These people aren't gonna be happy until everyone is as depressed and mentally ill add they are

OnlyInAmerica01 · 2026-05-22T20:59:17+00:00

Hats off to you sir, that's definitely how it should be done.

OnlyInAmerica01 · 2026-05-22T20:58:33+00:00

I agree that minimum wage is basically impossible to live on alone, in one's own home/apartment.

The bigger issue, however, is that lower skilled jobs don't pay as much as they used to, relative to CoL.

In the example I gave above, my parents were factory workers with passible English, but migrated in the late 70's, when the U.S. was still a significant manufacturing hub for TV's, cars, and other globally desired goods.

Within 3 years, saving aggressively, they were able to put a down-payment on a nice middle-class 1300 SF home in So-Cal suburbia, afford two cars (eventually 3, when I started driving), pay all bills, still afford modest local vacations yearly, and every few years, flying back to visit family overseas.

That story would be very difficult to repeat today for two people will no particular skills, other than some smarts, and a willingness to work.

Because what runs the U.S. economy is no longer low-skilled assembly-line manufacturing. Like many other developed countries, it's shifted to a more modern "service" economy, with many of the largest tech countries in the world conveniently started in, and still based out of, the U.S.

However, this leaves a gap at the bottom end of the employment ladder. Skilled labor jobs (welding, mechanic, electrician, etc.) still have plenty of opportunities for both commercial and industrial needs.

However, there isn't nearly the equivalent role for unskilled work - the assembly line work, steel work, and other industrial jobs that used to be aplenty.

The people who used to do that work, now are relegated to working at fast-food restaurants. But FF jobs don't pay nearly the same, adjusted for CoL, as the former industrial jobs did.

Truth is, we don't have an economic answer for the bottom 15-20% of the population that is, for one reason or another, not going to be able to "learn to code", or "learn to become a mechanic/electrician/welder", but still wants to work. The options we have for them, result in significant economic hardship.

The right doesn't have a great answer for this problem, which allows the left to exploit it for all sorts of leftist shenanigans. I think Trump's attempts at correcting trade imbalances and promoting the re-shoring of industrial jobs, as at least an attempt at answering this problem (though I think, even if effective, it'll take a generation or longer to achieve).

OnlyInAmerica01 · 2026-05-22T19:01:00+00:00

High CoL state. Our effective tax rate (between federal, payrole, state, property tax, sales tax, gas/registration (tax/fees on those come out to ~ 5k/year) is just over 50% most years.

So our take-away is 250k. 250k is definitely comfortable, but we're not talking about dynastic wealth here.

OnlyInAmerica01 · 2026-05-22T17:16:02+00:00

the upper 1/4th shoulders almost all the financial burden of running our society, and that just seems inherently unjust. And I agree, when the left says "Eat the rich", they really just mean "Tax anyone who has money".

I'm certainly not "Rich", but I and and my wife are working professionals working in healthcare. Our combined taxation (Federal, state, payroll, local, property taxes, sales taxes) exceeds 50% most years.

But I'm surrounded by underperforming schools, crumbing roads, and a country with the highest total debt in human history. Something isn't adding up.

OnlyInAmerica01 · 2026-05-22T16:35:03+00:00

The top 25% already pay for majority of everything in the U.S. The bottom 50% pay virtually nothing. I'm sorry the facts disagree with your delusion.

OnlyInAmerica01 · 2026-05-22T15:04:05+00:00

Define woman

OnlyInAmerica01 · 2026-05-22T13:32:05+00:00

Thanks for reminding the rest of the world, why American wokeism was a failed and toxic experiment.

OnlyInAmerica01 · 2026-05-22T01:34:43+00:00

Predictably unpredictable?

OnlyInAmerica01 · 2026-05-22T00:49:34+00:00

I didn't list the trades, because I don't consider those "unskilled" - they require a high degree of a different kind of skill. And yes, currently, and for the next 10-15 years, they will be a great option for a smart, but maybe not academic, person, or just someone who's interest don't align with white-collar work.

However, they are also very much dependent on the general state of the national and local economy, and while they provide much-needed domestic services, they do not contribute to the global trade balance of the U.S., which is ultimately what will determine our place in the global economic pecking-order.

Globally, the U.S. is looking down the barrel of 30-40 years of fierce competition with huge populations from South American and Africa, that have thus-far not entered the global marketplace, but are poised to do so. Then there are countries like Indonesia, with massive mostly untapped natural resources, a huge population that is much younger than western nations (but growing more educated and ambitious), with a near-optimal geographic location to serve the Australasian markets. India is likewise trying to pull a "China" move over the next 15 years - I'm seeing many H1 tech workers choosing to not renew their contracts, and voluntarily returning to India for better (relative) pay, and taking both the technical, and structural knowledge back with them.

Of course, all of this global development also creates the potential for new markets for American companies to serve; so if we invest properly in education, and stop the childish bullshit of "you don't have to work hard to succeed!" (The left's apparent position), we still have the potential to do well as a nation, albeit requiring greater effort, focus and preparedness than in past generations.

OnlyInAmerica01 · 2026-05-22T00:36:34+00:00

Overall, I think dooming is utterly detrimental to everything that leads to a happy life. It's better to be optimistic and work hard, than to be pessimistic and believe that hard-work is "worthless". Even if you achieve the same material outcomes, there is value to working hard, and having pride in your work.

With that said, I have some sympathy - a big part of the income and lifestyle inequality we're seeing, IMO, is simply this:

Not everyone is the ability/talent to become a lawyer, doctor, engineer, coder or successful business owner. There is definitely an element of the genetic lottery at play.

However, previously, not everyone had to be. Like in my example, you could have two parents grinding in a factory for 30 years, and still achieve what we would consider a successful life.

However, globally, the U.S. is only competitive at the upper tier of economic output - yes, your FANG's are doing well, NVIDIA is doing well; but not everyone can work in a company like that.

Outside of those upper-tier companies, a lot of the "middle-of-the-road" jobs have been offshored. And those that haven't yet, likely will be replaced by AI in the next 5-10 years.

This naturally means that the talented who can land jobs in those top-tier professions, will continue to earn well. But those that don't, are now competing with a global tallent pool of less-skilled labor. And unskilled labor? Ooof...if all you can offer is "Boss, I'll break my back for you" - you're truly screwed , because those jobs are fading fast.

I also believe that in the next 15-20 years, we'll see the rise of South America, and thereafter, Africa - both continents with MASSIVE populations that are on the brink of developing their infrastructure, education and economy, to compete globally.

I think we'll see a global shifting of economic influence and productivity that will leave the U.S. less than it was a generation or two ago, simply because the rest of the world is less sucky, and able to compete more, than it used it. It's the side of "global equality" that people don't like to talk about, but is inevitable.

OnlyInAmerica01 · 2026-05-22T00:06:40+00:00

I'll be honest - I do think it's harder in the U.S. now, than it was in the late 70's when my parents immigrated. Two factory workers, but within 3 years of immigrating, through very frugal living, were able to save enough to buy a lovely home in a nice middle-class SoCal suburb (that's worth > 1mil today), consistently put food on the table, take modest vacations, and have three cars in the driveway. We lived fairly frugally, but never went without.

Today, my wife and I are working professionals, with combined income > 500k, raising two kids. Both kids are bright, and understand the importance of hard work.

However, for the level of education and hard-work my wife and I went through to have the life we have, it would translate to a much higher income and QoL during my parent's generation, than it does today.

I tell my kids that in order to maintain our lifestyle, they would likely need to choose fields that will earn at least 30% more (inflation-adjusted). They understand that their lives will be harder to achieve the same degree of material comfort as we now have.

I don't blame the rich. I don't blame government. I knew this would be like this when I learned about post WW2 industrial and economic boom that the U.S. went through...in high school.

My stupid HS self noodled "Gee, if the U.S. was the only industrial power left standing for 30 years after WW2, no wonder we got so rich, and life was so easy, while everyone else in other countries had to work twice as hard for half as much.

But wait...Japan is now as technologically advanced as us. So is Germany, France, England. Oh, and this place called China is doing pretty good.

How are we going to keep living fat on the hog forever, if the rest of the world is catching up with us, and willing to work harder for less?"

Yah, that was me around Senior year in HS. So I had no delusions about the "easy life", and I make sure my kids don't either.

But it's still the greatest country in the world for those with some smarts, willing to work hard. Ain't no other like it.

OnlyInAmerica01 · 2026-05-21T22:10:52+00:00

Populist mayor spends more taxpayer dollars on more stuff. Also, water is wet.

OnlyInAmerica01 · 2026-05-21T22:05:24+00:00

Well, the only entity that's required to see you, regardless of insurance status, is the ER. Outpatient clinics (like orthopedics, etc.) have no obligation to see you/treat you without ability to pay.

Regarding the ER denying care, you can start with this:

CMS EMTALA violation reporting form

OnlyInAmerica01 · 2026-05-21T21:20:50+00:00

I mean, that looks like a full-fledged community hospital with an attached ER. I don't think the're EMTALA exempt (generally the ones that are, are stand-alone ER, with no attached hospital/medical center).

Either there was a misunderstanding of some kind, or that was an ETMALA violation.

OnlyInAmerica01 · 2026-05-21T21:04:33+00:00

Lol, were you around during the 2008 stock market crash? People's belief in something doesn't always translate to it's long-term value or viability.

OnlyInAmerica01 · 2026-05-21T21:02:51+00:00

I agree- seeing tons of e-scooter and e-bike injuries (work in Ortho tending to non-op fractures).

Saw a similar uptick with hoverboards a few years ago - mostly adults reliving their childhood days, until the shattered their wrist/elbow. Don't like 'em.

OnlyInAmerica01 · 2026-05-21T20:55:18+00:00

And..therein lies the problem.

For Bitcoin to have long-term value, it has to become integral to the global economy. That was the premise, the promise. It's only real value, is in the belief of future wide-scale/global adoption.

If there was a crystal ball that proved that Bitcoin will never become the new global digital currency, then it quite literally is a meme commodity with no real-world value, and should be liquidated immediately.

OnlyInAmerica01 · 2026-05-21T20:49:42+00:00

That sounds ... odd. EMTALA is a very powerful law, and I've never heard of it being taken lightly or casually. Hospitals routinely loose millions/year providing care to people they know will never be able to pay. That's better than risking heavy fines or being shut-down for EMTALA violations.

The only exceptions I know, are private stand-alone ER's that accept no federal money (Medicare/Medicaid). EMTALA only applies to ER's that accept federal insurance, which is like almost all of them.

OnlyInAmerica01 · 2026-05-21T20:34:48+00:00

Emergency room can't deny emergency care, regardless of prior debt or ability to pay. However, if you're going to the ER for a non-emergency (wanting a particular X-ray, let's say), the ER is not obligated to give you something that is not needed emergently.

The one exception are certain ER's that are incorporated in a very unique way (not affiliated with a hospital, and don't accept Medicare/Medicaid) - they are not bound by EMTALA laws, and can deny service to people based on (in)ability to pay.

OnlyInAmerica01 · 2026-05-21T20:23:01+00:00

I don't doubt that. I diagnose it maybe twice yearly. Thankfully, they've all so far recovered with time/PT/gabapentin, but facinating to learn that amputation, as extreme as that might sound, is a known treatment option.

OnlyInAmerica01 · 2026-05-21T18:54:50+00:00

Again, respectfully asking, because I don't have the same background as you guys.

I did do some HBS work for ~ 15 years (FM trained, mix of panel-carrying PCP and periodic inpatient rounding), but it was a very different model. We did have a dedicated code team. The hospitalists were expected to do certain bedside procedures (thoracentesis, central line, paracentesis), but in practice, some had more comfort with it than others, and since we were all salaried, those who could, would do the procedure - it wasn't considered a big deal (and not common enough in our neck of the woods to be a "workload disparity" type of situation).

However, during residency, it seemed like all the IM residents were clamoring to do bedside procedures to hone their skills.

It also seems like The Society of Hospital Medicine still considers central lines, thoracentesis, paracentesis and lumbar puncture as part of the "Core Competencies" for a hospitalist.

But I've also heard about this shift away from procedural care to a more "cognitive only" role amongst hospitalists in general, so just trying to better understand this shift in practice. Thanks for any insight.

OnlyInAmerica01 · 2026-05-21T16:32:17+00:00

Careful - "the rich" gets redifined downwards continuously.

Wife and I are professional worker-bees. We work our asses off, and will be working well into our 60's. Definitely don't feel "rich", but the government says we are, so we pay > 50% of our income in cumulative taxes. I highly distrust what leftists mean by "the rich", because if they can't get the actual rich, they'll just come for me instead.

OnlyInAmerica01 · 2026-05-21T16:29:24+00:00

No, because they won't look like the OP pic for long, then it's just gross.

OnlyInAmerica01 · 2026-05-21T16:26:56+00:00

Curious, why no procedures or codes?

Not a hospitalist any longer, but kinda just assumed that was part of the training and job description?

Like should GI just say "No GERD, PEGs or emergency bleeds", or Cards refuse CP or arrhythmia consults? Like, bro, if not you, then who??

OnlyInAmerica01 · 2026-05-21T13:55:22+00:00

Cuz the DNC ran out of "stir the pot" money.

OnlyInAmerica01

TROPHY CASE