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No, you're not being intellectually honest. You're lying and making things up. I don't know whether that's due to ignorance or bad faith. And I don't give a dam

by nradov 1y ago

No, you're not being intellectually honest. You're lying and making things up. I don't know whether that's due to ignorance or bad faith. And I don't give a damn about your condescending "feedback": save it for someone who cares. There is no credible allegation here that Apple has dodged US federal or state tax laws. Government sponsored health plans such as Medicare aren't legally required to pay for all FDA approved treatments (and much of what they do pay for are procedures which aren't subject to FDA approval at all). Commercial health plans offered by UHC and their competitors cover everything that is medically necessary (and they often cover more than Medicare does), but as with everything in healthcare the precise definition of that term gets a bit fuzzy in some edge cases.

doctorpangloss 1y ago
Okay well, I think you know a lot about this stuff, and it’s worth thinking very deeply about these questions: - why does Apple prefer the status quo? How do they “make more money”? Why do they use UNH? They make software, if it’s so simple as you say, administer plans, why don’t they do it themselves? Btw, Apple Health as in Health IT does exist! So does Google’s Health (IT)? - how can health IT be the second worst performing VC sector (only Ed tech is worse), but UNH is worth whatever it is, hundreds of billions? What is UNH’s actual product? It’s not “being a middleman” - that’s health IT… - why do doctors think Kaiser sucks? Like how does Kaiser make money? - do we have “death panels” in this country? What do they look like? These are all related. In general, I don’t think health IT has the answers to rising costs. That’s the POV I’m hearing. It’s likely that greater adoption of health IT has accelerated, not slowed, the growth of costs in a way that has not improved outcomes per dollar. That’s an orthodox opinion. In my experience, the intellectual leap for a lot of engineers working in enterprise sales heavy sectors is two realizations: (1) that just because something happens, doesn’t mean it makes sense (2) and just because you give people what they ask for, such as in the context of health IT fulfilling dull consulting services asks, doesn’t mean that what people are asking for makes sense or is a net positive, maybe by any metric. And anyway, most experts agree that the middlemen in the healthcare sector, like pharmacy benefit managers and insurers, are responsible for a significant part of the cost difference per outcome here compared to Europe. To me, it is unsurprising that middlemen in general cause costs to rise for very little actual gains, even if in their POV, they are fulfilling some requirement by regulations or whatever. You know, they’re stuck in the “I did what someone asked and paid for, and therefore it makes sense” mindset.

by nradov 1y ago

doctorpangloss 1y ago

Okay well, I think you know a lot about this stuff, and it’s worth thinking very deeply about these questions: - why does Apple prefer the status quo? How do they “make more money”? Why do they use UNH? They make software, if it’s so simple as you say, administer plans, why don’t they do it themselves? Btw, Apple Health as in Health IT does exist! So does Google’s Health (IT)? - how can health IT be the second worst performing VC sector (only Ed tech is worse), but UNH is worth whatever it is, hundreds of billions? What is UNH’s actual product? It’s not “being a middleman” - that’s health IT… - why do doctors think Kaiser sucks? Like how does Kaiser make money? - do we have “death panels” in this country? What do they look like? These are all related. In general, I don’t think health IT has the answers to rising costs. That’s the POV I’m hearing. It’s likely that greater adoption of health IT has accelerated, not slowed, the growth of costs in a way that has not improved outcomes per dollar. That’s an orthodox opinion. In my experience, the intellectual leap for a lot of engineers working in enterprise sales heavy sectors is two realizations: (1) that just because something happens, doesn’t mean it makes sense (2) and just because you give people what they ask for, such as in the context of health IT fulfilling dull consulting services asks, doesn’t mean that what people are asking for makes sense or is a net positive, maybe by any metric. And anyway, most experts agree that the middlemen in the healthcare sector, like pharmacy benefit managers and insurers, are responsible for a significant part of the cost difference per outcome here compared to Europe. To me, it is unsurprising that middlemen in general cause costs to rise for very little actual gains, even if in their POV, they are fulfilling some requirement by regulations or whatever. You know, they’re stuck in the “I did what someone asked and paid for, and therefore it makes sense” mindset.