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No mention of riots and “no go” zones....

It's gotta be true if Alex Jones says it.

https://www.cnn.com/2019/06/18/media/alex-jones-lawsuit/inde...
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"As usual, the "American exceptionalism" model falls far short of the mark. <LOL>"

I don't know how to measure relative risks in an uncertain world. Often the debate breaks down on ideological lines with some arguing that government can not be trusted to protect pensions, SS, etc., and others arguing that Wall Street tycoons cannot be trusted. I don't fully trust either.

Ispouse and I worked up to our early 60's partly because we did not fully trust SS, or her state pension (Va is a little better than average at 77% funded), or our sheltered accounts, or our taxable accounts, nor even our FDIC protected accounts to the extent that inflation could destroy the value of the latter.

But, to the extent that Ispouse is already drawing income from her SS, pension and 403(b), we are getting back more than zero from payments into those accounts (can't think of a better term at the moment). To the extent that I am drawing income from my taxable accounts I am getting back more than zero from my contributions to those accounts. To the extent that I am not yet drawing income from my IRA or my SS, I am hedging against extreme longevity and inflation while enjoying retirement.

As a lifelong (but retired) trial lawyer, I concede that I am not smart enough to fully comprehend the arithmetic. That was a lie. I am too lazy to do a deep dive into the arithmetic. So far, ptheland's analysis sounds 'truthy' to me.
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iampops writes,

"As usual, the "American exceptionalism" model falls far short of the mark. <LOL>"

I don't know how to measure relative risks in an uncertain world. Often the debate breaks down on ideological lines with some arguing that government can not be trusted to protect pensions, SS, etc., and others arguing that Wall Street tycoons cannot be trusted. I don't fully trust either.

</snip>


I think capitalism works well if it's properly regulated.

The best retirement plan in the country is the Thrift Savings Plan (TSP) for Federal Gov't employees. It invests in low-cost index funds (sold by capitalists) and has an overall expense ratio of 0.04% (4 basis points)

If you're in a retirement plan that lets Wall Street run wild, and you're losing the 2.00% per annum to fees and costs that Wall Street's business model is based on, you need to save about twice as much money for retirement to make up for the skim.

intercst
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As usual, the "American exceptionalism" model falls far short of the mark.

Would you have been able to retire as early as you did if you lived in a country that had a very generous retirement pension system, like Denmark, but as a result, had to pay a 52% income tax rate because of such? That generous pension would not have been available to you for decades after you quit working.

You certainly would have less income available to make the personal investments that you have been living off of all these years.

We certainly have problems with our own system but I doubt very many American's would want to pay as much as the Danish do to make it to the A category.

Personally, I think our "exceptionalism" on this topic is that fact that we are likely to have many more people like you in American, that can afford to retire early on their own dime, than most any other country. I mean, that certainly fits the definition of exceptionlism more so than the shared (but happy) mediocrity of everyone getting the same thing at some future date.
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Hawkwin asks,

<<As usual, the "American exceptionalism" model falls far short of the mark.>>

Would you have been able to retire as early as you did if you lived in a country that had a very generous retirement pension system, like Denmark, but as a result, had to pay a 52% income tax rate because of such? That generous pension would not have been available to you for decades after you quit working.

</snip>


Probably not. But who are we designing the pension system for? A few "lottery winners" like me, or the average, middle-class American? (Answer: In the US, it's designed for the lottery winners.)

If the average American (family of 4, median income of $60,000/yr) was capable of doing the arithmetic, they'd find that a system that provided free health care, free college for the kids, and a pension you can live on in exchange for a 50% tax rate is cheaper than what they have now. There's a reason the Danes and the Swedes are all smiling and happy. There's a lot less stress in their system.

intercst
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I think capitalism works well if it's properly regulated.

Most systems work well if properly regulated. :)

The tough part is getting everyone to agree on what that proper regulation is. Just look at all the discussions we've had here on minimum wage or drug/healthcare prices.
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Probably not. But who are we designing the pension system for?

I was responding to your editorial comment re exceptionalism. The so-called American Dream of exceptionalism isn't the shared mediocrity of Denmark.

Again, I have no argument against the idea that our program could be better but I have to wonder if by trying to get to an 'A' result such as Denmark's, that we might have to reduce our opportunity for such exceptionalism.

Based on your response of "probably not", then it would appear that you agree.

Allow me to ask another question. Would you GIVE UP your 20 years of early retirement for a retirement system such as the Danish?

Would you go back and do it all over again for less stress?
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"There's a reason the Danes and the Swedes are all smiling and happy. There's a lot less stress in their system"

The Swedes aren't all that happy these days. Two of the largest cities now have massive 'no go zones' and their culture is under attack. Within 30-40 years, they'll be bowing down to Mecca five times a day.

The native Swedes aren't reproducing, and millions of immigrants, mostly from Muslim countries have been imported to shore up the contributions to the tax system to fund that lush retirement. Which really isn't all that great.

20 years ago, when I first retired at age 52, I went to Thailand. To a small beach resort not on the 'tourist circuit'. Nice and cheap , too...could eat for a few dollars a day, stay for $15-20 a night, or probably $80 a week. Met a nice retired Swedish chap who spent the winters in THailand to get away from the high cost of living in Sweden. His 'pension' didn't go far enough at home.

Yeah, if you don't mind working till mid/late 60s likely in well regimented society.

when I was in Sweden for the better part of a week, EVERYTHING was high cost. Typical European prices for dinner. Everything had 20% VAT tax. And 20% 'gratuity' as part of every bill.

My mother's cousin (I guess a far distant cousin of mine) constantly complained of the HMO like health care system where you seldom saw the same doc - you saw whoever was on duty that day. You'd go through the same routine of telling them you long term problem, and they'd start at the top of the question list, go through it like a robot, boot you out after your 15 minute appointment, with more of the same pills. same for another cousin.


t
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My friend in CA, who did well investing in start ups, had a million dollar stock option exercise coming.

He moved to Nevada for his tax residence....Las Vegas.... kept his CA house and rented it out at some ridiculous price........one of these days , he's likely to sell it, too, as an 'out of state resident' and not pay any CA taxes on the sale...

Saved about $100,000 in CA state taxes...... (10%)..... as he was already raking in big bucks for his 'consulting' and benefits.....and other investment income....... he's half retired now...

---

"New York, California high-tax state exodus just beginning, expert warns"





t.
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The Swedes aren't all that happy these days. Two of the largest cities now have massive 'no go zones' and their culture is under attack. Within 30-40 years, they'll be bowing down to Mecca five times a day.


The timing of this is funny; one of my best friends from college was just back here a couple weeks ago visiting from Sweden. She was working as a consultant in Sweden several years ago, and when the assignment was done she came back to the US. However, the client offered her a position and she jumped at the chance to go back. She loves it there and comes back here every so often. However, she was back this time to move her elderly mother back to Sweden with her. She constantly sings the praises of the social structure of Sweden and how they support their citizens. No mention of riots and “no go” zones....
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He moved to Nevada for his tax residence....Las Vegas.... kept his CA house and rented it out at some ridiculous price........one of these days , he's likely to sell it, too, as an 'out of state resident' and not pay any CA taxes on the sale...

Saved about $100,000 in CA state taxes...... (10%)..... as he was already raking in big bucks for his 'consulting' and benefits.....and other investment income....... he's half retired now...


I doubt that he was able to sell his CA residence and not have to pay non-resident income taxes to CA on the sale. Most states operate like that, and I cannot imagine that CA is any different.

My parents gave my brother and me their house many years ago, and when brother and I finally sold it, I had to file non-resident taxes in RI to pay taxes on the gain on the sale. Non-residents who work in MA and live in NH or RI, for instance, have to file non-resident tax forms in MA and pay MA income taxes. They do then get a credit for those taxes in their home state, so they don't pay taxes twice on the income, but income taxes do get paid. For those in NH where there is no income tax, they only pay state taxes to MA. For folks like DS who lives in RI but works in MA, he paid MA income taxes and took a credit in RI paying any difference owed to them.

I cannot imagine that CA is any different.
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He moved to Nevada for his tax residence....Las Vegas.... kept his CA house and rented it out at some ridiculous price........one of these days , he's likely to sell it, too, as an 'out of state resident' and not pay any CA taxes on the sale...

Presuming his income is more than some relatively low limits, unless he's committing tax fraud, he's still filing CA state income tax returns because of the rental income, and since he's renting it out at 'some ridiculous price', presumably paying taxes on the profit. From https://www.ftb.ca.gov/individuals/faq/ivr/210.shtml

You are required to file a Nonresident or Part-Year Resident Income Tax Return (Long or Short Form 540NR) with California if you have income from California sources, such as rental income, income from the sale of property, or partnership income in 2018 and you are:
Single with a total income from all sources of $17,693 or more
Married with joint income from all sources of $35,388 or more


And, as implied from the bolded part above, he will pay CA state income taxes on the sale of his property. (Note that if the rental activity has resulted in losses, he can use the losses to offset the profit.) From CA FTB Pub 1031 https://www.ftb.ca.gov/forms/2018/18_1031.pdf

Example 12 – You are a resident of Nevada. You own residential rental property located in California. Your property has always shown a loss. You sold the property for a gain.

Determination: Because the property is located in California, the gain on the sale is taxable by California. Since rental real property is classified as a passive activity, the sale “triggers” the release of suspended losses incurred in taxable years beginning on or after January 1, 1987. The suspended losses may be used to offset any gain from the sale or income from other passive activities. For more information, get form FTB 3801, Passive Activity Loss Limitations, and instructions or FTB Pub. 1016, Real Estate Withholding Guidelines.


AJ
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No mention of riots and “no go” zones....

It's gotta be true if Alex Jones says it.

https://www.cnn.com/2019/06/18/media/alex-jones-lawsuit/inde...
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Hawkwin asks,

Allow me to ask another question. Would you GIVE UP your 20 years of early retirement for a retirement system such as the Danish?

Would you go back and do it all over again for less stress?

</snip>


I'm a poor example. There really wasn't much stress in the current system for me (i.e., I earned a healthy salary, lived in a city with low housing costs (Houston), had minimal medical expenses, and wasn't sending any kids to college.

When folks complain about "Denmark's 52% tax rate" and compare it to 20% or whatever in the US, you have to add in the services that Denmark's taxes are covering that aren't covered in the US (e.g., medical care, college, pensions, etc.)

For example, you can swim in the harbor in Copenhagen due to strict environmental regulations and no doubt "more taxes". I wouldn't try swimming in the Houston Ship Channel in a low-tax paradise like Texas.

intercst
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"I doubt that he was able to sell his CA residence and not have to pay non-resident income taxes to CA on the sale. Most states operate like that, and I cannot imagine that CA is any different.

My parents gave my brother and me their house many years ago, and when brother and I finally sold it, I had to file non-resident taxes in RI to pay taxes on the gain on the sale. Non-residents who work in MA and live in NH or RI, for instance, have to file non-resident tax forms in MA and pay MA income taxes. They do then get a credit for those taxes in their home state, so they don't pay taxes twice on the income, but income taxes do get paid. For those in NH where there is no income tax, they only pay state taxes to MA. For folks like DS who lives in RI but works in MA, he paid MA income taxes and took a credit in RI paying any difference owed to them.

I cannot imagine that CA is any different. "


OH, but it can be.

He is a 'consultant' and usually works for shares/options on start ups. Or consulting on continuing basis. He doesn't have to be 'at work' like a salaried person. (he's already very wealthy due to several other ventures). Just enjoys keeping working part of the year. He doesn't need 'current income'.

He didn't sell his CA house...just renting it out. But when he does, he won't be a CA resident or paying CA taxes. Well, these days they don't even tax first $250,000 gain single/500K married gain, right?

I worked with him for about 5 years in our advance technology program at MCI......I was doing radio stuff, he was doing fiber optics, cables, multiplexers, etc.


t
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intercst:""When folks complain about "Denmark's 52% tax rate" and compare it to 20% or whatever in the US, you have to add in the services that Denmark's taxes are covering that aren't covered in the US (e.g., medical care, college, pensions, etc.)"

Oh, I sure would not have wanted to work to 62 or 65 or 66 or 68, whatever the retirement age will be there in a few years. Or here.

During most of my working career, my health insurance was paid for by my employer. usually included dental and vision benefits, too. I'd bet intercst got the same deal at his employer.

My employer paid 100% of the tuition for my Master's Degree while I was working there. Went part time in evenings for 3 years. I had to buy the books.

For me, back in the 1960s, I graduated college with less than 30% of a years pay in 'debt' and had it paid off in less than 2 years.

It's been the LIBERALS and countless tens of thousands of pages of rules and regulations, forcing colleges to slice and dice student bodies, come up with a zillion 'programs' to allegedly fix any imbalance between gay African Americans who 'identify' as transsexuals' this week, but might identify differently next week, etc. The percentage of adminimistratium has gone from 10% back in the 1960s to over 50% these days with reams of diversity councilors, grief counselors, classes in LGBT studies and probably degrees in same, and attacks on institutions, clubs, culture......... 50 years of liberals running up the cost of college.

I'd bet not one dime is spent on programs for transssexual Native Americans identifying as female this week in Denmark's colleges.

t.
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tele writes,

He didn't sell his CA house...just renting it out. But when he does, he won't be a CA resident or paying CA taxes. Well, these days they don't even tax first $250,000 gain single/500K married gain, right?

</snip>


I'm sure he's paying taxes on income sourced in California (i.e. rental income on his Calif. home, or any capital gains on a sale). California tax collectors are very aggressive in pursuing out-of-staters.

When I worked for Exxon in Houston, I attended a one-week training session in California and I got a tax bill from California demanding CA state income tax one one week's salary. (I forwarded the "tax bill" to Exxon and they handled it.)

intercst
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I once saw a man pull a crab trap out of the Houston ship channel. Still makes me shiver.

I have a Danish friend who acknowledges that while they pay high taxes to live there they also get a lot in return.

If we tally all the taxes and fees we pay here, in addition to college and healthcare costs, we pay close to what Danes pay but get far less in return and many more risks.
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OH, but it can be.

No, not really.

He didn't sell his CA house...just renting it out. But when he does, he won't be a CA resident or paying CA taxes.

Unless he's committing tax fraud, he's still paying CA taxes on renting it out, if it's profitable. And if it's not profitable, he probably still should be filing CA taxes to document the losses, so that he can claim the losses against the profit when he sells.

And as a non-resident selling real estate in CA, he still will pay CA income taxes on the profit. In fact, it's likely that part of the proceeds of the sale will be withheld for him, and he will have to file tax forms to get money back.

Well, these days they don't even tax first $250,000 gain single/500K married gain, right?

Unless the closing for the sale of the house is less than 3 years (to the day) after he moved to NV, there is no exemption.

AJ
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The Swedes aren't all that happy these days. Two of the largest cities now have massive 'no go zones' and their culture is under attack. Within 30-40 years, they'll be bowing down to Mecca five times a day.

This won't do any good, but...

There are "no-go zones" in Sweden where the police can't enter.
FALSE: https://www.snopes.com/fact-check/sweden-crime-no-go-zone-po...


A number of localities in the United States, France, and Britain are considered Muslim "no-go zones" (operating under Sharia Law) where local laws are not applicable.
FALSE: https://www.snopes.com/fact-check/sharia-law-muslim-no-go-zo...


Some urban areas in Sweden have been called no-go zones. The Swedish government states that "no-go zones", where "criminality and gangs have taken over and where the emergency services do not dare to go" do not exist....
https://en.wikipedia.org/wiki/No-go_area#Sweden



The best anyone could say is that portions of Swedish cities have been struggling with higher rates of crime, which is true of many cities around the world, including here in the United States.

But why let the truth get in the way if a good pearl-clutching lie makes you feel better?
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I was trying to count the number of people you probably offended in that post but lost count.
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tele has not been an inhabitant of this universe for at least a decade. I am not sure why anybody feels the need to respond to him.
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I was trying to count the number of people you probably offended in that post but lost count.

I was just trying to figure out what the post was about.
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"Even if a 50% tax would make the entire life easier and better, they would not be able to enjoy it if they knew that brown people were getting an easier better life too."


Unlike the US, the Europeans face tax rates up to 70% of income. First, they have MANDATORY deductions, just like our SS and Medicare, but at double the rate. They get to keep 1/3rd to 1/2 of their paycheck, and then pay 20% Value added tax on just about everything they buy. Yeah, cars 30% more expensive...... and of course, then there is the $6 or $8/gal price for gas.......or diesel.......and high annual car registration fees.

What is it, 70% of working people get their insurance through their employer. When I was working, it was 'free' to me as a single. Now, I guess you have $1000 deductible or something......

Our seniors get on Medicare.

If you are disabled, two years after you are declared 'disabled' you go on government medicare, regardless of age.

If you are 'deprived kids' you wind up on Medicaid......for those 'welfare' moms often now 4 generations of them. No 'baby daddies' to be seen as they lower the dollar amount. Plus of course, the welfare moms get hundreds of millions in aid and free $$$$.



sorry, it's liberals who are the problem, pushing for 'guaranteed income' even if you are too lazy to work, free this, free that....there is no free. Other taxpayers have to pay for it. And you bet, lots of us aren't interested in that. Nor silly reparations or other give away pandering of the democrats. Nor expanding the welfare state.

What is it now? 75% of 'immigrants' are now on food stamps and other monthly payment programs.....unable to hold jobs in our high tech society.....and democrats want to flood the country with tens of millions of illegal border runners......

Yeah, it's math.....and we are going to the wrong way


t.
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I have a Danish friend who acknowledges that while they pay high taxes to live there they also get a lot in return.

Denmark/Population: 5.8 million
United States/Population: 327.2 million

One of these is not like the other.
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Rayvt,

Denmark/Population: 5.8 million
United States/Population: 327.2 million

One of these is not like the other.


You are better than that.

Denmark GDP 324.9 billion USD
United States GDP 19.39 Trillion USD

One of these is not like the other.

Andy
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Denmark/Population: 5.8 million
United States/Population: 327.2 million

One of these is not like the other.

You are better than that.

Denmark GDP 324.9 billion USD
United States GDP 19.39 Trillion USD

One of these is not like the other.

Andy


Time for someone to mention land area?

CNC
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Time for someone to mention land area?

One of the projects I was on at Motorola in the late 90's worked with a team in Copenhagen (we were in Chicago). Every so often one team would go the the other's country for 1-2 week technical meetings.

Most Europeans do not grasp how BIG the US is.

One weekend in Chicago, on Friday we asked the Denmark guys what they had planned for the weekend. They said that they were going to hop in the car and drive to New York city to see Times Square. We suggested that they make other plans, as it would take 2 days just to drive from Chicago to NYC.

In discussions, we noted that if they got in a car in Denmark and drove south all day long, they would be 5 countries away. Whereas in they drove south from Chicago all day long, they would still be in the same STATE.
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...we noted that if they got in a car in Denmark and drove south all day long...

Well, one way I've found to talk with folks from other countries is to use their frames of reference. In the case of explaining how long a trip from Chicago to New York is, I would say to them that it would be like driving from Copenhagen to Paris.

Pete
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Denmark/Population: 5.8 million
United States/Population: 327.2 million

One of these is not like the other.


If that is the what makes it work, do it state-by-state...
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Unlike the US, the Europeans face tax rates up to 70% of income. First, they have MANDATORY deductions, just like our SS and Medicare, but at double the rate. They get to keep 1/3rd to 1/2 of their paycheck, and then pay 20% Value added tax on just about everything they buy. Yeah, cars 30% more expensive...... and of course, then there is the $6 or $8/gal price for gas.......or diesel.......and high annual car registration fees.

Having previously lived, worked, and paid taxes in the 5th highest tax rate country in the world for many years - Austria - I can attest to the high tax rates and HCOL. Don't forget that one files taxes each year with a professional tax accountant in European countries and there are many , many allowable tax deductions. This means one's effective tax rate is much, much lower than any marginal tax rates one may see by doing a cursory "Google" search to see what the top tax rates are in various countries. For us, personal income tax rate was much lower in Austria than here in the US (property tax is also much lower), but cap gains were a bit higher, and the VAT and equivalent SS were higher. Deductions were allowed and helped with all of it.

What do you get for the higher taxes? Depending on which specific country - a lot of benefits including excellent infrastructure, universal health care, educational expenses (college), childcare, pension, government support for the arts, housing based on income for those with lower incomes, sick leave, a month's paid vacation, etc... . I don't recall we ever complained about paying the higher taxes with all that we got with it while living and paying taxes there.

I don't think anyone is being fooled that in the US with lower marginal and effective tax rates, when you add in the expenses we must cover out of pocket that are covered as benefits in other countries with the higher tax rates - it all pretty much comes out in the wash in terms of a household's cash flow. Although the tax on gas/diesel is much higher, the infrastructure is so good, that life without ownership of a vehicle(s) is not out of the ordinary.

If the middle class (in the US) wants European government benefits, it should prepare to pay for them. Raising taxes on the rich simply won’t cover the costs.
https://thehill.com/opinion/finance/372502-if-americans-want...
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Rayvt,

Denmark/Population: 5.8 million
United States/Population: 327.2 million

One of these is not like the other.

You are better than that.

Denmark GDP 324.9 billion USD
United States GDP 19.39 Trillion USD

One of these is not like the other.

Andy


Different??? Yes. But economies of scale and depth of experience managing large populations could make these differences an advantage to the US. Simply pointing out that Denmark is smaller than the US does not automatically make the point that ideas that work there would not work here.
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sgeeeeee writes,

Different??? Yes. But economies of scale and depth of experience managing large populations could make these differences an advantage to the US. Simply pointing out that Denmark is smaller than the US does not automatically make the point that ideas that work there would not work here.

</snip>


Exactly! Economies of scale and bulk purchasing should be giving the US some of the lowest health care costs in the industrialized World. Instead, political corruption and the fact that almost every Congresscritter is bought & paid for by the health care lobby is forcing US citizens to pay twice as much as anyone else.

intercst
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health care lobby is forcing US citizens to pay twice as much as anyone else.

Median doctor pay in Denmark is about 43,000 Krone a month, or about $6500.

https://www.statista.com/statistics/878471/salary-distributi...

Median doctor pay in the US is about $24,000 a month.

https://medium.com/nomad-health/complete-list-of-average-doc...



Even as a person that supports a Medicare for all solution, I don't see how it is politically feasible to have doctors accept a 75% pay cut.
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Hawkwin writes,

health care lobby is forcing US citizens to pay twice as much as anyone else.

Median doctor pay in Denmark is about 43,000 Krone a month, or about $6500.

Median doctor pay in the US is about $24,000 a month.

</snip>


Pay doctors the same salary they get in the Netherlands. Their specialists actually are higher paid than in the US, yet their overall health care costs are half ours, they live longer, and have lower infant mortality.

https://journal.practicelink.com/vital-stats/physician-compe...

intercst
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" Although the tax on gas/diesel is much higher, the infrastructure is so good, that life without ownership of a vehicle(s) is not out of the ordinary."

Tens of millions who live in the NY area, Boston area, Phila area , Los Angeles area and hundreds of other US cities don't own cars. They ride mass transit. A lot more people than the population of the entire country of Denmark. You can easily live in Washington DC without a car.

My friend Sue had a car in DC....she drove her 15 year old car once a week to go to the food store in VA which was better than her local markets.....that was it......oh, in summer, to the Arlington outdoor public pool..... but she had places to swim in DC year round too. She really didn't 'need' a car but had one.

I lived in Arlington - and what was the end of the Metro then. Rode it to and from work. COuld easily get into DC on weekends for activities. Could have lived there without a car, but had one. You could hop AMTRAK to get to Baltimore, Phila, NYC in a few hours...faster than flying.

All depends where you live in the US.

The state of VA is 2.5 times the entire country of Denmark in sq miles

The state of TX is 15x the size of Denmark.

Half the people in the US pay ZERO percent marginal rates. they don't pay income taxes at all.

In addition, millions pay NEGATIVE income taxes. they get money back through EITC and other programs.



t.
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Pay doctors the same salary they get in the Netherlands.


???

Your link shows that General Practice docs in the Netherlands are paid 72% of what US docs get ($117k vs $161k).

In other words, your solution to a 75% pay cut is a 28% pay cut? I don't see that as substantially more politically feasible.
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telegraph complains,

Half the people in the US pay ZERO percent marginal rates. they don't pay income taxes at all.

In addition, millions pay NEGATIVE income taxes. they get money back through EITC and other programs.

</snip>


Not only do "millions [of poor, brown and black Americans] pay NEGATIVE income taxes", but many millionaires pay negative income taxes as well.

The US is a wonderful place to be idly rich. I realize that arithmetic is scary, but the biggest cause of budget deficits is light taxation of the wealthy, not the fact that hungry kids are getting "free lunch" at school.

intercst
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Hawkin writes,

Your link shows that General Practice docs in the Netherlands are paid 72% of what US docs get ($117k vs $161k).

</snip>


Something like 40% of a US general practitioners overhead cost is the administrative staff required to deal with 40 different for-profit private insurers and the doctor's unreimbursed time spent arguing with insurers to get paid for the work done.

I bet many doctors would trade eliminating that for-profit, private insurance nonsense for a lower salary.

intercst
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Something like 40% of a US general practitioners overhead cost is the administrative staff required to deal with 40 different for-profit private insurers and the doctor's unreimbursed time spent arguing with insurers to get paid for the work done.

I bet many doctors would trade eliminating that for-profit, private insurance nonsense for a lower salary.

intercst


Not taking side or arguing withe stats given here but isn't your response conflating the doctor's "total take" with his "personal income?
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FCorelli asks,

Something like 40% of a US general practitioners overhead cost is the administrative staff required to deal with 40 different for-profit private insurers and the doctor's unreimbursed time spent arguing with insurers to get paid for the work done.

I bet many doctors would trade eliminating that for-profit, private insurance nonsense for a lower salary.

intercst

Not taking side or arguing withe stats given here but isn't your response conflating the doctor's "total take" with his "personal income?

</snip>


My understanding is that a lot of a primary care physicians time is spent talking/writing letters to insurance companies to get care for their patients, or to get paid for work done. This isn't time they get compensated for, or an activity they enjoy doing.

If you eliminated the insurance company burden, it might remove 20 hours/week of unpaid admin work. I bet a lot of doctors would accept a lower income in exchange for the additional time off.

intercst
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Not only do "millions [of poor, brown and black Americans] pay NEGATIVE income taxes", but many millionaires pay negative income taxes as well.

The US does not have a wealth tax, it has an INCOME tax.

Your soapbox is getting tedious. And really doesn't have anything to do with the topic of this board, which is Retirement Investing. Flog your hobby-horse on a board that it is on-topic for. Please.

On this board, stick to the Retirement Investing topic.
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Rayvt writes,

The US does not have a wealth tax, it has an INCOME tax ......

</snip>


put me in your p-box, problem solved.

intercst
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Since this thread has been so heavy on medical costs and government factors...

There's this. You think maybe (well intentioned) US government induced pricing distortions are part the problem?

https://www.vox.com/policy-and-politics/2018/7/31/17629526/m...


Certificates of need. Maddening. Government protection of the consumer or cronyism? Sold as the former, motivated by the latter? Or am I just getting older and more cynical.

I remember my dad wrestling with the state regulators over certificates of need as the administrator of a small town Hospital in the 70s. He worked for a non-profit owned and run by a parachurch charity that saved and reinvigorated several small town hospitals in the 50's and 60's. Stuff like really took the fun of it out for him/them. They were devoted to reinvesting and expanding capabilities in those formerly floundering hospitals but the government fought them every step of the way. In the end, the for profit hospitals wore them down and they, along with neighboring Sisters of Providence Hospitals sold out.
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"many millionaires pay negative income taxes as well.

The US is a wonderful place to be idly rich. I realize that arithmetic is scary, but the biggest cause of budget deficits is light taxation of the wealthy"

Ah , there you go again as a typical liberal confusing 'income' with 'wealth.

And you set the perfect liberal example of someone who exercises their options to pay very little income tax, if any, control your 'income' despite your 'wealth' , and suck up on government subsidies like ObamaKare for $8/month.

Would raising tax rates to 50% on high income earners, on the 'wealthy' impact you? Nope, not a dime.

Back in the 1950s and 60s with 90% type marginal rates, the wealthy stashed their wealth in real estate (taking depreciation, mortgage interest, etc) to have little 'income' but lots of cash flow, and loaded up on tax free muni-bonds as well.


Either than, or ran a business or corporation which invested most of the proceeds back into the business, paying maybe zero dividends.

Of course, many small businesses managed to lose a lot of cash transactions back then too..there were no credit cards way back......




t.
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No. of Recommendations: 5
NozRydr writes,

Certificates of need. Maddening. Government protection of the consumer or cronyism? Sold as the former, motivated by the latter? Or am I just getting older and more cynical.

I remember my dad wrestling with the state regulators over certificates of need as the administrator of a small town Hospital in the 70s.

</snip>


Unfortunately, if a hospital has an idle piece of expensive medical equipment, the temptation will be to tell patients they need it, whether that's true or not. It's even worse if the prescribing physician owns the piece of idle equipment.

That's what caused the "certificate of need" requirements. It's a lot cheaper to have one MRI machine in town that's running 24/7, than three machines at different providers each operating part-time.

When I lived in Houston, I needed to get an MRI of my lower leg (calf). Doctor wanted to send me to Methodist Hospital where the MRI was $3,500. A store front MRI Clinic in my neighborhood would do it for $1,000, and if you we're willing to do the MRI after 10 PM at night, you got a 20% discount, bringing the cost to $800.

A 20% co-pay on a $800 charge (i.e., $160) sounded a lot better to me than 20% of $3500 (i.e. $700).

intercst
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intercst:" Something like 40% of a US general practitioners overhead cost is the administrative staff required to deal with 40 different for-profit private insurers and the doctor's unreimbursed time spent arguing with insurers to get paid for the work done"


It's not only that, but million dollar a year liability insurance policies for gynecologists, brain surgeons, etc, due to mostly democrat scumbag lawyers out to make fast bucks.

Bet you don't have that problem in Denmark, right?

Nor do you have 37 different FEDERAL forms to fill out

Wait until your first Medicare 'wellness' check. It's 90% bullcrap and some doctors ask questions like 'do you have a gun at home'? Have you fallen in the last six months? (and couldn't get up)? and 20 other idiotic questions that MUST be answered every time you go for your wellness check. DO you have hand rails in your house? Loose carpets? Pets?


Then likely the doctors in Denmark probably get a 'free' education and start work debt free. Not so here for most.

The average engineer makes about $67,500 a year there. You won't do much better than that likely. Probably next to none will retire early as taxes eat up most of your possible savings.


t.
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Also interesting that rayvt criticized you for responding to tele and not tele - especially since you at least get your facts right and tele makes them up.
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put me in your p-box, problem solved.

intercst


No. You do have useful and informative things to say. It's just this particular hobby-horse that's getting tedious.
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Wait until your first Medicare 'wellness' check.

Yeah, that first one was a surprise to me. Buncha useless folderol. They are also free (no copay), so I was surprised when they billed me the $10 copay. I asked about that, and was told that my visit included some things that were above & beyond the wellness visit criteria, so Medicare tagged it as a regular office visit.

The "above & beyond" was some blood tests, for liver/kidney functions or whatever. Things that I would call malpractice if they WEREN'T things checked at a "wellness" visit.
So much for the logic of Medicare.


It's 90% bullcrap and some doctors ask questions like 'do you have a gun at home'?

99% bullcrap unless your doctor does the extra stuff that my doctor did.

And...heh. I've been _waiting_ for some doctor to ask if we have any guns at home. Alas, none have. 'course, here in this part of the country no doctor is likely to ask that, because the answer would usually be, "Duh!!".


Our doctors office has a "No Guns" decal on the front door. When my wife went in to have some X-rays done, she whispered to the xray lab tech, "Will you freak out if you see my (concealed carry) pistol?" The tech laughed and lifted her shirt to show the gun on her hip.
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Unfortunately, if a hospital has an idle piece of expensive medical equipment, the temptation will be to tell patients they need it, whether that's true or not...

Oh well in that case...


Nevermind. I forgot. The government is here to help us. More state involvement in directing medical economies is good.
Market forces and laws of physics are suspended when it comes to consumption of medical services.

Silly me. Thanks for setting me straight.
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Market forces and laws of physics are suspended when it comes to consumption of medical services.


I don't know about the laws of physics, but market forces are definitely suspended when it comes to consumption of medical services.

When you need them, there is no time for price/service shopping. Your choices are always constrained by the immediacy of the need. (obviously there are some 'regular' services where that is not true but the critical ones are the issue).

Not to mention that there is no transparency of pricing or even definition of requirements.

The market forces option for health care will always result in more expensive, less efficient results.
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I don't know about the laws of physics, but market forces are definitely suspended when it comes to consumption of medical services.

methinks something was lost in this flat communications medium. maybe if I'd put a "wink, wink, snide mode:ON" you'd have caught it.


Looking at your reply I'd say we are in violent agreement about the customer's problem with things as they are -- right up to your final conclusion. /heh/


I agree with your penultimate sentence about the problme with lack of transparency of pricing or even definition of requirements.

Isn't that lack of market transparency a government induced (or allowed) problem? A result of the government protecting the supply chain from market forces by regulations and barriers to competition to protect the large providers (can anyone say "Lobbyists"?)?


If the government involvement with things like "certificates of need" was lessened why would not the market forces be unleashed to work in the consumers favor?
There was mention of some oversupply problem or something that might occur? How is that a bad thing? Isn't that how markets work to self correct in response to the thousands of consumer and supplier signals that happen daily?

Isn't the cure for low oil (MRI/imaging) prices, low oil (MRI/imaging) prices?

The cure for high oil prices is high oil prices -- once the government allows drilling, no?

Is not the problem with certificates of need that the cure for high prices is not allowed? It is subject to government committee approvals (and perhaps lobbyist pressures)?


Are not certificates of need just distorting the market and resulting in less for more($) for the consumer?

Just saying it might create an oversupply and put some folks in a supply crunch due to closures is to ignore that the market has a say in meeting the need that such a correction creates.

IMHO, we've got to do better than that as a counter point argument.
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No. of Recommendations: 18
"Market forces and laws of physics are suspended when it comes to consumption of medical services.

Silly me. Thanks for setting me straight."


Anyone who thinks market forces as a solution for healthcare does not understand how markets work.
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‘Living drug’ offers hope to terminal blood cancer patients – BBC News
https://www.bbc.com/news/health-48706822

How does the treatment work? CAR-T is the pinnacle of personalised medicine as it has to be developed for each individual patient.

Firstly, parts of the immune system – specifically white blood cells called T-cells – are removed from the patient’s blood.

They are frozen in liquid nitrogen and sent to laboratories in the United States.

There, the white blood cells are genetically reprogrammed so that rather than killing bacteria and viruses, they will seek out and destroy cancer.

They are now “chimeric antigen receptor T-cells” – or CAR-T cells.

Millions of the modified cells are grown in the lab, before being shipped back to the UK where they are infused into the patient’s bloodstream. The whole manufacturing process takes a month.


So…the Brits freeze a sample of the T-Cells, ship them off to the US for a month’s worth of heavy lifting, the results of which are sent back to the UK where they are infused into the patient by some lab tech.

Yet this is a triumph of socialized medicine in England?

Sure it is.
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Yet this is a triumph of socialized medicine in England?


I don’t get the connection you’re making between a medical breakthrough and socialized medicine?
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So…the Brits freeze a sample of the T-Cells, ship them off to the US for a month’s worth of heavy lifting, the results of which are sent back to the UK where they are infused into the patient by some lab tech.

Yet this is a triumph of socialized medicine in England?

Sure it is.


Considering that British patients are apparently getting the treatment as a part of their National Health System (based on your article), yet in the US, there are still discussions on whether insurers will even cover the treatment https://www.healio.com/hematology-oncology/cell-therapy/news...

“We are seeing massive consolidation in the payer industry,” he observed, and payers are often demanding that providers follow value-based frameworks to guide treatment decisions to receive reimbursement. Guidelines like those established by the National Comprehensive Cancer Network, which Maziarz called a “value-based framework,” now take on greater importance in the delivery of cancer care.

There is an ongoing battle in the payer industry over whether to cover CAR T-cell therapy, Maziarz explained, in an industry where endorsements matter.


I would say that it is a triumph for the British.

AJ
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I would say that it is a triumph for the British.

Once again, another country free-rides on the US.
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Once again, another country free-rides on the US

Where does it say that anything is free? I’m sure it’s being paid for, and probably some American company is billing them out the wazoo.
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Here you go: this is what CAR-T therapy costs in the US:

https://www.targetedonc.com/publications/targeted-therapy-ne...


Although much enthusiasm has been generated from these promising findings, it was quickly burdened by the overwhelming list prices for CAR T-cell therapy: $475,000 for tisagenlecleucel and $373,000 for axi-cel. These list prices do not even include the hefty hospitalization fees associated with treatment, which can drive the total cost to over $1 million per patient in some instances.


...
“One of the biggest downsides of what we have seen from a CMS perspective is the issuance of the FY19 Proposed Rule,” said Allen. “The cost [for CAR T-cell therapy] is around $373,000. When you bundle in the NTAP payment with the case rate and the outlier, you still don’t reach the drug cost alone. This is not an ecosystem in which centers can continue to live.”


https://www.managedhealthcareexecutive.com/non-hodgkin-lymph...

At least in the U.K. patients won’t have to pay the crazy high ICU bills, etc that Americans would have to pay.
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Once again, another country free-rides on the US.

Actually, from your article:

How much does this cost?

This truly personalised medicine - made from and for each individual patient - is unsurprisingly expensive.

The official list price for this CAR-T therapy, called Yescarta, is more than £280,000 per patient.

A deal has been struck between NHS England and the pharmaceutical company Gilead Sciences, but how much this is costing remains confidential.

Simon Stevens, chief executive of NHS England, said: "CAR-T shows huge promise and it is fantastic to see that patients in the NHS are among the first in the world to benefit.


Looks like capitalism in operation, not a free ride at all.

AJ
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In this case, the free-ride is the development and the ability, not the price.

None of which has anything to do with the topic of this board.
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In this case, the free-ride is the development and the ability, not the price.

Again, not a free ride, but rather capitalism at work. The US company which developed the drug is selling it to the NHS at the price that was negotiated. A perfect example of capitalism - the company had something that the NHS wanted, so they are paying them a price that was agreed upon.

Or do you think that US companies should hoard all of their developments to sell just in the US? If that was the case, then this particular company would probably be selling less of this product, since apparently, US insurers are still trying to decide if they're going to cover it, while the NHS made their decision and is paying the company for it.

AJ
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No. of Recommendations: 18
Rayvt writes,

In this case, the free-ride is the development and the ability, not the price.

None of which has anything to do with the topic of this board.

</snip>


I disagree. Medical costs are a big concern to many retirees.

The fact that the UK negotiates low drug prices for its citizens while in the US Medicare is specifically prohibited from negotiating costs and we pay any crazy price that's charged, is an example for us all.

There's no reason for Americans to continue to fail at arithmetic.

As Dean Wormer said to Bluto in Animal House, "Fat, drunk and stupid is no way to go through life, son."

https://www.youtube.com/watch?v=mkoPq5AOCOA

intercst
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Here are the suggestions from the report to improve the US system.

- raising the minimum pension for low income pensioners
?- adjusting the level of mandatory contributions to increase the net replacement for median income earners
?- improving the vesting of benefits for all plan members and maintaining the real value of retained benefits through to retirement
- reducing pre-retirement leakage by further limiting the access to funds before retirement
?- introducing a requirement that part of the retirement benefit must be taken as an income stream
?- increasing the funding level of the social security program
?- raising the state pension age and the minimum access age to receive benefits from private pension plans
- providing incentives to delay retirement and increase labour force participation at older ages
- providing access to retirement plans on an institutional group basis for workers who don’t have access to an employer sponsored plan
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- providing incentives to delay retirement and increase labour force participation at older ages

</snip>


I'd be providing big incentives for early retirement. There's already a bottleneck in many fields with old farts sticking around past their sell-by date while depriving advancement to younger colleagues.

intercst
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"In this case, the free-ride is the development and the ability, not the price."

Hmm, your back must hurt from moving those goalposts over and over.....

Anyway, you are still wrong. There is no free ride. The NHS is paying a negotiated price to the company that developed the treatment. You can keep lugging those goalposts around, but it isn't going to change the fact that this is just an example of the British system of healthcare being clearly better than the U.S. version.
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"None of which has anything to do with the topic of this board."

I disagree. Medical costs are a big concern to many retirees.


1) Yeah, well look at the top item in the righthand column.
"Announcements
The Retirement Investing Board
This is the board for all discussions related to Investing for and during retirement. To keep the board relevant and Foolish to everyone, please avoid making any posts pertaining to political partisanship. Fool on and Retire on!
"


2) Lots of things are a big concern to many retirees. This is not "Retirement Concerns" board, it's "Retirement Investing" board.

It's rather useless to spend a lot of time railing about something that we can't do anything about. More useful to spend time on things we *can* do something about. Like improving investment returns.

Actually, I suspect that medical insurance costs are not a big concern to most retirees. Because most retirees are over 65 and thus are on Medicare. Medicare is a good deal for us, because we only pay about 20% of the true premium and the taxpayers subsidize the other 80%.

Ex: $135 Medicare premium -- With annual deductible for all Medicare Part B of $185!!!
+ $28 (average) Medicare Advantage premium. (FWIW, we pay $75 for a Humana plan.)
Total less than $200.

My employer-covered pre-65 retiree premium was $1000.


3) What is the point of bitching here about the American healthcare system? That's controlled by Washington and none of us here have any control over it. Are we under the impression that any of the powers that be in Washington read the Motley Fool Retirement Board for insight?

Might as well scream at the sky.

Even if we here all come to an agreement, so what? It will have no effect on anything.
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No. of Recommendations: 17
I’m confused. You posted the first link to the BBC’s CAR-T story yourself. If you didn’t think it belonged on this board, why did you post it?

“Do as I say, not as I do?”
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No. of Recommendations: 16
please avoid making any posts pertaining to political partisanship

So why did you bring an additional political aspect about medical insurance into this thread by starting a new topic within the thread by posting:

‘Living drug’ offers hope to terminal blood cancer patients – BBC News
https://www.bbc.com/news/health-48706822

How does the treatment work? CAR-T is the pinnacle of personalised medicine as it has to be developed for each individual patient.

Firstly, parts of the immune system – specifically white blood cells called T-cells – are removed from the patient’s blood.

They are frozen in liquid nitrogen and sent to laboratories in the United States.

There, the white blood cells are genetically reprogrammed so that rather than killing bacteria and viruses, they will seek out and destroy cancer.

They are now “chimeric antigen receptor T-cells” – or CAR-T cells.

Millions of the modified cells are grown in the lab, before being shipped back to the UK where they are infused into the patient’s bloodstream. The whole manufacturing process takes a month.

So…the Brits freeze a sample of the T-Cells, ship them off to the US for a month’s worth of heavy lifting, the results of which are sent back to the UK where they are infused into the patient by some lab tech.

Yet this is a triumph of socialized medicine in England?

Sure it is.


I copied your entire post to show that it responds to no other comment in the thread - thus it was a new topic within the thread that you brought up.

Yes, there are others who bring political aspects onto this board, but you seem to want to add to them, which only makes things worse. You can only control you.

AJ
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