AnonymousActuary
No bio...
User ID: 2163
AnonymousActuary
3mo ago
Wesnoth has a place near and dear in my heart as one of the first times I grok'd tactics in a game like this. I was playing a mission and just kept slamming my forces against the enemy with no ability to make headway. I finally realized if I pulled back a bit I could stretch his reinforcement lines out and build up overwhelming force, upon which point I broke through and destroyed him. Was very empowering.
AnonymousActuary
3mo ago
The reason people don't care that much is they are insulated from the cost in most cases (and indeed most of the outrage comes from when those cases breakdown - such as Out of network bills).
I don't really care what the ER charged me, I hit my deductible regardless every year. This principal-agent problem is obviously part of the issue with increasing costs.
The bigger problem though is just that there is a very small portion of the population that is very expensive to treat, and you/your loved ones have a small chance of losing the lottery in any given year and being part of that population. That's why premiums keep going up so much/Medicare solvency is threatened and all that. Someone who goes to the ER a few times a year/has a baby with the accompanying IP stays etc. is still a very small utilizer in the grand scheme of things.
AnonymousActuary
3mo ago
Insurance companies are working on this - ie I've seen presentations about trying to build variable copays into an app so someone trying to go to an urgent care or ER can go to one the company has contracted with at a cheaper rate.
AnonymousActuary
3mo ago
Adolin story carries hard tbh
AnonymousActuary
3mo ago
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.
AnonymousActuary
3mo 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
3mo 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
3mo 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
3mo ago
If everyone pays 100% of Medicare a lot of providers are going out of business. Commercial rates subsidized Medicare to some extent.
AnonymousActuary
3mo ago
Do you have kids?
AnonymousActuary
4mo 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
4mo 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
4mo 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
4mo 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
4mo ago
any D appointee would have, maybe, but he was the one who actually had.
AnonymousActuary
4mo 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
4mo 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
4mo ago
what substance he had was quite partisan - he argued against Little Sisters of the Poor, for instance
AnonymousActuary
4mo 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
4mo 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
5mo ago
Whatever Florida is doing is clearly right and everyone else should copy them.
AnonymousActuary
5mo 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
5mo ago
I too am very smart and can't think of any difference between a drug that treats blood cancer and one that treats a lifestyle choice.
The comparison between the drugs that treat type 2 diabetes/cardiac issues and those in question is left for the reader.
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