Price controls coming for health care

Oh, Brooksie - those are not MY course notes, and they are not "continuing education" course notes: they are MBA course notes from Stern School of Business. (I guess you didn't read them - or if you did you didn't understand them.)

Nonetheless, let us remember what you were saying where you quote me, to put it into context. You said: "Did you know that the WSJ post closing prices for MBS daily?" and then you posted this link:

http://online.wsj.com/mdc/public/page/2_3024-bondmbs.html

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

NO THEY'RE NOT CLOSING PRICES! As the chart you posted clearly states, "*Extrapolated from benchmarks based on projections from Bear Stearns prepayment model, assuming interest rates remain unchanged."

What a maroon!

Now, do you want to go back to your statement that MBS's can't be used to manage duration, aka interest rate risk? I can post some more links for you, if you do.

Do you want to go back to your statement that banks keep most mortgages they originate on their books?

Because I can post some more of those links for you too, if you do.

To quote somebody I know and don't respect, "You leave me convinced you are the biggest idiot on this site."

Brooksie, why don't you tell us more about your airplane pilot adventures and VFW status? That would certainly be more interesting than the blather you post here about stuff that you don't know, even though it is likewise a figment of your imagination.

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

NO THEY'RE NOT CLOSING PRICES!

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

Now that I've made an utter fool out of Brooksie (again), we can get back on topic:

Life Expectancy Rises Around the World, Study Finds

http://www.nytimes.com/2012/12/14/health/worlds-population-living-longer-new-report-suggests.html?hp&_r=0

"But while developing countries made big strides – the average age of death in Brazil and Paraguay, for example, jumped to 63 in 2010, up from 28 in 1970 – the United States stagnated. American women registered the smallest gains in life expectancy of all high-income countries between 1990 and 2010. The two years of life they gained was less than Cyprus, where women gained 2.3 years of life and Canada, where women gained 2.4 years. The slow increase caused American women to fall to 36th place in the report’s global ranking of life expectancy, down from 22nd in 1990. "

Of course this is CLEARLY everybody's fault but doctors'!

Anyone is free to move to Paraguay if that is what you are getting at.

Find your way to Paraguay!
bgrfrank: I don't know what this discussion is about, nevermind who's getting at where.
It's been going on for days.

"Of course this is CLEARLY everybody's fault but doctors'!"

I have un-ignored Steve for this thread.

Anyway I don't say its the doctors' fault anymore than I think its rich people's fault for not voluntarily paying higher taxes. But I do want rich people's taxes raised. I don't think its the doctor's fault any more than I think its each individual SUV driver's fault. But I do want policies enacted that encourage lower carbon emissions. I don't think its the doctor's fault any more than I think its each school teacher's fault that our kids continually test well behind those in other nations. But I do want major reforms of our k-12 school systems. Etc.

Doctors are just behaving the way our system is designed for them to behave.

Oh, jason!
You "have un-ignored Steve for this thread"?!
What bullshit, jason.

Well wow, Jason! I'm speechless.

I agree with you and said so earlier: it's not the fault of doctors personally - they are just responding to how the system is set up. But they have to recognize that the system is set up for them to prescribe & do too much.

So far I haven't heard a doctor say that.

>I have un-ignored Steve for this thread.

So open minded.
Why don't you go back where you came from?

>But I do want rich people's taxes raised.

I want Jason's taxes raised.

jason isn't reading our comments, huntersburg.
He has us "on ignore"!
NYCNovice is in jason's doghouse now.
It's a very crowded house.

Why would he want NYCNovice in there with him?

"So far I haven't heard a doctor say that."

But the AMA endoresed Obamacare - and more than a few polls showed that the plurality of doctors would pick a single-payer system. Not SPECIALISTS, who'd get paid less. But not all doctors are specialists. For example:

"US doctors support universal health care - survey"

http://www.reuters.com/article/2008/03/31/idUSN31432035

jason put her "on ignore" because she didn't agree with him and he claimed she insulted him.

Also lets note that for FORTY YEARS and projected going forward the next ten, spending per patient on medicaid has grown slowest, medicare after that, and private insurance the fastest.

See page 13 & 14 for historical

http://www.kff.org/insurance/upload/7670-03.pdf

and below link for projected

http://www.offthechartsblog.org/medicare-and-medicaid-spending-trends-dont-justify-restructuring/

Its not even close. Spending per patient has increased WAY slower for medicare/aide. In fact, had overall spending increased at the same pace since the 70s we'd be spending about $1T less per year overall. So in other words, we'd be more like Canada, proportionately.

Here is a chart showing just medicare versus private, and then anotehr showing medicare versus medicareSCHIP versus pure private plan spending. Per patient. Now remember, people have been living LONGER past 65 every year, and yet medicare spending per person has increased much more slowly than private plans. Hmmmm....

http://theincidentaleconomist.com/wordpress/wp-content/uploads/2011/06/mcare-private-krugman.jpg

http://healthblog.ncpa.org/wp-content/uploads/2010/08/index-of-constant-expenditure-capita-larger.jpg

Sorry...so the first is per PATIENT and the second is a chart PER PERSON (whether old or not.) The first is accurate because it shows how much each PATIENT uses, while the second reflects the fact that there are simply more old people than there used to be, so OVERALL medicare spending has gone up, even as per patient spending has been slower growing than private plans. And overall mediCAID spending has gone up as more are on the program. But spending growth PER PATIENT has been slower even than mediCARE.

Conservative blogs love to use the second and never the first.

This thread is more compelling than RHOBH blogs. I would ordinarily feel guilty about posting such nonsense an SE thread, but this one was never about real estate and has really jumped the shark, so I feel like anything goes. Can anyone believe the drama going on between Brandi and Adrienne? I am hoping they work it out in next episode, but I am not optimistic.

thx jason--compelling shit

Steve, I gues. You don't understand the links you post. Since you obviously don't have an MBA in fiancé from NYU maybe that is it. Try to read it again very slowly. Read the part where it says MBS are negatively convex a few times. Read it over and over again until you understand. If you stll don't, maybe ask someone to explain it to you. If that does, I don't know what to tell. Oh, maybe you can call your professor you held in such high regard. If that does not help, not sure what to tell you.

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

NO THEY'RE NOT CLOSING PRICES!

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

Yes you can use MBS's to hedge interest-rate risk, aka duration.

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

No banks don't hold the bulk of their mortgages originated - they sell them.

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

What a maroon!

Tells us about your days as a Flyboy, Brooksie. Can't wait to hear that fantasy, either!

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

What a maroon!

You spelled macaroon wrong.

"...maybe ask someone to explain it to you...."

Why don't YOU explain it to me, Brooksie?

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

Then tell me about your days as as Flyboy.

Brooksie, baby! It's been DAYS and you still haven't SPLAINED it to me!

Or told me about your days as a Flyboy.

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

Steve, only one other person focused on Brooks' claims about being an armed forces pilot - Truth - and she has been deleted.

I'm waiting for Brooksie to 'splain to me the convexity of mortgage-backed securities.....

For DAYS now.

truth gone, brooksie gone. therefore truth=brooksie???

http://streeteasy.com/nyc/talk/discussion/4510-streeteasy-board-a-primer

And getting back on topic (since brooksie's gone awol!) I just got my new health insurance premiums for next year: an increase of 13% - in one year, when inflation is 0%.

Think there's no problem?

Steve - It sounds like you can afford it so I am not sure where the problem lies vis-a-vis you personally; I believe many on this board who have argued against price controls support increasing the availability and affordability of healthcare, but you would not appear to be among those who are adversely affected by the current system other than through having to allocate a larger percentage of your income than you would like to healthcare, so I do not understand the point of this most recent post: Do you want your insurance costs decreased so that you can buy a nicer Mercedes than the one you have stated that you already own? I really am trying to understand because you never actually answered my question about whether FFS physicians operating outside the insurance system would be allowed to charge whatever the market would bear under your ideal system. The answer may lie in one of your posts on here, but I have not been able to discern it and have been confused by various statements along the lines of "let the Revolution begin." Is your ideal system Medicare for everyone with physicians who opt out of the system being allowed to charge whatever they want with the added prediction that physicians won't opt out of system because anyone who opts out the system won't be able to compete/survive/proper? Again, tone is always lost in e-mail, so I am not judging, just trying to understand.

"you never actually answered my question about whether FFS physicians operating outside the insurance system would be allowed to charge whatever the market would bear under your ideal system."

Yes I did. I said that I did not think there would be enough demand for such physicians to have a material effect on the market. Yes they might do well in Hollywood, Bollywood, and on 5th Avenue, but there are only so many potential patients who could afford to take the risk of being without insurance. Right now it's basically limited to plastic surgeons.

No $30 a month extra is not a problem for me, nor is it the issue. The issue is 13% means that costs double every 6 years.

Even still I could live with it, but a lot of people can't; it is unsustainable in the long-term.

That is the issue.

Steve, did you reread the link you posted from Stern? Did you read it sliwly? You still don't understand? Try reading it again.

Slowly Steve, very slowly

Oh, Brooksie! You said I needed to ask somebody to splain it to me, and I asked you to splain it to me.

PLEASE PLEASE PLEASE Brooksie. Because you know so much about everything, like, uhm, that banks keep their originated mortgages on their books.

HAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!

What a maroon!

Okay, so it sounds like you agree with my characterization of your position as a prediction "that physicians won't opt out of the system because anyone who opts out of the system won't be able to compete/survive/prosper." But then you go and confuse me anew with your statement re "potential patients who could afford to take the risk of being without insurance." Under a medicare-for-all system, everybody would have insurance, even if they chose not to use it and avail themselves of it. I also find it hard to believe that those physicians who do not take any insurance are "basically limited to plastic surgeons"; I know two primary care physicians who do not take insurance, and I don't know that many physicians, so I doubt I know the only two non-plastic surgeons who don't take any form of insurance. I absolutely get and agree re the issue being that many people cannot afford insurance and support fixing that situation, but under the "medicare for all" system, wouldn't the costs for those who chose to use system paid for by their supplemental insurance policies still end up paying considerably more? Would you personally choose to purchase the supplemental insurance or would you stay with the basic mandated? When I worked for the government, I was thrilled to pay $30/month for my health insurance; the problem was that I could not find any doctors within NW DC who were accepting new patients with my plan. Again, I am not trying to be difficult and I fully acknowledge that I myself do not have perfect reading comprehension skills. I assume most people who would be annoyed at my continuing this conversation have simply stopped reading the thread, and I would understand if you yourself did not want to discuss further, but I am trying to figure out if your ideal system is Canada's or is it England's? or some other? Are you happy with Obamacare? If so, what did you mean by statement "let the Revolution begin." I just want to know exactly what your ideal system would look like. I apologize if you already answered this question in one of your posts and for asking you to repeat your answer if you have in fact already answered the question. Totally understand if you are done with me and do not want to discuss further.

P.S. - One point of clarification re physicians who do not take any insurance at all; that does not mean that patient's insurance policy won't reimburse patient who uses such physicians; just means all the paperwork is on the patient. The two physicians I know who don't take insurance say they want nothing to do with fees set by insurance companies or the paperwork involved in dealing with them.

Steve, I not the one one this site that claims to be an expert in everything. That is you my friend. I just point out how foolish you sound. That's all.

I didn't confuse anything.

Doctors who don't take insurance is not the same thing as "patient's insurance policy won't reimburse patient who uses such physicians." Unfortunately, you're talking about two different things: one is a physician who is a member of a PPO or HMO, and the the other is a physician who is not. In the latter case the physicians still need to complete the paperwork because the patients are incapable of doing the coding; it is an "out-of-network" doctor, and I have no problem if people want to pay for that. I was referring to doctors who would not even do that, which is what your statement implied.

When I lived in the UK and Spain, two single-payer systems, I had supplemental insurance paid by my employers at the time. Whether I would buy such a policy now would depend on what it actually provided, and at what cost.

There is no such thing as a "perfect" system; somebody will always be unhappy with something. Obamacare hasn't fully kicked in yet so we don't know how it will work, precisely, except that we know it will work differently in different states. The UK's NHS works well, though don't expect luxuries.

The "revolution" is the revolution in the structure of the healthcare market and its current perverse incentives to over-prescribe and over-perform. FFS is responsible for that, clearly, but there are a lot of vested interests. We need to see how it will play out, though this might be the next step:

http://www.mass.gov/governor/pressoffice/pressreleases/2012/2012806-governor-patrick-signs-health-care-reform.html

Steve - thank you for further clarifying your position.
Hi Brooks2.

I'm not "gone".
I haven't been "deleted".

I'm not "Brooks2". I don't even drive a car, nevermind pilot a jet.

I still wish Brooksie would SPLAIN it to me, because he obviously didn't even read the Stern link, because had he he would have seen that it's not a valid link.

HAHAHAHAHAHAHAHAHAHAHAHAHA!

Sigh...Why I ignored Steve in the first place. I am out of this board until january. Have fun berating each other with personal insults, guys.

This discussion really went to junk after NYC1234 exited it; not that anyone cares, but just so the record is clear, I am still firmly in NYC1234 camp here, and I fear a world of price controls in healthcare. I sat on the board of a mental health facility for three years; the majority of the patients were uninsured and their care was paid for by city's mental health services department. The city was only willing to pay $X for each patient; the facility I worked with was only one of two facilities in the city that would take such patients (more than one patient with dual diagnosis schizophrenia & substance abuse). Each year I was on the board, we struggled to keep the facility open and could only do so through private donations. Inability to meet payroll and other operating expenses was not because the facility was inefficient - we are talking bare minimum; the individuals who staffed the facility were incredibly dedicated and worked for well below market; as older staff retired, we had great difficulty finding anyone to replace them. All the members of the board felt strongly about keeping the facility open; so we all kicked in, plus made pitches to others in the community to pitch in. I just got the "end of year" appeal from the facility, and it is not pretty. I do worry about providers simply exiting the industry under a single payer system.

Private donations are keeping things afloat, NYCNovice.

The Robin Hood Foundation raised over 15 million dollars even before the hurricane relief benefit concert at Madison Square Garden.
Over 50 million dollars raised from ticket sales and donations called-in during the concert.

It's not 50 billion, although better than waiting for the government$.

"That may prompt banks to hold more Treasuries and government-backed mortgage securities as they deploy excess deposits. Lenders held $1.87 trillion of U.S. government debt and so-called agency securities as of Dec. 5, a 9.7 percent increase from last year."

http://www.bloomberg.com/news/2012-12-18/bank-deposits-surge-2-trillion-more-than-loans-credit-markets.html

Steve, do you still not understand. Does it still not makes sense to you that banks buy MBS?
read this article VERY SLOWLY..

stevejhx
about 9 weeks ago
Posts: 12292
Member since: Feb 2008
ignore this person
report abuse

First, you don't even know what they are: they are NOT closing prices, but rather model-estimated benchmarks for different types of notes with different nominal interest rates.

Second, treasury prices do not have the default and prepayment risks, and therefore all like treasuries trade at the same interest rate.

And third, yes, actually, they are extremely difficult to price, and that is not from me via my advanced certification from NYU in FIXED INCOME SECURITIES MANAGEMENT (you can look it up), it is the first thing you learn in the textbooks about pricing securities.

Here are some course notes on how to do it:

http://people.stern.nyu.edu/igiddy/ABS/absmbs.pdf

here;s the link you posted Steve-- another one for yo to reread..SLOWLY

Here is an excerpt from your link, for you to read VERY SLOWLY-- "Securities backed by fixed-rate mortgages have "negative convexity." his refers to the fact that when interest rates rise, the MBS
behave like long-term bonds (their prices fall steeply); but when
rates fall, their prices rise slowly or not at all.

Brooks: jason is "out of this board until January".
That may give you enough time to sort this discussion out with stevie.

My flight to San Francisco leaves tomorrow night. Wouldn't it be fun if jason is taking the same flight as I am? He will ignore me.
Maybe I'll see jason in The Tonga lounge at The Fairmont Hotel on Nob Hill.
He happily chatted on se with me about that place, back before he started ignoring me.
I don't know if The Tonga lounge is an "ignore-free" location.
Maybe jason will chat with me there.
Maybe I'll see jason on the beach when I get to Maui.
He will ignore me.

Carry on, Brooks.

sounds like a good tool to hedge "interest rate" risk with ..."when interest rates rise, the MBS
behave like long-term bonds (their prices fall steeply); but when
rates fall, their prices rise slowly or not at all."

hummm that does not sound too good to me.

Brooks/Stevejhx - Can't you just challenge each other to a duel or something? If not, carry on.

Hi Truth - I have no idea what is going on between between the various longtime posters, don't care and just wish nobody would attack anybody else outside the context of the subject matter of any given thread. With that said, I am glad to hear rumors of your demise were unfounded. Enjoy your trip to Hawaii; I am about to get on the road myself (sadly not to Hawaii or SF), so I, too, am out for the duration of the holidays.

truth, when people spend serious amounts of time trying to prove to all how enviable their life is, it usually indicates failure, insecurity and unhappiness--you are one of those people.

given the rest of what you spew, and what has been learned of you, it it safe to conclude you are an unhappy, insecure, failure....and a bit bitter, too.

Carry on. See you at the next Robin Hood event!

Though that might not "sound too good" to you, that is because you don't know what you're talking about: it is precisely what a hedge does - it behaves in the opposite direction of what it is hedging.

And it is precisely why MBS's are used to hedge against treasuries, and vice-versa: it hedges duration risk because if interest rates change, MBS's act in the opposite way as treasuries, reducing the total duration of a bond portfolio.

Here's what the pdf says: "Positive convexity is desirable, because it cushions a bond’s price fall and accelerates its rise."

"Mortgage-backed securities and other callable bonds may have negative convexity which cushions a bond’s price rise and accelerates its fall!"

Since no one can always accurately predict which way interest rates will move, you would want to manage the duration of your bond portfolio by having a mixture of bonds that perform in opposite directions.

If you only have one bond that is a different matter; but if you have a large bond portfolio, you need bonds that behave differently.

That is what a "hedge" is, and that is why all the quotes on the prior page say what they do.

What a maroon.

No Steve. It's clear. You are the moron.

"And it is precisely why MBS's are used to hedge against treasuries, and vice-versa: it hedges duration risk because if interest rates change, MBS's act in the opposite way as treasuries, reducing the total duration of a bond portfolio."

This is false! Treasuries are positively convex so they will NOT act in the opposite way as treasuries you fking moron'

Correction not act in the opposite way as MBS which are negatively convex.
U fking moron

Treasuries are used to hedge the duration risk of a MBS portfolio that a bank buys to increase yield! Banks don't but MBS to hedge duration risk!!!

Do you finally understand WHY banks but MBS?!!! Read the fking bbeg article I posted Ya moron

"We also enter into forward commitments to sell loans and mortgage-backed securities to hedge the value of the interest rate lock commitments and loans held for sale. We typically designate forward sale commitments that hedge mortgage loans held for sale as fair-value hedges if we can demonstrate the sale commitment is highly effective at offsetting changes in value of the mortgage loans."

http://www.wikinvest.com/stock/Temple-Inland_%28TIN%29/Derivative_Instruments

"Consider a mix of corporate bonds, municipal bonds, government bonds, agency bonds and mortgage-backed securities to hedge against fluctuation in one sector."

http://www.life123.com/career-money/investing/bonds/investing-in-bonds-2.shtml

"Retirement funds, which have suffered as Europe%u2019s debt crisis and low interest rates hurt government bond yields and drove up liabilities, could benefit from increased margins on mortgages, Eloy Lindeijer, head of investment management at Dutch investor PGGM NV, said in June. Investors could use Dutch residential mortgage-backed securities to hedge interest-rate risks, he said."

http://iriscake.com/tag/june-investors/

"Traded mortgage-backed securities, euro-dollar futures contracts, treasury futures contracts and options on mortgage-backed securities to hedge interest rate volatility for banks%u2019 mortgage pipelines."

http://www.linkedin.com/in/kmapel

"Delivered product to investor on a Mandatory and AOT basis utilizing Mortgage Backed Securities to hedge the interest rate risk."

http://www.linkedin.com/pub/kevin-keadle/6/2a6/296

Do I need to keep on going Brooksie, or have I made enough of a fool out of you already?

Here's some further reading, Brooksie:

"As I described last week, portfolio managers holding MBS need to undertake convexity buying and selling as interest rate levels change; the duration of their portfolio is changing with rates, although the changes are the opposite of what a portfolio manager would normally do as rates move. In a bond market rally, a rational PM would look to extend his/her duration in order to get the maximum benefit from rising bond prices; in a selloff, the PM would shorten the portfolio’s duration in order to minimize his/her exposure to declining bond prices. Because of prepayments, however, the opposite is happening. Rising rates imply lower levels of prepayments and longer MBS durations, meaning that without adjustments the portfolio’s value would become more sensitive to changing rates. A decline in interest rates, alternatively, means that prepayments are increasing, shortening the duration of MBS and forcing PMs to buy bonds in the face of higher prices."

http://www.mortgagenewsdaily.com/channels/secondary_markets/02212012-duration-and-convexity.aspx

MBS's perform in the OPPOSITE way that treasuries and other noncallable (or nonprepayable) bonds do, which is what I said, and what you denied, or in your immortal words, "U fking moron."

Go ahead you post many things you do not understand

Any Flyboy stories, Brooksie? I'm working on some Big Cases, and I need entertainment.

How about this one, Brooksie, registered on Edgar?

"During 2003, the Company entered into various agreements to buy and sell mortgage backed securities to hedge the interest rate risk on mortgages held for resale that have a fixed interest rate to the borrower."

http://google.brand.edgar-online.com/EFX_dll/EDGARpro.dll?FetchFilingHtmlSection1?SectionID=2960778-276926-304616&SessionID=NCx3FHPq9T_wkE2

Or this from Wells Fargo:

The company began to invest in longer-term securities, after selling lower yielding ARMs and securities over a year ago.

"This is due to a rise of long-term interest rates, which added $30 billion in securities at attractive yields. These yields are higher than those at which the company sold their lowest yielding ARMs and long-term securities between mid 2004 and mid 2006. Half of the added securities were in the mortgage company, which uses mortgage-backed securities to hedge the interest rate risk in the mortgage servicing portfolio."

http://www.123jump.com/earnings-calls/Wells-Fargo-&-Company-Second-Quarter-Earnings-Call/23445

Do you want more?

Oh look, it's wbottom/yikes, who spends serious amounts of time trolling me, claiming that I'm not who I say I am.
(I'm just a music business publicist. Why does that annoy him so much?)
and that I don't go to events that I mention in my comments. ( I live in NYC, why wouldn't I go to those events?)
That I don't work in the music business, blah, blah. (wbottom/yikes claims to be a big 1-percenter finance biz guy. Why would my being a music business publicist cause him so much envy?)
He's envious to the point of being distracted from his "life" of insecurity and unhappiness.
He has learned nothing about me.

It's "safe to conclude" from what has been learned about him from his "Bye Truth" comment, that he is so focused on trying to insult me that he just can't stop trying.

Why do I matter so much to wbottom/yikes?

Bye, wbottom/yikes.
You won't see me at the next Robin Hood Foundation event because you aren't invited.

Yo, wbottom/yikes, you got mail.

Put in an order with the se Avon lady:
"Ding dong".

NYCNovice: Those rumors were started by wbottom/yikes/rangersfan and the se Avon Lady.

As you can see, I'm very much alive.

I don't know why my presence on streeteasy would cause anybody to despise or attack me.
It's just a website.
It makes no difference to me in real life.

Going to San Francisco is no big deal. Even jason goes there.
It's just a stop on the way to Maui.

From Maui to Bora Bora and then to Australia.
Been there before. No big deal for me.

For wbottom/yikes/rangersfan, the se Avon Lady and a bored NYC housewife -- it's causing them to detest me.

Too bad for them.

Wherever you're going for the holidays, enjoy yourself NYCNovice.

stevie and Brooks: pardon the intrusion from wbottom/yikes/rangersfan and his women.

I hope you both resolve this before the new year.

Riversider started a discussion about "price controls coming for health care?" and you guys are back to your
disagreement about MBS.

Happy Holidays to you both.

oh frumpulus! no obsession at all, just occasional amusement with your need to tell everyone how wonderful and enviable you and your life are.

go figure...now you're off to the exotic south pacific--but youre kind of a water person, no? living in bay ridge and all?

bye truth was simply a reference to the fact that all of your recent comments had been deleted by SE and you went stone quiet for a few days.

now youre back. nbd. you will certainly prove cntinually amusing.

bye frumpulus!

and here's wbottom/yikes within minutes of my comment being posted.
Only he and his gang are envious of me.

Others here on se have real lives to be interested in living.

I see my "recent comments".
Yet wbottom/yikes/rangersfan and the se Avon lady seem to have had a group grope on se because I was away for a couple of days.
I only went to N.J. to see the Stones.
wbottom/yikes was here all that time waiting to troll me.

Yo, you have mail.
From Brooklyn.
Not Bay Ridge, but still Brooklyn.
Stay away from the water, wbottom/yikes.

Such effort he puts into his need to troll me.
He thinks my life "is wonderful and enviable" and he can't stop.

Truth prevails, right?

I was just reading the thread about nanny tipping where Wbottom was attacking uwsmom. Interesting.

Correct, huntersburg.

Interesting. wbottom/yikes is a wealthy one-percenter but he needs to troll me to get his jollies.
He'll be here looking for me every day while I'm out of town.
Watching, waiting and hoping.
I've been away from se before for days, weeks and months.
He was here on se watching, waiting and hoping.

Happy Holidays, huntersburg.

Poor Brooksie!

BTW, is this the article you wanted me to read? "Bank Deposits Surge $2 Trillion More Than Loans: Credit Markets"

The one that says that the end of the TAG program "may prompt banks to hold more Treasuries and government-backed mortgage securities as they deploy excess deposits"?

The one whose next sentence is "“It’s not how you want to make your money if you’re a bank..."?

HAHAHAHAHAHAHAHAHAHAHAHAHA!

Or this piece of Brooksie Financial Wisdom: "Treasuries are positively convex so they will NOT act in the opposite way as MBS which are negatively convex."

That's good! A negatively convex bond does not act in the opposite way as a positively convex bond! Obviously, then, negatively convex bonds act in the EXACT SAME WAY as positively convex bonds, which is why one is negative and the other is positive.

At least according to Brooksie.

HAHAHAHAHAHAHAHAHAHAHAHAHA!

Yikes, BTW I did log out and my posts were still visible. Steve's became visible, but Truth's were still hidden. So I think you put me on ignore by mistake. Just FYI. I am going home for X-Mas for two weeks, have fun insulting each other for 50 posts and then staying in topic for 1, guys!

Will anyone who is reading this please tell Jason that I apologized and ask him to read me again, because my last post (reproduced, in pertinent part, below) is on point, and I want him to consider it. I do admire his passion and want him to channel it in the most productive way. Totally understand if he has determined that he is already doing that, but just throwing out something that he may not have considered. No response expected.

". . . just so the record is clear, I am still firmly in NYC1234 camp here, and I fear a world of price controls in healthcare. I sat on the board of a mental health facility for three years; the majority of the patients were uninsured and their care was paid for by city's mental health services department. The city was only willing to pay $X for each patient; the facility I worked with was only one of two facilities in the city that would take such patients (more than one patient with dual diagnosis schizophrenia & substance abuse). Each year I was on the board, we struggled to keep the facility open and could only do so through private donations. Inability to meet payroll and other operating expenses was not because the facility was inefficient - we are talking bare minimum; the individuals who staffed the facility were incredibly dedicated and worked for well below market; as older staff retired, we had great difficulty finding anyone to replace them. All the members of the board felt strongly about keeping the facility open; so we all kicked in, plus made pitches to others in the community to pitch in. I just got the "end of year" appeal from the facility, and it is not pretty. I do worry about providers simply exiting the industry under a single payer system."

>Yikes, BTW I did log out and my posts were still visible. Steve's became visible, but Truth's were still hidden. So I think you put me on ignore by mistake.

By mistake, exactly.

>Will anyone who is reading this please tell Jason that I apologized and ask him to read me again, because my last post (reproduced, in pertinent part, below) is on point, and I want him to consider it. I do admire his passion and want him to channel it in the most productive way. Totally understand if he has determined that he is already doing that, but just throwing out something that he may not have considered. No response expected.

You know NYCNovice, you have to pick your friends and your enemies. You can't expect love from everyone. Even Bill Clinton had to stop sneaking out in the middle of the night to go from Ron Burkle's house to David Geffen's house.

HB - I really don't care if anyone is my friend or enemy, but I do enjoy substantive discussions with some playful nonsense thrown in here and there. I have to watch myself b/c I really don't want to hurt anyone's feelings and can be a bit harsh at times. I am so used to the rough and tumble back and forth with opposing counsel that I am generally impervious to the effect that my words might have on civilians. I do think Jason deserved a smack on the side of the head, but I did not think he would take it so hard given what he dishes out. I would like him to go a bit deeper on issues than the knee-jerk propaganda that I feel he just puts out without full understanding of what various posters are saying. PS: I love how you keep everyone in check; you are hands down my favorite grey poster, though Alanhart is a close second. Where is he btw?

>HB - I really don't care if anyone is my friend or enemy,

Oh please Jason, please come back, please kiss kiss, pretty please

Keep posting Steve your ignorance is astounding!

Oh and while you are getting coffee for the"big cases"you are working on, I'll have one., remember how I like it .. Strong and black!
Hahahaha fetch me some more coffee hahaha

>Oh and while you are getting coffee for the"big cases"you are working on, I'll have one., remember how I like it .. Strong and black!

Like you like your men?

Brooksie's Financial Wisdom: "Treasuries are positively convex so they will NOT act in the opposite way as MBS which are negatively convex."

Definition of positive convexity: "The price-yield curve will increase as yield decreases, and vice versa. Therefore, as market yields decrease, the duration increases (and vice versa)."

Negative convexity: "as market yields decrease, duration decreases as well."

That's not opposite, is it Brooksie?

http://www.investopedia.com/university/advancedbond/advancedbond6.asp#axzz2Fb3sn2Ua

WHAT A MAROON!

The problem with healthcare is we don't know what it could potentially look like in a few weeks or months down the road. Both sides have caved in moderately are their ideologies so if everything is on the table who knows what will happen. For all we know medicare and social security eligibility will go up a few years to combat rising costs. It is going to be an interesting with lots of fighting, I mean negotiating from all interested parties.

stevie, amazing to me that in your steadfast need to always be right you actually were "debating" someone earlier in the thread who not only has WAY more technical expertise (MD running multiple practices) than you on this topic but also has a ton of useful practical experience in this field. yet, you dismissed him and fell back to your usual position when in distress of feint, bs reference post, feint, bs reference post, repeat. all in your quest to never admit a wrong. again, this guy has a ton more technical and practical knowledge yet you couldnt relent.

with your multiple degrees from nyu stern, blah, blah, blah - did they ever teach you to LISTEN??!! might freeking learn something...alas, you are too far gone.

Ranger, since when does an MD make one an expert in health economics?

Since never, I would say, as that is a highly technical field of research. I would not dare opine on what might be ailing someone, but how the healthcare sector is structured - that's a different matter.

Best regards,

@stevejhx

Actually you finally stated the problem. You have whittled down all of medicine to "mortality" rates = quality of care. You have looked at this statistic as your sole measure of quality. I don't blame you because you know nothing about the several thousands of disease processes that exist so this is a simple way to justify your mindset. Also, it is clear that your personality type is "know-it-all", this is not debatable by any stretch so I also understand why it is so important for you that everyone listens to you speak.

To not understand anything about the technical details yet claim that understanding the economics alone is sufficient for devising a solution...that's simple buffett, page 1. Know your business. Don't get involved in selling widgets and telling people how to manage the business if you don't even know what the widget is. Very few doctors understand the economics, I will give you that. However, those of us who have managed practices in both the outpatient and inpatient settings have a pretty good understanding of the relative inefficiencies.

The vast majority of patients that are seen outside of the hospital are not seen in the context of extending mortality. Mortality rates have much more to do with how a person manages their life choices than anything else. Studies by several respected journals have demonstrated actually that amongst all the medications we have created, essentially there are only 2 things that have significantly altered the mortality rates for a population: 1) washing hands with soap and water & 2) vaccines. This is also why 3rd world countries are currently rapidly extending mortality rates; because these concepts are only now being filtered to the masses (by now I mean over the past 20 yrs).

The crux of our work, ie 99% of the medical care in the outpatient world, is to alleviate people's symptoms, and make people's lives more bearable and functional. This is actually a side-product of being in a highly capitalistic society that is much more important than in a socialist system where this is not an issue. My uncle is in a Scandinavian country and the waiting time for cataracts is in the 12+ month range. His employer told him to just sit it out so he is getting paid for 12 months without work to wait for the cataract surgery to go back to work. Again this does not affect his mortality.

The stats for this are really disease based. Pick an ICD-9 code and then compare the overall symptomatology and treatment from country to country, you will find some very positive findings in the US medical system.

I agree with you that unmonitored fee-for-service cannot be the basic service offered to everyone. Currently, doctors over order tests because of fear of malpractice as well as several that feel the need to "do" something. Amongst all doctors, there are also several (as in all industries) that are corrupt and use this as a way to generate b.s. revenues. This is not the norm. It is considered dirty and especially in highly specialized fields in a competitive market (like NYC), over ordering tests can really create a horrible reputation and kill your practice, not to mention get you sanctioned by the OPMS and state licensing agencies. If you don't think doctors get together and talk trash on those that we feel are unethical about this, you are nuts.

The crux of your argument, although not entirely flawed, is completely misunderstood. You seem to think Obamacare is similar to the systems setup abroad. It is not. Our hospitals are privately owned (some publicly). Some are nonprofit. But they are not government controlled, nor is it in their interest to do anything except generate profit. What makes you think that when all care is consolidated to 1 provider in an entire community, that the price will drop? Do you understand how monopolies work? Healthcare is not something that the government/Medicare/private party insurers can balk on; the hospitals will have all of the negotiating power in this new environment. And btw, this is not clandestine, it is well known. The C-suites of most large hospital complexes are interchangeable and although there is competition, when it comes to these upcoming negotiations, the price will be fixed - by the hospitals. And it won't be one that your 13% increase will be able to afford.

And btw since you know so much Steve, perhaps you can explain to all of us why all doctors don't use electronic medical records and the real reason that medical records are not easily exchangeable between offices...this alone would resolve a VAST majority of medical issues and improve care! It is not by accident and definitely not due to a lack of technology. The inability for information to be shared amongst different medical offices so that quality of care can be measured is a fundamental basic step in improving care. Does it concern you in the least that the US government is not interested in this situation at all but would rather let the hospitals manage it? Do you know why it is the case?

Yes, 1234, it is everyone's fault but the doctors'.

"You seem to think Obamacare is similar to the systems setup abroad."

No, actually, I don't think that at all, but it does have some similarities to the Swiss system.

"But they are not government controlled". Some actually are - Google "Health and Hospitals Corporation."

"Do you understand how monopolies work?"

Yes, because unlike you I have a degree in economics.

Regarding the sharing of medical records, you're wrong. Not only is it one of the things that the VA does exceedingly well, Obamacare sets up payments and incentives to do just that.

I know - it's everybody's fault but the doctors'.

Everybody's but the doctors' fault.

http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/20/surgeons-left-4857-objects-in-patients-over-the-past-two-decades/?hpid=z4

And really, 1234, your "You have whittled down all of medicine to "mortality" rates = quality of care" is about the same as teachers complaining about standardized tests.

The measure of outcome is mortality; the question is at what PRICE is a certain outcome achieved? And the fact is that in terms of mortality (and also morbidity, BTW) our system costs twice what the next most expensive system costs, with the outcome measured at about #38 in the world.

Would you buy the most expensive car in the world if it was ranked #38?

Ok let's say it's the doctors fault. Who will be the doctors 2 years from now? It's the same group of doctors. Great logic Steve.

"Regarding the sharing of medical records, you're wrong. Not only is it one of the things that the VA does exceedingly well, Obamacare sets up payments and incentives to do just that."

The VA is not an outpatient office nor is it what is being fixed! I'm asking you to explain why we don't exchange records efficiently between our offices. Also Obamacare only incentivizes us to buy an Electronic Medical Records system, doesn't increase the transparency or exchange of information between 2 offices, which is the real problem. What good is it if your records are electronic but in a blackbox only seen in the doctors' office? Why do you think they let the other part of the reform go, ie, the part that actually makes EHRs communicate with labs, imaging centers, and referring offices?

"Do you understand how monopolies work?" "Yes, because unlike you I have a degree in economics."
We can all tell by the quality of your posts how good this education is and how well you really understand this.

HHC is not what will control the prices trust me, they are the weakest link in the chain.

Would you buy the most expensive car in the world if it was ranked #38?

Terrible analogy, chances are the world most expensive car isnt transporting you from point A to B with a top ranked combination of efficiency, comfort, and reliability.

Well apparently, given the internationally recognized statistics, neither is our #38 ranked healthcare system.

NYC1234 - Once I understood fully that Steve's positon is that his sole criterion for quality is mortality and that his interpretation of data leads him to believe that a more socialized system will lead to better mortality stats at a lower cost, I felt no need for further discussion. I do not measure quality of system by single criterion of mortality (this is value judgment), but even if I did, I don't believe a more socialized system would improve that statistic at lower cost (this is my conclusion from data presently available). Thank you for taking time to weigh in on this discussion. I come to SE for real estate education, but am always delighted when I encounter a posts such as yours that educate me in other areas as well.

Maybe I missed the post where this was discussed - but the more pressing reason to have a "free" public health option is the real financial burden that medical costs pose to the average person. Personally, I would like to see this load distributed by taxes going to pay for such a thing. Y'know - a public good kind of thing.

I am 100% for universal healthcare as well. In fact, I don't know of any doctors that I have worked with who don't support it. Ultimately the patients end up in the ER (of a hospital) which is the most expensive place to get care so currently if we could cut out the ER visit costs alone, it would likely cover a large proportion of the universal coverage. What I oppose is the control of an already inefficient system by the sole member (hospital) that causes the vast majority of the inefficiency.

From a perspective of self-interest, access to regular health care can save a lot of taxpayer dollars, particularly in certain areas such as pre-natal care and pediatrics. And avoiding routine care in the ER.

But I agree with 10023, access to certain things like decent health care and public education are a public good issue, I'd argue part of evolving beyond a third-world status. We are doing very poorly in this regard.

Nyc10023 - I am in your camp here but am not well enough versed in subject matter to know what best approach is, which is why this thread caught my attention. Nyc1234 made it clear early on that he was in favor of inreasing availability and affordability but was opposed to stevejhx proposed system. I'd try to find the post but I can't wade through all the intervening nonsense.

A limited amount of healthcare just like a limited amount of free food and a limited amount of housing subsidy and a limited amount of free education is a public good. There is a significant amount of negative public problems by all of life's necessities being a free for all. Case in point is the unlimited free access to the emergency room.

We all agree that routine treatment in ER is killing system; question in mu mind remains how to improve situation. I have to believe Obamacare will be an improvement, but I am relatively uneducated in this area, which is why I tuned into this discussion. Carry on because I would love to learn more.