if you get a hospital acquired infection, you’re paying more.
Thank you, I'd forgotten about "hai". While we're forcing HC providers to publish their prices we should also be forcing them to publish their other relevant stats, including infection rates.
There are HC providers that are wonderful, others that are horrible, and there's no way to tell the difference. That's a great example where lack of any market feedback is killing people.
Compared to more than 1% of our Fucking GDP? … Medicare ain’t wasting that much, that’s for sure!
This is a program spending percentage points of the GDP, which is growing exponentially and threatens to break the budget.
It had better be wasting 1% or more of the GDP. If it isn't wasting money then at some point we get to choose between breaking the budget and people dying on the streets.
...while there are certainly cases where people try to bilk the system...
The problem is what's legal. Medicare pays negotiated rates on particular procedures, i.e. "health codes". However many procedures can legitimately be put under various codes, and/or can changed from one code to a much higher costing code with some trivial change.
Ergo "testing facilities" which are in the same building "separated" by some door holding a big sign saying "you're leaving this facility" (presumably legally they're different buildings as well). In-the-same-facility medical tests are billed at one rate. Extern-to-this-facility tests are billed at another. And it's legal... although it certainly doesn't add value.
I don’t understand the question.
My question is, is Medicare paying more per patient than the privates are? Efficiency of a system is average(patient-cost+admin-cost), not average(admin-cost).
Private companies can't run administration that tight without becoming unprofitable, which suggests their administration (i.e. their own medical code warriors) adds value by keeping prices down. Part of that isn't "reducing the cost of a code", it's "claiming three codes are actually one".
Medicare doesn't run administration that tight but also doesn't have to earn a profit and thus doesn't have to keep prices down. I wasn't able to find numbers this subject which normally doesn't mean good things.
At the same time, clearly 15 years in prison is excessive punishment for stealing a poster.
Clearly no one here understands the real nature of the crime committed.
The crime, no matter what it was called, was actually blasphemy or whatever. That poster was of NK's living god, the man who rides a unicorn, does not shit, writes a dozen books a day, and who proved himself the world's best golfer the first and only time he picked up a set of clubs.
Picture Christ still alive, actively performing miracles, and his most ardent followers running the country in his name. That's North Korea.
A "pissChrist" type event, and that poster counts, is taken seriously there. 15 years is a gift, being beaten to death by your fellow prisoners or the guards is expected.
My hunch is that at least some of the outrage, especially among people of color, is that the outpouring of sympathy for Warmbier probably feels like it stands in stark contrast to the relative lack of sympathy extended to people who look like them in the states who are victims of government oppression.
American minorities aren't oppressed by North K standards. A bad year in NK can have the gov deliberately destroying everyone's life savings. A really bad year in NK can result in cannibalism and/or mass murder. A good year in NK has the gov putting people to death because they're too successful, trying to leave, or not worshiping their leader.
American minorities gain power via their victimhood, so admitting some other population is MUCH more oppressed is a bad thing.
The quick summary is that Medicare [Administrative Costs] overhead is 2%. Private is high-teens.
Yes, but at what cost? Efficiency of the total system is not measured by lack of administration, especially when most actors are deliberately inflating their fees.
In theory you could reduce admin costs to near zero by just mailing a blank check to every HC provider every time they ask.
Depending on the injury or sickness, they might not even be in a place to look around. If you’ve been in an accident, your going to need help immediately rather than latter.
True, but how relevant is this? What percentage of HC fits this? I think it's in the single digits percentage-wise but let's call it 10%.
Hopefully sweating down the price of 90% of the system will also reduce costs for the other 10%. Hopefully the hospital won't charge you 10x for an emergency MRI, and if that's actually a thing then maybe it needs a legal remedy.
And published prices also lets non-patients evaluate and force competition on the system. The job of Insurance companies, in terms of keeping their own prices down, gets much easier if they can eval prices and not medical codes designed to obfuscate things.
So, sure, they could publish the rates, but that won’t tell you a whole lot about what you’ll actually *pay* to have something done.
Good products push bad ones off the market.
And normally if you enter into a contract to buy a product and they give you another, then that's a breach of contract. For that matter when buying a car you're not forced to buy the tires, steering wheel, etc, separately.
Stimulus, which at the time, and in retrospect, was pro growth.
Paying someone to dig a hole and then paying someone else to fill it in is not "pro-growth". It may be necessary for social stability, but that's a different issue.
Bank bail outs
Yes, this is pro-growth, in the sense that letting the banks burn down would have been terrible for the economy. I also think it could have been handled better (firing the top two ranks of management) but that's a different issue.
Fundamentally Bush's TARP was indeed necessary to keep the economy going.
The auto bailout
Probably not. The gov picking winners and losers is normally a bad thing and substituting politics for economics. It's a mistake to think the automakers would have simply vanished. The airlines declare bankruptcy every now and then without it destroying them.
Wall st reform could certainly be argued to be pro growth... Reducing the risk the banking industry can destroy the economy is a good thing, right?
First, it's seriously unclear risk has gone down. We increased regulation, these regulators are the same ones who were asleep at the switch last time.
2nd, There's been a fair amount of squeaking that this regulatory handcuffing has reduced growth. There are better ways to do this, my expectation is Wall Street is smarter than its regulators.
Investments in green technology...
There are arguments in favor of green tech, but wanting to do this doesn't means it's "pro-growth". The gov is taxing economically efficient industries to subsidize economically inefficient industries. What it should be doing is creating a level playing field.
Picking winners and losers is nearly always anti-growth, ditto gov boondoggles. Get rid of gov support and most of these green technologies disappear.
Somehow government investment only has an ROI when it comes to defense and law enforcement thought, right?
I'm unaware of either of those activities having an ROI. They're basic gov functions.
TPP, a trade deal, which I guess all of the sudden the right hates as anti-growth,
The Right is wrong. Trade deals are pro-growth, but normally it's the Left which opposes trade.
Infrastructure, which was a bad idea when he proposed it but apparently kicks ass now that trump is talking about it.
Infrastructure is something the gov does well and which which has a decent ROI. That the stimulus mostly ignored infrastructure was a lost opportunity, especially in the context of the construction industry being hurt the most by the recession.
However, given how the stim was advertised as being for "shovel ready jobs", we've already purchased that horse once. I doubt Washington has the ability to spend well large one-shot moneys. Everyone lines up with their hands out and what gets funded has much to do with politics and little to do with economics.
Nor do I think this should be "new" money. Infrastructure is one of the gov's basic responsibilities. That infrastructure has been starved speaks to fundamental problems with entitlements crowding out all other spending, but that's a different conversation.
What is trump proposing? Lower taxes, gut regulations. HMMMM, hows that going and where have i heard that before?
Reagan. It worked so well then in terms of growth that lots of politicians have copied his rhetoric, although I can't think of any who have actually attempted to follow through on it.
Trump, to his discredit in terms of growth, is opposed to immigration and trade. To his credit, he's at least paying attention to the issue... and he's steadily walked back the bulk of his anti-growth promises.
So you’ll forgive me if, after 8 years of not only hearing that XX policy will slow growth, but that it will destroy it, forever, and kills jobs (whether it the deficit, or health care, or stimulus spending, or cutting defense, letting too many brown people in, and on and on), all while reality pretty consistently disagreed,
If "destroying growth forever" is your measure of failure, then even 911 was fine.
And some of the things on your list are "I don't like this, so it must be anti-growth". Letting people into the country (regardless of color) is largely good for the economy.
I refuse to entertain an argument that Obama’s presidency sucked economically.
Then you deserved to lose the election.
...tacit admission that what growth did occur on his watch was due to him.
This is like claiming that a doctor who does NOTHING is responsible for a patient's successful recovery. Under Obama, at best growth wasn't a priority, at worst it was something to be sacrificed for more important priorities.
Employer-based healthcare would vanish, so the money not going to that health care system would be available to be captured by the state. ...The legislature thinks that it can provide the same aggregate volume of care at a lower cost, largely due to pricing power...
Let's take a look, big picture, at what "success" would look like. Assume (:handwave:) a quarter of all HC spending is wasted via insurance/bureaucratic systems fighting with each other.
The legislature capturing that money means hundreds of thousands of highly paid, highly intelligent bureaucrats/insurance people/medical coders are unemployed, to the tune of 4% of CA's GDP. They're going to scream to high heaven, as will their allies and their various organizations. So we're looking at the AMC, the doctors, nurses, etc all making TV ads claiming that the politicians are killing people.
These groups are heavy donors of the Dems, but California's wonderful politicians will stand up to them and the political pressure and do what's best for the patients. This frees up amazing amounts of money which can be used to give the uninsured sick care and keep good care for the people who currently have employer insurance.
And I don't believe that for a second. FAR more likely imho is we keep all of these groups alive, don't ruffle too many feathers, and add another layer of bureaucracy. (This reality is why I like market solutions)
And since they're not saving any serious amount of money, they need, and will continue to need, massive tax increases for NEW money into the system to cover everyone who wins in the new system.
Or alternatively, they can have serious losers, say, everyone who currently has employer insurance (which is probably another political non-starter).
I’d feel a lot better if we just forced all HC providers to publish their prices so people could compare.
You think that will fix our healthcare problems? Seriously?
Everything? No. But I think that would open the door to other things at least being possible. Without that we're stuck with the overhead of dueling bureaucracies, say like the "Pentagon".
The reason that cost negotiation works is that the insurer can say to the provider “look, if you accept us paying you less than you ask for, we’ll throw business your way, and you can make it up in volume”. Obviously, this works better for insurers that have more patients to send to the provider. So imagine that you have three hundred fifty million patients; that’s a pretty big volume to make it up from!
The underlying assumption here is we're going to build a massive bureaucracy which will deal with the hospital's massive bureaucracy and it's going to be much more successful than the current massive bureaucracies.
I'd feel a lot better if we just forced all HC providers to publish their prices so people could compare.
The United States is going to need to do the reverse, get doctors to go along with a salary reduction. Good luck with that.
Reducing the money in a system isn't the same as giving everyone in it a haircut of equal proportions.
Our system has multiple massive bureaucracies whose only purpose is to deal with each other. Fire half of the administrators and pass the money saved to the patients.
I think it’s simpler than that, JB: a really big group of people want something like NHS because it provides better HC at lower total cost and another really big group of people oppose that type of centralization for ideological and pragmatic reasons. The first group denies political reality and the second group denies policy reality.
"Policy reality" means looking at whether you're increasing demand/supply/whatever and seeing what the expected outcome of that. It's NOT bringing in one component of someone else's system out of their context and claiming we're going to get the same outcome.
For example,California is thinking of going with a single payer, they need eye watering tax increases to even try it.
All of this is smoke and mirrors. It doesn't matter whether we've got "single payer" or "whatever". As long as the HC system itself is broken, costs aren't going to go down.
I had surgery two or three years ago, my doctor couldn't tell me how much it would cost because he didn't know. All costs in the system are opaque and hidden from view. If they want to charge me $1000 for an aspirin, they can and I wouldn't be able to even notice without an absurd amount of research on my part. The insurance companies have massive bureaucracies set up to prevent that kind of nonsense, hospitals have the same set up to do it.
Who pays is besides the point. Moving to single payer isn't going to get rid of the hospitals' bureaucracies, nor remove their strong incentive to play these games.
We need medical cost reform, not medical insurance reform.
Don't explain it with doors, explain it with playing cards. You're looking for the Ace of Spades, all 52 are face down. You pick a face down card, the dealer flips over 50 of the 51. Do you want to switch?
3 doors runs into the human instinct to keep what we've got and not risk a change. That's a huge benefit for endurance hunters.
*Comment archive for non-registered commenters assembled by email address as provided.
On “There Will Be No Single Payer”
According to George Turner's link, emergency medical was 4.85% of total HC spending. 41% of that was injury, 10% communicable diseases.
I'll repost the link: https://vizhub.healthdata.org/dex/
On “Icons of a Fickle News Cycle”
BTW my statements about their leader were all official NK-speak.
NK is basically a cult pretending to be a country, admittedly with nuclear weapons.
On “There Will Be No Single Payer”
dollars.
"
Thank you, I'd forgotten about "hai". While we're forcing HC providers to publish their prices we should also be forcing them to publish their other relevant stats, including infection rates.
There are HC providers that are wonderful, others that are horrible, and there's no way to tell the difference. That's a great example where lack of any market feedback is killing people.
"
This is a program spending percentage points of the GDP, which is growing exponentially and threatens to break the budget.
It had better be wasting 1% or more of the GDP. If it isn't wasting money then at some point we get to choose between breaking the budget and people dying on the streets.
"
The problem is what's legal. Medicare pays negotiated rates on particular procedures, i.e. "health codes". However many procedures can legitimately be put under various codes, and/or can changed from one code to a much higher costing code with some trivial change.
Ergo "testing facilities" which are in the same building "separated" by some door holding a big sign saying "you're leaving this facility" (presumably legally they're different buildings as well). In-the-same-facility medical tests are billed at one rate. Extern-to-this-facility tests are billed at another. And it's legal... although it certainly doesn't add value.
My question is, is Medicare paying more per patient than the privates are? Efficiency of a system is average(patient-cost+admin-cost), not average(admin-cost).
Private companies can't run administration that tight without becoming unprofitable, which suggests their administration (i.e. their own medical code warriors) adds value by keeping prices down. Part of that isn't "reducing the cost of a code", it's "claiming three codes are actually one".
Medicare doesn't run administration that tight but also doesn't have to earn a profit and thus doesn't have to keep prices down. I wasn't able to find numbers this subject which normally doesn't mean good things.
On “Icons of a Fickle News Cycle”
Clearly no one here understands the real nature of the crime committed.
The crime, no matter what it was called, was actually blasphemy or whatever. That poster was of NK's living god, the man who rides a unicorn, does not shit, writes a dozen books a day, and who proved himself the world's best golfer the first and only time he picked up a set of clubs.
Picture Christ still alive, actively performing miracles, and his most ardent followers running the country in his name. That's North Korea.
A "pissChrist" type event, and that poster counts, is taken seriously there. 15 years is a gift, being beaten to death by your fellow prisoners or the guards is expected.
"
American minorities aren't oppressed by North K standards. A bad year in NK can have the gov deliberately destroying everyone's life savings. A really bad year in NK can result in cannibalism and/or mass murder. A good year in NK has the gov putting people to death because they're too successful, trying to leave, or not worshiping their leader.
American minorities gain power via their victimhood, so admitting some other population is MUCH more oppressed is a bad thing.
On “There Will Be No Single Payer”
Yes, but at what cost? Efficiency of the total system is not measured by lack of administration, especially when most actors are deliberately inflating their fees.
In theory you could reduce admin costs to near zero by just mailing a blank check to every HC provider every time they ask.
"
True, but how relevant is this? What percentage of HC fits this? I think it's in the single digits percentage-wise but let's call it 10%.
Hopefully sweating down the price of 90% of the system will also reduce costs for the other 10%. Hopefully the hospital won't charge you 10x for an emergency MRI, and if that's actually a thing then maybe it needs a legal remedy.
And published prices also lets non-patients evaluate and force competition on the system. The job of Insurance companies, in terms of keeping their own prices down, gets much easier if they can eval prices and not medical codes designed to obfuscate things.
"
Good products push bad ones off the market.
And normally if you enter into a contract to buy a product and they give you another, then that's a breach of contract. For that matter when buying a car you're not forced to buy the tires, steering wheel, etc, separately.
"
Source?
On “For Democrats, Blue-Dogs are the way Forward”
Paying someone to dig a hole and then paying someone else to fill it in is not "pro-growth". It may be necessary for social stability, but that's a different issue.
Yes, this is pro-growth, in the sense that letting the banks burn down would have been terrible for the economy. I also think it could have been handled better (firing the top two ranks of management) but that's a different issue.
Fundamentally Bush's TARP was indeed necessary to keep the economy going.
Probably not. The gov picking winners and losers is normally a bad thing and substituting politics for economics. It's a mistake to think the automakers would have simply vanished. The airlines declare bankruptcy every now and then without it destroying them.
First, it's seriously unclear risk has gone down. We increased regulation, these regulators are the same ones who were asleep at the switch last time.
2nd, There's been a fair amount of squeaking that this regulatory handcuffing has reduced growth. There are better ways to do this, my expectation is Wall Street is smarter than its regulators.
There are arguments in favor of green tech, but wanting to do this doesn't means it's "pro-growth". The gov is taxing economically efficient industries to subsidize economically inefficient industries. What it should be doing is creating a level playing field.
Picking winners and losers is nearly always anti-growth, ditto gov boondoggles. Get rid of gov support and most of these green technologies disappear.
I'm unaware of either of those activities having an ROI. They're basic gov functions.
The Right is wrong. Trade deals are pro-growth, but normally it's the Left which opposes trade.
Infrastructure is something the gov does well and which which has a decent ROI. That the stimulus mostly ignored infrastructure was a lost opportunity, especially in the context of the construction industry being hurt the most by the recession.
However, given how the stim was advertised as being for "shovel ready jobs", we've already purchased that horse once. I doubt Washington has the ability to spend well large one-shot moneys. Everyone lines up with their hands out and what gets funded has much to do with politics and little to do with economics.
Nor do I think this should be "new" money. Infrastructure is one of the gov's basic responsibilities. That infrastructure has been starved speaks to fundamental problems with entitlements crowding out all other spending, but that's a different conversation.
Reagan. It worked so well then in terms of growth that lots of politicians have copied his rhetoric, although I can't think of any who have actually attempted to follow through on it.
Trump, to his discredit in terms of growth, is opposed to immigration and trade. To his credit, he's at least paying attention to the issue... and he's steadily walked back the bulk of his anti-growth promises.
"
If "destroying growth forever" is your measure of failure, then even 911 was fine.
And some of the things on your list are "I don't like this, so it must be anti-growth". Letting people into the country (regardless of color) is largely good for the economy.
Then you deserved to lose the election.
This is like claiming that a doctor who does NOTHING is responsible for a patient's successful recovery. Under Obama, at best growth wasn't a priority, at worst it was something to be sacrificed for more important priorities.
On “There Will Be No Single Payer”
No, ergo I've got no skin in the game. I can afford to be cold and cynical and watch from afar with interest.
I think it'd be an interesting experiment. I also think it'd melt down... but if it actually worked I'd be fine with shamelessly copying it.
"
Typo. I meant "AMA".
A ton of those bureaucratic systems which need to be shut down are inside the hospital, hard at work inflating bills.
"
Let's take a look, big picture, at what "success" would look like. Assume (:handwave:) a quarter of all HC spending is wasted via insurance/bureaucratic systems fighting with each other.
The legislature capturing that money means hundreds of thousands of highly paid, highly intelligent bureaucrats/insurance people/medical coders are unemployed, to the tune of 4% of CA's GDP. They're going to scream to high heaven, as will their allies and their various organizations. So we're looking at the AMC, the doctors, nurses, etc all making TV ads claiming that the politicians are killing people.
These groups are heavy donors of the Dems, but California's wonderful politicians will stand up to them and the political pressure and do what's best for the patients. This frees up amazing amounts of money which can be used to give the uninsured sick care and keep good care for the people who currently have employer insurance.
And I don't believe that for a second. FAR more likely imho is we keep all of these groups alive, don't ruffle too many feathers, and add another layer of bureaucracy. (This reality is why I like market solutions)
And since they're not saving any serious amount of money, they need, and will continue to need, massive tax increases for NEW money into the system to cover everyone who wins in the new system.
Or alternatively, they can have serious losers, say, everyone who currently has employer insurance (which is probably another political non-starter).
"
Everything? No. But I think that would open the door to other things at least being possible. Without that we're stuck with the overhead of dueling bureaucracies, say like the "Pentagon".
"
The underlying assumption here is we're going to build a massive bureaucracy which will deal with the hospital's massive bureaucracy and it's going to be much more successful than the current massive bureaucracies.
I'd feel a lot better if we just forced all HC providers to publish their prices so people could compare.
"
Reducing the money in a system isn't the same as giving everyone in it a haircut of equal proportions.
Our system has multiple massive bureaucracies whose only purpose is to deal with each other. Fire half of the administrators and pass the money saved to the patients.
"
"Policy reality" means looking at whether you're increasing demand/supply/whatever and seeing what the expected outcome of that. It's NOT bringing in one component of someone else's system out of their context and claiming we're going to get the same outcome.
For example,California is thinking of going with a single payer, they need eye watering tax increases to even try it.
"
All of this is smoke and mirrors. It doesn't matter whether we've got "single payer" or "whatever". As long as the HC system itself is broken, costs aren't going to go down.
I had surgery two or three years ago, my doctor couldn't tell me how much it would cost because he didn't know. All costs in the system are opaque and hidden from view. If they want to charge me $1000 for an aspirin, they can and I wouldn't be able to even notice without an absurd amount of research on my part. The insurance companies have massive bureaucracies set up to prevent that kind of nonsense, hospitals have the same set up to do it.
Who pays is besides the point. Moving to single payer isn't going to get rid of the hospitals' bureaucracies, nor remove their strong incentive to play these games.
We need medical cost reform, not medical insurance reform.
On “For Democrats, Blue-Dogs are the way Forward”
I'll repeat. What pro-growth policies do the Dems support?
As far as I can tell, one of the big reasons 4% isn't "easy" is because the Dems (and other groups to be fair) are opposed to those sorts of policies.
On “Morning Ed: Education {2017.06.19.M}”
The key words are "after some training". Pigeon's are dumb enough to not overthink it and learn by example.
http://blogs.discovermagazine.com/notrocketscience/2010/04/02/pigeons-outperform-humans-at-the-monty-hall-dilemma/#.WUncnX7yvmE
"
Don't explain it with doors, explain it with playing cards. You're looking for the Ace of Spades, all 52 are face down. You pick a face down card, the dealer flips over 50 of the 51. Do you want to switch?
3 doors runs into the human instinct to keep what we've got and not risk a change. That's a huge benefit for endurance hunters.
*Comment archive for non-registered commenters assembled by email address as provided.