Post #324,501
4/12/10 1:54:36 PM
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And the next..
..which is one less doctor and all the staff laid off because 1) dermdoc is an idiot and 2) his portrayal of the decline in reimbursement rates seems pretty accurate.
Many examples now of outpatient surgical procedures (1-4 hours of doc time) being reimbursed to them at below cost...and about 30% of the amount that a plumber would get coming to unstop your drain on a weekend.
Now, while the plan may not be to "ration" care...if you make the field less lucrative...what incentive is there to undergo the multiple years of extra education and residency (very expensive)...if they can make more money as a plumber and not have 250k of student loans to pay back?
Simple question really. Doesn't take a repo whackjob to come up with it.
I will choose a path that's clear. I will choose freewill.
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Post #324,504
4/12/10 2:09:23 PM
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Where?
The examples, I mean.
Making the field less lucrative is pretty much the only way you're going to get health care costs under control... the problem is that the field is too lucrative, not lucrative enough.
Docs think they're god. Fortunately, they're wrong.
Interestingly enough... despite the fact that it's not nearly as lucrative to be a doc up here, they still make more money than plumbers. You must have very highly paid plumbers down there... or are you thinking that you can take the "weekend home visit" price for a plumber and extrapolate that out to their annual income?
You know, my Dad's a lawyer, and a very senior one in the area. He charges app. 350$/hr. This puts him at about 166% of a master plumber's hourly rate in the area. He doesn't seem to think that this is unfair at all. Can't imagine why.
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Post #324,507
4/12/10 2:20:16 PM
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plumbers rates for a home visit vary from $65 to name brand
$100 an hour. My doc sees about 3-4 patients per hr and the reimbursement is $26 per patient on my plan. Plumbers usually dont have $200k of student debt to pay off either.
thanx,
bill
If we torture the data long enough, it will confess. (Ronald Coase, Nobel Prize for Economic Sciences, 1991)
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Post #324,509
4/12/10 2:26:05 PM
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Master plumbers up here
can expect app. 200$/hr. They don't end up with (typical for med students here) app. 125K in debt, but it does take them 20+ years to get there.
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Post #324,510
4/12/10 2:30:37 PM
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Re: Where?
http://www.nytimes.c...=2&pagewanted=all
I don't think your dad's lawyer would bill in increments this small. $20-25 per visit, given the general expense level needed to run a practice? Doc either gives 3 minutes to the patient or looks elsewhere.
How about we look at the other areas..like admin, insurances, etc. Doc has to clear 100k per year before he even buys groceries. (office, 1 staff at min wage and malpractice). (thats 21 patients per day, btw)
Yeah...criminal that they don't want to accept that.
I will choose a path that's clear. I will choose freewill.
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Post #324,518
4/12/10 3:08:03 PM
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What, lawyers don't have to by malpractice insurance?
20-25 for three minutes is 400-500/hr.
My dad charges in increments of twelve minutes. I should perhaps point out again that he's also one of the most senior lawyers in the region. I could get reasonably equivalent services for the same price you're quoting for the doc there for 12 min. Oh, and only a foolish lawyer pays minimum to their secretary... the costs of running a practice are not that different for them as compared to doctors.
21 patients per day... at eight hours... gives them 20 min. per patient... or is it three again?
When it comes to the professions boo-hooing about how they're not making enough money while they pursue policies that exclude wide swathes of the society from being able to avail themselves of the profession's services... I tend not to feel very sympathetic to the profession.
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Post #324,524
4/12/10 3:33:14 PM
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Thats to break even.
20 min per patient before they can afford to buy lunch. (off of the dollar menu)
and you, yourself, bring up that having only one person, at min wage, to run your office is a bad idea...
So you are railing against me in these posts...and strengthening my argument all at the same time.
So you want a good person to run the office, pay them double, plus all the taxes...now you are at 110k per year before you rent the office space...say 140k all in before you get the furniture, buy the equipment, install a phone, etc.
So now we're at about 29 patients per day before the doctor earns one penny.
Are you now beginning to understand why doctors are starting to refuse Medicare/Medicaid patients? And this is the system that we are being told will save us from ruin. Also, wonder why old folks are complaining about quality of care when the doc only gives them 5 minutes (cause he has to crank through 60 patients in a day to make the payments on his school loans until he's 40)?
How about we understand why min levels of malpractice are 50k and up? How about we determine why the cost of a bed in a hospital is 1000+ per day? Determine why the TEST, not the doc reading the results...is 800-1000/per?
You seem perfectly happy to shortchange the person with your life in his hands..and perfectly accepting of the fact the government values his services less than that of a program level bureaucrat.
I will choose a path that's clear. I will choose freewill.
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Post #324,525
4/12/10 3:40:15 PM
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Dude, you don't seem to understand something
One thing that no lawyer in Canada has to do is to buy health insurance for themselves or their employees. Our insurance rates are a lot lower than yours too. They can do very very well with that level of remuneration, thank you.
You're the people living in a broken system, not us.
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Post #324,531
4/12/10 4:01:54 PM
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..and it is Our Nature to Fight that Fact with every Disney
-Land fantasy which shall proclaim We Be Numbah One!!! Forever
..even as the last broken ox-cart wheel runs out of grease just as the underfed ox expires.
{sigh} There is no cure for hubris except humiliation.
______________________________________________________________________________________________________________________________________________________
I could almost see voting for Palin in 2012 on the grounds that this sorry ratfucking excuse for a republic, this savage, smirking, predatory empire deserves her. Bring on the Rapture, motherfuckers!
-- via RC
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Post #324,536
4/12/10 5:32:31 PM
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would you care
to actually say something on topic? Heaven forbid...
I will choose a path that's clear. I will choose freewill.
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Post #324,535
4/12/10 5:31:53 PM
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Don't I?
what do you consider "fair" compensation?
I'm talking about paying someone (fully loaded) about 50k...which gives the employee/office manager about 30k...no health benefits thought about in that equation. Thats just about double the poverty line. (don't forget that there's almost 10% goes to gov and there are other costs associated with employment. Or are you trying to tell me that you can pay a quality office manager 15k us because your system is so much better than ours?
Even if my math is off by 10k it doesn't help the equation. You are still talking about a doc needing to mill through 40-50 patients a day to make as much as he/she is paying the office manager to run the office. The office manager has invested a high school education. The doc, 10 years of post graduate. Having them paid equal sounds fair, I guess?
---
Ok, to reality
Now while those rates are, thankfully, not currently representative of the average...it is the office visit rate for medicaid and a lot of state run plans...and it certainly does emphasize that the government run programs place very low value on medical services...so low in some cases that it is not a sustainable model. (or it could be that they know the docs will make it up on charging much more than necessary on privately insured or uninsured patients)
Is it any wonder in a situation like this that there is every reason to over diagnose? If you can't make a living keeping your patients healthy (incurring just wellness visits at 20 per)..then you better make sure they catch something...
And your fine system has the whole wait time issue, which sounds a bit like there aren't enough doctors to meet an "on demand" model (which the folks down here consider "rationing" because we currently have an on demand model).
Over 60% of the country doesn't like what was done here...thats more than there are Republicans...so you can't blame all this discussion on folks like the teabaggers or the "dittoheads". Real, normal, everyday american democrats don't like it either.
I will choose a path that's clear. I will choose freewill.
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Post #324,539
4/12/10 6:23:24 PM
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Most physicians aren't sole proprietors.
http://www.bls.gov/oco/ocos074.htm
Physicians and surgeons held about 661,400 jobs in 2008; approximately 12 percent were self-employed. About 53 percent of wageÂand-salary physicians and surgeons worked in offices of physicians, and 19 percent were employed by hospitals. Others practiced in Federal, State, and local governments, educational services, and outpatient care centers.
According to 2007 data from the American Medical Association (AMA), 32 percent of physicians in patient care were in primary care, but not in a subspecialty of primary care.
Are they worried about billing issues? They don't seem to be on the whole: http://www.nejmjobs....ation-trends.aspx (from 2007):
Physicians heading into the job market for the first time or eyeing a career move in 2007 will find plentiful opportunities and attractive compensation packages regardless of their specialty or preferred setting. Demand for specialists and primary care physicians is high in many regions, especially in non-urban areas. That demand is translating into substantial signing bonuses, generous education loan repayment, and other competitive benefits  especially among large groups and health systems.
[...]
The employment picture is bright across the board. Even primary care, in which flat incomes and reimbursement produced a challenging practice environment in the recent past, is experiencing gains. Incomes for family practice physicians, internists, and pediatricians increased in 2005 and 2006, and the Centers for Medicare and Medicaid Services recently modified the Resource Based Relative Value Scale to attach a higher relative value unit (a measure of the physician work component) to most office-consultation services. The latter will increase Medicare reimbursement to most primary care physicians, industry experts concur.
[...]
As the health care-delivery landscape changes, so do physician-compensation systems and practice models. For example, as costs increase and concerns about cost-effective care intensify, annual bonuses are undergoing modification. Community practice bonuses have typically been based on collections. Yet increasingly, they are being based on RVUs, the recruiting firms report. Quality-based bonuses  particularly for improved management of chronic conditions  are also on the rise. At KaiserÂs TPMG, for example, physicians can earn up to 10 percent of their annual salary in an incentive payment that is based half on quality and half on service (measured by patient satisfaction).
[...]
Doesn't sound so bad to me.
If the median income for a GP in 2008 was $157k+ http://www.bls.gov/o...ent/oes291062.htm , then they're obviously bringing in a lot more than that into their practice.
They're not eating off the dollar menu...
HTH.
Cheers,
Scott.
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Post #324,542
4/12/10 6:36:38 PM
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And how much of that is by necessity?
where the old style "family doctor" model simply cannot be sustained any longer based on the math I've already posted.
Also, most of your info is 2007 based on older studies. Medicare/Medicaid has been cut again since then...
And you notice in the articles that the providers had to game the system to get doc content back up to have the reimbursement levels (then) sustainable.
----------
Add to this, that this is current system with private insurance out there as the offset. While the current change leaves this model in place, it is clearly not "desirable" by many...preferring to tell us that a single payer government system is better (just look at Medicare)...when that model currently (left to itself) is unsustainable.
------------
Can it be done...probably.
Can >we< do it?
------------
And aren't we getting into another "i don't feel bad for them cause they make more than I do" discussion?
I will choose a path that's clear. I will choose freewill.
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Post #324,553
4/12/10 8:25:21 PM
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No, that's not it.
You're supposing an awful lot about his business without a lot of information...
It's not that "I don't feel bad for them because they make so much." It's "I don't feel bad for them because the evidence is that, on average, they're not telling the truth."
I went to graduate school with a fellow from Iran. Over there, the people at the top of the professions are engineers and architects - not physicians. There is no intrinsic reason why physicians should be on top of the professions over here.
Nobody is immune from the blessings and curses of the economy. We spend vastly more for medical care than other countries - at least partially due to inflated compensation for physicians. It seems to me that it's silly to expect that the rate of increase in average physician compensation isn't going to decline at least until things are back in something approaching balance. Of course, physicians are going to lobby against it, but I don't think they'll win for very long.
Yes, that data is from 2007 and 2008. You're welcome to post later averages if you think they've changed greatly.
Oh, one more thing. http://www.aap.org/r...rch/readfirst.htm
Fees shown in this report series represent fee-for-service (FFS) payments reported by states for state-administered Medicaid programs only. Nationally, the majority of children enrolled in Medicaid programs are enrolled in managed care plans, which may or may not benchmark provider payment rates to fees shown in this report. In fact, payment levels are known to vary widely between state-administered plans and managed care plans in some states. As examples, some of New York State's Medicaid managed care plans reportedly pay substantially higher than its state-administered FFS plan, whereas the opposite has been observed in Hawaii.
IOW, "Medicaid only pays $25 for office visits!111" is not enough information to draw any conclusion about the state of his business or (obviously) the state of the medical profession.
FWIW.
Cheers,
Scott.
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Post #324,563
4/13/10 12:12:49 AM
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Not really
I'm doing simple math based on info on 3 major expense categories to run a single doc practice...which, if riches were to be had, should provide a good living.
The profession has evolved into patient mills...and gee, you think there could be a reason for this?
So you throw out the averages...and since the average doc pulls down 150 per year on their education investment...all must be right with the world...and heavens, we're so backward that we think doctors are important and might deserve compensation.
Not disputing that we pay more. What, though, do we really pay more for? Only 20 cents on the dollar for healthcare goes to doctors.
In 2000, (and I can't imagine it being much better now) the cost of overhead (and who, I wonder, designed the payment system) was 31% http://www.pnhp.org/...ons/nejmadmin.pdf
Part of that overhead will eat into the docs 20% take, as well.
So, maybe you are taking it out on the wrong people.
(Nah, can't be. They have a nicer car than you. )
I will choose a path that's clear. I will choose freewill.
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Post #324,565
4/13/10 4:00:05 AM
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Regardless
To lay an employee off for voting "wrong" is out of order.
Even if one is not making as much money as one deserves.
---------------------------------------
Why, yes, I did give up something for lent. I gave up making sense.
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Post #324,568
4/13/10 8:28:47 AM
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Agree
and pretty much said so in the first post
I will choose a path that's clear. I will choose freewill.
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Post #324,520
4/12/10 3:12:12 PM
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I suspect someone's giving worst case numbers...
Take a lookie here. Data for Colorado for 2007, but the variation is probably in the ballpark.
http://docs.google.c...65OcUkvaScrrORrkQ
Depending on the purpose of the visit, the Medicaid reimbursement is $9.02 or $124.54. In many cases, even for Medicaid, they get paid a lot more than $25 for an office visit.
http://www.bls.gov/o...s074.htm#earnings
Earnings of physicians and surgeons are among the highest of any occupation. According to the Medical Group Management Association's Physician Compensation and Production Survey, median total compensation for physicians varied by their type of practice. In 2008, physicians practicing primary care had total median annual compensation of $186,044, and physicians practicing in medical specialties earned total median annual compensation of $339,738.
Self-employed physiciansÂthose who own or are part owners of their medical practiceÂgenerally have higher median incomes than salaried physicians. Earnings vary according to number of years in practice, geographic region, hours worked, skill, personality, and professional reputation.
In 2008 there were 661,000 physicians in the US.
Sorry, but lots of people spend a lot of time in school and in post-school training. Physicians are better at working the system than almost any other doctorate holders. E.g. veterinarians' median earnings were $79k in 2008 (same site).
HTH.
Cheers,
Scott.
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Post #324,521
4/12/10 3:22:48 PM
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I don't need to read the numbers.
One of my clients is Temple Community Hospital, a small hospital in a very old part of Los Angeles. They deal largely with immigrant families and money is very tight.
The doctors' parking lot is like a min-showcase for luxury vehicles - Mercedes and Porsche for the most part.
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Post #324,523
4/12/10 3:31:57 PM
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Quod Erat.. oh, you know..
And Vets are Like That too. I am finding ... fershure.
Everybody wants to be Special -- as long as there are enough non-combative proles who will continue to surrender Their Pie so that His is Bigger. Because 'everyone else is comatose, too'.
______________________________________________________________________________________________________________________________________________________
I could almost see voting for Palin in 2012 on the grounds that this sorry ratfucking excuse for a republic, this savage, smirking, predatory empire deserves her. Bring on the Rapture, motherfuckers!
-- via RC
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Post #324,526
4/12/10 3:40:18 PM
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To each..
..according to their needs...
Yep, that'll work.
I will choose a path that's clear. I will choose freewill.
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Post #324,528
4/12/10 3:54:48 PM
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And without a soupçon of *Society Maintenance by Each
and Every beneficiary:
* 'fairly' 'apportioned'
Why, you get a vitriolic, sanctimonious and slogan-spewing dis-united crop of malcontents and a dysfunctional aggregate. Like Here, Now and further-on along ... the current path of terminal disintegration:
so evidently under way, if one Zooms-Out for an overall perspective. From time-to-time.
Keep whistling past that cemetery of more-More-MORE for the fewer and fewer, (up there in the 2%)
Everyone needs a leitmotif.
Hey.. Dickie Wagner wrote some beauts for various other kinds of Götterdämmerung (s)
But there are no guitars in those. Sorry.
______________________________________________________________________________________________________________________________________________________
I could almost see voting for Palin in 2012 on the grounds that this sorry ratfucking excuse for a republic, this savage, smirking, predatory empire deserves her. Bring on the Rapture, motherfuckers!
-- via RC
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Post #324,530
4/12/10 3:58:58 PM
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Ah, I see...
...that one should work to have as many children as possible and inflate one's need...while at the same time invest the least amount in myself...because no matter what, the government will make sure that I want/need for nothing.
Any other method of thought leads to complete dysfunction.
Does that sum your argument up?
I will choose a path that's clear. I will choose freewill.
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Post #324,532
4/12/10 4:13:04 PM
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As Peter Geyl observes,
The man who has made up his mind for all contingencies will often be too quick for one who tries to understand.
Now you may parse 'merit-ocracy' -- as those who invent the slogans always make sure that they are personally entitled to the fullest-measure of that 'merit', before the slogan's release. cha cha etcetera
______________________________________________________________________________________________________________________________________________________
I could almost see voting for Palin in 2012 on the grounds that this sorry ratfucking excuse for a republic, this savage, smirking, predatory empire deserves her. Bring on the Rapture, motherfuckers!
-- via RC
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Post #324,537
4/12/10 5:40:18 PM
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could you point to some place in
history where perhaps a model has been in place that would suit your purpose? Something of this planet perhaps? While you have traditionally rallied to the cause of "what do conservatives want to conserve?", I don't believe you have yet to promote Ashtotopia to anyone, either.
While your snark certainly does entertain...I am reminded of that great literary scholar S Wright, who noted...
"A friend of mine once sent me a postcard with a picture of the entire planet Earth taken from space.
On the back it said, Wish you were here"
I will choose a path that's clear. I will choose freewill.
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Post #324,607
4/13/10 5:19:50 PM
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The problem with the Reactionary view is apparent:
If something beneficial to society as a whole Didn't happen-exactly In The Past® --
It Couldn't Happen in any next.
Substitute Reactionary for the modern 'Conservative', 97.7% identical.
Pity the word has been elided within the billions of soundbytes spewed all over the æther.
Guess most of the current writers are too young ever to have heard it.
(Sorry, there's no Ashtopia to be outlined.
After all, there wasn't one way-back. How could there be one next?)
______________________________________________________________________________________________________________________________________________________
I could almost see voting for Palin in 2012 on the grounds that this sorry ratfucking excuse for a republic, this savage, smirking, predatory empire deserves her. Bring on the Rapture, motherfuckers!
-- via RC
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Post #324,612
4/13/10 7:29:08 PM
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Thanks for clearing that up
the other ways are bad...your way doesn't exist. It could.
Hence the SW quote.
I'll anxiously await Zefram in your honor.
I will choose a path that's clear. I will choose freewill.
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Post #324,628
4/14/10 12:06:58 AM
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Well, perhaps even, you could.. think outside The Box? too
______________________________________________________________________________________________________________________________________________________
I could almost see voting for Palin in 2012 on the grounds that this sorry ratfucking excuse for a republic, this savage, smirking, predatory empire deserves her. Bring on the Rapture, motherfuckers!
-- via RC
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Post #324,635
4/14/10 4:07:00 AM
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I could..and often do...
...but prefer to deal with issues within a defined set of reality that doesn't require 6.7bn "aha" moments to work.
I will choose a path that's clear. I will choose freewill.
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Post #324,529
4/12/10 3:55:38 PM
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And all those beemers
parked in East LA mean that the motorheads in the projects make too much as well, I'm sure.
Sure those cars don't belong to the celebrities that have to be there for their community service gigs?
I will choose a path that's clear. I will choose freewill.
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Post #324,552
4/12/10 8:19:05 PM
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Lots of Beemers in East LA
They belong to the drug dealers.
But they're just successful capitalists and that's good, right?
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Post #324,562
4/12/10 11:56:56 PM
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enterprising young men they are!
*sniff*
I will choose a path that's clear. I will choose freewill.
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Post #324,571
4/13/10 8:49:38 AM
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snort!
If we torture the data long enough, it will confess. (Ronald Coase, Nobel Prize for Economic Sciences, 1991)
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Post #324,522
4/12/10 3:27:20 PM
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Same tired argument that
..if we don't pay the Las Vegas Financial Roulette-with-Other-people's-money "Risk Eliminating Experts" their annual $$20-200M "bonuses" -- why, they'll pick up their Platinum marbles and go elsewhere.
Or: how on Earth it was, when max tax rates were in the 70-percentile (and earlier even 94%) -- all those Suits managed to have 3 to 13 alternate mansions anyway: and DIDN'T "just quit in a huff". Etc.
Sorry, Charlie - Starkist doesn't want tuna with good taste; it wants tuna that tastes good, aka:
This Permanent Recession (for the vast majority) / nobody Wants to Say DEPRESSION, because that would be too-truthy -- will be altering the expectations of the massively-overpaid ... indefinitely.
Werd. Cthulhu Knows the evil that lurks in the minds of men
-- he taught The Shadow.
Carrion with the social Darwinism; it's cute when you writhe :-0
(Eventually the proles decide to Get a Real Share, Finally /??/ or Destroy the Edifice.)
It is not logical but it is often true.
~~ via Spock
______________________________________________________________________________________________________________________________________________________
I could almost see voting for Palin in 2012 on the grounds that this sorry ratfucking excuse for a republic, this savage, smirking, predatory empire deserves her. Bring on the Rapture, motherfuckers!
-- via RC
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