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Comment Re: defense versus health and human services. (Score 1) 482

Easy answer: Because, due to a lack of regulation, we have the most expensive Health Care industry on the planet.

Umm, you do realize the US has one of the most heavily regulated healthcare industries in the entire world, right? Hell, our entire healthcare model (employer-provided healthcare + ACA) was pretty much designed by regulation (see below).

https://en.wikipedia.org/wiki/...

Following the second world war, President Harry Truman called for universal health care as a part of his Fair Deal in 1949 but strong opposition stopped that part of the Fair Deal.[14][15] However, in 1946 the National Mental Health Act was passed, as was the Hospital Survey and Construction Act, or Hill-Burton Act. In 1951 the IRS declared group premiums paid by employers as a tax-deductible business expense,[6] which solidified the third-party insurance companies' place as primary providers of access to health care in the United States.

Just because they're doing a pisspoor job regulating (for example, by focusing on giving people insurance instead of cost controls on healthcare) doesn't make the market unregulated. It just makes it regulated by morons.

Comment Re:Provide this at the state level (Score 1) 278

Like most "originalists" you think your interpretation of the constitution is the only one.

The Constitution isn't meant to be interpreted. Where the Constitution is unclear, judges look to precedent (historical rulings). Never were they meant to insert their own "modern spin", feelings, or interpretations. The biggest issue with the modern judicial age is literally a case of Slippery Slope fallacy, whereby one judge takes liberties with what the government is allowed to do and then 10 years later the next person grabs a little more freedom away based on the last precedent and then 10 years later there's another loss, ad infinitum until the federal govt has so much case law on the books that they literally have unlimited power.

An "originalist" is nothing more than someone who believes in law rather than gut feeling and sentiment.

The original authorities involved in crafting the constitution are no longer around. Instead, we have constitutional scholars and supreme court justices. They know a lot more than some angry internet dude yelling for less government until he loses something.

Sadly, that's very debatable. Obama was a freakin constitutional law professor and he routinely exceeds his allotted powers, the most egregious example being this: https://en.wikipedia.org/wiki/...

Additionally, there are Supreme Court justices that base some of their decisions on nothing related to the Constitution whatsoever. For instance, take the statement by Roberts here regarding a recent ACA case: The statutory scheme compels us to reject petitioners interpretation because it would destabilize the individual insurance market in any state with a federal exchange, and likely create the very death spirals that Congress designed the act to avoid, Roberts wrote.

He's literally stating, "This badly written law will fall apart if we revoke this unconstitutional part of it, therefore I will rule in its favor"

Here's another one (http://www.cnn.com/2016/06/27/politics/supreme-court-abortion-texas/): "When a State severely limits access to safe and legal procedures, women in desperate circumstances may resort to unlicensed rogue practitioners, faute de mieux, at great risk to their health and safety," she wrote.

That has nothing to do with whether or not something is legal/constitutional, so why is it even coming out of the mouth of a judge?

Want another one? Try Roe v Wade, where the Court literally invented a new fundamental right by quoting a right to privacy...that's right...your right of privacy is what gives you a Constitutional right to an abortion. That Court also pretty much choose to define life on their own, which is why we have the "third trimester" caveat.

In reality, what happens with court justices now is that prevailing public sentiment drives their actions moreso than the law. That's why Brown v. Buhman failed, yet Obergefell v. Hodges succeeded. Unless you can explain to me how we have a fundamental right to marry, but that right ends at exactly one person. Or say laws that prevent parent-child and brother-sister marriages -- again, if marriage is a fundamental right that shall not be infringed, why does the 14th Amendment only protect some cases (interracial, same-gender) whereas prohibiting others? It's clearly being determined via cultural fiat (namely, the "eww factor") rather than by law.

Comment Re:That can't be right (Score 1) 533

Btw, I should add that nowhere else in our free market does such a convoluted system exist. Mechanics, maids, plumbers, electricians...you name the service. Their prices are either advertised upfront, or you can get a quote prior to receiving services. If said prices are too high, you can shop other companies. Healthcare is the only industry where you have no F'in clue what you're going to pay until you get the bill and you're locked into a very specific network because your employer AND your insurance company control your market access.

Comment Re:That can't be right (Score 1) 533

The insurance market is selling insurance to individuals. The healthcare market is selling healthcare to patients.

Except it's not. The patients receive the healthcare, but they don't pay for it, nor do they choose 100% of it...the insurance companies do. Imagine you're buying a car where your choice of car was limited to "SUV, compact, or limo". You pick the category and then your employer chooses who will provide your car insurance and that insurance company selects your exact car brand. The car manufacturer then determines what options you will have on your vehicle. If you don't want that brand car or those car options, find another job. Should your employer pick a shitty or expensive insurance option, you're fuck-all out of luck. Should the manufacturer pick car options that are ludicrously expensive, both you and the insurance company are fuck-all out of luck. That's roughly analogous to the situation to healthcare.

The patients are paying healthcare providers to act as effective negotiators for them, and backing them with their patronage.

They are in fact not doing this. Patients with insurance pay next to nothing to healthcare providers. The bulk of the money always comes from insurance. Additionally, people don't choose their patronage to healthcare providers based on negotiating ability. They choose it based on doctor familiarity and history (or specialists by reference or reputation), often set from an early age (my primary doctor hasn't changed in decades, nor would I want him to). And again the consumer is rarely even choosing their insurance -- their employer is. And what they pay is completely hidden from the consumer as well...it's just another cost to the company. So they could just as easily offer you a salary 10k lower than you would normally have to account for your additional healthcare expense and not spend any time whatsoever shopping for a better deal, thereby leaving you with the option of shopping for a new job to get affordable healthcare (if you even manage to realize you're being underpaid)

Remember the lie "if you like your insurance/doctor, you can keep it"? ACA forced a change in my insurance, which my current doctor was NOT an "in-network" member of. It's a perfect example of the lack of consumer choice in this market. I wanted my doctor. I could not have him, namely because I am not the one in control of my healthcare choices.

Do you believe it's a sane healthcare system for me to basically have to find a new job to be able to keep my doctor? In the current system, true costs of healthcare are hidden from insurance companies since rates are negotiated. Then true costs of insurance are hidden from the consumer, since employers bundle the cost into your salary. Wanna see what's stagnated middle class salaries for the past decade? Look no farther than healthcare.

So what? Nearly half of all providers are out of my care network. They're excluded from my healthcare options because they cost me three to ten times as much. If the hospitals, doctors, psychiatrists, and pharmacies wanted my business, they should have signed on with CareFirst's BlueChoice PPO network and CVS Caremark's Pharmacy Benefits Manager

You're acting like the "in-network" concept is some kind of insta-win. My new insurance is costing me WAY more than I ever paid in the past with my old insurance (on the order of double or triple). So I challenge that assertion. And I had BlueChoice insurance. It's what I was forced to drop because they didn't cover my doctor. Now I'm on my wife's insurance with UnitedHealthcare, another shitshow. Apparently all their bloodwork has to be done at in-network Labcorp and there's no coordination between healthcare providers and health insurance providers to make this happen. So last time when I went to the doctor for bloodwork, despite the fact the nurse drawing my blood being covered by my insurance, they shipped if off to "their labwork provider of choice", which my insurance promptly refused to cover since it wasn't LabCorp.

To get costs down, you must get the healthcare providers to lower their prices

And your plan for this in the current system is what exactly? You're acting like insurance companies and "in-network" concepts are the solution, whereas I don't see them doing a damn thing about costs.

You can only disconnect competition from the healthcare insurance market by ignoring half of the stuff actually going on

That's only true because you've accepted a system where health insurance pays for 100% of your healthcare and you trust your employers and the associated insurance companies to be "trusted stewards" of cost savings. If insurance actually behaved like insurance and left healthcare in the hands of the consumer (like it should), the disconnect wouldn't seem as weird to you. I've never been in an accident that would require an expensive operation, nor had any expensive chronic illness spring up that would require very expensive drugs. I shouldn't have had to invoke my medical insurance at all over the course of my life, yet I can't even get a routine checkup without going through them unless I'm willing to pay the "no-insurance $1000 rate".

If a hospital is spending $63,000 to provide care and charging $58,000 for that care, it goes out of business. Period.

Yes, and if that same hospital could provide that same care for $48,000, but continued to spend $63,000 because apathy/inertia/laziness/incompetence/take-your-pick, your healthcare and consequently your health insurance will be ludicrously expensive and you'll never know why. Where's the stick/carrot that encourages the healthcare providers to operate efficiently? I don't see one. They're certainly not wanting for patients...our healthcare demand outstrips our supply (and likely always will) and their audiences are captive unless they have remarkable job mobility.

Comment Re:That can't be right (Score 1) 533

You mean the competition among insurers for customers, and the competition among health care providers for access to large insurer provider networks? The things that can make or break your business

Again, you're focused on insurance market competition and not on healthcare competition. And health insurers have little reason to push lower the cost of healthcare itself. ACA has guaranteed their profit to be capped to a percentage of premiums. So they have a vested interest to keep premiums high. They also have very little reason to worry about competition since health markets tend to be very regional, they don't have to worry about competition across state lines, and lock-in among big business is fairly high (you only see a great deal of turnover in insurance policy in smaller business since the search & implementation process for new insurance carries a great deal of cost itself).

So despite businesses having substantial motivation to achieve lower premiums, they don't have the carrot or the stick to force that change in the actual healthcare market.

The rest of that $80,000 hospital bill... $75k of it was cost. You paid $5k of it into business profits ... Now tell me what in the hell causes all those costs

It's easy to find that answer. Find out why the hospital down the street can do it for 50% the cost. I couldn't tell you what the actual reason is, since these numbers aren't even remotely transparent to consumers. And if I had to wager a guess, I'd say it could be anything from creative bookkeeping (to be able to make use of those additional dollars while not reporting it as a profit) to inefficiency (extra/extraneous tests, too long hospital stays, brand drugs over generic, etc, etc), salary differences among nurses/doctors, etc. Honestly, it could be just about anything. And you'll never know exactly what is causing it until you shine the spotlight on healthcare instead of insurance. Expecting insurance companies to take aggressive steps towards solving this mystery and finding cost savings is a major mistake. They don't have the motivation to do so.

Maximized competition and whatever else can't push prices down below those actual costs, else the hospitals and medical companies go out of business.

You don't know that. There are many companies that operate on a tight profit margin that have managed to make their operations more efficient when forced to (just look at all the energy companies out there that have managed to make leaps and bounds in well efficiency after oil & natural gas prices tanked, something that wasn't even on their radar when they were making a profit). Companies need a motivation driver to encourage that change. So long as hospitals aren't losing money, they also have no motivation to find cost-savings. They aren't competing with surrounding hospitals...they already have a captive consumer market (namely, everyone in their favored provider's insurance networks). I'm surprised you just assume these guys are running a trim operation. I've come to expect waste and bloat where there isn't any compelling reason to make it otherwise. These hospitals could have double the ambulances they need, excess nurse staff sitting around twiddling their fingers, zero effort to negotiate lower salaries with their doctors, zero effort to comparison shop for better equipment/drug deals. There could be tons of fat to trim. Who knows until you actually put some pressure on them?

Comment Re:That can't be right (Score 1) 533

Actual medical service is often cheap elsewhere. This I don't understand

This is because you're focused on insurance and "negotiated rates" instead of actuals

such as with doctors's offices charging $300, charging insurers a negotiated $30, and charging uninsured patients $10; but also with million-dollar surgeries turning into an $80,000 bill by some magic.

Here you see the problem. The numbers at their origin are completely wonky, almost equivalent to throwing darts at a dartboard. No one is shining the spotlight at the costs of healthcare itself because they're too focused on the insurance side of things. Insurance hides true cost pictures, because through an insurer, things are negotiated in a completely unpredictable way (see your ~$2 blood-work example, your $300 -> $30 doctor example, and your million dollars -> 80k example)...it's not "magic" that causes this complete crapshoot of prices...it's the lack of a competitive market. There is no "invisible hand" in the healthcare industry where supply/demand/cost balances itself...nobody is making a cost-risk or cost-reward analysis -- instead healthcare providers and insurance companies come up with fairly arbitrary numbers. Consumers rarely if ever see true prices and have little no ability to find more affordable healthcare deals since insurance locks us into a very limited network of providers. You're literally at the mercy of your insurance company. And if they decide they're not willing to cover your needed drug, well you're SOL, because the non-negotiated rate is a billion dollars.

Competition is precisely what we have.

No, a bunch of "car salesmen" negotiating behind my back my healthcare costs with god-knows-who is not competition. "Competition" means true costs are exposed (not "negotiated rates") and consumers have the freedom and mobility of choice to pick one doctor or hospital over another based on known rates. It's the kind of transparency and competition that would prevent a bunch of people from trying to sell an EpiPen for 10 billion dollars when another company can do the same exact thing for 10 dollars.

Solve the market problem and you solve healthcare costs. But as long as you have a bunch of middle men working behind the scenes to hide costs from you (and a govt focused on ignoring cost and merely spreading the higher cost burden onto the rich and healthy), you'll never solve the problem.

Comment Re:Step 1: Ignore the mouth (Score 1) 559

There's a fact about Trump that's growing ever more apparent: his mouth is nearly useless. Only his actions matter (and they've yet to unfold).

This is true of all politicians. Or did you actually believe Obama when he told you he wanted to eliminate the Patriot Act? (after voting to extend it as a senator)

Comment Re:haha - Russian government is so ignorant (Score 1) 44

They are nowhere near stupid.

They don't want to reliably deny Russian citizens access to some specific sites (why would a sane government ever want that?).

They want to be able to quickly suppress any protest rally on the internet when the hour comes (if it comes at all). To achieve that, they don't need to patch all the holes; it's enough to know where holes are. Should the hour come, all sites used for hosting protestant communication will be shut down "due to technical reasons" (if not completely legally by that time - new legislation is being passed all the time) and all proxy IPs will be banned on ISP level.

This means that one needs to block sites which few technically savvy people need badly, but which are not crucial to the general public. Such tactic reveals proxy/vpn endpoints and other evasion methods without causing an uproar. Which they did twice to github (re-allowing it back both times), and which they seem to be doing to linkedin now.

Comment "Just" put "some" servers in Russia (Score 1) 44

How is this law impossible to comply with? Put some servers in Russia. That's it.

It's not that easy in practice. For instance, one can run a fairly big site on MySQL, but if there's requirement to put part of the storage in a specific place, the choice is limited:

1. Rewrite the software to handle distributed database;
2. Run a totally separate entity in Russia (same logo, same software and nothing much else in common);
3. Move ALL data storage to Russia.

In theory, a common database with master-master replication is possible, but that's not actually compliant with the law because Russian citizens' data gets stored abroad in the end.

For giants like Google and Facebook who already use distributed custom databases that's peanuts. For a (say) low-cost airline, not so much.

Comment Not a big deal (Score 1) 44

There are hh.ru and moikrug.ru (which effectively mirrors linkedin's functionality) for those looking for a job in Russia. I bet there's a party at both offices! (Well, given the time difference, they should be already drunk).

However, the trend is disturbing. Roskomnazgul is taking on larger and larger targets. If they get an uproar, they fall back immediately (like with github and wikipedia). If there's no uproar, they move on. One bit at a time.

Comment Re:Hmmm well (Score 1) 2837

Yeah, they can't reverse shit without getting a few Democrats in the Senate to go along. Please look up 'cloture'.

You know, that thing that Democrats were crying about from 2010 until 2016? It's now their best friend.

I think you'll be surprised to find out how much stuff Obama passed by Executive Orders (43 changes to ACA alone). That stuff can be undone with a snap of the fingers. And there are many other games to be played within our strange legal system as well. Look up reconciliation...that's the only way ACA got passed in the first place. It bypasses cloture, and can be used to repeal major parts of ACA.

Comment Saving the world halfway through doesn't count (Score 1) 167

I wouldn't be so skeptical. Things like this happen (happened to me, too). However, the "interns saving the world" cry wolves far too often, while lacking the confidence or knowledge to break the news straight to the right people (the devs in GP's case). And as one gets older, it's easier to remember the times when you were right :)

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