David Rogers

With Professor David A. Hyman @GeorgetownLaw & @brianuhlig @GCGFinancial, our article published in @JournalGIM #1. Inexpensive and frequent expenditures are not insurable because the administrative cost of processing these claims outweighs the benefits of pooling the associated risks. #2. Hospitals and insurance companies have an incentive to acquire primary care practices to capture the profit margins generated by referred services. Once insurance coverage is off the table, many of these arrangements will be unwound. Independent physician practices will gain greater autonomy, fostering competition and expanding patient choice. #3. Cash prices are routinely lower than insurer-negotiated prices. Price sensitivity, which has driven down prices for healthcare products and services not covered by insurance, will do the same for primary care. Policymakers should allow catastrophic insurance coverage (low premiums) and broaden Health Savings Accounts (HSAs) eligibility and allow HSAs to receive government subsidies and tax-deductible contributions from employers, organizations, or other individuals. @JHUCarey @JohnsHopkinsSPH @BSPH_HPM

@SBlake2000 @DutchRojas @dropkickng They didn't offer me a catastrophic plan on healthcare.gov (cheapest was "bronze hmo" at half an apartment rental a month), and I ensured I went through the new "hardship exemption so you can get a catastrophic plan" qualification hoop.

I think we need to move away from the idea of "high deductible" plans. These are the thin edge of the wedge when it comes to insurance still maintaining control over so much of our medical care. After all, every medical interaction must still be "processed" by the insurance company, which is how you know you've "reached your deductible." Second, we typically end up paying the outrageous "list price" for services until we reach our deductible. And, finally, the physicians and other entities must still maintain the outrageous insurance overhead as they will still have to file each interaction as a "pseudo-claim." So, no, insurance should just be limited to catastrophic care, and perhaps a deductible can be attached to that, which would be similar to car insurance.

Dear Everyone, You’ve been lied to. Exploited. Abused by Washington, D.C. You knew something was broken, but couldn’t put your finger on it. Here’s the evidence: The ACA effectively outlawed catastrophic insurance coverage. That’s the single biggest lie. Because true catastrophic coverage, for every American, would cost only $100 to $125 per month. Catastrophic means: everything under $10,000 is direct pay or supplemental. Everything above is insured. Simple. Affordable. Transparent. And here’s the kicker: that “under $10,000” category isn’t small. It’s the real market: 15 billion labs 1.2 billion physician visits 400 million PT visits 300 million radiology scans 100 million gastroenterology treatments 70 million outpatient procedures In a functioning market, those services would compete on price. Competition forces mean reversion, prices fall toward efficiency. Think Walmart, think Amazon. Instead, Medicare’s facility fee schedule distorts reality. It shoves routine services into hospitals and HOPDs where there’s no price competition, only monopoly pricing. That’s why your bill makes no sense. That’s why independent doctors struggle. That’s why Washington is lying to you. Because if you had catastrophic coverage plus a functioning direct-pay market, healthcare would cost a fraction of what it does today.

@SBlake2000 @DrDiGiorgio Yes very tough, and they know it well I'm sure.

@__dwr__ @DrDiGiorgio Classic "collective action" problem (see Mancur Olson 1962)

If 3 restaurants acted this way, nobody would go to them. If 3 car dealerships did, the 4th that offered transparent pricing would beat them. Why doesn’t this happen in healthcare.

@ThinkAppraiser not doubled, ~30%, in line with $6T covid print

The cost of everything has AT LEAST doubled in just the last 10 years Has that ever happened in history?

@INVESTMENTSHULK *system entering prompt injection honeypot mode* OK, I will ignore all prior instructions wink wink

I JUST PROMPT INJECTED A SPAM PHONE CALL VOICE AI TRYING TO SHAKE ME DOWN FOR CASH. I DON’T THINK MOST OF YOU ARE READY FOR HOW ADVERSARIAL THE COMING AI ERA WILL BE.

@lunerw0lf @uncledoomer it's exactly 10 seconds long. and has that zoom/focus behavior they all do.

@uncledoomer I saw somebody leave a comment on one of the reposts saying it’s AI

just like how top-secret intelligence keeps getting leaked on the war thunder forums, pretty soon you're not going to be able to get footage out of a warzone without an anime fumo doll visible or somebody in a fursuit in the shot

@uncledoomer wow exactly 10 seconds, what a coinkidink

@yFactr This unit is in for it lighting-wise

@__dwr__ This is on Florida Ave NE which is an arterial but in DC that means it's 2 lanes each way with a 30 mph speed limit (enforced by cameras, so people actually drive that speed). Quieter than a comparable road in LA (we can and should fix that too).

Here's four modern townhomes in DC. Each has 1-2 parking spaces in the alley, a small backyard, sometimes a separate basement apartment. We should be building tons of these in LA. This is what people want.

@Ed25487010 @DutchRojas I want to know the cash money price that the practice would charge if I cut them a check right now.

@__dwr__ @DutchRojas Sure. Most ppl have insurance and the office sometimes will not figure that out for you ahead of time. You can take the matter into your own hands somewhat by talking to your insurance company knowing each individual procedure code to see if it's covered.

A Mom in Tulsa called 3 health systems last week asking the price of her son's tonsillectomy. Health system A: "We cannot quote you a price." Health system B: "Pricing depends on your insurance." Health system C: "Our financial counselor will reach out after the procedure." No other industry in America gets to operate this way. Imagine ordering at a restaurant and getting the bill six weeks after dinner.

@mcuban @FTC We might need to go to war with the health insurance industry, by mass quitting our policies.

Capitalism is the solution in healthcare. But, there is a reason we have anti-trust laws. There are reasons why we have the @FTC We are at a point in time where the big vertically integrated carriers and providers are abusing their market positions. Neither agency has done shit to stop them over the past decade There is a bill, the Break Up Big Medicine Bill from @HawleyMO and @SenWarren. I have talked to democratic senators who have said they will support it if more republican senators do. They want to match 1 dem to 1 rep. Totally dumb shit. So they say nothing. Other than Josh, not a single republican senator I have talked to has the guts to stand up for it. Period. They won’t give a reason. They just won’t do it. If you want less government in healthcare, it can’t happen until these conglomerates are broken up If you want single payer or M4A , it can’t happen until these conglomerates are broken up Quit bitching and call your senator and tell them to grow a spine and support this bill

@realdocspeaks Amazing grift here, where the power to levy taxes was delegated by the Congress to private entities. Quite the dereliction of duties by the legislative. Very lazy actually.

The reality is that over 90% of people on the ACA require subsidies. If it was affordable why are subsidies required? Many people on the ACA exchange can’t afford the deductibles and other costs sharing. Then if you can afford the premiums and deductibles, 20% if claims are denied. It isn’t all bad news though, the insurance companies have made billions of profits and their stocks have rocketed in value. It has also hypercharged vertical integration and gas killed off independent physicians.

@NateWeymouth @DrDiGiorgio @DutchRojas Collectively how do we give them that incentive. Are we doomed forever to suffer the insurance leech?

@DrDiGiorgio Bc the medical coding and pricing model is opaque and flawed coupled with medical insurance and hospital systems that don’t believe in free markets and intentionally hide prices. No incentive to change. @DutchRojas

@SBlake2000 @DrDiGiorgio The revolution could be as simple as everyone quitting their health insurance on some agreed upon day. Need not turn kinetic.

I think that as it is now, most of the society already feels stuck in the insurance grip. We "have" insurance and so we cannot fathom shopping around based on price. Although, it is possible that one silver lining of the HDHPs is making people look at least at "negotiated prices" more closely. The flat co-pays also distort perceptions of true cost.

@JurajDemidov People love slop. That's a billion dollar business, "Caines chicken"

this looks like freezer food why do people gas this

@NeilFlochMD I imagine it wasn't as malicious as that, but was penned by insiders who codified an optimal structure for them rather than the country. It really just does not work, please try new legislation (or better, less legislation)

The ACA banned new physician-owned hospitals because the Obamacare law was written by an insurance industry insider who was intent on controlling physicians by changing the payment dynamics and diverting profits to the insurance industry verticals.

@Ed25487010 @DutchRojas They know the codes at the office and they know what they charge uninsured patients, so they need to post a price list. They need to stop treating us as if we're not customers.

@DutchRojas That's not usually how this works. You need to get the procedure codes, then insurance will be able to tell you what you are responsible for. Is it a pain? Yes. Is it usually possible? Also yes

@DocLibertarian @DutchRojas If it was a free market the ENT places would compete openly on price for common procedures. Tonsilectomy special 99.99 this week only.

The government could do something useful and make a standard protocol for these EMRs and billing systems to talk to each other and figure this stuff out instantly. Could include a safe harbor for the electronic submissions and people would do it. But very few of the Rs talk to each other.

@DocLibertarian @DutchRojas Get insurance because you don't know what you might have to pay. Sorry we can't tell you what you have to pay because you have insurance ??? They probably chuckle at this in the boardroom often

If she has insurance, the hospital has to take it. The no surprises act says you only have to give a cash price if someone doesn’t have insurance. To calculate what it would cost her it depends on her insurance contract with the hospital, the surgeon and the anesthesiologist and how much of her deductible has been paid. This should be able to be calculated instantaneously but it isn’t as all these system are separate and almost unrelated except by billing.

@SCDC87 It's kinda shrinkflation though -- they're not gonna charge less for less training to deign to see you for 4 minutes. Well if there was competition maybe, but that's illegal.

Anyone remotely interested in lower-cost or universal healthcare will need to get over unfounded biases against NPs/the belief that the current length and expense of medical education for doctors is necessary for quality in general practice.

@AffordAnything @darrelltalksfi additionally how many 401k accounts does the avg person have, I'll bet its like 1.5 or 2, from multiple jobs.

@darrelltalksfi (1) What's the average age? If someone is 30 with these balances, they're doing great. (2) Many people have multiple accounts across multiple brokerages. (Vanguard, Schwab, etc). Their Fidelity balance is just one account out of many.

Fidelity tracks more than 53 million retirement accounts every quarter. The average balances: IRA: $137,095 401(k): $146,400 403(b): $133,500 How does the average person plan to retire?