So much for Toyota's job creation

Nope.

http://wcco.com/traffic/local_story_023095109.html

As for your second point, I think it makes great sense, since I bought a car made in another country and I get to deduct it this year! :lol:
In all seriousness, lots of companies have to buy products for their business that may not be offered in this country. It's the way of the global economy.

 

there aren't many toyotas that are built in japan anymore, you know.

and as far as the nascar thing, i can't find a list. but i recall TRD fans bitching and moaning about this extra handicap and that extra handicapon the tundra truck. and all the freaking out by the big 3 racing owners says something, doesn't it?

 

Okay, so you're supporting a free market for healthcare? If you have the money, you'll see a "private" doc. I feel like you're trying to rope in some argument to say, "See, that's why you should by American!"

PS, Money doesn't always buy the best healthcare, just the most expensive. :mellow:

 

I quoted the NYT article and it's source. Given the nearly 40% increase in output here in the US.. Yes that seems likely. It's a shift just like the textiles and the steel industry 20 yrs ago. It happens all the time. It's why we are so very good we let the more proficient succeed.

 

I wasnt only talking about Toyota. It's a massive rush into the south now. MB, BMW, Hyundai, and Toyota, Honda, Nissan. You saw the stats. They speak for themselves.

 

And in TX, AL, MS they are hiring as fast as they can and businesses in those areas are feeling the surge of new money coming into those local economies. Like I said in the piece, It is exactly the same as when the textiles moved from New England to the Carolina's. It's business as usual and it's always been that way and it's good overall.

People do have feet. It's a cold statement but why whine.. adjust and move on.

 

Not true, and knowing what I know, that statement is laughable :lol: . How much a physician charges for service has absolutely NOTHING to do with how good he or she is. Simply put, we bill for as much as we think we can get, insurance pays as little as they think they can pony up, and it ends up somewhere in the middle. How good your negotiating team is probably has more to do with how much you make.

Now insurance companies are planning a tiered system where they will rank doctors and your premiums will be less if you pick a doctor in a higher tier. How will they be ranked? By how little they spend per patient. Not mortality rates, or good outcomes, but by monetary measures.

I did a c-section on a woman who showed up in the hospital one day. Never saw a doctor at all for her whole pregnancy. I had to get 9 months worth of prenatal information in 2 hours. She had no insurance or job. You know how much I made for all that...exactly $0.00. Now I can fight tooth and nail to get the "money I deserve", but I'm not going to try to get water from a stone. Also, I think we should provide some of our service for free. We make a good living, it doesn't do me any harm to "donate my expertise".

Any way, I don't know what that has to do with GM's ability to provide a good product.

 

Actually, I have to agree with Malorn on this one... Just like anything else, there's usually a correlation between price and quality. I would imagine if I wanted to be "checked out" by what is considered the BEST (insert practice here) in the world, it would not be cheap...

 

So if I charge $4000 for a cesarean section while my partner charged $400, that makes me better?

You probably have seen those magazine articles about the "Best Docs in(insert state)" When I was in NJ during training we would see the docs we knew and laugh. Not because they were bad, but because they weren't seeing patients. They were great docs...doing research into "Fetal Cerebral Artery Doppler Patterns" or "Endothelial Growth Factor and PIH", but they had stopped seeing patients years ago.

Getting bach to pricing, that statement you said makes sense when you apply it to manufacturing, but does it apply to service? Do you get a better rate of return on your investements by having it actively managed as opposed to using an Index fund with low cost? Does spending $400/night at a hotel guarantee better service than $100/night? Is getting your oil changed at Toyota for $40 mean that Joe's Auto Shop did it worse because he charged $19.99?

Last example and this is a true story. My boss trained at the Mayo Clinic in Rochester, Minnesota. People fly in from all over the world to get their healthcare there. One night when he was on call, they got a call from some rich woman in Georgia. She was flying in to Rochester in her private plane because she had an ectopic pregnancy and wanted to go to the Mayo's world renowned Ectopic Pregnancy Center. My boss, had graduated from med school the year before and he was in his first year of residency. The faculty physician on call told him, "Charlie, you're head of the Mayo Clinic Center for Ectopic Pregnancy tonight." Point is, there was no MCCEP. People believe that the when you go to the Mayo, you get treated by the greatest experts in the world, but in the end, this woman was seen by a first year resident, and when she was put under, she was operated on by residents while the "expert" watched. And this is what happens at every academic hospital in the US.

Long story...gotta end it.

 

Of course not, you're right in that it does not *guarantee* (key word) better service, no such thing as a *guarantee* on anything... see below...

Dude, what planet are you living on? :lol: (no offense, just an expression)

Again, the key word is *guarantee*, this isn't REALISTIC, there are no *guarantees* on anything, but when the rubber hits the pavement, you are more likely to:

- get a better rate of return if you hire the right investment managers, and for many of those, don't even bother looking at the building they operate out of unless you have X million minimum.

- $400/night hotel? Of course you're FAR more likely to get better service. Go one step further, pay $5,000 at the best hotel in Manhattan, what are the chances you're going to get crappy service? Far less than the $100/night Holidy Inn.

Ok, answer this one then, name a world-renowned practicing ob-gyn, who is considered by whatever authority/group, to be in the top 1% ob-gyn's on the globe. Why do I suspect you wouldn't exactly get to see him/her unless you ponied up some good coin....

 

1. Baha Sibai, tops in the world on PIH. University of Cincinnati.

2. Anthony Vintzeleos & Frank Manning developed the biophysical profile for fetal well being, both at University Hospitals in NY & NJ.

3. Leon Speroff. Wrote THE book on infertility. Spends most of the year lecturing around the world, lecturing to students. University professor in Oregon, salaried position.

4. Phil DiSaia. Wrote THE book on Gynecologic cancer. Operates out of UCLA Medical Center.

Here are some of their bios:

http://www.ccpe.com/800-995-6555/faculty.html

When I mean wrote THE book in 3 & 4, I mean they wrote the standard textbooks used in Obstetrics & Gynecology. If you ask any Ob/Gyn who is Speroff & DiSaia and they can't answer, I would question their credentials. Sibai, Manning and Vintzeleos are also very well known in Ob/Gyn.

Notice they all work in state run University hospitals. They can't, I stress CAN'T charge more to patient X then to patient Y because they're experts.

And given that they are at University hospitals, they spend most of their time training residents. And most university hospitals take indigent patients. Chances are Dr. DiSaia is operating on some homeless patient with uterine cancer.

Now, I can set up a shop and claim to be the best Ob/Gyn in the world and charge whatever I want hoping some rich women walk through the door and pony up a ton of cash. These boutique practices are opening up now.

But you asked for one and I gave you 4.

 

Cool! You chose one that features one of my articles.

 

Ok, couple of things to keep in mind though, who you think are the worlds best might be different than who Bill Gate's advisors (or even GWB's), but, I digress, I asked you and you for your input, and you answered.

So, if this is the case, how do they control the potential "flood gates" of every wealthy person in the world requesting an audience with them, if they are in fact the best in their various respects, and are known as such through word-on-the-street, so to speak?

 

They do it the same way I do it...it's called the scheduling secretary. And any physician can limit their patient load. Being that they work for the university, they have to abide by the scheduling rules set up.

I would have to say though, you should get very little argument from any Ob/Gyn about those guys being the best.

Now I'm not naive. If one of those docs gets a call from the White House saying Laura Bush needs a hysterectomy, I'm sure the administration will arrange some special time for them. I've met 4/5 people I mentioned on that list and I seriously doubt they would say, "I'll see her, but I'm doubling my fee." They are really classy docs who seem really in it to advance science and health.

They may be bad examples, because I do get your point. Now if your talking plastic surgeons(read: breast surgeons), then it's a different ball of wax. There, I'm sure the best strike out on their own and charge a lot. There, you get what you pay for. But for the truly great docs that I know, I'm sure they would'nt be trying to gouge people out of money.

 

This is a quote from an Ob magazine about one of the docs I mentioned:

OBG Management hailed Philip DiSaia ’59 as one of two or three modern-day doctors who have had the greatest impact on gynecologic oncology. “Women with one of the gynecologic cancers, as well as physicians who care for them, owe much to Phil DiSaia,†wrote the magazine in November.

 

That's cool! Thanks for the discussion...

Although this line stuck out (in my mind anyway):

"I'm sure they wouldn't be trying to gouge people out of money."

Although that's pretty damn cool, for whatever reason (most likely the great meat tenderizer of life), I sort of go around assuming everyone is a depraved crack-addict with dark ulterior motives trying to soak me for all I'm worth... :lol: I think I just lack faith in genuinely humanitarian practices... :lol:

 

It's just too bad your not a woman, so you won't ever have the chance to meet them.