yunyun333
5d ago
It's on page 30 as 'eliminations'.
UHC pays its own doctors more, and in general insurance companies will steer customers towards their own, more expensive facilities, but there's limited studies on how it affects care in general. You'd think that it should increase the number of procedures done at least, but that's not so clear.
The study found that when independent physicians integrated with a hospital, they changed their care practices (for example, by reducing the number of patients they put under deep sedation) and increased their throughput (measured by the number of patients they treated). Specifically, the integrated physicians reduced their use of deep sedation by about 3.7 patients for every 100 treated. However, patients of integrated physicians experienced “a significant increase in both major post-colonoscopy complications such as bleeding (3.8 per 1,000 colonoscopies) and other complications such as cardiac or nonserious GI symptoms (5.0 and 3.3 per 1,000 colonoscopies, respectively).”
The researchers found that the reduced use of deep sedation “at least partially explains the increase in adverse outcomes” and that it was “driven mainly by hospitals no longer allocating expensive anesthesiologists to relatively unprofitable colonoscopy procedures.”
Moreover, integration increased the number of patients a physician was able to treat and elevated reimbursement per procedure—integrated doctors were reimbursed about $127 more per colonoscopy procedure than independent doctors, or about 48% more.
yunyun333
5d ago
It's at least the reason for high drug costs.
If you look at UnitedHealth's 10-k, Optum (the provider network) made $253b in revenue, but $151b of that was 'internal eliminations' transfers from UnitedHealthcare (the insurance arm) to Optum.
https://www.unitedhealthgroup.com/content/dam/UHG/PDF/investors/2024/UNH-Q4-2024-Form-10-K.pdf
yunyun333
5d ago
Vertically integrated insurance companies can charge themselves more so it looks like patients get more bang for their buck. The PBM (owned by the health insurance company) charges the health insurance company a high price for a drug, increasing "payout" (numerator of the medical loss ratio) while simply shifting revenue internally. The same thing happens with insurance-owned clinics and pharmacies.
yunyun333
6d ago
Pharmacy benefit managers (PBMs) are supposed to negotiate drug prices between manufacturers, pharmacies, and health plans, since they can essentially pool negotiating power. In practice, they're integrated with the health insurance companies, so they rent-seek and take what are basically bribes from the manufacturers (in the form of rebates) to make the drugs "cheaper" to consumers, while also forcing independent pharmacies to take smaller reimbursements or lose access to their network.
yunyun333
6d ago
Doctors get paid well but the administrative burden is also a large part of the discrepancy. Providers have to spend way too much time negotiating with insurance companies over payments and what will and won't be covered. There's an entire business around denying as many claims as they can get away with. Part of it is inherent in a multi payer system (Germany's public-private system has higher costs than the UK) but there are plenty of aspects to the 'managed care' system, like provider networks and utilization management, that are unique to the US.
Similarly, drug development is notoriously expensive and the costs have to be passed down to the consumer at some point - but the insurance companies are hardly innocent bystanders forced to pass them through. Pharmacy benefit managers are supposed to negotiate reasonable prices/rebates and formularies between drug manufacturers, pharmacies, and insurance companies - but the three largest companies (Optum, Caremark, Express Scripts) managing 80% of all prescriptions are owned by UnitedHealth, CVS, and Cigna, which defeats the whole 'independent negotiator' thing and just makes them rent seekers at consumer/government expense. It also makes it possible to skirt the medical loss ratio rule by shifting profits.
yunyun333
6d ago
What will the future of the US healthcare system look like?
The current system is a patchwork of primarily employer-sponsored healthcare (60% of non-elderly Americans), the ACA marketplace (offering government-approved plans through private insurance companies), Medicare for the elderly, and Medicaid for the poor, disabled, and children. About 8-9% of the population is uninsured. Prices are higher and health outcomes worse than comparable developed countries.
Obamacare attempted to reduce the uninsured population by, among other things, implementing Medicaid expansion to all adults under 138% of the federal poverty level and granting tax credits to help defray the cost of marketplace plans (for incomes up to 400% of the FPL). During COVID, these subsidies were increased and expanded to higher income levels, but Congress allowed them to expire this year, resulting in average premium increases of ~114% for about 22 million people, although an additional vote is scheduled this month.
In addition, low-income adults utilizing expanded Medicaid will be required to demonstrate 80 hours of work per month starting in 2027. Mike Johnson framed this as kicking out unemployed young men mooching off the system - even the old welfare queen trope has been de-DEIified. Georgia already implemented a similar work-requirements program as part of their Medicaid expansion in 2023, resulting in the bulk of the money going to administrative costs and only about 9k out of 250k low-income adults enrolled.
As a result of all of this, the uninsured population will likely increase this year, which may even cause premiums for people with health insurance to rise due to a death spiral effect - if more people are uninsured and can't pay their medical bills, the costs may be shifted to covered patients.
The above article takes the pessimistic view that the system is unlikely to improve significantly, because tying healthcare to employment is such a nice perk for employers (the system started during WW2 when companies offered health insurance as a replacement for wage increases due to federal wage freezes). European or Canadian style universal healthcare certainly seems less likely than ever.
yunyun333
1mo ago
Drones have made armored assaults extremely difficult. It's just too hard to amass a strike force without being spotted, much less crossing the killzone. That's why they switched to light 'vehicles' like golf carts and whatnot - the best survivability is speed and concealment. The idea behind "Line of Drones" was to remove the need for frontline infantry - it hasn't lived up to those goals, but it's the reason they haven't collapsed when they have such a manpower crisis.
yunyun333
2mo ago
But I will also point out that what you demand was on offer in 47 and rather than accept them the surrounding Arabs went to war with Israel and lost.
Setting aside the question of whether it was a smart decision to reject the partition plan, it's easy to see why they didn't view it as legitimate. Imagine if Mexican immigrants petitioned the UN to split the American Southwest into a new Hispanic state because they (illegally) immigrated there in sufficient numbers.
yunyun333
2mo ago
Israel has four neighbors, two of which are borderline failed states and the other two are strong American allies. None of these countries are staging an invasion.
yunyun333
2mo ago
That's right below a headline about the hostages on my page.
'You're my life, my hero': Hostages reunite with families after two years
yunyun333
3mo ago
The US didn't lose vietnam because of rules of engagement. Americans and their allies killed a shit ton of civilians, most of which was never brought to trial internally or revealed to the public.
yunyun333
3mo ago
Who should have authority to order executions? It makes sense to push that up to the higher ups. Maybe the burden of evidence could be lower if they simply wanted to arrest him, although tons of people got thrown into military prisons for no good reason in afghanistan.
yunyun333
3mo ago
There's no evidence that they were fired at, although one vehicle did take damage from ricochet fragments of an M203 grenade fired by the convoy. They panicked and fired indiscriminately.
https://www.cnn.com/2020/12/24/opinions/blackwater-defendants-pardon-trump-opinion-oconnor
yunyun333
3mo ago
The us wouldn't have been driven out of Afghanistan if they decided to ethnically cleanse the whole place and start putting up housing like the Israelis do.
Why would Americans want to live there?
yunyun333
3mo ago
The beard issue is silly ;what's more concerning is Hegseth saying that rules of engagement are for pussies. He advocated for trump to pardon men like eddie gallagher and the blackwater operators at nisour square. At least for now the military is limited to blowing up narco boats and standing around federal buildings.
yunyun333
3mo ago
Saudis have dumped a ton of money into sports ventures like LIV golf and saudi league ft. ronaldo. They've also spent (a lot less) on esports/gaming such as the esports world cup where they crowned their own sponsored org as the victor two years in a row. The end goal, presumably, is to gain positive cultural influence in the west as opposed to simply oil, repressive islam, and terrorism. Maybe for pride as much as anything else.
yunyun333
3mo ago
There are plenty of studies on the relationship between vaccines and atopic diseases like asthma. Some find an effect but nothing like a 4x factor. https://pubmed.ncbi.nlm.nih.gov/36180331/
The study used in the hearing wasn't published. We can debate why that is, Siri argued that it was because they were afraid of losing their jobs. But plenty of scientists have published studies showing a correlation between vaccines and increased prevalence of various ailments.
yunyun333
3mo ago
We hit some new lows over the weekend with the MAGA gang desperately trying to characterize this kid who murdered Charlie Kirk as anything other than one of them and doing everything they can to score political points from it,
That's it? He didn't even, like, celebrate his death.
Seems like Nexstar is trying to butter up Trump for some deal that needs governmental approval in the future.
Tyler Robinson, Kirk shooter, has been caught after a family friend turned him in
The markings on the bullets described by authorities indicate that the suspect, Tyler Robinson, was steeped in online culture and included references to the Antifa , or the anti-fascist, movement. A fired shell casing was inscribed with “notices bulges OwO what’s this?” - a reference to a “copypasta” - a piece of text that is repeated over and over again, often to troll people online.
Authorities say one unfired casing had the words “Hey fascist, catch!” and three down arrows - a common symbol used to represent the anti-fascist movement. A second casing had the lyrics to a song “Bella Ciao” inscribed on it. The song honours WWII-era partisans of the Italian resistance who fought Nazi Germany.
The third unfired casing was inscribed with the words “If you read this, you are gay lmao” - again an apparent reference to online trolling humour.
Parents, keep your kids away from Discord. Will be interesting to see if this guy is a true believer or just ragebaiting.
yunyun333
3mo ago
The Qataris that funded Hamas with explicit Israeli approval.
For years, the Qatari government had been sending millions of dollars a month into the Gaza Strip — money that helped prop up the Hamas government there. Prime Minister Benjamin Netanyahu of Israel not only tolerated those payments, he had encouraged them.
During his meetings in September with the Qatari officials, according to several people familiar with the secret discussions, the Mossad chief, David Barnea, was asked a question that had not been on the agenda: Did Israel want the payments to continue?
Mr. Netanyahu’s government had recently decided to continue the policy, so Mr. Barnea said yes. The Israeli government still welcomed the money from Doha.
When is violence against a person justified? Usually the legal boundary is immediate threat. So if a politician is advocating for you to be put into camps, then that seems like a reasonable starting point. But then you have to consider 'reasonable fear of immediate threat' and things get much murkier. Is it reasonable to fear that pro-mass migration politicians intend to destroy your community with foreigners?
In America it's still only the crazies/extremely disaffected that are actually willing to go out and kill for politics, usually. People will cheer on the killer but almost none of these people would actually be willing to do something similar.
The British successfully invaded Afghanistan multiple times, but never held it for prolonged periods. Which is probably what the US should have done.
There's this book, No Good Men Among the Living, which argues that the US successfully destroyed the Taliban in the invasion, but then stupid governance and our taking sides in the vast web of tribal politics brought it back.
So in every district Jan Muhammad appointed a Popalzai governor and police chief, or figures from closely related tribes. The trouble was, many of these communities had already chosen their own leaders during the waning days of the Taliban. In Khas Uruzgan, elders had elected as district governor an anti-Taliban personage from the mujahedeen era, a former school janitor named Tawildar Yunis (“Groundskeeper Yunis”). He was working out of the governor’s house, along with a locally elected police chief and other officials, collecting weapons from surrendering Talibs. But they were not Popalzais and, even worse, maintained political links to one of Jan Muhammad’s rivals from the civil war years. So Muhammad appointed a local Popalzai elder and friend of the Karzais, Abdul Qudus, as his governor. But Yunis refused to budge, the imprimatur of Khas Uruzgan elders lending his claims an undeniable air of legitimacy. Unswayed, Abdul Qudus then requisitioned the local school for himself and his coterie of followers, declaring that it was now the rightful governor’s residence and that it was his job to collect Taliban weapons. In response, Yunis appealed to everyone from Gul Agha Sherzai to President Karzai himself, but none were willing to wade into the growing mess. Tensions rose by the day. Jan Muhammad’s side began openly questioning Yunis’s anti-Taliban bona fides, throwing him into fits of rage. He returned the favor by declaring Jan Muhammad’s men soft on the Taliban.
The actual Taliban were perplexed. During the standoff, a trio of senior Taliban officials made their way to Khas Uruzgan to surrender to the new government: Tayeb Agha, an erudite, well-spoken twentysomething who had served as Mullah Omar’s personal secretary and adviser; former finance minister Agha Jan Mutassim, who had publicly rejected calls from Pakistani clerics to wage jihad against the Americans; and Health Minister Mullah Abbas, the official who had been responsible for recruiting Heela and other women to study as nurses and midwives. All three had been members of the Taliban since the movement’s inception. Their surrender should have been a political coup for the young Karzai government. But surrender to whom? Who was actually in charge?
And then the Americans, acting on bad information, stormed both 'government' offices in a nighttime raid, killing Abdul Qudus and his fellow officials (Yunis managed to escape and was never seen again). The three former Taliban guys decided that surrendering didn't seem like such a good idea and went back to Pakistan where they helped lead the new Taliban insurgency.
yunyun333
4mo ago
Terence Tao: I’m an award-winning mathematician. Trump just cut my funding.
In just six months, the United States has seen a wholesale assault on the scientific infrastructure that helped make it a world leader in innovation. Grants have been cancelled mid-project, fellowships for the next generation of researchers gutted, and federally funded institutes stripped of the resources they need to operate. These decisions are not the result of scientific review or Congressional debate, but of abrupt political directives that bypass long-standing norms, disrupt multi-year projects, and erode the independence of our research ecosystem.
In that time, I have seen first-hand how sustained federal investment—channeled through agencies like the National Science Foundation (NSF)—powers the collaborations that link universities, government laboratories, and industry. At UCLA's Institute for Pure and Applied Mathematics (IPAM), where I now serve as Director of Special Projects, those collaborations have laid the groundwork for both theoretical breakthroughs and practical technologies. My own research at IPAM, for instance, helped lead to the algorithms that now cut MRI scan times by a factor of up to 10. This is the America I chose as my adoptive home: a place where science is valued as a public good, and where researchers from around the world come to contribute their ideas and energy.
It is therefore stunning and devastating to discover that the new administration, in just its first six months, has deliberately attacked and weakened almost all the supporting pillars of this ecosystem. Executive actions have cancelled or suspended federal grants with unprecedented scale and speed, with billions of dollars worth of ongoing research projects and experiments disrupted. This is not because of a negative scientific assessment of the work, but instead by seemingly arbitrary justifications. Critical funding has been pulled for as insignificant a reason as the presence of a key word in the original proposal that is retroactively deemed unacceptable.
Federal support is, of course, a privilege, not a right; and Congress has the constitutional authority to set the budgets and rules for any expenditure of public funds and resources. But many of these executive actions have not waited for either explicit or implicit Congressional approval, and in some cases have even directly ignored past Congressional mandates for appropriations. Relative to the sheer size of the federal government as a whole, the amount allocated for supporting science is not massive. The NSF mathematics and physical sciences (MPS) directorate, for instance, is the largest of the subdivisions of the NSF, and has an annual budget of approximately $1.7 billion. This looks significant until one realizes that it amounts to about five dollars per US citizen per year, and less than a tenth of a percent of the federal budget as a whole.
He seems to be referring to how the admin took an axe to science funding by ctrl+F-ing for 'woke' dictionary terms: underrepresented, minority, diverse, etc. The problem is that the effects seem to be about indiscriminate regardless of whether you were a true believer or merely box checking. Will we see upgraded diversity science pledges in the next democrat admin? Researchers might have to carefully consider the political leanings of their funding proposals in election years.
yunyun333
5mo ago
Israel fought the Suez Crisis on US & UK's behalf.
UK and France. The US told them quite firmly to stop, which they did. The US was not particularly pro Israel until Lyndon Johnson, who let himself get bossed around by his very pro-Israel foreign policy guys.
Israel didn't directly instigate Iraq 2 of course, but many of the higher ups in the executive branch who were pushing for an invasion of Iraq were ardent Zionists (see the Office of Special Plans, which also involved an espionage scandal involving an analyst passing information to Israel through AIPAC).
Ultra niche markets would obviously be rife with insider betting. Fool and his money, etc.
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