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Posts by M. Dodge Thomas

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  • Heritage Action blames GOP moderates for collapse of new health deal

    04/06/2017 1:09:31 AM PDT · 39 of 39
    M. Dodge Thomas to WENDLE

    “The rest of them can go to the ER and Wait 10 hours.I DON’T CARE!!”

    Problem is, if the indigent use the ER as their Primary Care Physician, the rest of us DO PAY!!

    I’d rather subsidize 75% of someone’s premiums and co-pays, which leaves them with at least some skin in the game, than subsidize 100% of their care, and have it be a complete freebie they use without a thought for the cost.

    ______________________________________

    “I thought they were on Medicaid?”

    If you mean the *very* poorest, yes, most are eligible.

    But especially in states which are not accepting Medicaid expansion, *lots* of people who are working jobs which leave them barely living from paycheck to paycheck make too much for Medicaid, but too little for Obamacare (ACA).

    IMO, this is a *really* dangerous situation politically: these are the sorts of voters who elect left-wing populist demagogues in places like Venezuela.

    Governments which *really* screw the middle classes to “buy” the votes of the desperate poor with handout programs and government “jobs”, often accompanied by very high levels of corruption and nepotism.

    And IMO it “could happen here” if the people working one-and-half low-paying jobs to ends meet have to wait 10 hours in the ER to deal with their son or daughters strep throat.

    And that’s especially true if they become convinced that *both* the Democrat and Republican parties “DON’T CARE” that they are risking their job by taking time off while waiting in the ER with a miserable child.

  • Heritage Action blames GOP moderates for collapse of new health deal

    04/05/2017 7:15:30 PM PDT · 37 of 39
    M. Dodge Thomas to WENDLE

    “The best solution is just to go back where we were in 2007 and beef up the ER with better service if you don’t want to pay for insurance.”

    To the extent that the ER is treating people able but unwilling to pay for insurance, and is unable to recover the cost of treatment from the patients, that amounts to massive cost shifting from irresponsible takers unwilling to purchase insurance to the rest of us.

    I’m willing to pay taxes to subsidize someone - and especially the person working two jobs that between them barely pay for gas and rent - as long as they pay *something* based on their ability to pay anything.

    The person who pisses me off is the guy who can find the money for payments on a new Harley but “can’t afford insurance” or “don’t want the government stealing *my* money”, has a few drinks, and ends up in the ICU with extensive neurological damage - on *our* dime.

    I don’t like an insurance mandate, but unless and until we start doing “wallet biopsies” to check for insurance, and tossing the voluntarily uninsured back out on the curb to bleed out (which ain’t gonna’ happen), IMO a mandate is fairer than sticking the rest of us with the entire bill.

  • Heritage Action blames GOP moderates for collapse of new health deal

    04/05/2017 4:09:31 PM PDT · 28 of 39
    M. Dodge Thomas to WENDLE

    “Taking this case as an example, why should I pay bigger premiums for him?”

    My answer would be, for the same reason his parents should pay premiums to cover *your* care if you you slip on the ice and experience a head injury that requires a six month hospitalization and further months of rehab.

    This infant (and his parents) were not at choice about his condition, any more than the rest us are “at choice” about the possibility of catastrophic medical bills and/or or lifetime medical costs - we can’t know our future actual risk except in an actuarial sense that is meaningless or misleading to most people.

    A lot of people are unclear about this, believing for example that a “healthy life-style” will reduce the likelihood that they will experience high lifetime medical costs, and meanwhile complaining about the cost of insuring others who appear to be taking greater risks with their health.

    In fact, the opposite is true: the better your general health in youth and middle age, on the average the *greater* your lifetime medical costs as you are more likely to to live long enough to develop dementia and/or expensive multiple chronic conditions!

    On this basis Obamacare (or any insurance scheme which spreads risk across the entire population) is the best deal, long term, for people in good general health as they are the most likely to otherwise face the likelihood of medical bankruptcy in old age (and such costs at the end of life are the real “Death Tax” on average Americans, BTW).

    These kinds of concern are IMO the most frustrating problem when it comes to thinking realistically about politics and health insurance: lots of things which are “obviously” true are not, and many things which are true are deeply counter-intuitive.

  • Heritage Action blames GOP moderates for collapse of new health deal

    04/05/2017 2:35:13 PM PDT · 19 of 39
    M. Dodge Thomas to WENDLE

    “They don’t give a crap because they have special government insurance that you can’t buy.”

    Actually, since January 1, 2014, congressional Members and congressional staff wishing to purchase employer-sponsored insurance must do so through through a plan or exchange created under Obamacare (ACA), in this case the District of Columbia’s small business health options program (SHOP) exchange, also known as DC Health Link, or “DC SHOP”.

    So they have the basic health care options as anyone else in DC who eligible to use the exchange.

    They DO have a few other options that are only available to Federal employees,including Federal Flexible Spending Account Program (FSAFEDS); the Federal Employees Dental and Vision Insurance Program (FEDVIP); the Federal Long Term Care Insurance Program (FLTCIP); the Office of the Attending Physician; and treatment in military facilities.

    _____________________________________

    One of the *really* frustrating things about discussions of community rating is that few people are aware of the “paradox of aging”: that the “healthier” you are now, the higher (on average) your lifetime health-care costs will likely be, as you are more likely to live long enough to get a form of dementia and/or develop expensive multiple chronic degenerative diseases.

    So it’s the healthiest young adults who will be the greatest beneficiaries of the aspects of the ACA the Freedom Caucus is trying to eliminate on the grounds that they are unfair to the young and healthy.

    So next time you are standing in line next to a morbidly obese person purchasing cart full of carbohydrates and four cartons of unfiltered Camels, reflect on the fact that they are performing a highly altruistic act by working hard on dying early, and thus reducing overall healthcare costs!

  • Trumpís Patriarchal Counter-Revolution (Sad and funny at the same time)

    04/04/2017 5:02:37 AM PDT · 16 of 16
    M. Dodge Thomas to Leo Carpathian

    My just-retired wife worked her her way up the corporate ladder in the software industry (serving two corporate mergers and several massive layoffs along the way) by working longer, harder and smarter than almost all of her male counterparts.

    It would have been impossible for her to do so if her male counterparts had been allowed to opt out of dealing with her on a one-to-one basis. Just. Simply. Impossible.

    I’m sorry, because this is going to offend a lot of people.

    But when I read about a man who refuses to work with women on a one-to-one to one basis unless that are chaperoned, I wonder if I’m living in the US, or Saudi Arabia.

  • How liberal professors are blackballing studies confirming Trumpís claim of voter fraud

    03/31/2017 3:26:09 PM PDT · 27 of 29
    M. Dodge Thomas to detective

    The link in 22 discusses votes by improperly registered voters, which are likely inevitable given that some voters don’t change registration when they move.

    Your original claim was that something far more serious is happening: widespread systematic fraud on the part of election officials as evidenced by 1) Highly improbable vote skews and 2) votes cast in excess of registered voters.

    The link in 22 does not provide evidence of either.

  • How liberal professors are blackballing studies confirming Trumpís claim of voter fraud

    03/31/2017 3:02:59 PM PDT · 26 of 29
    M. Dodge Thomas to detective

    “It is against the law to ask voters at polling places if they are citizens or even for ID.”

    Don’t know about your state, but here (IL) unless a voter is already registered at the voter’s current address and is voting in the precinct of registration and the signature appears to match the voter signature on file, an election judge can challenge the voter and require ID.

  • How liberal professors are blackballing studies confirming Trumpís claim of voter fraud

    03/31/2017 2:52:49 PM PDT · 25 of 29
    M. Dodge Thomas to detective

    “In many Democrat Party controlled precincts, the number of votes tallied is greater than the number of registered voters and the vote is around 99% Democrat.”

    I’ve often seen this and similar claims, however when I try to source them back to hard evidence, to date I’ve always hit a dead end.

    Can you provide a source referencing a specific election and precinct?

  • The Bill To Fix Health Care - Permanently

    03/31/2017 2:03:27 AM PDT · 53 of 54
    M. Dodge Thomas to M. Dodge Thomas

    For those not familiar wit TRIPS 31, these is a good introductory explanation at:

    https://www.wto.org/english/tratop_e/trips_e/factsheet_pharm02_e.htm#bolar

  • Healthcare Economics in 8 Minutes (How To Really Make It Cheaper)

    03/31/2017 1:45:28 AM PDT · 47 of 47
    M. Dodge Thomas to freeandfreezing

    Actually, there is a lot of innovation taking place in the healthcare market to address such concerns - we just don’t hear much about it because it’s large-scale private entities which are driving the process: self-funded employers, pension plans and unions which are experimenting with outcome-based pricing, competitive bundled pricing, reference prices, medical tourism and the like.

    So a lot of the reforms you suggesting are already taking place, and even more aggressively in privatized portions of system than in Medicare and Medicaid.

    And most of them are effective pretty much in direct proportion to extent that they subvert current opaque fee-for-service pricing - which is exactly the model that people comfortable with the older system (ex: Tom Price) see as the solution!

    So politically, we are increasingly witnessing a head-on collision between older and a newer models of health-care pricing, with the counter-intuitive result that a substantial number of conservatives end up supporting the older model - which is a system that as you note above makes effective market competition *more* difficult.

  • How liberal professors are blackballing studies confirming Trumpís claim of voter fraud

    03/31/2017 1:17:45 AM PDT · 20 of 29
    M. Dodge Thomas to detective

    “There are no procedural checks in place to stop them from entering the country or from voting.”

    Actually, as regards voting, there are very powerful checks, starting with the right of the minority party in a given area to have election judges vetting voters at the precinct level, observing the vote count, and vetting “instant registration” and similar votes post-election.

    As a result, I’ve never seen a creditable explanation of the exact mechanics of how industrial-scale voting fraud is supposed to occur.

    I’m not talking about the wilder sorts of easily debunked claims, such as “Tens of thousands of voters were bussed in from out of state, everyone in politics knows this is true” (but somehow, there is not even one verifiable cell phone picture or video of even *one* of the busses).

    I’m talking about actual, practical abuses of the voting process which would allow hundreds of thousands to millions of non-citizens to vote without detection.

    And when you try to find such accounts of such methods, they just don’t exist.

    I have yet to find *one* creditable account of how this could be accomplished as a practical matter, or *any* hard evidence that large-scale abuse has occurred. And all of the practical” methods I have seen discussed would require large scale fraud which would be extremely difficult to hide (and *lots* of people are looking).

    So while I retain an open mind on the issue, until someone can present hard evidence that a significant amount of such abuse is *actually* occurring, or at least produce a reasonable account of exactly how it *could* occur, I regard such claims as a convenient excuse for under-performing politicians to avoid improving their message or their messaging.

  • How liberal professors are blackballing studies confirming Trumpís claim of voter fraud

    03/30/2017 3:08:18 PM PDT · 16 of 29
    M. Dodge Thomas to detective

    It’s a bit more complicated than this piece makes it appear, Jesse Richman has been been complaining for years that his research has been misrepresented for political gain.. but not by the left:

    “Trump and others have been misreading our research and exaggerating our results to make claims we don’t think our research supports. I’m not sure why they continue to do it, but there’s not much I can do about that aside from set the record straight.”

    Can’t post the link here, but you google the full account up at “WIRED MAGAZINE AND Author of Trump’s Favorite Voter Fraud Study Says Everyone’s Wrong”

    And please don’t shoot *me*, I’m just the messenger on this one.

    __________________

    The main reason all this matters, IMO, is that if you believe that there has been massive voter fraud bu non-citizens (and after extensive reading about this, I’ve yet to find any credible evidence that is the case, and lot’s that it’s not) , than you let yourself off the hook if you underperform at the ballot box (”They stole it!”) instead of asking yourself how to improve you policies or your messaging.

  • Healthcare Economics in 8 Minutes (How To Really Make It Cheaper)

    03/30/2017 2:49:34 PM PDT · 44 of 47
    M. Dodge Thomas to freeandfreezing

    Sorry, some sloppy writing on my part in the reply above. I was not referring to you personally there - for all I know, you could be an MD with a doctorate in statistics - I was referring to the situation of a typical consumer.

  • Healthcare Economics in 8 Minutes (How To Really Make It Cheaper)

    03/30/2017 5:36:43 AM PDT · 43 of 47
    M. Dodge Thomas to freeandfreezing

    Fee for service medicine jsut isn’t *like* the rest of the economy.

    1) In many situations evaluating the quality of service is impossible for individual consumers, both because they lack the knowledge and experience to make such judgments, and because information required to make them is not available.

    For example y9ou or some member of you immediate family have probably had major surgery.

    Was accurate comparative information about outcomes for the surgeon readily available? How about the incidence of antibiotic resistant infections at the hospital? Did you vet the anthologist?

    If you did (or even could have, since you have limited statistical and medical knowledge) how did you know if you were actually comparing apples to apples - for example, are the demographics of your surgeon’s practice similar to other practices to which it might be compared?

    For these and may other reasons, individual consumers can’t effectively compare even fairly straightforward sorts of medical treatment - to the extent these judgement can be made at all, they *have* to be outsourced to organizations with sufficient medical and statistical knowledge to make them.

    This problem alone makes individual decision making with regard to health care choices different from buying most anything else.

    2) But it gets worse: even if individual consumers *could* make informed judgements about the quality of the care they will be receiving, they often can’t determine in advance what many services - for example a typical hospitalization - are going to cost. Would you buy a car on that basis?

    For these reasons, realistic attempts at health care reform are *always* about making the US system *more* like a functional market, not less, for example by focusing efforts on paying for outcomes rather than individual components of treatments.

    But it’s not realistic - in fact, it’s counterproductive - to assume that at the individual level purchasing healthcare is like other day-to-day purchasing decisions.

  • Healthcare Economics in 8 Minutes (How To Really Make It Cheaper)

    03/26/2017 5:12:01 PM PDT · 40 of 47
    M. Dodge Thomas to fireman15

    A quick GOOGLE indicates the CHM requires participants 65 and older to Carry Medicare A & B, which would largely address my concerns about any possible upwards drift in the average age of participants - it would appear that for these members CHM is in effect similar to Medicare supplemental plans.

    _____________________

    CHM’s financials are available “on request”, but apparently are not routinely published on-line - and this would be the place to start in understanding the economics of the program.

    _____________________

    In the case of health care coverage, “The Devil is in the details”, for example it appears that coverage for birth defects and congenital conditions is limited to $25,000, and these are potentially some of the most expensive conditions to treat. Nothing wrong with this exclusion - as long as members are aware of it - but it is an example of an important type of coverage limitation allowed because this is not “insurance”.

    ____________________

    I wasn’t suggesting that any particular Insurance Plan would encourage members to choose palliative care over heroic EOL measures, rather that the the membership of *any* such mutual aid society might be more likely to “be on the same page” (whatever page that is) than a similar group of insured drawn from the public at large.

  • Healthcare Economics in 8 Minutes (How To Really Make It Cheaper)

    03/26/2017 3:19:27 AM PDT · 30 of 47
    M. Dodge Thomas to Rusty0604

    Some parts of the healthcare system are a lot easier to price transparently than others.

    When we visit a primary care physician the “range of service” provided is pretty narrow: it comes down to treatment, recommendation for additional diagnostic tests, or referral to a specialist. It might be a 15 minute visit, it might be a half an hour, but it’s not going to require four hours, let alone four weeks.

    And while the provider can’t exactly predict the ancillary costs of providing a given service, it’s unusual for there to be high unexpected costs.

    So while we still have the problem of selecting a primary care provider (be that an individual or a group) both the consumer and the provider can expect to have a fairly accurate idea of the amount of service directly involved in a typical transaction.

    The problem is the *indirect* cost to the consumer - depending on the accuracy of the diagnosis and any additional follow-up recommended, the consumer is faced with additional costs far in excess of initial visit, and often without any practical means of evaluating whether or not the recommendations resulting in additional costs were cost-effective.

    This problem only gets worse as the complexity of treatment increases: the mythical “informed consumer” would likely have to make dozens if not hundreds of individual choices about optimum cost/benefit during the course of a hospitalization for the treatment of a complicated condition - in effect the consumer *has* no rational choice other than to delegate almost all that decision-making to someone else.

    So while “price transparency” is theoretically helpful in making consumer choices, as a practical matter even an intelligent consumer with time to research and consider options is forced to delegate the majority of such decision-making to someone else, and the nature of the system becomes critical.

    For example, given that what consumer is actually buying is a complicated package of goods and services customized on a minute by minute basis to their individual needs, fee-for-service pricing is about the worst possible option, and something like a fixed price for hip replacement is a much better alternative in terms of limiting their financial risk - always assuming that they’re able to compare outcomes as well as pricing when considering where to have the surgery performed.

    Joe flower is pretty much an agnostic about which alternatives will work best, and stresses that different alternatives are probably appropriate in different situations, but his major point is that it’s *very* difficult to control costs - no matter how transparent - in a fee-for-service system.

  • Healthcare Economics in 8 Minutes (How To Really Make It Cheaper)

    03/26/2017 3:19:27 AM PDT · 29 of 47
    M. Dodge Thomas to Rusty0604

    Some parts of the healthcare system are a lot easier to price transparently than others.

    When we visit a primary care physician the “range of service” provided is pretty narrow: it comes down to treatment, recommendation for additional diagnostic tests, or referral to a specialist. It might be a 15 minute visit, it might be a half an hour, but it’s not going to require four hours, let alone four weeks.

    And while the provider can’t exactly predict the ancillary costs of providing a given service, it’s unusual for there to be high unexpected costs.

    So while we still have the problem of selecting a primary care provider (be that an individual or a group) both the consumer and the provider can expect to have a fairly accurate idea of the amount of service directly involved in a typical transaction.

    The problem is the *indirect* cost to the consumer - depending on the accuracy of the diagnosis and any additional follow-up recommended, the consumer is faced with additional costs far in excess of initial visit, and often without any practical means of evaluating whether or not the recommendations resulting in additional costs were cost-effective.

    This problem only gets worse as the complexity of treatment increases: the mythical “informed consumer” would likely have to make dozens if not hundreds of individual choices about optimum cost/benefit during the course of a hospitalization for the treatment of a complicated condition - in effect the consumer *has* no rational choice other than to delegate almost all that decision-making to someone else.

    So while “price transparency” is theoretically helpful in making consumer choices, as a practical matter even an intelligent consumer with time to research and consider options is forced to delegate the majority of such decision-making to someone else, and the nature of the system becomes critical.

    For example, given that what consumer is actually buying is a complicated package of goods and services customized on a minute by minute basis to their individual needs, fee-for-service pricing is about the worst possible option, and something like a fixed price for hip replacement is a much better alternative in terms of limiting their financial risk - always assuming that they’re able to compare outcomes as well as pricing when considering where to have the surgery performed.

    Joe flower is pretty much an agnostic about which alternatives will work best, and stresses that different alternatives are probably appropriate in different situations, but his major point is that it’s *very* difficult to control costs - no matter how transparent - in a fee-for-service system.

  • Healthcare Economics in 8 Minutes (How To Really Make It Cheaper)

    03/26/2017 2:50:08 AM PDT · 28 of 47
    M. Dodge Thomas to freeandfreezing

    “Do you have any support for your argument? Your statement that “no such system exists...or could” seems to have the kind of certainty often associated with bong based science. How do you know what “could” exist? Did you see it in your crystal ball?”

    This is the problem with trying to discuss policy with libertarians, you are constantly in the position of “prove it’s impossible”.

    This is the reason that “libertarians you will always have with you”.

    Almost every other damn fool scheme for organizing society is at least practical enough to have been actually attempted, at least short-term:

    Pure communism, brazen kleptocracy, organized theocracy, governance by ad hoc divine revelation, strong monarchy, various sorts of anarchism, “free love”, if humans can dream it up, it has been tried somewhere long enough to demonstrate it’s strengths and weaknesses.

    Strong libertarianism however is so utterly impractical that its practitioners have never been able to sustain even a brief experimental attempted at scale to demonstrate its practicality.

    It’s so impractical, it’s the only scheme that has never actually been tried!

    And absent the attempt, libertarians will smugly ask (in the face of the pretty obvious answer) “prove that it’s impossible!”.

  • Healthcare Economics in 8 Minutes (How To Really Make It Cheaper)

    03/26/2017 2:38:01 AM PDT · 27 of 47
    M. Dodge Thomas to Wuli

    “You can see how auto insurance operates similar to home insurance. You are more “the customer” and the only customer in the relationship with the repair outfit, NOT your insurer.”

    As it happens, Joe Flower has used taking your car to the body shop as an example of how the market for health insurance is different:

    https://healthcareinamerica.us/we-all-want-healthcare-to-cost-much-less-but-we-are-asking-the-wrong-question-8f6a0cb45253#.hnlsh6y79

  • Healthcare Economics in 8 Minutes (How To Really Make It Cheaper)

    03/26/2017 2:30:29 AM PDT · 26 of 47
    M. Dodge Thomas to fireman15

    “But we also have the responsibility to control the expenses and look out for the group.”

    Voluntary insurance pools face the same ultimate problem as any other insurance system : what happens as the membership ages? As I noted in a post above, healthier the lifestyle you live, on the average the higher your lifetime healthcare costs.

    So a system that can work well if the majority of its membership is under 50 will be headed for financial difficulty as the age distribution shifts upwards, and the “responsibility to control the expenses and look out for the group” becomes increasingly pressing problem.

    Conceivably the members of a voluntary association who shared very similar underlying principles and values might be able to have a more rational discussion of the financial realities and might be able to reach a greater degree of consensus on what that “responsibility” entailed; for example the individuals might be more willing to forgo the last few months of heroic treatment for cancer as an altruistic strategy for the greater good.

    But humans being humans, I wouldn’t count on it.