domain:slatestarcodex.com
Throwaway05
23hr ago
Agree with the other poster and - insurance companies practically practice medicine all the time by deciding what is covered and what isn't, they deny this is the case however "you can still get X thing we just won't pay for it" works very well as a legal smoke screen and in the case of things like malignancy they can absolutely drag their heels and turn your melanoma from a short procedure to life altering or death causing.
FCfromSSC
Nuclear levels of sour
23hr ago
...Has anyone ever heard of attempts to use freezing water to provide mechanical force for metalworking? Making pressings, for example?
hydroacetylene
23hr ago
Health care sharing is a thing. It's worse than real insurance but you're just getting what you pay for there. The one that's solidarity something is better than the one that's samaritan's something. I am not the expert on these things or how they work but there's plenty of people who's main medical expenses are child-related who are very happy with them.
DuplexFields
Ask me how the FairTax proposal works. All four Political Compass quadrants should love it.
23hr ago
What a lot of people never learn is how much the modern imperial states (Fascist Italy, Nazi Germany, FDR’s USA, the Soviet Union and Communist China) resembled each other, differing mostly in how their philosophers describe them and how much (and how often) their governments are perceived to be allowed to violate their citizens’ and enemies’ human rights.
The opposite of libertarian isn’t communism, it’s totalitarianism.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
23hr ago
I think the only person who dislikes the gameplay of HD2 is Cjet, or at least I think he was the person who says it's a grenade chucking sim. He prefers the Starship Troopers game, which is a highly confusing stance! I got my money's worth out of HD2 even though I only played sporadically of late. I also got my money's worth out of ST, if only because he gifted me a copy haha.
I'd love to join in, assuming there's room!
hydroacetylene
23hr ago
Your best bet when dealing with medical bills Act Like a Dot Indian. 'I'm not paying that, it is too much'. They'll knock it down eventually.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
23hr ago
Say what you will about the British government, they have a unified, highly legible design for all their official websites. When I was filling up my DS-160 for a US visa, I was struck by how positively antiquated it was in comparison.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
23hr ago
Aight, I let it through. But you should probably put the submission statement in the body of the post, probably easier to parse once people start commenting. You can do both that and include a link without issue.
hydroacetylene
23hr ago
I mean, you can always cartelize healthcare providers and insurance companies and leave them aligned, together against the patient.
Throwaway05
23hr ago
Okay so two things going on here:
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The funny numbers bit. The system is designed around everyone having insurance. The numbers on a bill a not random but can essentially be thought of as random. The hospital negotiates with the insurance by saying X and the insurance says 1/4X and then the hospital says 1/2X and that's what the insurance decides to pay. It's stupid but it is the system, the numbers are funny on purpose. If you don't have insurance you get absolutely obliterated but you can usually negotiate with the hospital because they know the numbers are funny, but "you have insurance" and "this weird shit happens" is how society and government have decided to run this bullshit so that's the way it is.
-
The ED is for if you are dying, if you are not dying you are not supposed to be there, and it is expensive in the way that you'd expect for "this is the place where you are dying."
Unpacking this is complicated and it results in a mix of things that are the fault of various patients and things that aren't, but for the most part the ED is more expensive, complicated, and a higher level of care than actually being in the hospital. On a hospital floor things happen slowly - you might have a handful of nurses on a step down floor, your doctor might see you once at the beginning of the day. In the ED nurses have few patients, numerous types of staff you might not even think about are running around constantly (like the lady whose only job is to get people's insurance), people are in and out of your room, labs come back stat, people are constantly checking if you are dying or not. Most patients in the ED are on telemetry, most patients admitted to the hospital aren't. All these things are extremely expensive and a lot of them happen outside of patient understanding and line of sight. The ED is more like an ICU. This is part of why patients being boarded in the ED is such a catastrophe.
In any case the ED is designed such the majority of patient's are pre-triaged. You are "supposed" to go to your PCP first, or people to call your PCP's answering service. Most people used to do that while the modern model was being developed but they don't anymore. Many people use the ED as a PCP, go get obvious "wait and see" things checked out, don't use common sense, and so on. Other people can't really be blamed because they have a sensible complaint and don't triage because they aren't medical people, or because it's hard to get a PCP these days or one with a good answering service. But the system isn't designed for this. Add in other things like homeless and illegal immigrants don't or can't pay and you've got a mess.
Part of this is specifically American - in other countries people use PCP as designed more, or are more comfortable with waiting, but that isn't how we are. Step-down EDs or the equivalent have been triaged but they hard because if you fuck it up you'll get sued to hell (another American problem).
Additionally emergency care doesn't reimburse well from private or government insurance so one has an incentive to build out and staff EDs to match the volume they are getting.
The last piece is the professional fee aspect - you are paying for someone with a lot of training to figure out how safely they can do the minimum on you. Ideally we diagnose without any testing, give you the minimum of interventions, and use our brain power to rule everything that could kill you or be going wrong with your body.
Because we are on the hook if anything goes wrong! But we also don't want to give you an expensive full body scan that will give you cancer in thirty years.
NPs have much lower professional fees but they also scan and test people much more and cause more bad outcomes and unnecessary complications.
You pay ED physicians so much for them to safely do nothing, which is weird as hell but is what the ED is designed for.
hydroacetylene
23hr ago
These are not Christendom. Christendom is an earthly kingdom(or group of kingdoms/republics) dedicated to expanding Christianity in a generally aligned way. It's possible, but a bit of a stretch, to point to some fringey parts(Francoist Spain, South Vietnam under the Ngo family) of the general US sphere in the cold war as the last vestiges of Christendom. But Christendom today is either dead or limited to Liechtenstein. It is, specifically, a state, operating like a normal state.
netstack
Texas is freedom land
23hr ago
More than one, certainly.
I do not believe that the kind of society I describe will necessarily arrive, but I believe (allowing, of course, for the fact that the book is a satire) that something resembling it could arrive...[it is] a show...[of the] perversions to which a centralised economy is liable and which have already been partly realisable in communism and fascism.
Dude hated the Soviet Union; he was also pretty unhappy with getting bombed for years.
magicalkittycat
23hr ago
Why political revenge narratives don't make sense to me.
It essentially implies the difference between the right wing and left wing argument about things are about morals and not about the effectiveness of policy or economic ideas for the good of our country and our citizens. If "your rules fairly" includes doing things that you think are stupid, inefficient, counter-productive and extra prone to corruption then doing it back would be strange.
Presumably if you hold an idea like "smaller governments are generally better for a country's growth" or "the state taking ownership in companies leads to bad incentives" or "free speech benefits the country's citizens and the country as a whole" then it would make little sense to abandon them once you've taken power if you want the best for the nation.
After all if you care about the country, I would assume you want good and effective policy. If you see the left's policy ideas as bad and harmful to our future, it's not a great idea to join in on the self-harm. Unless you're a traitor and hate the country, you would be pushing for what you think is the best policy. Now people might disagree on what is best for growth, what is best for the people, and what is best for the country but we should expect them to pursue their ideas in the same way if they care about America, towards ideas they think are good.
This is part of why principled groups can stay principled so easily. An organization like FIRE truly believes that free speech is beneficial. Suppression and censorship when their side is in power would be traitorous to the good of the country in their mind, even if done out of a desire for revenge. A person like Scott Lincicome of CATO truly believes that government taking equity of private enterprise is bad policy, and thus it's easy for him to critique it.
They aren't "turning the other cheek", they just actually believe in the words they say and the ideas they promote. They want good policy (or at least policy they think is good) for the benefit of the country. Sometimes you can see this in politicians, like how Bernie Sanders supports the plan to take equity in Intel. He believes government ownership of corporations is good for the country so he supports it even when the "enemy" does it. I think he's a stupid socialist but it's consistent with what I expect from a true believer. And you see with libertarian Republicans like Ron Paul, Justin Amash and Thomas Massie criticizing the Intel buy.
Counter to this, the "revenge" narrative comes off like the advocates never believed the words they were saying. It suggests their stated beliefs don't reflect what they think is good for the future of the US, but rather personal feelings and signaling to their in-group community. If they changed their minds it would be understandable, but if that's the case then the revenge narrative is unnecessary to begin with, they can now argue on the merits.
OracleOutlook
Fiat justitia ruat caelum
23hr ago
Oh no! LDS theology has something in common with Hinduism? That's terrible! Anyways.
This wasn't meant as an insult. Hinduism has a pretty strong philosophical system. It was phrased as a question because I'd be interested if you saw parallels yourself.
I don't typically argue the Ontological argument because we no longer have the necessary (ha!) shared philosophical background to make the argument sound coherent.
Just the cosmological or rational argument will make the case just as well. I'm not going to go through the whole exercise now in my own words, but I pretty much agree with all said here. (extract from Chapter 3 of Brian Davies' "The Reality of God and the Problem of Evil")
If I were to try to distill it into a single comment instead of a chapter of a book, I would say it like this: "God's nature is that which does not need an explanation to exist. It is necessary that there is something that does not need to be acted on, and God is what that thing is. One of the attributes of God's nature is that it contains its existence."
Then perhaps I would give an analogy - "Everything in the world changes when acted upon. The existence of any one state of being depends on actions taken upon its predecessor. It's like a line of people who have the direction to only raise their hand if the person next to them raises their hand first. It doesn't matter if that line is infinite, unless there is someone who always had their hands raised, no hands will go up. Nothing will happen. God is that which already had its hands raised - whose nature isn't 'raise hands when something else raises hands' but who's nature is 'hands are raised by default.'"
And then we can extrapolate based on that other logical traits such a thing would also possess. But I'm expressing this as hypothetical as I have 0 desire to debate God's existence on the Motte.
But mostly, I was wondering if the world-view of LDS has to do with why LDS authors are becoming more popular and the world-view of Catholics has to do why Catholic authors were more popular in the 20th century.
I think, based on your responses to me, that you agree that there is a difference between the two attitudes towards reality. Catholics believe in things like Natures, and LDS does not. Catholics believe that we are creatures, LDS do not. There are other differences that perhaps we could work together on narrowing down. .
These difference might help explain why the rest of modern society likes the fictional contributions of the LDS more than devout Catholics in the past 20 years. It's not due to Catholics becoming less intellectual (look at the make up of the Judiciary.) It's not due to Catholics no longer writing. But LDS writers have been making blockbuster hits and that probably says something more about changes in society than changes in LDS or Catholic doctrine.
Catholic theology would not agree with "we pull off the natural man" but perhaps you define natural man as something like Catholic's conception of Original Sin or something. Cross-denomination communication is hard.
gafpromise
23hr ago
But what's considered life saving? Say a person has a condition that is chronic and deteriorates their heart over time. Untreated, it will lead to heart failure but this could take years. Treatment is an insanely expensive medication or some kind of invasive procedure that has to be done periodically. Insurance, in its arcane wisdom, decides they don't want to pay for it. Eventually the person ends up in the ER with a heart attack. The heart attack is treated but not the underlying condition. The patient is just sent home. This is a fake example because I'm not a doctor but very easy to imagine something similar playing out. The medication treatment is not "life saving" because the patient was able to live for years without it, therefore it clearly was not that vital, right?
When you think about it, it's similar to the debate about covering "preventative" measures, including counseling on diet and exercise. Some people think it's absurd, but I would argue that by not covering preventative and maintenance types of treatments early on, they're creating much more serious problems down the road.
roystgnr
23hr ago
The LEM descent engine was aimed straight down and was only around ten feet above the soil its exhaust kicked up when the contact probe cut it off. The HLS Starship's current solution (though Musk still wants to try direct Raptor landings eventually) is to do its final descent with mid-body RCS-sized engines, a hundred feet up and angled outward. There's still the possibility of plume recirculation from those kicking a chunk of regolith in a bad direction, but even if something hits a main engine they only need one out of three still working at that point.
It's still crazy to only do a single unmanned landing+ascent test before putting people on it, though. We're not racing the Soviets this time, we can afford to "lose" the race to China, and the combination of "SpaceX has pretty great software for precision vertical landings of rockets without a human pilot" with "SpaceX will be landing on unprepared soil for the first time and often takes a few tries to get a new solution right" really suggests we wait a little longer before adding humans.
Technically we're not single-sourcing the lander anymore; Blue Moon is supposed to be ready in time for Artemis V circa 2030. In theory they're launching an unmanned test of the smaller Mk1 version of it next year. I wouldn't be surprised if the schedules slip further, though, whether or not the slippage is "Elon time" bad.
MaiqTheTrue
Renrijra Krin
23hr ago
I'd like to steelman the idea of prior authorization by rolling it into my own perspective that I've been trying to sustain over time.
The fundamental principle is that prices matter to patients. This statement simultaneously seems trivial and is also quite profound in context of the medical industry. There are doctors even here on The Motte who have sworn up and down that prices don't matter, but frankly, they're just wrong about this. This NYT piece reinforces this basic principle, though it does not state it quite so forthrightly.
That is, the story of the article is that, two days before the planned surgery, the author and his wife.
Price matters, but it’s really hard to put a price on survival. And even with transparency in pricing, there’s no way to know the difference between “cheaper but just as good” and “cheaper because it’s dangerously substandard care/medicine.” And it’s likewise difficult to tell when something that sounds trivial isn’t. It’s a lot of information asymmetry that the patient can have a really hard time understanding. And in some cases a high price can be taken for a sign of quality.
Throwaway05
1d ago
I think we need to go back to basics - it seems trivial to me that healthcare doesn't function as a market and doesn't work like other non-governmental activities. I provided a few examples of this in my replies.
If we can't get on the same page about that I'm not sure we'll be able to talk productively.
Quantumfreakonomics
1d ago
It doesn’t seem obviously retarded to me to have both a per-patient complexity-weighted administrative charge, and also a per procedure/per doctor-hour charge. Invoices for complex professional services are incredibly dense like this in many industries.
Throwaway05
1d ago
Oh yeah I see - yes we are in an area where you run into two problems "this should have a billing code and doesn't" (classic example again - insurance fuckery) and as in this case "even if this had a billing code it would be unwise to use."
If you use "low priority - don't need to see patient" billing code on someone and they have an adverse outcome you are going to get eviscerated on the stand "you could have saved her life if you just went to see her!" and going to straight to bankruptcy.
I don't know what the right solution is to this but I am pro-tort reform.
It's true that I under emphasize coinsurance and deductibles in these conversations but the deductible is going to end up used fully if anything significant happens in most insurance plans and should be considered a sunk cost when evaluating plan choices.
Ultimately using hospital pricing information if it was available would be difficult since the hospital prices interact with your insurance in unpredictable way and a lower sticker price could end up being an order of magnitude higher when comparing after insurance costs.
You are right that I need to be more active at remembering that in some of the individual situations though, even if it doesn't impact the more structural issues.
MaiqTheTrue
Renrijra Krin
1d ago
The difference is that China still believes it’s good and that it is capable and has a right to do things and claim the benefits of having done them. The West probably at least since the 1950s has been browbeaten into being a henpecked househusband hoping that by acting weak it can appease everyone else. Until the West believes in itself like China does, expect no large scale projects.
Plaintiffs are unlikely to succeed on the merits. Connecticut’s restrictions on AR-15s, .300 Blackout-chambered “other” firearms (in Plaintiffs’ intended configuration), and large capacity magazines are one more chapter in the historical tradition of limiting the ability to “keep and carry” dangerous and unusual weapons. The challenged statutes are “relevantly similar,” to historical antecedents that imposed targeted restrictions on unusually dangerous weapons of an offensive character—dirk and Bowie knives, as well as machine guns and submachine guns—after they were used by a single perpetrator to kill multiple people at one time or to inflict terror in communities.
Unanimously, the 2nd Circuit has now redefined "dangerous and unusual" to mean "unusually dangerous". I don't see many ways to resolve this which don't leave the Second Amendment a dead letter, or at best allow a gun in a circumstance. The logic? To repeat myself: (because fuck you, that's why)
Association of N. J. Rifle & Pistol Clubs, Inc. v. Platkin updates
In theory, recent changes to the 3rd Circuit's makeup could result in this case having a pro-gun and perhaps even fast decision. The case had no chance at the appeals level (two judges, Schwartz and Freeman, have already signed onto pretty bad anti-gun rulings), so this could even simplify matters.
In practice, I'm not that optimistic. The whole circuit has only a slight R-D lean, and it has enough squishy Rs on a complex enough topic that it'd be a hard situation to run on, and unlike Range has no easy way to limit to the borders of this case or the limits of the popular.
On the other hand, I guess it could be worse. It could be Koons. Except then there's a question why the en banc Koons, too.
greyenlightenment
investments: META/FBL, TSLA, TQQQ, TECL, MSFT ...
1d ago
I always assumed that life-saving care must be rendered unconditionally, but that the insurance company can still refuse to cover certain elective procedures, in which the hospital is under no obligation to perform them.
greyenlightenment
investments: META/FBL, TSLA, TQQQ, TECL, MSFT ...
1d ago
Summary:
There is an extreme amount of intraindividual variability, yet advice tends to be one-size-fits-all. This is especially relevant for fitness and dieting advice.
Advice does not work as well in adversarial situations, in which both parties are applying the same advice.
Too many people applying the same advice dilutes it effectiveness. This is seen in college admissions, where everyone follows the same essay-writing advice.
Survivorship bias may make some advice appear better than it actually is. Those who are successful at applying advice will tell others. The majority, who fail, will just go away.
Other advice is time sensitive or topical, and what worked in the past will not work now or in the future. 'Value investing' worked great for much of the 20th century, but became less effective in the 21st century.
Pretty normal to essentially charge for "doctor - seeing you, thinking about you, and documenting you" and "things doctor did to you."
However in this case you could alternatively summarize it as "random blender of shit put together in an attempt to get the insurance company to pay enough for the hospital to stay afloat."
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