Steve Randy Waldman
@interfluidity.com
since we have now all read ChatGPT responses and seen Midjourney pics, all of our creative work is now derivative of AI. soon we’ll be required to pay licensing fees.
Steve Randy Waldman
@interfluidity.com
hell as a most fascinating terrarium we all can tap the glass.
Steve Randy Waldman
@interfluidity.com
the scale of the moneycane in health care is huge, lots of problems may seem comparatively minor in quantitative terms while large relative to personal finances. but it matters that from a patient perspective it’s misleading, a scam. it seems a lot, and is corrosive to any sense of legitimacy.
Steve Randy Waldman
@interfluidity.com
Great call! Finally (for all the rows), it's clear that "Plain paid" is $0.00.
Steve Randy Waldman
@interfluidity.com
Basically, it feels like much of how US health insurance works is like Las Vegas hotel/casino comps. 1/
Steve Randy Waldman
@interfluidity.com
The hotel rooms, the hotel restaurant dramatically inflate undiscounted top-line prices, so that when high rollers are comped, the value of their benefit relative to the puffed-up prices seems gratifyingly large. 2/
Steve Randy Waldman
@interfluidity.com
Doesn't seem like a great way to run a fifth of the economy. /fin
Steve Randy Waldman
@interfluidity.com
right. but if the way they make the numbers add up stomps on their paying customers and them fibs to them about it, it's not a wonder those paying customers get pretty mad about it!
Steve Randy Waldman
@interfluidity.com
Cross-subsidies are in general inferior to tax support, they concentrate the burden of support on arbitrary groups of related payers who no more ought to "owe" the supported than the rest of us should for ensuring everyone can participate. Sliding-scale pricing sounds more "progressive" than it is.
Steve Randy Waldman
@interfluidity.com
I guess I think if this number is not separately accounted (it can be pooled and netted when it's paid, but there should be a line for it), it's misleading to represent it as a benefit to the insured. These statements are making an affirmative claim. The amounts are large. They should be accurate.
Steve Randy Waldman
@interfluidity.com
so that would be embedded in the $1K I might actually pay them (I will try to negotiate it down), not in the $3.5K-$6K various presentations are representing as an insurance benefit, right? 1/
Steve Randy Waldman
@interfluidity.com
from a user benefit perspective, it's kind of insult to injury. after fake benefits, the price patients pay is padded to help cover indigents. a good cause, for sure! 2/
Steve Randy Waldman
@interfluidity.com
but i'm not sure my pneumonia is why i should make a contribution (as opposed to say all of us sharing the burden via tax dollars), and that's not a payment or benefit paid by insurers, at least not until the deductible is met. /fin
Steve Randy Waldman
@interfluidity.com
(i didn't before! i hope i don't now!)
Steve Randy Waldman
@interfluidity.com
yeah. day-of-visit the estimate was $500-and-something, it's crept up to double. it's all very lovely.
Steve Randy Waldman
@interfluidity.com
This one is a screenshot directly from the insurance company's EOB, logged into their website.
Steve Randy Waldman
@interfluidity.com
I don't doubt that in aggregate funds flow from insurers to ERs. Do insurers in some reasonably direct way cover the cost of uninsured indigents? That's not a thing I'd expect. 1/
Steve Randy Waldman
@interfluidity.com
In any case, the question is whether there was some variable cost paid by the insurance company due to my deductible-not-fulfilled visit to the ER. Yes, lots of funds slosh around the HC system in hard to track ways. But they r representing a benefit to me I think is not real, at best misleading. 2/
Steve Randy Waldman
@interfluidity.com
(I had a rough little pneumonia! Two rounds of different antibiotics later I'm on the mend, I hope, but it's been a bit unpleasant. Thanks for asking!) /fin
Steve Randy Waldman
@interfluidity.com
A great rejoinder to the kind of bullshit one often gets, "Oh, you miss New Deal, the era when we were making progress towards social democracy? I see you are nostalgic for Jim Crow then, you moral cretin." infosec.exchange/@david_chisn...
Steve Randy Waldman
@interfluidity.com
So, this is for an emergency room visit. I'm far from having met my deductible. The phrase "insurer covered" suggests my insurance company is paying something, but I think in fact they've just negotiated a less ridiculous price, and the only actual cash flow is coming from me. 1/
Partial screenshot of billing statement: Billed $6,693.82 Insurance Covered - $5,577.14 Your Balance $1,116.68
Steve Randy Waldman
@interfluidity.com
Am I wrong? If I am not, isn't this presentation misleading? Is it legal? Should it be? /fin
Steve Randy Waldman
@interfluidity.com
Here's the EOB presentation of the same visit. Not that the top line numbers don't match, although my cost does. The same ambiguity obtains. Does "plan benefits" represent a negotiated price, or an actual cash flow? cc @bananapantz.bsky.social @paulriz504.bsky.social
Steve Randy Waldman
@interfluidity.com
(the prior presentation was from the providers' statement to me.)
Steve Randy Waldman
@interfluidity.com
This is horrifying.
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Steve Randy Waldman
@interfluidity.com
i’m not saying good outcomes are likely. i’m saying we’re in the maelstrom and the best we can do is pursue them.
Steve Randy Waldman
@interfluidity.com
people who do this for a living make a lot of money, while, say, homeless people do not. obviously what is paid is not productivity.
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Steve Randy Waldman
@interfluidity.com
the original drone delivery.