Leaving New York City

[dwy000]

12 minutes ago, rkbabang said:

Just wondering.  Serious question.  Is it normal for a company's stock to be in the green the day its CEO is gunned down in cold blood on the street?

 

 

They reconfirmed 2025 earnings last night in advance of the investor update so it would probably reflect that

[dwy000]

17 minutes ago, LC said:

 

The providers many times can only charge what insurers will pay. Providers are not the ones with pricing power - it is the insurers. 

 

But yes the whole system is screwed and only a single payer solution will work.

 

And so it tells you all you need to know about American society when the best, most obvious solution repeatedly gets voted down.

I don't think that's entirely true.  The providers will be capped on what the insurers will pay but they generally will directly charge the consumer for an excess.  If you go to hospital you will get a bill showing headline price, negotiated discount price for that insurers customers, how much the insurer paid and then you are supposed to pay the difference. 

[changegonnacome]

1 hour ago, Castanza said:

Prior to HMO1973 Most people only carried catastrophic insurance. It was cheaper, competitive

 

Totally agree - disconnecting the patient from the price of service via the HMO cut-out then abstracting the cost of the overall insurance even further by embedding it as a group benefit paid for by your employer (but then ultimately paid by everyone that purchases goods or services from that employer)....is one of the many ways that the US healthcare 'vampire squid' financial shakedown has increasingly got out of control.......its a kind of zombie bloated bureaucracy where no individual provider or worker in it could ever be accused of the shakedown.... but rather the shakedown is the labyrinth system itself for which there are thousands of little innocent cogs that dont need to be there.....

 

The American healthcare system represents a kafkaesque nightmare......as most know on this forum being involved in the finance world....when you encounter something that is needlessly complex......well......where there's mystery, there's margin'......

 

 

[Luke]

15 minutes ago, changegonnacome said:

 

Totally agree - disconnecting the patient from the price of service via the HMO cut-out then abstracting the cost of the overall insurance even further by embedding it as a group benefit paid for by your employer (but then ultimately paid by everyone that purchases goods or services from that employer)....is one of the many ways that the US healthcare 'vampire squid' financial shakedown has increasingly got out of control.......its a kind of zombie bloated bureaucracy where no individual provider or worker in it could ever be accused of the shakedown.... but rather the shakedown is the labyrinth system itself for which there are thousands of little innocent cogs that dont need to be there.....

 

The American healthcare system represents a kafkaesque nightmare......as most know on this forum being involved in the finance world....when you encounter something that is needlessly complex......well......where there's mystery, there's margin'......

 

 

Yerp, by the way, all of this is counted as GDP growth! I can only say it's madness.

 

EDIT: South park gold and on point again as always...

Edited December 4 by Luke

[changegonnacome]

2 minutes ago, Luke said:

Yerp, by the way, all of this is counted as GDP growth! I can only say it's madness.

 

EDIT: South park gold and on point again as always...

 

Southpark is on point as always!

 

No healthcare system is perfect........but what I've seen hybrid private-public healthcare systems I've encountered globally are probably the best........a single payer system with blanket universal access......creating a base layer of care and cutting off the tails of medical bankruptcy.........but where private hospitals & private insurers......compete for incremental healthcare spend because they are providing incremental outcomes, speedier turnarounds, better service over the basic public option.

 

Not perfect - but as @Castanza has pointed out - too many talented people are shackled in the US by the employer health insurance chain.........it has undoubtedly suppressed entrepreneurship over the last couple of decades.

 

 

[Gregmal]

A little amazing too how this happens in broad daylight, in one of the busiest corridors in the country; no one does a thing, and they cant find the guy now LOL....thats NY for you. 

[Dinar]

2 hours ago, 73 Reds said:

Well, the average doctor visit isn't $30k or even $10k.  And if you are poor and go to the ER, the visit is free.

Nobody buys insurance for a $300 doctor visit.  However:

a) When you pay a tax if you are not insured = Thank you comrades Obama & Pelosi

b) Health insurance premiums are deductible while doctor visit is not

c) When hospitals are allowed to charge a price 3x higher for cash vs insurance company

d) When child birth is $50K

 

 

You are being forced to buy health insurance. 

[Dinar]

2 hours ago, LC said:

 

The providers many times can only charge what insurers will pay. Providers are not the ones with pricing power - it is the insurers. 

 

But yes the whole system is screwed and only a single payer solution will work.

 

And so it tells you all you need to know about American society when the best, most obvious solution repeatedly gets voted down.

What makes you think that single payer would work?  a) Name one thing that our government does well b) How much would it cost, how would you pay for it and what would be the consequences of the proposed financing scheme?

[nsx5200]

1 hour ago, Dinar said:

Nobody buys insurance for a $300 doctor visit.  However:

a) When you pay a tax if you are not insured = Thank you comrades Obama & Pelosi

b) Health insurance premiums are deductible while doctor visit is not

c) When hospitals are allowed to charge a price 3x higher for cash vs insurance company

d) When child birth is $50K

 

You are being forced to buy health insurance. 

Everybody will eventually use health care, so why not make everybody pay into the system while they are able?  That means make everybody paying for health insurance, sick or not.  If you know of a vampire or zombie that's been living forever and does not use health care at all, then we can probably make a special exception him/her/it.  I suspect even a vampire can run into a batch of bad blood once in a century due to global pandemics and can use some healthcare as well though.  I've never ran into one, so it's speculation.  if you have met one, please share.

 

When everybody pays into the system, then you might do a single-payer to gain economy of scale to negotiate the prices down.

 

Without universal health care, in which Obamacare is a step towards, then the incentives are misaligned between health and cost.  We're seeing the outcome from that misalignment.

 

As to the effectiveness of a government program, we don't have to look far.  We can look at Medicare, or NHS from UK, program in Canada, etc... almost all those programs have better alignment of incentives, and thus have better outcomes, price and health-wise.

[Dinar]

22 minutes ago, nsx5200 said:

Everybody will eventually use health care, so why not make everybody pay into the system while they are able?  That means make everybody paying for health insurance, sick or not.  If you know of a vampire or zombie that's been living forever and does not use health care at all, then we can probably make a special exception him/her/it.  I suspect even a vampire can run into a batch of bad blood once in a century due to global pandemics and can use some healthcare as well though.  I've never ran into one, so it's speculation.  if you have met one, please share.

 

When everybody pays into the system, then you might do a single-payer to gain economy of scale to negotiate the prices down.

 

Without universal health care, in which Obamacare is a step towards, then the incentives are misaligned between health and cost.  We're seeing the outcome from that misalignment.

 

As to the effectiveness of a government program, we don't have to look far.  We can look at Medicare, or NHS from UK, program in Canada, etc... almost all those programs have better alignment of incentives, and thus have better outcomes, price and health-wise.

Again, what will be the cost of the single payer system and how will you pay for it and what will be the impact of the way you pay for it?  NHS is very badly run and so is Canada.

[LC]

4 hours ago, dwy000 said:

The providers will be capped on what the insurers will pay but they generally will directly charge the consumer for an excess.

The doctors I know who run private practice say the opposite - they will not bill more than what insurance will reimburse. Perhaps it is different across practices.

[changegonnacome]

2 hours ago, Dinar said:

When you pay a tax if you are not insured = Thank you comrades Obama & Pelosi

 

This does not exist anymore - the individual mandate at a Federal level is gone....only California, Massachusetts, New Jersey, Rhode Island, and the District of Columbia retained their own state level mandate.

[Castanza]

3 minutes ago, LC said:

The doctors I know who run private practice say the opposite - they will not bill more than what insurance will reimburse. Perhaps it is different across practices.

Definitely depends because I’ve seen the opposite and experienced it my

self. 
 

Nobody does it perfect and Canada is far from perfect according to the Canadians I know. Other systems like the ones in Czech are pretty expensive. Many of my coworkers who come here prefer the US system. Why? It’s cheaper for them. A high deductible health plan is a massive savings. If you’re making 70k usd equivalent in Czech, you’re paying like ~7k in taxes every year just for healthcare. This is like maxing your HD health plan every year in the US even if you don’t use any medical services. This could be short sighted though as they are mostly young and medical costs go up the older you are so you probably recoup a lot of that. 
Im not opposed to some universal system, but I think a better solution would be two or three pronged

1.) Remove the employer mandate and allow the free market to work. Pricing is competitive, quality is competitive etc. 

 

2.) Maybe start with a universal system that that only handles catastrophic coverage. 
 

3.) Expand incentives like HSA offerings, or make them borderline mandatory like 401ks. Tax incentives like “fit checks” or something. 
 

I get we live in a society, but I’m not gonna lie when I look around at all the Texas Roadhouse land whales we had here in the states and think; “why should I care about your health when you clearly don’t care about it either?” 
 

End of the day the current system is broken and I know it’s stifling innovation, overall happiness, and the American Dream. 

[LC]

2 hours ago, Dinar said:

What makes you think that single payer would work?  a) Name one thing that our government does well b) How much would it cost, how would you pay for it and what would be the consequences of the proposed financing scheme?

 

I am not sure if single payer would work. But I do think it would work better than the current system.

 

One thing government does well? National defense.

 

How much would it cost? Half-a-trillion less than the current system:

 

"Through the mechanisms detailed above, we predict that a single-payer healthcare system would require $3.034 trillion annually (Figure 3, Appendix), $458 billion less than current national healthcare expenditure.⁴⁰ Even after accounting for the increased costs of coverage expansion, our data-driven base case includes $210 billion savings on hospital care, $111 billion on physician and clinical services, $224 billion on overhead, and $180 billion on prescription drugs (Figure 3). Consequently, per-capita annual expenditure would drop from $10,739⁶ to $9,330, equivalent to a 13.1% reduction"

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC8572548/#:~:text=Through the mechanisms detailed above,than current national healthcare expenditure.

[Gregmal]

Yea I was watching Landman, great show by the way, and when it was mentioned oil and gas was the 7th largest industry in the country I was curious those above it…at the top? Insurance and healthcare…total bs. In a fucked up way, taxes and insurance are the government created royalties that keep most people in modern day shackles.

Edited December 5 by Gregmal

[Castanza]

6 minutes ago, LC said:

 

I am not sure if single payer would work. But I do think it would work better than the current system.

 

One thing government does well? National defense.

 

How much would it cost? Half-a-trillion less than the current system:

 

"Through the mechanisms detailed above, we predict that a single-payer healthcare system would require $3.034 trillion annually (Figure 3, Appendix), $458 billion less than current national healthcare expenditure.⁴⁰ Even after accounting for the increased costs of coverage expansion, our data-driven base case includes $210 billion savings on hospital care, $111 billion on physician and clinical services, $224 billion on overhead, and $180 billion on prescription drugs (Figure 3). Consequently, per-capita annual expenditure would drop from $10,739⁶ to $9,330, equivalent to a 13.1% reduction"

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC8572548/#:~:text=Through the mechanisms detailed above,than current national healthcare expenditure.

Is per capita really a good way to measure medical expenses though? 

[Dinar]

5 minutes ago, LC said:

 

I am not sure if single payer would work. But I do think it would work better than the current system.

 

One thing government does well? National defense.

 

How much would it cost? Half-a-trillion less than the current system:

 

"Through the mechanisms detailed above, we predict that a single-payer healthcare system would require $3.034 trillion annually (Figure 3, Appendix), $458 billion less than current national healthcare expenditure.⁴⁰ Even after accounting for the increased costs of coverage expansion, our data-driven base case includes $210 billion savings on hospital care, $111 billion on physician and clinical services, $224 billion on overhead, and $180 billion on prescription drugs (Figure 3). Consequently, per-capita annual expenditure would drop from $10,739⁶ to $9,330, equivalent to a 13.1% reduction"

 

https://pmc.ncbi.nlm.nih.gov/articles/PMC8572548/#:~:text=Through the mechanisms detailed above,than current national healthcare expenditure.

US gov't does national defense well?  You are funny, take a look at all of the cost over-runs on every military program to start.  O'k, $3.034 trillion, how would you raise that?  That is 15 percentage points of GDP.  What kind of tax increase would that require and what would be the incentives to work after that?   Marginal tax rates are already 55% in California, NJ and NYC.   If you get to 70% marginal tax rates, you are going to get a very steep decline in GDP.  The only way to do it without impacting incentives would be VAT.  

[LC]

1 minute ago, Castanza said:

Is per capita really a good way to measure medical expenses though? 

I think so - when a single payer system is expected to increase coverage, it makes sense to measure cost changes on a per-unit basis. 

 

But overall cost comes down too on an absolute basis as well...so what's not to like?

[mcliu]

1 hour ago, nsx5200 said:

Everybody will eventually use health care, so why not make everybody pay into the system while they are able?  That means make everybody paying for health insurance, sick or not.  If you know of a vampire or zombie that's been living forever and does not use health care at all, then we can probably make a special exception him/her/it.  I suspect even a vampire can run into a batch of bad blood once in a century due to global pandemics and can use some healthcare as well though.  I've never ran into one, so it's speculation.  if you have met one, please share.

 

When everybody pays into the system, then you might do a single-payer to gain economy of scale to negotiate the prices down.

 

Without universal health care, in which Obamacare is a step towards, then the incentives are misaligned between health and cost.  We're seeing the outcome from that misalignment.

 

As to the effectiveness of a government program, we don't have to look far.  We can look at Medicare, or NHS from UK, program in Canada, etc... almost all those programs have better alignment of incentives, and thus have better outcomes, price and health-wise.

Have you tried using the healthcare system in Canada? Up to 20,000 DIE each year waiting for treatment. Probably more if tens of thousands didn't travel elsewhere for medical tourism. Millions of people don't have primary GPs. Surgery wait times are in months. Also, a lot of our best doctors go to the US to practice. Meanwhile income taxes+CPP+OAS can get up to 50-60% of income, then you pay 2% property tax on houses that are 10x household income, 13-15% sales tax.

[LC]

2 minutes ago, Dinar said:

US gov't does national defense well?  You are funny, take a look at all of the cost over-runs on every military program to start.  O'k, $3.034 trillion, how would you raise that?  That is 15 percentage points of GDP.  What kind of tax increase would that require and what would be the incentives to work after that?   Marginal tax rates are already 55% in California, NJ and NYC.   If you get to 70% marginal tax rates, you are going to get a very steep decline in GDP.  The only way to do it without impacting incentives would be VAT.  

 

OK - please let's leave national security up to DOGE. I am sleeping more soundly already.

 

We raise 3.5 trillion/year to pay for healthcare. Where does that come from? 

I'm sure citizens and corporations would enjoy 500B back in their pockets. 

[Ghost]

Do yall recall the show Breaking Bad..where the main character Walter White turns to a life of crime to pay for his cancer treatment.  If that happened in Canada, the show would be a 5 min episode...Walter goes to the doctor and gets cancer treatment...the end.  

 

 

 

[Spekulatius]

UNH Stock is up another $5, so no harm done. Maybe shooting CEO’s increases shareholder value. What is not to like?

Edited December 5 by Spekulatius

[rkbabang]

3 hours ago, Spekulatius said:

UNH Stock is up another $5, so no harm done. Maybe shooting CEO’s increases shareholder value. What is not to like?

I guess the market likes it, or at the very least doesn’t hate it. 

[73 Reds]

13 hours ago, Dinar said:

Nobody buys insurance for a $300 doctor visit.  However:

a) When you pay a tax if you are not insured = Thank you comrades Obama & Pelosi

b) Health insurance premiums are deductible while doctor visit is not

c) When hospitals are allowed to charge a price 3x higher for cash vs insurance company

d) When child birth is $50K

 

 

You are being forced to buy health insurance. 

I think this discussion is largely circular.  You also have to buy food, shelter, clothing, and other necessities.  Is there anything more important than your health?  Why should we hot have to pay dearly for quality health care?  I'd much rather have an insurance driven health care system with the best available health care than a government subsidized system (paid for by the population in the form of higher taxes) with lesser quality health care providers.  And when you self-insure you can negotiate the cost of major surgeries and procedures with your provider in advance.   The issue is far from cut and dry.  Should we suggest that Berkshire and Fairfax stop charging so much for reinsurance even though insureds require such insurance to ensure their very survival in the event of catastrophe?   

[Gregmal]

What I dont get, is why be a scumbag like UNH and some of the bigger ones? People buy insurance for a reason; give them a proper policy and charge them appropriately for it. I had a basement pipe burst a few winters ago, and the remediation guy that came by asked about insurance. I said I had USAA, and he goes...oh you have nothing to worry about, USAA and Chubb always pay. Whats the point running a scum shop where you stiff people or litigate when someone encounters an issue that they specifically bought the insurance to cover?