Search found 577 matches
- Mon Mar 18, 2024 4:48 pm
- Forum: Personal Investments
- Topic: Can I retire with $1.75M at age 43?
- Replies: 169
- Views: 11218
Re: Can I retire with $1.75M at age 43?
IMO anyone can retire when their resources will support their desired lifestyle for life expectancy+10 years. I do not desire a $2000-3000/month lifestyle or even a $5,000/month lifestyle but many people do and perhaps the OP is one of them. There are people who live on the street and beg, steal, and do a little day labor when necessary to get by. There are others who live in convents and monasteries with vows of poverty. One of them remarked that he had taken a vow of poverty at age 25 and never had to worry about money again. None of that looked desirable to me, but so what? It takes a lot to make me happy, but others are happy with less money and less of everything else than I have. Lucky them! OP's plan would not suit me, but so what? H...
- Sat Mar 16, 2024 7:28 am
- Forum: Personal Consumer Issues
- Topic: Dumped from PT due to low Medicare reimbursements?
- Replies: 59
- Views: 3780
Re: Dumped from PT due to low Medicare reimbursements?
One of the criteria Medicare uses to determine medical necessity of prolonged rehabilitation programs is whether the patient is making progress or not. If the patient has ceased to make progress as documented in the therapist's notes, even though the goals of therapy may not have been achieved, the lack of progress suffices to bring about a Medicare denial of payment. It may be that the treating surgeon is hopeful that further progress may be achieved with PT, but the PT providers believe that they have done all they can. If they cannot document continued progress (e.g. greater walking distance, improving range of motion, improving power/strength) then Medicare views further therapy as futile and will not pay for further treatment, as they ...
- Fri Mar 15, 2024 1:48 pm
- Forum: Personal Consumer Issues
- Topic: Dual majors and non big 50 colleges
- Replies: 111
- Views: 7179
Re: Dual majors and non big 50 colleges
The most important things I did for my kids were the enrichment opportunities (intentional) and developing a wide range of connections (unintentional). The connections turned out to be crucial to professional opportunities for two of my kids.
- Fri Mar 15, 2024 1:04 pm
- Forum: Personal Finance (Not Investing)
- Topic: QCDs before age 73?
- Replies: 30
- Views: 2440
Re: QCDs before age 73?
Once you enter your 70s, you never know what your health will throw at you. For those of us who enjoy giving with warm hands, QCDing from the pretax account before RMDs makes some sense. Contributions to schools, religious endeavors, and favorite causes can be just a bit more generous from the pretax account. Reasonable people may differ.
- Mon Mar 11, 2024 4:38 pm
- Forum: Personal Finance (Not Investing)
- Topic: Annual expense to live upper middle class lifestyle in suburban Midwest
- Replies: 20
- Views: 2379
Re: Expense to live upper middle class lifestyle in suburban Midwest
Varies a lot even at short distances in Chicagoland. Property costs are greater when close to employment centers, when crime is low, and when schools are good. In Lake County Ill, a 4 bd 2.5 bath home in Highland Park, Lake Forest, or Lake Bluff probably $1-2 million. Close to employment, low crime, excellent public schools. 45-55 minute train commute to Chicago Nearby Waukegan and Zion similar home probably $250,000 range but 15-20 minutes further from employment centers, higher crime, poor public schools. 60 minute commute to Chicago from Waukegan. Wadsworth or Gurnee (same schools) same house probably $400-600K. Low crime but borderline public schools at this writing. 15-20 minutes further from employment centers than the top group. Plea...
- Sun Mar 10, 2024 2:35 pm
- Forum: Personal Consumer Issues
- Topic: What is your favorite book?
- Replies: 186
- Views: 19949
Re: What is your favorite book?
Probably is the same set of Roueche stories. First edition was 1947, I have the 1980 edition. Others in a medical vein. Blood Pure and Eloquent by Max Wintrobe, a well written story of the development of hematology from the late 19th century onward to the author's death in the late 1980s. Drs Wintrobe and Bill Dameshek were rivals for the title of "Father of Modern Hematology" but in the lead up to WW2, they worked together on a project to develop a defense against mustard gas, as that was anticipated to be a weapon that US troops might face. That work led to the idea that a mustard derivative might be an effective antileukemic drug. Nitrogen mustard and the rest of cancer chemotherapy grew out of that work. Surviving the Extremes...
- Sun Mar 10, 2024 1:18 pm
- Forum: Personal Consumer Issues
- Topic: What is your favorite book?
- Replies: 186
- Views: 19949
Re: What is your favorite book?
Offbeat stuff in a medical vein;
The Facemakers by Lindsey Fitzharris; Relates development of plastic surgery and restorative dentistry to correct facial wounds suffered in combat in WW1. Same author wrote "The Butchering Art" on my to-be-read list
The Knife Man by Wendy Moore, the career of John Hunter, founder and a developer of of the scientific approach to surgery. A great read.
The Medical Detectives by Berton Roueche, public health sleuthing to figure out the causes of epidemics in late 19th and early 20th centuries.
More to come.
The Facemakers by Lindsey Fitzharris; Relates development of plastic surgery and restorative dentistry to correct facial wounds suffered in combat in WW1. Same author wrote "The Butchering Art" on my to-be-read list
The Knife Man by Wendy Moore, the career of John Hunter, founder and a developer of of the scientific approach to surgery. A great read.
The Medical Detectives by Berton Roueche, public health sleuthing to figure out the causes of epidemics in late 19th and early 20th centuries.
More to come.
- Sat Mar 09, 2024 6:47 am
- Forum: Personal Investments
- Topic: 16 yr old - how can I best take on high risk?
- Replies: 65
- Views: 5236
Re: 16 yr old - how can I best take on high risk?
OP might start or join a poker club with other good high school math students. Poker is applied statistical math + reading people and controlling your own emotions. You learn whether you have the statistical math chops to understand the game. You learn that good bets sometimes lose and bad bets sometimes win, but over many games over time, the math works. You learn whether you have (or can develop) the mental makeup to tolerate the inevitable ups and downs of chance without overreacting emotionally to wins or losses.
- Fri Mar 08, 2024 8:09 pm
- Forum: Personal Investments
- Topic: Career ending, getting fired. Can we FIRE ?
- Replies: 152
- Views: 22159
Re: Career ending, getting fired. Can we FIRE ?
SSDI criteria for blindness are pretty strict, listed as vision not correctible to better than 20/200 or an angle of vision of 20 degrees or less. In other words you really do have to be blind or close to it. If you qualify on either of those criteria, it should not take more than a year to get SSDI but you need to have medical records available that support that degree of disabling vision loss.
If your vision is disabling you from the occupation you are trained for but does not meet the listed criteria, you may need an attorney to argue your case unless the medical records clearly support your inability to work, perhaps for a combination of diminished vision and other issues.
If your vision is disabling you from the occupation you are trained for but does not meet the listed criteria, you may need an attorney to argue your case unless the medical records clearly support your inability to work, perhaps for a combination of diminished vision and other issues.
- Fri Mar 08, 2024 10:33 am
- Forum: Personal Investments
- Topic: 16 yr old - how can I best take on high risk?
- Replies: 65
- Views: 5236
Re: 16 yr old - how can I best take on high risk?
High risk may bring high rewards, but not necessarily. As Nisiprius says, to get the risk premium you do have to take the risk. The highest risk brings the highest potential return (betting on green) but also the highest potential for loss. The holy grail of Bogleheads investing is the sweet spot that gives a reasonable (optimal?) balance between risk and likelihood of achieving the target reward. Opinions differ widely on what degree of risk is appropriate or tolerable and what the target reward should be. Some prioritize risk control and accept the resulting rewards, others aim for greater reward targets and accept the attendant risk. Most take more risk when young and in the accumulation phase of life, meaning in BH terns a higher alloca...
- Mon Mar 04, 2024 5:45 pm
- Forum: Personal Finance (Not Investing)
- Topic: If/how/how much to financially assist kids that choose not to go to college
- Replies: 48
- Views: 3794
Re: If/how/how much to financially assist kids that choose not to go to college
I know two tradesmen my kids' age who used their "college funds" to capitalize small contracting businesses as tradesmen once they felt their skills as tradesmen were adequate to be successful. One was a doctor's son. Both have successful small contracting businesses in their early 50s. Good on them and their parents too.
- Fri Mar 01, 2024 1:52 pm
- Forum: Personal Finance (Not Investing)
- Topic: Mid-career change to law?
- Replies: 127
- Views: 11693
Re: Mid-career change to law?
The original post sounds like an over-idealized midlife daydream. Educated guys all have them for a time. As far as acting upon it, it would work out better than a 19 yo girlfriend and a divorce but it's not as reasonable or attainable as an archetypal dream like a pricey sports car or a country club membership. Family members who gave BigLaw a whirl dropped on request for personal reasons. Really no life outside of work in that. They have been happier with less glory and less money but more of a life. Grinding out OP's current gig for 4-6 more years with a good savings rate would result in a NW of 4MM or so, enough to fat FIRE and enroll in college for carefree intellectual stimulation if he chose. One of my happiest retired doctor friends...
- Tue Feb 27, 2024 4:02 pm
- Forum: Personal Finance (Not Investing)
- Topic: Cancer Diagnosis Hubby
- Replies: 36
- Views: 4544
Re: Cancer Diagnosis Hubby
Will try to steer clear of general or specific medical advice. Random thoughts; !. Learn to handle the doctors. Come to every visit armed with a list of items you want to have addressed, the most important to you and your husband to be addressed first. The doctors and their assistants are sometimes time-limited by their clinic schedules and obligations to other patients, so get the most out of the time you get with them. You may not be able to get thru your whole list each visit, so prioritize. The doctor may ask to look at your list so as to address it more completely and efficiently. The doctors have their "must" agenda for your visit, but your agenda is important to them as well. They need to know what your agenda is. If you do...
- Sat Feb 24, 2024 2:49 pm
- Forum: Personal Finance (Not Investing)
- Topic: Resident physician nearing the end and with debt
- Replies: 48
- Views: 5234
Re: Resident physician nearing the end and with debt
Second the advice to avoid the long commute. Better live near your clinic and hire help for your wife. Better quality of life for you and family and cheaper than a Land Cruiser. Unless your assistance from family members is virtually live-in, expectations regarding gramma help with young families are seldom realized in full in practice from what I have seen and experienced. If they really want to help, they are already helping as much as they can. The actually available family support may not justify the sacrifice you would make undertaking the long commute. The education debt is a lot, but on the scale of your expected earnings, not that much of a burden. I paid off my loans with a check my second attending year and I'm a PCP. You probably...
- Wed Feb 21, 2024 3:39 pm
- Forum: Personal Consumer Issues
- Topic: Hearing aids: Costco or audiologist?
- Replies: 44
- Views: 5211
Re: Hearing aids: Costco or audiologist?
Hearing aid technology has been advancing briskly for the past 15 years. The value proposition depends on your use case. If you are just going to use them at home with your SO or the TV, a cheap and simple amplifier will do. If you want to go out to restaurants with others, the directional feature makes it possible to partake in the conversation. You need a smart phone to adjust the settings on the HA, and the feature allows you to hear whomever you are looking at directly with a 45 degree angle either way and noise cancellation cancels out the ambient clatter and other conversations in the restaurant around you. If you are at a music event, you can adjust to full surround and enjoy the music, but lip-read your companion's conversation. If ...
- Tue Feb 20, 2024 3:59 pm
- Forum: Personal Consumer Issues
- Topic: Do you use a second refrigerator/freezer?
- Replies: 74
- Views: 4601
Re: Do you use a second refrigerator/freezer?
When we had kids at home and were more active ourselves we did. Now just two old people, our one fridge is usually pretty bare.
- Tue Feb 20, 2024 3:21 pm
- Forum: Personal Consumer Issues
- Topic: middle school science books
- Replies: 19
- Views: 2517
Re: middle school science books
In undergrad and med school, study groups would go thru the text and class notes and adjunctive material and ourselves make up potential test questions from the material. If you knew the teacher and the material, it was pretty easy to anticipate test questions. This was well before the digital era. For middle schoolers, this would require more time for hands-on effort from the parental units than most parental units can spare.
For board exams, certification exams, etc there are commercially available test questions galore, not sure such are available for middle school materials.
For board exams, certification exams, etc there are commercially available test questions galore, not sure such are available for middle school materials.
- Tue Feb 20, 2024 9:57 am
- Forum: Personal Consumer Issues
- Topic: What inferior good do you love?
- Replies: 232
- Views: 25555
Re: What inferior good do you love?
Dive Bars;
Had my bachelor party as a crawl of dive bars near downtown Chicago. All of them are gone or gentrified now except maybe the Billy Goat. Haven't been there in 25 years or more. There are none in walking distance of where I live now, only a gentry bar full of kids.
Had my bachelor party as a crawl of dive bars near downtown Chicago. All of them are gone or gentrified now except maybe the Billy Goat. Haven't been there in 25 years or more. There are none in walking distance of where I live now, only a gentry bar full of kids.
- Tue Feb 20, 2024 9:21 am
- Forum: Personal Finance (Not Investing)
- Topic: 20-30X income, is that the "retirement rut"?
- Replies: 90
- Views: 13512
Re: 20-30X income, is that the "retirement rut"?
Retooling for a second career in one's 40s used to be common. Probably still is. I knew a few policemen and a teacher who became attorneys during those years and practiced law into their 70s and 80s. One of the policemen decided on that course while recovering from a GSW suffered in the line of duty. I know several men and women who became RNs in their 40s. A few who became teachers in their 40s. Even a couple of guys who became MDs in their 40s. Yes, such moves do require energy, ambition, confidence, and perseverance. Retooling seems like a better and more commonly chosen path than rice-and-beans FIRE with a 40-50 year time horizon. If the current job is that depressing, perhaps it would be best to work to defeat self-pity, maybe get a do...
- Mon Feb 19, 2024 11:26 am
- Forum: Personal Consumer Issues
- Topic: middle school science books
- Replies: 19
- Views: 2517
Re: middle school science books
I don't know of anything that would fit OP's criteria apart from a text series used in middle schools. For that, the local science teachers may be the best source of information as to the pros and cons of what is available. For simple hands-on experiment using common household items, Janice vanCleave' s "Chemistry for Every Kid" and "Physics for Every Kid" were good. There is a Q/A type explanation of the principles involved in each experiment. It teaches scientific principles and shows that the principles work in real life. Downside is the need for adult supervision. There are about 100 exercises in each as I recall. The Thames and Kosmos kits for experimenting in chemistry and physics are more advanced and more didacti...
- Mon Feb 19, 2024 11:04 am
- Forum: Personal Consumer Issues
- Topic: Happy Valentine’s Day! What’s your love song?
- Replies: 88
- Views: 4457
Re: Happy Valentine’s Day! What’s your love song?
We Had a folk-guitar group made up of sisters we grew up with play our wedding ceremony in 1971. There were six sisters and I believe 4 or 5 played our wedding. For the recessional they played an acoustic guitar rendition of Beethoven's "Ode to Joy". I have no recollection at all of what lyric they used, just that that number capped off the ceremony for us and whenever I hear any version, it brings me back there.
- Mon Feb 19, 2024 10:31 am
- Forum: Personal Consumer Issues
- Topic: Aids for slowing down speech when talking with hard-of-hearing
- Replies: 52
- Views: 5421
Re: Aids for slowing down speech when talking with hard-of-hearing
I have only anecdotal experience doing the reverse stethoscope method, but I have over fifty years of experience with it. It's not 100 % effective but it will often work when all else fails. Usually used with patients who were unable to afford good quality personal hearing devices or left them at home.
Hearing aid technology has improved a lot in recent years. Always better to have up to date hearing aid.
Hearing aid technology has improved a lot in recent years. Always better to have up to date hearing aid.
- Sat Feb 17, 2024 8:03 am
- Forum: Personal Investments
- Topic: Asset Allocation for Early Career Physician: What Would You Do If You Could Do It Again?
- Replies: 65
- Views: 5144
Re: Asset Allocation for Early Career Physician: What Would You Do If You Could Do It Again?
Am a 75 yo general internist. Never a high earner on the order of the OP. I would be more prudent with my investments starting out than I was. As I aged, and especially as I reached FI, I found that I enjoyed the medicine more and more, and did not want to retire. That can happen as your skills improve with experience and if your health holds up. Happened to a lot of my friends and colleagues. With a high income, good savings rate, and a probable long career ahead, risk-taking was unnecessary. That may not be optimal in terms of terminal net worth, but it works out well enough for those who use that approach. About twelve years into practice, I realized that letting the professionals manage the money with a prudent AA was best for me. I cou...
- Thu Feb 15, 2024 4:11 pm
- Forum: Personal Consumer Issues
- Topic: What inferior good do you love?
- Replies: 232
- Views: 25555
Re: What inferior good do you love?
Stopped carrying a wallet 50 years ago after being pickpocketed in Chicago. Just wrap credit cards and ID in thick rubber bands. The rubber bands come free when I buy asparagus or broccoli.
My favorite and most comfortable cool and cold weather coats were bought cheap and well-worn at the Sallies' 14-15 years ago. DW won't be seen with me wearing them.
My favorite and most comfortable cool and cold weather coats were bought cheap and well-worn at the Sallies' 14-15 years ago. DW won't be seen with me wearing them.
- Fri Feb 09, 2024 11:21 am
- Forum: Personal Consumer Issues
- Topic: What is your favorite book?
- Replies: 186
- Views: 19949
Re: What is your favorite book?
Had to interrupt my post on this thread for my Medicare Wellness + visit. WW2 from the German side; "Tigers in the Mud" by Otto Carius. He was the highest scoring German tank ace to survive the war. I don't know of an American or British tanker who provided a similar memoir. Or even a Russian tanker which could be interesting. Would have been scary stuff going up against tigers and 88s in a Sherman or even a T34. I know of no Japanese war memoir of a surviving front line soldier. Guy Sajer's "The Forgotten Soldier" is an excellent (fictionalized?) Franco-German account of infantry combat on the Russo-German front. "The Sorrow of War" by Bao Ninh is a dramatic memoir from a North Vietnamese infantryman emphasizi...
- Fri Feb 09, 2024 7:57 am
- Forum: Personal Consumer Issues
- Topic: What is your favorite book?
- Replies: 186
- Views: 19949
Re: What is your favorite book?
West from Appomattox by Heather Cox Richardson, development of the US after the Civil war. Annals of the Former World, John McPhee; A geological tour of the USA along the route of I80 from coast to coast with a local geologist as guide and interviewee at each segment of the US along the way. Very interesting pop geology. The Caro series on Lyndon Johnson is fabulous. It's on every shelf in DC but few have read it. It's on audio and you can get it on your phone on Audible. Learn a lot about how US government worked back in the day. Power Broker is fine, more NYC-centric if that's your thing. The Prize, Daniel Yergin. If you are a nonfiction reader you probably have read it. WW2 stuff; With the Old Breed by EB Sledge is unmatched for drama an...
- Wed Jan 24, 2024 5:05 pm
- Forum: Personal Finance (Not Investing)
- Topic: Washington Post: "That 'free' annual checkup might cost you"
- Replies: 112
- Views: 11778
Re: Washington Post: "That 'free' annual checkup might cost you"
I always address my chronic issues and medication renewals at the same sitting as my annual preventive visit because it is more efficient for me to do so. I expect an additional bill for that service because it is an additional service apart from the annual review and preventive advice. I never need advice to get a vaccine, screening blood test, followup colonoscopy, etc because I am on top of that myself. I do update my doctor on new meds I'm receiving that have been prescribed by other doctors, update her on new procedures I have had, developments in family history, and check to make sure my immunization record is up to date. She does a cognitive check. That is all there is to the annual preventive visit. Having my blood tests reviewed, m...
- Tue Jan 23, 2024 5:05 pm
- Forum: Personal Finance (Not Investing)
- Topic: Does Medicare pay for Hospice care?
- Replies: 23
- Views: 2758
Re: Does Medicare pay for Hospice care?
Medicaid is a state-federal program for the indigent whose coverages and allowances vary state to state and may vary quite a lot. Medicare is a federal program and it does cover hospice. In our area there are a number of active hospice commercial providers, some affiliated with large integrated healthcare groups, some independent. The hospice providers in a given area may differ in their assessment of the needs of a given patient. The hospice provider will propose a care plan based on their own assessment of needs. Hospice providers may vary in the range and depth of resources they can bring to bear on a given situation. Some hospice providers have their own inpatient facility. In our area, this is made available to people estimated to have...
- Mon Jan 22, 2024 4:45 pm
- Forum: Personal Investments
- Topic: Early Retirement Plan - Age 38 w/over $2 million
- Replies: 120
- Views: 28657
Re: Early Retirement Plan - Age 38 w/over $2 million
Another vote here for the sabbatical. Can live your plan, see if you like it as well as you expect to like it while not burning a bridge back to well-paid work. If you really love the $2500/month lifestyle enough to cut loose from an income, mazel tov. When you arrive at the decision point, if you decide that all you really needed was a long vacation, that's great too. I don't see much of a downside to it. IMO anyone can retire whenever their resources will support a lifestyle they consider desirable. Bogleheads and Bogleheads couples will differ greatly as to what constitutes a desirable lifestyle. Others will differ as to whether and to what extent parents are obligated to provide their children with an undergraduate education. Others sti...
- Sun Jan 21, 2024 9:40 am
- Forum: Personal Consumer Issues
- Topic: If you love outdoors/hiking, what do you do in the winter?
- Replies: 62
- Views: 5775
Re: If you love outdoors/hiking, what do you do in the winter?
When I was in my 20s and 30s and had a dog, I ran in all weathers except at -20F and worse. Dangerous for the pooch and for me then.
In middle age, cross country skiing was fun, especially on nearby farms and woods without noisy snowmobilers. Really liked the quiet.
Now in my 70s I just walk and put on heavy clothing and insulated boots and take a walking stick when it's icy to reduce fall risk.
Agree with Karl J that trail hiking has a special beauty in winter.
In middle age, cross country skiing was fun, especially on nearby farms and woods without noisy snowmobilers. Really liked the quiet.
Now in my 70s I just walk and put on heavy clothing and insulated boots and take a walking stick when it's icy to reduce fall risk.
Agree with Karl J that trail hiking has a special beauty in winter.
- Fri Jan 19, 2024 7:54 pm
- Forum: Personal Finance (Not Investing)
- Topic: Giving High-Level Advice to Younger People If You Are Older
- Replies: 70
- Views: 5792
Re: Giving High-Level Advice to Younger People If You Are Older
Not sure what OP means by high level advice. Not a common term in my circles. Advice to people with a high level of ability? Young people with high socioeconomic status and good privilege networks may find OP's advice helpful.
People seldom ask me for financial advice. When young people in nursing or technical occupations ask me , If they are young and in the low income/low tax rate time of life, I advise them to contribute enough to the Roth 401K to obtain the max match into the t401K.
When young doctors ask me, I advise them to save and invest along BH lines.
This is the kind of advice I received from my senior partner when I was young. Worked for him and me, may continue to work for our younger friends.
People seldom ask me for financial advice. When young people in nursing or technical occupations ask me , If they are young and in the low income/low tax rate time of life, I advise them to contribute enough to the Roth 401K to obtain the max match into the t401K.
When young doctors ask me, I advise them to save and invest along BH lines.
This is the kind of advice I received from my senior partner when I was young. Worked for him and me, may continue to work for our younger friends.
- Mon Jan 15, 2024 4:22 pm
- Forum: Personal Consumer Issues
- Topic: Chicago Vacation
- Replies: 56
- Views: 4591
Re: Chicago Vacation
Depends a lot on what you want to get out of the trip. Kid friendly stuff; Museum of Science and Industry is down in Hyde Park five miles south of the downtown museum campus, and you will need a cab or an Uber to reach it and to return from your downtown hotel. There is a city bus line that goes from downtown to Hyde Park that used to have a lot of U of Chicago students and employees on it, not sure I would ride it with kids anymore. My grandkids were kind of disappointed in it, The interactive mechanical stuff from my childhood and my kids' childhoods were largely gone, more electronic stuff. The agricultural stuff was improved. If your kids are into science, it's great. My budding scientist grandson loved it. Natural History Museum (AKA F...
- Sun Jan 14, 2024 12:40 pm
- Forum: Personal Finance (Not Investing)
- Topic: Calling all doctors….again
- Replies: 110
- Views: 20849
Re: Calling all doctors….again
Graduated med school 50 years ago, have no legitimate perspective on handicapping med school admissions in the present era. Two of my classmates at the state U med school became Harvard Professors, other classmates became professors elsewhere. Lack of pedigree did not hinder developing prestigious and successful academic careers. afan may be correct that prestigious med schools give you a leg up in obtaining the most competitive residency slots in the most competitive specialties, I would not know. The graduates of such programs may have advantages in getting a coveted first post after residency, but I wouldn't know. What I have observed is that talent will out over a long career and where one trained matters relatively little after obtaini...
- Mon Dec 25, 2023 12:26 pm
- Forum: Personal Finance (Not Investing)
- Topic: Can I negotiate a 'new patient' bill from doctor?
- Replies: 57
- Views: 8335
Re: Can I negotiate a 'new patient' bill from doctor?
Medical services and the associated charges/payments are unlike charges/payments in other professional and business services. Generally speaking, neither the provider of the service nor the receiver of the service knows what the charge/payment will be at the time of service. Once the service has been completed a bill is sent to the insurer and the charge/payment is adjudicated between the medical service provider's business office and the customer's insurance carrier. The price of the same service varies from customer to customer of the medical clinic as the price negotiated varies from insurer to insurer. Medicare sets a price for each procedure or E&M code and the price that medicare sets may (or used to) vary by locality, being highe...
- Sun Dec 24, 2023 12:30 pm
- Forum: Investing - Theory, News & General
- Topic: A Christmas Message
- Replies: 140
- Views: 14261
Re: A Christmas Message
Merry Christmas Taylor and God bless you.
- Fri Dec 15, 2023 2:38 pm
- Forum: Personal Consumer Issues
- Topic: Pros and Cons of "Do Not Resuscitate"
- Replies: 209
- Views: 49781
Re: Pros and Cons of "Do Not Resuscitate"
Random thoughts on DNRs and related subjects. State laws rule in this regard and state laws differ in regard to POA activation(not valid if not activated), validity of advance directives and how validity is determined, guardianship authority, and what protections are available for people who make a good faith decision on the spot which turn out contrary to the legal directives of the patient. Need to know your state laws or have an attorney help you. Have had many patients tell me when still sentient and looking at immediately impending death from a major hemorrhage, cardiac event, etc some variation on; "I know I signed that paper doc, but I'm not ready to go, so please do everything you can for me right now." Sometimes this chan...
- Sun Dec 10, 2023 9:26 am
- Forum: Personal Consumer Issues
- Topic: Good decisions that paid off for you 60, 70, 80, 90+
- Replies: 30
- Views: 4872
Re: Good decisions that paid off for you 60, 70, 80, 90+
At age 15 I decided to become a medical doctor instead of becoming a policeman which had been plan A. Worked out well. At age 20 I decided to marry DW instead of the woman who had been Plan A. Plan A became a thrice married feminist professor. At age 40 during our marital crisis, after selecting a divorce attorney and while I was looking for where I might live after leaving the big suburban house DW would live in, a remark by a patient reoriented my thinking and I decided to go to counseling if DW was willing and do whatever was required of me to revive the marriage and make it again the big positive in my life that it had once been. No subsequent decision has been more consequential. At age 60 got Cadillac LTCI because I expect to predecea...
- Fri Dec 08, 2023 1:13 pm
- Forum: Personal Investments
- Topic: Christmas present = forced retirement
- Replies: 128
- Views: 20218
Re: Christmas present = forced retirement
Anyone (or any couple) can retire whenever they are satisfied with the lifestyle that reasonably prudent management of their available assets plus any available lifetime income sources will support. Most respondents question whether OP can maintain his lifestyle while prudently managing the assets he reports. OP argues that he can maintain an adequate lifestyle, as his expenses are modest by BH standards and some of the modest expenses he reports are modifiable. Other respondents have questioned whether OP's management of his invested resources is prudent. Reasonable people may differ. Most people near to where I live support a family on something less than a prudently managed $2.1M can provide, but they are living lower middle class lifest...
- Thu Nov 23, 2023 2:52 pm
- Forum: Personal Consumer Issues
- Topic: The psychology of frugality when you no longer need to be frugal
- Replies: 152
- Views: 28844
Re: The psychology of frugality when you no longer need to be frugal
DW and I have had trouble spending, partly because I preferred staying busy working into my 70s and partly because DW's health issues have precluded our pursuing retirement plans A or B which involved earlier retirement and a lot of plane travel. Fortunately we traveled when we were young and healthy and haven't missed out on much of importance. Our FA says we should spend more, but we usually can't think of much to spend on. Hard to think of something we want that we don't have. DW likes a big car so she has a Highlander. I am not a car guy and chose a low-hassle Camry. After taxes, our biggest expense has been donations but this year we began paying grandkids' college expenses and that should continue for the rest of our lives. Otherwise,...
- Tue Nov 21, 2023 10:02 am
- Forum: Personal Consumer Issues
- Topic: Favorite Audio (Audible) Books?
- Replies: 23
- Views: 2180
Re: Favorite Audio (Audible) Books?
For long listening projects, a second for the Robert Caro Lyndon Johnson series and the Lonesome Dove series (Dead Man's Walk, Comanche Moon, Lonesome Dove, and Streets of Laredo).
Gilda Radner's "It's Always Something" which she reads herself was excellent. Eddie Fisher reading his own bio was also excellent.
James Joyce comes off much better on audio than off the page IMO.
Anything by Richard Feynman.
Gilda Radner's "It's Always Something" which she reads herself was excellent. Eddie Fisher reading his own bio was also excellent.
James Joyce comes off much better on audio than off the page IMO.
Anything by Richard Feynman.
- Fri Nov 17, 2023 4:49 pm
- Forum: Personal Investments
- Topic: Starting off My investment Journey ... Looking for Advice! (Young 20s)
- Replies: 14
- Views: 1679
Re: Starting off My investment Journey ... Looking for Advice! (Young 20s)
Another vote for loading up the Roth when young and in a relatively low tax bracket. Most likely income and tax bracket will increase with usual career progress, making pretax contributions more advantageous relative to the current bracket. For people in their 20s, I do not agree that projections of tax rates 30-50 years into the future are a reasonable guide for arbitraging tax rates to guide the decision of Roth vs pretax 401K. Reasonable people may differ on this point. At age 25, expecting annual returns in line with the past, (5-10%), Roth investments will double at least twice, possibly several times between now and retirement age and the inside buildup will be untaxed on withdrawal. The same doublings in a pretax 401k will be taxed a...
- Fri Nov 17, 2023 12:47 pm
- Forum: Personal Finance (Not Investing)
- Topic: Estimating Life Expectancy Accurately - Defying the Lake Wobegon Effect
- Replies: 202
- Views: 23471
Re: Estimating Life Expectancy Accurately - Defying the Lake Wobegon Effect
Calculators give estimates based on populations. The more the population under consideration resembles the study population on which the calculator is based, and the larger the population, the more accurate the calculators' predictions will be. The results of the calculators have only limited application to an individual. If the calculator gives you a life expectancy of 10 years, prudence would seem to dictate planning for a somewhat longer time period, say x+10? If you are really optimistic, x+more. After all, you never can tell. Genes, other forms of luck, prudent personal habits, and in many cases the quality of medical they receive all play their roles in health and longevity. Some guys characterized by fitness and active lifestyles who...
- Sat Nov 11, 2023 12:56 pm
- Forum: Personal Finance (Not Investing)
- Topic: Buying a 120k car... yes, I need your help
- Replies: 275
- Views: 33203
Re: Buying a 120k car... yes, I need your help
A few years ago, a workaholic friend received a special bonus from his boss with the proviso that the whole sum be spent on a week's vacation away from work. He invited 7 of his friends on a golf trip to Florida in midwinter. We flew down, played 5 courses in five days, had a rest day, and flew home. Only cost me what I lost in bets on the course. His bonus paid for every other expense for 8 for the week. This was my friend's choice of how to spend a command splurge. He could have done it other ways. I probably would have done a week in Paris up first class myself. Doesn't make me right or him wrong. De gustibus aut bene aut nihil. (Latin proverb meaning, "regarding someone else's taste either speak well of it or say nothing") OP ...
- Thu Nov 09, 2023 4:31 pm
- Forum: Personal Finance (Not Investing)
- Topic: Low ball offer: do I counter or walk away? [IM Physician]
- Replies: 44
- Views: 6557
Re: Low ball offer: do I counter or walk away? [IM Physician]
Random thoughts provoked by the OP; I agree with the advice to counteroffer with what OP can reasonably expect in the local target market for physician services. The people on the other side of the negotiation will try to get the best deal they can for your services. When we were a private group, we sought experienced physicians with a record of skillful practice, a good energy level, and a necessary minimum of personal charm. We did not like to hire new grads without a track record unless personal characteristics were outstanding. Lacking any of those characteristics reduces one's value as a hire. Combining them all makes you valuable and you will be successful in our setting or in any other reasonable setting. In most contemporary setting...
- Sun Oct 29, 2023 4:01 pm
- Forum: Personal Finance (Not Investing)
- Topic: Prior Authorizations When Using Part D Plans
- Replies: 42
- Views: 3836
Re: Prior Authorizations When Using Part D Plans
The doctor/Nurse Practitioner/Physican Assistant (prescriber) office submits a prescription. The Pharmacy Benefit Manager (PBM) sends a request for a prior authorization (PA) to the prescriber. Small offices must complete the PA form and return it to the PBM, an annoying and time-consuming task. As time spent on it is unpaid and if not urgent, it may not make it to the top of the to-do list immediately. In large integrated groups, there is often an office or department that handles all of the PAs from all of the prescribers in the group (dozens to thousands of prescribers) and completes the forms and supplies supporting documentation from the prescribers' records if needed. In some cases, medical records supporting the diagnosis for which t...
- Sun Oct 29, 2023 10:24 am
- Forum: Non-US Investing
- Topic: High-Risk portfolio (Aiming for higher expected returns than 100% market-cap equities) [Denmark]
- Replies: 68
- Views: 9998
Re: High-Risk portfolio (Aiming for higher expected returns than 100% market-cap equities) [Denmark]
Nisiprius says that to get the risk premium, you do have to take the risk. If I understand his post, OP is asking about enhancing risk in order to enhance the risk premium and so get rich more quickly than he would with patience and diversification. He says he is prepared to run greater risks than most investors (i.e. he is prepared to speculate). Risk assets perform best when financial conditions are favorable and when markets are favorable. Some speculators do get rich quickly by knowingly taking enhanced risks. They usually have good timing as part of their success. Vanderbilt, JJ Hill, and others developed steam-powered railroads early in the American industrial revolution when there was abundant capital and a whole continent open to de...
- Fri Oct 27, 2023 11:33 am
- Forum: Personal Finance (Not Investing)
- Topic: What net worth are you targeting at age 90?
- Replies: 126
- Views: 16983
Re: What net worth are you targeting at age 90?
DW and I plan to continue to pay for our grandkids' educations if our children will let us and to otherwise continue to give with the warm hands, so if DW predeceases me, I am not expecting to leave a lot behind apart from the life insurance we mistakenly purchased 40 and 50 years ago. we purchased LTCI c 2010 which has developed into a sort of financial bargain in a sense, and we have an annuity that has paid the LTCI premia with its gains (making the gains free of taxes) over the 13 years we've had it. There is enough remaining in the annuity to pay 15 or so years of premia for DW and me in the unlikely event that we (or one of us)are still around in 15 years. Life expectancy is harder to handicap than it used to be. The doctors estimated...
- Fri Oct 20, 2023 10:55 am
- Forum: Personal Finance (Not Investing)
- Topic: Tales from this insane real estate market [Home sales]
- Replies: 2907
- Views: 515658
Re: Tales from this insane real estate market [Home sales]
Prices in SE Wisconsin vary with proximity to employment centers. Prices in Kenosha and Pleasant Prairie are still pretty high for what you get probably due to its proximity to Abbott, Abbvie, and the big federal installation in Lake County Illinois. Ditto Pleasant Prairie and the other state line towns. Racine, next town north of Kenosha is much more reasonable in terms of value. Madison still expensive in terms of value with the State government and the big state university there. Milwaukee and its immediate environs pretty steady as far as I can determine but it varies by neighborhood and suburb. The Wisconsin political-economic system remains business friendly at this time so there are still a lot of commercial refugees from Illinois bu...
- Tue Oct 10, 2023 5:15 pm
- Forum: Personal Finance (Not Investing)
- Topic: pre-med “fraternity”
- Replies: 22
- Views: 2874
Re: pre-med “fraternity”
Am > 50 years post undergrad. there were no pre-professional fraternities in my time and place there. The fraternity experience was a positive for me and my friends for those days. I am still in touch with some of my surviving brothers many decades later. I don't recall what the dues were but they look like a bargain from the current perspective whatever they were. The pre-med/pre-dent study group within the fraternity was helpful at the time. You learn from the guys a year or two ahead of you and you help the guys coming along after you to be successful. With tests online now, premed/predent fraternities probably have an extensive file of old tests in the major courses to help guide students taking the courses. Our fraternity consisted mai...
- Fri Oct 06, 2023 2:14 pm
- Forum: Personal Finance (Not Investing)
- Topic: Physicians - how to join private practice group?
- Replies: 13
- Views: 1703
Re: Physicians - how to join private practice group?
In our area, medicare pays about $110/RVU in primary care. Private insurances pay about $120/RVU. A busy internist/FP does 6000(+/-2000) RVUs per year serving 1200-1500 patients. Doctor is working at least 50 hrs/week to produce 6000 RVUs in primary care. Overhead is probably $50-70/RVU (that's a guess. Ours was $45/hr in 2008 before the big overhead boosting storm of mandates and regulatory compliance costs began to hit primary care a few years later. IT mandates alone would add $10/RVU) depending on volume, locale, and ancillary services offered on site. So assuming an equal mix of medicare and pvt insurance, an average fee-based practitioner earns $200,000-300,000 net of expenses. The large integrated group practices pay about $40-50/RVU...