He went to college on Social Security survivor benefits.

I thought that was a joke. Boyhood dream to cap entitlements?

***From the time of his father's death until his 18th birthday, Ryan received Social Security survivors benefits, which were saved for his college education.***

I am sure Ryan would like it if someone said that they were dreaming of taking away survivor benefits of Social Security since drinking out a keg.

gotta be close to 100% that Ryan was a buttchugger

Because the government pays you for it.

Renodoc is actually probably a pretty good person, he just doesn't really know much about health care at the macro level, despite being a doctor.

https://twitter.com/sangerkatz/statu...39422265704449

https://twitter.com/girlziplocked/st...79741071347712

If that's the case, then wouldn't he want them to remain covered?

I think the same thing. His reaction to the Jack Ury hand shows he's a decent guy with a sense of humor. He's just had his political brain hijacked my my-side-ism and can't see straight when it comes to that.

Also there's that thing where doctors tend to think their opinion on anything remotely healthcare-related is infinitely superior to anyone who's not a doctor.

Ah shucks

Theres three retina practices in town. Mine sees 80% of the medicaid in town. Playing 3-5, even with my paltry win rate, is a more profitable use of my time.

Im not for this bull**** Ryan bill. I dont really think its a great idea to dump 3-400,00 Nevadans off the medicaid roles in one shot. Like i said before, any lasting change in health policy is going to require a seachange of the "my-side" stuff you are describing and true bipartisanship

I like how the phone app (old style) shows the one guy i have on ignore in spoilers. Cool.

Perhaps. Just like baseball players think they know everything about baseball economics. Doctors may know their tiny universe of healthcare. But healthcare includes so much outside they don't know -- worker's comp, medicare, medicaid, insurance, surgery centers, hospitals, elective procedures, EMRs, accountable care organizations, nurse unions, non-profit, and 5,000 other parts.

It is 18% of our economy. Impossible for anyone to know it all. And especially make any accurate predictions what anything will mean in 10 years when we don't even know where we are going to be in 10 months.

Federal Medicaid has already technically been repealed in PA. They are throwing people off who can't prove or are slightly above the income level to qualify. I'd say Jan 1, 2019 it will be repealed altogether. Now I have the ****iest insurance and higher copays. Thanks Drumpf.

You'd think so, but here we are anyway.

Don't.

We count people "insured" who have super-high deductibles -- $6,000+. The majority of those people who choose those plans can't afford the $6,000 deductible and went with it because of the lower monthly premiums. Because of the higher deductibles, they avoid getting medical treatment because they are paying $1 for $1 until $6,000.

So, yeah, they are covered in case of a catastrophic event, but I am sure the vast majority don't use their "insurance." And because of the negative incentive to use health care, people have a higher likelihood of becoming sick.

It is bankruptcy protection more than health insurance. And the % with this type of "insurance" is rapidly accelerating.

Also there's that thing where doctors tend to think their opinion on anything remotely healthcare-related is infinitely superior to anyone who's not a doctor.

I've done a fair amount of admin work (COS, hospital board of directors) and I would agree that most docs have only the haziest idea about a lot of the macro stuff.

But most of them (and most hospital administrators) would like the people who theoretically understand this stuff to get an understanding about the micro stuff - the day to day actual caring for patients. In my little corner of hell, when some waterhead politico says something like "they can just go to the Emergency Room" implying that somehow this provides adaquate heath care, it proves they know **** all about health care as a whole. When another politico thinks (as golfnutt noted) that a policy with an eye-watering deductible is coverage, it proves it again.

No hospital, never mind a docs office, can stay open at Medicaid/Obamacare rates. You can just about keep the lights on with Medicare, if you don't care about stuff like new equipment/physical plant stuff. I used to see 35% of patients for nothing (actually less than nothing, factoring in med mal) and now I get maybe $30 or so a head which I'm happy to have - but the hospital isn't coming close to breaking even on those patients....but solving the problem would require grownups on all sides of the problem, which are lacking.

In passing to any Brits around, how's it looking for the NHS? I only get my info from the Economist, and they're painting a pretty bleak picture. Are you guys going to muddle thru in classic form, or are things really falling apart over there?

MM MD

You mean are they "hanging on in quiet desperation?"

These are not the same thing. These are not within shouting distance of each other.

Well said. And it doesn't take into account the long-term impact of policies on people. Delayed treatment usually means much more costly treatment overall. So we are pushing a lot of this further down the line.

It seems we should start reducing the obesity problem from the top down.

***This little bit of data points toward an interesting fact: according to the Centers for Disease Control, Trump is clinically obese. The Republican is 6" 2" and weighs 236 pounds, giving him a body mass index (BMI) of 30. A normal BMI for someone of his height, says the CDC's BMI calculation, is between 18.5 and 24.9. Above 30 is in the obese range.***

No chance that will happen in this country. I will eat what I want and I won't have a government bureaucrat telling me what my portion size should be.

We should think of a strong incentive system for people to lose weight and/or punishment system. This alone could solve the healthcare crisis.

I don't think I have seen any healthy 85-year olds that are overweight. The ones that make it that far are frail. Easier on your heart and lungs to carry around bones than huge mass. I actually think it is better to be slightly overweight when you are younger and then change to underweight when you get older. Hard to do.

I can't see someone like Trump becoming skinny. He actually is the perfect candidate and age to start it right now. He should try to lose 60 to 70 pounds by the time he is 80. He can do it. Will he? Probably not. There could be a life-event that gets him there. God's way of saying make way or change. Nobody gets out alive.

Sure. But relaxing coverage requirements is a Republican proposal.

The incentive system for not being obese is the innate human desire to have sex. The only reason Trump gets to **** hot models is because he's rich as ****.

Anyway, you are correct. Obese people don't live to see 85. I work in a hospital. It's true. The obese ones all die in their 60s/70s.

Is their any 2+2 dissent to health care service mandatory price disclosure?

Whether the prices of the doctors office visit or hospital per day charge is displayed in the waiting room, or on their website, or whatever.

I had an allergy test done in January. The standard 30+ pinpricks on the back. Literally charged the insurance company $12,000! Insurance company paid $4000. Crazy.

If you don't die, you are wheelchair bound with an oxygen tank until you do die. Miserable.

You should have choices at birth:

a) Eat however you want and you will die at 70.
b) Moderation and you may just make it to 70 and if you do, you will have a decent shot to make it to 86.

Both cases you still end up dying. The problem is group (a) won't just take themselves out of the system. They will change choices when it is too late. Kind of like smokers stopping when they get lung cancer. Too late. And it costs the system (and all of us) a ton more money that we all pay.

That wasn't the price of the allergy test. You PRE-PAID for an entire YEAR of treatment which you were not fully aware. All the shots. The test you got costs about $50. The key to the test is to get you to sign up for the treatment where all the money is made. And only 25% of people complete a year of treatment so all that money is kept by the allergy companies.

Legal, yes. Transparent? What do you think?

The system doesn't want transparency. And companies charge different amounts for the same test. The hospital where you are at may charge $40,000 for a knee replacement while there is another one 300 miles away that charges $7,000. Same with MRI tests.

Another reason for single-payer so patients (consumers) don't have to make all these complex decisions.

These are not the same thing. These are not within shouting distance of each other.

You're right. Or more properly, I didn't explain what I was trying to get at.

Obamacare seems to be gravitating towards honking big deductible policies. If a patient has a deductible but can't pay it, the /doc hospital can provide care for free, or decline to see the patient without being paid up front with $$ the patient doesn't have (going back to golfnutts point about noncovering coverage). Neither seems optimal, from a $$ point of view. So with Obama care, you get no $$, and with medicaid you get some $$ but not enough to keep the lights on.

MM MD

"Is their any 2+2 dissent to health care service mandatory price disclosure?"

In theory it's a good idea, but the actual disclosures are mostly going to be useless.

In my line of work, the most common presenting complaint is abdominal pain. The work up for abdominal pain can lead to a bill ranging somewhere between $300 (basically the minimum for a patient to be checked in and for me to say "hi") to 10K or so if you need the full Lab/CT +/s US and 30K to a bazillion dollars if you have a leaking aneurysm. How helpful a range of $300 to 30K+ would be to a patient is questionable.

More helpful might be a general basket of services that each hospital had to post - say the most commonly ordered labs/imaging studies and charges for a day in a general bed and an ICU bed. Dunno how excited the admin would be about that, though.....

MM MD