12 ms·

> just look how fast Luigi Mangione got out of the news. What news would there be? He was arrested and locked up, his court case hasn’t started. Should we have

> just look how fast Luigi Mangione got out of the news. What news would there be? He was arrested and locked up, his court case hasn’t started. Should we have “Luigi still in jail” headlines?

mschuster91 2y ago
I'd have expected a debate about healthcare cost and actual reforms resulting out of it because the momentum clearly was there, but hey, here we are... For a while, until he was caught, there was a debate beginning to form what drives someone to execute a healthcare executive on the street - but the day he got caught, the debate got suppressed and no one is talking about it anymore.
- JumpCrisscross 2y ago
  > I'd have expected a debate about healthcare cost and actual reforms It was all show no thought. The big questions remain unanswered. Where are costs inflated between pharmaceuticals, providers, hospital administrators, insurance administrators and patients seeking unnecessary care? How do we reform insurance when most people hate our healthcare system while simultaneously liking their own coverage? Luigi didn't add anything substantive to the debate. Instead, his role was in facilitating venting. Someone still has to come up with an idea beyond "I hate this." > there was a debate beginning to form what drives someone to execute a healthcare executive on the street On Twitter, maybe. For most people, it was another Manhattan mental-health case murder. The chase and his good looks provided salacious intrigue, but only for so long as he was on the run.
  - s1artibartfast 2y ago
    >The big questions remain unanswered. Where are costs inflated between pharmaceuticals, providers, hospital administrators, insurance administrators and patients seeking unnecessary care? Pharma costs are inflated by R&D costs and promotion. Insurance overhead is actually relatively lean, but base cost is primarily driven by cost of goods, and to a lesser extent admin. Provider costs are inflated by high legal and regulatory liability, shortage of qualified staff to offset liability, and high admin. At a the highest level, cost is driven by an inability to discover and set prices at market clearing rates. Manufacturer dont sell fixed price product into a market, but negotiate complex bulk deals with PBMs, pushing some prices up and others down. Similarly, hospitals/providers dont set prices at clearing rates, but negotiate 1:1 pricing, with some products above and below cost. Last, and I suspect most significantly, health plans cant meaningfully vary in provided care, only cost sharing. That is to say, a bronze plan must include the same medications and procedures at a gold plan, differing only in copay. This breaks the price feedback on COGs. (e.g. a generic only insurance plan is illegal, so name brands face reduced competition). If I were Medical Czar, I would look at banning preferential pricing/institutional rebates for goods and services. I would allow more heterogeneity in policies (e.g. generics only, no implants, limited oncology, ect). This would crush innovation, but also greatly reduce pricing as it moves from cutting edge, to 10 year old technology. Provider shortage is a tougher nut to crack, but I think it would require radically altering the residency program as it exists today and loosening requirements for other healthcare professionals.
    - JumpCrisscross 2y ago
      If you had to pick one policy that maximises impact and messagability, what would it be?
      - s1artibartfast 2y ago
        I dont know that they work well in isolation, as there are multiple market failures at play. If I had to pick one, I would say heterogeneity of insurance plans as most fundamental. Consumers must have some exposure to cost savings or liability for downward price pressure exerted and inferior substitutes to be selected. People will never pick a $20 treatment over a $20,000 unless they have skin in the game, even if it is 99% as effective. I think this has to be instituted at a insurance policy level for a number of reasons. Charges are stochastic and in the future, while policy premiums are predictable and immediate, allowing consumers to see cost or savings across the entire policy and pre-commit. Measurability is tough on this because it amounts to allowing inferior treatment, and I dont think this could be papered over, even if it brings down the price of all care and allows more treatment in aggregate. Uniform pricing is much better on the messaging. It is adjacent to collective bargaining, just mediated by a market instead of a technocrat. It can be sold to the left as an attack shadowy rentseekers. It can be sold on the right as a free market reform. On the pragmatic front, it can It has a transparent pricing angle, where you could see prices, which current transparency legislation seems to fail. I also think there is a lot of negative will pent up about negotiated pricing and the idea of companies paying drastically lower prices than an individual because they can throw their weight around when bargaining.
      - DANmode 2y ago
        Not who you asked, but: "Remove the people between you and your doctor."
        refurb 2y ago
        Unless you're paying for it 100% out of pocket, this will never happen. In all socialized systems the government decides what your doctor can do, 100% of the time. Of course from a patient perspective it looks much less restrictive, but that's only because your doctor never brings up treatments that aren't paid for. One of the big issues with the US system is that the patient is put right in the middle of the decisions so sees all the rejections, has to deal with all the paperwork, and pays the price when things go wrong.
- dragonwriter 2y ago
  > I'd have expected a debate about healthcare cost and actual reforms resulting out of it because the momentum clearly was there No, it wasn't; if the momentum was there, the debate would have been self-sustaining and not dependent on new news events relating to Mangione to sustain it. > but the day he got caught, the debate got suppressed and no one is talking about it anymore. The debate didn't get suppressed and didn't need to be; the “debate” in the major media wasn't a real debate, it was just a way to stretch attention to Mangione news for a few more commercial breaks, and once there were no more news events for it to leverage for that purpose, it was abandoned by the same people who had been driving it. And, to the extent that there were people engaging in social media and elsewhere who saw the debate as genuine, they didn't need to be suppressed, as they never had momentum, they just mistook cynical commercial manipulation for opportunity.
s1artibartfast 2y ago
This is the failure mode of the anarcho-liberal awareness premise. "Awareness" is almost never the limiting factor to policy change. This is why awareness based movements such as occupy, BLM, and climate protests go nowhere. Everyone is aware of climate change, police brutality, or inequality. Organized opposition with leverage and a compelling alternative is the bottleneck. Awareness isn't a policy position and doesn't advance debate. Luigi did not have a thesis capable of changing minds. I dont know and haven't seen a single example of someone having their mind changed. Just people more fired up on their priors.
- harimau777 2y ago
  Wasn't the thesis that can change minds behind Luigi basically "If we don't fix the system then this could happen to me"?
  - s1artibartfast 2y ago
    I dont think that is a policy proposal, nor do I think it is compelling to the voters and policy maker that would need to implement the change. My point is that acting out until someone else comes up with a solution and someone else implements it almost never works. You have to change minds en masse.

> just look how fast Luigi Mangione got out of the news. What news would there be? He was arrested and locked up, his court case hasn’t started. Should we have “Luigi still in jail” headlines?

mschuster91 2y ago

I'd have expected a debate about healthcare cost and actual reforms resulting out of it because the momentum clearly was there, but hey, here we are... For a while, until he was caught, there was a debate beginning to form what drives someone to execute a healthcare executive on the street - but the day he got caught, the debate got suppressed and no one is talking about it anymore.

JumpCrisscross 2y ago
> I'd have expected a debate about healthcare cost and actual reforms It was all show no thought. The big questions remain unanswered. Where are costs inflated between pharmaceuticals, providers, hospital administrators, insurance administrators and patients seeking unnecessary care? How do we reform insurance when most people hate our healthcare system while simultaneously liking their own coverage? Luigi didn't add anything substantive to the debate. Instead, his role was in facilitating venting. Someone still has to come up with an idea beyond "I hate this." > there was a debate beginning to form what drives someone to execute a healthcare executive on the street On Twitter, maybe. For most people, it was another Manhattan mental-health case murder. The chase and his good looks provided salacious intrigue, but only for so long as he was on the run.
- s1artibartfast 2y ago
  >The big questions remain unanswered. Where are costs inflated between pharmaceuticals, providers, hospital administrators, insurance administrators and patients seeking unnecessary care? Pharma costs are inflated by R&D costs and promotion. Insurance overhead is actually relatively lean, but base cost is primarily driven by cost of goods, and to a lesser extent admin. Provider costs are inflated by high legal and regulatory liability, shortage of qualified staff to offset liability, and high admin. At a the highest level, cost is driven by an inability to discover and set prices at market clearing rates. Manufacturer dont sell fixed price product into a market, but negotiate complex bulk deals with PBMs, pushing some prices up and others down. Similarly, hospitals/providers dont set prices at clearing rates, but negotiate 1:1 pricing, with some products above and below cost. Last, and I suspect most significantly, health plans cant meaningfully vary in provided care, only cost sharing. That is to say, a bronze plan must include the same medications and procedures at a gold plan, differing only in copay. This breaks the price feedback on COGs. (e.g. a generic only insurance plan is illegal, so name brands face reduced competition). If I were Medical Czar, I would look at banning preferential pricing/institutional rebates for goods and services. I would allow more heterogeneity in policies (e.g. generics only, no implants, limited oncology, ect). This would crush innovation, but also greatly reduce pricing as it moves from cutting edge, to 10 year old technology. Provider shortage is a tougher nut to crack, but I think it would require radically altering the residency program as it exists today and loosening requirements for other healthcare professionals.
  - JumpCrisscross 2y ago
    If you had to pick one policy that maximises impact and messagability, what would it be?
    - s1artibartfast 2y ago
      I dont know that they work well in isolation, as there are multiple market failures at play. If I had to pick one, I would say heterogeneity of insurance plans as most fundamental. Consumers must have some exposure to cost savings or liability for downward price pressure exerted and inferior substitutes to be selected. People will never pick a $20 treatment over a $20,000 unless they have skin in the game, even if it is 99% as effective. I think this has to be instituted at a insurance policy level for a number of reasons. Charges are stochastic and in the future, while policy premiums are predictable and immediate, allowing consumers to see cost or savings across the entire policy and pre-commit. Measurability is tough on this because it amounts to allowing inferior treatment, and I dont think this could be papered over, even if it brings down the price of all care and allows more treatment in aggregate. Uniform pricing is much better on the messaging. It is adjacent to collective bargaining, just mediated by a market instead of a technocrat. It can be sold to the left as an attack shadowy rentseekers. It can be sold on the right as a free market reform. On the pragmatic front, it can It has a transparent pricing angle, where you could see prices, which current transparency legislation seems to fail. I also think there is a lot of negative will pent up about negotiated pricing and the idea of companies paying drastically lower prices than an individual because they can throw their weight around when bargaining.
    - DANmode 2y ago
      Not who you asked, but: "Remove the people between you and your doctor."
      - refurb 2y ago
        Unless you're paying for it 100% out of pocket, this will never happen. In all socialized systems the government decides what your doctor can do, 100% of the time. Of course from a patient perspective it looks much less restrictive, but that's only because your doctor never brings up treatments that aren't paid for. One of the big issues with the US system is that the patient is put right in the middle of the decisions so sees all the rejections, has to deal with all the paperwork, and pays the price when things go wrong.
dragonwriter 2y ago
> I'd have expected a debate about healthcare cost and actual reforms resulting out of it because the momentum clearly was there No, it wasn't; if the momentum was there, the debate would have been self-sustaining and not dependent on new news events relating to Mangione to sustain it. > but the day he got caught, the debate got suppressed and no one is talking about it anymore. The debate didn't get suppressed and didn't need to be; the “debate” in the major media wasn't a real debate, it was just a way to stretch attention to Mangione news for a few more commercial breaks, and once there were no more news events for it to leverage for that purpose, it was abandoned by the same people who had been driving it. And, to the extent that there were people engaging in social media and elsewhere who saw the debate as genuine, they didn't need to be suppressed, as they never had momentum, they just mistook cynical commercial manipulation for opportunity.

s1artibartfast 2y ago

This is the failure mode of the anarcho-liberal awareness premise. "Awareness" is almost never the limiting factor to policy change. This is why awareness based movements such as occupy, BLM, and climate protests go nowhere. Everyone is aware of climate change, police brutality, or inequality. Organized opposition with leverage and a compelling alternative is the bottleneck. Awareness isn't a policy position and doesn't advance debate. Luigi did not have a thesis capable of changing minds. I dont know and haven't seen a single example of someone having their mind changed. Just people more fired up on their priors.

harimau777 2y ago
Wasn't the thesis that can change minds behind Luigi basically "If we don't fix the system then this could happen to me"?
- s1artibartfast 2y ago
  I dont think that is a policy proposal, nor do I think it is compelling to the voters and policy maker that would need to implement the change. My point is that acting out until someone else comes up with a solution and someone else implements it almost never works. You have to change minds en masse.