JustJeff88 posted:

Malcolm XML posted:

Also ban drug ads

VitalSigns posted:

Turning a drug that is already full-blown medicine into a product isn't like coming up with an iPhone after capacitive touchscreens and flash memory were invented.

It's just a matter of doing the clinical trials to prove it's safe and effective, which follows well-established protocols, and then manufacturing it or contracting someone to manufacture it. It doesn't need a slick interface or a hip form-factor so I really don't think private industry is really essential to make sure the bottles the publicly imagined and researched medicine comes in are a fashionable color.

All the creative stuff was already done. But hey if you think it's impossible for government to uh run a clinical trial and then manufacture something, you have no reason to oppose it they'll easily be outshone by the wonderful private pharma companies who are currently *checks notes* withholding critical treatments from patients out of greed.

BlueBlazer posted:

Just keep those little floss picks everywhere. It ain't that hard.

Azhais posted:

Out of curiosity did you try the nose mask or just write it off due to sinus issues? Unless you're a mouth breather (which the sleep study should tell you) it might be worth a shot to see if it works better for you. One of the big concerns I had going in was "what if I have a cold?"

As it turns out when it comes to the "snot vs high pressure air" war the snot doesn't stand a chance. No matter how stuffed up I am about a minute after I put the mask on I'm breathing free. Granted I'm near maxed out on the machine, I don't know where you stand.

hobbesmaster posted:

That probably varies greatly on your particular sinuses because while I’m not a mouth breather while sleeping if I don’t have a cold I am when I do have a cold. I eventually switched to a full face mask from nasal pillows because of that.

blackmet posted:

CPAP chat:

My doctors and insurance were at least honest that, "yes, we will be monitoring usage to determine if we will cover this" upfront. It works well, and I'm such a heavy sleeper that I don't notice it when I'm knocked out anyway.

I get charged $45 a month for 5 years the machine and whatever weird random amount they come up with for supplies. The machine is able to be bought outright for $450 online. So, I make 60 PAYMENTS of $45 a month for something that should be 10 payments of $45, or a one time sunk cost of $450.

The rental and supplies were supposed to auto charge to my HSA card. They didn't. And I wasn't notified until I was $900 in arrears and my supplies were cut off. I made a $500 payment (enough to keep it turned on), turned off the auto pay, and now I basically pay what I feel like I can afford each month towards the remainder.

Rhesus Pieces posted:

I realize CPAP machines are necessary for the vast majority of people they’re prescribed to, but the more I hear about the sleep study and CPAP machine business the more it sounds like a corrupt fly-by-night racket.

Paying $2700 over 5 years for a $450 machine sounds worse than rent-a-center except it’s for vital medical equipment instead of lovely flatscreens.

Amniotic posted:

I always figured fraud was at the heart of the motorized scooter ads as well. (Your rascal is covered by Medicare!)

Anyone post the picture of the letter denying the heart transplant until the GoFundMe is set up yet?

Rhesus Pieces posted:

https://twitter.com/danriffle/status/1066340719189786626?s=21

Great system we have going here

hobbesmaster posted:

Private sector death panels are clearly preferable to government run ones

Discendo Vox posted:

I want to emphasize it's not really SCOTUS that's the issue here- it's a combination of 1. the WLF, which is a decades-old, terrifyingly competent Koch litigation entity, 2. decades of funding strangulation and capture and brain drain at FDA (which is still actually a really clean agency when all's said and done) and 3. the DC circuit, which has had this issue with libertarian judges since the 80s.

Ultimately, if this went to SCOTUS, I think that even now it's quite possible a ban would be upheld.

quote:

the Foundation's stated goal is "to defend and promote the principles of freedom and justice."

Tiler Kiwi posted:

Out of curiosity I looked up the WLF and the first thing I see on wikipedia that leaps out is


I immediately winced.

Rhesus Pieces posted:

https://twitter.com/danriffle/status/1066340719189786626?s=21

Great system we have going here

happyhippy posted:

Eagerly awaiting US diagnosis's/insurance to take into account subscriber numbers of your social accounts to treat you.

"Sorry, but you only have 50 Instagram followers, and 40 non family Facebook friends. The projected Gofundme resultspublic backlash from this will not be enough justification for us to offer to cover your cancer treatment."

Tiler Kiwi posted:

Out of curiosity I looked up the WLF and the first thing I see on wikipedia that leaps out is

Discendo Vox posted:

Yeah, and they're among the worst of the bunch. For those not familiar with how the Kochs run things (I only know a tiny bit of it), one of their contributions to the world of policy influence was they set up their foundations with a relatively sophisticated, fairly meritocratic (here meritocratic meaning "best at doing terrible things") funding structure based on means testing. This was pretty revolutionary and created a genuinely competitive space where more effective (again, read: evil) conservative organizations kept funding, while those that couldn't produce results, didn't stick around. It's part of why the Kochs have such a huge network and so much influence- they effectively select and fund winners, and other groups and stakeholders glom onto that. WLF is a winner of winners, a real champion. I have no idea how they're composed internally, but I know they're legally effective. They're insanely flexible legally, able to rapidly roll with any particular case outcome to bring up a new line of attack, and they set up test cases in advance that frame the next win, in advance of their ongoing lawsuits, for multiple outcomes. Very few organizations can do that. Ultimately, they're able to prevail because there have been Rebublican legislatures and judicial appointees, but they're able to capitalize on that in a way few others do.

Accretionist posted:

This sounds like 'evolution by natural selection'

Does the left have anyone/anything Koch-sized doing this? If not, why not? It's a good idea.

Accretionist posted:

This sounds like 'evolution by natural selection'

Does the left have anyone/anything Koch-sized doing this? If not, why not? It's a good idea.

Accretionist posted:

This sounds like 'evolution by natural selection'

Does the left have anyone/anything Koch-sized doing this? If not, why not? It's a good idea.

Pablo Nergigante posted:

Capitalists are very protective of their capital which makes them right-wing by default

GoluboiOgon posted:

[...]

quote:

also, i'm not sure that the left should buy into social darwinism as an organizational tactic

quote:

it is trump's organizational style and you can see in real time how having departments fight with each other handicaps his own administration.

quote:

Montana, like many large employers, self-funds its plan. That means it pays the bills and hires an insurance company or other firm to process the claims. More than half of American workers are covered by self-funded plans. As the boss in this arrangement, Bartlett assumed she’d have access to detailed information about how much the plan, which was managed by Cigna, paid for procedures at each hospital. But when she asked Cigna for its pricing terms with the hospitals, Cigna refused to provide them.

Its contracts with hospitals were secret, Cigna representatives told her. That didn’t sit well with Bartlett, she recalls. “The payer cannot see the contract,” she says, “but we agree to pay whatever the contract says we will pay.”

***

Under Bartlett’s proposed new strategy, the plan would use the prices set by Medicare as a reference point. Medicare, the federal government’s insurance for the disabled and patients over 65, is a good benchmark because it makes its prices public and adjusts them for hospitals based on geography and other factors. Montana’s plan would pay hospitals a set percentage above the Medicare amount, a method known as “reference-based pricing,” making it impossible for the hospitals to arbitrarily raise their prices.

quote:

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That’s good in theory but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here’s how: Let’s say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

It’s like if a mom told her son he could have 3 percent of a bowl of ice cream. A clever child would say, “Make it a bigger bowl.”

Wonks call this a “perverse incentive.”

“These insurers and providers have a symbiotic relationship,” said Wendell Potter, who left a career as a public relations executive in the insurance industry to become an author and patient advocate. “There’s not a great deal of incentive on the part of any players to bring the costs down.”

quote:

To understand the scope of what they were offering, consider Optum. The company, owned by the massive UnitedHealth Group, has collected the medical diagnoses, tests, prescriptions, costs and socioeconomic data of 150 million Americans going back to 1993, according to its marketing materials. (UnitedHealth Group provides financial support to NPR.) The company says it uses the information to link patients’ medical outcomes and costs to details like their level of education, net worth, family structure and race. An Optum spokesman said the socioeconomic data is de-identified and is not used for pricing health plans.

Optum’s marketing materials also boast that it now has access to even more. In 2016, the company filed a patent application to gather what people share on platforms like Facebook and Twitter, and link this material to the person’s clinical and payment information. A company spokesman said in an email that the patent application never went anywhere. But the company’s current marketing materials say it combines claims and clinical information with social media interactions.

***

The LexisNexis booth was emblazoned with the slogan “Data. Insight. Action.” The company said it uses 442 non-medical personal attributes to predict a person’s medical costs. Its cache includes more than 78 billion records from more than 10,000 public and proprietary sources, including people’s cellphone numbers, criminal records, bankruptcies, property records, neighborhood safety and more. The information is used to predict patients’ health risks and costs in eight areas, including how often they are likely to visit emergency rooms, their total cost, their pharmacy costs, their motivation to stay healthy and their stress levels.

People who downsize their homes tend to have higher health care costs, the company says. As do those whose parents didn’t finish high school. Patients who own more valuable homes are less likely to land back in the hospital within 30 days of their discharge. The company says it has validated its scores against insurance claims and clinical data. But it won’t share its methods and hasn’t published the work in peer-reviewed journals.

McCulley, LexisNexis’ director of strategic solutions, said predictions made by the algorithms about patients are based on the combination of the personal attributes. He gave a hypothetical example: A high school dropout who had a recent income loss and doesn’t have a relative nearby might have higher than expected health costs.

Willa Rogers posted:

I've had three other probublica tabs open since that cpap thingy a while back and finally got around to reading them.

1. In Montana, a Tough Negotiator Proved Employers Don’t Have to Pay So Much for Health Care

(Cool story about how a state regulator forced provider-pricing controls for the state's employees; the new stat I learned is that 1/2 of American workers are covered by employer self-insured plans.)


2. Why Your Health Insurer Doesn’t Care About Your Big Bills

(Former insurance guy takes on the industry's opaque pricing with providers; points out how the ACA's "limit" of profits against costs actually incentivizes insurers' collaboration with providers to keep costs high.)


3. Health Insurers Are Vacuuming Up Details About You — And It Could Raise Your Rates

("Wellness" programs are an excuse for insurers to suck up personal data & working with data brokers--sometimes owned by the insurers themselves--to aggregate personal information.)


ProPublica has other excellent stories on the topic.

Malcolm XML posted:

employer self insurance is huge because employers can construct very nice risk pools. most big companies will transition to it.

Willa Rogers posted:

Yah, and one of those stories mentioned how insurers love it; they get paid to administer the plans (as they do Medicaid & Medicare, which are both very profitable for insurers) without having to underwrite the actual costs.

The difference with the government programs, though, is that the government sets the provider pricing with the hospitals & docs, instead of the opaque & corrupt practice of insurer/provider secret pricing that benefits both by having higher costs.

Flesh Forge posted:

Maybe you don't have any contact with CPAP users but a) you need to use the equipment a certain amount for it to be therapeutic at all, i.e. if you use it 1 night out of 10 then it does not provide any long term benefit to your health; b) the machines and their supplies are very expensive; and c) people literally do get them as prescribed, stick them on a shelf and never use them. When people waste expensive resources, yes, even fully socialized medicine systems will withhold them.

VitalSigns posted:

In that case though you'd be going after the doctors improperly prescribing unnecessary CPAP devices (presumably in exchange for kickbacks from manufacturers), right?

VitalSigns posted:

In that case though you'd be going after the doctors improperly prescribing unnecessary CPAP devices (presumably in exchange for kickbacks from manufacturers), right?

You wouldn't be just withholding care from patients everyone agrees needs the CPAP machine but isn't using it properly for whatever reason.

Discendo Vox posted:

I'm curious if CPAP devices might have been identified as another potential locus of Medicare fraud. That would explain a lot about the circumstances.