3 ms·

In broad strokes this is also what has happened to the US health care system and other important realms in the past few decades: making numbers in spreadsheets

by wrs 7y ago

In broad strokes this is also what has happened to the US health care system and other important realms in the past few decades: making numbers in spreadsheets (and the compensation of a small number of people) a higher priority than the actual problems supposedly being solved, whether it’s communications, national security, or the well-being of the population. Somehow, profits as measured by the finance sector have become an absolute positive, as if there’s never any tradeoff with other non-financial goals. Money isn’t real, and generating more of it can never be a sensible primary goal; phones, airplanes, and health are real.

taxicabjesus 7y ago
IMHO, health care in the United States is used as a job project, to provide jobs for all the people who used to build stuff. When I was a taxi driver, one of my jobs was to take poor people to their medical appointments. The taxi company I used to drive for has reformed itself around its contracts with the various insurance companies. I never got a number for how much the government paid to get people to their appointments, but I imagine it was on the order of $2/mile (the driver got $1.50/mile, iirc). Some of the people I took to their appointments certainly had transportation charges that were higher than the fee paid to the service providers -- say $100/round trip for transportation, vs. $30 for the counseling session or doctor's appointment...
- debatem1 7y ago
  Why was the government paying a contract between an insurance company and a taxi company?
  - vharuck 7y ago
    State governments typically plan activities by connecting private sector groups and greasing the wheels. A lot of money goes to encouraging regular checkups or screenings, but people are less likely to go if they need to take a bus: routes and schedules mean they need to take off more work, and it's easy to just skip and do one of the million other things that need done now (even just unwinding). But a taxi who comes to you is convenient and hard to say "No" to.
    - kbenson 7y ago
      So is the claim here that the state is paying for the rides to the checkups? The comment even indicates that the taxi companies structures themselves around the insurance company contracts, which unless the state is paying insurers, doesn't seem to have the state in the loop. I'm confused how the state is supposed to be in this too.
      - InvaderFizz 7y ago
        I'm not sure how the insurance fits in, but you can see where this would fit in with state/federal payments if you look into Medicare NEMT. Here is one such example: https://www.npr.org/sections/health-shots/2018/01/27/581055275/no-car-no-care-medicaid-transport-program-faces-cuts-in-some-states https://www.npr.org/sections/health-shots/2018/01/27/5810552...
      - taxicabjesus 7y ago
        Medicaid is the United States' program for providing health care to poor people. Medicare (for people 65 years and older) is administered by the federal government, while Medicaid is separately administered by each state. "In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly." - https://en.wikipedia.org/wiki/Medicaid#State_implementations https://en.wikipedia.org/wiki/Medicaid#State_implementations Arizona is a subcontracting state. The state government pays insurance companies to manage the services provided under the Medicaid program; the insurance companies pay the transportation companies to get people to their appointments. > The comment even indicates that the taxi companies structures themselves around the insurance company contracts It started out as a taxi company... Then "transportation vouchers" came along, so businesses could get people where they needed to go without having to give people cash for taxi fares. Over the decades vouchers became a larger and larger part of the taxi company's business. Paper vouchers for drivers became electronic vouchers; pickups and dropoffs are scheduled electronically. When the Apps came along the taxi company's business of leasing taxis mostly evaporated, so the company got rid of its taxi fleet and now focuses on its transportation contracts ("vouchers"). > I'm confused how the state is supposed to be in this too. In the comment above I mixed up who pays for what, but ultimately the transportation funds come from the state government and federal government, filtered through the state's subcontracted insurance company.
robertAngst 7y ago
Healthcare is expensive because of Physicians. They are the bottleneck. The American Medical Association has lobbied 400,000,000 dollars in the last 30 years to make sure they are the only ones that can issue prescriptions. Making 300,000 USD/yr is unnatural, even for professionals. The market is artificial and gives them massive power even outside yearly income.
- zdragnar 7y ago
  You're not wrong that physicians are an artificially restricted job market. The consequence is that most people actually spend very little time with one; PAs and nurses do a lot of what a doctor used to do. Rather than doctors salaries driving up health care, there are fewer doctors serving more patients. A substantial amount of the increase in health care is the fancy facilities, high tech equipment, and the under-charging by medicaid and medicare for services. On the one hand, I know a doctor who was essentially paid by medicaid less than minimum wage for certain treatments. On the other hand, I paid cash for a pre-surgery physical to make sure I was healthy enough for the surgery (I showed up thinking they were in my insurance network, and they were not). Basically, a couple hundred bucks down the drain for a nurse to take my temperature, blood pressure, height, weight, and for a doctor to look at me and say "yup, you're good to go".
  - tech_tuna 7y ago
    There are doctors in my extended family. . . the way their referral networks work and the way they can restrict who can practice in the same town/area is straight up mafia.
- tech_tuna 7y ago
  Don't forget the HMOs and Big Pharma. Healthcare in the US is massively one big racket.
- masonic 7y ago
  they are the only ones that can issue prescriptions. In California, Nurse Practitioners and Physician Assistants can write prescriptions. Is CA unique?

by wrs 7y ago

taxicabjesus 7y ago

IMHO, health care in the United States is used as a job project, to provide jobs for all the people who used to build stuff. When I was a taxi driver, one of my jobs was to take poor people to their medical appointments. The taxi company I used to drive for has reformed itself around its contracts with the various insurance companies. I never got a number for how much the government paid to get people to their appointments, but I imagine it was on the order of $2/mile (the driver got $1.50/mile, iirc). Some of the people I took to their appointments certainly had transportation charges that were higher than the fee paid to the service providers -- say $100/round trip for transportation, vs. $30 for the counseling session or doctor's appointment...

debatem1 7y ago
Why was the government paying a contract between an insurance company and a taxi company?
- vharuck 7y ago
  State governments typically plan activities by connecting private sector groups and greasing the wheels. A lot of money goes to encouraging regular checkups or screenings, but people are less likely to go if they need to take a bus: routes and schedules mean they need to take off more work, and it's easy to just skip and do one of the million other things that need done now (even just unwinding). But a taxi who comes to you is convenient and hard to say "No" to.
  - kbenson 7y ago
    So is the claim here that the state is paying for the rides to the checkups? The comment even indicates that the taxi companies structures themselves around the insurance company contracts, which unless the state is paying insurers, doesn't seem to have the state in the loop. I'm confused how the state is supposed to be in this too.
    - InvaderFizz 7y ago
      I'm not sure how the insurance fits in, but you can see where this would fit in with state/federal payments if you look into Medicare NEMT. Here is one such example: https://www.npr.org/sections/health-shots/2018/01/27/581055275/no-car-no-care-medicaid-transport-program-faces-cuts-in-some-states https://www.npr.org/sections/health-shots/2018/01/27/5810552...
    - taxicabjesus 7y ago
      Medicaid is the United States' program for providing health care to poor people. Medicare (for people 65 years and older) is administered by the federal government, while Medicaid is separately administered by each state. "In some states Medicaid is subcontracted to private health insurance companies, while other states pay providers (i.e., doctors, clinics and hospitals) directly." - https://en.wikipedia.org/wiki/Medicaid#State_implementations https://en.wikipedia.org/wiki/Medicaid#State_implementations Arizona is a subcontracting state. The state government pays insurance companies to manage the services provided under the Medicaid program; the insurance companies pay the transportation companies to get people to their appointments. > The comment even indicates that the taxi companies structures themselves around the insurance company contracts It started out as a taxi company... Then "transportation vouchers" came along, so businesses could get people where they needed to go without having to give people cash for taxi fares. Over the decades vouchers became a larger and larger part of the taxi company's business. Paper vouchers for drivers became electronic vouchers; pickups and dropoffs are scheduled electronically. When the Apps came along the taxi company's business of leasing taxis mostly evaporated, so the company got rid of its taxi fleet and now focuses on its transportation contracts ("vouchers"). > I'm confused how the state is supposed to be in this too. In the comment above I mixed up who pays for what, but ultimately the transportation funds come from the state government and federal government, filtered through the state's subcontracted insurance company.

robertAngst 7y ago

Healthcare is expensive because of Physicians. They are the bottleneck. The American Medical Association has lobbied 400,000,000 dollars in the last 30 years to make sure they are the only ones that can issue prescriptions. Making 300,000 USD/yr is unnatural, even for professionals. The market is artificial and gives them massive power even outside yearly income.

zdragnar 7y ago
You're not wrong that physicians are an artificially restricted job market. The consequence is that most people actually spend very little time with one; PAs and nurses do a lot of what a doctor used to do. Rather than doctors salaries driving up health care, there are fewer doctors serving more patients. A substantial amount of the increase in health care is the fancy facilities, high tech equipment, and the under-charging by medicaid and medicare for services. On the one hand, I know a doctor who was essentially paid by medicaid less than minimum wage for certain treatments. On the other hand, I paid cash for a pre-surgery physical to make sure I was healthy enough for the surgery (I showed up thinking they were in my insurance network, and they were not). Basically, a couple hundred bucks down the drain for a nurse to take my temperature, blood pressure, height, weight, and for a doctor to look at me and say "yup, you're good to go".
- tech_tuna 7y ago
  There are doctors in my extended family. . . the way their referral networks work and the way they can restrict who can practice in the same town/area is straight up mafia.
tech_tuna 7y ago
Don't forget the HMOs and Big Pharma. Healthcare in the US is massively one big racket.
masonic 7y ago
they are the only ones that can issue prescriptions. In California, Nurse Practitioners and Physician Assistants can write prescriptions. Is CA unique?