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Blazin

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UNH up nicely on the news, since investors could parse the nuance that the Whitehouse intends to increase/extend subsidies to insurance companies just have to wrap it up in some tough talk.
 
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Aldarion

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What @Cad is describing about admin costs is actually a massive problem nation-wide, not just in healthcare.

You can start with David Graeber’s 2018 study on "bullshit jobs." Admin jobs in the US have grown over 140% since 1980. His survey work estimated that 30-40% of workers believed their job contributed nothing of real value. Not "I dislike my job," but "my job would not matter if it disappeared." That number has popped up again in research out of the UK, the Netherlands, and the U.S., with some analyses suggesting that in certain industries, over half of administrative roles could vanish with no effect on output.

Universities are the clearest canary: administrative staff have ballooned at up to 6x the rate of enrollment growth, sucking up billions while adding almost nothing to educational quality. Corporate HR, compliance, and "operations strategy" teams are following the same curve. Every new policy requires an analyst. Every analyst requires a supervisor. Every supervisor justifies a coordinator. It's organizational mitosis. Cells dividing because that's what cells do, not because the organism needs it.

The McKinsey Global Institute estimated that roughly one-third of tasks performed in the modern office environment are "non-value-adding." Not low-value, non-value. Pure overhead. Just pseudo-work invented to keep middle-class employment afloat in an economy that offshored nearly all of its physical production.

A large swathe of jobs now are just white-collar sandbags. A giant work program dressed up in ergonomic chairs and corporate jargon. And this is where "AI" comes in. Which actually would be a solution to a lot of the things Cad is bemoaning. But rather than having it help offset healthcare costs like it will and should, these vampires are just going to add it to their bottom lines instead.
Every word in this post is true. And its amazing how many of the different kinds of problems with modern society can be traced clearly to this same cause. Here we're limiting ourselves to the economic impacts, but thats far from the only damage.

The question is, is it possible to ever clean out the parasites when they outnumber the actual workers by such a large factor?
 
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Aldarion

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Even with that 400% markup, hospital makes about 3-6% profit margin… because if their only payer is Medicaid or Medicare then they would go under.
It is absolute bullshit accounting to say you only make 3-6% ""profit"" while paying your administrators high six figure salaries.

Absolute bullshit, and it happens across apparently every industry. I don't understand why people accept and then parrot back this obvious lie of accounting.
 
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Sanrith Descartes

I was forced to self-deport from the /pol thread
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UNH up nicely on the news, since investors could parse the nuance that the Whitehouse intends to increase/extend subsidies to insurance companies just have to wrap it up in some tough talk.
gone christmas GIF
 

Blazin

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My wife working in healthcare for 30 years were talking about it this weekend, there is no fixing healthcare in the US with UNH as it exists. It's the poster child for everything wrong with ACA.

When we spend time talking about inflation/govt spending the fed etc. , healthcare is the real elephant in the room. So messed up it's hard to even look into the issues without just giving up and say "yeah we are fucked" . Wait till people see what their premiums are going to do next year. I didn't get a chance to read the posts from this weekend yet so maybe repeating but there is so much leeching off of actual care its hard to fully appreciate the extent of it. Radical change is needed, instead we are going to get more bullshit solutions piled on to a giant bull shit pile.
 
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Sanrith Descartes

I was forced to self-deport from the /pol thread
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My wife working in healthcare for 30 years were talking about it this weekend, there is no fixing healthcare in the US with UNH as it exists. It's the poster child for everything wrong with ACA.

When we spend time talking about inflation/govt spending the fed etc. , healthcare is the real elephant in the room. So messed up it's hard to even look into the issues without just giving up and say "yeah we are fucked" . Wait till people see what their premiums are going to do next year. I didn't get a chance to read the posts from this weekend yet so maybe repeating but there is so much leeching off of actual care its hard to fully appreciate the extent of it. Radical change is needed, instead we are going to get more bullshit solutions piled on to a giant bull shit pile.
100% agree with you but a couple things I will add. The fearmongering on social media about rate hikes is insane. The numbers they are posting are bullshit. I got my quotes and with the premium tax credit it went up about $150 a month. So yeah it sucks, but its not earth shattering. The other thing I will add is self employed people who get these credits are quite experienced in manipulating their self employed income to take full advantage of the credits. So yes there will be some folks who get raped, but it wont be the large percentage of people the fear mongers are posting about.

Anecdotal observation: I had my annual physical this month and asked the office what my bill would have been if I had no insurance. $120 for the visit and $125 for the full bloodwork. Honestly not bad all things being equal for a once a year type of thing. The vast majority of Americans without health issues and between 20 and 40 should be using high deductible plans. They should be carrying catastrophic health care insurance to cover hospital stays and shit like that. Better to go out of pocket $500 or even 1k a year as needed than be paying 10k a year in premiums out of their paychecks. Having young kids is a different factor and honestly they should be able to get a policy just to cover the young child since the odds are higher of something happening.
 
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Kirun

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Every word in this post is true. And its amazing how many of the different kinds of problems with modern society can be traced clearly to this same cause. Here we're limiting ourselves to the economic impacts, but thats far from the only damage.

The question is, is it possible to ever clean out the parasites when they outnumber the actual workers by such a large factor?
Honestly, I think you're hitting the uncomfortable part most people keep dancing around: there simply aren't enough "real" jobs to keep a modern country employed at 96%+, and cutting bloat means exposing that reality in broad daylight. Technology has eliminated the need for millions upon millions of jobs and that number gets worse every day.

Even if we magically retrained every redundant admin, compliance officer, "project coordinator," and middle manager into trades or production roles tomorrow, the math still doesn't pencil out. We wouldn't have enough positions for them, and automation already wiped out the kinds of low-skill roles that used to absorb excess labor. This isn't even just about AI either. Just basic software, robotics, optimized logistics, and lean workflows eliminated millions of jobs long before ChatGPT showed up.

That's why administrative sprawl became the de facto employment plan: white-collar ballast jobs that didn't directly drive output but kept people attached to the labor force. And the moment you start cutting that fat? You expose how thin the real economy is.

So yeah, if you actually want to fix the structural issues, keep full employment, keep inflation under control, stop predatory sectors from devouring retirees, and drag the country into a sustainable 21st-century model, there's no version of this that doesn't involve pain. We've been kicking the can for 40 years. We're out of road. You either do a controlled burn now or let it go full Chernobyl in 20 years when the demographic and healthcare cliffs hit simultaneously.

Healthcare especially is a monster. It needs to be gutted. Not the doctors or the hospitals, the entire middleman apparatus: billing departments bigger than inpatient wings, insurers that add zero clinical value, administrative layers that metastasized like tumors. Older Americans should be the loudest voices demanding reform, because they're the ones getting financially flayed alive by the system as it stands. If nothing changes, retirement health costs will eat whole generations.

And with all that stacked together - administrative bloat, automation displacing low-skill labor, demographics collapsing, healthcare cannibalizing savings, etc. - it's not crazy to think we end up with UBI or something functionally similar just to keep the floor from falling out. Whether the job losses come from AI or from finally enacting policy reforms that should've happened decades ago almost doesn't matter. The jobs disappear either way.

So yeah, you can't fix this without realignment. And you can't realign without shedding millions of jobs. And shedding millions of jobs forces you to confront the fact that we never had enough necessary work to justify our employment numbers in the first place. Pain now, or catastrophe later. There's not really a third option.
 
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TJT

Mr. Poopybutthole
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Be real. What's going to happen is that every actor with any agency is going to cooperate in kicking the can down the road until its not possible to do so anymore.

Implicitly choosing catastrophe every time. Just like in every other similar scenario.
 
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Khane

Got something right about marriage
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100% agree with you but a couple things I will add. The fearmongering on social media about rate hikes is insane. The numbers they are posting are bullshit. I got my quotes and with the premium tax credit it went up about $150 a month.

That's a lot of money man.... a whole lot.

I think I need to spell out that I am not joking. How can you be so casual about that? $150 more a month just for the "privilege" of having insurance (which is not healthcare)
 
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Gravel

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100% agree with you but a couple things I will add. The fearmongering on social media about rate hikes is insane. The numbers they are posting are bullshit. I got my quotes and with the premium tax credit it went up about $150 a month. So yeah it sucks, but its not earth shattering. The other thing I will add is self employed people who get these credits are quite experienced in manipulating their self employed income to take full advantage of the credits. So yes there will be some folks who get raped, but it wont be the large percentage of people the fear mongers are posting about.

Anecdotal observation: I had my annual physical this month and asked the office what my bill would have been if I had no insurance. $120 for the visit and $125 for the full bloodwork. Honestly not bad all things being equal for a once a year type of thing. The vast majority of Americans without health issues and between 20 and 40 should be using high deductible plans. They should be carrying catastrophic health care insurance to cover hospital stays and shit like that. Better to go out of pocket $500 or even 1k a year as needed than be paying 10k a year in premiums out of their paychecks. Having young kids is a different factor and honestly they should be able to get a policy just to cover the young child since the odds are higher of something happening.
We actually just met with some guy to talk about different plans (he was an idiot and didn't provide any help), but the summary is our premiums didn't really change whatsoever. The only thing we're considering is changing from a gold plan because we can't quite figure out what it's providing us. We've been on a gold plan since we retired, but it seems like we're just paying higher premiums and out of pocket for nothing. The actual coverage between silver and gold (and for that matter, bronze) are identical.

The whole ACA system is so convoluted and retarded. I honestly can't figure out what the fuck is going on.
 

Gravel

Mr. Poopybutthole
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Honestly, I think you're hitting the uncomfortable part most people keep dancing around: there simply aren't enough "real" jobs to keep a modern country employed at 96%+, and cutting bloat means exposing that reality in broad daylight. Technology has eliminated the need for millions upon millions of jobs and that number gets worse every day.

Even if we magically retrained every redundant admin, compliance officer, "project coordinator," and middle manager into trades or production roles tomorrow, the math still doesn't pencil out. We wouldn't have enough positions for them, and automation already wiped out the kinds of low-skill roles that used to absorb excess labor. This isn't even just about AI either. Just basic software, robotics, optimized logistics, and lean workflows eliminated millions of jobs long before ChatGPT showed up.

That's why administrative sprawl became the de facto employment plan: white-collar ballast jobs that didn't directly drive output but kept people attached to the labor force. And the moment you start cutting that fat? You expose how thin the real economy is.

So yeah, if you actually want to fix the structural issues, keep full employment, keep inflation under control, stop predatory sectors from devouring retirees, and drag the country into a sustainable 21st-century model, there's no version of this that doesn't involve pain. We've been kicking the can for 40 years. We're out of road. You either do a controlled burn now or let it go full Chernobyl in 20 years when the demographic and healthcare cliffs hit simultaneously.

Healthcare especially is a monster. It needs to be gutted. Not the doctors or the hospitals, the entire middleman apparatus: billing departments bigger than inpatient wings, insurers that add zero clinical value, administrative layers that metastasized like tumors. Older Americans should be the loudest voices demanding reform, because they're the ones getting financially flayed alive by the system as it stands. If nothing changes, retirement health costs will eat whole generations.

And with all that stacked together - administrative bloat, automation displacing low-skill labor, demographics collapsing, healthcare cannibalizing savings, etc. - it's not crazy to think we end up with UBI or something functionally similar just to keep the floor from falling out. Whether the job losses come from AI or from finally enacting policy reforms that should've happened decades ago almost doesn't matter. The jobs disappear either way.

So yeah, you can't fix this without realignment. And you can't realign without shedding millions of jobs. And shedding millions of jobs forces you to confront the fact that we never had enough necessary work to justify our employment numbers in the first place. Pain now, or catastrophe later. There's not really a third option.
This post made me laugh a bit to myself. I've mentioned before I had the bullshit jobs conversation with my coworkers probably 7 or 8 years ago now. Since it was F/A-18, which meant lots of engineers and mathematicians and shit as a make work program, my solution was that we could retool the entire organization for space exploration.

Granted, that's a fringe case of an organization made up of people suited for that mission. I don't know what you do with healthcare or university bureaucrats.

But surely we can come up with someone more productive than infinity HR jobs.
 

Sanrith Descartes

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That's a lot of money man.... a whole lot.

I think I need to spell out that I am not joking. How can you be so casual about that? $150 more a month just for the "privilege" of having insurance (which is not healthcare)
So I see our insurance as catastrophic insurance. Protection against hospital stays and the like. I am old enough where this possibility isn't very close to zero. So while I don't pretend to like an increase of a hundred a month for a family plan, I am still paying it. I take solace in the face I have raised prices on all my clients this year to compensate for my costs rising and this is one of those costs.
 
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Sanrith Descartes

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We actually just met with some guy to talk about different plans (he was an idiot and didn't provide any help), but the summary is our premiums didn't really change whatsoever. The only thing we're considering is changing from a gold plan because we can't quite figure out what it's providing us. We've been on a gold plan since we retired, but it seems like we're just paying higher premiums and out of pocket for nothing. The actual coverage between silver and gold (and for that matter, bronze) are identical.

The whole ACA system is so convoluted and retarded. I honestly can't figure out what the fuck is going on.
There is near zero difference between Gold and Silver on the Florida Blue Select plans so we went to Silver last year. The bronze there are some actual real differences but I haven't had time to dig into them yet to do the cost benefit analysis. We either stay silver or maybe go bronze.
 
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Khane

Got something right about marriage
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We actually just met with some guy to talk about different plans (he was an idiot and didn't provide any help), but the summary is our premiums didn't really change whatsoever. The only thing we're considering is changing from a gold plan because we can't quite figure out what it's providing us. We've been on a gold plan since we retired, but it seems like we're just paying higher premiums and out of pocket for nothing. The actual coverage between silver and gold (and for that matter, bronze) are identical.

The whole ACA system is so convoluted and retarded. I honestly can't figure out what the fuck is going on.

Its not that the ACA is convoluted and retarded. It's that the ACA very literally "poked the bear" that is these behemoth insurance companies. It fast forwarded them trying to fuck us in as many ways as possible because it incentivized them to do so. And they did. There was never any chance that the government could create legislation that beat insurance companies. Ever.

HDHPs used to actually be really good for healthy people. Slowly they are becoming the actual only option with astronomically criminal deductible amounts. All while still having to pay pretty substantial premiums.

When HDHPs were first introduced I was in my mid 20s and remember subscribing to one. My premium was $23/mo and my deductible was $1k. This was about 18 years ago. Oh how times have changed
 
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Gravel

Mr. Poopybutthole
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There is near zero difference between Gold and Silver on the Florida Blue Select plans so we went to Silver last year. The bronze there are some actual real differences but I haven't had time to dig into them yet to do the cost benefit analysis. We either stay silver or maybe go bronze.
Sounds like we've just been subsidizing the other plans for the last 4 years then.

Switching from gold to silver will cut our premium in half, our out of pocket by 2/3, and shit like copays and prescriptions to almost nothing.

Oh well.
 

Sanrith Descartes

I was forced to self-deport from the /pol thread
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Sounds like we've just been subsidizing the other plans for the last 4 years then.

Switching from gold to silver will cut our premium in half, our out of pocket by 2/3, and shit like copays and prescriptions to almost nothing.

Oh well.
I hate to say it buy you really need to go line for line and see the differences. If I recall, the big differences is the out-of-pocket maxes and maybe some of the deductibles. Maybe 5 or 10 bucks on a Dr. visit. Stuff like that. if you visit a Dr once or twice a year better to pay an extra $20 and save $1000 in premiums.
 

Sanrith Descartes

I was forced to self-deport from the /pol thread
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Sounds like we've just been subsidizing the other plans for the last 4 years then.

Switching from gold to silver will cut our premium in half, our out of pocket by 2/3, and shit like copays and prescriptions to almost nothing.

Oh well.
Silver plan costs $3207/month before any credits. Bronze plan costs $2559/month. Credits can get Silver down to $429/month and Bronze down to $0/month. Deductible $6125 Silver vs $2100 Bronze. Out-of-pocket max increases $1800 8100 Silver and 9900 Bronze). Tier 2 PCP visit is $15 Silver and $50 Bronze. Specialist is $30 or $100. X-rays are $175/250. Labs $35/$60. Drugs generic $8/30. Urgent care $30/100 and ER visit is $350 after deductible vs $1500 no deductible. Hospital stay is $600 per stay after deductible vs $3000 per day no deductible.

So looking at the hospital thing, the Silver having a $6125 deductible that has to be met so a 2-day stay is the same cost ($6k) either plan. The ER visit could actually be cheaper on the Bronze plan if you haven't done much to the deductible during the year. But...saving $5100 in premiums you put that in the bank to cover any possible costs during the year with the Bronze plan could cover that 2-day stay while the Silver plan on the same 2 day stay is fucked with $6k deductible and also the 5k in premiums paid.

Looking at the out-of-pocket, the 5k in savings on Bronze covers half your out-of-pocket max so a long hospital stay still can cap out of $4k when you consider the 5k premiums savings.
 

Fucker

Log Wizard
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Honestly, I think you're hitting the uncomfortable part most people keep dancing around: there simply aren't enough "real" jobs to keep a modern country employed at 96%+, and cutting bloat means exposing that reality in broad daylight. Technology has eliminated the need for millions upon millions of jobs and that number gets worse every day.

Even if we magically retrained every redundant admin, compliance officer, "project coordinator," and middle manager into trades or production roles tomorrow, the math still doesn't pencil out. We wouldn't have enough positions for them, and automation already wiped out the kinds of low-skill roles that used to absorb excess labor. This isn't even just about AI either. Just basic software, robotics, optimized logistics, and lean workflows eliminated millions of jobs long before ChatGPT showed up.
I had a job doing a complete reorg of a pretty big company. I studied all the business units, all the jobs, all the RE holdings...basically everything. This company operated out of two huge main buildings and a large number of off-site essentially zombie real estate holdings. The company was so large it had an on-site motorpool and full time pilots. Different types of union jobs in departments that could do anything. It was more or less a small, self-contained city. The company even had its own track rigs and helicopters. Triple digit # of employees at its peak.

It was purchased by another company whose CEO wanted to make it larger. A new company came along with a fraction of employees and no legacy costs and murdered them.

The result? The old company is entirely GONE. The buildings are empty, and they even sold every inch of copper in that place. All those high paying union jobs are gone. Almost ALL the jobs are gone, and all that is left is a few people in a tiny strip office handling paperwork for outsourcing for the out of state main business. Further, most of those jobs weren't replaced with new outsourced jobs, they were replaced with nothing.

At one point, most of these people were useful to the organization. At the drop of a hat, they weren't. I used to live in a tech hub that had a similar story. Hundreds of giant empty buildings that were once full of well paid people. All those jobs now forever gone to China and India.

Hell, I grew up in a boom town. Once businesses started to unwind and downsize, they all did. Boom turned to permanent bust. All those jobs back into the ether from whence they came.
 

Khane

Got something right about marriage
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Silver plan costs $3207/month before any credits. Bronze plan costs $2559/month. Credits can get Silver down to $429/month and Bronze down to $0/month. Deductible $6125 Silver vs $2100 Bronze. Out-of-pocket max increases $1800 8100 Silver and 9900 Bronze). Tier 2 PCP visit is $15 Silver and $50 Bronze. Specialist is $30 or $100. X-rays are $175/250. Labs $35/$60. Drugs generic $8/30. Urgent care $30/100 and ER visit is $350 after deductible vs $1500 no deductible. Hospital stay is $600 per stay after deductible vs $3000 per day no deductible.

So looking at the hospital thing, the Silver having a $6125 deductible that has to be met so a 2-day stay is the same cost ($6k) either plan. The ER visit could actually be cheaper on the Bronze plan if you haven't done much to the deductible during the year. But...saving $5100 in premiums you put that in the bank to cover any possible costs during the year with the Bronze plan could cover that 2-day stay while the Silver plan on the same 2 day stay is fucked with $6k deductible and also the 5k in premiums paid.

Looking at the out-of-pocket, the 5k in savings on Bronze covers half your out-of-pocket max so a long hospital stay still can cap out of $4k when you consider the 5k premiums savings.

Just don't even buy insurance. The best thing Trump did was remove that fucking ludicrous penalty for abstaining from all this. You even alluded to being able to negotiate on your own behalf without insurance.

That's actually the best way to fix all this shit. Maybe even the only way. Old school collective bargaining.
 
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