Contract manufacturers vs board stuffers

Yup. The folks owning and running the grocery store lived right above it. Commute time 15 seconds, one hallway and one flight of stairs, no vehicle necessary.

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agreed

Quote "It's not the northern countries who are being fleeced, but the citizens of Italy and Greece"

It's the people that actively participate in the fleecing.

Corruption is a major problem but the population has got to stop throwing stones and setting things on fire when confronted with the fact ... ... that they can no longer retire at 60.

First there need to be longer work times, no more eearly retirement for everybody. Without work no money and thus no infrastructure. Someone has to pay the piper and that cannot be northern countries all the time.

It generally is.

When paid by the government then they are government workers. Not everyone believe in the benefits of such a system.

I thought you'd also be old enough to know.

Ever heard of mutual funds?

Not perhaps, those are the facts.

No. You stated the reason yourself right below.

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So tell us, why do you think they keep doing it then?

me why they do

You can, for example, learn that the US has a solid base of leading enterprises. Something which, unfortunately, cannot be said at all for other places. It's a matter of unleashing this energy more, and that's not a matter of an administrative change.

The fact that you or others don't like republican presidents means nothing to us. Sorry to say but that's how it is.

It has absolutely nothing to do with nationalities. Else Italy and Greece would not be top vacation destinations. But they do want everyone to carry their own load, and rightfully so.

So the subsidy rules are wrong. There siould not be such subsidies in the first place.

That is unethical behavior. Some states have realized that and declined, and I profoundly applaud them.

Even then it doesn't. Almost none of the high speed systems can live without the Government dole, the only exception being TGV and Shinkansen.

That's the typical leftist view that you express so ofetn: Who cares how much debt we accumulate. Well, a lot of American see that very differently now and that's a very good thing.

Wrong. Look at airlines, they are smarter. They build their first legs where the traffic is. Because that is the smart thing to do.

A surprising number of them is non-political.

You have no clue about those people. But nevermind, these are the guys that will make the decisions, whether you like it or not.

You obviously never were in a managerial role with serious P&L responsibility.

Tort reform is where it should have started. Any engineer know that it is stupid to chuck a whole big system before looking at the details and finding out what ails it. But, of course, since lawyers are major capaign contributors to the dems ...

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It was the status quo.They did what their friends and neighbours did.

Ask any Republican. Statisticians have a more nuanced point of view.

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True. And not everybody believes that the earth is a slightly flattened sphere.

I'm old enough to know that it's easy to over-simplify complicated situations, less easy to choose useful simplifications.

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That can buy up the US balance of payment deficit every month?

It's not in their interest that the US economy crashes and burns this week. The economy of the European Union is now bigger than the US economy - not much bigger, but growing. At some point the US market is going to be costing the rest of the world more than it's worth. "Too big to fail" doesn't just work for banks.

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That is _not_ an excuse. It's the same as telling the judge in traffic court "But all the others were also going 100mph!". He will not have mercy, and rightfully so.

Let me quote two Canadian (!) judges who know quite a bit more than you do: "Access to a waiting list is not access to health care". They actually wrote that in a formal court decision.

Why do you think scores of Canadians come to the US for treatment? Why do you think Canadians quietly carry Mayo Cards in the pockets?

As my link evidenced the bulk of US Treasuries are not bought by governments.

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But they have money.

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No. But I was close enough that I knew what was going on, In high tech stuff, the risks are substantial and the potential profits have to be big enough to cover a significant proportion of flops.

Outside observers put the blame on the absurd administrative costs, rather than malpractice insurance, somewhat to my surprise.

The US problem is that it has a whole big system that doesn't work very well and costs at least half as much again per head as anybody else's - twice what the UK system costs. The rational approach would be to toss what you've got and slavishly copy something that works better.

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Exactly. That's why they are the movers and shakers.

That is the scientist's view point. The business man's view point is very different. They calculate high-tech production down to the last iota. From having been at the helm quite a few years I can confirm that a few percent in extra taxes, fees or whatever they want to call it can make or break the overall feasibility at a certain location.

The alternatives are, for example, to move location. And that's exactly what is happening with the place where I was managing: Production is being moved out of California, to Costa Rica.

To give you one example of a rather stupid move by the current administration: They have instituted an extra tax on medical device makers. That tax is 2.3% and it is skimmed right off the top, from the revenue.

Yes, that is true. And why do we have the absurd administrative cost? Because of fear of lawsuits every little diaper change gets documented, there is gross overprescription of procedues and meds, and so on. The reason is that they want to be able to tell the judge "We have tried everything in the book, so they can't blame us for not having tried everything in the book".

The Bush administration has instituted some excellent health care tools for the people. For example health savings ccounts or HSA. Since you are controlling the inflow and outflow of money this results in higher transparency of the costs involved. Everything must be in the open, just like the bill from your car repair shop. Way it should be. The Obama administration has begun to dismantle this tool. In consequence, cost transparency vanishes again. Another wrong trend.

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They try to. If you are re-engineering something that you have done before, this can work, but anything that pushes the state of the art is less easily predictable.

It is always the last straw that breaks the camels back, but if they think they can predict costs that accurately, they are being a trifle unrealistic.

In the 1970's Goerge Kent in Luton set up a production facility is Lossemouth in Scotland - or so I was told. It was a total disaster. The town was full of unemployed fishermen desperate to get work, and George Kent hired and tried to train a load of them to run lathes and milling machines. It didn't work. These days people are supposed to be better informed about the potential difficulties of finding skilled labour - after all everything is now done by machine so all you need are people who can fix the machines - but do keep us posted on how it all works out.

Do they have a justification for this selective excise?

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That sort of tool is great when you can understand what's going on, and take your business to another repair shop if you don't like what the your regular shop is doing.

Medico's find it very difficult to tell their patients what's going on in any kind of useful detail - the good ones work hard to tell the patients everything they might want to know, but the human body is lot more complicated than a car, and it takes a lot longer to train a medical specialist than it does to train a car mechanic, so there's a lot we don't get to find out about.

I've actually got my Dutch cardiologists letter of reference - plus two compacts discs of image data - to my Australian cardiologist - so I've had my nose rubbed in this recently.

Doesn't have to be that way at all. At my last PPoE we did true cutting edge products, they still don't have any competitors and I am fairly certain nobody will ever take them on. Because producing the stuff is so darn difficult. But we calculate the whole production in a very exacting way.

Nope, that's real life. Margins in med-tech are not at all as fat as some think. That is because you are constantly fighting reimbursement numbers.

It is very different in this day and age. People are very mobile and many countries are quite smart in providing fertile ground. Our guys are moving to Coyol, and they are in very good company. Example:

Some politicos still claim there is no exodus happening. Baloney.

It is one of the many new taxes instituted to pay for Obamacare. They just sock it to the med device companies, thinking they can squeeze some more out of that sector. They will learn a lesson in how the Laffer curve works. The sad part is that enetrprises almost never come back once they've left.

With HSA they have to. Because they must present you the bill and not quitely bill some HMO where you never see it. Cuts down on a lot of "questionable billing".

Sometimes docs give this data to you. Other times they make it difficult as heck. Same for cost comparison data. With government-run health plans there is always lots of abuse. It is easy because the patient never sees any details so they can completely snow them. If the patient sees the bill he or she can say "Now wait a minute, I never got an XYZ scan!". I have had numerous occasions where I was credited back between $10 and $200 after complaining. Without Bush's HSA plans this would have been impossible because I'd never have seen those bills.

That sounds odd. There must have been some justification of some sort

The Laffer curve doesn't work - except in the general sense that higher taxes motivate people to move - but in fact it's not so much the tax level as what people get for their taxes.

If high tax levels buy good infrastructure and the comprehensive education system that creates a skilled work force - as it does in Germany and Sweden - the optimum level of taxation is whole lot higher than it is in less well-run countries.

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They can itemise to the finest possible detail, but this doesn't guarantee that the patients will comprehend what each detail means. In a lot of cases, detailed itemisation can be a device for concealing crucial information by burying it in a mass of trivia.

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They can give you the data but they can't make it easy for you to appreciate everything that's going on.

Why just with government-run health plans? Private practice can be equally enthusiastic about over-treatment. And how do people make money out of it? Unnecessary over-time?

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How many patients can tell you the difference between an electro- cardiogram and an echo-cardiogram?

For about three months, I had the pleasure of living across the street from the office. The vertical component of my commute was further than the horizontal component. Now it's an hour each way. Blech...

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I had a 75-minute commute each way to my job in Venlo (back when I had a job) but 45 minutes of that was on a train, and I could nap on the train. It helped.

A little bit of distance (maybe ~15 minutes) can be a good thing, IMHO.

Now. It's simply a grab.

The Laffer curve has even worked for me. Once back in Europe I got estimates for a bathroom remodel. Pretty high. It was year-end and I was in a high tax rate by then. So I elected to not do engineering for three weeks and do the bathroom myself instead. It provided me a net savings of many thousand Dollars. With a lower tax rate I would have continued working and given the job to a remodeler. That was "the" classic case of the Laffer curve.

Then why did so many Swedes and Germans move to Switzerland?

Oh they do. Next in line: Campbell Soup factory. Another 700 jobs down the tubes. And the politicos still don't get it.

No. If they bill me for an XYZ scan and I didn't have an XYZ scan I am not paying. And they know that. If it's a government health system they can just bill it because nobody will ever find out that uncle Leroy never had that scan. Because uncle Leroy never sees the bill.

Nearly everyone has someone in the family or among close friends who can explain medical stuff correctly and in as much detail as needed. Then there is the Internet.

Not with HSA plans. As I explained, you _see_ everything that gets billed. Then a smart patient will question overcharges. And if necessary dispute them, which I have done numerous times. Before Bush brought us HSA I never did, because I never got to see any bills.

The usual: Bonuses, kickbacks, freebies, the "courtesy" vacation for the whole family in Davos, and so on. Why do you think med conferences are mostly held in ritzy tourist places?

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They don't have to. A son, daughter-in-law, friend, Internet, or whoever can. When they see two positions ending with "-cardiogram" on the bill the smart patients will inquire. In the same way they'll hand a suspicious bill from the auto shop to a friend who knows cars. Assuming people are dumb and using that as a reason that they "do not need to know" such details is wrong.

My commute this morning was 20 sesonds. And only because one of the Labradors had to go to the outdoor restroom.

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A little bit is good. I have a half-hour (16mi. or so) now, which is not ideal but it keeps me out of work on the weekends. ;-)

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It certainly looks that way to you. Am I to assume that you are an objective observer?

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That wasn't the Laffer curve - which claims that there's a optimal level of taxation to maximise government revenue. Right wing politicians are convinced that it is lower than whatever happens to be be the local tax rate, and reduce tax rates in the expectation of collecting more tax revenue from a more active economy. They've always been disappointed.

Economists have looked into it, and basically say that whatever the "optimum" level is nobody taxes that heavily in the real world.

Your spot of do-it-yourself wasn't the Laffer curve in action, but a reflection of the fact that you aren't paid what you are really worth by your employers (as determined by what happens when someone less competent does the same job) and that you are pretty good at do-it- yourself. Competent do-it-your-selfers typically take twice as long to do an adequate job as the professionals take to deliver an appreciably better result. I've done enough of it to know that I should confine myself to small jobs where the time it takes to find a professional to take on the small job is an appreciable part of the budget.

The Swiss education system is up there with the Swedes and the Germans. The usual reason for migrating to Switzerland is having lot of money in a Swiss bank account that your country of origin doesn't know about. Every now and then some Swiss bank employee transfers a bunch of records about foreign depositors onto a CD and sells it to the French/German/Dutch tax authorities. If you've migrated to Switzerland, you aren't a foreign depositor any more, and the bank employee no longer knows where to send the details of your account..

What would the politicos have to do to keep the jobs in California? Mostly the factories ought to be automating rather than shipping unskilled jobs off-shore, but that won't keep jobs in California either.

Actually, they do.

You may get an electro-cardiogram without getting an echo-cardiogram, but in my experience you never get an an echo-cardiogram without getting a separate electro-cardiogram.

How do they know that the bill is "suspicious"? They won't invoke the omniscient relative or friend until they realise that the bill is suspicious in the first place.

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Assuming that the detail is good in itself is also wrong. Sufficiently detailed billing can act as a very effective smoke screen, and for every relative who knows what they are talking about you have about a dozen over-confident idiots.