U.S. Budget Negotiations

[ZenMode]

I guess we're doing this again?

1. They do not need to know "nearly precisely" how many patients they are losing. For one thing, all they need to know is whether it's too many. Think of it this way: if our football team is down 52-10 headed into the fourth quarter, we don't know precisely how many points we will end up with but we know we're going to lose.

They aren't "down" anything. They aren't trying to overcome a deficit. They're a hospital with a budget.

Second, for high revenue businesses like hospitals, statistical projection methods work very well. If you have a million customers, and then next week you have 900,000, that's what you need to know. If it's 893,356 or 913,122 doesn't matter.

Your range is "nearly precisely", IMO.

Third, in budgeting and all business analysis, the standard practice is to run projections on different base cases. for instance, in financial projections: you might run the numbers assuming a best case scenario of 3% interest rates going forward; an average case of 4%, and a worst case of 5%.

Ok.

Put all these together and companies have a very good financial picture. They don't know exactly what will happen, but they know the likelihood. They can tell you with quite a lot of precision what their chances of survival are. For instance, they might know that they have a 10% of surviving. That's a piss poor likelihood.

This is circular. In order to be precise, they have to be precise with the variables that go into the estimate.

2. You don't think the hospitals know each others' finances, roughly speaking?

Knowing, so specifically, the finances of all medical facilities, All around the country, who could be impacted to the point of closure or needing subsidies? Absolutely not. That a silly claim.

They do.

BS

They have trade associations. There are consultants who gather data. They know the reimbursement schedules, and the population in various areas. They know the doctors' salaries and staff salaries.

Ridiculous claim.

They might not know exactly which hospitals will close but they can predict accurately that it would be between X% and Y%.

BS again

Note: I don't know this for sure about hospitals per se, but I know this for a fact for other big businesses and I see no reason hospitals would be different given that they hire the same MBAs.

Well, no shit.

3. They do not need to know exactly how the government will calculate subsidies if they know it's not enough.

Again, circular. You have to know how it's calculated to know it's not enough.

I've read where the stabilization fund would have to be north of $200B. So no matter what the subsidy calculation, it's not going to cut it.

You're again assuming detailed knowledge on all kinds of variables that there's no reason to believe they know.

4. They know within HOURS because they've already modeled it. Hospitals employ hundreds or thousands of people in administrative/analyst roles. What do you think they do all day? Just because you pick your nose doesn't mean that's what everyone does.

It's all just circular reasoning. You assume they know X, which makes them able to know Y, Even though you are assuming that they know X to start with.

 

[wmheel1287]

In order for this hospital to make a truly informed decision, they'd have to know:

• Nearly precisely how many patients they'll be losing
• How much revenue those patients generate now and will in the future
• How much money they'll be subsidized from the government which means they ..
• Need to know how many medical facilities will be closing around the country....
• ...How much the remaining facilities will receive which means they also....
• Need to know how the federal government calculates subsidies.

Are you telling me they knew that within hours of the bill passing?

Also @superrific

Of course they know how many patients they will lose to a sufficient extent..and it doesn't need to be precise. If the facility is already struggling and is 70-80% Medicare/Medicaid, any distruption at all is enough.

Future prognostication of use based on past trends is pretty straightforward in the medical world.

Furthermore, you’re ignoring the fact that in many states (including and especially NC), almost EVERY practice and hospital in rural areas is owned by the same conglomerates. For example, you would have to look pretty hard to find a hospital or major practice east of I95 not owned by UNC Health or Vidant (formerly ECU Health). The same is true in the Triangle of UNC/Duke/Wake Med. Within an hour of Greensboro its all Moses Cone/Wake Forest. Everything west of GSO is Atrium Health.

They all know minute by minute what each practice, provider, and hospital is doing, where the patients come from, how they pay, and what their expected usage is.

 

[superrific]

1. You missed the point of the analogy. You can be uncertain about the precise effects in the future and yet certain that it will not be enough.

For instance, I don't know how much money I would raise if I went door to door in my neighborhood asking for donations. I'm certain it wouldn't be enough to cover a $5000 gambling debt I owe to the mafia because the government wouldn't let me deduct my losses.

2. Do you understand probability? You don't, evidently. If I say that I have a 50% of succeeding at something, I don't know exactly what will happen the next time I try. But if I try 10 times, I'll probably succeed between 3 and 7 times. If I try 10000 times my success rate will be very close to 50%. Get it? You can model all the factors you say are unknown and use that to make the projection.

It's amazing what people can do with skills and a lot of computing power.

3. How is it a ridiculous claim to note that hospitals receive reimbursements according to a published schedule? That they know how much doctors are getting paid because they see job listings and ask doctors how much they are making and get employment reference letters etc. etc. Population is publicly available data. Medicaid spend is publicly available. What is it that you think they can't possibly know?

 

[kickazzz2000]

They aren't "down" anything. They aren't trying to overcome a deficit. They're a hospital with a budget.

Your range is "nearly precisely", IMO.

Ok.

This is circular. In order to be precise, they have to be precise with the variables that go into the estimate.

Knowing, so specifically, the finances of all medical facilities, All around the country, who could be impacted to the point of closure or needing subsidies? Absolutely not. That a silly claim.

BS

Ridiculous claim.

BS again

Well, no shit.

Again, circular. You have to know how it's calculated to know it's not enough.

You're again assuming detailed knowledge on all kinds of variables that there's no reason to believe they know.

Have you never run a business?

 

[heelinhell]

Just to be clear, I agree completely. I just have a hunch MAGA does not.

I agree with you that MAGAs may recoil if they don't see an old white male MD enter their exam room.

I'm just saying based upon my experience over the last 5 years and encountering medical folks, I like and feel comforted seeing "ethnic" medical folks entering my exam room.

 

[wmheel1287]

Have you never run a business?

Yeah... this kind of bill watching is part of the gig for sure. NC had proposed legislation in the General Assembly that would have cut the required continuing education of every licensed profession in the state by 50%. CE accounts for 21% of my revenue. Had the bill become law, I would have cut 2 admin staff, 2 moderators, and one instructor. I would have made those moves the moment the governor signed the bill. Thankfully it died in committee on June 12.

 

[lawtig02]

Have you never run a business?

Zen? Run a business???

 

[WaynetheDrain]

I don't know why you guys bother with Zen. He's utterly irredeemable as a human being and willfully misinformed about every topic. His only goal is to play devil's advocate in defense of Trump, and he's completely nonplussed by the reality that no facts are ever on his side.

Fuck him. Seriously.

 

[p5mmr9]

I think this is a bit too strong. That was one of the points, not necessarily the main one. I mean, you're right; there was also more going on.

IIRC, Insured patients do not cost the system less than uninsured people. It's that their care is delivered at a fraction of the cost. So while we pay as much per insured as uninsured, we are delivering a lot more care in the first instance. It's the same way that Caleb Love scored about as many points as Tyler Hansbrough. One of them was a bit more efficient than the other . . .

Now, there are also distributional issues as to who pays in each case, and yes that was a significant issue under ACA and that's why some of the obscure financing provisions were in there.

Generally speaking, uninsured delay treatment (additional cost if the delay worsens the diagnosis), seek ambulatory and emergency care at a higher rate (additional cost), and either default on medical debt (additional cost) or just don't pay entirely (additional cost). They are also generally charged more which feeds into the previously noted issues. The cost to the system is when these debts and payments are defaulted as medical care cost increases for everyone. Yes - insured will seek more treatment, but that treatment tends to be preventative which is fairly inexpensive compared with hospitalization. The "unpaid care" component is really where the cost to the system becomes inflationary to the whole.

Hospitals charge more for unisured:

Study: Hospitals Often Charge More to Insured than Uninsured for Same Services

A highly selective liberal arts college in the heart of Hartford, Connecticut, Trinity prepares students to be leaders unafraid of forging new paths.

www.trincoll.edu

Unpaid debt is rolled into the healthcare system as a whole:

Spending on Health Care for Uninsured Americans: How Much, and Who Pays? - Hidden Costs, Values Lost - NCBI Bookshelf

More:

The Uninsured and the ACA: A Primer – Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act – What are the financial implications of lacking insurance? – 7451-14 | KFF

For many uninsured people, the costs of health insurance and medical care are weighed against equally essential needs, like housing, food, and transportation to work, and many uninsured adults report being very or moderately worried about paying basic monthly expenses such as rent or other...

www.kff.org

 

[p5mmr9]

Regardless, I think everyone agrees pulling insurance from patients is a net negative financially. The actual numbers are debatable.

 

[Geisterfahrer]

No one but you said criminal liability.

What’s the basis for civil liability?

 

[donbosco]

I don't know why you guys bother with Zen. He's utterly irredeemable as a human being and willfully misinformed about every topic. His only goal is to play devil's advocate in defense of Trump, and he's completely nonplussed by the reality that no facts are ever on his side.

Fuck him. Seriously.

Practice for the outside world?

 

[ZenMode]

Have you never run a business?

I've run a business within a larger business. I didn't start either one.

 

[superrific]

Generally speaking, uninsured delay treatment (additional cost if the delay worsens the diagnosis), seek ambulatory and emergency care at a higher rate (additional cost), and either default on medical debt (additional cost) or just don't pay entirely (additional cost). They are also generally charged more which feeds into the previously noted issues. The cost to the system is when these debts and payments are defaulted as medical care cost increases for everyone. Yes - insured will seek more treatment, but that treatment tends to be preventative which is fairly inexpensive compared with hospitalization. The "unpaid care" component is really where the cost to the system becomes inflationary to the whole.

Hospitals charge more for unisured:

Study: Hospitals Often Charge More to Insured than Uninsured for Same Services

A highly selective liberal arts college in the heart of Hartford, Connecticut, Trinity prepares students to be leaders unafraid of forging new paths.

www.trincoll.edu

Unpaid debt is rolled into the healthcare system as a whole:

Spending on Health Care for Uninsured Americans: How Much, and Who Pays? - Hidden Costs, Values Lost - NCBI Bookshelf

More:

The Uninsured and the ACA: A Primer – Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act – What are the financial implications of lacking insurance? – 7451-14 | KFF

For many uninsured people, the costs of health insurance and medical care are weighed against equally essential needs, like housing, food, and transportation to work, and many uninsured adults report being very or moderately worried about paying basic monthly expenses such as rent or other...

www.kff.org

Interesting. My knowledge of the stats is a bit dated, as I mentioned. I agree with everything you've written there. I think it's just a question of comparing two numbers, empirically determined. It doesn't matter either way, of course. We all know that uninsured care costs a lot.

It also matters, I think, whether you count life expectancy. I don't remember if the stuff I read did or not. Life expectancy does weird things to calculations. For instance, smokers were wonderful for public finance because, even though they consumed a lot of costs treating their cancers, they died much earlier and thus collected less social security, had less treatment overall, didn't need long-term care as much, etc. etc.

 

[sringwal]

Of course they know how many patients they will lose to a sufficient extent..and it doesn't need to be precise. If the facility is already struggling and is 70-80% Medicare/Medicaid, any distruption at all is enough.

Future prognostication of use based on past trends is pretty straightforward in the medical world.

Furthermore, you’re ignoring the fact that in many states (including and especially NC), almost EVERY practice and hospital in rural areas is owned by the same conglomerates. For example, you would have to look pretty hard to find a hospital or major practice east of I95 not owned by UNC Health or Vidant (formerly ECU Health). The same is true in the Triangle of UNC/Duke/Wake Med. Within an hour of Greensboro its all Moses Cone/Wake Forest. Everything west of GSO is Atrium Health.

They all know minute by minute what each practice, provider, and hospital is doing, where the patients come from, how they pay, and what their expected usage is.

There are two good things about living in Burlington. The first is an equal proximity to the beach and mountains. The second is being surrounded by some of the best health care options in the US.

 

[rodoheel]

I've never understood being able to claim gambling losses on taxes.

You can only use them to offset gambling wins, not other forms of income