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Sundae posted:In a vacuum, I'm sure CA could negotiate quite sufficiently. Where I think it'll break down is that we have a national government who will gladly ignore every concept of state rights the moment it gets in the way of something they're paid enough to care about. I would gladly push through a single-payer system at state level but expect that, if California did it, it'd run into every possible hurdle and eventually get blocked at federal level. (I'm not saying the state shouldn't still try; I'm just opining my expected outcome.) This is how I think it would go down too. It isn't even clear what happens if California waits for a favorable federal government to attempt it. If the government flips, what penalty do the senators from the Dakotas suffer for later shutting down single payer in California? It would have to be so good that constituents in other states are beating down doors to get it.
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Jul 8, 2017 03:44
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Leperflesh posted:GOOD poo poo. It's kind of damning that we treat prospective healers as disposable min-max labor but that's capitalism for you. I'm reminded of the story i heard about the Admiral (General?) who was placed in charge of the initial creation of the US nuclear sub fleet. Dude was a notorious hardass, super stickler for details, very exacting in all respects. The reason? He knew that they pretty much had one shot at doing this kind of thing, and that even the smallest slip or careless consequence of ignorance could shut the whole thing down. Feels kind of like that.
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Jul 8, 2017 06:01
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The reason why residents and doctors work long hours is that there is an intentional shortage of doctors arranged for by their professional associations which drives doctor's wages up. If doctors only slightly opened the gates and allowed for more people to enter the profession, this problem would go away. Of course, doctors' incredible salaries, guaranteed by virtue of entering medical school, would also go down, and that'd be wildly unpopular with them.
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Jul 8, 2017 10:50
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Yeah American medicine is a lot like a gang. They don't take just anyone and the initiation is long and brutal, but once you're through, you're a made man for life, just so long as you never, ever turn on them.
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Jul 8, 2017 11:04
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silence_kit posted:The reason why residents and doctors work long hours is that there is an intentional shortage of doctors arranged for by their professional associations which drives doctor's wages up. If doctors only slightly opened the gates and allowed for more people to enter the profession, this problem would go away. Of course, doctors' incredible salaries, guaranteed by virtue of entering medical school, would also go down, and that'd be wildly unpopular with them. You're not actually guaranteed an "incredible salary" by entering medical school; you're guaranteed it by entering residency. Residency positions are paid for by federal Medicare funding, and they cap the number of doctors that can enter the field. If more students were accepted to medical school without increasing the number of residencies (which is controlled by the federal government via Medicare funding), all that would increase is the number of students graduating with six figure debts and no jobs. This article isn't particularly deep but it has a bunch of the relevant numbers. Furthermore, offloading the massive costs of medical school onto students really distorts the employment choices that people make. The average medical student graduates with about $200k in student loans. You're never going to pay that back without proportionate salary. This also has the unfortunate side effect of driving people from lower income backgrounds away from even considering medical school because there are many other paths to job and financial security that don't involve hundreds of thousands of dollars of debt. (I can't find an article with publicly accessible statistics, but the number of lower-middle-class / working class students entering medical school has plummeted as med school tuition has risen; it's often less risky to become a nurse, PA, or nurse-practitioner.) And the types of jobs that could probably most use input from a more diverse set of employees to change the culture, techniques, and structure of American medicine -- jobs at major research hospitals -- are exactly the ones that pay the least. e: US physician culture is toxic and the system attracts and produces broken, self-aggrandizing money-grubbing jerks, but fixing this particular evil requires government participation, too, unfortunately. k stone fucked around with this message at 16:19 on Jul 8, 2017 |
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Jul 8, 2017 16:03
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k stone posted:You're not actually guaranteed an "incredible salary" by entering medical school; you're guaranteed it by entering residency. Residency positions are paid for by federal Medicare funding, and they cap the number of doctors that can enter the field. If more students were accepted to medical school without increasing the number of residencies (which is controlled by the federal government via Medicare funding), all that would increase is the number of students graduating with six figure debts and no jobs. This article isn't particularly deep but it has a bunch of the relevant numbers. This is brought up a lot, but I'm sure the doctors' lobby created that regulation. People on this message board like to bring up that regulation and claim that the US government can't pay for more residents to be trained, and that residents have negative productivity at hospitals and so increasing the number of residencies could only be done at great cost, but that doesn't make sense to me. It seems to me that residents could do a lot of useful work at hospitals, and the earlier conversation in this thread is pretty consistent with this. If all residents do is create work for real doctors, then why do they have to work insane hours? It doesn't make any sense. k stone posted:Furthermore, offloading the massive costs of medical school onto students really distorts the employment choices that people make. The average medical student graduates with about $200k in student loans. You're never going to pay that back without proportionate salary. This worry is kind of overstated. Even the most mediocre doctors in the least lucrative fields make a boatload of money, which is guaranteed for life, and will live extremely comfortably, and pay back their loans with no problem. That being said, it would be great to lower the debt doctors need to take on before they start entering their profession, and a good way to do that IMO is to restructure medical school so that it isn't a post-graduate degree and so students can enter after high school. It is pretty inefficient for students to have to shell out money for 4 years of school with only 1 1/2 years worth of relevant pre-requisites before they actually start their training for their profession.
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Jul 9, 2017 03:25
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I non-healthcare news, the wealthy East Bay town of Moraga has declared a fiscal emergencyquote:The community, where the median family income is $169,000 a year, illustrates an irony for some at the center of the California’s latest economic boom. While real estate prices have surged, the local tax collections haven’t necessarily followed the same trajectory because of Proposition 13, the 1978 ballot measure that keeps homeowners’ tax bills from rising by more than inflation or 2 percent a year. As a result, local government revenues are growing more slowly than the rest of the U.S., according to a state analysis, leaving some seeking other ways to raise money.
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Jul 11, 2017 21:06
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snyprmag posted:I imagine people will get frustrated paying a lot less tax than their neighbors.
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Jul 11, 2017 21:35
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snyprmag posted:I non-healthcare news, the wealthy East Bay town of Moraga has declared a fiscal emergency ah so that's why that sinkhole still hasn't been fixed
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Jul 11, 2017 21:42
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CopperHound posted:Either you got that backwards or severely overestimate people's commitment to the social contract. There were reports of boomers were downsizing once their kids moved out, so I imagine a fair number ended up with a higher tax bill on a "cheaper" house. Will another proposition be enough to repeal prop 13, or does it need something special?
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Jul 11, 2017 22:59
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proposition is enough but lmao if you think the democrats are going to put one on the ballot
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Jul 11, 2017 23:01
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Raskolnikov38 posted:proposition is enough but lmao if you think the democrats are going to put one on the ballot Repealing prop 13 wouldn't pass either. A lot of fygm homeowners out there.
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Jul 11, 2017 23:03
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snyprmag posted:Yep, got that backwards. As someone who just got my very first property tax assessment, it included language to transfer your lower tax value to a cheaper house if you are over 55 (maybe 60?). Also, as a property owner, I'm fully in favor of repealing prop 13, we need to loving fund our state
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Jul 11, 2017 23:13
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There's numerous ways you could revise Prop 13 to be less awful, like make it only apply to homeowner's primary residences. The big giveaway of Prop 13 isn't regular folks, who still pay a ton based on their insanely high property values, but businesses for whom property doesn't change hands for decades and thus a golf course in the middle of Beverly Hills pays about as much as a taco bell.
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Jul 11, 2017 23:33
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You're overestimating the voting population. These people were almost swayed by the plastic bag lobby. Imagine how easily they will vote no when they see a commercial with an old lady getting dragged out of her house by Jerry's Brownshirts.
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Jul 11, 2017 23:41
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I guess if you tried to make a repeal only apply to commercial property you'd get the same ads but with Are Small Business Owners, huh.
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Jul 11, 2017 23:47
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Yes. It's a nuanced problem that the legislature is better equipped to deal with, but the democrats are cowards and don't actually want to change anything.
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Jul 12, 2017 00:11
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The Wiggly Wizard posted:Yes. It's a nuanced problem that the legislature is better equipped to deal with, but the democrats are cowards and don't actually want to change anything. But the legislature can't repeal prop 13, even if the Democrats were brave it wouldn't make it happen.
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Jul 12, 2017 00:13
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Trabisnikof posted:But the legislature can't repeal prop 13, even if the Democrats were brave it wouldn't make it happen. well they could amend the constitution to give the legislature that ability but as the end result is still the members of the legislature voting for a tax hike: lol e: hm i just found out my assembly rep was the only republican to vote for the gas tax, maybe that stupid poll she sent out and i answered actually mattered Raskolnikov38 fucked around with this message at 00:22 on Jul 12, 2017 |
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Jul 12, 2017 00:16
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Depending on the local political climate, municipalities and other jurisdictions can often pretty easily pass additional taxes on property (admittedly ad valorem at prop 13 values or by square footage of the lot) to fund sundry matters. That has happened a few times at my residence recently with essentially no opposition. Given the insanity of the housing market there*, it is relatively equitable compromise. *As an aside, new owners basically have to demolish existing structures, build a mammoth house, and commit to short-term rentals or re-sell it to make money, with the result that communities built around long-term renters have been decimated or worse in some areas. So Prop 13 oddly effectively subsidizes long-term rentals here if the original owners don't sell. King Hong Kong fucked around with this message at 02:12 on Jul 12, 2017 |
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Jul 12, 2017 02:04
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snyprmag posted:Yep, got that backwards. There was another proposition which passed in 1986 allowing people over 55 to transfer their taxation value to their new home if they bought again within a year of selling. The boomers are pretty much isolated from that tax hike of purchasing, sadly.
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Jul 12, 2017 03:59
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Raskolnikov38 posted:well they could amend the constitution to give the legislature that ability but as the end result is still the members of the legislature voting for a tax hike: lol The legislature can't amend the constitution without a ballot measure.
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Jul 12, 2017 11:20
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Sundae posted:There was another proposition which passed in 1986 allowing people over 55 to transfer their taxation value to their new home if they bought again within a year of selling. The boomers are pretty much isolated from that tax hike of purchasing, sadly. This is the kind of scummy self-serving I would expect from like, Capitol Hill. Prop 13 is pretty disgusting.
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Jul 12, 2017 14:44
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I for one think it is both cool and good that the property tax relief California homeowners have demanded for so long has only ever been applied to old people.
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Jul 12, 2017 15:18
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Just like old people get universal healthcare and UBI, but those ideas are too out there for the rest of us. Prop 13 makes it so home owners have zero incentive to keep houses affordable. Maybe if Grandma's tax bill went up she would have some reason to vote for more construction.
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Jul 12, 2017 15:26
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I know a bit about the medical industry in the USA and I have to say that it's absolutely wonderful that I could go in for surgery with some dog-tired anesthesiologist in his 22nd hour of work watching over me. That happens pretty regularly and it's really great.
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Jul 12, 2017 19:27
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Megaman's Jockstrap posted:I have to say that it's absolutely wonderful that I could go in for surgery with some dog-tired anesthesiologist in his 22nd hour of work watching over me. 
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Jul 12, 2017 20:30
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CopperHound posted:I asked one of the new residents in town about the reasons for such long shift hours. It was interesting listening to him explain how it helps training and continuity of care. He seemed to be trying harder to convince himself than me. Abuse victim syndrome isn't funny.
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Jul 12, 2017 20:32
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CopperHound posted:I asked one of the new residents in town about the reasons for such long shift hours. It was interesting listening to him explain how it helps training and continuity of care. He seemed to be trying harder to convince himself than me. I hear the same. It's also to the point that they have to conform to the system if they ever want to practice, and the majority of them won't care to try and fix the system once they have a stronger voice.
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Jul 12, 2017 22:17
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Megaman's Jockstrap posted:I know a bit about the medical industry in the USA and I have to say that it's absolutely wonderful that I could go in for surgery with some dog-tired anesthesiologist in his 22nd hour of work watching over me. That happens pretty regularly and it's really great. Actually it is safer to be continuously assisted by a tired doctor than to be passed off to another, according to basically every study on it. But they are working on ways to improve that.
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Jul 13, 2017 00:37
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TROIKA CURES GREEK posted:Actually it is safer to be continuously assisted by a tired doctor than to be passed off to another, according to basically every study on it. But they are working on ways to improve that. Is the other doctor well-rested in these studies?
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Jul 13, 2017 01:42
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http://gizmodo.com/insanely-accurate-lip-synching-tech-could-turn-fake-new-1796843610 Welp, this will undoubtedly be working before the next election.
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Jul 13, 2017 01:43
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I haven't seen any research either way, but given the number of ways I've seen handoffs get hosed up, I would be wholly unsurprised to learn that each transfer of care greatly increases your odds of dying of a preventable medical mistake.
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Jul 13, 2017 04:11
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Have you considered just not being sick?
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Jul 13, 2017 05:06
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More gentrification incoming https://www.google.com/amp/amp.usatoday.com/story/103616164/
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Jul 13, 2017 05:09
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Maybe it will improve transportation infrastructure down there?
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Jul 13, 2017 15:45
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The Wiggly Wizard posted:Maybe it will improve transportation infrastructure down there? There's a ton of projects scheduled to be completed for the 2024 games. Not sure if pushing back to 2028 changes things.
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Jul 13, 2017 16:09
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TROIKA CURES GREEK posted:Actually it is safer to be continuously assisted by a tired doctor than to be passed off to another, according to basically every study on it. But they are working on ways to improve that. Scheduled surgery could largely solve this problem if the industry gave a poo poo. There's very few excuses: it's scheduled in advance, they know how much time you'll be on the table (usually) and yet...mysteriously...they keep working these docs (and nurse anesthesiologists) on these incredibly long shifts. Because they don't care. Nobody is saying a tired doc should walk away from the operating table halfway through. Megaman's Jockstrap fucked around with this message at 16:14 on Jul 13, 2017 |
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Jul 13, 2017 16:11
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Megaman's Jockstrap posted:Nobody is saying a tired doc should walk away from the operating table halfway through.
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Jul 13, 2017 16:33
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FilthyImp posted:Yeah, I see a big difference from "Tag in here, Smith, I'm in the middle of a quadruple bypass and need to clock out for the day" and "Hi, it's 11am and I've been on my feet since 3pm yesterday" loving christ, the ignorance about the medical field in this thread is staggering. It's not about having to leave surgeries (or something that just scheduling more surgeries would fix, since most surgeries are scheduled). Handoff and transition introduces potential signal and communications errors into patient treatment, and that is what is dangerous. For pretty much every patient, there is a ton of information that has to be communicated; about the treatment received, about past issues, about things that could become an issue in the future, about treatments that were tried but didn't work, etc. It isn't like a TV show where a new doctor shows up, takes a glance at the patient's chart, and just knows everything that is going on. There's a lot to absorb, and it's not something necessarily that can all be communicated clearly and efficiently. There have been a shitload of studies on this, so many that there are studies of those studies. (Though those studies aren't clear on if there's enough information on a good way forward.) Nurses generally get 12-hour shifts to reduce the number of handoffs. Something in the same time range could also work for residents, but then you have to make sure that the change-over for residents, nurses, and the other doctors don't end up having overlap. Gosh, who would have thought that hospital scheduling would actually be difficult?!? It's almost like the problems of the system aren't there purely because everyone but the goons posting on Something Awful Dot Com are in a grand conspiracy to make things harder!?!
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Jul 13, 2017 18:21
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