Hong Kong Experimenting With MMT

[pmward]

https://themacrotourist.substack.com/p/ ... mpaign=cta

Hong Kong is officially going to MMT style helicopter money to counter the virus's economic impact. I, for one, am interested in seeing how this plays out in markets and the economy since this is likely in our future as well once the Fed finished inevitably fully painting itself in the corner with monetary stimulus.

[boglerdude]

FedBucks. A debit card that can be spent on utilities, health care, healthy food, child care, education and transit.

[Mountaineer]

FedBucks. A debit card that can be spent on utilities, health care, healthy food, child care, education and transit.

Now that's an idea I could get behind.
I find it ironic, BD, that sometimes I strongly agree with you, and other times vehemently disagree with you.

Isn't that a mark of an objective person, e.g. one who evaluates the facts and makes their own conclusions vs. running with the lemmings of identity politics (or other topics)? In other words, KUDOS to you MangoMan.

[boglerdude]

Its called not being an idealogue. Pug's salty cuz he doesnt want to admit the ADA/AMA are cartels that inflate wages by restricting supply of doctors.

But speaking of Fedbucks, are they a better idea than having the gov directly own and operate, for example, gas companies?

[boglerdude]

In 50 years robots will farm, build houses and cars, and fight wars. Millions out of work, meanwhile the population will be older and nursing homes 30k/month. We need more doctors to bring that cost down. I'm skeptical the AMA is allowing the maximum number of qualified people through. A bit off-topic, but my father's still practicing dentistry at 72. He hates it =) He took over his father's practice. btw I just ordered Biomin-F toothpaste from Canada. Prob a gimmick but worth a shot.

> What is your opinion on the inability of any firm owned by white men from ever getting a city, county or state contract

I'm not sure if thats true. But Fedbucks solve racism, gives everyone the tools to better themselves

[Mountaineer]

Pugchief, pardon my curiousity, but do you plan to stay in the Chicago area after you retire? I'd appreciate any additional comments you could offer about the pros and cons of the area. I'm intrigued why people choose to remain in high cost/high crime/high government corruption areas (my assumption is based on what you have said and others have reported); there must be some rather large pros to put up with the cons. Thanks.

[Mountaineer]

Pugchief, pardon my curiousity, but do you plan to stay in the Chicago area after you retire? I'd appreciate any additional comments you could offer about the pros and cons of the area. I'm intrigued why people choose to remain in high cost/high crime/high government corruption areas (my assumption is based on what you have said and others have reported); there must be some rather large pros to put up with the cons. Thanks.

I have considered taking residency in FL and only living here for 5.5 months in the summer, partly for the weather and partly for the tax/corruption, but my GF is nowhere near financially set to retire, and my children and grandkids are 5 minutes away which would be tough to give up. The Chicago area has a lot to offer. I am in a suburb around 30 miles from downtown where there is very little crime, access to anything and everything I would ever want or need in a short drive and the corruption level of local government is relatively low AFAIK. The corruption is worst in the statehouse, the city of Chicago and Cook County. While real estate here is not cheap, it's nowhere near the levels of CA, DC, NYC, etc. Being in the suburbs of such a large city allows for many benefits by extension that might not be available in a smaller burg.

But probably, because I've lived here my entire life, this is home. And this is where my family and friends are.

Thank you!

[boglerdude]

> A 60 year old chiropractor buddy of mine closed his practice and learned to drive a semi-trailer last year bc he couldn't make enough in his practice. Is that what you want?

Yeah. Markets. But there may be some strong-arming/monopoly issues where the insurance companies can steal your cash patients because they can afford so much advertising. Hopefully in 10 years dentistry will be done by robots, remotely operated by the most skilled folks around the world. But with FedBucks your needs will be met and you can do whatever you want.

[Kriegsspiel]

Hopefully in 10 years dentistry will be done by robots, remotely operated by the most skilled folks around the world. But with FedBucks your needs will be met and you can do whatever you want.

I wonder if the remote-controlled surgery is a plausible scenario, in the sense that I usually see it brought up as a way for more people to get access to the best surgeons since a lot of the friction is taken away (location dependance, sterilizing, physically moving from OR to OR, etc). But I'd figure that the surgeon would still only be able to do as many surgeries as they currently do; concentration/focus would become the limiting factor.

[Kriegsspiel]

Back to one of boglerdude's earlier points though, about needing MORE doctors for all the old and sick people we have.. why do they need to be actual DOCTORS? Nurses and physician assistants can do a ton of stuff and it doesn't cost as much to train them.

[boglerdude]

Even better, illegals so they can be paid less.

Pug, how does the dental industry weed out those who dont have the dexterity to do good surgery

[boglerdude]

Dont most people hate their jobs? Thats why retirement is hyped. & he's bad with money

[WiseOne]

Back to one of boglerdude's earlier points though, about needing MORE doctors for all the old and sick people we have.. why do they need to be actual DOCTORS? Nurses and physician assistants can do a ton of stuff and it doesn't cost as much to train them.

Just catching up with this thread!

The answer to the above is that nurses and physician assistants can absolutely do almost everything a primary care physician does, except be the one that gets sued when something goes wrong - there has to be an MD involved for that one reason. There is however another problem: being a primary care physician is such a lousy job that NO ONE, including nurses and PA's, wants to do it. Primary care residencies attract so little interest from American medical students that they are dependent on FMGs (foreign medical graduates) to fill their slots.

I'll let you guys in on a secret: I don't have a primary care physician. I go to an endocrinologist for menopause-related issues, and she orders/nags me for the preventive care she thinks is important. I keep thinking I should get one, but I just don't see the need. You don't need a referral to get preventive procedures if you want them, and you can get direct to patient lab tests for a lot cheaper than ones ordered by an MD (plus you save the cost of the visit). For urgent visits, there's telemedicine from the comfort of my home or a perfectly good urgent care clinic down the street.

[pmward]

That is surprising, primary care seems like such a cushy job in comparison. Although, I'm not knowledgeable of the medical field. What is it that makes primary care unattractive? Is it less pay?

[Kriegsspiel]

Back to one of boglerdude's earlier points though, about needing MORE doctors for all the old and sick people we have.. why do they need to be actual DOCTORS? Nurses and physician assistants can do a ton of stuff and it doesn't cost as much to train them.

Just catching up with this thread!

The answer to the above is that nurses and physician assistants can absolutely do almost everything a primary care physician does, except be the one that gets sued when something goes wrong - there has to be an MD involved for that one reason.

Why?

[WiseOne]

Primary care doctors do very little medicine and you would be shocked at how much paperwork they have to deal with. They refer out anything more complicated than a sore throat. I've even known them to pass on things like managing high blood pressure - they refer that to cardiologists. Frankly, I don't know what purpose they serve in the American medical system, except to satisfy insurance companies that require referrals before you can see a specialist. (This does NOT apply to rural areas, e.g. the upper peninsula of Michigan, where there are not a lot of specialists around and primary care doctors do a lot of stuff including deliver babies.)

In answer to krieg's question: Most states require that NPs can only practice and write prescriptions under MD supervision. That is legal speak for "somebody who can be sued."

[vnatale]

Primary care doctors do very little medicine and you would be shocked at how much paperwork they have to deal with. They refer out anything more complicated than a sore throat. I've even known them to pass on things like managing high blood pressure - they refer that to cardiologists. Frankly, I don't know what purpose they serve in the American medical system, except to satisfy insurance companies that require referrals before you can see a specialist. (This does NOT apply to rural areas, e.g. the upper peninsula of Michigan, where there are not a lot of specialists around and primary care doctors do a lot of stuff including deliver babies.)

In answer to krieg's question: Most states require that NPs can only practice and write prescriptions under MD supervision. That is legal speak for "somebody who can be sued."

I must fall under the rural area exception. My primary care doctor is also the head of medical in the practice. Yet he is who I see, he gives m full attention, and he'll even do things like remove stitches.

The only issue he's referred me to others is for my first ever colonoscopy. But, maybe, I've just not brought to him any issues serious enough for him to refer me to a specialist.

Vinny

[Libertarian666]

Primary care doctors do very little medicine and you would be shocked at how much paperwork they have to deal with. They refer out anything more complicated than a sore throat. I've even known them to pass on things like managing high blood pressure - they refer that to cardiologists. Frankly, I don't know what purpose they serve in the American medical system, except to satisfy insurance companies that require referrals before you can see a specialist. (This does NOT apply to rural areas, e.g. the upper peninsula of Michigan, where there are not a lot of specialists around and primary care doctors do a lot of stuff including deliver babies.)

In answer to krieg's question: Most states require that NPs can only practice and write prescriptions under MD supervision. That is legal speak for "somebody who can be sued."

Sounds like it's time for my solution to litigiousness in medicine.

Allow the enforcement of contracts between doctors and patients that the patients won't sue but will get their own "bad results" insurance if they want it.
This would pay off in the event of their having a bad result without having to sue the doctor.
Besides the obvious reduction in paperwork and elimination of malpractice insurance for the doctors, this would enlist the insurance companies on the side of the patient.
That's because if you are planning to go to a doctor, you ask your "bad results" insurance company for premiums for whichever doctor or doctors you are considering.
Whichever one has the lowest bad results insurance premium is least likely to cause a bad result.

I mentioned this to a random person in an elevator many years ago and he almost had a stroke.
He was a malpractice lawyer.

[Kriegsspiel]

Back to one of boglerdude's earlier points though, about needing MORE doctors for all the old and sick people we have.. why do they need to be actual DOCTORS? Nurses and physician assistants can do a ton of stuff and it doesn't cost as much to train them.

Continuing in this vein, let's talk about specificity. Why do "we" require all doctors to go through the medical school pipeline as-is? AFAICT, medicine (like pretty much every other profession) is becoming hyperspecialized. It seems to me that a better system would be to dispense with the all-encompassing medical education and training, which is only getting more expensive as the base of knowledge and technology increases, and just start the specialization process earlier.

To illustrate my point, consider someone who just wants to be a surgeon. Why do they waste their time learning about things they never deal with? I'm sure this isn't unexplored territory, but why can't (why shouldn't) they be able to disregard things that are irrelevant to knee surgery, get through medical school and become certified quicker and cheaper, and just do the thing they want to do?

EDIT: The excellent Lacking Ambition blog touched on this WRT lawyers (and, bringing it full circle, Hong Kong) a while back:

I have a friend in my class. He’s Chinese and has a job lined up for after graduation with a firm in Hong Kong helping people to emigrate to the U.S.. In all likely-hood he could probably learn to do all the tasks of the job with about 2-3 months of focused training. But he needs to be a member of the bar to do the job, so instead he has to go through 3 years of law school. For him, it’s just about getting passing grades on his way through, then passing the bar. There’s no real interest in the subject outside of the pending job offer.

I don’t begrudge him for his lack of interest. His situation seems perfectly rational to me. So when we hang out we talk about China, or Boston, or video games, or family and his soon-to-be-born son, or business. – But never law. He’s not interested.

Because of situations like his, a lot of people lately are calling for a change in legal education. – Suggestions range from making the law degree a bachelor’s degree, to cutting law school to just two years. After all, it doesn’t take three years of training to help people fill out a bankruptcy petition or a green card application.

I think the calls for reform stem from valid concerns. The price of tuition is out of control. All some people really want to do is practice in a tiny little area of law, like my friend, maybe there should be a way for them to do that without having to go through 3 years of graduate school. Perhaps some kind of “enhanced-paralegal” certification could be established to allow people to practice in a limited area of the law.

[WiseOne]

I'm with MangoMan - the broad exposure is very useful if you're practicing at a high level. I make use of stuff I learned outside of my specialty all the time.

That said...I don't think you need the 11-15 years of post-high school training to do primary or urgent care. That is NP kind of stuff. In fact, even within specialties NPs often see routine followups, both in the hospital and outpatient. Going a step further, a lot of routine visits could be handled by an AI/expert system, without requiring an MD at all. There is a telemedicine service "Virtuwell" that actually does this - it leads you through a questionnaire, then you get a live interview only if needed. Otherwise, an NP reviews the results and texts you instructions.

Libertarian666 - your idea is great - isn't that what we already have, malpractice insurance? Sounds like you're saying to eliminate the malpractice part and make it for any bad outcome with no regard for whose fault it is. Nice idea. It would go well with my idea: have a mechanism for patients to report problems to the state medical board, then have the medical board rule on whether a doctor is at fault. If so, then and only then can the doctor be sued. It would really help winnow out the many ridiculous cases out there.

[Kriegsspiel]

Well, ok, maybe some people would still want to see a doctor like that. But I don't see why it should be REQUIRED. What if someone just wanted to do rhinoplasties? Or colonoscopies (weirdo)? They could open their Colon Technician shop. People could still go to a doctor with 15 years of higher level education, but I think they'd be ok with a plastic surgeon who didn't know shit about psychiatry or the anatomy of the gut or whatever as long as they could save a ton of money on the rhinoplasty.

[Kriegsspiel]

Well, ok, maybe some people would still want to see a doctor like that. But I don't see why it should be REQUIRED. What if someone just wanted to do rhinoplasties? Or colonoscopies (weirdo)? They could open their Colon Technician shop. People could still go to a doctor with 15 years of higher level education, but I think they'd be ok with a plastic surgeon who didn't know shit about psychiatry or the anatomy of the gut or whatever as long as they could save a ton of money on the rhinoplasty.

If I was going to have surgery, I would want the most highly trained surgeon available who understood all aspects of medicine, not someone who went from high school into a surgery tech program.

But if you want a rhinoplasty, I watched a youtube video once on how to do it, so I could probably give you a semi-decent result at a great price.

I'm not looking to talk YOU out of paying more for a rhinoplasty surgeon who also knows psychiatry, or how some drugs he's never going to prescribe or be expected to offer advice on interact. But the fact that it's required by the medical licensing establishment (AFAIK) makes everyone pay more even if they wouldn't mind being able to go to someone with less credentials (less relevant credentials).

[Libertarian666]

I'm with MangoMan - the broad exposure is very useful if you're practicing at a high level. I make use of stuff I learned outside of my specialty all the time.

That said...I don't think you need the 11-15 years of post-high school training to do primary or urgent care. That is NP kind of stuff. In fact, even within specialties NPs often see routine followups, both in the hospital and outpatient. Going a step further, a lot of routine visits could be handled by an AI/expert system, without requiring an MD at all. There is a telemedicine service "Virtuwell" that actually does this - it leads you through a questionnaire, then you get a live interview only if needed. Otherwise, an NP reviews the results and texts you instructions.

Libertarian666 - your idea is great - isn't that what we already have, malpractice insurance? Sounds like you're saying to eliminate the malpractice part and make it for any bad outcome with no regard for whose fault it is. Nice idea. It would go well with my idea: have a mechanism for patients to report problems to the state medical board, then have the medical board rule on whether a doctor is at fault. If so, then and only then can the doctor be sued. It would really help winnow out the many ridiculous cases out there.

I assume that you have never been sued for malpractice, but I have slightly more experience than that.
Namely, I was once in the jury pool for a malpractice case.
The case was about an incident that had happened about 20 years earlier.
The jury was instructed that we were to decide whether the physician had committed malpractice by not following the correct procedures as of the time of the incident.

A couple of things were obvious to me at the time.
1. There is no way in the world that laypeople could decide that with any likelihood of getting the answer right.
2. The person harmed had waited 20 years to be compensated.
3. The legal fees to be paid by the malpractice insurance must have been massive.
4. There was no way for the patient to have had any idea that the doctor was in fact careless, if that was the case, as malpractice premiums are paid by the doctor.

This is completely unlike what I propose for the following reasons:

1. With my approach the person harmed would be compensated immediately as soon as the bad result had been verified.
2. No finding of guilt would be necessary.
3. No legal fees would be incurred.
4. Best of all, the insurance premium itself, being paid by the patient. would convey a tremendous amount of information about the claims record of the doctor in question.

[boglerdude]

> Except people who already think medicine is a cartel will cry foul

Ahem. Those of us who recognize the cartel, aren't ideologues. The government review sounds like a good idea, maybe with some crowdsourcing (allowing the Internet to review the case and provide input)

A lot of the time, people who sue are just angry and they're willing to burn money on lawyers.

[Libertarian666]

> Except people who already think medicine is a cartel will cry foul

Ahem. Those of us who recognize the cartel, aren't ideologues. The government review sounds like a good idea, maybe with some crowdsourcing (allowing the Internet to review the case and provide input)

A lot of the time, people who sue are just angry and they're willing to burn money on lawyers.

Correct. My understanding is that the best predictor of whether a doctor will be sued for malpractice is not his actual track record on results, but his personality. Patients don't sue doctors they like, even if they aren't actually very good doctors.