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brown water

Certifiably Surly
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Everything posted by brown water

  1. Much of the migration from clinics to hospitals happened for reasons similar to my prior post. Many hospitals qualified for even lower drug prices under a federal rule (340b) that was intended to subsidize hospitals that cared for underserved communities. Under 340b the significant drug discount created a windfall profit that was used to hire the oncologists out of private practice often for well more than they were currently earning. The point remains, the system puts in conflict patient outcomes, total cost to the system and economic incentives to financially rational actors.
  2. She’s not wrong about this. Medicare pays average sales price plus 6% for chemotherapy drugs. Large oncology practices with buying power negotiate lower than average prices from distributors while smaller practices typically pay more but everyone receives the same reimbursement. So, yes, oncologists do make money on chemotherapy and, frankly, it has been a obstacle (among others) to the uptake of personalized medicine where genomic testing may indicate a more effective treatment. In fact, in the early 2000s the Medicare reimbursement changed from average wholesale price plus 15% to average sales price plus 6% which significantly narrowed the margin made on drugs. As a result, the total amount of chemotherapy prescribed increased significantly. I wish it wasn’t true but like everywhere cost plus payment tends to yield more cost to generate more payments. In this case, the narrowing of margin produced more cost as physicians seemed to solve back for their otherwise lost income.
  3. Would Fullvarine be an acceptable compromise?
  4. Caption... Florida Georgia Whine embarks on the This Is How We Troll tour
  5. I’d find the place with the longest post arrival quarantine requirement. And then conveniently forget to mention the requirement.
  6. Chokkums Razor
  7. So made a minor course correction. Opted for white face instead of black. Felt like it was a bit more traditional and that the white showed the subtle complications like the panoramic date better. The AD didn’t have a steel bracelet available so they made a minor discount on a strap with deployant clasp and are getting the bracelet from the factory at no additional cost. @52-80 I lost the blue lume which was disappointing and what first caught my attention
  8. In honor of the Masters opening round. 2 lb bone in ribeye over pimento cheese mashed potatoes
  9. Project Homecoming!
  10. niiiiiiiiice
  11. Got a text from one of my whiskey contacts that he just got in a 17 yo store pick whistle pig rye. Tasting notes are candy and cola. Asked him to consider renaming it the “Gaetz Batch.” I know the label says 10 but those who share my vice know that it’s a minimum and individual barrels can be older...
  12. More like Medium Pace HS amirite?
  13. Also took a long look at this...
  14. Just ordered this GO on a stainless bracelet. Will probably add a leather and rubber band soon. Seems pretty flexible. What say the brethren?
  15. Thursday. Nearly 5lb bone in ribeye... Actually the dry brine started Monday.
  16. Not that intellectual honesty has ever been their strongest trait but I’m coming around to letting them go. I get the irony that these idiots likely railed against public health driven restrictions on economic grounds. Now they choose to take their discretionary spending that could support local businesses out of the country. Logically inconsistent. Sure. Hypocritical. Of course. Totally on brand. Yep. But where I land is being fine with them never coming back. Would I prefer them rot in prison? Sure. But I’ll take getting the fuck out forever as a consolation prize.
  17. Lazy Tuesday night. NY strip and figuring out the new grill. Thursday is looking like the big day. Double cut prime bone in ribeye with my best friend and his 2 sons.
  18. ^^ Klandora’s Box?
  19. Texas Star Grills in Houston. They were great but iirc not in your part of the world.
  20. Bought one over Christmas. Guess I was the beneficiary of the transition because it’s the old model at the new price. Loving it so far.
  21. And by the way, has the republican infighting been called klannibalization? Because it should.
  22. I’ll preface this that I’m no political scientist or strategist... First, I’m happy the trial is delayed and wish it was a bit longer actually I’m all for swift resolution but my experience with trump is that time won’t be his friend. New details of malfeasance are starting to emerge. More importantly I expect being out of the spotlight can only last so long. And when he does emerge it will be for unwanted reasons. High on that list, in my estimation, will be attacking the disloyal republicans to try to regain some lost credibility with his most vocal and extreme supporters. Which brings us to the second point which is the internal conflict of the Republican Party. I assume ideology is important but more important will be who controls the established political machinery. Third parties are DOA in our system. Trump is already threatening to form the patriot party. If a “traditional” republican had to choose I assume they’d prefer that to having the patriot mentality consume the gop and control its political machinery. Trump / trumpism is a metastasized cancer. The prognosis for the gop is bad either way but it seems like the choice is between long shot curative regiment or entering hospice. That said, I expect them to acquit out of cowardice. Simple logic that they likely lose either way so don’t piss of the crazies.
  23. Friday night with a wagyu strip and a couple interested bystanders
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