ejstronge

> The article clearly shows the skills necessary to work as a doctor are a lot wider than academic ability.

Where does the article show this?

> And the schools prefer it (at least in the US) - limited highly paid doctors means they can charge exorbitant tuition.

What's the evidence for your position? Researchers who study this question have shown that the cost of medical education is significantly higher than the price assessed to students.

In other words, having more medical students would cost schools money.

> Because doctors' associations and regulatory bodies (like AAMC in the US) lobby to keep it that way to keep the value of their profession up.

This isn't true of the AAMC position in the US today, and when it was true in the 90s, there were many articles about an upcoming oversupply of physicians.

First, US medical school graduating classes are smaller in number than the number of available residency positions. So every year, the US is importing physicians trained in other countries.

Next, residency positions (required to practice in the US) are funded by the US government. You could readily contact your US representatives about the problem you perceive - if this a legitimate concern for you.

Additionally, US residency positions don't need to be funded by any government body, at all! Hospitals need 'simply' show that there is enough patient volume to support educating additional residents. This is another avenue where you can intervene, if this is indeed something you care about.

Lastly, 'advanced practice providers' are filling in large amounts of the deficits in physicians in primary care providers. So focusing on the number of physicians is to ignore the huge growth of NPs and PAs - some of whom can function without a physician in some parts of their practice.

I see many people blame 'the AAMC' for healthcare problems, but worry that not many appreciate the lack of a role the AAMC plays in the number of providers in America.

> Those aren’t fancy cuts or prime grade beef. Just regular steak... I don’t know how the low income families deal with a 30% increase in their grocery bills

I don't think low income families are buying steak - and price increases in luxury goods can understandably grow faster than in staples like non-steak beef.

> Ahh yes, nothing treats heart hypo perfusion quite like forcing the heart into overdrive and massive vasoconstriction. Why is the US so far behind on this???

This is actually quite reasonable, especially if it’s paired with an existing defibrillator. Epinephrine is part of the advanced, cardiac life support algorithm, but it’s just not used in a pen format, since ACLS is typically performed in the hospital setting.

https://cpr.heart.org/-/media/CPR-Images/CPR-Guidelines-Imag...

Edit:

Recently, in the news, there was a discussion of using ECMO in the setting of patients who would require CPR. Take a look at this article for more: https://www.nytimes.com/2024/03/27/magazine/what-to-know-ecp...

> That’s ridiculous because in a single per system the government stands in front anyways. > There are plenty of drugs in Europe doctor might want to prescribe but the government says “nope, not going to pay for it”

Not only does this happen with the current system, it’s worse, because there aren’t always explicit instructions about what will be covered - so your care depends on whether your doctor is willing to beg the insurer to provide a drug to you

> Ion Torrent and Genapsys are barely used due to accuracy problems,

Accurancy didn't have very much to do with Ion Torrent's demise. As we're reminded in the OP, Illumina pushed the MiSeq platform, and there wasn't much reason to transition to Ion Torrent. Now, with 250 bp+ PE reads on Illumina, there really isn't much special about Ion Torrent besides its somewhat superior homopolymer performance.

> but Oxford Nanopore's considerable logistical benefits of tolerating a wide range of input DNA concentration, quick time to data, low capital cost, and long reads has kept them alive. Maybe they will grow more with higher accuracy.

This statement is reasonable in today's era, but ONT was nowhere close to being competitive with Ion Torrent and other platforms during the time where labs were considering the Ion Torrent devices vs continued spend on Illumina platforms.

The accuracy, tolerance to unusual DNA samples, and read length with clinically-relevant base qualities were unusable until 2018/2019.

Many drugs are prescribed in ways that take advantages of their side effects. Indeed, many drugs are designed for one purpose but perform a second purpose much better.

It’s clear that these drugs cause weight loss (in everyone) so I’m not sure what further certification and testing might show

It is a compelling study, but retrospective trials, in general, aren't the correct design to answer this kind of question. I am not saying the results aren't accurate - just that in medicine, there have been instances where a prospective trial offers a different conclusion that that of prior, retrospective trials.

Next, I'm no statistician, but I have never heard of this kind of trial being proof of causality (it can only provide supportive data - but as above, we know that the results may prove incorrect in a stronger study design). There are a lot of confounding factors that make causality a difficult thing to prove in humans.

There is actually a way to prove causality in humans, and I suspect someone will do this for marijuana since it is a hot-button issue: https://archive.cdc.gov/#/details?url=https://www.cdc.gov/ge...

I am not disagreeing that cannabis may be a cause.

This kind of article doesn’t offer any evidence toward the idea outside correlations - and this kind of correlation is very tenuous.

A good example to demonstrate the idea is the outsized use of tobacco products amongst those with ADHD diagnoses. Do we immediately conclude that ADHD rates are influenced by the availability of cigarettes? Or can we instead ask how nicotine may influence neural circuits that are abnormal in ADHD?

Won’t have the space/time to respond fully, but the allusions to bipolar disease and, especially, schizophrenia need to be viewed quite cautiously.

I do not believe these disorders are thought to originate from environmental factors present in late teenage years. Thus, we should expect a large increase in these diagnoses if cannabis is indeed a causative agent that is now more attainable than it used to be.

Also, individuals will instinctively self-medicate (think about a pet favoring a wounded paw). If these disorders reflect structural brain abnormalities - which they do, in large part - we then can’t distinguish whether cannabis use is a compensatory mechanism or a causative mechanism

> They also usually prevent one from applying AP credits or IB credits to college courses

Maybe this was your experience, but I have not ever heard of this, so ‘usually’ may not be the correct descriptor.

It is not disingenuous - it is quite clear that the kind of driving that happens in rural settings (fast, two-lane roads, no lights) is different from the kind of driving that happens in cities (slower, larger roads, street lights, stop lights)

https://www.mvmlaw.com/blog/do-car-accidents-happen-more-in-... has multiple links supporting this

> They count pure # of accidents and not accidents per miles driven from what I heard.

> misleading

I will agree that the data presented could be much better than they currently are.

To call this misleading, however, wouldn't you have to have a reasonable prior that the miles driven for Teslas are so much higher than the other brands that the trend we see doesn't make sense?

I would be more persuaded if you said that Teslas are more likely to drive in urban environments where crash risks are higher - it is hard to imagine that two popular brands with ICEs, Ram and Subaru, would have fewer miles driven than Teslas

It would seem to be the same - but also restaurant workers likely don’t hit the minimums frequently, since the kitchen would probably be unprofitable to run in settings where front of house are only making $3/hr.

They used tips (and may still use tips) to refund themselves for the minimum pay offered to dashers.

The language was very deceptive, as giving a tip did not always increase the amount of money received by a dasher.

Are you referring to the LinkedIn case? There has not been a decision on the legality of scraping in that matter

You and I are in agreement (see my responses earlier in the chain).

All of this has nothing to do with a land value tax; instead, some people believe that cities should not allow vacant properties. This is a fine opinion, but it does not need to invoke a 100 year-old theory on taxation

> If a developer wants to sit on a parcels for 3 decades, they're still able to do so but they'll also need to pay up for keeping high-value land vacant. That money can then be reinvested into the community.

How is that different from what happens now?

It sounds like what you are saying is that you don't believe that property taxes are high enough since there exist vacant buildings.

That is a fine thing to believe but there is nothing about the current structure of property taxes that goes against this, in principle, besides the tax rate.

I hear you, and I can sympathize as someone who has lived in cities that have changed rapidly.

However, I can see a long-term venture fund taking the exact bet you suggested. If the value of the new building that combines parcels is high enough, there is no way a land value tax would address your desire to stop landlords from waiting for opportune development projects.

What you would like is a punitive vacancy tax, perhaps combined with a required sale after a certain amount of vacancy.

My ultimate question is why you might want this. A land value tax is supposed to encourage the highest and best use of a parcel. This developer recognized that the highest and best use of a parcel might actually include the use of adjacent parcels. Shouldn't we encourage this?

I know you were not using the term incorrectly. My problem is with the term, altogether.

As you've said, you wish to have a higher tax on land. That is very reasonable, and a policy position that one could examine within the established context of our property tax regime.

> Property tax doesn't adequately tax the value of the land. That's the whole point. This was a vacant, unbuilt lot in the heart of New York City. For ~thirty years. That shouldn't even be a thing ever.

No tax will prevent this behavior if the final benefit to the owner is high enough.

How would a land value tax on three adjacent parcels stop an investor from waiting 30 years for the chance to combine the parcels and unlock far greater value?

I don’t have examples but in my coastal city, land values (for homes) are near 20% of the improvement. Edit: I'm seeing 40% land value compared to total assessed value for homes in my neighborhood, incidentally

Yes, but instead of proposing a new phrase, it would seem that one could simply propose an increase on the tax rate on land values?

I am aware of the history of the term - just frustrated that it’s thrown around as a brand new idea.

A problem with this system is how to assign land values if not using the sales value approach used in property tax assessments

> Property tax has a low tax value for the land itself and a high value for the improvements on the property.

This is not true in cities like NYC or Boston; also likely not true in many parts of LA. This is why people tear down houses to build new houses.

How would a land value tax change this? The developer was paying a property tax the whole time, and this tax explicitly considers the value of the land.

A vacancy tax may have helped but maybe not. A useful disincentive would need to reduce the developers anticipated return on combining the parcels - and it’s not even clear that this would be a good goal

I again don’t have a sense of how this works, but the activities performed by a resident are overseen by a qualified doctor. Eventually, the residents are able to supervise other residents and only consult the qualified doctor for important matters.

This would seem to increase the potential productivity of a hospital. So I am confused by why you say residents are a cost on balance sheets (again, considering that their pay comes from Medicare/Medicaid)

Residents are not fully qualified physicians, so it does make sense that they cannot bill for their work.

Further, residents, by and large, are paid for by Medicare.

> While they may provide value in other ways, they are viewed as cost on the balance sheet.

Are you saying that replacing residents with physicians would be more advantageous to hospitals? I don't have a sense of the numbers or billing processes involved

Other nations have longer post-graduate training requirements, sometimes including compulsory national service. For many specialties, a US high school grad will be fully qualified before her UK peer

This is a difficult issue - if we accept the statements on their face (and I don't have enough information to accept or reject the statements), it seems that there was waste by hospitals that were doing just what I mentioned, soliciting residents that were not needed.

From the article: "But why should hospitals be interested in this when, under current law, they automatically get sizable government subsidies for training residents who as part of their education take care of many of the hospitals' patients, work long hours and collect meager salaries?"

If this issue were to arise again in today's political climate, I imagine there would be a redistribution of seats away from in-demand specialties to primary care.

I'm not an expert on this topic, but the article confuses a handful of issues that should be separated.

There is a limit on the number of seats in US medical schools but this does not affect the number of new practicing physicians in the US directly. Thus the article's discussion of MD matriculations and of DO programs should be ignored.

The article correctly states that all physicians must complete residency programs. The US Medicare and Medicaid programs fund the vast majority of residency slots. Residency slots preferentially are awarded to US medical graduates (i.e., new MDs) but they are available to any graduate of an accredited MD program. Thus, if a bottleneck exists, it exists here.

However, hospitals can - and do - use other funds to train medical graduates in their residency programs. I do not know the thinking about how many such slots a residency program operates, but this would have been a far more interesting area for the article to examine.