171–180 of 181 posts
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I have a degree from a cow college. I'm very good at what I do. But I'm at a disadvantage: my network doesn't include people who are valuable to know. The dudes who started Dropbox are dudes friends of mine knew in college. People like that aren't in my rolodex. That's what these colleges are for: social entry into that class of mover shaker, be it MIT for tech or an Ivy for politics. This stuff is the difference bet…
Hope is not lost in this situation - you just have to work at it more. I'm a stellar mind who also went to public schools for undergrad and grad, but I focused on self-development and networking after. I went from $50k a year to likely over $120k (that is in negotiation) in the span of 1 1/2 years of hard effort &learning. I too racked up lots of debt from school, about $200k total. I am forced to focus on money beca…
I did. A "stellar mind" would also probably understand how much insane luck it took to get where I am with my rolodex, too.
It blows my mind that it costs $400k to become a quality dentist in the USA these days. No wonder I see people train overseas and then just get a license here. How is health care ever going to be affordable in this country if the doctors and dentists have to carry so much debt?
I've found that many people are surprised when they discover that dentists in the USA are medical doctors and have a similar education.
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Medicare isn't allowed to negotiate, but it automatically gets the average selling price, inclusive of all discounts. Disproportionate share hospitals get 23.1% discount. It's not like the US gov't isn't extracting it's share. Medicaid IS allow to negotiate and has federally mandated discounts. Medicaid covers more people in the US than ANY of the Canadian provinces who do negotiate. What does that tell you?
Methodology is important. See here: http://www.law.cornell.edu/uscode/text/42/1395w-3a > the manufacturer’s “average sales price” means ... sales to all purchasers ... in the United States ... divided by the total number of such units So it looks like the ASP is fixed to the shit price that results from fragmented bargaining by US companies. A 23% discount on a 100% markup = drug companies laughing all the way to the…
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Exactly my thought when I read that. $400,000 for dentist? Heck some people don't even give them as much respect as they give to other kind of doctors. Some say they aren't even doctors. No wonder people go to India or Eastern Europe to get their teeth replaced.
They are literally not medical doctors.
The root of this problem is that the liberals have been paddling relatives good sounding notions such as "everyone needs to go to college" thing and the subsequent government moves to ensure that every tom dick and harry can go to college. This was about to happen.
Everyone gets to drive on roads in the US because we each pay a bit per gallon of gas. Couldn't we all go to school if we each paid a little bit for it and you just had to show up?
BTW, road maintenance costs are mostly due to heavy vehicles such as trucks (and weather). Cars cause negligible damage. So though truckers complain about high taxes, they're actually still paying less than a "fair" amount. So says my transportation professor, anyway.
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Medicare isn't allowed to negotiate, but it automatically gets the average selling price, inclusive of all discounts. Disproportionate share hospitals get 23.1% discount. It's not like the US gov't isn't extracting it's share. Medicaid IS allow to negotiate and has federally mandated discounts. Medicaid covers more people in the US than ANY of the Canadian provinces who do negotiate. What does that tell you?
Methodology is important. See here: http://www.law.cornell.edu/uscode/text/42/1395w-3a > the manufacturer’s “average sales price” means ... sales to all purchasers ... in the United States ... divided by the total number of such units So it looks like the ASP is fixed to the shit price that results from fragmented bargaining by US companies. A 23% discount on a 100% markup = drug companies laughing all the way to the…
The top 3 insurers (who negotiate these prices) in the US cover nearly 100 M people. Medicare gets those discounts included as well.
As for Medicaid, it often pays the lowest price of all purchasers in the US. For many doctors, Medicaid reimburses them so little, they lose money on drugs. That's why many doctors don't want to take Medicaid patients.
Earlier quoted context omitted.
Medicare isn't allowed to negotiate, but it automatically gets the average selling price, inclusive of all discounts. Disproportionate share hospitals get 23.1% discount. It's not like the US gov't isn't extracting it's share. Medicaid IS allow to negotiate and has federally mandated discounts. Medicaid covers more people in the US than ANY of the Canadian provinces who do negotiate. What does that tell you?
Last I heard, the pharmaceutical companies had come up with various ways of artificially manipulating the price they officially sold drugs for in order to take advantage of this, such as making direct offsetting payments to hospitals rather than discounting the prices.
There was some manipulation of the ASP back in the early 2000's, but those companies were charged under the False Claims Act and paid a pretty significant penalty. I don't think there is widespread manipulation at this point.
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> You can grind your teeth at the rest of the podcast where the administrators claim a lot of this cost is building amenities and facilities that students now expect out of a high-tier college like all-single dorms, a myriad of cafeteria options, and 24/7/365 library and IT staffing. I've seen a fair number of universities in the U.S. and other similarly developed countries, and one of the most striking differences I…
When your customers are price-insensitive, it becomes stupid to not go all out on amenities.
This is an interesting NPR Planet Money podcast where they try to break down why Duke's tuition costs $60,000/yr (and Duke claims that the actual cost of a student is really $90,000/yr). http://www.npr.org/blogs/money/2014/02/26/283018555/episode-... One of the most interesting points is that colleges are in a unique inverted position when it comes to price vs. demand. Cutting their tuition price would actually decre…
> Cutting their tuition price would actually decrease the perceived value of the degree, and thus lower the demand for their product. Even if you accept this as true (which is interesting but is also a bit of a stretch), it certainly doesn't explain why tuition consistently rises at a rate several times that of inflation. The latter items certainly do.
Customers (students) have been allowed easy access to student loans, which makes them less picky about price differentials and closes the loop. Closing the loop allows it to accelerate beyond the scope of inflation.