yzerman19

Been 20 years since I took macro economics, but my recollection of one of Keynes' tenets was that you could generate economic growth through government spending. That is what I am getting at. You and I are of different opinions on moving location or switching careers, and docs aren't paid by the hour- they are paid on production- or migrating back towards # of patients in primary care and other triple aim incentives. Why is there a primary care shortage? because even doctors (most of them)who know they want to be doctors choose every other option first, because the difference in comp is so dramatic. Be a cardiologist, make $900k, be a pediatrician, make $120k. The commonality- investment banking, law, medicine- long hours equals big wallet. Kill the incentive, kill the work. Good post. This is good conversation

Not Country Club Edina...the debate to live out on tonka vs in Edina is more about commute IMO

I've never worked in the NoDak market, but my understanding is that it is monopoly virtually everywhere, on both sides. I guess you have oligopoly on the provider side in Fargo. Compare that to the Twin Cities, where there are really 3 giant health systems and 3 more medium health systems, a few specialty cartels, and pretty decent competition among 4 payers. Different competitive market. Rural vs Urban healthcare is a very interesting topic from the health economics to the community economics.

Its kind of a keynesian debate then whether or not gov spending into private enterprise is the best way to expand economic growth. At this point we are addicted to it. The other issue is the mobility of labor/capital. If I am very bright and motivated, I want to get paid. If it isn't in healthcare, I go somewhere else. Think of the surgeon working 60-70 hours per week for $400k per year. if that becomes $200k, he/she isn't going to work 60-70 hours, requiring more surgeons to keep up with demand. If I am an very talented 22 year old, I then question the value of incurring $200k in debt and foregoing an decent income until I'm 30. Then you lose docs or lose docs with talent.

Subsidy equals a redistribution, no?

Provider consolidation certainly plays a role. There are many, many drivers. Deteriorating population health. Better care, extending life and quality of life, but at extra expense, supporting small independent rural providers in order to ensure access. ACA benefit requirements do also play a role

The trouble with the talking heads is that they are very, very smart, but they have a single outcome in mind. They seek not construction from industry experts, but rather validation of their beliefs. My interactions with policy makers has been that they ask your opinion, listen, talk it through, appear to grasp it, then ignore it in their final report and simply state that as part of their due diligence they had thought leaders from industry. Implying a consensus, when none was reached.

Not my intent. You also seem to be very well versed in the subject matter

You're referring to economies of scale, which should occur at a large enough level of membership. The problem is those economies of scale just don't come to fruition on anything other than claims processing, which is truly as close to the clerical at you represented. So, a huge chunk of CEO comp is simply supply and demand on Wall Street. I mean its mostlymstockmoptions and grants that have nothing to do ( other than distantly) from the actual profit margin if the company. Also, united is a big, international conglomerate that makes more margin on non-insurance. Read big data and Optum. Ever wonder why every health plan is looking at vertical integration with providers or selling health and wellness? It's cause they need to find margin outside of insurance.

I've spoken with her and Zeke Emmanuel

Methodology is all Rbrvs, but the CF is negotiated. To those unfamiliar, physician compensation is based on a series of codes called CPT. Codes have a weight tied to them based on the resource intensity of the service they represent (RVU-relative value units). A simple office visit would have little RVUs, a heart bypass will have a lot of RVUs. The Conversion factor is negotiated. The conversion factor times the RVU nets the payment allowed by contract for the service. This is called the allowed amount.

I appreciate people's passion, and I'd really like to be able to convert that passion into an educated understanding. Not to share my political opinion, but just to understand how the industry works. I'll put my credentials in this space up against anyone- and by anyone, I really mean ANYONE- not trying to boast, just trying to make clear (without posting my resume) that I know what I'm talking about- AND i do not work for Blues of ND

Thanks Mate. The industry is hard to understand for most people, because it is a mystery of things like coding, actuarial science, and benefits that historically were designed to deter utilization or cost shift to employees. The other HUGE thing to remember with that maximum 15% gross margin is that I have to fund investment in the future and also (because we are talking fully insured) insulate myself from catastrophic claims. If they price too high, they won't sell policies in a competitive environment. If they price too low, they will not sufficiently manage the risk of high cost claims. In fact, any surplus (called risk based capital) is often a set large amount required by regulators to ensure the viability of the system in a crisis where no premiums are coming in, but people need services (read: pandemic or gov shutdown or depression) The question regarding % vs actual margin- it has to be %. Investors think about %.

9 year old is a freaking squirt...no way... Bantam is when I've seen real scouting happening, and usually for junior. Then junior and high school for college and pro.

Not the same way they don't. Not in the metro anyway.

That is fully insured only remember, self-insured has a margin of 2-5% and makes up more of most plans block in terms of %. This level of gross margin is among the lowest in all industry. Retail for example works in a 40% gross margin environment- minimum. Providers won't allow for a pooling of resources. It creates too much leverage and would reduce their reimbursement. I have been a consultant in this space- not with BCND, but with some national plans. It is not a panacea. If I had unlimited capital, health insurance would be the last industry I would want to go into.

I guess physicians, nurses, actuaries and other professionals are clerks... This is the most misunderstood industry on the planet, because most people have no comprehension of what goes on. Without the insurance company, you would pay MORE for healthcare or lose access to high value healthcare.

Love it! Go Farce, Go Sioux

Extremely unlikely that a non-top 16 pairwise winner will come out of the Hockey East or Big 10 conferences. It is a lock for Atlantic Hockey It is possible for NCHC and for WCHA and ECAC I would say that top 12/13 in PWR is safe. Now are we safely secured in 12/13? Not yet...getting closer...a sweep of western should just about do it.

MEDICAL LOSS RATIO...do you know what that means? It means that the money paid out as claims has to be no less than 85 percent of premium collected. With that remaining 15% you have to cover your costs...pretty slim gross margins. 15% pays salaries, real estate costs, customer service, provider and medical management... THEN...the self insured component. Most business is self-insured. You make no money there...it is simply admin fees which are very price competitive. Actually- medicare is about the only aspect of health insurance that is profitable for a commercial insurer. It isn't that hard- there is no money in health insurance any more.

Agree that it isn't the motivation. Historically, conferences have been based on geography, so by trying to fill seats, you will likely end up with the result. So, unintended consequences.

If I were cloud I'd go black...keep us out of the business suits

...if it ain't broke...

Johnson and LaDue are locks for all rookie team Thompson and Stecher will warrant consideration Goth berg and Simpson are locks on conference honors Schmaltz, parks, and Rocco will warrant consideration Nicely done boys- rookies doing great, which is the correlation back to this thread. Also- who'd have thought Tambellini and Murphy not in lineup...

Home team makes the call on alternate jerseys