Miscellaneous And Off Topic Subjects

[iam416]

They had at least a few electable candidates this cycle. IMHO the more electable guys never got any traction whatsoever, which was a little bit puzzling to me.

It's going to take some time/distance to really analyze the 2016 R primary. But one day, 20-25 years from now, when we can see whether it was anomalous or a party sea change or something in between, it's going to be fascinating to dissect why R voters actually pissed on every credible general election candidate they had.

Don't get me wrong -- I think you can analyze it now -- but, IMO, it'll be a more complete story in 20 years.

I mean, PAH is a bad general election candidate. The Ds were ripe for the picking. We'll see what the Rs doing in 2020.

[froot loops]

They had at least a few electable candidates this cycle. IMHO the more electable guys never got any traction whatsoever, which was a little bit puzzling to me. Some of the guys who made it further probably couldn't get over the top because Repub voters had no trust that they would follow through on their promises (e.g. Bush, Rubio).

It's not really a puzzle, the theoretical electable candidates in the GOP tend to fail the conservative purity test. It isn't just Presidential candidates, the GOP has pissed away a few Senate seats with these crazy primary candidates. It even has worked it's way into the House where a guy like Cantor lost his seat.

The 2016 GOP primary was basically 17 candidates with nearly the same laundry list of proposals so it was who could insult the best.

[froot loops]

There are far more examples of near perfect correlation to vote totals, the most recent being, you know, 2014 when the Rs jackhammered the Ds. Two anomalous results isn't reason. If gerrymandering were the cause then it would show up in every election because, well, it's present in every election. There's neither correlation nor, more importantly, causation.

But hey, if you're going to insist you're not a D, then reason isn't going to play much of a role here.

There is 435 house seats and there are charitably 60 races that are competitive. It's ridiculous.

You are not going to see some election where a party is in major control where the ACA is repealed or doubled down on.

[Hannibal]

It's not really a puzzle, the theoretical electable candidates in the GOP tend to fail the conservative purity test. It isn't just Presidential candidates, the GOP has pissed away a few Senate seats with these crazy primary candidates. It even has worked it's way into the House where a guy like Cantor lost his seat.

The 2016 GOP primary was basically 17 candidates with nearly the same laundry list of proposals so it was who could insult the best.

LMAO I can tell that you paid absolutely no attention to the primaries then.

[Da Geezer]

Jeff said:

Back on point ........There are too many factors influencing each of these independently or in concert. This is one of the reasons understanding the health care system is so difficult and formulating policy changes to make the system better so elusive.

Complicating matters is the competing politics and economic viewpoints of stake holders.....

But I do know that the current system is not sustainable and more importantly it sucks at delivering good care to all citizens equally. What is discouraging to me is that ....we continue to flail around trying to find something that makes all the stake holders happy. Isn't going to happen.

my emphasis

Getting there.... When you look at your hospital bill, and you are charged $ 5.00 for a crappy box of tissue, most folks (1) wish they could have had Kleenex and (2) just let it go. Somewhere, there is someone who is profiting from this obvious mismatch of need and supply. When these costs are in the system, it is foolish to rail against "profit" because the real question is "where is the excess going?" What we have with the ACA is a vast and growing government bureaucracy "overseeing" an extensive private bureaucracy. The idea that placing one bureaucracy in charge of another will cut costs is ludicrous to any reasonable person. So the light bulb goes on: "hey, why don't we just eliminate the private bureaucracy..."

Why don't we take the excesses out of the system in the first place? We will never know, but do you remember when policing changed and even the little things like broken windows were a concern? I don't know if that could happen with medical bills, but it certainly wouldn't hurt to try. Hanni makes a good point that folks really only care about their deductible. Why not make the deductible a percentage of the total bill? Why not itemize a pro-rated share of insurance costs and legal fees on each bill? In other words, be transparent about the hidden costs of health care and allow the individual patient have a vested interest in lowering the bill. I don't think we have ever even talked about how the US legal system affects negatively the health care system.

Thinking that "equal" treatment of the poor is attainable or even desirable is just magic thinking. It has never happened anywhere. We need the best possible treatment for the poor where they are located.

[iam416]

There is 435 house seats and there are charitably 60 races that are competitive. It's ridiculous.

In a regular Presidential election, there are roughly 8-10 states that are competitive.

You are not going to see some election where a party is in major control where the ACA is repealed or doubled down on.

The House is irrelevant to that. The Senate is the key and the boundaries are never changing. I agree that it will take full control of Congress + 60 in the Senate + the Executive to do either of those things.

[Dr. Strangelove]

Ohio voters ratified a joint plan to take a hammer to Ohio's gerrymandered legislature districts back last fall.

http://www.huffingtonpost.com/entry/ohio-gerrymandering_us_563a5c76e4b0411d306f487e

Democratic candidates for the state legislature won 55,000 more votes than their Republican counterparts but won only 39 out of 99 total seats. I guess this was the 4th most disproportional representation in the nation?

[AlabamAlum]

Jeff.. Hospitals still are paid by FFS.. and so are practices.. who does the billing doesn't change the system. Most of it is still FFS.. almost all in fact.

Insurance pays for what is done based upon rules.. Medicare and Medicaid does the same.. It's all paid based upon services and why billing coding has such a large impact on Revenue.. It's still pay for what is performed. It's not a Fixed Fee or a captive $$

Perhaps I missed your first point.. If it's FFS doesn't exist, I don't agree. If it's more decisions are being made corporately than ever, I agree. Or again, maybe I misunderstood.

btw.. Still over 50% of physician practices and specialty offices are independently owned. Fewer than before, but nowhere near dead. I do think MACRA will push that % lower.

Hospitals in this area, outside of a few large teaching centers, employ very few MDs. We contract with independent practices for ER, radiology, anesthesia, hospitalists, and a few other things as opposed to hiring them.

Directly hiring MDs is not good for the consumer or the hospital, really.

Benefits and risks of capitation vs FFS is a convo for another day. I can't spend sll day here! I have golf and drinking to do.

[Hannibal]

It's going to take some time/distance to really analyze the 2016 R primary. But one day, 20-25 years from now, when we can see whether it was anomalous or a party sea change or something in between, it's going to be fascinating to dissect why R voters actually pissed on every credible general election candidate they had.

There's no mystery about why if you ask me. Republican voters are sick and tired of watching their party bring a knife to a gun fight and accept the role as dhimmies in Washington (even when they win elections). It's like being a Big Ten football team trying to compete against the SEC West.

[froot loops]

LMAO I can tell that you paid absolutely no attention to the primaries then.

You may LMAO all you want but there was very little difference in their competing proposals. It was pretty much all supply side puffery, repeal Obama care and some sort of anti-immigration reform. I watched most of those debates and the candidates were dominated by the insult guy. His big change in proposal was banning Muslims and instead of building a fence he was building a wall. But almost all if not all 17 candidates were using some skeleton of the Ryan plan.

[Hannibal]

LMAO. So you didn't watch.

At all.

[froot loops]

There's no mystery about why if you ask me. Republican voters are sick and tired of watching their party bring a knife to a gun fight and accept the role as dhimmies in Washington (even when they win elections). It's like being a Big Ten football team trying to compete against the SEC West.

It's a funny statement but I'm not even sure what that means. The problem with the statement is it views as always a fight. What on God's green earth could they have done more to obstruct Obama?

[entropy]

AA... Many are hiring MD's to push business into their hospitals and/or create ACO's. I know several who don't make money on buying physician practices but do in the totality of a persons care. Something you probably know/understand..

Ideally, I think you'd want an alignment of independent physical offices that does the same thing. I do think the reaction to the cost pressure is leading many orgs into a different direction. jmo


I also think there is regionalism based upon competition, state rules and hospital goals on the % of physician practices that are owned independently or not.. so I'm not surprised you'd see that in your area.

I forget the name of the group in Chicago, but a large physician practice started buying other practices and they created a large enough organization that the hospitals have had to negotiate with them on where they are sending their patients. Rather surprised that didn't become a more common model.. Not dominant, but just more common.

[froot loops]

LMAO. So you didn't watch.

At all.

Allright smart guy, what were the major differences in economic policies?

Better yet what we're the electable candidates you thought got passed over? Maybe I'm thinking of different people.

Kasich was actually immigration reform so that was a difference, that pretty much sunk him.

[iam416]

Ohio voters ratified a joint plan to take a hammer to Ohio's gerrymandered legislature districts back last fall.

http://www.huffingtonpost.com/entry/...b0411d306f487e

Democratic candidates for the state legislature won 55,000 more votes than their Republican counterparts but won only 39 out of 99 total seats. I guess this was the 4th most disproportional representation in the nation?

Yeah. Husted tried to address the issue, but he faced opposition from both the Rs and some Ds. Don't underestimate the importance of "safe AA districts". The Ds ought to, e.g., split up Cleveland a million different ways to win a ton of seats at 55%. But that requires dismantling 85% AA districts and running a significant risk of losing AA representatives. In our brave new world of "disparate outcomes=racist!!!!", the anti-gerrymandering Amendment will be RACIST!!!!!