You're on a board full of technologists. Many are in SF or Seattle or NYC. A 10minute commute means you live in a 5-20 Million dollar home in SF. Not sure how realistic that is.
I work in NYC. The salary doesnt support having a home in the city. Yes, it can support a 1br apt, perhaps a 2br with roommates. Definitely not accomodations for a family.
i think there is a big diff between 10-30min and 45min
your 45min assessment is probably right for early career. once you have a family, it gets much harder and less common
Whether your company is WFH or RTO is a decision, but please dont try to do a hybrid -- where some employees on the same team are remote while others are in office. You end up with team members going to the office, and just staying on a zoom the entire day without actual interaction. Worst of all worlds.
>> Medicare pays 50% less than private insurance. So doing this would require either layoffs, cutting salaries for doctors/nurses/etc, or both. This may well be the right decision for society as a whole--that's a big part of the debate here--but there's no free lunch.
You arent considering
1. Hospitals eating the cost of the uninsured, which this would solve
2. Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce
> Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce
Would this go away, though? Instead of fighting with insurers they would be fighting with the government insurer?
I am very pro universal healthcare, I just don’t want to pretend there aren’t still going to be fights over what should be paid for.
No matter what, there are going to be disagreements on what medical procedures should be paid for and who needs them, as well as how much they should be billed for.
The way a lot of other countries deal with this is that the government calculates out a benefit vs cost assessment for every new treatment and only covers ones that come out ahead. But, that ends up with things like new targeted chemotherapies being unavailable for years after their initial release, vs in the US where they are available to much of the population once the right prior auth is filed. There is also more top down management of costs, such as long term life support for people in vegetative states.
All of this was branded as "death boards" in the American healthcare debate.
People hate it when faceless bureaucrats decide that some health care expense is too expensive for the large faceless bureaucracy to cover, when they have a medical issue that they would like the large faceless bureaucracy to spend money on. Perhaps in that world, some insane guy with a back injury who's unhappy about the quality of his care assassinates the Secretary of Health and Human Services, rather than the CEO of a medical insurance corporation (and hey, a lot of people hate RFK Jr. anyway, so maybe that assassin still becomes a folk hero for doing it).
This is already how Medicare works and it covers 70 million Americans. I’m not aware of any of these hypothetical violent outcomes being a huge problem for the program.
> Instead of fighting with insurers they would be fighting with the government insurer?
1. I'd rather fight the non profit-motivated entity
2. We can probably compare to VA and Medicare and even other countries to see what the fight will be like. I'm willing to bet it will be a big improvement.
> No matter what, there are going to be disagreements on what medical procedures should be paid for and who needs them, as well as how much they should be billed for.
Government insurance has a service motive. Private insurance has a profit motive.
What hospitals makes has nothing to do with physician pay - those are separate categories. Hospitals aren’t going to magically start giving some of their profit to doctors to help cover their lower fees.
OP makes a good point. The studies assumes two diametrically opposed things will happen - doctors will take a 50% pay cut but access to primary care physicians will increase.
Why would we solve the primary care physician shortage by cutting their pay?
Those are two real effects, but together they wouldn't compensate for the rate cuts.
About 8% of the population is uninsured. The uninsured population skews younger, with less healthcare utilization (Medicare already covers everyone 65 and older).
Another comment in this thread estimated billing overhead at 8.5%. Medicare for All would eliminate some, but not all of this, since Medicare is still a claims-based system. You would remove a lot of overhead around prior auths, which I agree is a good thing, but could be achieved with more focused legislation.
> .. 8% of the population is uninsured. ..
this is Bogus, one of the first argument hospitals make for inflated pricing is that they have to cover the cost of uninsured. if the uninsured doesnt exist then the whole line of BS argument falls.
> 2. Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce
This layer won't go without a fight. Maybe it _is_ the layer we're fighting against. The owners will still make profit, the providers still have jobs.. but the middle layers are useless bloat. They don't have skills to provide care, they don't operate at the capitalist layer. They are useless today, and even more useless tomorrow.
And that is likely useless layer is millions? of jobs.
How would this change solve: "Hospitals eating the cost of the uninsured..."?
Wouldn't it just transfer the cost from the hospitals to the universal coverage agency? This would make the financial picture even worse for the proposed system.
>>> Hospitals have an operating margin of 2-5%. Medicare pays 50% less than private insurance.
The hospital can be paid less without reducing their margin if they can remove a cost from their balance sheet. It does not make the system cheaper overall, but it means the hospital does not have to bear those costs directly. They may not have to bear them at all, because hospitals are not the only things in the system.
>> Putting 2 servings of ice cream in a thick plastic jar was always a dumb gimmick.
One gimmick I quite detest is the use of highly concave bottoms some companies use, so as to reduce the volume of actual product. Similar to deep indentations orange juice bottles use as a "handle" but which actually exists to reduce the volume of juice.
> And you must ask yourself, is the ability to sell your company to another company a benefit or should there be considerably stronger hurdles for this kind of thing?
Distribution is a huge problem for small companies. So you almost have to sell to a bigger firm to get beyond a certain size.
or partner with someone who can do distribution? I don't see why that necessitates selling the company. It's like saying the story in my game sucked so I sold it to Disney.
The best arbitrage was that purchasing a jar like that (empty, a la carte) would cost $3. So you were basically getting amazing ice-cream for $2. Half my pantry became reused Talenti jars.
La Fermiere makes these fancy little yogurts that are fine, I guess, but they come in these amazing little terra cotta cups that are amazing for all sorts of little organizing tasks. Each flavor's a different brightly colored glaze. I do wish they'd glaze the interior as well, though.
Haha, I have an empty Talenti jar and two La Fermiere cups in my room for trinket storage! FWIW my La Fermieres have interiors with same color glaze as exterior.
I talk to a lot of people in the Metro NY area. One problem here is -- if you need to commute into Manhattan (job center) -- it demands a certain salary, below which commuting in is a net-loss. Rent is $2000/mo. If you have a family and cannot have multiple roommates, you might be looking at $4000/mo.
"if you cannot afford it, stop complainingb and live elsehwere" they say...sure...but a commuter train into Manhattan can run you $30-50/day. Add in parking at the commuter train station and you're down about $60 or more a day.
Now suppose you eke out some net saving -- you've unqualified yourself from medicaid health insurance now. Your net savings may not even pay for your medical deductible.
There are a lot of reasons to just not bother unless the salary can get beyond all these hurdles.
Your theory is that some people don't find it financially worthwhile to work in NYC, so therefore they decide to just give up and not work and not move anywhere else and just do absolutely nothing instead?
You have to work where the jobs are. Where the jobs are is expensive as fuck, AI and the economy are driving down labor costs (both actual number of salaries and the cost of those individual salaries)... but rent and other living costs are only going up.
Not only is that my theory but that is literally the article we’re all commenting on “labor participation down” and this is one explanation based on discussions with hundreds of friends and classmates struggling with this issue.
> "if you cannot afford it, stop complainingb and live elsehwere" they say...sure...but a commuter train into Manhattan can run you $30-50/day. Add in parking at the commuter train station and you're down about $60 or more a day.
When people say that, I think they mean "get another job in another city that doesn't require a commute to Manhattan."
Yes, there are lots of cities in the US. Most cities dont have job centers. They might have jobs at Walmart, McDonalds, etc but not jobs that pay living wages. People are rational -- they either do the math, or have witnessed the math playing out in real life. You can live in a super-low-cost city but earning minimum wage don't make ends meet. Worse, it may even put you into a threshold where you get no medical care. If you have children, it doesnt pay for rent + healthcare + child care.
There is another reason people stick to major job centers -- because it is extremely risky moving to a 2nd or 3rd tier job center. You have to sign a 1yr lease on an apartment and are locked in. But your job isnt guaranteed for a year. There may be few or no other jobs in 2nd or 3rd tier job centers. Say you default on your lease -- now you have a way bigger problem because you cannot rent again (you have bad credit) and you also need to pass credit checks to get a job. https://www.nerdwallet.com/finance/learn/credit-score-employ...
Ultimately we all need to realize people are rational (NOT lazy) -- people are doing the math and the math aint mathing. Hence the "Sharp Drop in Labor Force Participation"
I'm guessing many (most?) people commuting to Manhattan aren't in the category of minimum wage workers.
Picking one of the most expensive places in the planet (Manhattan) as your example isn't helping you much. Lots of well known cities are much cheaper. When people I know move to, say, Tennessee, they're not working minimum wage. Ditto Kansas City, almost any Texan city except Austin. St Louis, Louisville, etc.
Until recently, even the Chicago Metro was still among the more affordable places for white collar workers - where you could buy a 2000 sq ft house and not go broke over doing so. I don't know if it's still the case, but it was still cheaper pre-pandemic than any of the cities in the Western states.
Edit: Just confirmed - Chicago is still cheaper. Affordable houses, in good neighborhoods.
Except it doesnt only impact minimum wage workers...or does it only impact NYC -- its the same problem in Washington DC, Virginia suburbs, Boston, SF, Seattle. I suppose they could move to some rural area for cheap rent, but what jobs exist there?
I have multiple relatives making $60k or $100k and can barely survive once you introduce healthcare co-pays, deductibles, rent, pharma copays, etc.
Please, for a moment, consider that you are a techie possibly making $250k $500k, or more and there are people suffering who making a third or a fifth of you. Consider that you might be single but there are others with kids. Also consider that you might have a Platinum healthcare plan but others have "healthcare" with 10k deductibles per familymember.
But New York City as a metro area is the largest conglomeration connected by low-cost mass transit in the country meaning there's a massive liquid housing market and job market ready to fingertips. So if you live in the suburbs and the commuting cost is a dilemma you can always consider moving to the city itself
To begin with, they should make it a legal requirement to list Condo vs Coop in listings, not "condo/coop". One is usually easier to get, the other pushes people thru discriminatory hoops that many profiles have no hopes of passing -- but get stuck in the theatre of process and formality (often not knowing the entire process is engineered to exclude them.)
Here is inflation since
https://libertystreeteconomics.newyorkfed.org/2022/04/inflat...
Please lets have some decency towards the struggles of students