AnonymousActuary
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User ID: 2163
AnonymousActuary
8d ago
https://slatestarcodex.com/2016/09/07/reverse-voxsplaining-brand-name-drugs/
This should be required reading for anyone in this site commenting on it.
AnonymousActuary
9d ago
In any given year, healthcare expenditure will not be normally distributed across the population, but instead heavily skewed to a small segment.
This is extremely true and makes me wonder if we could put a few more chronic conditions in Medicare like we do with dialysis and cut costs enough for everyone else that it could be closer to actual insurance (literally moving the sickest 1% of the population or so could cut premium by 40% - sickest 5%, more like 70%)
Honestly, I kinda wonder why Obamacare wasn't more like this - seems like it would've been an easier sell to put more people on Medicare than what the ACA actually was, and it would've left people alone as far as purchasing more expensive plans? You'd have to figure out how to compensate providers somewhat, but I'd imagine there are ways (bump up Medicare reimbursement rates a bit, slight increase in Medicare taxes, slight increase in corporate taxes to offset decrease in large group premiums from some employees care shifting to Medicare?)
AnonymousActuary
9d ago
oh I'm just saying if you set prices at 100% of Medicare. You can have transparent prices that are higher.
I know United (ironically) has been doing some work around varying copays such that the member is pointed towards providers with more favorable contracts with United. Maybe a little promise there.
AnonymousActuary
9d ago
If everyone pays 100% of Medicare a lot of providers are going out of business. Commercial rates subsidized Medicare to some extent.
AnonymousActuary
11d ago
Do you have kids?
AnonymousActuary
17d ago
He's definitely right that the ACA puts that cap on non-benefit expenses (including profit), but I would tend to agree that I'm not sure how much that raised premiums. The main thing the ACA did was put the onus on paying for chronically ill people not on medicare/medicaid/Employer insurance on the taxpayer (via APTCs) and the unsubsidized making more than 250% FPL (to some extent) and 400% FPL (to a very large extent).
Not sure why we didn't just put those chronically ill in Medicare like the dialysis population....though eventually you run into the problem that Medicare rates don't sustain providers - commercial population subsidizes. Tricky little issue we have here.
AnonymousActuary
17d ago
Story in healthcare same as everywhere - you have an increasingly rich populace with a rivalrous good that is non-discretionary (housing, education, childcare, healthcare), and the Government/private actor response is to subsidize demand and regulate supply than go shocked-pikachu-face.jpg when costs skyrocket.
AnonymousActuary
17d ago
Lasik is unironically used as an example of a field that insurance doesn't touch that has in fact gotten orders of magnitude better and cheaper over the years.
AnonymousActuary
19d ago
This is something I've actually been meaning to ask about - I saw somewhat credible comments that this was due to deregulation under Trump, but haven't heard the other side of the story.
AnonymousActuary
30d ago
any D appointee would have, maybe, but he was the one who actually had.
AnonymousActuary
1mo ago
enhanced ACA subsidies might be on the way out, which were new in the last few years. The status quo subsidies I have seen nothing about cutting.
I too would like to see our gerontocracy see deeper cuts but that seems to be politically untenable, to say nothing of the giant wealth transfer to them that was our COVID policy...
AnonymousActuary
1mo ago
Not commenting on your main question, but when it comes to whether someone gets help with Medical expenses I'm confused what you are referring too.
- ACA plans are heavily subsidized for (currently) everyone regardless of Income, and pending ARPA subsidy expiration will stilly very heavily subsidized for people <250% FPL and somewhat subsidized for under 400% FPL.
- If under <100% FPL Medicaid exists and is heavily subsidized care
- Children with serious chronic illnesses (from Cancer to more substantial handicaps) can be eligible for Medicaid including at-home nursing at no cost to their parents.
Texas has not expanded Medicaid, so if this person is somehow <138% FPL but not eligible for Medicaid otherwise they might be in trouble (weird coverage gap thing Congress should absolutely fix by just making everyone <138% FPL eligible for CSR 94 plans + highest level of APTC subsidies), but #3 would still apply.
AnonymousActuary
1mo ago
what substance he had was quite partisan - he argued against Little Sisters of the Poor, for instance
AnonymousActuary
1mo ago
I tend to think some of healthcare spend could be simplified as we regulate supply, subsidize demand, and then go shockedpikachuface.jpg when costs increase faster than inflation.
But the loop she identifies of admin is definitely not nothing and contributes to the regulation of supply.
I'm not sure there's an easy fix, I end up wondering if you just hope pharmacy innovation eventually gets you out of some of the trend (hep C drugs, HIV drugs, RSV vaccines, etc)
AnonymousActuary
1mo ago
This was great - reminded me of Siderea's great blog series on the spiral of admin that afflicts modern healthcare: https://siderea.dreamwidth.org/1179450.html
AnonymousActuary
1mo ago
Whatever Florida is doing is clearly right and everyone else should copy them.
AnonymousActuary
1mo ago
if you read any coverage of DeSantis back when he seemed like the rising star you would realize it is beyond likely, it is certain.
AnonymousActuary
1mo ago
AnonymousActuary
1mo ago
AnonymousActuary
1mo ago
AnonymousActuary
1mo ago
I swear someone had a comment thread recently about late term abortions, reasons for them, how many are motivated by maternal health/health of the fetus versus otherwise...I thought I had saved it but cannot find it. Anyone have any ideas?
AnonymousActuary
1mo ago
all well and good, as long as we recognize the official state religion as such and express the same degree of concern wrt it, as OP suggests
AnonymousActuary
1mo ago
honestly on these hail Mary's I never understand why they don't rush 5. 6 should be enough on the back-end anyways? I guess maybe you are worried about hook and ladder type stuff but Washington kept 6 back to block + the QB = only 4 players downfield anyways. Make him get it out early and there's not a lot that can go wrong (Miami against NE a few years back being one potential counterpoint).
This play was weird though because of the spy, but 6 should be able to block 4 for a while even if they hadn't had the weird spy option.
AnonymousActuary
1mo ago
protest to WWI, was it not?
I think there is something different in a lot of these areas in that the fans of (insert Taylor Swift, LEGO, Star Wars, Marvel, Funko Pops, Video Games etc) would probably still have been fans in the past, at least to some extent, but due to trends around marriage and having kids, instead of listening to a radio station or going to a movie or whatever they have high levels of disposable income and time to spend on their hobbies that would otherwise be spent on children.
I personally see this as net negative for society, others might see it as net positive, but I think it is hard to argue it is not happening.
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