Price controls coming for health care

Novice, you're free to listen to Brooksie on MBS's if you want, and if you believe that negative convexity = positive convexity, which is what he said, you will wind up all the poorer because of it.

Here's an interesting quotation on the "concierge sector":

""Frankly, it is not a viable solution for creating affordable, convenient care for the entire country," says Jason Hwang, executive director of the Innosight Institute, a nonprofit think tank focused on health care issues."

http://www.dailyfinance.com/2011/01/30/is-concierge-health-care-worth-the-money/

I'll say it once even though I've said it a thousand times: charging MORE for what is already the most expensive and least efficient healthcare system in the world with some of the poorest outcomes is not the answer, and I do not believe that there is significant demand to pay MORE for healthcare than people are already paying, or that people will choose to opt out of health insurance because the risk is too great - a one-week hospital stay can easily cost $50,000, which is about the median household income in the US. It's too great a risk.

You've yet to show ANY statistics - not even A statistic - regarding the uptake of "concierge" medicine in the US. You just think it's a good idea - BRAVA! But show us a statistic or two.

Here's some information on FTC (non-)enforcement of antitrust rules for hospitals and physicians:

http://www.ftc.gov/speeches/steiger/stg119.shtm

The rules were enacted in 1996, and they allow a collusion that is prohibited in most all other industries. That is what I said, unless you can show me where I didn't.

If you want to learn about health insurance companies' exemptions from antitrust law, I suggest you read about the McCarran-Ferguson Act. That is what I said, unless you can show me where I didn't.

You asked if the Mayo Clinic accepts Medicare - that was all. The answer is yes. What it does not accept is ASSIGNMENT of Part B, which doesn't cover much, though it will fill out the forms, but wasn't your question. It does accept part A, which is the primary part of Medicare.

If you have "fun with opposing counsel" it's because you ask bad questions. Next time ask whether the Mayo Clinic covers Medicare Part B, and you'll get a different answer. Not a materially different answer, but it will be different. The answer would be, "Yes, but not assignment."

1234 - thanks for the tiny-mind compliment, but I've yet to see anywhere where you state what WOULD work to fix the healthcare system. Tell us - in your opinion, what WOULD work?

Relevance to real estate?

Steve - Please stop. I actually wrote antitrust guidelines for HMOs and IPAs in 1993 and worked on a merger between two giants in the industry in 1998. Antitrust is one of my areas of expertise, and while I haven't done anything in healthcare in that area since 1998, I know I've got you covered. And you never understand my point re concierge medecine - my point was never that it was a solution for delivering healthcare to the majority of the population. I probably never made my point clearly and it is not important to me that you understand it. I am generally more of a "taker" on the Internet, coming on to learn rather than pontificate. Finally, re opposing counsel, I am never the ones asking questions; it is always the judge in motion hearings, and one of my favorite things is watching the judge's face when opposing counsel digs in on an absurd position. Note that earlier in my career, before I could choose my clients, I was directed on more than one occasion to dig in on an absurd position. That is part of an attorney's job, circumscribed only by colorably claim ethical obligation, which is sadly pretty much meaningless because how can a judge distinguish between an attorney who is acting in bad faith vs. an attorney who might not be the brightest bird in the bath.

And again, my typos are simply inexcusable, but I am pretty much assuming that nobody is reading this anyway!

Greensdale - Re bearing on real estate, does not bode well for a U.S. citizen's ability to buy NYC real estate.

And nyc1234 did offer the following two prescriptions: (1) standardized format for EMR's; (2) individuals taking better care of themselves by eating better, exercising more, etc.

"(1) standardized format for EMR's"

Yes he did, and he said it would save a lot of money, which a recent study said it wouldn't.

"(2) individuals taking better care of themselves by eating better, exercising more, etc."

That might affect how sick people get, but it doesn't change how expensive healthcare is, nor does it really address anything.

And I'm very glad that you're a self-confessed expert on antitrust - so what's your point? Because first, there aren't a lot of HMO's left. Then, I merely said that there is a fairly large antitrust exemption for doctors, hospitals, and insurance companies, which there is, and which allows collusion that would be prohibited in just about any other industry.

Collusion drives up prices.

" I probably never made my point clearly"

You never made any point, that I could find. All you did is say that I have no idea what is happening in that sector of the industry. You relied on an article in The Economist, best I can tell. Show me something that shows what its effect on the healthcare sector as a whole is, and I'll look at it. Thus far you haven't, because I don't think you can, because I don't think it is a material segment in the healthcare industry.

"It is not important to me that you understand it."

Maybe if you understood it first, it would be easier for you to explain it.

And I'm waiting for you to tell me what my "absurd position" is - because I haven't heard that from you yet.

1-primary care capitation with national guidelines (clear guidelines agreed upon by a committee of primary doctors and specialists) for determining when studies and labs should be ordered. bids accepted for capitation but quality monitored.

2-access to these agreed upon national guidelines from internet and mobile devices.

3-EHRs incentivized to build guidelines into the EHRs directly (such as when u type cough into history, it gives u a basic algorithm which determines whether or not u get a chest xray, etc). EHRs without guidelines built in must be sold clearly as such and also state that there will be a capitation penalty for using these crappy EHRs (something like 50% less than docs using standardized guideline based EHRs)

4-EHR integration via standardized protocol (like a doc file format), basically copying the VA EHR model, where everything is logged and nothing is redone unnecessarily. pharmacies, labs, all providing doctors able to access the same patient information anytime, anywhere as long as they are using a standardized EHR protocol software program.

5-Companies that use non-standardized EHR software can sell to the doctors with clear statement on page 1 of contract that states this a "non-standardized EHR software and if used, no reimbursement will be given from national insurances".

6-panel to deal with long-term ICU patients. doctors determine what patients are able to be saved via panels. any care beyond this point is paid by the family.

7-obesity-patients above 2 standardized deviations in obesity have to demonstrate that they are in an exercise program (unless documented that they cannot physically do it). otherwise, they pay an extra fee into the insurance companies, similar to what smokers have to do.

8-specialty care: fee-for-service. but again standardized and monitored. u can't just see a patient and perform a surgery (many insurances already prevent this). surgeons or subspecialists performing out of the normal range of procedures are monitored and dealt with via penalty if incorrectly practicing.

9-ease of HIPAA regulations to make it easier to analyze the data being generated by all of the above steps. ultimately, the EHRs will use this real-time analysis to modify their algorithms. for ex, if 10 coughs come in and 5 have pneumonia on xray, the system realized this spike and warns the physician to decrease threshold for diagnosing pneumonia. or if patients with back pain across the country and a set of specific symptoms are responding poorly to surgery, these inputs are sent back to say to the physician - this patient is not a good candidate for surgery. eventually, this info is codified and updates the national consensus panels on how to treat disease.

10-finally create local panels of doctors to monitor the guidelines locally and make sure there are no patient outliers. there will always be outliers. if a community has a different background, for ex, asthma in harlem, these inputs are considered as well.

step 1, EHR integration, copy VA, but add mobile devices and apps
step 2, create basic protocols and guidelines nationally. not per specialty but by consensus. this can be done today if the govt were interested in an efficient system.

step 3, start amassing data to modify the protocols continually

finally - hospitals - make them bid on service. their rates are insane. how the hell can u justify a 3-4x price for the same service??? CMS spends so much time trying to set rates but it seems when it comes to this massive disparity they look the other way. everyone knows why it exists.

Why . . . are . . . you . . . still . . . talking? That is a rhetorical question btw. I just want to get this thread to 1000. I am going to try to exit the conversation yet again. If nobody else joins, would you do me favor and repeat your position for another 93 posts so that the thread can get to stated goal?

My last post directed at Steve, not nyc1234.
Nyc1234 - PLEASE keep talking. Your posts provide invaluable insight that one cannot get through journalists.

Actually, 1234 makes excellent points and what he is saying is approximately what I was saying, though I would add smoking to obesity, and I don't think 2 standard deviations is enough as 2 standard deviations is a long, long way away, almost black-swan like.

I don't know what he means by "specialty care," so I can't comment on that, but at the very beginning I said copy the VA, switch to capitation system. I also agreed with him on end-of-life care, which isn't in his list but should be. I would add eliminating antitrust exemptions to hospital bidding, and I also think that politically it will be necessary to involve patient representatives in some of these steps, and there do need to be financial people and economists to help design the structure of the markets.

The hospital rates exist, I think, because, among other things, of a) training of doctors at hospitals covered by Medicare; and b) nonpayment of hospitals by the indigent and people with no health insurance. I think that Obamacare is starting to address those issues.

Novice, the problem is you, I think, because 1234 has finally posted very useful suggestions that are a good start.

heeeeerreeee we go, he just went into his usual pattern. actually he changed it up a bit. backpedal, feint, bs reference post, repeat.

Novice it only took you ten pages of posts to figure out what most of us have witnessed over the years. he will NEVER admit he was wrong or mistaken, the furthest you will get is that YOU misinterpreted his words or meaning. even when they come full circle! now, he would have you believe he and 1234 are making similar points. its a howl i tell ya......

rangersfan - Thank you for the reality check. I cannot believe he is serious; is there any possibility that he is just a mischievous presence who simply enjoys trying to make people go mad on the Internet?

Oh, Novice, you are too easy!

See pg. 1 for my comment on the VA: "Obamacare is a start, by forcing everyone to get insurance. We will eventually go toward a hospital-based VA-type system, which is the most effective in the country."

See pg. 1 for my comments on medical protocols and capitation system: "But what WILL change here is that healthcare budgets will be managed by a capitation system statistically adjusted for morbidity, following predefined medical protocols. That is what the VA did (implemented and followed standard medical protocols). "Private practice" will cease to exist as hospitals take over the provision of healthcare services. Fee-for-service will be eliminated."

My comments on antitrust begin on pg. 9 and continue here: "For once I agree with 1234, except I think capitation will be easier than he thinks - insurance companies have a limited exemption from antitrust law - which they shouldn't but that's a different matter - but hospitals don't."

What else would you have me say, other than YOU HAVE BEEN OWNED?

So, earlier in the conversation I tried to back away slowly. I am now running, at full speed, in the opposite direction, as fast as my legs will carry me, screaming for help. I must say that at this point I am quite glad to have a hockey fan on my side.

US citizen's ability to buy real estate?? That is what this discussion is about? How many US citizens buy NYC real estate?
This thread doesn't even have a consensus on the topic.

You should run, Novice, because you can find exactly what I said on the pages I cited, because as 1234 said I am good at cutting and pasting, and that's all had to do to own you: cut and paste what I had already said.

I said essentially what 1234 recommended, and those are my very words. I did not mention charging extra for obesity but it's not a bad idea.

Out of curiosity, does anyone involved in this 9 page discussion in their regular career either bill by the hour or bill by the word? And if yes, after this long discussion, would you conclude that it is a better model than billing by the service?

It depends, greensdale - if you bill by the service and you are the one who decides what services your client gets, then in fact it is a serious problem.

Imagine going to a restaurant where your waiter would tell you what you are ordering for dinner.

That is basically how our healthcare system works.

EXCEPT, not only does the waiter tell you what you are going to eat, but the person at the next table over will be paying for it.

Would you object?

Probably not, whether you needed to eat what your waiter ordered or even wanted it.

Add to that that you don't have the skills to determine if what is being ordered for you to eat is good for you or not - which in consuming healthcare, most people don't.

Then imagine that you have Prader-Willi Syndrome, where you can't feel if you are full. So you consume and consume and consume the food that the waiter is ordering for you (on which he makes his customary 20% tip!) that your neighbor at the next table is paying for, and you consume it till you burst.

Well, that is what healthcare in the US is like today. The country has Prader-Willi Syndrome for healthcare: we can't tell when it's enough because we haven't instituted effective controls over consumption.

Next table pays even if the eating patron bursts?
Could be a good reality show.

Yes, but the problem is EVERYBODY is at the next table, because the next table thinks you're paying for his meal, and you think the next table is paying for your meal...

...but the only ones who really benefit are the waiters (insurance companies) and doctors (restaurant owners). Everybody else just gets screwed, then dies.

If you have already bursted, are you still responsible for the next table? Or is your estate responsible?

Also even though you have Prader-Willi Bursting Syndrome, if your neighbor has already bursted, are you perhaps likely to cool it with the eating maybe just to be safe even though you don't feel full? You know, maybe even use other measurements like how long you have been eating for, or how much volume of food you saw? Also does it smell bad if your neighbor has bursted and the food from his stomach is splattered all over the restaurant? Also, if it is a game show, I was a big fan of Richard Dawson in Running Man.

Hey huntersburg:
I wasn't the one to bring up fruit/enchanting perishables on the "Merry Christmas" streeteasy discussion.
Nor how I needed to clean out my fridge before going away for vacation and how "this shit" was distracting me from the work at hand.

I was having a nice chat with walpurgis about things for sale in Chinatown gift shops and the directions, translated into English on the packaging.
Not talking to nor about her. Yet, she was angered by the comments between walpurgis and I, because we get along on streeteasy.
It was a "Merry Christmas" discussion that was going along quite well until she showed up.

If I did have extra fruit/perishables in my fridge before going out of town, I would drop them off at the soup kitchen. Especially if I worked there on a weekly basis.
Or I would give the fruit/perishables to a homeless person on the street.
Wasting food when it can be given to hungry, less fortunate people is thoughtless.

Getting off on calling me a "bitch","skank", the threats and all of the other angry commentary from her doesn't bother me. It's been going on for years, long before I started posting comments on streeteasy.
She can't control her anger. She has a problem -- but it's not me.

"Lord only knows..."

Rather than government mandate of eating well and excercising, each one of us has free will to do so, especially if we can afford to eat healthy food (and fruit).
Excercise is free.
Just get up off the chair and away from posting frustrated outbursts on streeteasy and take a walk outside.
Being chained to the computer and declaring how she "despise(s)" me won't lead to better health.
Just more frustration and anger, along with her claims of having "chats" with streeteasy and conspiracy theories about how my comments are posted, "agreements" with streeteasy and whatever else she's stewed about.

Time for a nice swim. Then a healthy meal followed by a walk.

stevie:
I've read about Prader-Willi Syndrome.
Some people just can't experience the feeling of fullness.
So they eat like guppies.

Guppies will continue to eat until their stomachs explode.
People will continue to stuff themselves until they vomit.

Some other people just have no control of their food and alcohol intake and are stuffed-up with frustration and anger.

"Lord only knows..."

:)

@steve

The price is expensive at hospitals for 2 reasons: they have near complete control when negotiating with insurance carriers who are scared that a hospital would kick them out of network. This is a legitimate fear and hospitals have done it and got amazing deals out of it.

The other reason is in addition to hiring doctors and employees u have to hire middle and upper management as well as union employees. In the past I have had 40 employees do in the hospital what only 6 would do in practice. Also had several managers in the process which in practice I don't need. Have to keep union happy in the hospital and "they r not interested in efficiency" (not my words)

You must be joking, "truth"

I'm a gym rat and I have a very expensive treadmill at home.

Nice try, though. Speaking of anger and misguided bile, do you deny your previous comments about my family? Hypocrisy is very ugly. I'm so sure that you take you're almost too ripe fruit to a food kitchen, after not mentioning that until now. Bullshit. And your writing is excrutiatingly bad, particularly for someone who claims it is her business.

>I'm a gym rat

Just like NYCMatt!

>Speaking of anger and misguided bile

You've been talking a lot about this bile thing lately. Have you talked to a gastroenterologist??

Those are also valid issues, but they don't take away from the fact that so are Medicare overpayments for training, nonpayment by the uninsured, and the fact that hospitals are allowed to charge more for the same procedures than private practices, which is insane.

Other issues are Medicare negotiating drug prices, and using Medicaid pricing for dual Medicare / Medicaid recipients. And I'm sure there are many others, too.

After reading this thread I see that some believe the VA hospital system is efficient and provides great care. Let me start by saying the VA hospital system provides neither. The care our service members receive is equivalent to care provided in third world countries. This government run system is despicable at best. I am a health care provider whom was in the military and I would never use the VA system for my health care. The only people whom will get great care, after this administration changes the way health care is delivered are the rich. In any country with socialized medicine the private hospitals for self payers give the best care minus the long waiting list. Remember there is a reason so many foreigners come here for there health care needs.

True

Agreed Chris. I would never go to a VA for medical care. I will admit their software integration is solid but they don't use this in the best way it could be used. Listening to Steve talk about the system makes my blood boil because I've seen what kind of care they get. It's absolutely not what we would get in a private hospital. The American public would never accept this severe level of rationing. Nor should they.

Steve many private docs see uninsured. And when the hospitals do, they often get paid through medicaid by conversion.

The govt subsidization of residents has nothing to do with this. That is necessary to get us through training.

Hospitals get paid more per case because they have control over the insurance companies in setting rates. The ACOs will increase this. Assuming they can get them started.

It's not my estimate of the VA's care - they are independent evaluations of its effectiveness, and it seems to be very effective. Yes there is rationing - Britain's NHS has rationing. We have rationing, albeit of a different sort: wealth.

On the one hand, we have Stevejhx, who has no actual experience with the VA, but has read a lot about it, claiming the VA is the gold standard of care and efficiency in healthcare

On the other hand, we have veterans who have actually received care from the VA, as well as physicians who have actually worked at the VA, claiming that the VA is not the model of care and efficiency that Steve is claiming it is.

Hmmmm, who is the reader to believe? I am going to go with the veterans and physicians on this one, and I can certainly understand how it makes the blood of those with actual experience in something boil to have someone who has only a superficial understanding of the subject matter speak about it with such confidence. My blood starts boiling every time Steve calls himself an economist and professes to have an understanding of the economic structure of the healthcare industry. Part of Steve's MO if challenged is to ask the challenger to explain to the audience why Steve is wrong. First, nobody in the audience really cares. But second, if anybody in the audience really did care, what challenging poster who makes the mistake of taking steve seriously has either the time or inclination to give an online course in their field of expertise in a real-estate chat room?

How many people have let stevejhx get under their skin? I know that Brooks2 has; I know that nyc1234 has; I know that I have. How many others have there been? I honestly don't know if Steve is not that bright or if he is just messing with people; either way, I counsel anyone who is reading this: Do not engage stevejhx; if he attempts to engage you, steer clear; run away; save yourself!! http://streeteasy.com/nyc/talk/discussion/4510-streeteasy-board-a-primer

And among the many reasons why NWT is my favorite SE poster, NWT is the only challenger I've found who has actually been able to get stevejhx to stop talking: http://streeteasy.com/nyc/talk/discussion/32651-buy-coop

novice, stevie will go on unabated and unfiltered cause thats just who he is. some believe engagement may prove to be fruitful and introducing logic and reason might prevail but not with stevie. if he senses truth, logic and reason is about to overwhelm his position, he will then pull out his feint, bs reference post and backpedal routine. he has a keen ability to wear people down with this "strategy" but ulimately the end game is most just throw their hands up in disgust after many wasted hours. he probably gets a peverse sense of joy from this.

so, no need to engage. he ultimately keeps digging his own hole and it gets bigger and bigger. the trick is to get him to jump in but he usually manages that all by himself. but not worth wasting your valuable time, he obviously has too much on his hands....

"claiming the VA is the gold standard of care and efficiency in healthcare"

Do you see "gold standard" anywhere in what I wrote? What I said I merely quoted, and it is not anecdotal evidence of people, but rather hard outcomes supported by studies.

Here's a summary from MarketWatch, that bastion of liberal bias owned by New Corporation:

http://articles.marketwatch.com/2010-06-02/finance/30721229_1_health-care-system-health-care-health-system

And here are the data published by the VA itself:

http://www.va.gov/health/HospitalReportCard.asp

Do you know of any other hospital or healthcare system that publishes data like these, novice?

Or that get reviews from their own patients like theses from that other bastion of liberal bias, the American Legion:

"Overall, Gadd said the SWS teams found the quality of VA health care to be excellent."

http://www.azlegion.org/legion-reports-on-va-health-care-quality/

Prior to 2000 the VA, by all accounts, was horrible. That is apparently not the case anymore.

"My blood starts boiling...."

Let it boil. You are the first - and hopefully last - economist who would take anecdotal evidence over real facts.

"I know that Brooks2 has...."

Brooksie is an idiot, backed his claims based on what somebody wrote on a blog, and makes claims that are demonstrably untrue, such as negative convexity = convexity, that banks keep most of the mortgages they originate on their balance sheets, that benchmark prices for bonds are "closing prices," and I could go on and on and on, but it's not worth the effort again.

"I know that nyc1234 has...."

I happen to agree with a lot of what 1234 has to say, and I said it before he did on this thread, but he made some very good points.

You, on the other hand, have gone on and on and on about "concierge care," without being able to cite a single statistic not even on what its uptake is in the country.

So you're working yourself into the Brooksie category.

Here's another study, stating:

"The VA runs the largest integrated health-care system in the country, with more than 1,400 hospitals, clinics and nursing homes employing 14,800 doctors and 61,000 nurses. And by a number of measures, this government-managed health-care program--socialized medicine on a small scale--is beating the marketplace. For the sixth year in a row, VA hospitals last year scored higher than private facilities on the University of Michigan's American Customer Satisfaction Index, based on patient surveys on the quality of care received. The VA scored 83 out of 100; private institutions, 71. Males 65 years and older receiving VA care had about a 40% lower risk of death than those enrolled in Medicare Advantage, whose care is provided through private health plans or HMOs, according to a study published in the April edition of Medical Care. Harvard University just gave the VA its Innovations in American Government Award for the agency's work in computerizing patient records."

http://www.time.com/time/magazine/article/0,9171,1376238-1,00.html

It's not "concierge care," I know.

How disappointing.

Arrogance combined with ignorance.
I know many who are arrogant, but I can tolerate it based on their superior knowledge and/or abilities.
I know many who are ignorant, and I am among the ignorant on more subjects than I can count or think of. I do not begrudge anyone who is ignorant, as long as they are aware of it.
It is the combination of ignorance and arrogance that makes my blood boil.

You can say all you want and rely on whatever anecdotal claims you want, novice, those are real studies by independent organizations - American Legion, University of Michigan, Harvard University, Rand Corporation, and so on.

The system is not perfect - it's underfunded, to say the least, and there is rationing by waiting lists (the biggest complaint about the UK's NHS, as well). But 1234's "It's absolutely not what we would get in a private hospital" is apparently untrue, both in terms of patient satisfaction and outcomes, at least according to private studies.

Though there is rationing, I will not deny that.

Steve, it's pretty unanimous and evident that the only idiot here is you.
Keep trying to worm your way out it. Keep writing things that I did is not going to help you.
I really think you need to get out more. Maybe some human contact or does that frighten you.

Novice, Rangerfan others, thanks

**that I did not say***

I'm so sorry, novice! Maybe if you could find something on the uptake of "concierge care" in America your boiling blood would affect me.

Or why you don't think the University of Michigan's survey of patient satisfaction and outcomes is worth the paper it's written on.

But then - alas....

And Brooksie! Brooksie, Brooksie, Brooksie! Negative convexity = positive convexity Brooksie!

Tells us some Flyboy stories, Brooksie!

This link is a GREAT summary of the different health care systems in the ten "most free" nations per the Heritigage foundation. Its useful because so many on this thread have no idea how such systems work in other nations.

"Conservative Think Tank Ranks Countries With Government-Run Health Care As The Freest In World

"....Former Senator Jim DeMint, the new president of the conservative Heritage Foundation, has decried Obamacare as “a cancer” that is “is fundamentally inconsistent with liberty.” During the Senate Obamacare fight, DeMint famously declared “If we’re able to stop Obama on this, it will be his Waterloo. It will break him.”
But a new report from DeMint’s own organization suggests that, far from being incompatible with freedom, countries with health care systems with as much or significantly more government control over healthcare are the freest countries in the world...."

http://thinkprogress.org/health/2013/01/11/1429241/conservative-think-tank-ranks-government-run-health-care-as-compatible-with-freedom/

>My blood starts boiling

I've recommended seeing a gastroenterologist to aboutready who seems to be having bile problems. I'm not sure where I'd direct you on this blood boiling problem.

Yeah, but, where is CONCIERGE CARE in that report?

Oh no, Jason is back - another poster who has the arrogance/ignorance combo. Too much for me.

Brooks2 - Always a pleasure, and I feel your pain.

HB - I think the only remedy for the blood boiling is steering clear of whichever posters set one off. It's hard because such posters can be entertaining. This is where you come in and why you are my favorite gray - you often vocalize the things that I am thinking while I am silently lurking. Please continue with this invaluable service; IMHO, you are an integral part of the site, and I maintain that POV even though you have taken aim at me in the past, as I fully expect you will from time to time again in the future. Nice blend of serious insight and comic relief.

if its too much, why don't you follow through on your original idea.

Go back to DC.

That's good, novice, but how does CONCIERGE CARE fit into it?

I have to go to dinner now, but I will undoubtedly check back tomorrow and may enjoy another chapter of "Watch HB run circles around CC." I can't figure out why, but I frequently end up feeling bad for CC, but then I reason, "he brings it on himself."

What is the distance expressed in horse drawn buggie days between COlumbia COunty and D.C.?

i'm crushed.

oh crap, the horse fell on COlumbiaCOunty. Someone call the fire brigade.

novice--how do you feel about the fact that no matter what i do or what i say, hb the sheriff is there?

HI C0lumbiaCOunty

Yes, novice, but what's that got to do with the unknown uptake (probably none) of "concierge care" in the United States?

How come chris13's and 1234's unbiased and unsupported opinions of the VA are more valid that the opinions of the users of the VA themselves, the VA's documented superior outcomes in care, and its proven cost-effectiveness?

All documented by you know fly-by-night organizations such as Harvard and the University of Michigan.

I'm curious - dying to know, actually! I'll check back in tomorrow ... dinnertime for me, too.

aboutready actually patrols this thread waiting for me to post a comment.
She states that she's "a gym rat and has a very expensive treadmill at home."

She has posted numerous comments on streeteasy about her family.
She then takes offense at any comments posted, other than hers, referring to her family.
If she had anything of interest to post comments about, we would not be reading the details about her family life.

I wrote that, if I had fruit/perishables and was about to go out of town, I would take them to a soup kitchen (if in fact, I had been volunteering on a weekly basis there, which I've never stated that I have done.)

She then goes on to state that my writing skills are not up to her standards, nor should they be in my "business" (the music/entertainment PR business, which she knows nothing about and can only dream to be involved in.)

Posting comments on streeteasy is not my "business".
Hypocrital, nonsense posted by aboutready is her hobby.
And appears to be her pasttime because she can not be hired and paid for doing any business.

There is no business wherein a bored housewife with unresolved anger issues would be hired.
That's why she's home on her computer, watching and waiting for me to post a comment.
Not to her nor about her (as was evidenced on the "Merry Christmas" discussion).

"Misguided bile" and "bullshit" is all she has to offer.

huntersburg:
Looks like you're getting a pass from the streeteasy community organizer on the:
"Can't you do the same for your streeteasy community?"

"You are the first - and hopefully last - economist who would take anecdotal evidence over real facts."

I'm a doctor, not an economist. I don't model reality for a living, I deal with it.

nyc1234 calling stevie an "economist" is more than flattering to him. please don't indulge him, you obviously have WAY more experience, insights, practical and technincal knowledge than he. and for every supply-side economist out there, there is a contra who can cut and paste bs reference posts too.....useless.....

Self-health care update:

There's a widespread flu outbreak in NYC.
Wash your hands every time you go back into your apt.building/office from being outside.
Within a few days it will be cold outside and you can wear gloves and scarfs covering your nose and mouth.
Eat fruit for extra vitamin C.

This has been a public service announcement from Truth.
Aloha!

rangersfan, besides disliking stevejhx, you've been around here since 2009, what else do you have to say about, well, anything?

>I'm a doctor, not an economist. I don't model reality for a living, I deal with it.

Excellent retort.

Also stevejhx, you are no Jack Kennedy.

I wasn't addressing you, 1234, about being an alleged "economist" - that was novice who claimed she was.

I agree with what you wrote as solutions - not the only solutions, but good ones. However, what you say about the VA directly contradicts what VA clients say about patient satisfaction, and about what independent research shows about its significantly better outcomes than Medicare and Medicare Advantage at a much lower cost.

>I wasn't addressing you, 1234, about being an alleged "economist"

But the Jack Kennedy comment, that was pretty good, right?

Does how come mean why?

It does, in fact, Brooksie, at least according to Shakespeare, in "Coriolanus": "How com'st that you haue holpe To make this rescue?"

According to my Oxford Dictionary it means, "said when asking how or why something happened...."

Do you have any other questions?

How com'st ... Ok that's. it's been a while since I read Shakespeare

You should try it more often - very enlightening. You will even see that he splits his infinitives.

I bet

I bet you'd like to know why novice supports unsubstantiated opinions over independent research, too.

I certainly would.

And I'd like to know the uptake of "concierge care" in the US, as well.

Gee, I'd like to know the uptake of "concierge care" in the US.

And what's precisely so bad about the VA if its users like it better than Medicare Advantage, and it provides better health outcomes.

Somebody, please....

Such simple questions, yet novice is nowhere in sight....

>Such simple questions, yet novice is nowhere in sight....

And yet how many hours, and you didn't express appropriate satisfaction with my Lloyd / Dan joke?

HB - I liked your Lloyd/Dan joke.

CC - You can't possibly be serious with that question to me? You introduced yourself to me in the midst of a substantive discussion on the Phillips Club by simply telling me to go away. I had never heard of you; you had not previously appeared on the thread; you added no substance to the discussion; you just popped up and told me to go away. I was like "huh? who is this guy and what is that about?" You then proceeded to pop up anytime I was discussing anything just to harass me. So, vis-a-vis you, I am definitely glad HB is around, and I do feel safer. I have found him to be an honest broker, and while I certainly cannot speak to every thread by a long shot, I feel like his general goal is the integrity of whatever discussion is taking place. From what I have observed, you deserve everything he throws at you; I have no idea who started it, but I've got to say that based on my personal experience with you, if I had to guess, you were the one who started it. It appears you are far more preoccupied with HB than he is with you.

Steve - I do like you, but am not sure why. Try doing your own research. Try "direct pay" if you are not having any luck with "concierge." Also, if you really want to understand my points, you need to understand market definition. Finally, I think the big point you are missing is that some in this conversation are looking forward rather than backwards. Things are changing rapidly. Anytime there is industry restructuring legislation, changes will be occurring faster than academics can do their studies and get their studies through peer-reviewed journals to publication. I understand that you are data hungry, and that is generally to be applauded, but try taking it to the next level.

P.S. to Steve - And the main thing you need to understand is that the real point of disagreement between you and me is that you seem to believe that the ACA is going to reduce healthcare costs, while I believe the ACA is going to increase healthcare costs. So here is the bottom line: Your personal healthcare costs are going to increase - deal with it. This will be the case regardless of whether the concierge/direct pay model proves viable. Nevertheless, for those physicians who can make the model work for their practice, I hope that the option is not regulated away.

Another non-answer from novice. She touts "concierge care" as the rage of the future, I ask her about it's uptake in the US, and zero response.

Instead she says she believes the affordable healthcare act is going to increase costs, with no proof of why.

Of course she also thinks that the VA provides substandard services hated by its members, when its members like it a lot more than Medicare, and independent research shows its outcomes are much, much better and a much much lower cost.

So - novice believes what she believes regardless of the research, and based on no fact, yet she believes it nonetheless!

From steve: "She touts "concierge care" as the rage of the future, I ask her about it's uptake in the US, and zero response."

Huh? I never said that concierge care was the rage of the future. Please do not say that I said things that I did not say and please do not try to characterize points that you do not understand. My point here is that more physicians will be inclined to pursue the concierge/direct pay model as they get squeezed. You said this model did not exist outside of plastic surgery. I said it did. I am right on this point. This is an active issue in healthcare law, and the only interesting comment here on this so far came from ereigel re insurance companies fighting back against this model, which suggests to me that they view it as a threat. I suspect the issue here for you is one of access to information; I suspect you are not around people who have sufficient capital to purse and foster this model or avail themselves of it. I have no idea what the future holds, but I do know people with money will fight for this model on both the consumer and provider front.

And re costs increasing under the ACA, have you digested none of the information nyc1234 provided?

And re the VA, I believe it is significantly better than nothing, but I do not believe it is the standard we should be aiming for.

I really don't want to continue this conversation in and of itself, but I am excited that we are approaching the 1000 comment mark!

"You said this model did not exist outside of plastic surgery."

No, actually, I didn't - you said you were discussing doctors who don't take insurance at all, but then switched your definition and stated that you hadn't explained yourself properly. When you switched your definition I changed that portion of what I said, though I didn't change my overall opinion of what you were talking about: doctors may "be inclined to pursue the concierge/direct pay model," but that does not mean that patients would "be inclined to pay for the concierge / direct pay model."

And I still don't think they will as the median household income in the US is ~$50,0000, and a one-week stay in the hospital can cost that.

You seem to forget your courses on the elasticity of supply and demand - there is virtually an infinite supply of a good at an infinite price, but virtually zero demand.

"please do not try to characterize points that you do not understand" - I understand perfectly what you're saying, but you've yet to provide any proof that there is any material uptake whatsoever of this model in the US (or anywhere else).

"I suspect you are not around people who have sufficient capital to purse and foster this model or avail themselves of it."

I don't think there are enough people in the country with sufficient capital to avail themselves of such a model; you've not provided any information otherwise, either.

"have you digested none of the information nyc1234 provided?"

I've agreed with 1234 on a lot of things, but nothing that he's said regarding ACA is at yet convincing, because it hasn't been implemented yet, most especially the health insurance exchanges. When they get implemented we can see how they will work. I have said always that it's impossible to determine with specificity how something will work if it's not even designed yet.

"re the VA, I believe it is significantly better than nothing, but I do not believe it is the standard we should be aiming for."

It seems to be better than Medicare and Medicare Advantage, and patients are overwhelmingly happy with it. What, then, do you think we "should be aiming for" beyond concierge care?

http://www.flickr.com/photos/sluggerotoole/153603564/

HB - Every time my husband catches me talking to the dogs he says, "you do realize they cannot actually understand you, right?" Clearly I have some sort of problem.

Clearly.

Good practice to keep the message simple for the jury.

Steve - Only time will tell on all fronts. The common ground is that we both appear to support the ACA, albeit for perhaps different reasons. Also, regardless of the size of the market for direct pay/concierge physicians, I am glad that were you The Premier, you would not outlaw them.

HB - feedback I got from the colleague whom I respect the most in last trial was that I forgot basic rule that you need to structure closing argument as if you were presenting to a 5 year old. I much prefer bench trial to jury trial.

>you need to structure closing argument as if you were presenting to a 5 year old.

Was this trial in Columbia County?

Structure isn't the only thing - clarity & content are important, as well.

Only 8 more posts, surely you can cut n paste a few more times.
Ok I won't call you surely...

i like how steve even has to argue with an attorney about what is important in a legal brief.

surely, there are another 7 industries we can get steve's brilliant ctrl+ thoughts on, no?

please, everyone, post what u do for a living, so steve can tell u what u r doing wrong.

stevie has never told me what I'm doing wrong, working in my business.
We don't always agree but he doesn't threaten me nor post juvenile rants and threats against me on streeteasy.

stevie is O.K. by me. No problems with him.

stevie:
That was a great party at Rocco's the other night with George Clooney.
Heard about it from friends in Fort Lauderdale.
A good time for all.

Closing arguments are oral, 1234.

Thank you.

for once, u r correct

I assume that means that I wasn't "correct" when I agreed with you?

actually at this point, i just want to see 1000 comments. ur move

From: http://www.nytimes.com/2013/01/06/business/despite-new-health-law-some-see-sharp-rise-in-premiums.html?_r=0&adxnnl=1&pagewanted=all&adxnnlx=1357662270-HOnK8zh9k4AMwzn1P8k54g

“There’s a four-letter word called math,” Ms. Voss said, referring to the underlying medical costs that help determine what an insurer should charge in premiums. Health costs are rising, especially in Iowa, she said, where hospital mergers allow the larger systems to use their size to negotiate higher prices. “It’s justified.”

1000

we made it!