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jazzdude

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jazzdude last won the day on July 9

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  1. It's decent training. What makes it challenging is that the TOT can shift, especially if you're trying to cross show center right at the end of the national anthem with a live performer that may go faster/slower than planned or rehearsed... Flyovers typically come out of the unit's flying hour program/local training fence, and are supposed to be "non-interference" with the unit's training objectives. So there's no additional cost to the taxpayer for the flyover, and it's usually good publicity for the military. A lot of flyover requests do go unfilled, as flying units are "paying" for them with a training sortie, or may have other operational commitments.
  2. Part of the issue is that it's really hard to cost out care. It's easy to say "a bandage plus some motrin is only a couple dollars at the store, why am I being charged $200+?! That's price gouging!" But there's a lot of overhead and indirect costs that have to be covered that are necessary to keep the hospital running. This isn't to say price gouging doesn't happen. You need to pay the doctors and nursing staff, not just for contact time, but for their time on shift without patients, vacation time, sick leave time, and admin time (a simple 15 min contact can be 30-45 min of work for the doctor to review charts/record, and then update charts/record afterward). But you also need to pay for janitors, mx, appointment clerks, billing/finance, and managers. You also need money to pay for continuing education and training for the professional staff. And the building/electricity/water. Don't forget computers, and licenses for electronic health records software. Then there's equipment and supplies that's rarely used but needed on hand for emergencies. Then on top of all that, since we're a capitalist society, the hospital needs to be profitable (though investing for the long term would make this easier, most hedge funds and investment groups seem to value quarterly growth and short term profits). But when you get the bill, there's no "overhead" charge. They build it into the prices for each billable line item. It's essentially like buying a car-only suckers pay the full sticker price. But in addition to insurance being a means to pool resources to cover large expenses should they arise, it also puts insurance companies in a good negotiating position for the price of services compared to an individual (like collective bargaining), which drives down costs but only in-network where they've negotiated prices. Some hospitals may elect to lower prices for people that can't afford to pay, heavily subsidizing the individuals costs. But that subsidy comes from somewhere, whether it's a wealthy donor, staff working pro bono, or by adjusting prices elsewhere for others. I do agree on generic drugs, but how do you put that into practice? A generic still has to go through the approval process, which takes time and can be costly, and the g producing the generic also needs to turn a profit. Along those lines though, if the government invested in/funded a treatment's research (which again, the federal government already does invest a good chunk of change in medical research), then it's reasonable for the government to have a say in pricing the drug.
  3. This is also how medical insurance works in our country. Except that it's not the government making the decision, but a private company out to make money for it's shareholders making that decision. And even with insurance, you can still run up some significant bills that wipe out savings pretty quickly. Especially if you end up at an out of network emergency room for a catastrophic event. I think many countries that have socialized medicine also have a second layer of medical care, where you can buy treatments above/beyond the basic coverage, or accelerate timeline. Even if you got rid of insurance and socialized medicine, so long as medical care is a limited resources, there will be some level of triage and prioritization of care Either way/system, money buys options. Unfortunately, I'd wager that most of us don't have that kind of money laying around
  4. This line of reasoning gets really weird really fast, where the activities I enjoy are fine and of acceptable risk, but those other activities I don't enjoy are dangerous and shouldn't be covered. Maybe I don't want to pay higher taxes for people injured participating in MMA (or insert any moderate to high risk activity). Maybe I don't want to pay higher taxes for treatments for alcohol related issues, both acute or long term effects. I'm sure no one here has ever lied to their PCM about how much they drink at their annual physical. I do understand your sentiment here though regarding personal responsibility and taking an interest in one's own health. This is the biggest thing that worries me about universal healthcare (especially when the line of discussion is to get rid of all insurance companies and go to solely government provide healthcare): access provided by the government may come with conditions that limit my choices elsewhere in life. My other concern is that we essentially already have a nationalized healthcare system for a select group of people: the VA healthcare system. I can't imagine implementing something, which would probably look similar to the VA, for everyone in the US. Lots of people would be very disappointed, and we would've wasted a lot of money.
  5. 4. Assess what is actually needed in the residency programs. They have been increasing in length over the years. You could argue it's to increase knowledge. You can also argue that hospitals are using residents as cheap labor (80 hour work weeks for $30-60k/year) to pad their budgets, and since new doctors must complete a residency, they have no real negotiating power for salary or work schedules, and can't just go to another program (since it is controlled by a central match board). 5. Increase the number of nurse practitioners and the scope of what they can do. This one has been on the rise in the last decade or so, and is a pretty contentious issue within the medical community, as they don't complete a residency before they can practice, and the scope of their training is more narrow. On the other hand, it makes for a cheaper, more accessible alternative to seeing a doctor, though the quality of diagnostics may not be as good. This is essentially how your bullet #2 has been put into practice. But on bullet 1-that's federally funded... And you can't receive medical treatment from a doctor in the US unless they completed a US residency program. Who pays for that? (Taxation is theft!/s) Should Congress control the limits on residency program seats? Why hasn't the free market increased the number of residency seats due to a demand for doctors? Also, one private organization runs the match process, so there's no other way to attend a residency than to go through that organization. It's not a free market for doctors looking to work in the US. And if a doctor wants change specialties (say they are burned out working in an ER and want to switch to family medicine), they have to go back through a new residency program, which takes a seat away from a new doctor. Why can't a doctor just apprentice to an experienced doctor with X number years experience outside of a match process to satisfy their residency requirement? On bullet 3, how do you encourage preventative care, especially for people without insurance, or have insurance with high deductibles/coinsurance costs? I like your approach to this discussion-too often the issue gets distilled into a soundbyte about universal healthcare and polarized by both political parties, when the truth and heart of the debate really is in the middle. But that doesn't make for good news entertainment, not does it rile up the voting base, so...
  6. Best can mean a lot of things to different people, and that's something that needs to be understood going into this discussion. If you can't see that there may be other definitions of what best means regarding healthcare, then any debate is meaningless. And you can't separate insurance from this discussion, so long as healthcare costs more than people can pay out of pocket for. That ignores 2 of the points you made: accessiblility and cost (cheap). Have you been following the discussions on changes in military healthcare? Dependents are starting to get pushed off base as MTFs downsize. However, even though they have decent insurance, people have found it challenging to find off base PCMs willing to take on new patients. Premiums for retiree Tricare are creeping up (though still way below open market prices), and the new-ish Tricare for Life adds additional cost on top of that (due to having to sign up/pay for Medicare). Defense isn't cheap. Was what we spent in Afghanistan worth it? Did that campaign make us stronger as a nation, or further essential national goals worth the price we paid? There are many on the left that say the defense budget is theft as well. Like you said, that money has to come from somewhere. Healthcare would be an investment in our society. Access to routine and preventative care should help more people be productive members of society. The question is how much to invest and what level of care to provide.
  7. Why should the government provide healthcare coverage for military families/dependants at extremely low cost to the member? Should service members pay insurance premiums comparable to the national average for premiums? At least for the service member, you could argue they should have healthcare coverage to protect the investment made in the service member if they have a critical skill. Should service members be covered for a pre-existing condition, or for medical accidents that happen not in the direct line of duty (say, breaking your arm while skiing on leave)? Or pay for coverage to cover non-line of duty accidents? The government subsidizes lots of things. Food stamps, social security, medical research, basic science research, education, arts, conservation of wilderness areas, roads, housing, etc. It also (heavily) subsidizes defense. Basically, it's all an investment in our society to hopefully make us all better, even if it's not a "right." What about combat zone tax exemption? Why not eliminate that? What purpose does it serve, besides essentially being a pay raise for doing the job we signed up to do? (Especially since HFP/IDP also exists)
  8. Access to Tricare was probably the single most important factor is me deciding to take the pilot bonus (and stay to 20). Pilot bonus put money in the bank/investment portfolio for my family if something were to happen to me (above and beyond SGLI), and check of the month would mean that even if I can't work after I reach military retirement, my family's basic needs could be met. But Tricare removes what I feel is the biggest risk to finances in retirement-healthcare costs. Healthcare costs are probably the one big risk (in my opinion) that can ruin financial security, especially as you get closer to retirement (real retirement, and no longer working), and could potentially wipe out decades, or a lifetime, of careful financial planning. Hell, it was hard enough to decide how much I was willing to pay when my pet cat went to the emergency vet; I can't imagine having a loved one going to the ER and having to set a price on their life because health insurance didn't cover the care (or cover enough with high deductables or co-insurance). Especially when I (eventually) am no longer working and living on a fixed income. What's the catastrophic cap for Tricare? $600 in a given year? It's low enough that as a major, it's a drop in the bucket in my emergency fund.
  9. Need more information... What defines "best" regarding healthcare? This is probably the fundamental question regarding healthcare policy. So what is best? Cutting edge technologies and research in treatments? Access to basic care at adorable prices? Access to basic care covered by taxes? Access to emergency/preventative/diagnostic care? You also make a strong assumption that you can separate insurance from the healthcare system. So long as people may need to pay for medical treatments that they can't afford to pay out of pocket for, insurance will be a factor in the discussion. It's like saying car insurance should be made optional (especially if you believe healthcare is not a right, since most people don't consider driving a car a right). As military members, it's easy to have a skewed opinion, as Tricare has pretty good coverage and is significantly cheaper than anything comparable on the open market.
  10. Remember when they did (tried) the same thing for the CENTCOM AOR? Pick your best and brightest and give them experience giving Afghanistan and Pakistan a hand... At least indopacom should have nicer locations...
  11. What we (as a country) spend money on reflects our values. If we're not spending money on it, then it's not a problem we truly feel is important or of a significant priority... As far as foreign aid, we are buying influence. Could be for access/basing/overflight, or for building a relationship to block China/Russia from the region so they buy american (or from our friends). This would in theory protect our industries and open (or keep open) markets. Education and healthcare are hard fixes, because it would involve a fundamental shift in the system surrounding both fields. For higher education, what gets cut when you lower tuition for the individual? If stuff can't be cut, how would offsetting with federal/state funding be monitored for value? Or would that money be better spent at the K-12 level vs college? How much of college is training vs education? Healthcare has a high bar to entry to practice medicine (expensive schools, limited residency programs) as well as high litigation/insurance costs? Most of the medical residencies are also federally funded already, so how do you increase the production of doctors without significantly increasing funding (which is probably why we see more nurse practitioners in medicine now)? How do you drive those costs down in a "free" market? A single T-6 sortie could feed a family (or two) decently for a month. A single C-17 training sortie costs about the same as the median US household income in 2019. Neither side has really cared about a balance budget. And most programs tend to grow in scope as time goes on, sometimes with good intents. Defense is no different. But to make cuts means first trimming the fat, then cutting into the meat and reducing capabilities.
  12. Also speculation, but maybe the extra drag improves the engine response (more linear power response and less spool up at higher power settings while flying slow)?
  13. I'd be willing to bet the reason for det cord over canopy jettison is requirement driven-specifically to attain a 0-0 capability and improve the overall ejection envelope while reducing weight to meet other requirements. Probably a lot easier to improve the ejection envelope by engineering "blow up the canopy in 0.1 seconds and shoot the seat through the hole" than figuring out how to jettison the canopy away (1 or 2 seconds? to clear the cockpit as ground speed zero, as well as all the other pitch/roll/speed combinations in flight) and then fire the seat. Problem gets compounded when trying to improve cockpit visibility by having a one piece bubble canopy- now you'll have a huge piece of glass to move if you want to reliably jettison the canopy in all phases of flight and on the ground. Or pay a significant weight penalty for whatever explosives needed to blow the canopy away compared to det cord. That weight penalty then affects other performance, such as range. My philosophy has always been that if I needed to use the ejection seat (in the T-6), I was in a situation where I was going to be dead anyways so it's a second chance at life. I was always a visor down/mask up/sleeves down/gloves on when in the seat kinda guy, but then again the T-6 air conditioner worked pretty well. But my experience with ejection seats has been in the training world, where you can work hard to stay at the center of the flight envelope, and there's generally no reason to push the bounds of safety, so my perspective is probably different than a fighter guy.
  14. One time while PCSing, I stopped in at the Houston space center, and they had a "meet an astronaut" talk. The astronaut was a Marine fighter NFO/WSO, then went to med school, then got picked up to be an astronaut, and was only in his late 30s. Pretty incredible path/career. So yeah, those guys are out there, and I know I'm nowhere near smart enough to do two of those things much less all three
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