Which affects Black Americans more: Discrimination or the Welfare State?
#41
(12-02-2018, 02:05 AM)Blackin17 Wrote: Physicians actually do have a measure for knowing what to charge. Medicare already does the homework on pretty much each and every procedure code that can be billed by a provider. Medicare takes into account the locality (region), and has a global conversion factor that are both applied to 3 areas (work involved, practice expense, and malpractice insurance). You should see the malpractice numbers for CA and NY, far higher than other localities! Through this formula, Medicare comes up with an allowable that is used as the basic standard on what the physician should receive for the procedure. Often the physician has a contract with an insurance company (or network) which pays him a percent of Medicare, usually above. They do know what they charge and what they will receive from each entity with which he/she has contracted.

I will agree that insurance companies are one of the biggest problems. There are some insurance companies that do not pass the entire discount to the patient/customer and take a percentage as profit.  For example, an insurance company may have a contract with a hospital that pays the hospital 40% of the billed charges (60% discount), yet they only tell your employer of a 50% discount (the employer doesn't specifically know this, they usually just know how a network compares with other ones for their own sample of medical claims). On a $100,000 medical claim, they've just made $10,000. This is on top of network access fees and insurance fees. As the big insurance companies have become more powerful, they have bullied or bought out the lower competition, so that 3-4 companies control a market, and put pressure on providers for deeper discounts, which they give because they are concerned about where they patients are going to come from. Hospitals, in turn are increasing costs to combat the discounts. It's a bad cycle and the winners are the big insurance companies.

I do understand that insurance companies have to deal with populations with high risks due to obesity, and other bad behaviors including that a lot of people don't see a doctor until they are really sick. Men typically don't utilize preventative care like they should. And people shouldn't be able to wait to get insurance when they get sick. If we eliminated or reduced the contractual discounts, the hospitals could charge less, and collect closer to what they charge for.  The cost of insurance would at least stabilize and possibly go down if the focus was on health CARE. One simple law. That insurance companies cannot pay a hospital less than their charge master (no discounts) would immediately allow hospitals to charge a lot less. And hospital claims make up nearly 70% of all medical costs.

The government has no place in the risk taking health insurance business. The have no business subsidizing the current insurance market. The cost of the risk is just passed on to us, without any incentive to mitigate the risk. There are free market solutions on this that might involve some government regulation, but these same insurance companies have powerful friends in the government in both parties, that ensure that our politicians will protect the insurance companies. I prefer a system that gives us as much freedom as is possible, not one that allows us to be controlled.


My comment re the insurance companies' takeover of the payment system (and I consider Medicare insurance, just with the government as underwriter) wasn't just the idea that the companies might be corrupt, but the opacity of the system between every set of hands that money should be flowing through.

Because of the way things are organized, everyone concerned feels like they're not spending their money. It's all someone else's money to them.

The average customer only knows or cares about the copay. I wasn't saying doctors have no way of knowing what they charge, just that most don't know because they also don't care - they know how much money they make per procedure and that's all that matters to them (now the accounting department would be a different story). The insurance companies don't feel like they're working with their own money, they just know they need to adjust premiums if their margin isn't met. 

The end result of all this is waste at every level. Eventually it carries over to vendors, too. This is a completely true story:

The Biomed department of a hospital contracted my company to put cameras above the operating table in every OR with a central monitor where they could have interns observe procedures for teaching purposes. After getting the specs they needed for the monitor, I called Dell (the only company the hospital system would use - another bullshit problem). I told the friendly lady I wasn't sure if I needed to talk directly to sales or someone in a more technical department because I need to determine what the various models were capable of to decide which to buy.

Sometime during this conversation, I happened to mention that the monitor was for a hospital and she immediately said, "Oh, a hospital! I'll just transfer  you to our medical sales department. After hashing out the model I needed with the medical sales guy, I got a quote of around 5 grand for the monitor. I thanked him and told him I'd get back to him after getting approval from the hospital. 

I then hung up the phone and hit redial. I asked for sales and gave them the model # I'd just picked with the guy from medical sales. The quote for the monitor from the non-medical sales dept was under a grand. 
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There are 2 things I can think of that would dramatically lower the cost of health care:

First, health insurance should protect from catastrophic loss, not routine health care. Think about car insurance, can you imagine how much the insurance would cost if you put in a claim every time you needed the oil changed or tires rotated? Can you imagine how much an oil change would cost after a few years of this? That's where medical procedures are right now. Making people responsible for non-catastrophic medical bills would make the whole process transparent and encourage competition, lowering prices.

Second, there should probably be some limit on the margin companies can charge for procedures and meds. Naturally, companies should be able to sell their products and services at a profit, but lifesaving meds and procedures being jacked up thousands of percent are not something I'd personally be angry to see some regulation on.
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#42
(12-02-2018, 12:50 AM)Blackin17 Wrote: Here's the thing on "gay" marriage. I mentioned that I am more moderate on social issues, somewhat libertarian, the mindset being that you should be allowed to do what you want, provided you are not harming others or putting others in danger. When it comes to LGBT stuff, I'm going to follow whatever the law allows for and I'm always going to treat people with respect (always have in my adult life). That said, I do believe that more people are choosing the sexuality they desire, than are being "born that way".  That's ok because in so choosing, they aren't harming anyone. I don't really care what people do in their own bedrooms (it shouldn't be something I even dwell on, even with straight couples), provided it doesn't involve things which do harm people such as pedophilia or abuse.  Secondly, while I do accept the law on gay people marrying, I do not believe that it rises to the level of a sacrament. I am entitled to my religious views on this. Some may still look at this as not fully recognizing the marriage, but my religious views are my private matter and exist within that community, but they don't override my public behavior which entails the basic respect for others in our secular society. That said, some of the public activism does bother me. Most people don't care anymore. I've worked with "gay" people, encounter them in daily life, but like everyone else, I'm judging them by the expectations such as "Are they good at their job", "Did they make a good mocha?", "Are they a good music teacher?", etc.

I think you'd find that most of the people like me feel the very same way, maybe with some religious differences. I think we have been highly misrepresented by the media and the left as intolerant. But that's all about identity politics, and the desire for power and control. We have to be perceived as the enemy, the same way we need to be identified as racists. Neither is really true. And a lot of us are simply tired of it and we're not going to accept those labels.

I'd like to say that gay people are 100% welcome in any group in which I associate, but I'd want you (not require you) to respect my views on the sacrament thing. That could still be a sticking point with some people, but it shouldn't be. I'm not saying to these people that God hates them. Admittedly, the sacrament stance is hard to defend without relegating gay marriage to secondary status.  What should matter however is that IS recognized by the state and I'm accepting on that. A gay marriage is granted the same status as mine by the state, with whatever legal benefits that might entail.

I understand. S'all good.
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#43
(12-02-2018, 12:13 AM)sam12six Wrote: Yes, there's some shaky ground when you're talking about a relationship where someone has direct authority (or perceived authority) over another. If Trump had said his secretary lets him grab her by the pussy... yeeaah, that's probably not a good thing for him to know if it were true, or even to say if it wasn't. If he said random beautiful women he meets let him grab them by the pussy (which he did), I don't see the issue. 

I'm talking about Whores, people!!
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You're right, a certain level of concurrence can be taken as evidence of causality. That doesn't apply in this case because every other period of climate change but the current one occurred without needing people to blame. So it's like one guy out of dozens (or hundreds, depends on how you want to chop up time) who got cancer chewed gum every day. You can totally say you believe the gum contributed to his cancer and I'll take it under advisement. If you want to make it illegal or make me pay a special tax for chewing gum, I'm gonna want to see where you (and others like you) are getting consistent results in your measurements and experiments. 

Don't misunderstand what I'm saying. I'm not saying the climate isn't changing. I'm not saying people aren't affecting (or aren't the driving force behind) it. If you suggest making an effort to live in environmentally friendly manner, I'll agree and tell you that's what I'm doing. If you're going to tell me I should give somebody money because climate change, though, I'm gonna want to see some numbers proving whatever the money's going for will have a positive effect.

Bottom line: If you tell me I should put in on a giant government algae farm to process a massive amount of CO2 out of the atmosphere, I'm willing to talk. If you say we should create a derivative market that'll make everything more expensive for me, put my country at a competitive disadvantage versus any country that chooses not to participate and needs Al Gore running it to save the world. I'm probably just going to say fuck Al Gore, and you too unless you can come up with extensive real data showing how that will help anything but Al's bank account.

Well, again, we have more context though. We know Trump favors models, actresses and porn stars, and he's admitted to a lot of stuff, as well as there being allegations:

He's said this among other things:

https://www.cnn.com/2016/10/08/politics/...index.html

Co-host Robin Quivers then asked Trump if sleeping with the contestants could be construed as a conflict of interest.

"It could be a conflict of interest," Trump said. "But, you know, it's the kind of thing you worry about later, you tend to think about the conflict a little bit later on."



"Well, I'll tell you the funniest is that before a show, I'll go backstage and everyone's getting dressed, and everything else, and you know, no men are anywhere, and I'm allowed to go in because I'm the owner of the pageant and therefore I'm inspecting it," Trump said. "You know, I'm inspecting because I want to make sure that everything is good."

"You know, the dresses. 'Is everyone okay?' You know, they're standing there with no clothes. 'Is everybody okay?' And you see these incredible looking women, and so, I sort of get away with things like that. But no, I've been very good," he added.

////////////////////////////////////////////////////////////

Scientists have conjectures that reducing CO2 emissions can (or could have) prevented a total 1.5 degree Celsius net increase, which is basically the limit before things get drastic. Sure, if it could be done some other way that's fine. But eventually, humanity will have to find new sources for energy/fuel regardless. Certain things do more harm than good as well, and while even I don't want to let go of certain things there really isn't much time left. I honestly don't have too much more to say about this. I care less about the how, but there are still plenty of climate change deniers who state your points, but as way to completely blow off climate change.
///////////////////////////////////////////////////////////

Upon looking into it, why is there such a difference between the costs of health care in the U.S. and its peers? I don't know how the government would do it without some form of socialism or regulation, but this definitely is a problem. It shows that there's blatantly overblown prices for the sake of sheer profit.  I understand wanting to make off of something, but it's still absurd. And people complain about government's budget, but we still by FAR spend way more on the military just to play grab ass in other countries. Maybe some of that guap should got to some form of health care reform or reducing the costs of things. 
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#44
(12-02-2018, 03:21 PM)Spops53190 Wrote: He's said this among other things:

https://www.cnn.com/2016/10/08/politics/...index.html

Co-host Robin Quivers then asked Trump if sleeping with the contestants could be construed as a conflict of interest.

"It could be a conflict of interest," Trump said. "But, you know, it's the kind of thing you worry about later, you tend to think about the conflict a little bit later on."



"Well, I'll tell you the funniest is that before a show, I'll go backstage and everyone's getting dressed, and everything else, and you know, no men are anywhere, and I'm allowed to go in because I'm the owner of the pageant and therefore I'm inspecting it," Trump said. "You know, I'm inspecting because I want to make sure that everything is good."

"You know, the dresses. 'Is everyone okay?' You know, they're standing there with no clothes. 'Is everybody okay?' And you see these incredible looking women, and so, I sort of get away with things like that. But no, I've been very good," he added.

////////////////////////////////////////////////////////////

Scientists have conjectures that reducing CO2 emissions can (or could have) prevented a total 1.5 degree Celsius net increase, which is basically the limit before things get drastic. Sure, if it could be done some other way that's fine. But eventually, humanity will have to find new sources for energy/fuel regardless. Certain things do more harm than good as well, and while even I don't want to let go of certain things there really isn't much time left. I honestly don't have too much more to say about this. I care less about the how, but there are still plenty of climate change deniers who state your points, but as way to completely blow off climate change.
///////////////////////////////////////////////////////////

Upon looking into it, why is there such a difference between the costs of health care in the U.S. and its peers? I don't know how the government would do it without some form of socialism or regulation, but this definitely is a problem. It shows that there's blatantly overblown prices for the sake of sheer profit.  I understand wanting to make off of something, but it's still absurd. And people complain about government's budget, but we still by FAR spend way more on the military just to play grab ass in other countries. Maybe some of that guap should got to some form of health care reform or reducing the costs of things. 



As far as people having sex with powerful people being wrong, there's the classic carrot and stick model. If it's your boss who propositions you, the stick (hurting your career) is implied. That's what makes it wrong (or on morally shaky ground) for me. On the other hand, if it's someone wanting a bite of carrot, I don't have an issue with both sides getting what they're looking for from the interaction. 

There are people out there (the majority of people who self identify as feminist and are under 30 years old) who are willing to call any interaction with a woman misogyny at their discretion. They don't like Trump, he's a misogynist. They liked Clinton, he just loved women. Looking at all those interview snippets you linked, I wouldn't suggest that Trump would be a good celibacy counselor, but I don't judge him like he's a criminal, either.
-----------

You're right, I've heard some people say similar things in the course of denying that humans are affecting climate change. That's the thing with the world today, no one's willing to be in the middle or accept that someone else is in the middle. Because of this, they never think, "Hmmm, this person has an opinion that is almost like mine with some minor differences.", and instead can only think, "This person is the enemy. Fuck listening to the enemy!!"

The fact, like it or not, is that due to how incredibly complicated climate modeling is and the relatively short period we've been collecting data (a couple of hundred years out of the billions the Earth has been around), we can't say very much in a definitive manner. Everything credible scientists say about the human effect on climate change is full of maybe, probably and strongly suggests.

Even if the most sky is falling interpretation is true, though. I still don't think anyone anyone should be collecting money for a climate change fund until they've shown through some successful experimentation data that they can use the money to make a positive change.

-------

There are two workable modern models to pay for health care:
1) The government pays for everything out of taxes
2) The government pays for nothing and people are responsible for their own health care

What we have in the US is sort of the worst aspects of either system bastardized into a hot mess. 

Because insurance is used to cover even the smallest medical expenses, we get the problems of single payer where costs go up constantly because everyone involved feels like they're spending someone else's money (the only way to offset this is to restrict service, a point we haven't quite reached in the US because there's still blood that hasn't been squeezed out of the middle class). It's actually worse than single payer because the insurance companies are profit driven and are going to do things like raise premiums or deny as many claims as possible to protect their profit.

In all but elite private clinics and such, we also have the negative things that come with privatized health care - like doctors rushing through their diagnosis to get to the next patient because they get paid per consult or doctors recommending meds that are not the best for the patient, but whose manufacturers do offer them a kickback. 

My personal opinion is that we should have people be responsible for their own routine health care, with insurance only covering catastrophic costs (like major surgery or long term care). If the government wants to pay health care for some of the populous, OK. What it should do is point a gun between the eyes of all medical suppliers and say, "The guys we're paying for... yeah, you don't get to make a thousand percent profit. We're limiting you to 30 percent (or whatever number)."

I know that last bit would make your typical Republican or Libertarian grab his chest and keel over, but that's why I don't think the labels fit me. I believe the government should stay out of day-to-day management of people's affairs, but should set limits to keep everyone running in the same lane.
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#45
(12-02-2018, 04:35 PM)sam12six Wrote:
(12-02-2018, 03:21 PM)Spops53190 Wrote: He's said this among other things:

https://www.cnn.com/2016/10/08/politics/...index.html

Co-host Robin Quivers then asked Trump if sleeping with the contestants could be construed as a conflict of interest.

"It could be a conflict of interest," Trump said. "But, you know, it's the kind of thing you worry about later, you tend to think about the conflict a little bit later on."



"Well, I'll tell you the funniest is that before a show, I'll go backstage and everyone's getting dressed, and everything else, and you know, no men are anywhere, and I'm allowed to go in because I'm the owner of the pageant and therefore I'm inspecting it," Trump said. "You know, I'm inspecting because I want to make sure that everything is good."

"You know, the dresses. 'Is everyone okay?' You know, they're standing there with no clothes. 'Is everybody okay?' And you see these incredible looking women, and so, I sort of get away with things like that. But no, I've been very good," he added.

////////////////////////////////////////////////////////////

Scientists have conjectures that reducing CO2 emissions can (or could have) prevented a total 1.5 degree Celsius net increase, which is basically the limit before things get drastic. Sure, if it could be done some other way that's fine. But eventually, humanity will have to find new sources for energy/fuel regardless. Certain things do more harm than good as well, and while even I don't want to let go of certain things there really isn't much time left. I honestly don't have too much more to say about this. I care less about the how, but there are still plenty of climate change deniers who state your points, but as way to completely blow off climate change.
///////////////////////////////////////////////////////////

Upon looking into it, why is there such a difference between the costs of health care in the U.S. and its peers? I don't know how the government would do it without some form of socialism or regulation, but this definitely is a problem. It shows that there's blatantly overblown prices for the sake of sheer profit.  I understand wanting to make off of something, but it's still absurd. And people complain about government's budget, but we still by FAR spend way more on the military just to play grab ass in other countries. Maybe some of that guap should got to some form of health care reform or reducing the costs of things. 



As far as people having sex with powerful people being wrong, there's the classic carrot and stick model. If it's your boss who propositions you, the stick (hurting your career) is implied. That's what makes it wrong (or on morally shaky ground) for me. On the other hand, if it's someone wanting a bite of carrot, I don't have an issue with both sides getting what they're looking for from the interaction. 

There are people out there (the majority of people who self identify as feminist and are under 30 years old) who are willing to call any interaction with a woman misogyny at their discretion. They don't like Trump, he's a misogynist. They liked Clinton, he just loved women. Looking at all those interview snippets you linked, I wouldn't suggest that Trump would be a good celibacy counselor, but I don't judge him like he's a criminal, either.
-----------

You're right, I've heard some people say similar things in the course of denying that humans are affecting climate change. That's the thing with the world today, no one's willing to be in the middle or accept that someone else is in the middle. Because of this, they never think, "Hmmm, this person has an opinion that is almost like mine with some minor differences.", and instead can only think, "This person is the enemy. Fuck listening to the enemy!!"

The fact, like it or not, is that due to how incredibly complicated climate modeling is and the relatively short period we've been collecting data (a couple of hundred years out of the billions the Earth has been around), we can't say very much in a definitive manner. Everything credible scientists say about the human effect on climate change is full of maybe, probably and strongly suggests.

Even if the most sky is falling interpretation is true, though. I still don't think anyone anyone should be collecting money for a climate change fund until they've shown through some successful experimentation data that they can use the money to make a positive change.

-------

There are two workable modern models to pay for health care:
1) The government pays for everything out of taxes
2) The government pays for nothing and people are responsible for their own health care

What we have in the US is sort of the worst aspects of either system bastardized into a hot mess. 

Because insurance is used to cover even the smallest medical expenses, we get the problems of single payer where costs go up constantly because everyone involved feels like they're spending someone else's money (the only way to offset this is to restrict service, a point we haven't quite reached in the US because there's still blood that hasn't been squeezed out of the middle class). It's actually worse than single payer because the insurance companies are profit driven and are going to do things like raise premiums or deny as many claims as possible to protect their profit.

In all but elite private clinics and such, we also have the negative things that come with privatized health care - like doctors rushing through their diagnosis to get to the next patient because they get paid per consult or doctors recommending meds that are not the best for the patient, but whose manufacturers do offer them a kickback. 

My personal opinion is that we should have people be responsible for their own routine health care, with insurance only covering catastrophic costs (like major surgery or long term care). If the government wants to pay health care for some of the populous, OK. What it should do is point a gun between the eyes of all medical suppliers and say, "The guys we're paying for... yeah, you don't get to make a thousand percent profit. We're limiting you to 30 percent (or whatever number)."

I know that last bit would make your typical Republican or Libertarian grab his chest and keel over, but that's why I don't think the labels fit me. I believe the government should stay out of day-to-day management of people's affairs, but should set limits to keep everyone running in the same lane.

I guess I mostly understand where you're coming from, my only major difference in opinion is how the carrot-stick model can play out. Sometimes wanting a bite out of the carrot is as simple as it sounds, but in more competitive situations like pageants or promotions, it becomes tricky. Even assuming it doesn't affect the authority's judgement at all (already a bit of a stretch), to the outside perspective it can look like you need to perform certain favors to advance or win. And the carrot seeker might also be doing it with nefarious intentions or as a bribe of sorts. 

It's not that I'm not understanding of people in relationships with skewed power dynamics. I understand that things can happen. But that's ALSO why I think people in those positions have to be more careful about how they talk about these things. 

"I better use some Tic Tacs just in case I start kissing her. You know I'm automatically attracted to beautiful—I just" start kissing them. It's like a magnet. Just kiss. I don't even wait. And when you're a star, they let you do it. You can do anything. Grab 'em by the pussy. You can do anything."[3]

 It'd be like an attractive/popular teacher who's never actually done anything with a student or been caught abusing power said 
"some of these students, they'll do anything to get your attention. I could just throw them in detention. Just start handing out slips. Don't even need a reason. And when you're the cool teacher, they let you do it. You can do anything. Even stop by their home. You can do anything." 
Sure, he/she might not have ever done any of this, but these kinds of remarks are unbecoming of a teacher, and it's plausible that the teacher, being popular and attractive, could get away with potentially abusing power against a student without any complaints. I'd at least want the teacher to roll back some of what was said.
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#46
(12-02-2018, 06:34 PM)Spops53190 Wrote: It's not that I'm not understanding of people in relationships with skewed power dynamics. I understand that things can happen. But that's ALSO why I think people in those positions have to be more careful about how they talk about these things. 

"I better use some Tic Tacs just in case I start kissing her. You know I'm automatically attracted to beautiful—I just" start kissing them. It's like a magnet. Just kiss. I don't even wait. And when you're a star, they let you do it. You can do anything. Grab 'em by the pussy. You can do anything."[3]

 It'd be like an attractive/popular teacher who's never actually done anything with a student or been caught abusing power said 
"some of these students, they'll do anything to get your attention. I could just throw them in detention. Just start handing out slips. Don't even need a reason. And when you're the cool teacher, they let you do it. You can do anything. Even stop by their home. You can do anything." 
Sure, he/she might not have ever done any of this, but these kinds of remarks are unbecoming of a teacher, and it's plausible that the teacher, being popular and attractive, could get away with potentially abusing power against a student without any complaints. I'd at least want the teacher to roll back some of what was said.


I get you. I'm just more of a free speech absolutist (not quite entirely, but almost an absolutist). To me, you can say absolutely anything (anything that's not encouraging someone to commit a crime) and it doesn't matter. Once you actually do something (or admit you did something, I guess), then there's something to look at.

This goes double for someone like Trump who's clearly a shit talker and says a lot of stuff you know he doesn't expect you to treat as gospel truth.
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#47
(12-02-2018, 02:05 AM)Blackin17 Wrote: I do understand that insurance companies have to deal with populations with high risks due to obesity, and other bad behaviors

The obesity epidemic is a whole other can of worms. That's another giant convoluted mess. The gist of it is, the sugar industry paid off scientists back in 1960's, so the most unhealthy food is artificially cheap due to being subsidized by the government. The healthy food actually costs less to produce, but is arbitrarily more expensive. This also crosses into the medical industry as most doctors are completely ignorant to proper diet and just how big of an effect it has on health. Not only that, but most doctors aren't interested in preventive medicine, but more interested in invasive procedures and treatments, not cures. Don't even get me started on prescription drugs and the pharmaceutical industry lobbying to keep less harmful drugs that have proven to be beneficial and better alternatives illegal purely because of greed.
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#48
The videos of 'Professor Black Truth' are insightful.
*Pocahontas


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#49
This is the densest conversation I have ever seen on a site devoted to talking about porn.
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#50
^ How cryptic of you. I'm guessing you aren't going to go into further detail, either. How disappointing.
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