mwerd

Oh well in that case, you would have to have a totally different conversation about bundled payments.

The price (chargemaster) that the hospital might list for all of the a-la-carte care you're provided is totally separate from how they will get paid on it. If you present at the ER and are triaged with stabilizing care, the nurse can't tell you that price because it will depend on your status at discharge, which is not yet known or in her scope of license to determine. If the doctor sees you and sends you home, that's one price (tied to Medicare outpatient prospective payment system or OPPS). Depending on how severe your issue is, the triaging care, such as pain relievers, may or may not be included in the "evaluation and management" procedure coding level you're assigned. There's one of those codes and typically separate bills for both the facility and the attending physician on your visit. If you're admitted to the hospital, what happened in the ER is not really relevant anymore, because now the facility portion of your care will be paid for based on your diagnosis related group (MS-DRG) at discharge, which has no bearing on how many a-la-carte services/drugs you received. Your insurer negotiates payment per DRG (usually as a spread to Medicare) but the hospital, recognizing that they can get screwed and lose a fortune if they have a really complicated case, will probably negotiate a stoploss provision for "outlier claims", saying something like after $750,000 of billed charges, we don't want MS-DRG reimbursement anymore, we want 35% of billed charges.

The regulation, primarily driven by Medicare, prevents any of this from being simple enough to communicate at point of care.

That doesn't even touch the administrative burden of documenting and collecting on all of that care. If your care wasn't meticulously documented by providers making hundreds an hour to type longform notes, it's essentially free, because no provider will risk billing for care they can't support with documentation. Once insurance pays (or not, they might deny the claim), they will often say "yeah we agreed to pay you x but the patient has 20% coinsurance so here's 80%, you need to talk to him about the rest". The hospital and especially caregivers are not aware of how much of your annual out of pocket max you've spent (thereotically they could check with the insurer, but not realistically in an ER), so maybe you have 20% coinsurance or maybe you don't, only you and the insurance company can realistically know that before the hospital sends the bill.

So now that you've glimpsed one hellscape of a reimbursement scenario, which price did you want the nurse to tell you?

It's totally insane and it all starts with CMS and the insurers. The hospitals would love to simplify and have menu pricing for your care, run your card, and send you on your way. No insurer would contract to pay that way because it would "incentivize the providers to administer unnecessary care".

Can't speak to aspirin specifically, but I think generically you're pushing a false assumption. It is not easy for the rest of the health industry to provide stable pricing of drugs, especially for the types of rarer drugs that are administered in inpatient care settings. Go click around GoodRx drug prices and tell me how stable even generic drug prices are. There's a post here on HackerNews every 6 months about the outrageous cost of insulin, one of the most commonly prescribed and readily available pharmaceuticals (within a lot of variation depending on patient needs).

It's complicated. You're oversimplifying it.

They have the transparency to supplier costs but it's so variable and granular that it's not meaningful to discuss.

Drugs in a clinical setting are priced on a per unit basis (which might be per mL), usually with a flat markup over cost. In practice, that can mean a patient getting IV drug treatment could receive two different charges for the same drug in the same day. If it's a hard to find drug and they deplete batch 1 from supplier A, then administer batch 2 from supplier B, the cost per unit could change by multiplies.

Using the earlier airline example, it's like trying to say what the cost of a generic flight is. The answer is always going to be it depends.

Combining that kind of cost structure with a transparency requirement means you get unusable, and as parent commenter mentioned, laughable results. It's not malicious compliance driving this garbage price transparency, it's a fundamental misunderstanding of how the healthcare system works.

Easy.

Now try it at a rural critical access hospital for rattlesnake antivenom with a short shelf life, so it usually expires unused. They are required by law to stock it or they cannot have their emergency room open. Estimate the revenue generated from treating the one patient who needs it every other year, and by the way, you have 9 contracted payers with different rates and you don't know which one, if any, the patient will have. Rinse and repeat for every other drug required to provide "critical care". Maybe layer on infusion of exotic chemotherapy drugs or monoclonal antibodies to treat a new pandemic virus.

It's not easy.

Not trying to be rude but he already told you the answer. You really should look up 340b. It's a federal program to rebate drug costs for certain types of patients and is a legal form of price discrimination. When you provide a drug in a healthcare setting, it can be a very different price depending on who receives it, because the federal government has the 340b program.

Your argument about cost to manufacture isn't relevant in the same way that the marginal cost of a flying one more passenger on an airline isn't relevant. We all pay different prices for airline seats. Hospitals pay different prices for the same pharmaceuticals.

There are a lot of smart people working in healthcare. A lot of people go into the industry thinking they know better and wash out. See the latest Berkshire Hathaway + JPM + Amazon failure.

I logged in to post this exact suggestion. A couple of templates like [married home owners] and [single renter] that would jumpstart the process would be nice.

It would be easier for me if I could start with a template. Having a few buttons for representative simulations like "married high income" and "single FIRE" that you could then adjust to your scenario instead of starting from scratch would be nice.

D.C.'s population has gone down since the 1950s and it still faces affordable housing and homeless issues. I don't think population growth or decline is a clear driver.

It was over 300 of miles from the white sands missile range. The plane had just flown over the western edge of Oklahoma, in the far northeast corner of new Mexico. It was closer to the air force academy in Colorado Springs than it was to white sands.

The financial accounting standards board updated their guidance in late 2018 to require calculating the present value of expected future SaaS agreement payments and adding that to the balance sheet, so it’s still CapEx in most cases.

Their net income swing is almost entirely attributable to a ~1 billion change in investment returns. Their operating income only fell 20%, because they had 8% increase in operating expenses without a commensurate increase in revenue.

It's actually all laid out in your link.

This won't help consumers. The prices (both charges and what Medicare pays) are already effectively public: https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Pr...

The problem, as some other comments point out, is that they're way too complicated. The link I posted, for example, is just the provider charges. A hospital visit typically has a facility claim and at least one provider claim. Depending on the type of service received and the agreement between insurance and facility, the facility fees can be billed a variety of ways (diagnosis related groups, ambulatory payment classifications, or HCPCS). Each provider that sees you or performs labs, x-rays, etc can bill separately, and each could have a separate or no contract with your insurance. The latter is how surprise 'out of network' bills happen.

It's a total mess and hopelessly complex for the average consumer.

>The SEC appreciates the assistance of the Financial Industry Regulatory Authority and the Options Regulatory Surveillance Authority.

As Matt Levine at Bloomberg is fond of saying, if you don't want to get caught insider trading, don't use options.

https://www.bloomberg.com/view/articles/2014-06-17/there-mig...?

No, the argument in the book is that upbringing matters through ~college graduation but the probability of success (which I think caplan roughly defines as the ability to support an average American family) reverts to genetic probability by 35. Caplan makes a point to say this assumes upbringing in an OECD type of economy.

Been a while since I read it but he covered the obvious counterpoints from what I remember.

It's laid out pretty clearly in his annual budget posts that he doesn't need to do any of that to live. He and his wife simply like doing those things. That's a big difference and I think you're being disingenuous not to give him that credit.

It can be helpful to enlighten an ignorant person though. Take the bastardization of the word "literally", or even "peruse" if you want a less inflammatory example. If one person uses the word in its original meaning and another interprets that word according to a colloquially bastardized version that essentially has the opposite meaning, I think it's entirely appropriate to quote a dictionary to the misinterpreter and incumbent upon them to interpret the word in its original meaning (if at all the intention is in question).

Bastardizing words, particularly those that have a prior established meaning to a minority community like atheists, is tyranny of the majority. It's not their fault that people don't know what atheist means and interpret the word incorrectly. If you reject that notion then I think you a) endorse a recursive loop where ignorant people never have to learn new vocabulary (or worse, get to make up definitions matching what they want to believe the other person is saying) and b) the bar to exchanging information gets set unreasonably high because speakers have to constantly define terms for their audience. There is some duty to learn and understand in a conversation. If you don't know what the words mean, look them up or don't get upset when corrected. That's how you have a conversation that progresses past semantics.

Seems a bit convenient to his point of view. Western democracy is much more strongly associated with Greek city-states like Athens and the ancient Greek leagues than Judeo-Christian theology.

Poor bats. They also get their lungs exploded by the pressure differences created near wind turbines: https://www.wind-watch.org/news/2016/09/27/wind-turbines-are...

SLC has worse air pollution than LA for the weeks it's inverted (approximately 6 weeks a year). Climate change is adding to the problem.

http://archive.sltrib.com/article.php?id=3799747&itype=CMSID

Automatic license plate readers + warrant database + notify law enforcement that their fugitive is traveling x direction at y time.

Not so absurd as this already happens to some degree http://prospect.org/article/license-plate-tracking-increases...

Anyway, your point is moot as reddit complies with all applicable child pornography laws just like any other US based internet business AFAIK.

Not really sure what we're talking about here anymore. I'm trying to point out the absurdity of this dystopian future state where a bunch of vigilantes get to decide who is able to participate in society and use its infrastructure.

Yes, if it was noteworthy or somehow remarkable and written to the standard of the NYT, I would. There was a fantastic piece that toed this line on This American Life not too long ago (https://www.thisamericanlife.org/radio-archives/episode/522/...). I'm generally in favor of people having a medium to say things I disagree with and even find distasteful. That's what I think of when I hear "free speech". It's a core American value.

I would also "tolerate" the opinion piece, in any medium, that argued against it. I think it's very easy to make a good argument against pedophilia so I'm not at all worried about some random NYT op-ed piece suddenly turning the societal norm. Just like I'm not too worried about someone writing an op-ed that argues for slavery again. Once 'we' thought these things were ~ok, now we know they're not, and we have a long list of very good reasons for that that are nearly impossible to overcome.

I don't understand the fear of ideas that censorship advocates have. What's so scary about someone being wrong and having an opportunity to learn as much? If you stifle every conversation on topics we as a society have long since covered, these ideas will grow and fester in the dark (say, on StormFront or whatever). It's OK to let them in the light every now and then so that we have an opportunity to educate those who might not have learned the lesson.

I dunno, I think it's pretty trivial to back into life expectancy and genetic risk factors from publicly available ancestry information combined with death certificates. We have ~200 years of pretty good records here in the US and many more if you go into Europe's records. From that data you can get a really good idea of longevity for a given person.

Ancestry.com even has a public tool for doing this at a high level: https://www.ancestry.com/name-origin?surname=trujillo

Seems the cats been out of the bag for a long time.

Maybe you shouldn't throw around 'dumb' quite so liberally.

Absolutely absurd argument.

Do you use toll roads? They're a business. Criminals and even "child rapists" use them too. Can't believe you would further their ability to move about our society and evade law enforcement by willfully funding the infrastructure they use.

Get over yourself with your absolutist nonsense.

13F filings are at best deceptive for a fund like medallion. That is, for any fund that is not primarily a net long equity fund, a 13F filing shows only a small subset of their position.

Medallion could hold any number of other positions in the form of derivatives etc. That are paired with or set against these common stock positions.

If you read or listen to Jim Simons he makes it pretty clear that Renaissance trades on relationships or trends and isn't particularly in the business of betting which individual stock is going to perform better than its peer group.

I don't think 13F filings are useful to understand their strategies.

It likely makes the scores​ higher on tests, though not necessarily because they've learned the material better.

Anecdotally, I've seen recent immigrant children struggling to understand user interfaces (that I would argue were poorly designed, not that it matters to anyone caught in the bureaucracy) that more computer literate kids "get" immediately. The struggles with UI, such as kids literally spending dozens of minutes trying to get to the next question, undoubtedly exhaust and frustrate them. One can only guesstimate the effect on test scores but it can't be positive.

More exposure to a variety​ of software/UIs seems to matter.

Journalists with a publicly verifiable track record who had a history of adversarial journalism. He chose them for their principles, not their charisma. It seems like you're grasping at straws here. How is an embedded contractor with high level security clearances supposed to get cozy with journalists? It's ludicrous.

Snowden watched what happened to Bill Binney and Thomas Drake and knew that the suggested whistleblowing path was a trap. Journalists were the second to last resort (the last being the wikileaks approach). The outcomes are evident. He was right. There is/was a problem and courts and commentators worldwide acknowledge that. Hell, even Obama acknowledged there were problems.

And on your last point: it turns out non-Americans have human rights too, something that Snowden would have no-doubt recognized after living in Switzerland. American exceptionalism bullshit is no excuse for crimes against humanity (i.e. mass surveillance).

These are uncharacteristically dumb comments from you.

I think part of the Sandra Bland story is the apparent escalation of the encounter BY the officer. Asking sarcastic, passive aggressive questions when you have the trust of the community and a gun at your waist is abusive. Its outrageous to many of us who watch the video and just juvenile bullying really.

Regarding your comments on the danger of policing, its somewhat fallacious--police work is generally safer than it's ever been and not any more dangerous than simply walking the streets in most U.S. cities. Im having a hard time pasting the link on mobile but Radley Balko has a number of articles on the subject in the Washington Post and Reason.

This is actually the case in at least one public example[1].

The U.S. Securities and Exchange Commission on Wednesday filed a lawsuit in federal court in Philadelphia against Bonan Huang and Nan Huang, saying the analysts used the nonpublic data to trade in the shares of consumer retail companies ahead of sales and earnings reports. The lawsuit said from November 2013 to January 2015, the two analysts, who had access to the data as fraud investigators, made hundreds, if not thousands, of keyword searches for sales data on at least 170 publicly traded companies. The SEC said the two employees were able to analyze the data to determine if a company's sales were increasing or decreasing on a periodic basis.

[1]http://www.reuters.com/article/2015/01/22/capital-one-fin-in...

I don't think the SPLC is really in the same league as the ACLU. SPLC is entirely politically motivated. The SPLC is famous for their "hate group" list. The problem is, a hate group is whatever the SPLC says it is. Their criteria are quite loose and their application of that criteria is quite loose as well. You won't find eco-terror and animal rights groups on the SPLC hate group list because it doesn't align with SPLC's political ideology. One might try to rationalize the hypocrisy by pointing out that the SPLC says it applies hate speech based on hate for "immutable characteristics" but SPLC seems fine to bend that rule to denounce anti-religious hate.

I hope anyone reading your comment and feeling generous donates to the ACLU instead of the SPLC.

I've always heard this called mosaic theory, not trade secrets. https://en.wikipedia.org/wiki/Mosaic_theory_%28investments%2...