pretty flat but the administrative professional costs went from $2,001.00 in April to $2,406 the next month going forward. My bloodwork costs $103.00 but the last round we ran a count for measuring the effects of the treatments. That cost was an extra $600 but Medicare did not cover that, Their payment was the same $2,219.60
My cardiologist was billed at $423 for the visit, MC paid $23.22 and I had a $40. copay
My pulmonologist was billed at $624. for a hi, how ya doin ? MC paid $52.82 and I had a $40 copay.
These gross amounts actually reflect what the self payers pay for these services.
The clinic wrote off $890.96 between the two. For my treatments ,they effectively write off the cost of the med itself which is $12,689 per. Where does this "money" come from ? Is the markup so much that the Clinic is at least breaking even ? What is the tax write off benefit ? You're the expert. There is no tax benefit for that "loss" that I am aware of. We have the same kinds of loss at our stores. They do not get a write off on that as far as I know.
The point is that you can bill for whatever rate you want with Medicare but it does nothing to the payment. Private insurers have similar arrangements with providers.
And there is another part called UC, which stands for the Usual and Customary Charge. That is a digest based upon regional surveys of providers to see who charges what for a procedure and then determines the payable rate based on UC, which affects both patient and provider as to who pays what part of the total. That is a whole nuther rabbit hole.
Another problem to the insured on Medicare Part D is that the annual total is based on the pharmacies retail prices in regards to hitting the donut hole. Sure, the copays are the same but if pharm A has a retail price for med that is $100 and pharm B has the same med at $75 you would want to use pharm B for that particular med. That keeps your annual total down and out of the donut hole for longer. But you have to shop around and find out what the retail price is at Walgreens, CVS or Walmart, and others. There is a difference. Takes work and you have to be willing to have several different pharmacies, which is bad. You want all your meds in one place incase of an interaction, it gets flagged automatically. You roll the dice with having more than one. Especially if you use providers in two or more different networks. You have to do the homework yourself. Better to find out immediately so the doc can write a different Rx sooner. The more and more that Epic / My Chart gets implemented the more info shows up from all your providers in one place regardless of network. All three hospital systems here in Cleveland can now see and talk to each other online.
And the FWIW part, I figure that over the soon to be past 16 years, my billing total is north of $3 million for this ongoing experience. With the IVIG that itself adds another $180,000 annually let alone the other already ongoing expenses. I'm not a babe in the woods. We did our own filing for Social Security Disability and succeeded on the first attempt for both of us. We managed all the hoops properly. Most people seem to need attorneys to do it, from watching TV.
