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"The Grab Bag" PMD-Style


Various interesting and useful medical and financial information including where health care money goes, business awareness in medical training and changes in the IRS code.


When I was a kid, there was a nationally syndicated newspaper column that I loved, L.M. Boyd's "The Grab Bag." It had all sorts of trivia that I suppose helped lead me to a later championship (1988). On a more pertinent and practical note, I periodically submit my own version of interesting and useful medico-financial information. So let's get on the bus and begin the tour.

— A Dartmouth Medical School study showed that for every $1,000 spent on pharmaceutical advertising, 24 new prescriptions were written. Just one more example of the self-deception we doctors practice when we say that we are immune to such things.

— Computer algorithms account for two-thirds of the NYSE's trading. It obviously works for those footing the large bill for these things. But where does that put the individual investor? We need to be, firstly, aware and, secondly, somehow involved (mutual funds, index funds?), if only as a hedge.

— A recent study showed that 27% of our health care dollar goes to administrative costs, about $83,000 per doctor. In Britain the number is 10% and in Canada it is 3%. It makes you wonder, again.

— Another study showed that 80% of cellphone users overpay, by an average of about $200 per year. If it is worth it to you, just make one call to your carrier and ask for a better deal. You'll probably get one.

— The average age of filing for social security is 64. That's roughly a split between the get-in-earlies at 62 and the wait-for-full-draw at 67.

— In 2010, 54 medical schools offered a combined MD/MBA program. As I have often said some business/organizational awareness needs to be in every MD's training, not just as a separate program for the few who know ahead of time to be interested.

— In the last 10 years, 4,428 changes have been made to the IRS code. I know that we haven't kept up. The question is, has your CPA?

— In this wacky election season, have you noticed that our political system has a bias to filter out the thoughtful and replace them with the faithful?

— It will really help your heirs if you put all of your passwords somewhere early and easy in your estate documents and a copy with your lawyer.

— Drug addiction treatment and education saves about $5 in welfare costs alone for each $1 spent on it, according to the Schaffer Library of Drug Policy. And each $1 spent on incarceration eventually generates $15 in welfare costs. That's aside from the $30,000 a year spent on jailing a drug person, and the $450,000 spent on convicting them. So treatment and prevention would seem to be a pretty good way to save a lot of money as well as helping the poor souls thus afflicted.

— What you spend is much more important to your financial status than what you accumulate. And Thomas Stanley in "The Millionaire Mind" shows that frugality pays. For instance, 70% of millionaires surveyed reported they have their shoes resoled rather than buy new ones, and 71% make a list before they go shopping.

— The shift to hospitalists over the last 20 years, originally pushed by the managed care insurance programs to save money, has had some interesting effects. One is that many primary care doctors are no longer in the hospital every day, isolating them in their offices and reducing the interactions among specialties that used to be a key communications bridge.

A second is that a study from the University of Texas showed that patients treated by hospitalists spend about half a day less in the hospital and were charged $282 less. Not as much as expected, but helpful. But when follow-up charges and unexpected extra ER visits were factored in, the charges for the patient's care was $332 higher on average. That works out to at least $1 billion in extra costs for Medicare alone.

— Remember that your investment opportunities are someone else's castoffs.

— “A nickel ain't worth a dime no more!" - Yogi Berra

— “Money talks but all it says is goodbye." - (many)

— “If you think no one cares and you are alone, try missing a few car payments." - (many)

— "Money is not the problem, you are. Money is just where the problem shows up." - (many)

— Ernest Hemingway on how people go bankrupt, or get rich: "Slowly, then all at once."

R.I.P. L.M. Boyd.

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