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Brisketexan

Brisketexan 105,143

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I think some states will actually start to separate from the US when this happens. 

And there will be bloodshed within them.

Good. I’m becoming convinced that’s what we need. We treat this republic as disposable. If it’s worth fighting for, it’s worth FIGHTING FOR. A bloody insurrection in secessionist Georgia, where half the residents don’t want to secede to be the Free State of Raciststan, well, that’s probably the only path that’ll make any difference.
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lemonlime

lemonlime 5,503

Posted
Posted
28 minutes ago, Brisketexan said:


And there will be bloodshed within them.

Good. I’m becoming convinced that’s what we need. We treat this republic as disposable. If it’s worth fighting for, it’s worth FIGHTING FOR. A bloody insurrection in secessionist Georgia, where half the residents don’t want to secede to be the Free State of Raciststan, well, that’s probably the only path that’ll make any difference.

 I'm at the point of let em.  If the people of Georgia want to live in the Free State of Raciststan, and the people of say, Oklahoma and West Virginia want to have an uneducated populace with shitty public schools open 4 days a week, paying their teachers minimum wage, which will be even lower once they stop getting tax money from donor states (the blue states they ridicule as libtard), they can leave and take their orange god with them.

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jimmyjazz

jimmyjazz 45,957

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1 minute ago, lemonlime said:

 I'm at the point of let em.  If the people of Georgia want to live in the Free State of Raciststan, and the people of say, Oklahoma and West Virginia want to have an uneducated populace with shitty public schools open 4 days a week, paying their teachers minimum wage, which will be even lower once they stop getting tax money from donor states (the blue states they ridicule as libtard), they can leave and take their orange god with them.

I'm a little confused as to how we exactly let Oklahoma and West Virginia secede.  I mean, I guess we could just take their land (and oil, and COAL! MAGA!) and kick the idiots over the wall, er, border . . . but really?

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Brisketexan

Brisketexan 105,143

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 I'm at the point of let em.  If the people of Georgia want to live in the Free State of Raciststan, and the people of say, Oklahoma and West Virginia want to have an uneducated populace with shitty public schools open 4 days a week, paying their teachers minimum wage, which will be even lower once they stop getting tax money from donor states (the blue states they ridicule as libtard), they can leave and take their orange god with them.

The question is what do the non shitstain people in that state do? I think they fight. I would.
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'stache

'stache 21,816

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1 minute ago, Brisketexan said:


The question is what do the non shitstain people in that state do? I think they fight. I would.

I'll fucking leave.  Move to California or Vermont.  If they try to stop me I'll shoot them in the fucking face.  But they're fucking cowards, which is why they are falling for this nonsense to begin with, and they'll never actually use their open-carry penis extension.

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lemonlime

lemonlime 5,503

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4 minutes ago, jimmyjazz said:

I'm a little confused as to how we exactly let Oklahoma and West Virginia secede.  I mean, I guess we could just take their land (and oil, and COAL! MAGA!) and kick the idiots over the wall, er, border . . . but really?

They can have their polluted land,  have their polluted air (hopefully too much of it doesn't travel, oil drilling, MAGA!, and go bankrupt building nonsense walls.  I'll drink my bourbon and watch WV burn.  I just feel bad for Bama Chick.

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jimmyjazz

jimmyjazz 45,957

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9 minutes ago, lemonlime said:

They can have their polluted land,  have their polluted air (hopefully too much of it doesn't travel, oil drilling, MAGA!, and go bankrupt building nonsense walls.  I'll drink my bourbon and watch WV burn.  I just feel bad for Bama Chick.

Well, that's all well and good, but no sovereign nation (and definitely not the US) is gonna just let a captured state secede.  Any effort would end in capitulation, because the alternative would be civil war, and even Okies aren't that stupid.

I can't believe I just typed "even Okies aren't that stupid".

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Gap03

Gap03 3,308

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19 minutes ago, lemonlime said:

They can have their polluted land,  have their polluted air (hopefully too much of it doesn't travel, oil drilling, MAGA!, and go bankrupt building nonsense walls.  I'll drink my bourbon and watch WV burn.  I just feel bad for Bama Chick.

Until Texas actually stops electing so many dipshits, I'm going to hold off on talking shit about WV, Oklahoma and Alabama ...

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ChiTownDoc

ChiTownDoc 21,154

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1 hour ago, Brisketexan said:


The question is what do the non shitstain people in that state do? I think they fight. I would.

I already left.  I'll move my friends and family out - the few that are left.  I can't think of too many R majority areas I'd want to live anyway.  Seriously.  Bumblefuck America tends to be full of idiots.  What a shock...

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Johnny Sack

Johnny Sack 8,397

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4 minutes ago, ChiTownDoc said:

I already left.  I'll move my friends and family out - the few that are left.  I can't think of too many R majority areas I'd want to live anyway.  Seriously.  Bumblefuck America tends to be full of idiots.  What a shock...

Yet the really smart and wealthy state you live in has one of the shittiest balance sheets in the USA.  Is that because it’s filled with idiots?

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ChiTownDoc

ChiTownDoc 21,154

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Just now, Johnny Sack said:

Yet the really smart and wealthy state you live in has one of the shittiest balance sheets in the USA.  Is that because it’s filled with idiots?

LOL - yes because all the big industry here that generates billions in taxes is sent straight to DC.  You think if that money was kept local Chicago would be billions in debt?  LOLOL

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Johnny Sack

Johnny Sack 8,397

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8 minutes ago, ChiTownDoc said:

LOL - yes because all the big industry here that generates billions in taxes is sent straight to DC.  You think if that money was kept local Chicago would be billions in debt?  LOLOL

Yes I do.  Liberals and public sector unions have proper fucked the state financially.  Path to bankruptcy.  

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ChiTownDoc

ChiTownDoc 21,154

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Just now, Johnny Sack said:

Yes I do.  Liberals and public sector unions have proper fucked the state financially.  Path to bankruptcy.  

I'm actually a fiscal conservative - the R are not that anymore.  But I would definitely say if you go all in on D fiscal policy you end up like Chicago/Detroit.  If you go all in on R policy you end up like KS/OK.  Neither works. 

But if push came to shove, and more metro areas didn't have to share with rural America, they'd be better off (and rural America could fuck cities by cutting off farming etc).  I was born in west Texas and grew up in Oklahoma.  I personally think rural areas suck - that's an opinion.  As was my tongue in cheek 'fuck bumblefuck america' diatribe. 

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Brandywine

Brandywine 1,316

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Posted (edited)
2 hours ago, jimmyjazz said:

I'm a little confused as to how we exactly let Oklahoma and West Virginia secede.  I mean, I guess we could just take their land (and oil, and COAL! MAGA!) and kick the idiots over the wall, er, border . . . but really?

As you said, if they secede we invade them. They’ll have to pay for their own troops, planes, guns, and so on. I say let them have what they want, invade them and kick their ass out of their country. Then make it a State again but don’t let them back in. 

Edited by Brandywine
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Johnny Sack

Johnny Sack 8,397

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1 hour ago, ChiTownDoc said:

I'm actually a fiscal conservative - the R are not that anymore.  But I would definitely say if you go all in on D fiscal policy you end up like Chicago/Detroit.  If you go all in on R policy you end up like KS/OK.  Neither works. 

But if push came to shove, and more metro areas didn't have to share with rural America, they'd be better off (and rural America could fuck cities by cutting off farming etc).  I was born in west Texas and grew up in Oklahoma.  I personally think rural areas suck - that's an opinion.  As was my tongue in cheek 'fuck bumblefuck america' diatribe. 

Don’t you make your wealth from raking huge profits from Medicare, Medicaid and insurance companies?  Are you helping your patients or just taking a huge rake from the rest of us?

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Gil Bang

Gil Bang 25,960

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6 minutes ago, Johnny Sack said:

Don’t you make your wealth from raking huge profits from Medicare, Medicaid and insurance companies?  Are you helping your patients or just taking a huge rake from the rest of us?

There are no such things at "huge profits from Medicare and Medicaid", and little chance of getting that from private payors.


Reimbursements are LOW.

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Johnny Sack

Johnny Sack 8,397

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9 minutes ago, Gil Bang said:

There are no such things at "huge profits from Medicare and Medicaid", and little chance of getting that from private payors.


Reimbursements are LOW.

Wrong.   Providers make the biggest profit margin in health business.  

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SubliminalHorn

SubliminalHorn 6,788

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8 minutes ago, Gil Bang said:

There are no such things at "huge profits from Medicare and Medicaid", and little chance of getting that from private payors.


Reimbursements are LOW.

Seriously. Spoken by someone who has no idea how Medicare actually works and reimburses. Our clinic gets something like 2.5x less than what bill them. Yeah just raking it in. 

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Johnny Sack

Johnny Sack 8,397

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5 minutes ago, SubliminalHorn said:

Seriously. Spoken by someone who has no idea how Medicare actually works and reimburses. Our clinic gets something like 2.5x less than what bill them. Yeah just raking it in. 

Who do you think has a higher profit margin?  Insurance companies?  Or providers?

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ChiTownDoc

ChiTownDoc 21,154

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1 hour ago, Johnny Sack said:

Don’t you make your wealth from raking huge profits from Medicare, Medicaid and insurance companies?  Are you helping your patients or just taking a huge rake from the rest of us?

LOL, funny you should ask.  I actually kill it with value based medicine.  So we have contracts in 24 states with pretty much every managed care company under the sun and medicare.  The days of billing insurance/medicare huge sums of money and getting away with it are toast.  So, for example, you take on risk.  You charge $82 an average visit for a patient but you prove that you lower readmission rates to hospitals.  You get knee/hip replacement/CHF/COPD patients home faster - but they can't be readmitted back to the hospital or you get dinged financially.  If you don't just 'take a huge rake' as you put it, you can do very well.  So no, I don't rake huge profits - I actually make money because I show Medicare/insurance companies I make a little money and save them a lot - hence I have a fuckload of contracts.  We average 50000 visits a month.  But I'm glad you asked...

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bolverk

bolverk 29,677

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4 hours ago, Brisketexan said:


And there will be bloodshed within them.

Good. I’m becoming convinced that’s what we need. We treat this republic as disposable. If it’s worth fighting for, it’s worth FIGHTING FOR. A bloody insurrection in secessionist Georgia, where half the residents don’t want to secede to be the Free State of Raciststan, well, that’s probably the only path that’ll make any difference.

I watch Matthew McCaunaghey's Free State of Jones last night. Not too bad.

His character had the right idea.

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Anastasis

Anastasis 23,469

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2 minutes ago, ChiTownDoc said:

LOL, funny you should ask.  I actually kill it with value based medicine.  So we have contracts in 24 states with pretty much every managed care company under the sun and medicare.  The days of billing insurance/medicare huge sums of money and getting away with it are toast.  So, for example, you take on risk.  You charge $82 an average visit for a patient but you prove that you lower readmission rates to hospitals.  You get knee/hip replacement/CHF/COPD patients home faster - but they can't be readmitted back to the hospital or you get dinged financially.  If you don't just 'take a huge rake' as you put it, you can do very well.  So no, I don't rake huge profits - I actually make money because I show Medicare/insurance companies I make a little money and save them a lot - hence I have a fuckload of contracts.  We average 50000 visits a month.  But I'm glad you asked...

yes, value/outcome-based arrangements are where everything is headed. Nobody wants to pay FFS anymore.  

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Anastasis

Anastasis 23,469

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3 minutes ago, ChiTownDoc said:

LOL - only an absolute clown would think providers do anywhere near as well as fucking insurance companies.  Give me a break. 

I feel like I have posted this graphic like 1000x. It's quite simple, pharma, devices and hospitals are where the money is being made in healthcare. 

 

main-qimg-779934da58605da95cf1c869b4333f

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bolverk

bolverk 29,677

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1 hour ago, Johnny Sack said:

Don’t you make your wealth from raking huge profits from Medicare, Medicaid and insurance companies?  Are you helping your patients or just taking a huge rake from the rest of us?

Why you sound like a gotdam SOCIALIST!

11 minutes ago, ChiTownDoc said:

LOL - only an absolute clown would think providers do anywhere near as well as fucking insurance companies.  Give me a break. 

 

Yeah, providers actually have to DO something to earn their take. Insurance companies only make money by NOT providing their promised services.

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ChiTownDoc

ChiTownDoc 21,154

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32 minutes ago, bolverk said:

Why you sound like a gotdam SOCIALIST!

Yeah, providers actually have to DO something to earn their take. Insurance companies only make money by NOT providing their promised services.

And I don’t get to cherry pick great patients.  Insurance companies abuse Medicare so bad - they’ll take over on Medicare advantage plans for healthy seniors.  The minute they get really sick they turf them back to Medicare.  And we wonder why the government goes broke.  

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Anastasis

Anastasis 23,469

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32 minutes ago, bolverk said:

Yeah, providers actually have to DO something to earn their take. Insurance companies only make money by NOT providing their promised services.

This is antiquated thinking. At least with the organizations that I have visibility into.  Everything is moving towards aligning incentives across the various parties involved. Nobody has a problem paying for services that result in healthy outcomes. The problem is with paying for services or drugs that offer no real advantage and result in no incremental impact on HRQOL, outcomes, or costs. Or that have an offset horizon that is not compatible withe realities of people moving in and out of different plans and coverage. That dynamic is different in certain cases, eg narrow network plans that can only survive on the on managed medicaid and ACA individual markets for example.  The only way they make money is by restricting access to care. The biggest problem globally, imo, is creating a market where you have enough time horizon in terms of length of enrollment to allow sufficient time to recoup investments in healthcare that may not be realized for decades. That is really the best argument for single payer in my opinion. 

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bolverk

bolverk 29,677

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2 minutes ago, Anastasis said:

This is antiquated thinking. At least with the organizations that I have visibility into.  Everything is moving towards aligning incentives across the various parties involved. Nobody has a problem paying for services that result in healthy outcomes. The problem is with paying for services or drugs that offer no real advantage and result in no incremental impact on HRQOL, outcomes, or costs. Or that have an offset horizon that is not compatible withe realities of people moving in and out of different plans and coverage. That dynamic is different in certain cases, eg narrow network plans that can only survive on the on managed medicaid and ACA individual markets for example.  The only way they make money is by restricting access to care. The biggest problem globally, imo, is creating a market where you have enough time horizon in terms of length of enrollment to allow sufficient time to recoup investments in healthcare that may not be realized for decades. That is really the best argument for single payer in my opinion. 

3

And shareholders ain't got time for that.

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Buzzrock

Buzzrock 14,920

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LOL, funny you should ask.  I actually kill it with value based medicine.  So we have contracts in 24 states with pretty much every managed care company under the sun and medicare.  The days of billing insurance/medicare huge sums of money and getting away with it are toast.  So, for example, you take on risk.  You charge $82 an average visit for a patient but you prove that you lower readmission rates to hospitals.  You get knee/hip replacement/CHF/COPD patients home faster - but they can't be readmitted back to the hospital or you get dinged financially.  If you don't just 'take a huge rake' as you put it, you can do very well.  So no, I don't rake huge profits - I actually make money because I show Medicare/insurance companies I make a little money and save them a lot - hence I have a fuckload of contracts.  We average 50000 visits a month.  But I'm glad you asked...


Value selling, imagine that
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4th&Five

4th&Five 41,554

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Posted (edited)
1 hour ago, Anastasis said:

I feel like I have posted this graphic like 1000x. It's quite simple, pharma, devices and hospitals are where the money is being made in healthcare. 

 

main-qimg-779934da58605da95cf1c869b4333f

As a business owner that sells medical devices to hospitals I assure you most of us are scraping by. The examples on that chart are laughable. 

Edited by 4th&Five
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Gil Bang

Gil Bang 25,960

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3 minutes ago, 4th&Five said:

As a business owner that sells medical devices to hospitals I assure you most of us are scraping by. The examples on that chart are laughable. 

I've basically given up on being a medical equipment middle-man.   There's no money in it anymore.  7-8 years ago I was turning 300,000 in equipment minimum in a given year.  Some years MUCH more.    

Now?  Meh.  

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Anastasis

Anastasis 23,469

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8 minutes ago, 4th&Five said:

As a business owner that sells medical devices to hospitals I assure you most of us are scraping by. The examples on that chart are laughable. 

If you don't like that one, I am happy to consider alternative data. In every analysis I have seen over the last decade the ordinal ranking is fairly consistent.  Pharma>Devices>Hospitals>Insurers, and when providers are included they wedge in between hospitals and insurers. 

 

 

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