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Zauper posted:In order for any of that to work, they would need to all be in the room at the same time, or look at the others notes. Given that they don't, that's a flawed assumption. given that none of them were doctors, that would also be a flawed assumption. thankfully, in the real world, those are in fact logged independently and conferred on when the answers differ. it's half the reason for all this electronic record standardization poo poo, there are programs being rolled out as we speak to help automatically flag precisely that to take some of the human error out of the equation. i know. it sucks being on the receiving end of a vast, uncaring bureaucracy to which you are nothing but an entry in a spreadsheet with a dollar sign attached. rest assured not ALL the steps involved are based purely on profit.
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Nov 1, 2018 02:02
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Zauper posted:They definitely are not electronically logged from the trash can. In my experience (with specialists, my PCP doesn't do this questionnaire duplication stuff), the only ones logged are the ones the doctor asks. Because he's logging them as I answer. like Kommienzuspadt points out, the nurses often have their own parallel systems. (the institutional origins of which are funny, in a very ahahahah jesus christ what the gently caress kind of way: when a doctor gets old and lovely, it was extremely useful to have a paper trail on hand to justify firing his rear end. improved patient outcomes were considered a pleasant side effect.) synergizing those, hypothetically, results in the holy grail everyone in the industry has been chasing since the dawn of EMR, a chance to automate away a tired nurse and a checked-out doctor missing something real expensive. the institutional wrangling over the most financially viable definition of "missing something real expensive," of course, is still the stuff of nightmares, but it's a nightmare that's a few business cycles away from being properly addressed at this point. the first round of studies on the implementation are going to have to come back first.
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Nov 1, 2018 02:16
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Pablo Nergigante posted:This is why the profit motive belongs nowhere near health care as Zauper can explain to us, it just wouldn't be cost-effective for insurers to cover these people how is he to keep these job, if he was expected to stop these people from dying. https://www.youtube.com/watch?v=QEJ9HrZq7Ro&t=16s
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Nov 20, 2018 16:38
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Leon Trotsky 2012 posted:If you were to put it to a vote and have politicians or the general public decide where to allocate, then these people likely wouldn't be getting treatment either. the effort and manpower were already thrown at it by the government. a solution was found. the contribution of pharmaceuticals and insurance, in their totality, are setting a price on the grounds it's less profitable to cure the disease than to treat it, and deciding nobody gets it as a result.
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Nov 20, 2018 17:13
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Leon Trotsky 2012 posted:That post was mostly about the problem with orphan diseases as a whole and not this particular instance. No matter where the funding or direction comes from, you will still have to "pick" people who won't get their treatment developed or supplied. whipping out excuses that you know don't apply to own the libs
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Nov 20, 2018 17:21
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VitalSigns posted:It already yielded a cure that's not what broke in this case dummy it's echoes of talking with evopsych true believers. every mention of observable reality being in conflict with their theory met by a new and more exciting rephrase of "but if that WEREN'T the case-"
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Nov 20, 2018 20:26
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Flesh Forge posted:That's fine I guess aside from the part where he claims it's entirely normal and good, yes
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Nov 21, 2018 19:42
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but he's not wrong in that particular post.
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WampaLord posted:You have missed my point entirely, congratulations. there is a caste of liberal whose moral compass, in its entirety, is the need to defend Normalcy. what is Normal must, necessarily, be good. because I am normal. and therefore I must be good. if normalcy is not good- if normalcy in fact includes hovering over the sick in the hopes you can deny them further medical care thanks to their sleep habits- then I might not be good. they tend to get really upset when someone isn't reassured by the statement "all procedures were followed."
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Nov 21, 2018 19:48
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burn down health insurance companies and salt the ashes? but they're following all the rules they wrote! there must be some mistake. you must be being unreasonable. the system says you die bankrupt. so you must deserve to die bankrupt. unlike me. who is normal. and follows the rules. and cannot possibly imagine a situation where I'm taken out-of-network for an emergency, or just get coverage denied on grounds some insurance guy somewhere thinks he needs to keep the provider network honest. those things happen to Bad People. you can tell. the system wouldn't punish them if they hadn't made a mistake.
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Nov 21, 2018 19:53
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there is something so painfully illuminating in the finest defense of trying to get people denied medical care for their sleep habits being a shrug emoji. "i don't give a poo poo about this. so why should anyone else."
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Nov 21, 2018 20:19
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Flesh Forge posted:No, those people are fine, you're a prick though insurance companies deny people coverage based on their sleep habits? i sleep someone calls the people doing this a nasty name? real poo poo
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Nov 21, 2018 21:33
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Flesh Forge posted:"Those insurance companies are garbage." - Ok good to see we are now discussing more topical matters than healthcare reform in the healthcare reform megathread, such as how you feel disrespected by the arguments of forums poster Yeowch!!! My Balls!!!
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Nov 21, 2018 21:41
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Malcolm XML posted:Medicare fraud is real lol but it's usually collusion between patients and doctors or possibly providers creatively billing or lying strike that, reverse it. usually the doctor isn't in a position to get a kickback. providers, on the other hand, are INCREDIBLY powerfully incentivized to bill you as the most expensive thing possible
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Nov 29, 2018 22:00
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Spacewolf posted:Don't people usually mean doctors when they say providers...? most people, yes, but in the healthcare business arena doctors are an inconveniently expensive set of Provider employees and contractors. when you read "provider" replace it with the word "hospital" and you will only occasionally be wrong.
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Nov 29, 2018 22:06
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Lightning Knight posted:So the hospitals and the insurance companies are colluding to commit fraud or unethical practices, in billing and not generally the doctors, is what you're positing? those two are rarely colluding, actually, and it's one of the biggest sources of friction in the system! unethical doctor practices are, despite the amount doctors make, generally of the good old-fashioned employee unethicality type. half-assing it, loving patients/staff on the job, stealing poo poo, getting high and/or drunk, lying about billable hours, and general incompetence. but doctors are not paid by how expensive the problems they take care of are (well, directly, at least) and doctors are not the ones who write up the bill to insurance companies. providers, however, are paid in direct proportion to how expensive the problems they take care of are. and they are the ones who own the billing department. so, with the billing department given the choice of describing checking up on your sniffles as a Standard Checkup or as a Pneumonia Screen? spoiler warning, there is someone looking over their shoulder politely reminding them that this is a business, and it would be ever so helpful to categorize it as the one that lets them charge insurance more. and that's only if you're worried about being caught! flat-out inventing patients you say you've treated and procedures you say you've subjected them to is FAR from unheard of. the all-time champion at this is currently the junior Senator from the State of Florida. and then on the other side of the equation, fighting this, are the insurance companies. who make their money by strategically refusing to pay for the service their customers paid for. on the grounds that "nah, that doesn't look right" or "nope, looks expensive."
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Nov 29, 2018 23:44
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Lightning Knight posted:Well this is lovely. What should be done about this on a policy level? I imagine the answer is "nationalize healthcare" but I assume there are intermediate steps we could take? the answer that some people have tried to make work is consolidating insurers and providers under one roof. Kaiser out on the West Coast is the biggest example, an insurance company that also owns a shitton of hospitals. they still run into the perennial problem with this model: provider-owned insurers lose money on insurance, and insurer-owned providers lose money on providing. one of the biggest underlying issues, that helps but will absolutely not be a silver bullet, is a switch from a fee-for-service to capitation model. remember how providers get paid by how expensive the problems they treat are? this means that, from a raw economic perspective, any amount of preventative health care, trying to stop you from having a heart attack, is providers picking their own pockets. if I can make five hundred dollars from putting you on statins now, or five hundred thousand from putting your heart back together after it tries to rip itself in half? sure, option B is hopelessly inhuman and monstrous. but this hot tub is really nice. this problem in particular is solved under a capitation model. in a capitation model, a hospital is given a big sack of money, and a big sack of patients. it is told "this is for those. if you do a good job, you make more. if you do a bad job, you make less. good luck!" this model has the -minor- issue, however, of being reliant on insurance and providers playing nice with each other. the insurer is fundamentally going to want the money bag to be as small as possible and the patient bag to be as expensive as possible. the provider is going to want the reverse. and both are going to fight like hell over how best to structure that such that people at risk for heart attacks don't piss in their nice clean risk pools. as opposed to now, when only insurers are trying to ice them out.
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Nov 30, 2018 00:01
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Discendo Vox posted:I'd disagree with that a bit. Fee for service also creates perverse incentives for physicians. definitely, but they're a lot less dramatic than a provider group cutting all funding for preventative care on grounds its existence is cutting their own throats financially.
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Nov 30, 2018 00:05
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in conclusion, the profit motive in health care, uniquely, is not a land of contrasts, and the insurance industry as it exists in america today needs to be burned down and the ashes salted. in deference to their decision to pay ten dollars for a dying comedy forum, Reik and Zauper will be given fifteen minutes warning before their workplace's unscheduled demolition.
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Nov 30, 2018 00:16
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Discendo Vox posted:I'm sensitive to it because private practitioners and networks are a locus of abuse for things like prescription drugs and alt med abuses. definitely. it's just that by and large private practitioners are a thing of the past these days, outside of fields like psychiatry. and all the damage a single Doctor Feelgood can do to gently caress a community up pales before the population-shattering power of "hey could we switch to this new pain medication, it's gotten a bunch cheaper since the invasion of Afghanistan for some reason."
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Nov 30, 2018 00:19
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https://www.politico.com/story/2018/12/10/establishment-democrats-progressive-medicare-1052215 nothing particularly new in this piece, but I loved this line. the most credulous, brain-dead neoliberal zombies on the face of the loving planet posted:Medicare for All skeptics point to the lengths the Obama administration went to secure industry support for the ACA prior to its passage in 2010, an effort that did little to insulate Democrats from eight years of political blowback. Yet another major government health care expansion could be even more painful, they say. hmmm. we gave them everything they asked for, and they hosed us anyway. but if we don't do that this time, maybe they'll gently caress us harder?
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Dec 11, 2018 17:04
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KingNastidon posted:do you believe this would have any impact on private sector biopharmaceutical investment and innovation moving forward? imagine the number of man-hours freed up by you, personally, no longer having to tell yourself "i am a good person, despite my paycheck being based on a program of amplifying human suffering."
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Jun 20, 2019 15:27
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KingNastidon posted:The belief is that any and all existing R&D spend would be nationalized with centralized budgeting and prioritization. Drug development currently moves forward based on risk adjusted NPV or rate of return that is acceptable to shareholders. In this future it would be some combination of probability of technical/regulatory success, unmet need, and reduction in total healthcare expenditures by addressing that unmet need. Voters would have no real idea how prioritization is determined nor need to care, similar to how voters today largely aren't aware of how NIH allocates its budget. and imagine a world where you, drug marketing analytics boy, could devote your efforts to something like that instead of scaremongering over how if your employer doesn't get to gouge diabetics on insulin, nobody will ever develop another treatment ever again. people on a poverty-wracked island that's been the subject of unremitting trade warfare for decades managed to figure out a way to prevent mother-to-child HIV transmission your paymasters decided just wasn't cost-beneficial enough to look into. an industry that lacks you is demonstrably better at providing the aid that is (hypothetically) the thing it is there to provide. imagine the horror, friend. the horror of people working on alleviating human suffering without having to run it by some insufferable nerd who says "well, yes, but can we hold the threat of death over them in order to extract rents if we give them this?"
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Jun 21, 2019 05:19
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KingNastidon posted:Yes, Yeowch, we get it. Socialism good, people that participate in profit-seeking industries today bad. Do you just scour the forums looking for people you don't like so you can make mean spirited personal comments while contributing zero subject area expertise or moving the conversation forward in an interesting way? feel free to click on the question mark by my name. i've been in this thread for considerably longer than you, and you might learn a thing or two about those icky "provider" people you're distantly aware have something to do with how healthcare actually gets distributed. not only can it be done. it has been done. and it has accomplished things it is your job to prevent from happening, on the grounds they're just not profitable enough. because there is an entire world of inefficiencies you have been carefully trained not to see, on the grounds you are one of them. you are extremely concerned about the drag on the system provided by the "free-riders" on pharmaceutical research. and that is a worthy concern!  it's just a little funny to hear concerns about drag coming from the bulbous, pus-seeping tumor on the underside of the wing.
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Jun 21, 2019 05:56
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silence_kit posted:Yeah, in this thread usually the insurance companies are the bogeyman (I think a lot of this is because this is who everyone interacts with when it comes time to pay for health care, and so other causes of high cost in the system get projected onto them) and get the lion's share of the blame. I suspect that the cause of America's health care cost problem is more complicated than that, and to really do a good job of reducing cost, everybody in the industry would have to take a haircut. they exist in the unique position of their value-add explicitly being jack poo poo. providers and pharma both gouge in unreal, horrific ways that need to be dealt with, but they provide a service beyond figuring out who it's most profitable to kill, and so require a response to 'b-b-but this would destroy our business model' beyond "GOOD, YOU loving CORPSE-EATING MONSTERS." American health insurance companies do not have that saving grace, and so make an easy primary target for regulatory intervention.
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Nov 5, 2019 02:12
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KingNastidon posted:Even if importation from India was 100% safe it would still be short-sighted policy that throws a bunch of wrenches into long-term drug development decision process. No biotech VC is going to invest in the initial clinical development/regulatory process for novel small molecule drugs knowing the launch price will be set at India manufacturing cost. Think recent examples like TKIs in hematology/oncology, DAAs in Hep C, ARIs in prostate cancer, etc. Allocation of development dollars will shift to biologics and personalized cellular/gene therapies where importation is less of a threat. if kingnastidon can't keep charging people a 50000% markup on insulin, and killing those who can't pay, how can his masters be expected to invest in other drugs with a much lower profit margin??? please do not ask what incentivizes them to do that under the current system, that question is communism.
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Dec 26, 2019 16:35
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KingNastidon posted:Thanks for reading the first two sentences in the article, Yeowch. Always great to see your thoughtful contributions. tremendous fan of any article that starts with "yeah, sure, we're corpse-eating monsters grown morbidly obese on the flesh of the weak, -BUT-" the counterargument remains the same it was last time you tried pushing this garbage. people on a poverty wracked island that's been the subject of constant trade war for decades figured out how to prevent mother-child AIDS transmission. all that delicious blood money that you assure us you use for Helping People (tm) couldn't get there, for reasons you assure us had nothing to do with it not being profitable. you are complaining that your masters going on a diet would make them less fat. no more. no less.
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Dec 26, 2019 16:51
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KingNastidon posted:Who are my masters again, Yeowch? I think VCs and other investors would shift their funds away from small molecule development or biotech in general if drug importation and/or 75% branded price cuts were implemented. Do you disagree? It's okay to agree and say that ______ alternative should happen, even if it's not currently being proposed. the core mistake you are making- if I am being charitable, and it's not you actively lying to obscure the reality- is in the assumption the people you kill to keep your profit margins high die in the service of reinvestment into r+d. that is, empirically, not where your masters put that money. that money goes to you. Yeowch!!! My Balls!!! posted:you are extremely concerned about the drag on the system provided by the "free-riders" on pharmaceutical research. and that is a worthy concern! which renders this conversation not an impassive discussion of how to "preserve innovation," but a parasite wheedling in terror about how DARE someone cut off the stream of human misery from which he derives his sustenance. Yeowch!!! My Balls!!! fucked around with this message at 17:37 on Dec 26, 2019 |
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Dec 26, 2019 17:35
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