It's so bad you have to pay people to move to Vermont

bdfreetuna said:

Not really a "nuance person", are you?

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?? And why should he be? He was answering to BG who's been dispensing right wing pablum wherever he can stuff it, and he does it really well. So the breitbart remark is well deserved. And the point was really about a huge inefficiency of our healthcare industry. About that spring_mt_h is very much correct.

Bumpsis said:

?? And why should he be? He was answering to BG who's been dispensing right wing pablum wherever he can stuff it, and he does it really well. So the breitbart remark is well deserved. And the point was really about a huge inefficiency of our healthcare industry. About that spring_mt_h is very much correct.

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Seemed like the point of the post was to straw-man the opposing argument divisively using welfare mamas and illegal immigrants. I can think of higher forms of discourse.

https://youtu.be/B5dDOKrFUOw

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Get a load of this! It's real.

mister moose said:

practices of giving incentives to physicians from drug companies

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There are numerous things wrong with your overall post, but I'll key on this one because it shows an absurd amount of ignorance on your behalf.

As a seller of medical products, I can't buy a doctor an f'n donut without reporting it to the feds and having that doctor record it as compensation.

The SS Bribery Ship to doctors by drug and device companies set sail almost 15 years ago.



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deadheadskier said:

There are numerous things wrong with your overall post, but I'll key on this one because it shows an absurd amount of ignorance on your behalf.

As a seller of medical products, I can't buy a doctor an f'n donut without reporting it to the feds and having that doctor record it as compensation.

The SS Bribery Ship to doctors by drug and device companies set sail almost 15 years ago.

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FACT CHECK: Mostly true, with shades of gray (though it was only about 10 years ago).

You're 95% correct, except there are ways around it, depends upon how creative you want to get, or more precisely, do you want to push the envelope. I actually put the kibosh on some activity I didn't like a few years ago due to what I consider, shall we say, excessive risk. I predict within the next few years the Feds are going to ring a major up on Sunshine Act with a hefty fine, because many in healthcare are working what I would call end-arounds. I'll also go out on a limb and say I believe the lawsuit will involve a third party. It's the same old story. Government has a law and people pay attention to it. Years pass, government doesn't really enforce it. People get emboldened. Smart people get creative. Years more pass. Too many people are in the know. Government finally gets a clue. Someone gets a multi-million dollar fine. It's coming.

This is one thing Obama did that I actually support, because abuse was rampant; though as with many things Obama, they went extremist far. For instance, in DHS' "donut" example, while that sounds like sarcasm, it isnt. If you want to have a small event with physicians & just do the pleasantly of having a plate of cookies & cups of coffee, the government demands you ascribe a monetary value to the cookies & coffee and report it to the Feds. This is, of course, completely insane & totally against the spirit of the intent of the law, because, government...

The loop holes available are not enough to influence buying decisions. Yes, you can buy a donut for folks without an MD next to their name and have that MD stand in the back of the room observing.

What you can't do is buy doctors vacations for their families for "speaking engagements" like you could pre-sunshine.

The law has largely worked as intended. I work for one of the largest and fastest growing international medical technology companies in the world. We don't f around with that law. I have dozens of former colleagues now working for other companies that don't either.

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deadheadskier said:

There are numerous things wrong with your overall post, but I'll key on this one because it shows an absurd amount of ignorance on your behalf.

As a seller of medical products, I can't buy a doctor an f'n donut without reporting it to the feds and having that doctor record it as compensation.

The SS Bribery Ship to doctors by drug and device companies set sail almost 15 years ago.

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Um, okay. Here's some absurd amount of ignorance:

A ProPublica analysis has found that doctors who receive payments from the medical industry do indeed prescribe drugs differently on average than their colleagues who don't. And the more money they receive, the more brand-name medications they tend to prescribe."
https://www.npr.org/sections/health-shots/2016/03/17/470679452/drug-company-payments-mirror-doctors-brand-name-prescribing

The findings suggested that for oral anticoagulants, or blood thinners, and non-insulin drugs used to treat ​

diabetes , payments to specialists were associated with greater prescribing of brand-name drugs than payments to non-specialists, who receive fewer gifts.
https://www.usnews.com/news/articles/2016-08-18/pharmaceutical-companies-influence-doctor-prescribing

Those articles are only a few years old, far from 15 years ago. Your point, other than grandstanding, was that the wild west era was over. It isn't over, it's just been downsized and given a shiny coat of paint.

​

As I said, there are ways around it. Though those sound like pretty stupid ways which were easy to get caught. There are definitely far more clever ways afoot out there. Though that ABMD example is more what I'm talking about, that Subsys example is just straight-up fraud, which is not what I'm talking about.

Orca said:

Get a load of this! It's real.

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Not sure I can exactly get over Bernie's hair. 38 years ago and he still has a crazy coif.

mister moose said:

More absurd ignorance:


First, on March 8, 2018, the U.S. Attorney’s Office for the District of Massachusetts announced a $3.1 million dollar settlement with Abiomed, Inc., to resolve allegations that Abiomed violated the Anti-Kickback Statute (AKS) and False Claims Act (FCA) by inducing physicians to use its products. Abiomed allegedly violated the AKS by paying for expensive meals for physicians (and their spouses) in excess of Abiomed’s own guidelines for such events, and by listing fictitious attendees at such meals to reduce the per-attendee cost of the meal, in order to influence the attendee-physicians to order and use Abiomed heart pumps. Interestingly, in its settlement announcement the DOJ highlighted the fact that Abiomed’s per-meal payments exceeded “Abiomed’s own $150 per person guideline,”

March 9, 2018, the U.S. Attorney’s Office for the District of Rhode Island announced that a physician had been sentenced to over four years in federal prison for committing health care fraud and for violating the AKS. In this case, the physician admitted to soliciting and receiving kickbacks in excess of $188,000 in the form of purported speaker fees from a pharmaceutical company to induce him to prescribe Subsys, a highly-addictive version of the drug Fentanyl. The physician also admitted to committing health care fraud by falsely claiming that patients had “breakthrough pain from cancer” in order to secure approval for Subsys prescriptions from payors (including Medicare). Notably, this case is one of a number of criminal convictions that have been secured against providers for accepting kickbacks from Insys – the Arizona-based manufacturer of Subsys – through its speaker programs, and Insys and certain of its employees are currently the subject of cases involving similar allegations in other jurisdictions.
​

https://www.healthlawdiagnosis.com/2018/03/recent-anti-kickback-cases-emphasize-government-scrutiny-of-speakers-bureaus-and-lavish-meals-funded-by-pharmaceutical-and-device-manufacturers/



I'm left wondering why an absurdly ignorant moose seems to be more aware of this than an industry insider, who claims that there isn't so much as a donut being passed around as "incentives". I'm glad you personally don't buy any donuts. But it's time to see the forest.
​

​

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You're not more aware, not even in the slightest fashion. Your post here only further prooves that those that try and skirt the sunshine act, tend to get caught and penalized.

but say they didn't. let's roll back to your initial claim that bribing docs has a meaningful impact on the cost of medical services in this country.

how much is it?

what do you believe the percentage increase that criminal behavior has on cost of care to consumers?

what do you think those activities contribute to the bottom lines of the companies that still flirt with the legallity line?



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BenedictGomez said:

You're 95% correct, except there are ways around it, depends upon how creative you want to get, or more precisely, do you want to push the envelope. I actually put the kibosh on some activity I didn't like a few years ago due to what I consider, shall we say, excessive risk. I predict within the next few years the Feds are going to ring a major up on Sunshine Act with a hefty fine, because many in healthcare are working what I would call end-arounds. I'll also go out on a limb and say I believe the lawsuit will involve a third party. It's the same old story. Government has a law and people pay attention to it. Years pass, government doesn't really enforce it. People get emboldened. Smart people get creative. Years more pass. Too many people are in the know. Government finally gets a clue. Someone gets a multi-million dollar fine. It's coming.

This is one thing Obama did that I actually support, because abuse was rampant; though as with many things Obama, they went extremist far. For instance, in DHS' "donut" example, while that sounds like sarcasm, it isnt. If you want to have a small event with physicians & just do the pleasantly of having a plate of cookies & cups of coffee, the government demands you ascribe a monetary value to the cookies & coffee and report it to the Feds. This is, of course, completely insane & totally against the spirit of the intent of the law, because, government...

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There’s never going to be an easy solution to the problem. It’s not just the health care system. ANY government regulation, if it’s not enforced for long enough, people who start to ignore it. Kind of like the speed limit on the interstate!

I work in another highly regulated industry. I write computer program to “help” ease operation of all kind. As part of that process, we routinely add in checks to kick out operation that’s against the law or regulations.

It’s not uncommon we get “complaints” from our user “You’ve introduce a bug, I can’t do x or y any more”. Well, because it’s illegal! “But we’ve been doing it for ages”. Haha!

You got the idea. “But officer, I’ve been driving this stretch of highway day in and day out, EVERYONE going at least 80mph!”

In terms of VT, what are the tipping point incomes for this welfare state?

As in in how poorly are all these people doing that requires all the handouts? How big are the handouts? I feel a lot of the discussion completely blows by these figures and just assumes everyone who is on the dole either deserves it wholeheartedly or are complete and total fraud welfare queens.

For example, you can have a household income over 150k a year and still qualify for certain a properties within the affordable housing program here in Jackson. 150!

Other programs are no different from other places like food stamps or unemployment.

I guess what are these egregious examples of state dependence everyone keeps mentioning. I have a hard time seeing VT as being so egregious in terms of welfare state vs being hard on business. You can be pro business much easier than you can roll back public subsidies.

Any gambler knows once you are on the juice you are on the juice you probably aren’t getting off without pain.

Id like to know also as I could conceivably cash out of real estate here and buy places cash in VT, which is kinda appealing. You can get a serious spread in Vt right now for pretty damn cheap even with the taxes. I’m pretty much their target audience for this promotion, with the ability to work remote and enough resources to conceivably make it happen.

AdironRider said:

In terms of VT, what are the tipping point incomes for this welfare state?

As in in how poorly are all these people doing that requires all the handouts? How big are the handouts? I feel a lot of the discussion completely blows by these figures and just assumes everyone who is on the dole either deserves it wholeheartedly or are complete and total fraud welfare queens.

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I think the discussion here of the welfare state is broader than specific public assistance programs for the poor. Welfare state in the context of this discussion refers to excess public spending of all types. Vermont's problem is that it wants a first-rate welfare state based on a third-rate economy. It cements its third-rate economy with laws and taxes that are burdensome to business. There are lots of links sprinkled throughout this thread that you can investigate.

AdironRider said:

Id like to know also as I could conceivably cash out of real estate here and buy places cash in VT, which is kinda appealing. You can get a serious spread in Vt right now for pretty damn cheap even with the taxes. I’m pretty much their target audience for this promotion, with the ability to work remote and enough resources to conceivably make it happen.

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You aren't getting public assistance if you can buy a nice place with cash. Not having a mortgage makes the tax burden more palatable, I am sure. Glad for you that your real estate ventures in Jackson have done so well.

AdironRider said:

Id like to know also as I could conceivably cash out of real estate here and buy places cash in VT, which is kinda appealing. You can get a serious spread in Vt right now for pretty damn cheap even with the taxes. I’m pretty much their target audience for this promotion, with the ability to work remote and enough resources to conceivably make it happen.

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Why on earth would you want to leave Wyoming for Vermont, are you originally from Vermont?

Orca said:

I think the discussion here of the welfare state is broader than specific public assistance programs for the poor. Welfare state in the context of this discussion refers to excess public spending of all types. Vermont's problem is that it wants a first-rate welfare state based on a third-rate economy. It cements its third-rate economy with laws and taxes that are burdensome to business. There are lots of links sprinkled throughout this thread that you can investigate.



You aren't getting public assistance if you can buy a nice place with cash. Not having a mortgage makes the tax burden more palatable, I am sure. Glad for you that your real estate ventures in Jackson have done so well.

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Just to be clear, I am not seeking public assistance but trying to gauge just where the problem is. Correct me if I am wrong, but it sounds like you think the government employs vastly more people to do the same job. I don't think it is the benefits. My Dad worked in wastewater treatment in NH, we had a pretty stellar health plan and he gets a pension. It's not like governments elsewhere don't have plush benefit packages on offer. Are there examples of departments that exist in VT but not Massachusetts for example?

Vermont is still a very pretty place, and the thought of being able to buy a place cash at my age really takes most of my fears about making it work in VT away. I have a portable income, and without a housing nut, only need 50% of what I do now to live the exact same lifestyle. Actually, probably more like 40% since eating out and buying anything here is more expensive. I can also trade my 1 acre here for about 100 in VT. That room to roam and not have it be some barren dry farm is pretty appealing. The skiing isn't as great sure, but lets just say Jackson loses a certain appeal as you age and get more limited in how extreme you want to be on any given Tuesday.

From my outside perspective, it seems like the problem is the lack of a good business climate and a reduction of tax receipts. You are left with a higher percentage of people that need assistance while not increasing that overall number of people as the earners and business owners leave. Same with government employees. Towns still have to operate, regardless of population. Streets still need to get plowed and bills paid.

Orca said:

Not sure I can exactly get over Bernie's hair. 38 years ago and he still has a crazy coif.

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I can't get over his slanderous lies and disdain for our nation. Nobody throws out the "racist, homophobic, xenophobic, Islamophobic" slur on patriotic individuals more than this piece of shit. I look forward to his defeat by a historical margin.

AdironRider said:

From my outside perspective, it seems like the problem is the lack of a good business climate and a reduction of tax receipts. You are left with a higher percentage of people that need assistance while not increasing that overall number of people as the earners and business owners leave. Same with government employees. Towns still have to operate, regardless of population. Streets still need to get plowed and bills paid.

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Vermont is also anti-business. The politics there have changed more than you can possibly imagine in the last 20 years, and the politicians in Vermont are no longer merely liberal, but wacky leftist. You'll also be paying the very high 8% or 9& Vermont income tax rate versus 0% Wyoming income tax.

bdfreetuna said:

I can't get over his slanderous lies and disdain for our nation. Nobody throws out the "racist, homophobic, xenophobic, Islamophobic" slur on patriotic individuals more than this piece of shit. I look forward to his defeat by a historical margin.

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The Democratic Party (once again) isnt going to let Sanders get the nomination. They're rigging it against him (once again); and Obama is reportedly going to knee-cap him should Sanders actually become a threat to win it.