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Rational Responses to an Irrational System
ObamaCare is not proving to be the boon insurance companies expected (I know, I know; the poor dears). Via Megan McArdle, one of the many causes is that a number of health providers have figured out some very clever ways to game the system:
This weekend brought a new suggestion across my desk. At Forbes, Bruce Japsen writes that insurers think providers are funding nonprofits to pay Obamacare premiums for high-cost Medicaid patients, thus sticking insurers with a lot of big bills for a lot of very sick patients.
Why would they do this, you may be asking yourself? Because Medicaid reimbursements are extremely low. If you have a patient who is consuming tens of thousands of dollars a year worth of care, reimbursed at the rock-bottom rates that Medicaid permits, then it may well make financial sense for you to pay the premiums to switch that patient onto private insurance, where your services will be reimbursed at much higher rates. Since insurers are no longer allowed to charge sick people more for insurance, the insurers have to take them — and then pay their enormous bills. And since, needless to say, this only makes financial sense for patients who are extremely sick, that will have the effect of skewing the Obamacare risk pool in a very expensive direction.
Undoubtedly, the fix will be to regulate such “charities” out of existence. And, equally undoubtedly, people will respond by finding some new loophole — likely even less-efficient than this one — that will work until it’s closed by yet more state intervention; that’s just what we do. Baring a medical or political miracle, the process will continue until the money runs out and people start dying of preventable disease. It’s like climbing a ladder in free-fall: Each step is rational, but merely delays the inevitable by an instant while our downward speed increases massively due to gravity.
There might be an opportunity after the crash, but no one should look forward to getting there.
Published in Healthcare
So you mean every presidential candidate ever?
We’re gonna have the best healthcare, nobody dying in the streets. Heck, nobody even dying, except whoever the 2nd Amendment guys take care of.
Nice thought, but tar, feathers and rail are more traditional in American politics and less limited by geography. All you need is a feather pillow, a 4×4 or 4×6, hot tar or in a pinch a bucket of roof cement and a mob and you’re set.
The position of the center of mass of the system, “you-plus-ladder”, doesn’t change from what it would’ve been, but don’t you shift slightly higher than the unchanged position of center of mass?
This thread is taking a weird and awesome turn.
Ironic “like”.
If you threw the ladder downward, that would delay the inevitable for an instant. Climbing the ladder without throwing it would not.
(On the other hand, one could argue that putting the ladder between yourself and the ground would mean that upon impact you hit the ladder first, thereby slowing you down very slightly. Also, ouch.)
OntheleftC,
Ahhh, a traditionalist.
Regards,
Jim
As long as we’re quibbling, it’s Tom who is right. Climbing a ladder in free-fall makes no difference in the free fall of the mass center of you-plus-ladder, but it does place you higher relative to that mass center and ever so slightly delays your impact.
Edit: I see @owenfindy has beat me to the punch.
The allegory has been perfectly expanded to illustrate bi-partisan compromise as well as legislative futility.
Well done, folks! Take the rest of the day off.
I am redeemed!
Hey, I basically conceded that same point in #38, though I phrased it differently. And more satirically. Which is the most important thing, really.
The thread, however, is still lost.
Didn’t read that way to me:
There’s no difference between climbing the ladder or throwing it down in this example – in both cases you’re exerting a downward force on the object. So climbing the ladder also delays impact.
I think it goes much deeper than that.
Take the healthcare example. The fundamental truth is that it is simply impossible to have the type of healthcare system we say we want: namely, one in which nobody is refused care due to a lack of money. It doesn’t matter if we have single payer or free-market-plus-lots-of-charity – there will always be people “dying in the streets” because resources are scarce.
The left tends to just ignore this truth by pretending we can outsmart reality.
But on the right, there is enough intellectual honesty to paper over this reality, but not enough courage to admit that even in a time of relative prosperity, we cannot achieve our desired outcomes.
So the problem on the right is not that we are trying to fight the left’s irrationality with reason, but that we are ourselves being irrational by refusing to admit that we our objectives are impossible to reach.
Or left. Or right. Or left. Or …
I think the difference would be that throwing the ladder downward gives you and the ladder a relative separation velocity, whereas climbing to a higher rung and stopping there keeps you together with the ladder at the same velocity, just in a different relative position. Both delay your death but they are not exactly equivalent.
Of course conservation of momentum says that you could theoretically, if you throw the ladder hard enough, put yourself on a hyperbolic escape orbit and you’d literally never have to worry about hitting the ground again for the rest of your life — and afterlife. On the other hand you might be injured as you’re scorched to a crisp and disintegrated into a plasma by aerodynamic heating at roughly Mach 32 with over 10,000 psi of dynamic pressure. Even in the unlikely event if you survive that you’d soon be delivered — permanently — into the hard vacuum of space, which is bad for your lung tissue among other things.
No, meatbag, the bit between the parentheses!
Agreed. But the only parameter of interest in this discussion was “delaying death”.
I see we as the collective cannot let this one go.
You will be assimilated.
I’m not being disagreeable. You’re being disagreeable!
@owenfindy hi5s @markwilson
I know lotsa integrals. I have a good brain.
:rofl: Sprayed my highball all over my laptop and my M1911.
I could write a lengthy article on the member feed to explain why it’s all going under but I did that already. It’s all going to go under anyway. Many will suffer in all areas of healthcare but mostly the patients. There is no free lunch.
Doc,
With a vengeance.
Regards,
Jim
Excuse me, Dr, but is there some sort of concierge service arrangement that I can make for when this happens?
I’m full and burning out but yes you can find you someone. For now cash will get you somewhere. Our bizzarro world pricing system and lunacy in all aspects of medicine (Insurance, pharma, hospital, ancillary services like PT & respiratory care, doctors, patients,lab companies, lawyers) are responsible for the demise.
I’d rather have cash only and charity but alas we are headed to nationalized care and rationing. Australia does it OK, we just need to remove the greed and teach US citizens to adjust instead of expecting the healthcare system to ‘do everything’.
I think I was quoted 15K per patient per year just for concierge service, actual procedures are at cost.