There must be a pony in here somewhere.

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Pham Nuwen
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Re: There must be a pony in here somewhere.

Post by Pham Nuwen » 19 Jul 2019, 21:11

Undercutting nurse salaries is why I'm on my way towards a bright future.
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Warren
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Re: There must be a pony in here somewhere.

Post by Warren » 20 Jul 2019, 16:10

Shem wrote:
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.
What you said seems to confirm what he said. I don't see the contradiction.
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Shem
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Re: There must be a pony in here somewhere.

Post by Shem » 20 Jul 2019, 17:45

Warren wrote:
20 Jul 2019, 16:10
Shem wrote:
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.
What you said seems to confirm what he said. I don't see the contradiction.
They're supposedly looking to spend money, but are simultaneously cutting costs wherever they can. You don't see the contradiction there?
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Re: There must be a pony in here somewhere.

Post by Warren » 20 Jul 2019, 19:20

Shem wrote:
20 Jul 2019, 17:45
Warren wrote:
20 Jul 2019, 16:10
Shem wrote:
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.
What you said seems to confirm what he said. I don't see the contradiction.
They're supposedly looking to spend money, but are simultaneously cutting costs wherever they can. You don't see the contradiction there?
I don't think employee compensation and computers count as "medical payments". By cutting those costs it actually increases their bottom line, whereas fighting fraud doesn't because it lessens the amount they can claim as "medical payments".
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Shem
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Re: There must be a pony in here somewhere.

Post by Shem » 20 Jul 2019, 22:51

Paying a doctor is a medical payment, but paying a nurse isn't?
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Re: There must be a pony in here somewhere.

Post by lunchstealer » 21 Jul 2019, 20:26

Shem wrote:
20 Jul 2019, 22:51
Paying a doctor is a medical payment, but paying a nurse isn't?
My guess is that the 80% is reimbursements for procedure codes. I couldn't tell you whether on-staff RNs would count as medical expenditures. HMOs may be different, but I guarantee you that the offending plans that aren't vetting Doctor Dave Fitness Funtime Scam are PP0s.

Now, I only know more about healthcare policy because I have to actually navigate it myself because I can't just pay quacks out of pocket to tell people how awesome I am, but the calculus is that if UHC is spending $100b on reimbursements, they can take revenue of up to $125b and the $25b is for overhead and profit. if they successfully cut costs to $80b on reimbursements, they get a ceiling of $20b for overhead and profit, and if they bump their payments to $160b they get to make as much as $40b for overhead and profit. If there's some confounding factor that does in fact make them try to control general costs rather than just trying to control big ticket items for individual expensive patients.
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Mo
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Re: There must be a pony in here somewhere.

Post by Mo » 26 Jul 2019, 18:28

I mean Shem’s point is still valid. Margin expansion via cost cutting in a 20% margin world would still happen in a 30% margin world. My employer has significantly higher GP margins and we still do cost cutting.
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Re: There must be a pony in here somewhere.

Post by Warren » 26 Jul 2019, 19:15

Mo wrote:
26 Jul 2019, 18:28
I mean Shem’s point is still valid. Margin expansion via cost cutting in a 20% margin world would still happen in a 30% margin world. My employer has significantly higher GP margins and we still do cost cutting.
That's besides the point, nobody is saying insurance companies don't have an incentive to cut costs. The question is, Why don't insurance companies take measures to combat insurance fraud? lunch's hypothesis remains valid.
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Re: There must be a pony in here somewhere.

Post by Dangerman » 26 Jul 2019, 20:20

It's extremely time consuming and ends up with a lot of lawyers involved at a retail level, would be my guess from the outside.

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Re: There must be a pony in here somewhere.

Post by Warren » 26 Jul 2019, 20:57

Dangerman wrote:
26 Jul 2019, 20:20
It's extremely time consuming and ends up with a lot of lawyers involved at a retail level, would be my guess from the outside.
Even when someone calls your hotline with details on hundreds of fraudulent claims paid to an unlicensed doctor?
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Shem
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Re: There must be a pony in here somewhere.

Post by Shem » 28 Jul 2019, 12:01

Warren wrote:
26 Jul 2019, 20:57
Dangerman wrote:
26 Jul 2019, 20:20
It's extremely time consuming and ends up with a lot of lawyers involved at a retail level, would be my guess from the outside.
Even when someone calls your hotline with details on hundreds of fraudulent claims paid to an unlicensed doctor?
You mean the guy who didn't get away with it?
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Re: There must be a pony in here somewhere.

Post by Warren » 28 Jul 2019, 14:05

Shem wrote:
28 Jul 2019, 12:01
Warren wrote:
26 Jul 2019, 20:57
Dangerman wrote:
26 Jul 2019, 20:20
It's extremely time consuming and ends up with a lot of lawyers involved at a retail level, would be my guess from the outside.
Even when someone calls your hotline with details on hundreds of fraudulent claims paid to an unlicensed doctor?
You mean the guy who didn't get away with it?
He didn't get away with it because the ex-wife's father kept pushing.
To Pratte, it appeared he had struck out with Aetna, United, Southwest and the Texas Department of Insurance. “I was trying to get as many people as possible to look into it as I could,” Pratte said recently. “I don’t know if that tells me they are incompetent. Or they don’t care. Or they’re too busy.”
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Shem
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Re: There must be a pony in here somewhere.

Post by Shem » 28 Jul 2019, 18:12

Sounds like every other bureaucracy I've ever worked with.
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Re: There must be a pony in here somewhere.

Post by JasonL » 29 Jul 2019, 10:07

The 80% rule is and has always been a dumb idea. It all but eliminated incentives for providers to be challenged on costs which is really the biggest problem. It's a persistent fallacy of the left that "administrative bloat" and insurer profits form the difference between costs here and costs in other countries when the evidence is perfectly clear that it's provider costs being double to triple everyone else's.

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Re: There must be a pony in here somewhere.

Post by Shem » 29 Jul 2019, 11:56

JasonL wrote:
29 Jul 2019, 10:07
It's a persistent fallacy of the left that "administrative bloat" ...form the difference between costs here and costs in other countries when the evidence is perfectly clear that it's provider costs being double to triple everyone else's.
That's not accurate. Administrative costs in the US are twice what they are in other developed countries. It's just extremely difficult to address because it arises as a result of the lack of a single health care information and tracking system, forcing providers to replicate staffing in order to enable the systems to communicate. The fact that the government chose a pointless non-solution to address it doesn't mean the problem isn't real.
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Re: There must be a pony in here somewhere.

Post by JasonL » 29 Jul 2019, 12:14

It’s real in the range of 25% ish of the cost variances with other countries. It’s real but it’s not 3/4 or more of the problem - notably if you exacerbate the 75% problem in your fix for 25% you did something not smart.

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Re: There must be a pony in here somewhere.

Post by Andrew » 20 Aug 2019, 10:07

A coworker was talking about an expensive procedure their kid needs and how awful it is that the procedure isn't free like it would be in Canada. This is not a brand-new cutting edge thing, but still relatively new and fairly complex. While I'm an idiot, I'm not enough of one to discuss health care policy at such a time, so I stayed silent.

But this is why we're doomed. Far too many people have the attitude that as soon as a procedure or medication exists, then everyone is entitled to it for free. Development costs, operating costs, the skills needed to do it... doesn't matter. It exists, therefore they're entitled to it.
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Re: There must be a pony in here somewhere.

Post by Aresen » 20 Aug 2019, 10:26

Andrew wrote:
20 Aug 2019, 10:07
A coworker was talking about an expensive procedure their kid needs and how awful it is that the procedure isn't free like it would be in Canada. This is not a brand-new cutting edge thing, but still relatively new and fairly complex. While I'm an idiot, I'm not enough of one to discuss health care policy at such a time, so I stayed silent.

But this is why we're doomed. Far too many people have the attitude that as soon as a procedure or medication exists, then everyone is entitled to it for free. Development costs, operating costs, the skills needed to do it... doesn't matter. It exists, therefore they're entitled to it.
1) First, the Provincial Medicare has to decide that the procedure is standard rather than 'experimental'. (New procedures remain 'experimental' for a considerably longer time in Canada than the US.)
2) Second, the same board has to decide that the procedure is the most 'cost-effective' treatment. Yes, governments ARE constrained by costs.
3) Third, the government has to provide the facilities for the procedure. Your friend may not have noticed, but governments are not exactly entrepreneurial about building things. A part of this is the time the government takes to decide how many such facilities are *needed*. Years after MRI scanners had been accepted as a necessary diagnostic tool, the Province of British Columbia had ONE scanner for the entire province (population 4.5 million) while Seattle had twelve. (The numbers have since increased.)
4) Assuming the previous three have already happened, then your friend would have to get on the wait list for the procedure. A friend of mine who badly needed a hip replacement waited a year and a half.
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Re: There must be a pony in here somewhere.

Post by JasonL » 20 Aug 2019, 11:03

The longer I look at it the more convinced I am that what many/most people are actually angling for is an authority to tell them they did everything they could in end of life and extensive care conditions. They maybe don't want immediate best care, they want someone to tell them what's acceptable as a stopping point. In the absence of that they have moral intuitions that tell them never stop forever because then its your fault they died.

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Re: There must be a pony in here somewhere.

Post by Painboy » 20 Aug 2019, 14:29

JasonL wrote:
20 Aug 2019, 11:03
The longer I look at it the more convinced I am that what many/most people are actually angling for is an authority to tell them they did everything they could in end of life and extensive care conditions. They maybe don't want immediate best care, they want someone to tell them what's acceptable as a stopping point. In the absence of that they have moral intuitions that tell them never stop forever because then its your fault they died.
I think it has something to do with the seen/unseen thing as well. When it's available but most can't afford it it's seen as unfair. But when nobody can get the treatment then it's more like the "will of the gods" and the individual is saved from having to make any hard choices, asking for help, or facing up to any previous poor decisions that contributed to their state.

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Re: There must be a pony in here somewhere.

Post by JasonL » 20 Aug 2019, 15:08

I have this odd connection I draw to conversations we've had before with self defense things. I think one reason so many people favor such a strong justice and law enforcement arm is they intuit a view that civilization means they shouldn't have to ever be accountable for their own safety. I don't think it's top of mind reasoning, but it's an undercurrent. It's so absurd to think that you could shoot a bad guy, only cops can do that! What are you a superhero? Hur hur. Etc.

I think much of the institutional state exists to propel this notion forward. We woke up one day and nobody was supposed to save a single red cent for healthcare. I know it sucks blah blah prices, but literally before HSAs the level of personal health saving was actual zero. There is contstant talk if my industry from the Warren's of the world that retirement should be like that - nobody should have a poo retirement just because they never saved anything! Something 1%!!!

I think civilization is, in a post radical scarcity era, primarily about socializing the notion of accountability through institutional means. I used to think it was risk, but now I think it's more like "I want an institution to have a set of rules that tells me what is acceptable outcomes for a set of behaviors that are bluntly not all that hard, and it is super important to me to punish violations of those norms not because I'm worried that such a person will put us all in danger, but because I'm worried that person will have a strongly positive result and then I can be seen as not having done something I could have done." In my darker moments I think things like this.

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Re: There must be a pony in here somewhere.

Post by JD » 20 Aug 2019, 15:24

Most people want to never have to make any hard decisions or take any real responsibility. In my darker moments I think that most people are basically animals who want to live in a pen and be fed and cared for by a Great Leader.
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Re: There must be a pony in here somewhere.

Post by JasonL » 20 Aug 2019, 15:39

JD wrote:
20 Aug 2019, 15:24
Most people want to never have to make any hard decisions or take any real responsibility. In my darker moments I think that most people are basically animals who want to live in a pen and be fed and cared for by a Great Leader.
I would modify to ... struggling to hold onto the barnyard exactly here - what they want is Wise Men and Great Leaders to give them a checklist that is SUPER EASY and consisting of exactly what they want to be doing for the most part, they want a social compact and a set of punitive measures in place that A) allows them to look down at people who don't fill out the check boxes; B) promises them 100% life fulfillment and eternal happiness if get their check marks in all the boxes; and C) allows a mechanism to get restitution if that promise is violated OR if someone else seems to be have better outcomes for doing more than the checklist. The checklist is the thing. Civilization is checking easy boxes and receiving absurd promises in return.

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Re: There must be a pony in here somewhere.

Post by JD » 20 Aug 2019, 16:10

JasonL wrote:
20 Aug 2019, 15:39
I would modify to ... struggling to hold onto the barnyard exactly here - what they want is Wise Men and Great Leaders to give them a checklist that is SUPER EASY and consisting of exactly what they want to be doing for the most part, they want a social compact and a set of punitive measures in place that A) allows them to look down at people who don't fill out the check boxes; B) promises them 100% life fulfillment and eternal happiness if get their check marks in all the boxes; and C) allows a mechanism to get restitution if that promise is violated OR if someone else seems to be have better outcomes for doing more than the checklist. The checklist is the thing. Civilization is checking easy boxes and receiving absurd promises in return.
I think this goes a long way toward explaining the success of Communist countries. Where they fell down was in C and partly in B, which made people go all (╯°□°)╯︵ ┻━┻
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Mo
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Re: There must be a pony in here somewhere.

Post by Mo » 20 Aug 2019, 17:39

JasonL wrote:
JD wrote:
20 Aug 2019, 15:24
Most people want to never have to make any hard decisions or take any real responsibility. In my darker moments I think that most people are basically animals who want to live in a pen and be fed and cared for by a Great Leader.
I would modify to ... struggling to hold onto the barnyard exactly here - what they want is Wise Men and Great Leaders to give them a checklist that is SUPER EASY and consisting of exactly what they want to be doing for the most part, they want a social compact and a set of punitive measures in place that A) allows them to look down at people who don't fill out the check boxes; B) promises them 100% life fulfillment and eternal happiness if get their check marks in all the boxes; and C) allows a mechanism to get restitution if that promise is violated OR if someone else seems to be have better outcomes for doing more than the checklist. The checklist is the thing. Civilization is checking easy boxes and receiving absurd promises in return.
I think is an unfair comment from the “my toolbox is a checkbook,” because I believe it’s the exact same instinct. These are the things I’m good at and I want to deal with, I’d rather outsource the other stuff to someone else, whether it’s growing/raising food, fixing appliances, or dealing with unpleasant real world shit.
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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