Concerned

Comments:

• Musk and Zuckerberg political activities are a pretty effective counter to your entire argument. I think social media’s control over civic discourse has changed the entire argument. When people amass these huge fortunes and then spend them controlling our government, the consequences are dire and disastrous and will get worse. It started with the Kochs, and “Project 2025” will destroy America, all funded by right wing billionaires. The US defense relies heavily on Starlink and NASA on SpaceX. Remember when Musk cut Ukraine off of Starlink? Do we really want our national security dependent on Elon? Look at Zuckerberg’s recent transformation. He believes in “companies not countries”. He also says “Meta” has no responsibility for stopping falsehoods about vaccinations, election deniers, etc and is sorry he apologized to parents whose kids killed themselves because of Facebook pressure. With his money he apparently can do anything he wants. https://www.theguardian.com/commentisfree/2024/sep/27/mark-zuckerberg-metaverse-ai-elections-mental-health?CMP=Share_iOSApp_Other Billionaires are the problem. None of them got there by being nice or supporting the common good. Bill Gates was cited by the NLRB for employment violations when Microsoft had fewer than 50 employees. The example of the Whaltons giving money for art museums ignores the fact that Walmart destroyed previously vibrant small town businesses.

  Post: In defense of billionaires

  Link to comment from September 28, 2024

• I share many of these experiences. As a young doctor, I was convinced I could have a great career in academic medicine research and publishing. I took a job at a top flight medical school that required me to work at the VA hospital. Jonathan the VA makes Citi look like the most efficient organization in history. To succeed in academics I had to not focus on patient care, which reinforced my understanding that what I really loved about medicine was taking care of patients, the more complicated the better. As the VA was impossible for efficient patient care, I knew I had to leave and eventually joined a private practice where I stayed 30 years, and loved every minute. I realized I had found my ideal job, and was very appreciated by my patients, many of who still keep in touch.

  Post: Never Quite Enough

  Link to comment from September 21, 2024

• Corporations have proven to be horribly irresponsible in the use of their excessive cash, with absolutely no regard cor their “owners” their shareholders. Huge CEO salaries ( thousands of times their average worker) with no concern for preformance, excessive fringes, multiple corporate jets, lush meeting locales, and massive stock buybacks ( the latter accounted for 50% of the market’s gains ). Dividends do not eliminate these abuses, but the are at least a bit of a brake, and at in the case of most of the “Aristocrats” are part of the “corporation culture” and while not guaranteed, are pretty safe. Mr Grossman should use a few more examples, other than P and G.

  Post: Yielding No Advantage

  Link to comment from August 31, 2024

• In my 40 years of medical practice, I always found optimism was a powerful drug! I had many patients with horrible prognoses do very well, an unexpected outcome if you just looked at “medians”. No one knows what the future holds for any of us. I have had friends drop dead. One day at a time, stay close to family and friends, enjoy Paris and we will keep praying for you and your loved ones.

  Post: Looking Different

  Link to comment from July 6, 2024

• A quick search of Exon 20 therapy shows a good review as of March 2024 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11010879/ including the Papillon trial, recently completed and published. You dont need to go to the Mayo clinic for state of the art treatments! https://www.nejm.org/doi/suppl/10.1056/NEJMoa2306441/suppl_file/nejmoa2306441_research-summary.pdf

  Post: Looking Different

  Link to comment from July 6, 2024

• It vert much depends on the circumstances, and the kids. I am the only one in our family who has any interest in finances. My folks had a rag tag collection of stocks ( inherited from their parents) with cost basis in one case in the pennies. They never sold much but fortunately they had a great pension. They never told me much, other than giving me POA over their accounts when they were over ninety, so I knew where things stood. It didnt take long to sort things out, other than one gotcha that could have been prevented if my parents had told us about large gift they had made. Neither of our kids is interested either. One has limited financial needs which she can easily meet if she continues to work, now we have helped her buy a house, which we freely disclosed. The other kids spouse’s family is very well off and helped with their house. We have told them we will be gifting them stock irregularly, but some years maybe not. We try to keep things even but dont feel any compulsion to compete with the other-in-laws, and if we died tomorrow, one kid would be well ahead in gifts from us, but the other still has more assets. So the bottom line is we disclose the basics, tell them we will be fair, but they know and accept that we are not trying to be 50/50. It helps a lot that both kids like each other and talk a lot and that the new spouse adores her sister-in-law and vice versa. If there were already major conflicts, we would have to have a different plan I guess.

  Post: When to share estate plans and net worth with your adult children

  Link to comment from June 30, 2024

• When I read the opening paragraph I thought someone had hacked the site somehow, but no it appears this awful news is true. Like many others I subscribed to the WSJ only to read Jonathan’s articles, and followed him since. Wasn’t there a stint at Smith Barney or was it Merrill Lynch? You are like an old friend, although one I have never had the pleasure of meeting in the flesh. This is one of most positive things about the internet! Wednesdays and Saturdays always start with HD. I have bought your books for my kids and told them to get your newsletters. Your attitude and approach to this diagnosis is remarkable and brave, although only characteristic of your long, thoughtful advice over the years, Jonathan. I echo what everyone else says here, but maybe my long career in medicine may add an additional positive spin. No one with cancer ( or any other serious disease really) knows how the treatment will work. Every patient is really a new clinical trial with an “n of one”. That is all we docs can do is quote averages and past experience. We really do not know what the future brings to one patient. I have had many patients over the last 40 years face equally gloomy prognoses and live on for many happy and wonderful years. This was before the incredibly remarkable advances in cancer immunology and therapeutics in the last decade. Every week it seems the New England Journal of Medicine reports a new dramatic trial of monoclonal antibodies or immunotherapy, many in lung cancer. So good luck and God bless, Jonathan. We are all pulling for you and your family. I hope fervently that your advice on finances and life will continue for many years to come.

  Post: The C Word

  Link to comment from June 15, 2024

• Mr Rogers has had a great experience with MA, but probably because he lives in a large city with several large medical centers. I know San Antonio a bit, but I would be interested to hear if the University Hospital is always on the MA plans and if the mitral valve surgery was done there. There are two disadvantages to MA, stemming from their ability to limit the physicians and hospitals available to their members. In CT where I practiced Yale was frequently not available to MA plans because of its higher costs. Most of the outlying community hospitals were generally competent for simple problems, but I would not have wanted to be told my mitral valve surgery had to done at a community hospital, where the open heart program had just started and they had done 5 procedures. I saw this happen several times, and more patients were also forced to drive 30 miles or so for a CT scan although a ( non participating) place was available ( with better radiologists) next door. The other major disadvantage is that once you elect MA the supplemental plans you need with traditional Medicare do not need to accept you if you want to change so you may be stuck. The feds have finally caught on they are overpaying MA companies and are cutting the reimbursement rates ( causing dramatic declines in insurance companies stock prices). There will likely be further cuts and limits to care in MA plans. Remember , almost all MA advantage plans are owned by corporations whose first ( and only priority) is to make a profit, as large as possible. Traditional Medicare is usually universally accepted although I know in some states ( ie Texas) a lot of some specialists are refusing to participate. I dont know if they also refuse MA.

  Post: Which is better, traditional Medicare or Medicare Advantage?

  Link to comment from May 25, 2024

• In my career in internal medicine and geriatrics I had a number of patients with similar metatastic prostate issues. Hormonal therapy is almost always the first step but there have been remarkable advances in treating castrate resistant PC in the last few years, and several randomized trials showing increased survival with various new drugs. I had several patients take them without a lot of side effects. Good luck!

  Post: My Death Odyssey

  Link to comment from May 25, 2024

• While it may be hindsight, I have found the KISS (keep it simple stupid) principle works best in our younger years investing. Index funds, SP 500 etc. Now I am retired I find the decisions I have to make about investing and withdrawals far more complex. We have fortunately done well and have enough money to live on, despite we have no pensions. So now it is hard to decide how much to spend on ourselves, what to gift to our kids versus charity and what we should plan to leave them. They have good jobs and a house so really dont need money per say. The decisions about timing and delaying withdrawals until RMDs kick in are pretty complex, and I find most “ financial planners” cost too much for the advice you get. Fortunately, with retirement I have a lot. ore free time to figure this out.

  Post: Not Just Numbers

  Link to comment from May 15, 2024