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Just now, DEagle7 said:

If argue the opposite is true as well. How much can we pin on comorbidities when we operate in a dog crap healthcare system?  Well never know until we address one or the other. 

How are you making your determination other than incomplete data?  Must be anecdotal evidence. 

3 minutes ago, vikas83 said:

It's all about the scale -- most people have never heard of concierge doctors. My guy limited himself to 75 families in order to provide high quality care to people. But I have seen more and more doctors try and transition to it, at lower prices and with much larger client rosters. As the masses become aware of it, the whining will begin.

wow...what a bigshot! you can hire a team of fancy, concierge doctors but they still can't fix your face!

 

 

 

 

 

your face!!!  :roll: :roll:  

10 minutes ago, DEagle7 said:

What's obtuse is comparing the profit margins of a company that provides a essential need to average Joe's bait shop. It turns out when your company provides a service mandatory for the entire country you don't need 20% profit margins. And you can see that in the fact that United's gross profits have increased from about 20 billion in 2010 to about 90 billion in 2024. 

So spare me the nonsense about them going under of they actually had to pay for the stuff they're supposed to pay for. 

You need to stop asking a zebra to change its stripes. For profit companies with shareholders (public or private) will look to maximize returns for those shareholders. This is true of insurance companies, hospitals (the for profit ones) and physician groups. They aren't going to say "but this is an essential service, so we need to make less." It's the same as when that dullard AOC demanded Jamie Dimon agree that JPM wouldn't make loans to fossil fuel companies -- JPM is going to maximize profits. He should have told that moron -- "you're in Congress, pass a law making lending to fossil fuel companies illegal and we'll follow it."

The Democratic Party has pulled a magic trick where they get voters mad at corporations to cover for the politicians' failures to deliver on promises. Corporations aren't complicated -- they maximize shareholder value. If they don't, someone like me buys a block of stock, runs a proxy fight, takes over the board and fires management. If UNH decided to start making less money, or losing money, to approve more claims, the management would be ousted quickly. 

If we want HC treated as an essential good with no profit motivation, take it out of private hands and accept the outcomes.

8 minutes ago, Sack that QB said:

They're not "supposed to" pay for anything, they are not obligated to pay for everyone. And if their profit margin is 6%, I suppose you just don't want them to profit at all. I maintain your real issue is with the US healthcare system and not the insurance companies.

The are though. You sign a contract and pay and they still deny necessary medical coverage they should because they know they'll get away with it most of the time. 

And once again, a 6% profit margins is fine when you have 52 million members my guy. Comparing it to other businesses is just silly. 

1 minute ago, vikas83 said:

You need to stop asking a zebra to change its stripes. For profit companies with shareholders (public or private) will look to maximize returns for those shareholders. This is true of insurance companies, hospitals (the for profit ones) and physician groups. They aren't going to say "but this is an essential service, so we need to make less." It's the same as when that dullard AOC demanded Jamie Dimon agree that JPM wouldn't make loans to fossil fuel companies -- JPM is going to maximize profits. He should have told that moron -- "you're in Congress, pass a law making lending to fossil fuel companies illegal and we'll follow it."

The Democratic Party has pulled a magic trick where they get voters mad at corporations to cover for the politicians' failures to deliver on promises. Corporations aren't complicated -- they maximize shareholder value. If they don't, someone like me buys a block of stock, runs a proxy fight, takes over the board and fires management. If UNH decided to start making less money, or losing money, to approve more claims, the management would be ousted quickly. 

If we want HC treated as an essential good with no profit motivation, take it out of private hands and accept the outcomes.

Physician groups DO look at patient outcomes though. That's the disconnect. My ACO takes care of us sure but we draw the line at preventing people from getting care. That's the essential disconnect here. 

As I've said before I'm fine if we want to operate on a strict maximize profits model, but when it comes to essential health services there needs to be substantial oversight.  Everyone will **** but I don't care. 

11 minutes ago, BBE said:

How are you making your determination other than incomplete data?  Must be anecdotal evidence. 

The outcome data isn't anecdotal. Our price per capita isn't anecdotal. We also know how much certain risk factors increase mortality rates. We have a few percentage points higher than Canada and Europe in heart disease and diabetes. We're about 15% higher in obesity rates. Medically that shouldn't translate to a 3-8 fold increase in maternal mortality. It's very reasonable to accept there's more at play. 

12 minutes ago, DEagle7 said:

Physician groups DO look at patient outcomes though. That's the disconnect. My ACO takes care of us sure but we draw the line at preventing people from getting care. That's the essential disconnect here. 

As I've said before I'm fine if we want to operate on a strict maximize profits model, but when it comes to essential health services there needs to be substantial oversight.  Everyone will **** but I don't care. 

Who owns your group? Do the doctors themselves own it?

Groups that are owned by public shareholders, or private equity, are going to maximize returns.

1 minute ago, vikas83 said:

Who owns your group? Do the doctors themselves own it?

Groups that are owned by public shareholders, or private equity, are going to maximize returns.

Partially.

Then those groups should be regulated as well IMO. 

It was better when Doc Baker used to do house calls for a few eggs, maybe a whole chicken or 2 if things were bad.  Throw in a cup of coffee and piece of cake that Ma made and he would do a whole family checkup.  Those were the days.

26 minutes ago, DEagle7 said:

The outcome data isn't anecdotal. Our price per capita isn't anecdotal. We also know how much certain risk factors increase mortality rates. We have a few percentage points higher than Canada and Europe in heart disease and diabetes. We're about 15% higher in obesity rates. Medically that shouldn't translate to a 3-8 fold increase in maternal mortality. It's very reasonable to accept there's more at play. 

Actually the very comorbidities you mention do increase maternal/fetal mortality rates significantly.   

You are too devoted to making comparisons with incomparable data to support your view.  Nothing you have stated is supportable with reliable normalized data.  Look at the NHANES, the mortality rate increase tracks with the comorbities increasing.  But grrrr..evil insurance companies...

51 minutes ago, vikas83 said:

You need to stop asking a zebra to change its stripes. For profit companies with shareholders (public or private) will look to maximize returns for those shareholders. This is true of insurance companies, hospitals (the for profit ones) and physician groups. They aren't going to say "but this is an essential service, so we need to make less." It's the same as when that dullard AOC demanded Jamie Dimon agree that JPM wouldn't make loans to fossil fuel companies -- JPM is going to maximize profits. He should have told that moron -- "you're in Congress, pass a law making lending to fossil fuel companies illegal and we'll follow it."

The Democratic Party has pulled a magic trick where they get voters mad at corporations to cover for the politicians' failures to deliver on promises. Corporations aren't complicated -- they maximize shareholder value. If they don't, someone like me buys a block of stock, runs a proxy fight, takes over the board and fires management. If UNH decided to start making less money, or losing money, to approve more claims, the management would be ousted quickly. 

If we want HC treated as an essential good with no profit motivation, take it out of private hands and accept the outcomes.

I generally agree, except that we can also treat it like utilities - water, gas, electricity. We allow private utility companies to exist and operate on a for profit basis, but regulate them heavily on allowable profit margins, rate increases, etc. to keep costs reasonable and affordable for the general public. 

16 minutes ago, BBE said:

Actually the very comorbidities you mention do increase maternal/fetal mortality rates significantly.   

You are too devoted to making comparisons with incomparable data to support your view.  Nothing you have stated is supportable with reliable normalized data.  Look at the NHANES, the mortality rate increase tracks with the comorbities increasing.  But grrrr..evil insurance companies...

Of course they track and contribute to mortality. But not remotely on the scale you see when you compare to westernized nations.

You're clearly struggling so let me give you numbers. Obesity in pregnancy increases mortality rates by about a factor of 3-4. We have about a 17% difference in obesity rates compared to Germany and roughly 8x the rate of maternal death. About 8% difference and 4x the rate in the UK. 9% and 5x in Australia. Etc etc etc. 

The differences in diabetes and heart disease rates are significantly thinner too. The math simply doesn't add up. 

But grrrr... comorbidities amiright?

Again the data is NOT normalized.  You are comparing apples to oranges.  Nothing you cite normalizes for population differences and factors.  

 

16 minutes ago, Imp81318 said:

I generally agree, except that we can also treat it like utilities - water, gas, electricity. We allow private utility companies to exist and operate on a for profit basis, but regulate them heavily on allowable profit margins, rate increases, etc. to keep costs reasonable and affordable for the general public. 

Eh...those don't exactly work well. See PG&E bankruptcy.

EDIT: Also, no one has ever complained about the gas, electric or water bills to my knowledge...

 

6 hours ago, BBE said:

Again the data is NOT normalized.  You are comparing apples to oranges.  Nothing you cite normalizes for population differences and factors.  

And it never will be because we don't have America #2 we can give socialized medicine and see.  That doesn't mean there isn't anything that can be easily extrapolated by anyone with above a 3rd grade education. It's the same lame excuse we hear over and over again. "America is different so any comparison isn't perfect therefore it's all not worth arguing".  Infantile argument. 

What we do have is very robust data about how much obesity etc affect mortality. When we see a difference that is WAY higher than the predicted increased mortality rate compared to literally every westernized nation you'd be ignorant to pretend there isn't something else going on. 

23 minutes ago, DEagle7 said:

Of course they track and contribute to mortality. But not remotely on the scale you see when you compare to westernized nations.

You're clearly struggling so let me give you numbers. Obesity in pregnancy increases mortality rates by about a factor of 3-4. We have about a 17% difference in obesity rates compared to Germany and roughly 8x the rate of maternal death. About 8% difference and 4x the rate in the UK. 9% and 5x in Australia. Etc etc etc. 

The differences in diabetes and heart disease rates are significantly thinner too. The math simply doesn't add up. 

But grrrr... comorbidities amiright?

The overall % difference in obesity rate wouldn't tell the story though.  We'd need to look at the % difference in obesity rates among pregnant women.  Also we can't just look at 1 factor.  Not going to get to the answer using single variate analysis.  

2 minutes ago, DEagle7 said:

And it never will be because we don't have America #2 we can give socialized medicine and see.  That doesn't mean there isn't anything that can be easily extrapolated by anyone with above a 3rd grade education. It's the same lane excuse we hear over and over again. "America is different so any comparison isn't perfect therefore it's all not worth arguing".  Infantile argument. 

What we do have is very robust data about how much obesity etc affect mortality. When we see a difference that is WAY higher than the predicted increased mortality rate compared to literally every westernized nation you'd be ignorant to pretend there isn't something else going on. 

No, just possessing a better training in how population and confounding variables affect statistical comparisons.  You base all of your arguments on comparison to other westernized countries.   My argument is that you can't make accurate comparisons because of very different population demographics and comorbidities that are not normalized for.

 

For example, your obesity statistical comparison is total population and not in pregnant women or children, and yet you are convinced that obesity cannot be responsible for the observed increase.  And we haven't even gotten to two or more comorbidities, or race,...

7 minutes ago, Phillyterp85 said:

The overall % difference in obesity rate wouldn't tell the story though.  We'd need to look at the % difference in obesity rates among pregnant women.  Also we can't just look at 1 factor.  Not going to get to the answer using single variate analysis.  

You beat me to it.

16 minutes ago, Phillyterp85 said:

We'd need to look at the % difference in obesity rates among pregnant women.

EASY 100 THOSE ****ES R ALL FAT AF

18 minutes ago, Phillyterp85 said:

The overall % difference in obesity rate wouldn't tell the story though.  We'd need to look at the % difference in obesity rates among pregnant women.  Also we can't just look at 1 factor.  Not going to get to the answer using single variate analysis.  

 

11 minutes ago, BBE said:

No, just possessing a better training in how population and confounding variables affect statistical comparisons.  You base all of your arguments on comparison to other westernized countries.   My argument is that you can't make accurate comparisons because of very different population demographics and comorbidities that are not normalized for.

For example, your obesity statistical comparison is total population and not in pregnant women or children, and yet you are convinced that obesity cannot be responsible for the observed increase.  And we haven't even gotten to two or more comorbidities, or race,...

https://ijpds.org/article/view/2401

Looks like a 13% difference between the US and Europe. 10% for Australia. 

So go on. With those numbers and your "superior training", go ahead and show me how that percentage of a difference in a comorbidity that should increase mortality by 3-4x could possibly increase population mortality by as 8 fold. 

We can do heart disease and diabetes and race if you want but the margins are even slimmer there.  I'd accept we need multivariate analysis if we were even remotely close with the one factor that is significantly different in the US and the rest of the world, obesity, but we're not in the ballpark. You simply aren't getting those numbers from comorbidity differences alone. I went to med school but this is highschool math man. 

IMG_2331.jpeg

So I looked at some concierge docs in my area and it’s… surprisingly not expensive. 

5 minutes ago, DEagle7 said:

 

https://ijpds.org/article/view/2401

Looks like a 13% difference between the US and Europe. 10% for Australia. 

So go on. With those numbers and your "superior training", go ahead and show me how that percentage of a difference in a comorbidity that should increase mortality by 3-4x could possibly increase population mortality by as 8 fold. 

We can do heart disease and diabetes and race if you want but the margins are even slimmer there.  I'd accept we need multivariate analysis if we were even remotely close with the one factor that is significantly different in the US and the rest of the world, obesity, but we're not in the ballpark. You simply aren't getting those numbers from comorbidity differences alone. I went to med school but this is highschool math man. 

Did you just acknowledge the need for multivariate analysis while at the same time insisting you are right because you attended medical school? All while ignoring comments related to sample population. 

That is a new one...an appeal to self authority. 

 

It appears you are a practicing MD.  How much basic medical research have you done?

25 minutes ago, BBE said:

No, just possessing a better training in how population and confounding variables affect statistical comparisons.  You base all of your arguments on comparison to other westernized countries.   My argument is that you can't make accurate comparisons because of very different population demographics and comorbidities that are not normalized for.

 

For example, your obesity statistical comparison is total population and not in pregnant women or children, and yet you are convinced that obesity cannot be responsible for the observed increase.  And we haven't even gotten to two or more comorbidities, or race,...

Hey, I could get a good look at a t-bone by sticking my head up a bull’s a**, but I’d rather take the butcher’s word for it. 

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