When visiting Shrewd'm with a laptop, it can be pleasant to hold Command (or Ctrl with Windows) and '+' a few times. The site scales to allow any font size, and the larger font can be pleasant to read even for Shrewds with perfect sight! For luxury Shrewdness, you can combine that with setting the browser to full screen. You'll then find yourself Shrewding a lot.
- Manlobbi
Halls of Shrewd'm / US Policy
No. of Recommendations: 7
No. of Recommendations: 4
One thought about using any AI system for advice on anything that involves money, either buying products, or investing, what assurance is there the model has not been "trained" to direct people toward certain products, the same way search engines are trained to direct people to certain sites?
We had quite a discussion on the Policy board about costs and corruption in health care. I was using numbers from the Google "net sifter", but invited anyone to bring other numbers. No-one did.
Steve
No. of Recommendations: 0
I was using numbers from the Google "net sifter", but invited anyone to bring other numbers. No-one did.
Correction: one person brought numbers from the BLS, for health care job classifications, when we were discussing how overmanned the US system is. But, within a few minutes, I found another BLS healthcare classification, that was not included in the chart the other guy brought, and that one classification accounted for nearly 1M additional administrative staff, which begs the question of how many other admin staff are not in the BLS table presented.
Steve
No. of Recommendations: 0
We had quite a discussion on the Policy board about costs and corruption in health care. I was using numbers from the Google "net sifter", but invited anyone to bring other numbers. No-one did.
I chose a different point than you did, but didn't mention my problem of wondering if some care was in a different bucket than health care in France. Couldn't resolve it to my satisfaction.
No. of Recommendations: 5
Couldn't resolve it to my satisfaction.
Things in the US, vs other countries, are so far out of whack, I agree, can't be sure of what you are seeing. France has more docs per capita, and about the same number of nurses. But overall US employment in the sector is far higher, by an additional 7% of the US workforce, 11-12M people. French docs are paid a third what US docs are paid, but the French docs report better job satisfaction and better work/life balance, because the US docs get ground down by administrative overhead and bureaucracy. Then there is the eye-popping amount of fraud in the US, against both government programs, and private insurance companies. And the fraudster CEOs don't go to prison. The fraudster CEO of Columbia/HCA, going on to be elected Governor twice, and now sits in the Senate, instead of Leavenworth. I kept rechecking the numbers the net sifter was giving me, and my math. $875/person/year, in the US lost to medical fraud, vs $116 in France and $25.22 (yes, twenty five dollars and twenty two cents) in the UK? What? You want to think you are missing something, maybe a lot of things, because the discrepancies are so huge.
Steve
No. of Recommendations: 0
French docs are paid a third what US docs are paid,
That is not true when you factor in the doctor's medical school costs. Also the US doctor educates his or her children.
AI
Studying medicine in France is very affordable at public universities, costing EU/French students only a few hundred Euros (around €200-€450/year plus fees) for tuition, while non-EU students face higher, but still subsidized rates, often around €2,770-€3,770 yearly, though some universities offer exemptions; private options are significantly more expensive, ranging from €8,000 to over €20,000 annually. The main costs will be living expenses, which vary widely, and the long duration of study with limited income.
No. of Recommendations: 2
That is not true when you factor in the doctor's medical school costs. Also the US doctor educates his or her children. Yes, we covered that in the thread on Policy. Average French doc brings in about $100,000/yr, vs $300,000 in the US. But the US doc has a pile of student loans to pay off, while the French doc's education, as you said, cost little or nothing.
The US is headed for another medical problem. The current administration has decreed that nurses are not "professionals", so nursing students only qualify for a lower student loan limit, vs "professionals".
Trump administration says nursing isn't a professional degree amid new limits on loans
The new student loan caps take effect in July. Here's what that means for students looking to pursue advanced nursing degrees.
Previously, graduate students could borrow federal loans up to the cost of their degree, but under the new proposal, there would be caps on loans based on whether students are enrolled in a program that is considered professional or not.
the U.S. Department of Education said in a Nov. 6 news release. Students in graduate programs will now be capped at $20,500 per year with a lifetime limit of $100,000.
For students seeking a professional degree, loan limits are higher, at $50,000 per year, with a lifetime limit of $200,000, the news release states. The Education Department’s list of professional degrees includes pharmacy, dentistry, veterinary medicine, chiropractic, law, medicine, optometry, osteopathic medicine, podiatry and theology.https://www.nbcnews.com/news/education/trump-admin...Steve
No. of Recommendations: 0
“ For students seeking a professional degree, loan limits are higher, at $50,000 per year, with a lifetime limit of $200,000, the news release states. ”
And that’s nowhere near enough to cover medical school.
No. of Recommendations: 0
And that’s nowhere near enough to cover medical school.
It's enough for a nursing degree, but nurses are not "professionals" anymore.
from the net sifter:
Earning a nursing degree in the U.S. varies widely, from around $7,000-$25,000 for an ADN (2-year) to $40,000-$100,000+ for a BSN (4-year) at public/private schools, with MSN programs costing $30,000-$100,000+, plus thousands more for books, uniforms, NCLEX exams, and living expenses. Costs depend heavily on the degree level, public vs. private institution, and location, but a BSN is increasingly the standard, offering better career growth
Steve
No. of Recommendations: 0
Then there is the eye-popping amount of fraud in the US, against both government programs, and private insurance companies. A
This is the part that caught my eye and I was looking to see if there was something that we consider healthcare that they consider welfare, like end of life home care. But I couldn't tell. That would make the healthcare fraud more balanced possibly. That's the usual type of mistake. It's too large just to accept it without looking for mistakes. Somebody would have written about this by now.
No. of Recommendations: 3
This is the part that caught my eye and I was looking to see if there was something that we consider healthcare that they consider welfare, like end of life home care
From the net sifter:
In France, end-of-life care falls squarely under the healthcare system (part of Protection Sociale), legally guaranteed as a patient's right to a dignified end and relief from suffering, covered by social security and focused on palliative approaches like sedation and treatment withdrawal, rather than being classified as welfare. It's managed within the universal health insurance framework, emphasizing medical support and dignity, not just financial aid
You saw the bit I posted on "Policy" about the CEO of the software company? Apparently, his software generated fake doctor billings, to bilk insurance companies, for about $1B. But he's small fry, unlike the frauds by HCA and Tenet, so he's going to the slammer for 15 years, instead of getting off scot-free, like the hospital CEOs.
It's too large just to accept it without looking for mistakes. Somebody would have written about this by now.
That's the natural impulse, because the numbers are so huge. Why no-one writes about it? Well, they do, when it's Medicare being bilked. But the private insurance companies don't want it publicized, because it would upset shareholders at their breakfast: "You idiots are so sloppy, in spite of the hoops you jump honest customers through, that you get scammed for Billions every year?"
Steve
No. of Recommendations: 6
A lot has to do with a lack of imagination - and where one lives.
One option is to head off to Europe where, assuming you are bright enough to qualify, from the standpoint of American costs, a college education (through post-graduate school) is essentially free.
Another idea is to take a bite of the Big Apple.
Well over a century ago, my grandfather, as an immigrant child, clawing his way out of the slums of the Lower East Side attended The Cooper Union to get a free electrical engineering degree (during which time he started his first business). Founded by Peter Cooper to provide free education, but a financial crisis led to charging tuition in 2014. All students since then have been paying half-tuition or less. The school is going back to free tuition by 2027. It is one of the top engineering, architecture and arts school in the country.
Both my father and mother, as well as my sisters and wife attended the City University of New York for most of our degrees (I think one of Wendy's is from another institution and were additionally subsidized by assorted scholarships. The University offers a broad swath of programs including engineering, medicine, law, business - and about every other type of degree you can imagine.
The CUNY system was traditionally free, but when I went there, there was a nominal tuition (I'm guessing about 10% of current prices).
Today's prices:
NY State Residents (Full-Time Community College): ~$4,800/year
Out-of-State/International (Full-Time): ~$18,600/year or $620/credit
Part-Time (NY Resident): ~$305/credit
Undergraduate Tuition (Estimated, 2024-2025)
NY State Residents (Full-Time 4-Year): ~$6,930/year ($3,465/semester)
Graduate Tuition (Estimated, 2024-2025)
NY State Residents (Full-Time): ~$7,365/semester
Out-of-State/International (Full-Time): ~$1,005/credit
Financial Aid: Many NY residents attend tuition-free through programs like the Excelsior Scholarship, which covers tuition for families earning under $125k
So, in our case, our family has benefited for generations of essentially free, world-class education through post graduate levels and while most of us also worked during our student years, to the best of my knowledge, none of us went a penny into debt in order to obtain whatever education we desired.
Sure NYC has the highest taxes in the country, but it also has the best and most varied university, mass transit system, artistic centers, financial center and multi-ethnic environment of any municipality in the country (and, while Paris, London and Toronto veer in the same direction, I would say in the world).
So, the simple answer is, if you want an affordable education system, it simply has to be paid for with taxes.
Jeff
No. of Recommendations: 2
Today's prices:
I have posted the charts before, how Michigan has largely defunded higher education. In the 70s, public university students in Michigan paid about a quarter of the cost of their education, with the state picking up the rest. Now, the students pay about 70%, while the state covers 30%. Meanwhile, water bottling companies pump a few million gallons per day of water from the aquifer under the state, and only pay a $200/year permit fee. Can you imagine Texas giving oil companies a free ride like that? Michigan is also the trash destination of the Great Lakes region. The State tip fee in Ohio is $4.75/ton. Indiana 50 cents/ton. Michigan 36 cent/ton, because "must not burden...."
Steve
No. of Recommendations: 0
The United States is at the height of mismanagement right now.
No. of Recommendations: 0
In France, end-of-life care falls squarely under the healthcare system (part of Protection Sociale), legally guaranteed as a patient's right to a dignified end and relief from suffering, covered by social security and focused on palliative approaches like sedation and treatment withdrawal, rather than being classified as welfare. It's managed within the universal health insurance framework, emphasizing medical support and dignity, not just financial aid
Sigh. Steve I did that and ran into that. The difference is that you seem to accept that. I don't accept that quickly, color me skeptical. I use different types of questions at different times. I would expect someone to have written about even private insurers as they report it and are required to report it in most states and also Fed programs. So we end up with statistical projections, ... lies, damned lies, and statistics. I don't buy the reasoning on private companies... but I wouldn't share data that I'm not required to by law or some type of beneficial agreement. And from what I've gathered from what they do report, it's just as bad as Medicaid, etc. Notice I said Medicaid, not Medicare?
Nefster:
Medicare fraud losses are significant, with estimates around$60 billion annually, but exact percentages are hard to pin down, though improper payments (including fraud, waste, and simple errors) in traditional Medicare (FFS) hovered around 7-8% (or $30+ billion) in FY 2024, with fraud being a major component of that, although most improper payments are due to documentation errors, not necessarily criminal fraud.
Key Figures & Estimates:
Overall Loss: Estimates suggest Medicare loses roughly $60 billion each year to fraud, waste, and abuse, according to Senior Medicare Patrol (SMP) and the National Council on Aging (NCOA).
Improper Payment Rates (FY 2024):
Traditional Medicare (FFS): ~7.66% ($31.70 billion) in improper payments.
Medicare Advantage (Part C): ~5.61% ($19.07 billion) in improper payments.
Medicare Part D: ~3.70% ($3.58 billion) in improper payments.
Fraud vs. Errors: A large portion (around 79%) of Medicaid improper payments, for example, are due to insufficient documentation, not criminal fraud, and similar patterns exist in Medicare, say the KFF and Georgetown analysis.
No. of Recommendations: 1
Medicare fraud losses are significant, with estimates around$60 billion annually,
The net sifter attributed about $100B of the $300B/year lost to fraud, to Medicare.
I can understand why no-one wants to talk about fraud. The person in charge has the numbers, but if he tells anyone, it makes him look bad. Or maybe he takes the Sergent Schultz approach: he doesn't ask his staff questions about fraud, because he doesn't want to know. Shareholders might start asking questions, like "how can we pay you $20M/year, when you lose more than that to fraud every year?"
As I said, anyone has different numbers, bring them to the discussion.
Steve
No. of Recommendations: 0
I'd like to know what they mean by fraud? Is it less costly to allow someone to resell medical equipment than to go after them? Is it the medical suppliers are overbilling Medicare? There are several different definitions.
Then I'd like to know how much of the fraud they have gone after all along. It is not like they never lift a finger.
No. of Recommendations: 0
Then I'd like to know how much of the fraud they have gone after all along. It is not like they never lift a finger.
I did a Google search for articles about Humana, Cigna, and United Health "prosecuting fraud", and I only received articles about the insurance companies being prosecuted for fraud. The same question about Medicare, brought a string of articles about Medicare prosecuting others for fraud. Maybe I phrased the question wrong? Maybe insurance companies are not that vigilant about fraud, because they know they can always raise premiums to "make their number"? Maybe the insurance companies keep it quiet, so their shareholders don't see upsetting things in the newspaper?
Steve
No. of Recommendations: 0
Yes, we covered that in the thread on Policy. Average French doc brings in about $100,000/yr, vs $300,000 in the US. But the US doc has a pile of student loans to pay off, while the French doc's education, as you said, cost little or nothing.
It is not just educational debts. French doctors pay less for healthcare. American doctors, like every other American, pay a fortune for their families' healthcare. It adds up to substantial amounts of money.
If you factor in healthcare costs as taxation, American doctors pay more in taxes than other first-world doctors.
The upper middle class buys or was buying long-term care insurance. It is very valuable and very expensive. Another taxation. To maintain savings accounts into deeper old age, married doctors need it. Long-term care is an actual expense we all face: it, too, is inflated here.
