Alexandria Ocasio-Cortez

[Celery Man 20991]

 

[Hugo Stiglitz 23367]

 

[jimmyjazz 46049]

Well, that's a winner.

[retread 2951]

He seems like a horrible person.

[Hugo Stiglitz 23367]

3 minutes ago, retread said:

He seems like a horrible person.

[Gil Bang 25988]

what's his surly handle?

[GHOSTUSER 361]

2 hours ago, DixonHur said:

So Canadians spend half as much for healthcare, have a longer average life span, and half the maternal mortality of the US, but somehow in your mind that equates to a "degrading" in healthcare?

Interesting.

 

Did you read what sheeit wrote on the last page debunking the claim that US health care is somehow worse in measurables than OECD countries when in fact it’s the best. What would happen with Medicare for all would be a degradation of care for the middle class and upper middle class (which is the majority of this country) with the trade off that the poor will end up overutilizing “free” universal health care increasing costs and taxes for all of us. Those that can afford it would get concierge care from private doctors and hospitals. Basically, my taxes will go up considerably and I will still have to pay considerably out of pocket to get comparable care that I can get now. I will vote Republican as long as they are the party that opposes Medicare for all.

[Gil Bang 25988]

interesting, as you're the poster most likely to be diagnosed with HIV. 

[GHOSTUSER 361]

 

1 hour ago, David Dennison said:

And that's why many Americans have long waits, too.

They can choose another specialist if they’re booked. In Canada and the UK it takes months to get seen by anyone. 

[workswithseed 2109]

I just looked at Canada's wait time 21 weeks. Holy fuck

[Bozo_Casanova 26521]

Did you read what sheeit wrote on the last page debunking the claim that US health care is somehow worse in measurables than OECD countries when in fact it’s the best.* What would happen with Medicare for all would be a degradation of care for the middle class and upper middle class (which is the majority of this country) with the trade off that the poor will end up overutilizing “free” universal health care increasing costs and taxes for all of us.** Those that can afford it would get concierge care from private doctors and hospitals*** . Basically, my taxes will go up considerably**** and I will still have to pay considerably out of pocket to get comparable care that I can get now*****. I will vote Republican as long as they are the party that opposes Medicare for all******.

*Except he does no such thing, and neither does the advocacy piece he cribbed that nonsense from
** and now you are conflating the notion of “Medicare for all” (which as I’ve stated multiple times Im not in favor of) with a broad replacement of private care with public care, and Universal care. They aren’t the same thing. And we aren’t even talking about care. We’re talking about insurance.
*** Imagine! Customers exercising a rational choice, paying more for a premium product. Let be be the first to welcome you to this thing we call the market market.
****Thats not necessarily true. Wyden Bennett, for example, would have achieved universal coverage and was cost neutral (and almost totally private). And then your beloved party abandoned it. Because you don’t hold them accountable, because you are a sucker.
***** Because reasons, in some undefined scenario.
****** Because you’ve been had, see ****

[Bozo_Casanova 26521]

 
They can choose another specialist if they’re booked. In Canada and the UK it takes months to get seen by anyone. 

It took five months to get my daughter into a pediatric allergist after she went into anaphylaxis.when did Austin become part of Canada? When Cruz was elected?

[Anastasis 23481]

4 minutes ago, Bozo_Casanova said:

“Medicare for all” (which as I’ve stated multiple times Im not in favor of)

Can you lay out the various dem supported uhc plans and handicap them in terms of most likely direction we go in 2020. 

[Post Oak 20256]

1 hour ago, Hugo Stiglitz said:

 

 

[David Dennison 18944]

59 minutes ago, Iconoclast Texan said:

Did you read what sheeit wrote on the last page debunking the claim that US health care is somehow worse in measurables than OECD countries when in fact it’s the best. What would happen with Medicare for all would be a degradation of care for the middle class and upper middle class (which is the majority of this country) with the trade off that the poor will end up overutilizing “free” universal health care increasing costs and taxes for all of us. Those that can afford it would get concierge care from private doctors and hospitals. Basically, my taxes will go up considerably and I will still have to pay considerably out of pocket to get comparable care that I can get now. I will vote Republican as long as they are the party that opposes Medicare for all.

You're going to eventually lose on this front. It's not if but when.

Just thought you should know that.

[David Dennison 18944]

53 minutes ago, Iconoclast Texan said:

They can choose another specialist if they’re booked. In Canada and the UK it takes months to get seen by anyone. 

Not if you belong to an HMO.

[hayden_horn 11365]

1 hour ago, Hugo Stiglitz said:

 

She's a salty one for sure. It may get her into trouble but for now I don't care. She's funny and her twitter game is strong. 

[fattyflattie 4638]

11 hours ago, Dirk X West said:

No, it's an argument for funding school districts more equally.  You may not be aware of this, but there are many public school systems in this country that are excellent.  Not coincidentally, they're usually located in areas where property values are high.

Yeah. Well to do people want to pass that along to their kids by putting them in a better place to succeed.   Shocker.  They’d probably opt out of contributing to the school across the tracks entirely, and put their kids in private school if that was an option.  

[EuroHorn 3268]

Good for her living the American dream 

[Fozzz 152]

42 minutes ago, fattyflattie said:

Yeah. Well to do people want to pass that along to their kids by putting them in a better place to succeed.   Shocker.  They’d probably opt out of contributing to the school across the tracks entirely, and put their kids in private school if that was an option.  

We are all fuedalists at heart. 

[Nice Guy Eddie 13518]

11 hours ago, Cheeseweasel said:

You've hit on an important point here and why Obamacare is flawed. Those who need heathcare (Olds, sick) are going to buy it while those that don't (young) aren't. 

How do we have a system where everyone pays the same without absolutely fucking a generation of young people?

Obamacare allows for older people to pay higher premiums.  There’s a cap, like 3x, but triple the premium is hardly paying the same. 

The place where everyone pays the same premium is usually the employer based plans.  I suppose a company could charge older employers more but that isn’t common.   Instead they ask the younger employees to subsidize the older employees.  

[Cheeseweasel 26438]

I like the fact that at some point in the near future we are going to have a Trump/AOC Twitter war.

[bad_teammate 13222]

Angry online right-wing white guys are experts at fashion and the prices of women's clothes.

[FondrenRoad 4378]

22 minutes ago, Cheeseweasel said:

I like the fact that at some point in the near future we are going to have a Trump/AOC Twitter war.

Kind of surprised it hasn't happened already. 

[BrazilHorn 6628]

28 minutes ago, bad_teammate said:

Angry online right-wing white guys are experts at fashion and the prices of women's clothes.

They’re experts on birth control for women, why not fashion?

[Js1 85490]

35 minutes ago, FondrenRoad said:

Kind of surprised it hasn't happened already. 

Trump: AOC wears nice clothes and think she's for the people.  She's not, Republicans like me are!

AOC: YOU HAVE A GOLD FUCKING TOILET IN A BUILDING WITH YOUR NAME ON IT.

[Anastasis 23481]

17 hours ago, Bat Guano said:

Where are you getting those numbers?

Medicare admin costs are around 2%, Medicaid around 7%. Private insurers' admin costs are 12 -18%, depending on group sizes.

 

16 hours ago, jimmyjazz said:

How does this not put a ribbon on the entire argument?

Because those numbers are far too simplistic and misleading, and administrative costs are not a definitive measure of cost efficiency. Administration costs vary substantially by benefit type, design and market. Rolling all that up to a private category doesn't really tell the tale. There is also this little issue of math.  The 2% of expenditures to admin number assigned to Medicare is suppressed by the fact that their expenditures, given an older sicker population, are much higher compared to your typical commercial and employer sponsored private insurance plans. Big denominator suppressing the percentage results when admin costs are the numerator. A better way to look at admin is cost per head. Heritage did this analysis, Medicare comes in around $500 per head, private insurance around $450.

So let's call admin a wash in reality.  We are going to spend the admin costs either way. And admin costs are not necessarily a bad thing.  All admin costs are not created equal in terms of healthcare ROI. Marketing? Meh, an admin cost I could probably do without. Clinical care coordination to ensure appropriate post-discharge transitioning and follow-up after a stroke? OK. Utilization management to see that high cost specialty drugs are used at appropriate line of therapy in accord with treatment guidelines? I am listening. Developing clinical programs to drive preventative care and screenings in medically complex patients? Yeah, we should do that. Oh wait, those are administrative costs, fuck.

To reinforce, here's a link to a recent analysis out of Avalere (funded by an MA trade group), comparing costs and outcomes for older patients in Medicare across a variety of clinical conditions and medical complexity.  Among the most medically complex (dual eligibles) both costs and outcomes were better in private Medicare (MA) vs Medicare FFS. Among patients with diabetes, cost and outcomes were better, as a result of better preventative care was being delivered.  Overall, costs were similar. Private Medicare was associated with more preventative care and screenings and fewer avoidable hospitalizations. Medicare FFS associated with greater inpatient and emergent care costs.

Admin costs are a complex topic. Some are good, some are bad. Math is hard. Ribbons around a topic as complex as healthcare delivery in this country are few and far between.     

 

[tantric superman 4667]

10 hours ago, hayden_horn said:

She's a salty one for sure. It may get her into trouble but for now I don't care. She's funny and her twitter game is strong. 

[Francisco 2.0 32406]

1 hour ago, Cheeseweasel said:

I like the fact that at some point in the near future we are going to have a Trump/AOC Twitter war.

Possibly, but she's young and attractive, so he probably thinks he can fuck her.

He only attacks old and unattractive wimmenz on his Twitterphone.

[FondrenRoad 4378]

8 minutes ago, Anastasis said:

 

Because those numbers are far too simplistic and misleading, and administrative costs are not a definitive measure of cost efficiency. Administration costs vary substantially by benefit type, design and market. Rolling all that up to a private category doesn't really tell the tale. There is also this little issue of math.  The 2% of expenditures to admin number assigned to Medicare is suppressed by the fact that their expenditures, given an older sicker population, are much higher compared to your typical commercial and employer sponsored private insurance plans. Big denominator suppressing the percentage results when admin costs are the numerator. A better way to look at admin is cost per head. Heritage did this analysis, Medicare comes in around $500 per head, private insurance around $450.

So let's call admin a wash in reality.  We are going to spend the admin costs either way. And admin costs are not necessarily a bad thing.  All admin costs are not created equal in terms of healthcare ROI. Marketing? Meh, an admin cost I could probably do without. Clinical care coordination to ensure appropriate post-discharge transitioning and follow-up after a stroke? OK. Utilization management to see that high cost specialty drugs are used at appropriate line of therapy in accord with treatment guidelines? I am listening. Developing clinical programs to drive preventative care and screenings in medically complex patients? Yeah, we should do that. Oh wait, those are administrative costs, fuck.

To reinforce, here's a link to a recent analysis out of Avalere (funded by an MA trade group), comparing costs and outcomes for older patients in Medicare across a variety of clinical conditions and medical complexity.  Among the most medically complex (dual eligibles) both costs and outcomes were better in private Medicare (MA) vs Medicare FFS. Among patients with diabetes, cost and outcomes were better, as a result of better preventative care was being delivered.  Overall, costs were similar. Private Medicare was associated with more preventative care and screenings and fewer avoidable hospitalizations. Medicare FFS associated with greater inpatient and emergent care costs.

Admin costs are a complex topic. Some are good, some are bad. Math is hard. Ribbons around a topic as complex as healthcare delivery in this country are few and far between.     

 

You know, we don't have to do everything at once.  We should tackle low hanging fruit like banning pharma advertising and price gouging even while we are still arguing about how to move forward with healthcare coverage and costs overall.

[FondrenRoad 4378]

2 minutes ago, Francisco 2.0 said:

Possibly, but she's young and attractive, so he probably thinks he can fuck her.

He only attacks old and unattractive wimmenz on his Twitterphone.

Trump has a type and it isn't Latinas.  Its women who look like his daughter.

[Anastasis 23481]

1 minute ago, FondrenRoad said:

You know, we don't have to do everything at once.  We should tackle low hanging fruit like banning pharma advertising and price gouging even while we are still arguing about how to move forward with healthcare coverage and costs overall.

Agree on DTC. Been beating that drum for two decades. 

 

ETA: Can't edit previous post, but here is link to the recent study I mentioned. http://go.avalere.com/acton/attachment/12909/f-0571/1/-/-/-/-/BMA Report.pdf

 

Edited November 16, 2018 by Anastasis

[Cheeseweasel 26438]

17 minutes ago, FondrenRoad said:

Trump has a type and it isn't Latinas.  Its women who look like his daughter.

Well, he's not wrong.

[Bat Guano 359]

27 minutes ago, Anastasis said:

 

Because those numbers are far too simplistic and misleading, and administrative costs are not a definitive measure of cost efficiency. Administration costs vary substantially by benefit type, design and market. Rolling all that up to a private category doesn't really tell the tale. There is also this little issue of math.  The 2% of expenditures to admin number assigned to Medicare is suppressed by the fact that their expenditures, given an older sicker population, are much higher compared to your typical commercial and employer sponsored private insurance plans. Big denominator suppressing the percentage results when admin costs are the numerator. A better way to look at admin is cost per head. Heritage did this analysis, Medicare comes in around $500 per head, private insurance around $450.

So let's call admin a wash in reality.  We are going to spend the admin costs either way. And admin costs are not necessarily a bad thing.  All admin costs are not created equal in terms of healthcare ROI. Marketing? Meh, an admin cost I could probably do without. Clinical care coordination to ensure appropriate post-discharge transitioning and follow-up after a stroke? OK. Utilization management to see that high cost specialty drugs are used at appropriate line of therapy in accord with treatment guidelines? I am listening. Developing clinical programs to drive preventative care and screenings in medically complex patients? Yeah, we should do that. Oh wait, those are administrative costs, fuck.

To reinforce, here's a link to a recent analysis out of Avalere (funded by an MA trade group), comparing costs and outcomes for older patients in Medicare across a variety of clinical conditions and medical complexity.  Among the most medically complex (dual eligibles) both costs and outcomes were better in private Medicare (MA) vs Medicare FFS. Among patients with diabetes, cost and outcomes were better, as a result of better preventative care was being delivered.  Overall, costs were similar. Private Medicare was associated with more preventative care and screenings and fewer avoidable hospitalizations. Medicare FFS associated with greater inpatient and emergent care costs.

Admin costs are a complex topic. Some are good, some are bad. Math is hard. Ribbons around a topic as complex as healthcare delivery in this country are few and far between.     

 

Another point is that Medicare has a passive claims review policy - that is, they don't spend a lot of money figuring out ways to deny claims, which I've (anecdotally) heard is a problem with many insurance companies. Perhaps that's what you're getting at with the 'utilization management of high cost specialty drugs' bit, but from what I've heard many times insurance companies go way beyond that to denying routine claims. A more passive, presumably less expensive approach a la Medicare may not be such a bad thing. Reduces admin costs, and as you say increases the denominator because they're paying for more care - again not necessarily a bad thing.

I agree that more preventive care would be great. Seems like that should be applied at the primary care level - that is, doctors should be doing it. Seems a bit weird that insurance companies are the ones incentivizing what should be general health care principles.

[GHOSTUSER 361]

2 hours ago, bad_teammate said:

Angry online right-wing white guys are experts at fashion and the prices of women's clothes.

We’re the ones reviewing and paying the AMEX bills for the shopping trips to Neimans, Hermès and Chanel. I’m very well versed in prices 

[American Swindle 102]

43 minutes ago, FondrenRoad said:

You know, we don't have to do everything at once.  We should tackle low hanging fruit like banning pharma advertising and price gouging even while we are still arguing about how to move forward with healthcare coverage and costs overall.

They need more competition, we can't even import drugs that are approved in the UK to compete with Big Pharma...

[GHOSTUSER 361]

11 hours ago, David Dennison said:

Not if you belong to an HMO.

Again different levels of service and choices for those of different income levels. If you are stuck with a HMO you have a shitty job or income. Find a different job with a PPO or if self-employed and that is all you can afford then that’s too bad. We don’t bat an eye or have an issue as a society with those on the poor to rich spectrum having different means when it comes to something fundamental like transportation. Why should health care be any different. Nationalized health care would be analogous to all of us being forced to give up our nice cars to get to work and having to ride the bus. Thankfully as Americans, we value individual choice and the majority will choose to have an option of higher level of service than collectivizing resources to ensure everyone has minimum standard of care. As a country we don’t care enough about the poor to take care of them. That’s why there are community health clinics and other charities taking up the slack.

Edited November 16, 2018 by Iconoclast Texan

[Bozo_Casanova 26521]

11 hours ago, Anastasis said:

Can you lay out the various dem supported uhc plans and handicap them in terms of most likely direction we go in 2020. 

I don't think there are any real plans yet.

[Anastasis 23481]

10 minutes ago, Bozo_Casanova said:

I don't think there are any real plans yet.

I haven't heard anything except for M4A floated. 

[seven 1367]

20 minutes ago, Iconoclast Texan said:

Again different levels of service and choices for those of different income levels. If you are stuck with a HMO you have a shitty job or income. Find a different job with a PPO or if self-employed and that is all you can afford then that’s too bad. We don’t bat an eye or have an issue as a society with those on the poor to rich spectrum having different means when it comes to something fundamental like transportation. Why should health care be any different. Nationalized health care would be analogous to all of us being forced to give up our nice cars to get to work and having to ride the bus. Thankfully as Americans, we value individual choice and the majority will choose to have an option of higher level of service than collectivizing resources to ensure everyone has minimum standard of care. As a country we don’t care enough about the poor to take care of them. That’s why there are community health clinics and other charities taking up the slack.

Perhaps the worst health care analogy ever posted on this blog. Congratulations dumbass 

[GHOSTUSER 361]

8 minutes ago, Bozo_Casanova said:

I don't think there are any real plans yet.

The concerns about Obamacare and it’s cost were the main reason why the Diocese of Texas to sold St. Luke’s in the medical center. Now look at what’s happened to it since being sold. There is a new article seemingly every day about some horrible  issue with St Luke’s now. Under Episcopal control, it used to be the best hospital in town. That’s one of many negatives to come from Obamacare. The hit to my pocketbook was severe from increased employee contributions and deductibles. There are enough bad experiences from people like me who vote that will hopefully stave off further government involvement in health care.

[Bat Guano 359]

16 hours ago, hayden_horn said:

https://www.macrotrends.net/stocks/charts/UNH/unitedhealth-group/revenue

i wish i could screencap the chart at this link.

revenue growth and profit are the engine behind shareholder success in this country. i'm not sure that is in line with positive medical outcomes.

all these companies are doing extremely well by pinching everyone's costs. look at the costs chart posted above. 

somehow they are getting away with it.

why?

 

So one large insurance company is making > $52B per year in profit on revenue of $219 B. And it's been going up by double-digit percentages every year since 2010. But that's nothing compared to the 40% YOY increases pre-ACA.

That seems like a lot. Maybe has something to do with high health care costs? Just a guess....

[Anastasis 23481]

41 minutes ago, Bat Guano said:

I agree that more preventive care would be great. Seems like that should be applied at the primary care level - that is, doctors should be doing it. Seems a bit weird that insurance companies are the ones incentivizing what should be general health care principles.

The reality is that unless you align the incentives correctly to promote the outcomes that you want to see, they will not be achieved. Fee for service is an antiquated model for health care reimbursement and creates perverse incentives to increase resource use and costs with little focus on health outcomes.  We do not need to get tunnel vision on "paying for more care", as if that is a good thing. We need to be focused on realizing the benefit and positive outcomes from the care that is provided and aligning the incentives and reimbursement to those outcomes.

Rather than reimburse based on how many CPT codes we can string together on a claim for a diabetic management encounter, let's reimburse for hitting quality measures related to screening for complications and achieving A1C goal.  When a novel and high cost diabetes treatment is provided, let's add an outcomes component to the reimbursement.  If the patient discontinues the drug within 90 days, all reimbursements are refunded by the pharma to the payer. If the patient persists on treatment and hits A1C target, pharma gets a 5% kicker on the reimbursement on the back end.  FFS needs to DIAF. Private payers are driving the innovation in value based contracting arrangements, both on the pharma side as well as the provider side. We need more of that.

[Bozo_Casanova 26521]

14 minutes ago, Iconoclast Texan said:

The concerns about Obamacare and it’s cost were the main reason why the Diocese of Texas to sold St. Luke’s in the medical center. Now look at what’s happened to it since being sold. There is a new article seemingly every day about some horrible  issue with St Luke’s now. Under Episcopal control, it used to be the best hospital in town. That’s one of many negatives to come from Obamacare. The hit to my pocketbook was severe from increased employee contributions and deductibles. There are enough bad experiences from people like me who vote that will hopefully stave off further government involvement in health care.

No, that's not "the main reasons" why the diocese sold the Episcopal Healthcare System, but I'm not sure what the management of St. Luke's by Catholic Health Initiatives has to do with the negatives of Obamacare. Quality scattershooting, though.  
Maybe your employer should be better at shopping plans and teaching employees how to be good consumers of care. My contributions and deductibles on my HDHP we slightly below flat from 2013-2018, and for 2019 my deductible is the same and my premium went down by 60%.

[RayDog 682]

44 minutes ago, Bozo_Casanova said:

I don't think there are any real plans yet.

I saw a clip of Bernie saying he plans to propose that Medicare be extended to 55 year olds during the next session as a first step toward implementing his main bill which could only pass when Democrats control both houses and the presidency.

[Cheeseweasel 26438]

27 minutes ago, Bat Guano said:

So one large insurance company is making > $52B per year in profit on revenue of $219 B. And it's been going up by double-digit percentages every year since 2010. But that's nothing compared to the 40% YOY increases pre-ACA.

That seems like a lot. Maybe has something to do with high health care costs? Just a guess....

Not defending them, but not sure where you are getting those numbers. Gross profit doesn't equal net income. 

UnitedHealth Group net income for the twelve months ending September 30, 2018 was $12.563B,

That's 5.7%. Nothing to write home about.

[Bat Guano 359]

4 minutes ago, Cheeseweasel said:

Not defending them, but not sure where you are getting those numbers. Gross profit doesn't equal net income. 

UnitedHealth Group net income for the twelve months ending September 30, 2018 was $12.563B,

That's 5.7%. Nothing to write home about.

I got them from the link in Hayden's post. It had the gross profit numbers, but not net. Link for your numbers?

[FondrenRoad 4378]

31 minutes ago, RayDog said:

I saw a clip of Bernie saying he plans to propose that Medicare be extended to 55 year olds during the next session as a first step toward implementing his main bill which could only pass when Democrats control both houses and the presidency.

That's the worst idea I ever heard.  All or nothing.

[Guest Lobo]

It was Bernie's idol, FDR, that spawned employer-based health insurance.  He could have gone a different, more progressive way.  But he didn't.  

[Cheeseweasel 26438]

31 minutes ago, Bat Guano said:

I got them from the link in Hayden's post. It had the gross profit numbers, but not net. Link for your numbers?

Same link. Just have to tab over to Revenues. 

FWIW, I'd rather see that 12.5 billion in revenue going back into the system versus going to shareholders. There are plenty of stocks for people to buy. Healthcare doesn't need to be one of them