There must be a pony in here somewhere.

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

Post by JD » 19 Jun 2019, 17:21

JasonL wrote:
18 Jun 2019, 14:49
I think that risk aversion, fear of variance, comfort with status quo collectively determine the paths of modern civilizations. I think this effect becomes dominant very soon after "i'm not worried about starving to death", and I think it portends the end of growth.
It's one of my theories that people have what is basically a fixed amount of worry in their lives. If they no longer have to worry about starving to death or being killed by raiding warrior tribes, they just expend the same amount of energy worrying about illegal immigration or autism or whatever.
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Jennifer
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Re: There must be a pony in here somewhere.

Post by Jennifer » 19 Jun 2019, 17:31

JD wrote:
19 Jun 2019, 17:21
JasonL wrote:
18 Jun 2019, 14:49
I think that risk aversion, fear of variance, comfort with status quo collectively determine the paths of modern civilizations. I think this effect becomes dominant very soon after "i'm not worried about starving to death", and I think it portends the end of growth.
It's one of my theories that people have what is basically a fixed amount of worry in their lives. If they no longer have to worry about starving to death or being killed by raiding warrior tribes, they just expend the same amount of energy worrying about illegal immigration or autism or whatever.
Or -- to be fair -- worrying about things like "The doctor said this procedure would cost me $800 out of pocket, and only after it was done and too late for me to back out did I discover I'm actually on the hook for over eighty thousand." I can think of no other good or service in modern America where something similar applies: "Gee, I'm having a hell of a time affording food because I never get the bill until AFTER I've already eaten, and the grocery store or restaurant's initial price quotes can be literally orders of magnitude off ... I NEVER would've eaten that pizza had I known it would cost me $1,200 rather than the twelve bucks the waiter originally estimated."

"When I took my family to that Disney park I budgeted $500 for a day of fun ... only a month later did I discover I actually owe 50 grand."
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Aresen
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Re: There must be a pony in here somewhere.

Post by Aresen » 19 Jun 2019, 19:33

Jennifer wrote:
19 Jun 2019, 17:31
JD wrote:
19 Jun 2019, 17:21
JasonL wrote:
18 Jun 2019, 14:49
I think that risk aversion, fear of variance, comfort with status quo collectively determine the paths of modern civilizations. I think this effect becomes dominant very soon after "i'm not worried about starving to death", and I think it portends the end of growth.
It's one of my theories that people have what is basically a fixed amount of worry in their lives. If they no longer have to worry about starving to death or being killed by raiding warrior tribes, they just expend the same amount of energy worrying about illegal immigration or autism or whatever.
Or -- to be fair -- worrying about things like "The doctor said this procedure would cost me $800 out of pocket, and only after it was done and too late for me to back out did I discover I'm actually on the hook for over eighty thousand." I can think of no other good or service in modern America where something similar applies: "Gee, I'm having a hell of a time affording food because I never get the bill until AFTER I've already eaten, and the grocery store or restaurant's initial price quotes can be literally orders of magnitude off ... I NEVER would've eaten that pizza had I known it would cost me $1,200 rather than the twelve bucks the waiter originally estimated."

"When I took my family to that Disney park I budgeted $500 for a day of fun ... only a month later did I discover I actually owe 50 grand."
Well, defense contracts seem to work that way. And HSR and other mass transit proposals.
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Jennifer
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Re: There must be a pony in here somewhere.

Post by Jennifer » 19 Jun 2019, 19:42

Aresen wrote:
19 Jun 2019, 19:33
Jennifer wrote:
19 Jun 2019, 17:31
JD wrote:
19 Jun 2019, 17:21
JasonL wrote:
18 Jun 2019, 14:49
I think that risk aversion, fear of variance, comfort with status quo collectively determine the paths of modern civilizations. I think this effect becomes dominant very soon after "i'm not worried about starving to death", and I think it portends the end of growth.
It's one of my theories that people have what is basically a fixed amount of worry in their lives. If they no longer have to worry about starving to death or being killed by raiding warrior tribes, they just expend the same amount of energy worrying about illegal immigration or autism or whatever.
Or -- to be fair -- worrying about things like "The doctor said this procedure would cost me $800 out of pocket, and only after it was done and too late for me to back out did I discover I'm actually on the hook for over eighty thousand." I can think of no other good or service in modern America where something similar applies: "Gee, I'm having a hell of a time affording food because I never get the bill until AFTER I've already eaten, and the grocery store or restaurant's initial price quotes can be literally orders of magnitude off ... I NEVER would've eaten that pizza had I known it would cost me $1,200 rather than the twelve bucks the waiter originally estimated."

"When I took my family to that Disney park I budgeted $500 for a day of fun ... only a month later did I discover I actually owe 50 grand."
Well, defense contracts seem to work that way. And HSR and other mass transit proposals.
Sure, but they don't affect you directly, the way a medical bill with your name on it does. I mean, yes, if "the US government" pisses away 5 billion dollars on some cost overrun, that affects "individual US taxpayers" just as all matters of government spending and the national debt affect us ... but for all my complaints about various taxes, nobody is facing personal bankruptcy because "My actual tax bill this quarter was literally over 100 times greater than what the taxman told me I'd have to pay if I took on that particular salary or asset." Even voracious Connecticut property taxes don't work that way. "Wait, instead of 60 mills they're taxing me at 6,000 mills? When I bought this house I budgeted for a 60 mill tax rate; I can't afford to pay 100 times that much!"
"Myself, despite what they say about libertarians, I think we're actually allowed to pursue options beyond futility or sucking the dicks of the powerful." -- Eric the .5b

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

Post by Tuco » 23 Jun 2019, 10:15

JD wrote:
19 Jun 2019, 17:21
JasonL wrote:
18 Jun 2019, 14:49
I think that risk aversion, fear of variance, comfort with status quo collectively determine the paths of modern civilizations. I think this effect becomes dominant very soon after "i'm not worried about starving to death", and I think it portends the end of growth.
It's one of my theories that people have what is basically a fixed amount of worry in their lives. If they no longer have to worry about starving to death or being killed by raiding warrior tribes, they just expend the same amount of energy worrying about illegal immigration or autism or whatever.
I've thought this for a long time, too.

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

Post by Shem » 24 Jun 2019, 12:41

"VOTE SHEMOCRACY! You will only have to do it once!" -Loyalty Officer Aresen

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

Post by JasonL » 24 Jun 2019, 15:20

I think insulin is a perfect test case everyone should be looking at. The part I wish got more attention - why in the ever living fuck do “new” insulins get market share when they do very little to zero extra good over very cheap existing generics? “Pharma markets them” is an entirely inadequate answer.

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

Post by thoreau » 24 Jun 2019, 16:16

Can you outline the basic shape of an adequate answer?
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Re: There must be a pony in here somewhere.

Post by Warren » 24 Jun 2019, 16:21

thoreau wrote:
24 Jun 2019, 16:16
Can you outline the basic shape of an adequate answer?
Some believable motivation for turning your back on existing generics. Being "marketed" is not that.
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Mo
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There must be a pony in here somewhere.

Post by Mo » 24 Jun 2019, 16:21

Pharma markets them, stops marketing old ones and threatens to temporarily price war new entrants to the point of massive losses and still profit. You don’t need to fire a gun for it to be a credible threat. It’s in TFA, making bio similars ain’t cheap.
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Jadagul
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Re: There must be a pony in here somewhere.

Post by Jadagul » 24 Jun 2019, 16:35

"Making biosimilars isn't cheap" is a big part of the story there. The fact that insulin is off-patent doesn't actually mean that it would be cheap or easy for a new market participant to sell it.

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

Post by Mo » 24 Jun 2019, 16:40

Once the get up and running it would be pretty cheap and easy, but incumbents will drive new entrants out of business and then raise prices back up. It’s the same shit Rockefeller did with the railroads.
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

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

Post by Jadagul » 24 Jun 2019, 16:41

But getting it up and running is expensive because there's a ton of testing you have to do first.

Getting a generic drug up is relatively cheap. Getting a generic biosimilar up is not.

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

Post by Mo » 24 Jun 2019, 17:49

Yup, well aware of that. And incumbents will let you know they’ll crush you before you get out the gate. Which is how we’ll end up with Elizabeth Warren’s biosimilar factory that will suck, but Lilly will deserve. Or they’ll give a pass to European/Canadian biosimilars.
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

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Re: There must be a pony in here somewhere.

Post by Aresen » 24 Jun 2019, 17:56

Mo wrote:
24 Jun 2019, 16:40
Once the get up and running it would be pretty cheap and easy, but incumbents will drive new entrants out of business and then raise prices back up. It’s the same shit Rockefeller did with the railroads.
Rockefeller was Standard Oil. Carnegie was steel. The railroads could never get a proper cartel going until JP Morgan came along.
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Mo
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Re: There must be a pony in here somewhere.

Post by Mo » 24 Jun 2019, 18:03

Aresen wrote:
Mo wrote:
24 Jun 2019, 16:40
Once the get up and running it would be pretty cheap and easy, but incumbents will drive new entrants out of business and then raise prices back up. It’s the same shit Rockefeller did with the railroads.
Rockefeller was Standard Oil. Carnegie was steel. The railroads could never get a proper cartel going until JP Morgan came along.
Fuck you’re right.
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

no one ever yells worldstar when a pet gets fucked up - dhex

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

Post by Shem » 24 Jun 2019, 18:11

Mo wrote:
24 Jun 2019, 17:49
Yup, well aware of that. And incumbents will let you know they’ll crush you before you get out the gate. Which is how we’ll end up with Elizabeth Warren’s biosimilar factory that will suck, but Lilly will deserve. Or they’ll give a pass to European/Canadian biosimilars.
Most likely we'll wind up with de facto price controls through Medicare "negotiating," with insurers demanding pharma match prices to prevent unfair competition with the public option that also gets pushed through. Hence the pigs and hogs comment.
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Re: There must be a pony in here somewhere.

Post by D.A. Ridgely » 24 Jun 2019, 19:07

Mo wrote:
24 Jun 2019, 18:03
Aresen wrote:
Mo wrote:
24 Jun 2019, 16:40
Once the get up and running it would be pretty cheap and easy, but incumbents will drive new entrants out of business and then raise prices back up. It’s the same shit Rockefeller did with the railroads.
Rockefeller was Standard Oil. Carnegie was steel. The railroads could never get a proper cartel going until JP Morgan came along.
Fuck you’re right.
Not to mention until Westinghouse came along and figured out how to stop the damned things without derailing.

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Re: There must be a pony in here somewhere.

Post by Jasper » 25 Jun 2019, 12:38

Mo wrote:
24 Jun 2019, 18:03
Aresen wrote:
Mo wrote:
24 Jun 2019, 16:40
Once the get up and running it would be pretty cheap and easy, but incumbents will drive new entrants out of business and then raise prices back up. It’s the same shit Rockefeller did with the railroads.
Rockefeller was Standard Oil. Carnegie was steel. The railroads could never get a proper cartel going until JP Morgan came along.
Fuck you’re right.
RSN used to pal around with them when they were all kids.
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Mo
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Re: There must be a pony in here somewhere.

Post by Mo » 19 Jul 2019, 13:37

I’m not sure we can cover that cancer treatment, but $121K to Fitness Dave? Sure!

https://www.propublica.org/article/heal ... o-pays-you
his voice is so soothing, but why do conspiracy nuts always sound like Batman and Robin solving one of Riddler's puzzles out loud? - fod

no one ever yells worldstar when a pet gets fucked up - dhex

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

Post by JasonL » 19 Jul 2019, 13:46

The more money in accounts and transactions you deal with for individuals the more you become an account security and anti fraud business if you want not to sound like this.

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Re: There must be a pony in here somewhere.

Post by Warren » 19 Jul 2019, 13:48

Mo wrote:
19 Jul 2019, 13:37
I’m not sure we can cover that cancer treatment, but $121K to Fitness Dave? Sure!

https://www.propublica.org/article/heal ... o-pays-you
Insurance companies “are more focused on their bottom line than ferreting out bad actors,” said Michael Elliott, former lead attorney for the Medicare Fraud Strike Force in North Texas.
I think we found the source of the problem. If only there were some some way the ferreting out bad actors could benefit their bottom line.
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Re: There must be a pony in here somewhere.

Post by lunchstealer » 19 Jul 2019, 19:02

Warren wrote:
19 Jul 2019, 13:48
Mo wrote:
19 Jul 2019, 13:37
I’m not sure we can cover that cancer treatment, but $121K to Fitness Dave? Sure!

https://www.propublica.org/article/heal ... o-pays-you
Insurance companies “are more focused on their bottom line than ferreting out bad actors,” said Michael Elliott, former lead attorney for the Medicare Fraud Strike Force in North Texas.
I think we found the source of the problem. If only there were some some way the ferreting out bad actors could benefit their bottom line.
But when the law limits you to 20% margin, the only way to raise revenue is to pay out more. When Obamacare established the 80% rule, where insurers had to spend 80% of their revenue on medical payments, that meant that they had an actual incentive to spend more money. They might try to keep super big expenditures under control, but they still have to spend money to make money.
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Re: There must be a pony in here somewhere.

Post by Warren » 19 Jul 2019, 19:16

lunchstealer wrote:
19 Jul 2019, 19:02
Warren wrote:
19 Jul 2019, 13:48
Mo wrote:
19 Jul 2019, 13:37
I’m not sure we can cover that cancer treatment, but $121K to Fitness Dave? Sure!

https://www.propublica.org/article/heal ... o-pays-you
Insurance companies “are more focused on their bottom line than ferreting out bad actors,” said Michael Elliott, former lead attorney for the Medicare Fraud Strike Force in North Texas.
I think we found the source of the problem. If only there were some some way the ferreting out bad actors could benefit their bottom line.
But when the law limits you to 20% margin, the only way to raise revenue is to pay out more. When Obamacare established the 80% rule, where insurers had to spend 80% of their revenue on medical payments, that meant that they had an actual incentive to spend more money. They might try to keep super big expenditures under control, but they still have to spend money to make money.
No lunch. The big insurance companies are heartless greedy vultures preying on us all. Stop trying to rationalize the violence inherent in the system.
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Shem
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Re: There must be a pony in here somewhere.

Post by Shem » 19 Jul 2019, 20:43

lunchstealer wrote:
19 Jul 2019, 19:02
Warren wrote:
19 Jul 2019, 13:48
Mo wrote:
19 Jul 2019, 13:37
I’m not sure we can cover that cancer treatment, but $121K to Fitness Dave? Sure!

https://www.propublica.org/article/heal ... o-pays-you
Insurance companies “are more focused on their bottom line than ferreting out bad actors,” said Michael Elliott, former lead attorney for the Medicare Fraud Strike Force in North Texas.
I think we found the source of the problem. If only there were some some way the ferreting out bad actors could benefit their bottom line.
But when the law limits you to 20% margin, the only way to raise revenue is to pay out more. When Obamacare established the 80% rule, where insurers had to spend 80% of their revenue on medical payments, that meant that they had an actual incentive to spend more money. They might try to keep super big expenditures under control, but they still have to spend money to make money.
The local HMOs are replacing their RNs with MAs to save money, and are using computer systems that are more or less constantly crashing in the name of cost-cutting, so your explanation rings rather hollow.
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