Blade Doc

@MarkRuffalo @elonmusk Spend your own money

Hello @ElonMusk. This is how you are perceived. Not too late to course correct but it’s getting pretty late. You certainly have the extra money on hand to really help the people of the world instead of the hellbent road of chaos and destruction you are ludicrously barreling down. Put down the Ket straw. 🤪

@DGlaucomflecken This is a tendentious way of announcing barely more than proof of concept technology that is not yet recognized as useful much less standard of care.

NIC is finally recommending rapid tests for endometriosis. A saliva test and a sensor pad...so the nearly decade-long wait to do exploratory surgery to confirm what the patient has been telling us the whole time might finally be over. Turns out, we don't have to see women suffer for 9 years before we believe them. What. A. Concept. We broke down how these new diagnostic tools work and more on the latest Medlines episode.

@IM_Crit_ Elon Musk is usually correct, usually 10 years too early

"It is difficult to make predictions, especially about the future" -Yogi Berra

@fesshole Sometimes I think that they actually hate the patient and are making us torture them at the end.

Intensive care doc here. Don't make us keep them alive because you feel guilty about something. Realise they're going and let us make it as good as it can be. Please.

Then I asked for a simplified version of the above : Here it is in plain English. Denver hired UnitedHealthcare to run its employee health plan. Denver pays the actual medical and drug bills itself — United just processes them. That’s what “self-funded” means. The problem is that Denver can’t see what it’s actually paying for drugs. 1. United buys the drug for one price and charges Denver a different price. It keeps the difference. Say the pharmacy gets paid $40 for a prescription. United bills Denver $100. United keeps $60. Denver never sees the $40. The contract says this out loud in three different places — it’s not hidden, it’s just written in language nobody reads. There’s no cap on how big that gap can be. 2. Drug companies pay rebates. United keeps all of them and hands Denver a flat number instead. United collects rebate checks from drug manufacturers. Instead of passing those through, it promises Denver a fixed amount per brand prescription (about $740 in 2023). If the actual rebate was $1,500, United keeps the extra $760. The contract literally says any rebates above the fixed amount belong to United. Denver has no right to know what the real number was. 3. United decides which drugs are “specialty” — and specialty drugs are where the money is. The contract defines a specialty drug as, essentially, “whatever United’s own specialty pharmacy sells.” United also reserves the right to reclassify drugs whenever it wants. Once a drug is labeled specialty and filled at United’s own pharmacy, it drops out of the normal price guarantees entirely. So the most expensive drugs are the least protected. 4. The most expensive drugs of all — the ones given in a doctor’s office or infusion center — have no price guarantee at all. The contract flatly excludes them. Cancer drugs, infusions, injections administered by a provider. Zero pricing protection. 5. Denver can’t shop around, and it can’t leave without a penalty. Denver isn’t allowed to negotiate directly with any drug manufacturer. It must use United’s mail-order pharmacy exclusively. And if Denver hires an outside vendor that steers employees to cheaper drugs or cheaper pharmacies, United can cancel all the pricing guarantees. If Denver ends the drug program early, United keeps every rebate it owes. 6. Denver can’t audit its way out of this. Denver is allowed one audit a year, capped at 300 prescriptions, using a random sample United has to approve. No auditors paid on commission. No computer-based searches for errors. You cannot find a pricing problem across hundreds of thousands of claims by randomly checking 300 of them. The audit rules exist to make sure nothing gets found. Is any of it illegal? Almost none of it. It’s a legal contract that Denver signed. The one thing that might cross a line: federal law since 2021 bans “gag clauses” — contract terms that stop an employer from seeing its own cost and claims data. This contract says United may let Denver see its pricing information, at United’s discretion. Federal regulators have said that “only if the vendor allows it” language is exactly what the gag-clause ban prohibits. And Denver has to certify to the government every year that it has no gag clauses in its contracts. The one thing Denver could actually do about it: Colorado banned this drug markup practice, effective January 2025, and self-funded employers like Denver can opt in. It’s an election, not a lawsuit. Somebody should check whether Denver ever filed it. The bottom line for an HR person: the drug program looks free. There’s no fee for it anywhere in the contract. That’s the tell. United isn’t working for free — it’s getting paid out of the drug prices, and the contract is built so Denver can’t measure how much.

@Jacksonsrule This is a lie

Dad buys land for $100K. Today it's worth $5M. Dad doesn't sell because selling triggers huge tax bill. Dad borrows against it instead. A loan isn't income. So no tax. Dad lives off the loans for decades. Dad dies still owning the land. Kids inhert at $5M basis. Kids sell & owe nothing to the lRS. The $4.9M gain? Gone This is exactly what wealthy families do to avoid taxes and build generational wealth.

@grahamlebel @mattyglesias Hold the government accountable? How's that working out with Trump?

@mattyglesias Yeah but the landlord could actually be held accountable, unlike in this capitalist hell that you like to defend.

You could have a society where everyone lives in public housing but you would still “have a landlord,” it would just be some kind of public agency.

@DrNeilStone The usual strategy of making the next Republican candidate scarier than the last continues. I'm not sure that Trump will live long enough (2 administrations) to get the "strange new respect" treatment though.

Yes I admit I may have VDS Vance Derangement Syndrome

@ninthhostage @MorlockP They think that their preferences will be in force -- just like what they are doing in the rental markets

"credit scores were only invented in the 70s - we can get rid of them and we should" Many people have extremely bad intuition of understanding of what financial life was like pre-credit score - I do not think you want to go back to that

@spartywrx @EdGainesIII As long as the hospitals get a bigger cut everyone except the patients and physicians will be happy (and who cares about them?).

All my ultrasound guided shots delivered same day in 5min will now become fluoro guided injections scheduled another day at 3x the cost.

@joshuaiann85051 @elonmusk @wholemars The NHTSA has acknowledged data that shows that Tesla FSD is safer than human driving already. Do you have better data than "I said it"?

@elonmusk @wholemars Sorry, your robot driven cars are disaster prone dangers. Drive in front of trains, into active police standoffs, catering to the lazy, will be a real disaster. I said it.

One thing that really frustrates me is when Tesla Self-Driving exits the carpool lane or express lane and then gets stuck in traffic. As I see everyone else whizzing by in the far left lane, I get extremely annoyed knowing I should be there too. Respect the settings please 🙏

@TeslaTrip @elonmusk @wholemars Until it's legal for me to go to sleep, I get a say.

@elonmusk @wholemars Uh, no. Why on earth would anyone want that? No interventions is the goal. No human controls. No human in the loop.

@cammakingminds @peterrhague This is the stupid libertarian argument that firing a gun through a crowd should be legal as long as no one gets hit. Or drunk driving as they are "victimless" until someone gets hurt.

Yup no disagreement at all about intimidating people for clout booo. Super annoying. But be serious man... Defending yourself from not getting hit with a bike? You understand how I'm a little confused about the causality here? Does this person not become a problem AFTER causing harm? These people are in the middle of a bike lane. If I saw this dude coming I would keep looking at my phone. He wins the second you acknowledge him that's why he is doing what he is doing 😐

How do you punish this behaviour? Its reckless and antisocial, but prison would obviously be excessive. Our other options - community service, fines etc. - he would probably laugh off and ignore. Maybe we need to bring back the stocks...

Hey @DrOzCMS @CMSGov Keep up the good work of reducing Medicare professional fees while ensuring facility fees go up for United and the Non Profit Health Systems. Solid. I mean, you guys are a brilliant organization!

@Dr_mac2 That's great. As soon as you get enough people to staff rural EDs where they don't have any doctors much less fellowship trained ones, let me know. About 30% of my transfers are from NPs working alone.

I know this will be an unpopular opinion but F it. If you’re not EM trained you shouldn’t be working in an ED.

@RyanJTorres Too expensive for me to chance having to remove it

Having a tinted front windshield on the Cybertruck is an absolute must. Over the last few days my truck was in for service, and I noticed a major difference without the tinted front windshield on my Cybertruck loaner. It really spoils you, and you don’t even have to wear sunglasses most of the time. I have 3M Crystalline 50% I also discovered a cool feature in the Cybertruck loaner yesterday when it showed a pop-up letting me know my vehicle is ready for pickup. Definitely a nice addition to the software for loaner vehicles.

@pegobry_en People say "focus" but they really mean lie. Look at Spanberger's campaign in VA where she did a 180 immediately after the election on multiple issues

I see conversations among leftists about whether the "populist left" should "focus" on economic issues or social/culture war issues. What all these people seem to miss is that the issue isn’t "focus." The way that Bill Clinton and the New Democrats managed to shed their party’s toxic bagage was not by changing their "focus", it was by changing their *positions.* This was the significance of the "Sister Souljah" moment. Clinton wasn’t saying "Oh this stuff isn’t my priority." He was saying "I *disagree*, and here is a thought-out argument why, so you can trust that I mean it when I say I disagree." DSA types can choose to "focus" on whatever they want, as long as they subscribe to the laundry list of toxic issues, they will be vulnerable to attack on that basis. But they won’t change. Because they really believe that a dude beating up a woman on a boxing ring is good. They really believe castrating children is good. They really believe Hamas is good. They really believe borders are evil. And because they do, other people can point out that they do, and this will cause them to lose electoral support since most people find those views abhorrent. Regardless of what they choose to "focus" on.

@Scobleizer @Flock Clearly you don't know what "biting your tongue" means as you are clearly spouting off

The anti-surveillance people are tearing down @Flock cameras. Meanwhile the technology exists to take everyone to the World Cup and let you stand next to the ref yelling at him. But that will never happen. Everyone would have to wear a pair of glasses. Except in Las Vegas. The guy who put the electronics in showed me 100 cameras around the field. And Unity put me on the ball in its labs. Cameras can solve crimes and gather evidence in a much fairer way. Spent two hours talking about this on a street corner in Barcelona with the main developer at a leading body camera company that many police officers tell me they love now after originally fearing them. They show who is guilty in arguments between citizens and police. But, OK, tear down the thing that keeps you safe from a serial killer. That sounds like great thinking. Am biting my tongue.

@bethanyshondark @molmccann No. OTOH she has just admitted that they HAVE that power over her.

@molmccann We should absolutely give the bad guys veto power and make it impossible for women to serve as public servants.

She should resign. She is a mother of young children. She obviously fears for herself and doubtless for them. She is simply too young and in the wrong stage of life for a position that requires some real nerves of steel.