401k fees....Do you really know how much you pay?

Now, this topic is often times discussed in the media, but does an average John Q. Public (in our case, JQ Public, MD) know what exactly he/she is paying for a privilege of having  his retirement money to be exposed to the vagaries of the market?
My unscientific poll of my colleagues shows that 99%  of them are oblivious. Seeing the outrage on my face when I spoke about those fees, they politely  nodded their heads, but that was it.
To me, the asset-based fee of 0.33% PLUS monthly maintenance fees (that's what our 401k plan extracts-if not expropriates) amount to nothing less than a highway robbery.
Given the market projected return (risk premium, on top of risk free rate of 2.5% delivered by Treasuries), the asset based fee alone amounts to at least 10% of return!!
And we are not even talking about the expense ratios f the funds contained in 401k (average expense ratio is about 1-1.3%).
So right there, we're giving up close to 50% of potential return, while owning the 100% of risk.
But what else is there for retirement vehicles for middle class? (gasp)

State deferred compensation

For those of us who might be working in any shape of form for the State ( NY/NJ/CT etc..), and not necessarily full time- enough to get a small paycheck, which is often the case if your work for the " XXX State University Hospital" in any capacity:
you might be eligible to contribute to your  State deferred compensation program. No match, of course, by the State- just your own hard-earned, but pretax dollars. And that's on top of your annual limit of  $17,500 for 2014 you might be  already contributing to your private 401(k) through the "private" part of your work, up to the limit of, yes, another $17,500, totaling  $35,000/yr (without counting the match, or contributions by your employer). Now, that's a retirement planning!
(Anecdotally, most people who work for the State never heard of this, by the way)

Most mutual fund there are (relatively) decent, with low expense ratios, and they have my beloved index funds- by the way, yet another study came out showing how "great" active mutual fund managers are performing in the long run..  Will write about it in the next post...

Here's a website for those fortunate ones in NY State:

https://www.nysdcp.com/iApp/tcm/nysdcp/index.jsp

And for NJ:
http://www.state.nj.us/treasury/pensions/njsedcp.shtml

Obamacare is here. Now what?

In  health management class I took last Spring for my  MBA, we were perusing this website our Professor found for us: www.healthsherpa.com , where you can plug in your income numbers, your age/family size , without revealing any of the sensitive info (SS#, real income etc.) required for a real sign up at the now famous health exchanges.
 This is all to see what Obamacare product you can buy, how much it will cost, what kinds of copay/co-insurance you're looking at etc.
Most Obamacare plans are quite restrictive, patients (insureds in insurance parlance) can only use a very narrow HMO style system, copays are high... ( I didn't know it before, but apparently there's an annual out of pocket limit on all of these Obamacare products, the max. being in the range of $12,500 per family/yr). The low-income earners do get some tax subsidies

I think it was a clever trick on the part of the government to "outsource" the uncompensated care costs onto the heads of the medical providers and hospitals, forcing them to chase after unpaid (and large) copays, coinsurances and deductibles.
"Stayin' alive" and afloat for an independent practitioner is becoming even tougher then.

Hospital charges vary among the US hospitals

in our MBA class we have to write our own blog posts, and since this post (mine) is related to doctors' finances, I decided to repost it here, with some additional commentary:

LA Times from 5/8/13 published the article reporting on the  newly-released government data on hospital charges. As it was expected, they range widely for the same type of conditions even within the same city or a region.  (for example , charges for treating a pneumonia without complications can range from $17,000 to a whopping $70,000 in the L.A. area.

Sure thing, for us hard-nosed business statisticians it's not enough to know this. What we need to know if the patients those hospitals treated( and billed...) are comparable. For example, are they more or less the same age? Weight? Number and severity of other health conditions? Also, are costs comparable? (healthcare labor force in, say, New York City is very expensive for a variety of reasons. Also- operating costs of running a hospital. Etc.) Then, there's this pesky question: are those people who were charged more did better or worse (or same?) in terms of their health outcomes- that is, maybe people who were charged less ended up in the hospital again soon after discharge because they got substandard treatment

If they are equal, then, ("Twilight Zone" theme music)... we can ask "Why?" And, even better question is: what are the less expensive hospitals doing (or not doing) to keep their charges low?

Now, here's a very good question: are doctors' charges for those hospital stays the same? I have a feeling that all this differences are NOT due to doctors charges(in fact, they constitute a small proportion of the total bill).

However, the ARE a proverbial low-hanging fruit for the insurers and other payers for.. rightsizing.

Obamacare vis-a-vis doctors' finances

Now that the Supreme Court let the Obamacare stand, one burning question that I have is this: what does it all mean for the doctors' bottom line?
Many currently uninsured people will get coverage- I guess, that's a good thing for that bottom line? (it would be in a free economy, since there're millions of consumers of goods/services appear out of a thin air)

The only trouble is that these new consumers will be paying their 'bills" with OPM (others' people money), representing a tax on those who do pay them ( about half of the US population, incl. most doctors). This tax can take different shapes/forms(overt increase in taxation or creating newer taxes/covert taxation by increasing inflation etc), but will have to be paid neveretheless. From my MBA course I know that taxes are beneficial only if they create more wealth that the actual tax extracted from the economy ( does it ever?).
It seems unlikely to me that with all the governmental inefficiencies and outright fraud we're witnessing now within government plans that  it would truly create more wealth for the economy than it would extract from it.( just my half-educated guess).

Your salary. Your life.

I'm sure most of us met quite a few burnt-out, disenchanted and disinterested docs. All that makes them go through their clinical routine is their paycheck.
They (and a lot of their more cheerful colleagues) are trapped in what we can call a high wage trap: despite of being utterly dissatisfied with their current situation they make a decent salary, and to start something new and (possibly) exciting, which may or may not lead to a higher income, is outright scary, since we all developed a high dependency of this paycheck. Most of us would never go for it, because the more you earn, the more you have to loose. However, in a great scheme of things it's your life experience that matters (or should matter).

It's much easier to start something new when you really have nothing...

Salaried position vs. your own business

The deeper I am into my MBA course, the clearer I understand for myself that starting and running a business is... well, a serious business ( I am waiting for those "doh"s..)
No, seriously, if , in perfect or near-perfect competition all you can count on is so called "normal" profit (by definition, it's enough profit to attract capital investment to your business), i.e. NO economic (that is, real in lay terms) profit, all this means to you is that you're just trying to keep your business running without slipping way into the red/bankruptcy etc.
That's it. (and, by the way, that's most small- and medium-size businesses, incl. doctor's practices). And all this comes at a great expense in terms of time/effort investments. ( and, obviously, money). It's a rat race , too, just a different kind. ( and I skip all this silliness about "being your own boss" because you are always under some sort of constraint- most of the time, financial, so it's not like you can do whatever you feel like). Becoming a near-monopolist (FedEx or UPS) has a bit of an entry barrier, like $2 bln.
So one needs to be truly passionate about it to start it and continue doing it.
On the other hand, if you have what you think is a brilliant idea (Facebook?), I would probably just go for it. Because I see it as one of the few (if not only) chances of making it big.
So... what do you think?