Bitcoin …. SLOWS

And, we don’t mean price!

[By MIT Technology Review]

Bitcoin transactions have always been slow, but now they are expensive too, which means that small transactions are no longer worth it. The average cost has gone from less than a dollar at the beginning of 2017 to more than $40 per transaction yesterday, as the growing demand for new transactions has exceeded the network’s capacity to confirm them. Arguments over what to do about the bottleneck have grown into a full-fledged Bitcoin civil war.

One proposed solution is to build a secondary network that lets people transact “off-chain.” Some exchanges already allow users to exchange Bitcoin with each other without using the main blockchain. But in the context of blockchain research and development, “off-chain” means something more sophisticated.

The challenge: Bitcoin maintains its distributed ledger by having each computer running the Bitcoin software, called a “node,” process every single transaction. This is the essence of its decentralized nature, but it also makes the process of confirming transactions very slow, at least compared with traditional credit card networks. (Bitcoin can handle only a few transactions per second, whereas Visa can handle thousands.) Ethereum, the second largest public blockchain system, works similarly, which is why the network was brought to a near standstill recently by a mega-popular new platform for trading digital cats.

Finding a faster, more efficient way to confirm transactions on public blockchains would also reduce fees. Ideally, not every node would have to validate every transaction. But the trick will be achieving this without compromising the rest of the network’s trust.

How off-chain payments would work: It’s possible for multiple users to set up a “state channel,” in which a part of the main blockchain is locked in a certain state and can only be unlocked if each of the users signs off. The individuals can then send payments among themselves in a cryptographically-secure way, but without touching the main blockchain. At some point, users can update the state on the real chain to validate all of the transactions in between. The idea is that this principle can be extended to build a more complex payment network made of multiple channels, with a system for routing payments through them.

The players: One project aimed at creating a “layer two” for Bitcoin that would facilitate off-chain microtransactions is called the Lightning Network. An effort to achieve a similar goal for Ethereum is called the Raiden Network.

The current state of the tech: The Lightning and Raiden networks are still in the early stages of development, and each faces significant technical challenges. A simplified version of the Raiden Network that makes it possible to set up unidirectional payment channels is already available, however. The Lightning Network is said to have achieved a major milestone earlier this month when developers sent two Lightning transactions over the Bitcoin blockchain.

bitcoin

Conclusion

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Contact: MarcinkoAdvisors@msn.com

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The Tax Cuts and Jobs Act of 2018

The Tax Cuts and Jobs Act

By Robert Whirley CPA

Congress has enacted the biggest tax reform law in thirty years, one that will make fundamental changes in the way you, your family and your business calculate your federal income tax bill, and the amount of federal tax you will pay. Since most of the changes will go into effect next year, there’s still a narrow window of time before year-end to soften or avoid the impact of crackdowns and to best position yourself for the tax breaks that may be heading your way.

Attached you will find summaries of the various provisions. We have tried to make sure these are final given the fact that the law changed three times in 24 hours.

Here’s a quick rundown of last-minute moves you should think about making

Lower tax rates coming. The Tax Cuts and Jobs Act will reduce tax rates for many taxpayers, effective for the 2018 tax year. Additionally, many businesses, including those operated as pass-through, such as partnerships, may see their tax bills cut.

The general plan of action to take advantage of lower tax rates next year is to defer income into next year. Some possibilities follow:

• . . . If you are about to convert a regular IRA to a Roth IRA, postpone your move until next year. That way you’ll defer income from the conversion until next year and have it taxed at lower rates.

• . . . Earlier this year, you may have already converted a regular IRA to a Roth IRA but now you question the wisdom of that move, as the tax on the conversion will be subject to a lower tax rate next year. You can unwind the conversion to the Roth IRA by doing a recharacterization—making a trustee-to-trustee transfer from the Roth to a regular IRA. This way, the original conversion to a Roth IRA will be cancelled out. But you must complete the recharacterization before year-end. Starting next year, you won’t be able to use a recharacterization to unwind a regular-IRA-to-Roth-IRA conversion.

• . . . If you run a business that renders services and operates on the cash basis, the income you earn isn’t taxed until your clients or patients pay. So if you hold off on billings until next year—or until so late in the year that no payment will likely be received this year—you will likely succeed in deferring income until next year.

• . . . If your business is on the accrual basis, deferral of income till next year is difficult but not impossible. For example, you might, with due regard to business considerations, be able to postpone completion of a last-minute job until 2018, or defer deliveries of merchandise until next year (if doing so won’t upset your customers). Taking one or more of these steps would postpone your right to payment, and the income from the job or the merchandise, until next year. Keep in mind that the rules in this area are complex and may require a tax professional’s input.

• . . . The reduction or cancellation of debt generally results in taxable income to the debtor. So if you are planning to make a deal with creditors involving debt reduction, consider postponing action until January to defer any debt cancellation income into 2018.

Disappearing or reduced deductions, larger standard deduction. Beginning next year, the Tax Cuts and Jobs Act suspends or reduces many popular tax deductions in exchange for a larger standard deduction.

Here’s what you can do about this right now:

• Individuals (as opposed to businesses) will only be able to claim an itemized deduction of up to $10,000 ($5,000 for a married taxpayer filing a separate return) for the total of (1) state and local property taxes; and (2) state and local income taxes. To avoid this limitation, pay the last installment of estimated state and local taxes for 2017 no later than Dec. 31, 2017, rather than on the 2018 due date. But don’t prepay in 2017 a state income tax bill that will be imposed next year – Congress says such a prepayment won’t be deductible in 2017. However, Congress only forbade prepayments for state income taxes, not property taxes, so a prepayment on or before Dec. 31, 2017, of a 2018 property tax installment is apparently OK.

• The itemized deduction for charitable contributions won’t be chopped. But because most other itemized deductions will be eliminated in exchange for a larger standard deduction (e.g., $24,000 for joint filers), charitable contributions after 2017 may not yield a tax benefit for many because they won’t be able to itemize deductions. If you think you will fall in this category, consider accelerating some charitable giving into 2017.

• The new law temporarily boosts itemized deductions for medical expenses. For 2017 and 2018 these expenses can be claimed as itemized deductions to the extent they exceed a floor equal to 7.5% of your adjusted gross income (AGI). Before the new law, the floor was 10% of AGI, except for 2017 it was 7.5% of AGI for age-65-or-older taxpayers. But keep in mind that next year many individuals will have to claim the standard deduction because many itemized deductions have been eliminated. If you won’t be able to itemize deductions after this year, but will be able to do so this year, consider accelerating “discretionary” medical expenses into this year. For example, before the end of the year, get new glasses or contacts, or see if you can squeeze in expensive dental work such as an implant.

IRS

Other year-end strategies

Here are some other last minute moves that can save tax dollars in view of the new tax law:

• The new law substantially increases the alternative minimum tax (AMT) exemption amount, beginning next year. There may be steps you can take now to take advantage of that increase. For example, the exercise of an incentive stock option (ISO) can result in AMT complications. So, if you hold any ISOs, it may be wise to postpone exercising them until next year. And, for various deductions, e.g., depreciation and the investment interest expense deduction, the deduction will be curtailed if you are subject to the AMT. If the higher 2018 AMT exemption means you won’t be subject to the 2018 AMT, it may be worthwhile, via tax elections or postponed transactions, to push such deductions into 2018.

• Like-kind exchanges are a popular way to avoid current tax on the appreciation of an asset, but after Dec. 31, 2017, such swaps will be possible only if they involve real estate that isn’t held primarily for sale. So if you are considering a like-kind swap of other types of property, do so before year-end. The new law says the old, far more liberal like-kind exchange rules will continue apply to exchanges of personal property if you either dispose of the relinquished property or acquire the replacement property on or before Dec. 31, 2017.

• For decades, businesses have been able to deduct 50% of the cost of entertainment directly related to or associated with the active conduct of a business. For example, if you take a client to a nightclub after a business meeting, you can deduct 50% of the cost if strict substantiation requirements are met. But under the new law, for amounts paid or incurred after Dec. 31, 2017, there’s no deduction for such expenses. So if you’ve been thinking of entertaining clients and business associates, do so before year-end.

• Under current rules, alimony payments generally are an above-the line deduction for the payor and included in the income of the payee. Under the new law, alimony payments aren’t deductible by the payor or includible in the income of the payee, generally effective for any divorce decree or separation agreement executed after 2017. So if you’re in the middle of a divorce or separation agreement, and you’ll wind up on the paying end, it would be worth your while to wrap things up before year end. On the other hand, if you’ll wind up on the receiving end, it would be worth your while to wrap things up next year.

• The new law suspends the deduction for moving expenses after 2017 (except for certain members of the Armed Forces), and also suspends the tax-free reimbursement of employment-related moving expenses. So if you’re in the midst of a job-related move, try to incur your deductible moving expenses before year-end, or if the move is connected with a new job and you’re getting reimbursed by your new employer, press for a reimbursement to be made to you before year-end.

• Under current law, various employee business expenses, e.g., employee home office expenses, are deductible as itemized deductions if those expenses plus certain other expenses exceed 2% of adjusted gross income. The new law suspends the deduction for employee business expenses paid after 2017. So, we should determine whether paying additional employee business expenses in 2017, that you would otherwise pay in 2018, would provide you with an additional 2017 tax benefit.

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Also, now would be a good time to talk to your employer about changing your compensation arrangement—for example, your employer reimbursing you for the types of employee business expenses that you have been paying yourself up to now, and lowering your salary by an amount that approximates those expenses. In most cases, such reimbursements would not be subject to tax.

Assessment

Please keep in mind that I’ve described only some of the year-end moves that should be considered in light of the new tax law.

Robert Whirley & Associates, LLC + ProActive Advisory
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“Equality” of Investment Advice

“What is good for the goose is good for the gander”

By Rick Kahler CFP®

There is an old adage that says, “What is good for the goose is good for the gander.

In today’s urbanized world, most of us probably wouldn’t have the slightest idea what’s good for geese. Yet we still know that this saying reminds us to be cautious about anyone who makes recommendations they don’t follow themselves.

This is especially important when it comes to investment advice.

Duopoly

Have you ever wondered how your investment advisor invests their money? Have you wondered if the agent selling you cash value life insurance as a retirement investment is investing their retirement in the same? Or whether an advisor recommending a specific mutual fund, stock investment, or bond issue buys the same for their own portfolio?

Ask

My suggestion is to stop wondering and ask. I rarely have a client or prospective client ask me whether I invest my own money in the same way I invest the funds of clients. Most people think it is just too personal to ask how an advisor is investing their own funds and that the advisor may take offense.

Yet knowing how anyone offering investment advice to you invests their own funds is highly relevant. It’s especially wise to ask this if someone is trying to sell you on an “exciting opportunity” that sounds too good to be true. An evasive or vague answer is an obvious red flag. But even with a fiduciary advisor, I believe asking how they invest their own money is a legitimate question. I for one am happy to answer it. Yes, the investment vehicles and strategies I recommend for clients are the same ones I use for myself.

If an advisor is recommending a strategy or investment for you that they don’t subscribe to or invest in themselves, then it’s a good idea to ask another question.

Why not?

Certainly, there are good reasons why an advisor would not have the same asset allocation that they recommend for you. They may be significantly younger or older, or they may have a significantly more aggressive or adverse tolerance for risk. But if your advisor outsources your investments to SEI but uses Vanguard for themselves, I would want to explore that. Or if your advisor is about the same age as you are, but has a significantly different asset allocation and uses none of the investments she recommends that you invest in, I would want to know why.

If an advisor suggests that you put 35% of your investment funds into a private REIT but they don’t own a private REIT, what’s the reason? Or if they are recommending you own a managed futures limited partnership but they don’t own that same partnership or any managed futures funds. Or, maybe they are recommending the A shares of an actively managed mutual fund but themselves purchase passively managed institutional shares.

If you don’t feel comfortable or knowledgeable enough to ask questions like these about specific investments, it’s still important to find out about an advisor’s broader approach to investing. Do they recommend that you “buy and hold,” yet they actively time the market with their own portfolio? Or maybe they actively trade your portfolio while following a “buy and hold” strategy themselves.

Assessment

While portfolio specifics might vary, I want any investment advisor to buy into the same investment philosophy they are recommending to me. If they are going to be timing the market with my funds, I want them to be making the same market moves with their own funds.

If a “sauce” isn’t good enough for the advisor personally, it isn’t good enough to recommend to clients.

Conclusion

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Top 10 Highest Health Care Paying Jobs

USA 2017

By CareerCast

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Tips to Cruise Safely into the Holidays & New Year – 2018

Follow these 5 Tips to be sure you cruise safely into the new year!

By Dr. David Edward Marcinko MBA

I am not an auto mechanic but I did cover the local hospital ER for more than a decade.

So, here are some holiday driving tips and pearls for Christmas, Holiday motoring safety and the New Year 2018.

1. Get a Pre-holiday Vehicle Check-up

A general pre-holiday vehicle check-up at your dealership can reduce your risk of having problems on the road. You’ll want to pay close attention to your vehicle’s tire pressure. Temperature fluctuations can affect pressure and a little destabilization can create unsafe driving conditions. Be sure to check yours and when you need to add air to those tires.

2. Raise ‘Em High – to Not Drinking and Driving

Sounds obvious but it bears repeating. Whether it’s at the company Christmas party, New Year’s Eve or just catching up with friends for a festive drink, drinking and driving is just not worth it. Designate a driver or enjoy a mock-tail instead.

3. Slow the Reindeers Down and Pay Attention

Not only are drivers distracted today by all their electronic devices, pedestrians are too. Be aware and pay attention to everyone. Speed is another one of the leading causes of car accidents (plus sudden acceleration is a major gas guzzler). Yes, rushing around can make you feel like you can make up some time on the road. But we promise you that your friends and family would rather have you arrive safely even if you are 10 minutes late.

4. Buckle Up

Another pretty obvious tip…but, you don’t want to wrinkle your new party dress! That dress is not going to impress the Emergency Room Doctor! According to the National Highway Traffic Safety Administration, in 2015, seat belts saved an estimated 13,941 lives among passenger vehicle occupants age 5 and older. An estimated 266 lives of children under age 5 were saved by their use of restraints and an estimated 2,573 lives were saved by frontal air bags. You definitely want to be part of that statistic in the event of an accident.

5. Rest Up Before Your Trip

Be sure to stay alert and be well rested before heading out. Late night holiday gatherings or long trips to visit family can lead to drowsiness. Sharing the driving responsibilities can help. You can stretch and walk around to help wake your body up. Be sure to take additional breaks as needed. If you are feeling tired and fatigued, pull over to get coffee, water and a snack.

Assessment

Remember GOMER = Get Out of My Emergency Room

Conclusion

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Health Plan Provider Data Quality Confidence

For 2016

By http://www.MCOL.com

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Spirituality and Financial Planning

What does spirituality have to do with financial planning?

By Rick Kahler CFP®

That was my first thought when Stephen Brody, CFP, ChFC, EdD, contacted me about being interviewed for his doctoral dissertation on “Assessing Spirituality in Financial Life Planning.” The incongruity of the idea intrigued me, so I agreed.

Definitions: http://www.HealthDictionarySeries.org

Financial life planning

In order to understand Brody’s work, I first needed to know his definitions of both financial life planning and spirituality. Financial life planning is an integrated approach sometimes described by terms such as client-centered financial planning. It includes investment advising, but the scope of the engagement is much broader and emphasizes clients’ overall well-being.

Brody writes that financial life planning “is literally a matter of connecting your money and your values with your life. . . .the life of the client becomes the axis around which the financial plan develops and evolves. The client is at the center of the plan, and the money is simply the details to support a life well lived.”

Spirituality

Spirituality, for many people, is equal to religion. I used to believe that a spiritual person was a religious person and one couldn’t be a religious person without being a spiritual person.

That is not Brody’s definition of spirituality, which he views on a faith-neutral basis. One of his cited definitions of spirituality that makes sense to me is that it relates to searching for meaning, purpose, and a moral framework for connecting with self, others, and the ultimate reality.

Methodologies

Financial life planners use a number of methodologies which lead clients to a greater level of meaning and well-being. They look at money as a tool that supports someone in finding and living a life of meaning and purpose. Seen from this perspective, I have to agree that what a financial life planner does is spiritual. After all, I’ve never heard of someone’s last words being, “Life was so good—my financial planner helped me earn 5.76% compounded annually for 20 years.”

Brody’s research finds there are three types of intelligence needed by a financial life planner. They are IQ (intellectual intelligence), EQ (emotional intelligence), and SQ (spiritual intelligence). Brody describes IQ, which deals with knowledge, as the learning stage of the financial planning process. I contend that education is 50% of what a financial planner does. The psychological factors of dealing with money require EQ, or what he calls the understanding stage.

Brody defines SQ as “The ability to behave with wisdom and compassion, all the while maintaining inner and outer peace, regardless of the situation.” This refers to the character and moral factor involved in planning, which Brody suggests is the enlightening stage. This is where money supports meaning.

Like both intellectual and emotional intelligence, spiritual intelligence has its own skill set. Brody discusses 21 specific skills. Eight of them are summed up in just being aware of things like one’s own world view, purpose, values, and limitations.

From his research, Brody suggests that the ideal financial planning engagement is based on deep and meaningful conversations. He says it is “a process that seeks the development of the whole person,” as opposed to just focusing on concerns like rates of return and tax strategies. From these more meaningful conversations comes “a discovery and awareness that leads to the understanding of your life’s meaning, purpose, and moral framework.”

One participant in the survey said that appropriately sequenced questions help clients have a “glide path into self-discovery” and greater clarity of what’s important to them in life.

Assessment

From that understanding, planner and client can work together co-create a financial plan that aligns with the person’s vision of their ideal self and supports a fulfilling life.

Conclusion

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

The Merk Investing Outlook for 2018

What can possible go wrong in 2018?

By Axel G. Merk

Dear Dr. David E Marcinko and ME-P Readers,

With the stock market and Bitcoin reaching all-time highs, what can possible go wrong?

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In offering my thoughts on 2018, I see my role in reminding investors to stress test their portfolios. Is your portfolio built of straw, sticks or brick?

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http://www.merkinvestments.com/insights/2017/2017-12-07.php?utm_source=merk&utm_medium=link&utm_campaign=merk-campaign&registered=yes

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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Investing “Tips” on Initial Public Offerings [IPOs]

Some Investing Tips and Pearls

By Dr. David Marcinko MBA

Initial public offerings, known as IPOs, tend to attract a lot of investor interest – especially when the company is well-known. However, that excitement isn’t always matched by investment returns.

“Tips and Pearls”

So, here are some tips to consider before you decide to invest in an IPO:

• Don’t let the excitement surrounding an IPO cloud your judgment. Too often, there is little financial information about the companies themselves, and many are not profitable. This can translate into extremely volatile stock prices.

• While an IPO’s stock price tends to rise on the day it begins trading, investors who bought shares at the end of the first day haven’t always fared well. The stocks have often fallen below the closing first-day price after six months.

High volatility and a falling stock price are not generally a recipe for attractive investor returns.

So what steps should you take if you’re still interested in an IPO?

1. Understand that the opening price will likely be different from the official IPO price. New issues can experience extreme volatility in the first few hours and days of trading in the secondary market. When the company’s stock opens for secondary trading and becomes more widely available, the price can be significantly different from the IPO price set by the security underwriters. In addition, new issues often do not begin trading the moment the market opens.

2. Use a limit order. This can help you avoid paying more for the stock than you intended. Once you understand the risks of purchasing a stock during its first public trading days, work with your financial advisor to determine the highest price you’re willing to pay for the stock, and then set that amount as your limit.

3. Remember that an IPO must be priced before an order can be accepted. For example, Edward Jones typically does not accept orders until after an IPO has been priced, which is usually the morning the new issue begins trading. In addition, your financial advisor is not permitted to accept market orders for any IPO prior to its trading in the secondary market.

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https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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Assessment

Remember to always do your homework before deciding on any investment, including an IPO. This includes working with your financial advisor or accountant to determine whether the investment is suitable for your portfolio.

Conclusion

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Healthcare Spending Distribution

For FY 2016

By MCOL.com

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Conclusion

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The “CLOUD” Could Get Expensive for Health Care

 AND … DOCTORS

By Darrell K. Pruitt DDS

Without net-neutrality, cloud-based practice management (which is already more expensive than office-based) could cost even more.

The Impactful Industries

“4 industries that could be impacted by net neutrality – With a historic net neutrality vote set to take place tomorrow, people across the United States are rightly concerned about the future of the internet. Visions of price-tiered online spaces dancing in their heads, constituents all over the country are reaching out to their elected officials in a likely doomed effort to forestall what many see as the inevitable destruction of our mostly level digital playing field.”  Healthcare is one of the four.

Jack Morse for Mashable
[December 13, 2017]
http://mashable.com/2017/12/13/net-neutrality-impacts/#rypwq_M6Gmqi

Morse Speaks:

In addition to just being a pain in the ass, the repeal of net neutrality could do real harm to your health. That’s because the modern medical field has come to depend on that aforementioned free and open internet — something very much at odds with Federal Communications Commission chairman Ajit Pai’s plans.

These days, electronic health records are often kept in the cloud, and fast and reliable access to this data is vital to patient care. What’s more, telemedicine — remotely providing healthcare via some form of telecommunication — is super data heavy. Whether that’s remotely analyzing X-rays, or a rural patient connecting with a doctor in a far-off city, this stuff takes a lot of bandwidth.

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Assessment

Will your small-town hospital be able to compete with the Facebooks of the world when it comes to buying a piece of bandwidth pie? Unfortunately, we may soon have to find out.

Conclusion

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A New Term: The “Investor Class”

On the Impending Tax Reform Legislation

By Anonymous Physician

In any discussion of the current tax reform bills, a new buzzword has popped up: “the investor class.” This seems especially true during the current bitcoin craze. Every time I’ve heard this term on a political talk show, it has been used derogatorily to frame the proposed tax changes as resulting in “the rich getting richer” and the “poor getting poorer.”

Definitions

In every instance, “the rich” and “the investor class” were used interchangeably. This is no more accurate than using the terms “millionaire” and “billionaire” as if they are the same, which they certainly are not. A million-dollar investment portfolio will safely produce $30,000 a year in income. A billion-dollar portfolio will produce $30,000,000. That’s a big, big difference.

Equating “the investor class” with “the rich” is just as absurd. To illustrate, here is some information from a 2008 poll of 24,000 voters by Zogby International. According to an article by CEO John Zogby, “Who Belongs To The Investor Class,” which appeared in Forbes on February 12, 2009, 38% of those surveyed identified themselves as being in the investor class.

Of this 38%, almost two-thirds had a household income under $100,000, 44% did not have college degrees, 15% were Hispanic or African American, and 15% held blue-collar jobs. This last number is especially interesting because blue-collar workers made up only 21% of the total of those surveyed.

However, the most surprising statistic from the survey was this: of the people who said they were not in the investor class (62% of those surveyed), more than half had money in a 401(k) retirement plan. This means they were investors.

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https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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Obviously these folks saw the “investor class” as people other than themselves. My guess is that being an investor has a negative connotation with most Americans, perhaps related to the idea that “investor” equals “millionaire” equals “the rich.”

This is especially unfortunate, because if you don’t become an investor, your future isn’t all that rosy. Becoming an investor is mandatory if you want to provide for yourself in retirement. The alternatives—winning the lottery or eking out a meager existence on Social Security—are extremely unlikely or extremely unappealing.

Ironically, despite claims to the contrary, the proposed tax changes do not even favor the “investor class.” For decades Congress has taxed the profits from investments differently than ordinary income. This tax, the capital gains tax, is generally lower than the income tax rate charged on your earned income.

IRS

Neither the House or the Senate bill changes the way the IRS taxes capital gains. Instead, both versions would actually penalize investors. With lowering the ordinary income brackets, there will be cases where investors will actually pay a higher tax on their capital gains than on their ordinary income. I am guessing this may be an unintended consequence of the proposed act. However, it will be part of the new tax law unless the conference committee changes the capital gains tax brackets to match the new expanded brackets.

Regardless of the final version of the tax plan that becomes law, I suggest being skeptical about the term “investor class.” It is not the same as “wealthy.” Anyone using it probably has an agenda rooted in resentment of the rich.

Assessment

The real investor class is broad and easy to join. You belong to it already if you put even a small amount each month into an IRA or a 401(k) plan at work. OR, if you contribute to a 529 college savings plan for your kids. OR, if you have any money invested in mutual funds through an online brokerage. If you are wise enough to invest for the future, you are a part of the investor class.

Conclusion

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***

U.S. Childhood Obesity Growth Projection Trends

The trend is NOT our friend!

By http://www.MCOL.com

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Conclusion

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***

About Medical Alert Tattoos

It’s all about the …. INK!

[By staff reporters]

A medical alert tattoo is quite different from a scar tattoo. People dealing with a serious medical condition, such as diabetes can have a tattoo showing that they are a diabetic, thus meaning a higher likelihood of getting help should they fall under attack and not be able to communicate their problem verbally.

Alert medical tattoos offer a permanent solution as compared to medical alert bracelets. Bracelets have been known to break, and that not only means waiting for a new bracelet, but usually having to spend more money to get a replacement as well. With the consent of their parents, these medical tattoos have even been known to be a solution for children dealing with these kinds of diseases.

People experiencing allergies that can lead to major complications may also consider medical alert tattoos. People who have a penicillin or peanut allergy for example, can benefit from this type of tattoo in the event they eat something that has peanuts in it without their knowledge. This can result in something called anaphylaxis, which is a condition that requires immediate attention and treatment.

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Still0914_00003_1473896831872_6077107_ver1_0

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DNR: https://www.cbsnews.com/news/do-not-resuscitate-dnr-tattoo-leaves-doctors-debating-whether-to-save-his-life/

MORE: Medical tattoos: http://www.freetattoodesigns.org/medical-tattoos.html

EVEN MORE DNR: https://www.kevinmd.com/blog/2017/11/worst-case-scenario-question-must-ask-patients-even-healthy-ones.html?utm_content=buffer4077d&utm_medium=social&utm_source=linkedin.com&utm_campaign=buffer

Conclusion

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n-screaming-super-tease

“Getting Old is Better than the Alternative”

More on Retirement Planning

By Rick Kahler CFP®

At the gym where I work out it’s not uncommon to hear us old guys complaining in the locker room about our aches and pains. When the complaining subsides, inevitably someone will remark, “Well, at least getting old is better than the alternative.”

If you are fortunate enough not to die prematurely, you are going to grow old one day. As youth begins to gradually fade and health limitations increase, the reality that you will not be able to earn a living forever will present itself. At some point in time your financial support will need to come from something other than your job or business.

It’s very easy to dismiss this when we are young, because we’ve never known anything but being young. We take our health, vigor, and capabilities for granted. Just like anything that is “normal,” only when it’s gone do we tend to really appreciate it.

Normalacy

I never gave any thought to opening a door, drinking a cup of coffee, or cutting up the food on my plate—until I tore my rotator cuff and my right arm was rendered useless. A few weeks of doing without it taught me a whole new appreciation for the value and ease a functioning right arm brings to my life.

Unfortunately, many of the capabilities we lose with aging do not return after a few weeks of healing. The harsh reality is that eventually most of us will not be able to take care of ourselves in the ways we are used to.

Retirement planning

So when you think about “retirement planning,” here is what that really means: When you can’t earn an income, how will you be provided for? Where is the money for rent and utilities going to come from? How are you going to get to doctor appointments and the store when you can’t drive anymore? Who will help you pay your bills when your eyesight or your mind aren’t as clear as they once were? Who is going to help you with meal preparation or remind you to take your medications?

If you have fully funded your retirement, you can feel secure that, no matter what care and assistance you may need, you will have the means to pay for it. If you haven’t saved adequately, you will need to rely on others to take care of you financially as well as physically.

The “others”

For many people, “others” mean first spouses, then children, and finally governmental or charitable organizations. These all have limitations.

Spouses. What happens if you don’t have a partner? Or when they can no longer care for you? Or when both of you need care?

Children. Unlike many other countries and cultures, “living with the kids” is not necessarily expected or accepted in the U.S. Most children are not equipped emotionally or especially financially to become caretakers for aging parents.

According to studies I’ve read, the cost of caring for a parent who has not provided for themselves ranges from $250,000 to $700,000 in lost wages, opportunities, and out-of-pocket expenses. People may have to quit jobs to care for a parent or hire care at a cost of up to $100,000 a year. Few in American can afford that.

Government and charities. Social Security provides only a minimal income. Medicaid pays for only basic care such as shared living space. Services like public transportation, subsidized elder housing, and reliable in-home services are not available everywhere, especially in rural areas.

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https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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Assessment

This is not a pretty picture of retirement. Unfortunately, it is reality for millions of Americans. The consequences of neglecting to prepare financially for old age are all too real.

Conclusion

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Don’t let Population Health Demographic Trends Guide “Investment” Decisions

A Different Perspective on Population Health

By Dr. David Edward Marcinko MBA CMP®
http://www.CertifiedMedicalPlanner.org

Definition

Population health has been defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. It is an approach to health that aims to improve the health of an entire human population or cohort. http://www.HealthDictionarySeries.org

History

In fact, the nominal “father of population health” is colleague and Dean David B. Nash MD MBA of Jefferson Medical School in Philadelphia. And, although I attended Temple University down the street, David still wrote the Foreword to my textbook years later; Financial Management Strategies for Hospitals and Healthcare Organizations [Tools, Techniques, Checklists and Case Studies].

Factors

Now age, income, location, race, gender  and education are just a few characteristics that differentiate the world’s population. These are called ”disparities” and they have a major impact on people’s lives; especially their healthcare. And, I’ve written about them before.  Perform a ME-P “search” for more.

So, it’s only natural that we’re keeping an eye on two major demographic trends: aging baby boomers and maturing Millennials [1982-2002 approximately].

Why it’s important

The impact of large population shifts propagate throughout an economy benefitting certain sectors more than others and influencing a country’s growth prospects; tantalizing investing ideas?

Example:

For example, as baby boomers retire, we’ll likely see higher spending on health care, but less on education and raising children. Likewise, tech-savvy Millennials will likely prioritize consumption on experiences over cars and houses [leading economic indicator].

So, can we profit from these trends?

Assessment

Well maybe – maybe not! Overall economic prospects may not be completely affected by these trends. Spending habits on combined goods and services will shift, rather than rise or decline.

So, be careful. What matters most for your investment success is your demographics and investing according to your personal circumstances and goals [paradox-of-thrift].

Conclusion

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***

R.I.P Robert James Cimasi

In Memoriam

By Dr. David Edward Marcinko MBA

[Publisher Emeritus]

Robert James Cimasi MHA, ASA, FRICS, MCBA, CVA, CM&AA, CMP served as CEO of Health Capital Consultants, a nationally recognized healthcare financial and economic consulting firm headquartered in St. Louis, MO, serving clients in 49 states since 1993.

Mr. Cimasi had over 35 years of experience in serving clients, with a professional focus on the financial and economic aspects of healthcare service sector entities including: valuation consulting and capital formation services; healthcare industry transactions, including joint ventures, mergers, acquisitions, and divestitures; litigation support & expert testimony; and, certificate-of-need and other regulatory and policy planning consulting.

Bob served as an expert witness on cases in numerous courts, and has provided testimony before federal and state legislative committees. He and the experts at HCC also contributed greatly to our many textbooks and related publications. He will be missed.

https://www.healthcapital.com/hcc-news/hcc-news-archives

“Requiem in Pace” 

Rest in peace my friend. Robert Pine said it well when he noted,

“What we have done for ourselves is soon forgotten but what we have done for others remains and is immortal.”

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Why a CVS-Aetna Merger Could Benefit Consumers

Why a CVS-Aetna Merger Could Benefit Consumers

The following originally appeared on The Upshot (copyright 2017, The New York Times Company)

There are reasons for consumers to be optimistic about CVS’s reported purchase of Aetna for $69 billion. It’s one of the largest health care mergers in history, and in general, consolidation in health care has not been good for Americans.

But by disrupting the pharmacy benefits management market, and by more closely aligning management of drug benefits and other types of benefits in one organization, CVS could be acting in ways that ultimately benefit consumers.

You probably know CVS as a retail pharmacy chain — it runs nearly 10,000drugstores. But over the years, it has diversified. It now runs walk-in clinics, including in Target stores. And it runs one of the largest specialty pharmacies, dispensing high-priced drugs that require special handling.

In a big move a decade ago that set the stage for more recent developments, CVS purchased a majority of shares of Caremark for nearly $27 billion to enter the pharmacy benefits management business.

Pharmacy benefits managers are companies that help insurers devise and run their drug benefits, including serving as middlemen in negotiating prices between insurers and drug manufacturers.

Many health industry experts believe that pharmacy benefits managers effectively increase prescription drug prices to raise their own profits. This is because they make money through opaque rebates that are tied to drug prices (so their profits rise as those prices do). Competition among pharmacy benefits management companies could push these profits down, but it is a highly concentrated market dominated by a few firms, CVS among the largest.

But CVS’s recent moves may shake up an already changing pharmacy benefits landscape. In October, the insurer Anthem announced its intentions to part ways with the pharmacy benefits management firm Express Scripts. Instead, it will partner with CVS to develop its own pharmacy management business.

Anthem would not be the first insurer to forgo external pharmacy benefits management and take on the role internally. The insurer UnitedHealth Group also runs a leading pharmacy benefit management business, OptumRx. And CVS’s purchase of Aetna would also remove it as a middleman acting between that insurer and drug companies.

“While it’s still early, the moves by Anthem and Aetna have the feeling of the beginning of the end of the stand-alone pharmacy benefits manager business,” said Craig Garthwaite, a health economist with Northwestern University’s Kellogg School of Management. These insurers, and UnitedHealth Group, have concluded that outsourcing pharmacy benefits management may not serve their interests.

This removal of profit-taking middlemen could be good for consumers in the short run if it leads to lower drug prices. “In the long run, it might be harder for new insurers to enter the market because they won’t be able to negotiate lower drug prices than the larger firms,” Mr. Garthwaite said. “This could result in further concentration in the health insurance market.” That could harm future consumers, though not in ways we can predict today.

The CVS-Aetna deal would be just another of the many recent mergers across business lines in health care. Insurers are buying or partnering with health care providers. Health systems are offering insurance. Hospitals are employing physicians. Even Amazon is jumping into the pharmacy business in some states. This may be part of the motivation for CVS to buy Aetna — defensive jockeying to maintain access to a large customer base that might otherwise begin to fill drug prescriptions online.

Typically, mergers in the sector have led to higher prices and no better outcomes. But a CVS-Aetna merger might be different because their business lines complement each other. The most significant overlap is in the management of Medicare drug benefits: Both companies offer stand-alone Medicare prescription drug plans.

But there is a lot of competition in the Medicare drug plan market, so this overlap may not be a leading area of concern.

The CVS-Aetna merger is primarily about a supplier and its customer joining forces, what economists call a vertical merger. This type of merger can enhance a firm’s ability to coordinate across interlocking lines of business.

In this case, CVS-Aetna might more effectively manage certain patients with chronic conditions (those insured by Aetna), reducing costs. Let’s imagine that Aetna could leverage CVS’s pharmacies and clinics to help patients — who require medications to avoid hospitalizations — stay on their drug regimen. That could save the merged organization money. It could also translate into both better care and lower premiums, though there’s no guarantee at this stage of either.

One source of optimism: Research shows that coordinating pharmacy and health benefits has value because it removes perverse incentives that arise when drug and nondrug benefits are split across organizations. When pharmacy benefits are managed by a company that’s not on the hook for the cost of other care, like hospitalization, it doesn’t have as strong an incentive for increasing access to drugs that reduce other types of health care use. That could end up costing more over all.

So there’s reason to believe that a combined CVS-Aetna might find ways to reduce costs — and represent an instance when consumers actually come out ahead after health care consolidation.

Conclusion

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Bitcoin – “Millennials Fake Gold”

Bitcoin – The  Digital Generation’s Gold Surrogate

By Vitaliy Katsenelson CFA

I’ve been asked about Bitcoin a lot lately. I’ haven’t written anything about it because I find myself in an uncomfortable place in agreeing with the mainstream media: It’s a bubble.

Bitcoin started out as what I’d call “millennial gold” – the young (digital) generation looked at it as their gold substitute.

http://contrarianedge.com/2017/12/01/bitcoin-millennials-fake-gold/

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Conclusion

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Identity Management is a Challenge Health Plans Must Meet

Is your organization ready?

http://www.MCOL. com

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Conclusion

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What is Translational Medicine?

An Emerging and Protean Science

[By Staff Reporters]

Translational medicine (often referred to as translational science, of which it is a form) is defined by the European Society for Translational Medicine (EUSTM) as an interdisciplinary branch of the biomedical field supported by three main pillars: bench side, bed side and community. The goal of TM is to combine disciplines, resources, expertise, and techniques within these pillars to promote enhancements in prevention, diagnosis, and therapies.

DEFINITIONS: http://www.HealthDictionarySeries.org

Accordingly, translational medicine is a highly interdisciplinary field, the primary goal of which is to coalesce assets of various natures within the individual pillars in order to improve the global healthcare system significantly.

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http://www.translationalmedicine.com/

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. : https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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On Microsoft Health Accelerator, Merck Accelerator and Samsung NEXT

Microsoft Accelerator, Merck Accelerator and Samsung NEXT
have the highest awareness of all corporate health accelerators

By Markus Pohl

Among corporate health accelerators Microsoft Accelerator has the highest awareness level. Merck Accelerator and Samsung NEXT are ranking second and third. 42.8% of the digital health community has heard of Microsoft Accelerator. 26.7% have heard of Merck Accelerator, 26.4% of SAMSUNG Next and 24.8% of Grants4Apps by Bayer. Techstars (Barclays Accelerator, London) (18.2%) follows fifth with some distance behind.

These findings are part of our mHealth Economics program, the biggest survey of its kind with 2,400 answers from the digital global health community. In the ranking of of corporate accelerators’ awareness 21 corporate accelerators investing in healthcare have been included.

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Here is the full ranking:

https://research2guidance.com/microsoft-accelerator-merck-accelerator-and-samsung-next-have-the-highest-awareness-of-all-corporate-health-accelerators/

Conclusion

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***

U.S. Hospitals Feeling the Pain of Physician Burnout

U.S. Hospitals Feeling the Pain of Physician Burnout

Source: Reuters Health News via MDLinx [11/22/17]

neurotic

Hospitals are just beginning to recognize the toll of burnout on their operations

Experts estimate, for example, that it can cost more than $1 million to recruit and train a replacement for a doctor who leaves because of burnout. But, as no broad calculation of burnout costs exists, Dr. Tait Shanafelt, a former Mayo Clinic researcher who became Stanford Medicine’s first chief physician wellness officer in September said Stanford, Harvard Business School, Mayo Clinic, and the American Medical Association (AMA) are working on that. They have put together a comprehensive estimate of the costs of burnout at the organizational and societal level, which has been submitted to a journal for review.

Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors, and leads doctors to leave a profession they once loved.

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 Hospitals can ill afford these added expenses in an era of tight margins, costly nursing shortages, and uncertainty over the fate of the Affordable Care Act, which has put capital projects and payment reform efforts on hold.

For a graphic, click here.

http://fingfx.thomsonreuters.com/gfx/rngs/TRAVIS%20HARTMAN/010051RR403/index.html

Sound familiar?

MORE

Graphic-for-2-4-2019-pdf

stress

Conclusion

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***

Product DetailsProduct Details

The Home Office Tax Deduction Explained

What it is – How it works?

By Dr. David Edward Marcinko MBA CMP™
http://www.CertifiedMedicalPlanner.org

A taxpayer’s business use of his or her home may give rise to a deduction for the business portion of expenses related to operating the home.

The basic requirement:

1. There must be a specific room or area that is set aside for and used exclusively on a regular basis as:
a. The principal place of any business, or
b. A place where the taxpayer meets with patients, clients or customers in the normal course of their trade or business, or
c. A separate structure that is used in the taxpayer’s trade or business and is not attached to their house or residence.

2. An employee can take a home office deduction if he or she meets the regular and exclusive use test and the use is for the convenience of the employer.

Deductions

Deductible expenses include business portions of mortgage interest, property taxes, depreciation, repairs and maintenance to the overall home that help the business use area, janitorial services or maid, utilities, insurance as well as other expenses directly related to the operating the remainder of the home.

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https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

Conclusion

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