There must be a pony in here somewhere.

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JasonL
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Re: There must be a pony in here somewhere.

Post by JasonL » 26 Jul 2017, 17:26

fyodor wrote:
26 Jul 2017, 17:08
JasonL wrote:
26 Jul 2017, 15:35
If you perceive that the total cost of american healthcare is too high and you note that rates paid to providers are stunningly large compared to rates paid anywhere else in the world and you observe that the largest reason insurance has been unable to contain payments is the efforts of providers in both the political space and the scaring grandma space, I think it is entirely reasonable to ask questions when providers directly refute accountability for costs with "we shouldn't have to care about costs".
Absolutely ask questions. Just color me skeptical if one claims that the answer is that American providers are greedier, er, more inclined to scare grandma, than providers elsewhere.
My argument would be that their intransigence on cost containment through insurers combined with their lobbying to get legal barriers to entry constitute a large reason why many people think the only answer is single payer. Docs in single payer regimes aren't less greedy, they just have no choices. Or, they might actually be less greedy given that they came up in a system that had these caps in place.

Agree with Sandy that the innovation argument is about returns for investors in new stuff - pharma, biotech, devices and technology. Not delivery per se.

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dbcooper
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Re: There must be a pony in here somewhere.

Post by dbcooper » 26 Jul 2017, 17:37

JasonL wrote:
26 Jul 2017, 11:42
That particular set of players never gets enough shade in my view and fixing "the cost of American healthcare" means explicitly cutting their wages by good margins. Like HMOs aren't ideal but they should work better at cost containment than they do. The reason they don't is provider behavior, while saying "the cost of things isn't our business we are Healers", totally actually fight tooth and nail to preserve high costs and exclude competition.

You ever see that whole Aetna CA vs Big Hospital group thing? FFS. Docs wanted some absurd 40% hike in payment, Aetna said nope we'll cut you, docs went to direct mail to patients about losing your doctor and took out ads showing asthma kids dying because Big Insurance doesn't care. Die in a fire dude.
:lol:
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Jennifer
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Re: There must be a pony in here somewhere.

Post by Jennifer » 27 Jul 2017, 16:44

Sandy wrote:
26 Jul 2017, 16:44
Jennifer wrote:
26 Jul 2017, 16:06
JasonL wrote:
26 Jul 2017, 15:35
If you perceive that the total cost of american healthcare is too high and you note that rates paid to providers are stunningly large compared to rates paid anywhere else in the world and you observe that the largest reason insurance has been unable to contain payments is the efforts of providers in both the political space and the scaring grandma space, I think it is entirely reasonable to ask questions when providers directly refute accountability for costs with "we shouldn't have to care about costs".
But a lot of defenders of the current American medical status quo will counter by arguing "Americans might pay more for medical procedures than anyone else in the world, but America is also the leader in developing new medical technologies -- without it, people will stop making new discoveries, and medical progress will stagnate." (Granted, the hospitals and/or doctors and/or middlemen like EmCare generally are not the ones making these new discoveries and producing these new inventions -- but defenders of the status quo tend not to make such distinctions. IIRC, that wretch of a Martin Shkreli tried using a similar argument to justify his buying the patent on that one lifesaving drug and then jacking up the price several thousand percent.)
FWIW, I've only seen that seriously said about drug costs or experimental procedures, not routine care.
Going off a [thoroughly unscientific] survey of various Facebook acquaintances of mine, the status-quo defenders I've seen aren't making fine distinctions in that area. (Though, bending over backwards in an attempt to be scrupulously fair to them -- it's not as though "price transparency" is a key feature of the status quo anyway.)
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Mo
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Re: There must be a pony in here somewhere.

Post by Mo » 27 Jul 2017, 20:15

Sandy wrote:
26 Jul 2017, 16:44
Jennifer wrote:
26 Jul 2017, 16:06
JasonL wrote:
26 Jul 2017, 15:35
If you perceive that the total cost of american healthcare is too high and you note that rates paid to providers are stunningly large compared to rates paid anywhere else in the world and you observe that the largest reason insurance has been unable to contain payments is the efforts of providers in both the political space and the scaring grandma space, I think it is entirely reasonable to ask questions when providers directly refute accountability for costs with "we shouldn't have to care about costs".
But a lot of defenders of the current American medical status quo will counter by arguing "Americans might pay more for medical procedures than anyone else in the world, but America is also the leader in developing new medical technologies -- without it, people will stop making new discoveries, and medical progress will stagnate." (Granted, the hospitals and/or doctors and/or middlemen like EmCare generally are not the ones making these new discoveries and producing these new inventions -- but defenders of the status quo tend not to make such distinctions. IIRC, that wretch of a Martin Shkreli tried using a similar argument to justify his buying the patent on that one lifesaving drug and then jacking up the price several thousand percent.)
FWIW, I've only seen that seriously said about drug costs or experimental procedures, not routine care.
Usually, the provider stuff is hand-waved away or with scare tactics like, "You want to cut doctor's salaries i half. Who would want to do that job?"
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nicole
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Re: There must be a pony in here somewhere.

Post by nicole » 28 Jul 2017, 09:39

AHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH

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JasonL
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Re: There must be a pony in here somewhere.

Post by JasonL » 28 Jul 2017, 09:44

JFC

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nicole
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Re: There must be a pony in here somewhere.

Post by nicole » 28 Jul 2017, 09:52

I'm still screaming
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Re: There must be a pony in here somewhere.

Post by dead_elvis » 28 Jul 2017, 10:22

nicole wrote:
28 Jul 2017, 09:39
AHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH

If someone doesn't respond to that with "My fear is that I will die an unloved virgin who disappointed my parents." I'll cancel my twitter subscription.
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Re: There must be a pony in here somewhere.

Post by dhex » 28 Jul 2017, 13:55

Hahaha hahaha the fuck gave that jabronski a fucking phone?
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Jennifer
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Re: There must be a pony in here somewhere.

Post by Jennifer » 28 Jul 2017, 18:30

The latest Adam Ruins Everything was about "Hospitals" (more specifically, American-style medical care) and it went into more detail about what most of us here knew already: among other things, that hospitals will deliberately inflate their sticker prices but then charge significantly lower prices to insurance companies, so that said insurance companies can boast to their premium-payers "Look what a great deal you got through us!" (ANd people unlucky enough to lack insurance end up being charged full sticker price.) What I didn't know was that this was originally done at the insurance companies' insistence; basically, they said "Look, we give you a LOT of customers, so give us a discount or else." The snarky vignette the show used to describe this was as follows (paraphrased from memory):

OLD-TIMEY HOSPITAL ADMIN: Okay, patient, we're going to charge you what it costs to perform this procedure, plus a little extra so we can make a profit. So, it cost us five dollars to amputate your arm; we'll charge you six-fifty.

INSURANCE COMPANY: We give you lots of patients, so we want a big discount! Charge us only half price!

OLD-TIMEY HOSPITAL ADMIN: What? We can't afford that unless we raise our prices significantly! Okay, then, from now on we'll charge a hundred dollars to amputate your arm!

Given that a truly free market in healthcare is not politically feasible, I wonder if the least-worst solution might instead be to pass two pieces of legislation: one requiring a given hospital or clinic to charge all patients the same rate for a given procedure (as opposed to "We'll charge X dollars to the uninsured, Y dollars to anyone with Blue Cross insurance, and Z dollars to anyone with Aetna"), and another mandating that the charge cannot be more than X percent over the hospital's cost -- say, 20 percent or so. (For that matter, even "100 percent markup" would still be vastly better than what we see now -- having the patients' cost for a simple blood cholesterol test vary from $10 to $20 is much better than having it range from $10 to $10,000, as is the current status quo.)
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nicole
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Re: There must be a pony in here somewhere.

Post by nicole » 24 Aug 2017, 14:32

This narrative is insane

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JasonL
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Re: There must be a pony in here somewhere.

Post by JasonL » 24 Aug 2017, 14:54

I'm starting to think enabling twitter links may have been the end of an era at gryll. I'm probably at 30% of new content unviewable. Follow through links tell me page does not exist. If I have to sign up for twitter to keep using gryill ... man.

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Re: There must be a pony in here somewhere.

Post by Hugh Akston » 24 Aug 2017, 14:57

I have no Twitter and I can see all of the tweets that have apparently replaced actual articles now.
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Highway
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Re: There must be a pony in here somewhere.

Post by Highway » 24 Aug 2017, 15:09

Yea, you shouldn't be seeing nothing, Jason, unless your view is like mine where my company blocks twitter addresses. It's not about signing up for twitter.
"Sharks do not go around challenging people to games of chance like dojo breakers."

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JasonL
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Re: There must be a pony in here somewhere.

Post by JasonL » 24 Aug 2017, 16:44

Work laptop blocks twitter and I get "Loading tweet". Personal phone using tapatalk presents the image of the tweet in question but click through to context threads gets me "page does not exist".

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Re: There must be a pony in here somewhere.

Post by Warren » 25 Aug 2017, 17:00

The narrative is insane. Basically it says, there are no counties that will have no ACA insurers next year, so yeah Obamacare it's a success.
That a significant part of the country will have only one insurer because as a monopoly they can set whatever price they want, is being touted as a feature.
Women with strollers are legitimately the worst people, and should, like motorcyclists, not be considered people for liability and criminal purposes. - lunchstealer

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Highway
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Re: There must be a pony in here somewhere.

Post by Highway » 25 Aug 2017, 17:18

Warren wrote:
25 Aug 2017, 17:00
The narrative is insane. Basically it says, there are no counties that will have no ACA insurers next year, so yeah Obamacare it's a success.
That a significant part of the country will have only one insurer because as a monopoly they can set whatever price they want, is being touted as a feature.
I'm pretty sure they can't set "whatever price they want" if they want to be an ACA exchange participant. They're limited to a high percentage of total premiums going to direct health care costs. That's why there would be places with no insurers. If they could set whatever price they want, then someone would want to be there, no?
"Sharks do not go around challenging people to games of chance like dojo breakers."

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Re: There must be a pony in here somewhere.

Post by Warren » 25 Aug 2017, 19:55

Highway wrote:
25 Aug 2017, 17:18
Warren wrote:
25 Aug 2017, 17:00
The narrative is insane. Basically it says, there are no counties that will have no ACA insurers next year, so yeah Obamacare it's a success.
That a significant part of the country will have only one insurer because as a monopoly they can set whatever price they want, is being touted as a feature.
I'm pretty sure they can't set "whatever price they want" if they want to be an ACA exchange participant. They're limited to a high percentage of total premiums going to direct health care costs. That's why there would be places with no insurers. If they could set whatever price they want, then someone would want to be there, no?
I think that's the point.
Women with strollers are legitimately the worst people, and should, like motorcyclists, not be considered people for liability and criminal purposes. - lunchstealer

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nicole
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Re: There must be a pony in here somewhere.

Post by nicole » 21 Sep 2017, 09:47

I'm basically the unabomber now but for thinking we never should have figured out how to treat congenital heart defects.
"Fucking qualia." -Hugh Akston

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JasonL
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Re: There must be a pony in here somewhere.

Post by JasonL » 21 Sep 2017, 10:04

I may need more context.

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Re: There must be a pony in here somewhere.

Post by Warren » 21 Sep 2017, 10:13

nicole wrote:
21 Sep 2017, 09:47
I'm basically the unabomber now but for thinking we never should have figured out how to treat congenital heart defects.
My SO has a congenital heart defect. I take offense to that.
Women with strollers are legitimately the worst people, and should, like motorcyclists, not be considered people for liability and criminal purposes. - lunchstealer

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nicole
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Re: There must be a pony in here somewhere.

Post by nicole » 21 Sep 2017, 10:23

JasonL wrote:
21 Sep 2017, 10:04
I may need more context.
The Jimmy Kimmel test
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JasonL
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Re: There must be a pony in here somewhere.

Post by JasonL » 21 Sep 2017, 10:30

Oh. Right. Not how I'd position my objection to the argument but I agree with the gist there.

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Highway
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Re: There must be a pony in here somewhere.

Post by Highway » 21 Sep 2017, 10:35

I wonder how much of the idea that everyone can get "all the healthcare everyone needs for living forever until they get struck by a meteor" is down to people considering that health care is "just money". "Little Jonny / Grandma Wumpus / My wife would be all better if they could just get this expensive procedure! Why are people keeping them from living a happy life just because they don't have some unimaginable amount of money?" I mean, you get up above the level of the average car, and people really lose track of the scale of that kind of money. And it's not like there are other impacts to other people (like if we build a new road, it's money AND displacing people / killing trees and frogs / etc). It's just get the treatment > get better.
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nicole
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Re: There must be a pony in here somewhere.

Post by nicole » 21 Sep 2017, 10:51

JasonL wrote:
21 Sep 2017, 10:30
Oh. Right. Not how I'd position my objection to the argument but I agree with the gist there.
It seems to be neonatal care specifically that makes people completely insane. We are going to have to buy an infinite number of infinitely expensive companions for an infinite number of people, forever. So much "your baby doesn't have to die" when actually everyone's baby has to die. They're all going to die, that's what you made them for.
"Fucking qualia." -Hugh Akston

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