second this. if you stay out of leadership I think it's a lot easier to have a healthy relationship with work. you set your boundaries and stick to them. highly improbable anyone will know any different.
I quit a high pay/low cost of living job to move to a high pay high cost of living job when I was young. The skills, connections, experience I got were great but eventually it was clear I wasn't on a path for long term happiness in that city. I then quit that high pay/high cost of living job to move to a low cost of living area. I bought a house, which was unattainable in hcol area. I ended up getting promoted to comparable pay after a few years. I am now planning to go from leader to individual contributor role soon. I have saved enough in retirement accounts to still retire early, but I'm not in a hurry because my partner wants to work another decade or so and generally be stable while we raise kids.
you might Google and read up on the concept of "coast fire", which is essentially front loading retirement savings then working lower paying jobs while you let your savings compound.
It doesn't really matter how you do it as much as how you talk about it. Like most aspects of a healthy relationship, communication is key.
State law is really important if the relationship fails and you need to split commingled assets. If that's something you're worried about you should speak to an attorney.
To directly answer your question, we both direct deposit into a joint checking account. We spend on cash back credit cards that are auto paid out of the joint checking account each month. Mortgage and car note are out of the joint account. We both maintain access to small spending personal accounts/cards on the side for gifts and misc. stuff we don't want to discuss.
When the checking account gets over our healthy buffer of ~2-3 months spending, we sweep the extra to a taxable brokerage account and invest it in index funds.
We "pay ourselves first" with prediscussed, significant, automatic contributions to retirement savings, college funds for kids, or any key milestones like down payments or big vacations. that way any money that stays in the checking account or misc accounts are relatively guilt free and discretionary.
Of all of the things that I mentioned, contributing to retirement and big milestones before we can "touch" the money has been the most important for our peace of mind. we don't fight over money because we've already aligned on the big stuff.
I spent a week touring Rome and didn't see a single public bathroom.
Every society makes its choices and some of those seem weird when you look on the other side of the fence. The US is unique, sure, but so are other countries.
That's a point of view that would change quickly if you were in one of those management positions.
You get to a point where it's impossible to do the work anymore. There's too much of it. You have to develop teams, processes, structure, etc. that delivers the outcomes you're accountable for with full knowledge that you cannot do them yourself. It's very different than doing the work and experience shows that fewer people are capable of doing it, especially with any repeatability. The working world yearns for effective managers.
I encourage you to compare the productivity of the modern multinational corporation to any commune in history. The people working in collectives are not stupid or lazy. It's not an effective structure.
Nuanced but important distinction: these are ICD-10 diagnosis codes. They are only loosely related to what is billed and would not show up in the pricing data referenced by the OP.
College prices are about as real as hospital prices. Sure, some outliers literally pay that much, but the vast majority receive a discounted price for various reasons. When you factor in those discounts, the cost inflation is 2.5x instead of 17x as the article suggests. It's more than a forgettable idiosyncrasy. It's "how it works" and if the author of the article doesn't mention it, they're either so ignorant as to not be worth reading or they're being dishonest.
I thought it was important to give that context.
American higher Ed is often about prestige and branding. The pricing strategy is similar to luxury goods.
Let's hope the single payer isn't Medicare then, because you would have a lot fewer hospitals. Here's the money quote straight from the horse's mouth "In 2021, Medicare’s payments to hospitals continued to be below hospitals’ costs in aggregate" https://www.medpac.gov/document/march-2023-report-to-the-con...
Medicare and Medicaid are subsidized by a shadow tax on working people. Commercial insurance, like the majority of readers of this website get through their employers, pays roughly double the cost per procedure as Medicare and Medicaid. Your health premiums would be lower if we all paid the same price, but your taxes would be higher.
Yes. Unemployment below natural level and inflation still high single digits. They will raise rates. They have no choice. It's literally their dual mandate to do it.
Let's hope not, that would be a disaster. Inflation is far more pernicious than regional bank instability. The fed is acting appropriately in response to a spendthrift Congress, and in the process, stressing the system. There's not a good alternative, especially from the Fed's seat. I'm not trying to make it a political argument, but you're really pointing the finger in the wrong direction. The fed has two mandates when it comes to monetary policy - price and employment stability. That price stability is about market wide inflation, not bank stocks. Banks come and go. If you expect the Fed to prioritize something other than those two mandates, I do believe you're kidding yourself. Rate hikes will continue until the labor market or the inflation data indicate they should stop.
China and other manufacturing behemoths are producing dramatically more than they were before the pandemic and we are importing and buying all of those foreign goods.
https://fred.stlouisfed.org/graph/?g=117Ig
I don't know about where you live but I see a lot more automation in service industries where I live. We continue to innovate. There's a labor shortage and we are below the natural unemployment rate, and it's not that those workers are doing less, as real GDP continues to grow
https://fred.stlouisfed.org/graph/?g=117IF
The inflation we've seen is almost all demand driven. There's plenty of supply of goods and services compared to pre pandemic. Your narrative doesn't fit the data.
Everyone got their stimmy check, paid down their debt, quit commuting, and realized they could buy more stuff. They did that for a couple of years. Now that credit card balances are peaking again (and at higher rates!), demand will slow and there will be a recession. The fed, always looking in the crystal ball but mostly reacting to what's in the rearview, will ease off rates and the economy will level out. The fed can't get rid of business and credit cycles, but they can try to quiet the amplitude. They have blunt tools to do that.
https://fred.stlouisfed.org/graph/?g=117MH
I would point to a few key reasons for the complexity.
1) Value based care - It used to be simpler with a model called fee for service. Get paid for what you provide. Insurers, Medicare in particular, aggressively drove the industry away from that because they argued it incentivized unnecessary care. The general approach now is value based care, where the insurers and providers negotiate a rate for each type of procedure or case, usually quoted as a percentage of the Medicare rate. In practice, that means that hospitals don't get paid for what they did, they get paid for the problem they solved, regardless of what it took to solve it. I'm oversimplifying, as this all depends on the setting for the care and the contract specifics, but this is certainly a major factor in how things got so complicated.
2) Supporting documentation - To combat fraud, insurers require that an appropriately licensed clinician provide medical documentation supporting the problem's conclusion. The insurers actually check for compliance, i.e. that the notes support the conclusion, in a significant number of instances. In response, the provider side of the industry has instituted expensive software (Epic, Cerner) and employs an army of clerical workers to be prepared to respond to audits from payers. These audits come in many forms, the most common is a denial where the payer essentially calls bullshit on a single claim, and the providers have to cough up detailed justification to get paid. Many providers find responding to denials so onerous that they don't even try, they just eat the loss. You can't do that in isolation though, that expected loss gets baked into the prices over time. And now you've got your most highly trained, value add people in the industry, doing data entry, by the way.
3) silos of information and decision making - The hospital cannot definitely tell you what you will pay out of pocket. They may be able to tell you the negotiated rate they have with your payer for a specific service, but they do not know if you will have met your annual deductible by the time you are billed. Your insurer has that information, not the hospital or the doctor's office. Your doctor is also not likely to know the complex billing logic, so even if they could tell you what they typically write in their notes for what they intend to do to you, you would still have a few steps before you could figure out what's likely to be billed (because it has to be converted to billing syntax). You may also know things that would affect the billing decisions that your provider doesn't know yet. If you're going to have a procedure and you've got diabetes, for example, your case might be considered complicated and command a higher rate. The list of complicating diagnoses is long. That's one reason you usually get labs done before a procedure. The provider needs to know what they're dealing with and that information can affect how much you and your insurer will ultimately pay.
Each of these factors complicate the billing logic. They all exist for good reasons. You don't want call center workers diagnosing patients and telling them how much things are going to cost. You don't want providers performing unnecessary procedures to drive up billings. Insurers have found that well intentioned providers are often sloppy with their notes or outright unethical with their billing practices. If the insurers can catch those mistakes, they can deny payment, and make more money, some of which will be used to keep premiums lower.
It all exists for a reason but put it together and you've got a damn mess and no one's happy.
Agreed. Insurance, Medicare in particular, is the root of these issues, from my biased insider's perspective. Doctors don't want to deal with insurance any more than consumers do...
Well in the u.s. the decision about severity has to be supported by medical documentation from a licensed provider. That medical documentation has to be converted to billing codes and put on a Medicare designed claim form. Payers, primarily government institutions like Medicare and state Medicaid offices, regularly audit these claim forms by random sample. If they find errors on those forms, such as a severity code that was not supported by the documentation, they extrapolate the number of failed tests in their sample to the population of claims they paid and claw back those payments. Depending on context, they might actually impose treble penalties as well and run your name through the press as committing fraud.
Do they do something like that in South Africa? It's not exactly known for the high quality of it's institutions.
Paying for better care and experience is possible in any country. Perhaps it's relatively easy, in a high inequity country like SA, to pay for an experience you like. Labor is pretty cheap there. It's gonna cost you more in the U.S. but you can get that experience here too, if you want. Find a doctor who doesn't take insurance or maybe look at Atlas. Bring your checkbook...
I wouldn't say a surgery could be considered routine until it's complete. That's hindsight bias. Most hospitals can provide an estimate for these types of surgeries now, it's built into Epic, the most common electronic medical record system.
Out of network providers are a real issue and certain specialties, frankly, have the hospitals by the balls. The hospitals would love to employ those anesthesiologists. Good luck finding ones who will accept that job offer. We have the 'no surprises act' now that's supposed to address this issue but it's not working very well https://www.hfma.org/topics/hfm/2022/october/no-surprises-ac...
I can't imagine the stress of having a loved one, especially a child, in a life threatening state. Adding byzantine medical documentation, coding, billing, and collections on top is certainly insult to injury. As a patient and consumer, we just really shouldn't have to care.
If your daughter's treatment had complications, such as a hospital acquired condition and/or sepsis during treatment, her diagnosis at discharge may change. That would change the cost. It's not disingenuous to say that you don't know what a final claim will say until all of this complexity is adjudicated. The existing billing system exists for good reasons. I am not particularly in favor of them, but there are real constraints that must be considered before we can improve. I think the burden on clinicians is unreasonably high and the regulations, driven by Medicare, are so complex that they require an army of clerical staff to navigate. That's the reality of the situation and if the cost and customer experience of healthcare matters to you, I believe you need to confront that reality instead of dismissing it.