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Brainiac Five posted:I appreciate your abandonment of materialism in favor of the Triumph of the Will being coupled with these half-assed supervillain speeches. If I thought the acolytes of pragmatic centrism were moved by materialist analysis, I'd try to speak to them in that language. If I thought we disagreed on anything more substantial than the motivations that should drive the tactics we agree on, with goals we agree on, with concerns we agree on, I'd talk materialism with you! But as long as the pragmatic centrists are speaking in terms of grand finality and extravagant metaphor, about how their will alone defines the limits of possibility, about the hard complexities of a hard, complex world, and in short about how idealists are meddling with the primal forces of nature and they must atone, well, half the trick to education is speaking each others' language.
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Mar 30, 2017 02:49
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evilweasel posted:what I said is what i meant. your ideas are garbage for the resons specified in that post. your attempts to paraphrase what i said into your garbage ideas are wrong. Your ideas resulted in losing every level of federal government, most state governments, and the total extent of the Democratic Party's voice on health care for the next thirty months being whoever crafts the sickest burn on twitter, barring the district that elected Ted Cruz deciding they want a Democrat. The pragmatic view suggests an adjustment of strategy is warranted.
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Mar 30, 2017 02:59
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eviltastic posted:Why on earth would they be fronting costs? Bad faith claim denial is like the poster child for getting a plaintiff side firm salivating over a contingent fee contract. Insurers are one of few entities that regularly get dinged with hefty punitive damages even in states with really conservative or hostile juries. Is there something different about the medical context? There's an awful lot of ways to drag your feet, no standardized recordkeeping protocols so proving bad faith is incredibly hard, and it turns out betting on sick/dying people not having enough energy to exhaust their legal options is a lot safer than you'd expect. At the end of the day, if I told you 15% of the time you spun the wheel you made 100K, 83% of the time you lost a couple thousand bucks worth of employee time, and 2% of the time you lost 400K, you start spinning that wheel and you don't stop spinning it any time soon. There's a reason for the direct relationship between number of claims denied and executive compensation in the health insurance industry.
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Apr 28, 2017 16:30
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esquilax posted:Medicare FFS denies just as many claims as other insurers, and I've never seen any evidence that shows insurers deny more claims when they have a profit motive (insured plans) versus when they don't have a profit motive (employer self-funded plans). Only one state mandates that insurers back up their numbers with anything more than "we say so," and it's Vermont. Law went into effect back in 2013. Miraculously, overnight Cigna's claim denial rates went from a claimed 2% to 21%. Funny how that happens.
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Apr 28, 2017 16:59
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clockworkjoe posted:I wonder what happened to this: http://thehill.com/homenews/house/319314-right-set-to-fight-back-on-town-hall-protests There were a couple of decent articles on this, but the short form is that the Tea Party as a coherent political entity died and died ugly around the 2012 elections, replaced by the Tea Party as lucrative grifting opportunity. There's nobody giving the Freedom Caucus marching orders beyond a vague sense of fundamental malevolence.
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Apr 30, 2017 00:52
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Yeah, while when insurance companies commit fraud it's far more blatantly evil- straight up killing people to make a buck- hospitals are by no means innocent. Fun fact: the all-time champion for Medicare fraud is currently the Governor of Florida. Rick Scott oversaw an institutional program of inventing patients, falsifying documentation, miscategorizing routine services, etc, to the tune of 1.7 billion in fines, and that's just what they caught him doing. When you get right down to it, the root of the problem is that hospitals are incentivized to rip off insurers, insurers are incentivized to rip off hospitals, and neither one really has any incentive to give a poo poo about you being healthy.
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Apr 30, 2017 17:00
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Sir Kodiak posted:This may be a consequence of those arcane rules that nobody understands, but I don't understand how passing the Obamacare repeal influences whether later, unrelated legislation is revenue neutral. Whole idea was to save a ton of government money by axing ACA provisions, allowing them to return that money in the form of delicious delicious tax cuts.
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May 3, 2017 21:16
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Sir Kodiak posted:But I thought the point was to repeal the Obamacare taxes while repealing the spending, so that they are already using that saved money for tax cuts. As has been pointed out in this thread, one of the real complaints about Obamacare is that it raised taxes on the wealthy. Is it that they're going to cut the spending so much that there's room for even more tax cuts beyond the Obamacare taxes? Essentially! The details rapidly hit the point where it's difficult to separate the outright lies from the merely stretched truths.
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May 3, 2017 21:41
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Xae posted:Medicaid's reimbursement rate can be as low as half of cost. Carefully eluded are the insurance careers dedicated to figuring out when denial of coverage to sick people would be most profitable. Someone's gotta write the algorithms to determine when someone's about to get sick and their profile 'could use a once-over,' for, uh, no reason. Killing private health insurance won't fix American health insurance at a stroke, but it will eliminate something whose continued existence at anything like its present power is reliant on the system remaining broken.
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May 8, 2017 04:29
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axeil posted:Yeah in a system where doctors will accept a percentage of what they would bill to insurance just to have payment in cash and not dick around with insurance seems to indicate there could be a lot of savings by just nuking the insurance companies and having a true socialized program. The amount of hospital overhead dedicated to having the paperwork for twenty separate insurance systems payment method for every conceivable DRG code is also one of those gigantic "cost savings available here" signs, and that's before you factor in the dedicated Department of Nuh Uh responsible for contesting claims denied on grounds the hospital did something wrong. Within which, of course, can usually be found the department of maximizing claims convincingly, a profitable line of work for an ambitious hospital system. Going to full on fabrication is a little more hazardous, but everyone's got a dedicated "how do we bill the maximum" team.
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May 8, 2017 05:03
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Leon Trotsky 2012 posted:Brookings did a study a couple of years ago and came to the conclusion that the higher rate Americans pay for healthcare boils down to three big things. Man, that one was sneaky. "Medical professions, pharma, and medical devices." "therefore pay doctors less." Let's just wrap the second two parts of the equation up with the first, shall we? You're right that doctors will be paid less, but I am always amazed at how easily pharmaceutical companies price-gouging sneak out of this conversation. I mean, I get it, the only entity that could conceivably negotiate drug prices is the government, both insurers and providers are just short of helpless before them, and neither insurers nor providers really want any more evidence pointing to "the government taking this over is literally the only way to fix this," but man, the facility with which they elude being fingered as part of the problem. The medical device side of things you see more arguments about, because there you have a strong case government ain't helping. The split second medicare okays your new widget, you saturate the old-people advertising networks with "OUR THING GOT OKAYED BY MEDICARE, ASK YOUR DOCTOR ABOUT IT, IT WILL HELP YOU, AND IT'S BASICALLY FREE." quote:Those are all politically unpopular things to say and doctors have a very strong lobbying influence and enjoy a very high level of public trust, so it is difficult to get done. The insurance companies promote a ton of waste and perverse incentives, but they are not the primary drivers of cost compared to Canada/Europe. No, no they're not. Pretending doctors are, though, is only possible when you pull the trick you just pulled.
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May 9, 2017 18:54
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baquerd posted:Yes, yes, and yes. There is also someone at the doctor's office (well, managing hospital, most likely, these days) whose job it is to decide whether or not they can get away with charging you extra based on that judgement call when they present the bill to your insurance company. There is also someone at the insurance company whose job it is to decide whether or not they can get away with telling the doctor "gently caress off, we're not paying for that, collect from the patient or nobody." There is also someone at the doctor's office whose job it is to decide whether or not they should fight that person over getting them to pay or if it'd be easier just to try to collect full cash value from you. We have built an amazing system here.
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May 13, 2017 20:05
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FAT BATMAN posted:Does this mean that if I take an expensive medicine every 8 weeks that without insurance costs $8000 (Remicade), that makes them more likely to fight it bc they're taking into account that I probably don't have that kind of cash? Ahahahaha. No. Your financial status has nothing to do with this exercise. The debt collectors they'll sell the bad debt to will start hitting up your family members.
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May 13, 2017 20:23
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far more important for Senate Democrats to preserve their precious Posting Energies than to be seen visibly fighting for something, indeed, anything. any day now all that stored-up political capital's gonna get spent. aaaaany day now.
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Jun 13, 2017 18:12
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Mr. Nice! posted:so you would have them throw a fit for what purpose? They're going to delay the bill a trivial amount of time at most. It's not about saving up political capital. It's about being realistic. There's not a god damned thing they can do, so instead they must be pragmatic and work where they can. the purpose is to demonstrate that in the eyes of Senate Democrats, there are things worth delaying, because one week longer is that many more lives saved, and that many more chances for something to leak that makes someone decommit. this will prove the democratic party is pragmatic. the purpose is to demonstrate that as far as the Democratic Party is concerned, this is not a game, this is people's lives saved, and if they are going to be defeated by Republicans they are at least going to go down swinging. this will prove the democratic party is moral. the purpose is to demonstrate that the Democratic Party will act on a single goddamn thing it claims to believe. this will prove the democratic party deserves to continue to exist.
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Jun 13, 2017 18:19
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evilweasel posted:it won't delay things by a week, or any amount of time at all, and if it did they would do it as they already said for someone insistent on the pragmatic value of curling up into a whimpering ball to die quietly, you sure make a lot of noise
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Jun 13, 2017 18:25
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Mr. Nice! posted:It's not going to last a week. It's going to delay it by minutes. They have zero ways to effectively delay the bill at all. If McConnel has 50 votes, the democrats have two options: throw a fit that does nothing, refuse to participate in senate business and get zero say in any legislation, and get called out by every media outlet for it OR continue working on legislation where they have input instead. goodness. called out by every media outlet for throwing a fit about Republicans trying to kick millions of people off health insurance. i can see how there's no potential political benefits to doing that, certainly.
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Jun 13, 2017 18:26
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Mr. Nice! posted:They're going to call out the republicans constantly in media and otherwise. They're going to do it on the floor of the senate. They're going to do it at townhalls across the country. man, sure would be awful if there was a single media incident that they could point to at those townhalls. how cutting the news is going to be about Democrats throwing a tantrum over Republicans voting to kill people.
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Jun 13, 2017 18:31
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evilweasel posted:you get real whiny and surly when forced to confront facts and lash out like a small child the ultimate sin in the eyes of the Pragmatic, Centrist Liberal: 'make a show out of giving a poo poo.' they genuinely wonder why they lost everything to a senile game show host, you know.
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Jun 13, 2017 18:33
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JesusSinfulHands posted:To be fair to Obamacare's legislative strategy, it looks like regulations such as guaranteed issue, community rating, and essential health benefits can't be repealed without 60 votes in the Senate, which is a major impediment to GOP repeal efforts. I know some conservatives are harping on legislative mumbo-jumbo about Pence being able to waive away those rules, but if they abandon the 60-vote threshold for passing healthcare bills, Democrats are definitely pushing through the public option if not single payer next time they get a simple Senate majority. yeah, about that. ask Nancy Pelosi about if single payer is ever going to happen, the answer may surprise you. it is important we be rational, centrist, and reasonable about a Democratic health care bill, by which of course I mean "let Blue Cross/Blue Shield write the entire goddamned thing, what's the worst that could happen, we lose literally every level of government to a senile game show host running on a platform of gently caress The Mexicans?"
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Jun 14, 2017 05:21
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evilweasel posted:that's wrong and stupid turn on your monitor
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Jun 14, 2017 16:18
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Zachack posted:A bill can be too terrible for a moderate debatable
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Jun 20, 2017 22:02
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which, BTW, is the way they're appeasing insurance companies in more ways than one. as a replacement for the mandate, it's impotent and awful, but as a handout to insurance companies it is magnificent. that bit effectively relegalizes rescission. "whoops we didn't get that payment, you cant get back on for six months, please don't mind that per our actuarial tables you will be dead by then."
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Jun 24, 2017 17:52
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ThisIsWhyTrumpWon posted:You don't seem to understand that Healthcare is a limited resource. unlike the Ingenuity of the Small Business Owner, which is of course limitless, only a limited amount of health exists to be chipped out by pickaxes from the Health Mines
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Jun 27, 2017 15:28
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the fate of the NHS: ridiculously better numbers than us in literally everything except for five-year survival rates on some of the rarer kinds of cancer
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Jun 27, 2017 16:12
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ThisIsWhyTrumpWon posted:Ok lets invite some of the people from UKMT in here and ask them about how good of an idea it is to hand the government control of health care when the country just elected a literal fascist dictator and one of the parties like punishing poor people for fun. turns out they run a government health-care service poorly. the thing is, the incentive structures are such that even they cannot make it worse than our system, because even the most rapacious poor-murdering prick is confronted with the economic reality that it will actually cost them more to offer minorities less healthcare. it's been ten years of right-wing rule over there, man. the NHS still brutally kicks our asses, in both money spent per capita and number of people dying in agony that could have been averted.
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Jun 27, 2017 16:20
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silence_kit posted:Is medical malpractice actually a big issue for doctors or are they just overreacting? Depends on what you mean by actually. Is it an issue doctors care about? Absolutely. You want a doctor's opinion on how to lower medical costs, they'll always find their way towards talking about tort reform, because that's the one piece of the puzzle that actually impacts them financially. Malpractice insurance ain't cheap, and there are more than a few no-win scenarios where they can technically be sued for their decision no matter what they decide, and worst case scenario lose their license to practice medicine. Is it actually something that seriously impacts them, ahahaha no. The same logic that means insurance companies are usually safe screwing someone who's about to die means doctors are usually safe committing malpractice, and where tort reform has been accomplished it hasn't done poo poo to costs. But human risk analytics being what they are, the fear that any second Zeus might hit you with a thunderbolt for a gently caress-up scares people a lot more than knowing Zeus is going to hit you with a thunderbolt if you gently caress up.
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Jun 28, 2017 21:50
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jivjov posted:So republicans are just libertarians playing the long game? better to say libertarians are republicans who haven't figured out not to give the game away yet. see: Ryan, Paul
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Jul 19, 2017 14:59
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asdf32 posted:McCain has been one of the better republican critics of trump and right now only republicans matter. in the spirit of his criticisms of trump, I am Deeply Concerned about his brain cancer, but will still vote for it killing him painfully
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Jul 20, 2017 03:19
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yeah, turns out people whose job it is to facilitate murder get defensive when other people say "this person chose to use their life actively facilitating murder, gently caress him"
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Jul 21, 2017 15:48
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as our friends in california can attest, don't hold your breath on that one
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Jul 24, 2017 16:27
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Arkane posted:Single payer will be an amendment, brought by Steve Daines....allegedly echoes of the time the house passed "well, ALL members of congress have to be on Obamacare then!" and the Senate sent back "sure"
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Jul 27, 2017 00:06
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ill people... might not drag themselves into work? what nightmarish world is this where such hellish realities might come to pass
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Aug 29, 2017 18:29
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Hieronymous Alloy posted:The "what health care policy should we propose" question is not nearly as important or interesting as it sounds because hiya, public service announcement, the fee for service model is utterly loving broken in and of itself, and results in the worst kind of adversarial relationship between providers and insurers: providers trying to defraud insurers, insurers refusing to pay providers on grounds "this claim would be much cheaper for us not to pay out on," and the path of least resistance for any time neither side backs down being "well, gently caress the patient then." in a world where the hospital makes a couple hundred thousand off your heart attack and runs a net loss on giving you statins that will reduce the odds of that heart attack, it's amazing how stingy cardiologists are with statins before your first MI. famous study from a couple years back: the nation's rate of death from cardiac illness measurably drops during the American College of Cardiologists' annual meeting, because in their absence, their backups don't try any of the fancy expensive poo poo that kills people. capitation's the way you do this that incentivizes both sides to actually try to give a poo poo about their patients, because when you flip those financial incentives around it is amazing the lengths cardiologists will suddenly go to to avoid having to roll the dice on opening you up.
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Aug 29, 2017 23:14
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Hieronymous Alloy posted:In practice anything I've seen other than fee for service leads to payors (i.e., if you're talking capitation, MCO's) just trying to shuffle around who had to cover the least fortunate / highest expense patients, and/or denials of any expensive care based on pretextual grounds ("Yes you can't walk, but we don't think this wheelchair is medically necessary for you.") no disputes on the last paragraph, at least; it's just that from there step two is figuring out a viable capitation model, because in a world with a public option you are going to see hospital fraud go from an appreciable-but-relatively-minor issue to a significantly larger one. your experience matches up with mine; capitation systems run by private insurers operate on the principle of tying up all the expensive people and punishing hospitals you don't like with them, and capitation systems run by providers operate on the principle of trying very hard to pretend expensive people do not exist. as a result, the question "how do you design a payment model to minimize hospital fraud" turns out to be very important to answer, and a well-designed government-run one is in a position to sidestep the usual problems with private insurers maximizing payout by killing people. it turns out you have to put more thought into how to improve things than saying "you haven't thought enough about this" to the people who want to do more than you and calling it a day. who knew.
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Aug 30, 2017 15:29
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patients attempting to defraud insurers or providers is almost nonexistent- this is true. financially speaking the opioid crisis' class of pill-seekers is a drop in the bucket! shame about the other costs, but hey, free market, we can successfully claim they are not the health system's problem, they are social services' problem now. hospitals "aggressively pricing" treatment, i.e. defrauding insurers, that's a genuine problem, and costs insurers an appreciable amount of money. insurers coincidentally deciding that the most expensive treatments, for the people least capable of contesting the issue, are the ones it's most profitable to deny coverage on? costs hospitals an appreciable amount of money. from both parties' perspective, the solution to their fraud problem is the other guy's fraud problem.
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Aug 30, 2017 17:37
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evilweasel posted:the democrats passed obamacare knowing it was going to cost them elections (though it cost them a lot more than they expected) no, honestly, really, we care about giving UHC to people, even though we nobly accept it will cost the people who deliver it elections in related news, I admit no knowledge of this "california"
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Sep 1, 2017 22:15
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Peachfart posted:Agreed, of course this logic means that Bernie Sanders also doesn't want UHC since he was against the rider added to the Obamacare repeal that had UHC. opposition to a republican poison pill is exactly the same as a democratic supermajority immediately killing a bill it is fully within their power to pass good job gold star
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Sep 2, 2017 01:44
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Dead Reckoning posted:Writing good laws is actually really hard, especially when you're making what the Cali legislative analyst called, "unprecedented changes to a mature health care system." Activists aren't interested in the details of making good policy, because it turns out some of what they want is impossible or unpopular once people find out what it will cost them. strategy works pretty well for police unions, DR why not let other people have a taste
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Sep 4, 2017 20:39
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Dead Reckoning posted:I literally have no idea what you're talking about or its relevance to crafting workable UHC policies. it turns out that unceasingly demanding that other people work out the details on why, precisely, you should get everything you want is an effective advocacy strategy. now imagine that strategy was being used to call for providing health care to people, rather than explain why an eight-year old had his summary execution on tape coming.
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Sep 5, 2017 16:17
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