Before you know what you’re doing, you don’t know what you’re doing. And other people see it. That’s why being a newbie on the job can be such an excruciating experience: if not in reality, at least in the imagination.
At the beginning of my entrepreneurial adventure, I was your standard-issue progressive, waxing poetic about social justice while looking down on"corporate America". Judged people if they "looked Republican". Wouldn't date men who were "right-wing". I was even a Democratic Socialist of America.
First, I want to acknowledge that Trump supporters are not a monolithic group. They may stand by their man, but that doesn't mean they agree with everything he's doing. For instance: tariffs. …That said…
In most cases, lower inequality and higher GDP per capita were associated with higher levels of flourishing…. And then there's Slovakia and Slovenia: more equal, less affluent, and not yet flourishing. And then there's Russia…
When you're hot and sweaty and there's no relief, it's hard to have the energy or inclination to pursue challenging goals. Or just to get stuff done.
“…Happiness was linked to being a taker rather than a giver, whereas meaningfulness went with being a giver rather than a taker. Higher levels of worry, stress, and anxiety were linked to higher meaningfulness but lower happiness." Baumeister, Vohs, et al. (2013). "Some key differences between a happy life and a meaningful life."
…a 31% cut would get us to Denmark, which is good enough for me. The revised goal, then, would be to reduce annual healthcare spending to $2.3 trillion. In other words, we're looking for savings of a trillion dollars. Let the calculations begin!
…3. Increase federal and state budgets for the detection and prosecution of fraudulent medical billing, such as upcoding. 4. Greatly expand the number of nurse practitioners working as "full practice" primary care providers and gatekeepers, a status that allows them to work independently of a physician's clinical oversight. 5. Institute a no-fault medical malpractice system, much like the very successful one in Denmark. …
Take MRI scans, which cost about $1500 in the US. In Japan, the fixed price for an MRI scan is around $100 (depending on body part). Now you'd think that Japanese doctors wouldn't do that many MRIs because they couldn't make any money off them. But no - just the opposite: Japan leads the world in MRIs. What happened is that Japanese doctors asked MRI manufacturers to develop an inexpensive MRI scanner. And they got a cheap machine so they can do cheap MRI scans and still make a little profit. Sometimes the heavy hand of regulation can be a spur to innovation. …I say this as a lover of capitalism, for whom the word "corporate" elicits a sigh of gratitude.
Between the government and private insurers, medical office personnel spend an inordinate amount of time processing bills. What is reimbursable, what is not? What type of documentation is required? What billing code should we use? How much can we charge? And that is one big reason the US spends so much on healthcare administration. Time is money.
Doctors typically get a cut of the profits and that provides incentives for expensive care and/or high premiums (in the case of HMOs). Add in the relative ease of gaming the billing system, and you've got a recipe for out-of-control healthcare spending. It doesn't matter if the medical bills are paid by Medicare or private insurers. If the system of payment can be gamed, it will be gamed.
Last post was about outpatient services, specifically how reimbursement rates and physician profit-sharing arrangements contribute to the cost of outpatient care in the US. This post will address the cost of pharmaceuticals…A recent JAMA study ( Papanicolas et al, 2018) found that annual per capita spending on pharmaceuticals in the US was $1443, compared to an average of $680 for ten other developed countries.
…Thus, if you want to understand why these procedures cost so much, follow the reimbursement rates. For instance, in 1997 Medicare raised reimbursement rates in certain parts of the country. On average, areas with a 2 percent increase in payment rates experienced a 3 percent increase in care provision. Physicians charge what they can, and then some.
Given that old people consume way more healthcare than anyone else, why do other rich countries spend so much less on healthcare than the US, when the US has comparatively fewer oldsters? Something is very wrong with this picture. What is all that money going? … A lot is paying for outpatient care and administration, which alone account for half of US healthcare expenditures
What does this actually mean, though? That permanent housing be available at the snap of one's fingers, anywhere in the US? Not realistic. Maybe in Finland, but not here. There is no basic right to live in the community of one's choice. Small town USA is off the hook here.
Unfortunately, residential hotels are becoming a relic of the past. For instance, San Francisco had 65,000 residential hotel units in 1910; today there are only around 19,000 units. If we really want to get serious about reducing urban homelessness in the US, we need to bring back residential hotels. Of course, I'm talking new, improved residential hotels, with support services available to all residents.
…For instance, single resident occupancy (SRO) rooms are just 80 square feet, enough for a bed, dresser and little else. San Francisco’s largest SRO hotel has 248 units. It would take 30 such SRO hotels to house the city’s current homeless population. That’s a lot of new buildings taking up a lot of valuable real estate in a city that doesn’t come close to meeting the housing needs of its low- and middle-income workers.
In other words, rats make choices based on what they want and what they consider possible. They imagine the future, weigh the relative merit of different actions, seek additional information if needed, choose what to do, and then act. They are agents with desires and goals.
Homeless advocates are coalescing around a "housing first" approach to ending homelessness. The idea is to transition homeless people to permanent housing as soon as possible, ideally within a matter of weeks. Formerly homeless tenants would receive ongoing needs-based support, contributing a portion of their income to the cost of housing and services.
The big coastal cities, such as Los Angeles and New York, have contributed the most to this increase in homelessness. A large majority of the US homeless are individuals without children (e.g., 92% in San Francisco) and most are mentally ill, physically disabled, and/or abuse various substances.