Rand reconfirmed

Let me outsource the following reconfirmation of the Rand Insurance Experiment central insight to Vox:

The idea was that higher deductibles would make patients become smarter shoppers: If they had to pay more of the cost, they’d likely choose something closer to the $1,529 appendectomy than the $186,955 appendectomy (yes, some hospitals really do charge that much). This would push the really expensive doctors to lower their prices so cheaper physicians didn’t steal their business.

This was, however, just a theory. And a massive new study suggests it might have been all wrong….

Economists Zarek Brot-Goldberg, Amitabh Chandra, Benjamin Handel, and Jonathan Kolstad studied a firm that, in 2013, shifted tens of thousands of workers into high-deductible insurance plans. This was a perfect moment to look at how their patterns of care changed — whether they did, in fact, use the new shopping tools their employer gave them to compare prices.

Turns out they didn’t. The new paper shows that when faced with a higher deductible, patients did not price shop for a better deal. Instead, both healthy and sick patients simply used way less health care.

People suck at deciding whether or not a procedure, process, prescription or surgery is high value care of meaningless care.  Having to pay several thousand dollars to find is an excellent deterrent from getting any care as people will quickly be forced to make decisions between getting needed and high value care and paying the mortgage/rent.  Unless I have a sucking chest wound, I am paying the mortgage until I absolutely can’t avoid or ignore a problem.

This was the central finding of the Rand Insurance Experiment — cost sharing does a great job of reducing utilization.  It does a horrendous job of only getting rid of low value treatments and procedures.  High deductibles and cost sharing are a utilization control system not an effectiveness optimization system.

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190 replies
  1. 1
    Tim C. says:

    Yes, to our plutocrat overlords, this is a feature, not a bug.

  2. 2
    Kylroy says:

    “This would push the really expensive doctors to lower their prices so cheaper physicians didn’t steal their business.”

    Because people are great at doing hard-line negotiating when they’re on the verge of death.

  3. 3
    Keith G says:

    The most basic intro to how markets work expound about the need for abundant and clear information. Having shopped around for a medical professional do a simple procedure, I have found that one can spend hours and then more hours and still not reach the desired end goal.

    One tends to give up.

  4. 4
    Mack says:

    Absolutely this is the case, my family is living out those very choices. We are approaching 60, so more frequent check-ups are in order…but they are so damn costly we can’t pay both the premiums and the deductible AND the eventual out of pocket 20%. I don’t mind paying higher premiums if it means people with pre existing conditions can get coverage, but every health related cost we have has skyrocketed, and yes, sometimes it’s the mortgage/medical bill choice we face.

  5. 5
    pat says:

    I have never understood how a patient should become a better informed “shopper” when it comes to health care. I live in a city with two hospitals/clinics. I’m supposed to compare the price of all their procedures? X-rays, hip replacement, annual physical, and determine which is CHEAPER???

  6. 6
    Peale says:

    @Keith G: And if that goal is to find something affordable it may be pointless to keep going. I could shop for a Maserati. Once I find out the price from a dealer, I can shop around to see if I can find one that is cheaper, but honestly, why would I think I’d eventually find one that was the same price as my Camry?

  7. 7
    gogol's wife says:

    OT, but what do you do if you have a visitor from a foreign land, the kind of foreign land that provides medical services to its citizens within its borders, but doesn’t extend that when the person travels? Is there a company you recommend for short-term medical for visitors from abroad? I just spent 25 minutes on hold with the only one I could find, and I’ve given up. They don’t seem to answer the phone, which doesn’t give me a good feeling about dealing with them.

  8. 8

    You and your silly data.

  9. 9
    geg6 says:

    I know that it’s true for me. Since our deductibles have gotten so high, I don’t go to the doctor unless I’m dying. Which I rarely am as I am, as my sisters say, unnaturally healthy.

  10. 10
    mtiffany says:

    All these invisible-handjob-of-the-free-market theories rest on two easily refutable assumptions: 1) all parties in the market have equal access to all the information necessary to make a rational decision and the same intellectual capacity to reach it and 2) all people at all times behave rationally. First, some people are smarter than others. Second, Fox ‘News’ Channel.

  11. 11
    JPL says:

    I read the article earlier. Bush’s plan wants to set up an Uber model, where you can call doctors if you are sick.
    He’s also pushing high deductibles, in order to lower costs.
    MSM will ask him about it soon.

  12. 12
    hoodie says:

    If they had to pay more of the cost, they’d likely choose something closer to the $1,529 appendectomy than the $186,955 appendectomy

    I’m sure people comparison shop on appendectomies. It takes a think tank to confirm what is blindingly obvious? Shows the extent to which simplistic pop economic theory has penetrated into the public psyche.

    And a massive new study suggests it might have been all wrong

    Suggests it might? Really.

  13. 13
    japa21 says:

    There are, of course, several problems with trying to shop around for care. In theory, you can check to see what a provider’s contracted rate is with the insurance company. But they will want to know procedure codes, etc. You can’t just say, for example, hernia repair as there are several codes related to that.

    Additionally, you don’t know what codes a doctor is going to use until you see the provider by which time, it is too late. If people were able to self-diagnose and develop their own treatment plans ahead of time, then it is easier, but of course, that is a rather unreasonable expectation to have.

    But let’s assume you found a doctor and he/she was reasonable in terms of charges/insurance reimbursement rates. Then you find out you need to go into a hospital. Well, you are limited based upon which hospital the doctor is on staff at. He may be reasonable but the hospital is not so it doesn’t make any difference.

    Of course, one of the things about the high deductible is that, if you have to go into the hospital, it will get eaten up pretty quickly, but then you still have the co-pay until you hit your out-of-pocket maximum.

    So the whole theory of high deductible creating better consumers was doomed from the start. Of course, I tend to believe that was never the real rationale. The real reason for high deductible is to lower the premium to make a policy easier to sell, frequently to employers who then keep their employees’ contribution the same but reduce the cost to themselves.

  14. 14
    kc says:

    “Let’em die!” – the GOP base.

  15. 15
    Peale says:

    @JPL: Ohhh. We’re using a hot trendy company name.

  16. 16
    Calouste says:

    @japa21: Yep. Basically when you shop for healthcare, you don’t know exactly what you are going to buy, and the salesman charges heavily for identifying what you need and the estimate, which may or may not bear resemblance to what they are actually going to charge.

  17. 17
    Grumpy Code Monkey says:

    What good would it do you if the cheaper option was out of network?

  18. 18
    beltane says:

    @Calouste: And in most cases the customer is in no condition to walk away and say “I’ll get back to you.”

  19. 19
    Brachiator says:

    Turns out they didn’t. The new paper shows that when faced with a higher deductible, patients did not price shop for a better deal. Instead, both healthy and sick patients simply used way less health care.

    I don’t understand how a person is supposed to be able to price shop for a better deal. How would they get relevant information? How would they know how much time they had to make a decision before the medical problem they had became critical?

    I also do not see how the problem goes away under alternative health systems. Would all hospitals charge the same price? Even if the government simply pays for the procedure, how would anyone know whether the price paid was reasonable?

  20. 20
    sukabi says:

    @Kylroy: not only that, prying the cost info for procedures out of hospitals, doctors is an exercise in futility, especially when you also have a job, kids and other responsibilities to take care of…oh, and are the other doctors, clinics, hospitals in your network or not.

  21. 21
    Gene108 says:

    Considering providers do not know what their costs actually I never fully understood – even 10 years ago when high deductible plans were proposed – how to actually comparison.

  22. 22
    beltane says:

    @sukabi: Compiling a price list for all procedures, facilities, providers, etc. in a given area would be a full-time job for a dedicated team of professionals. How on earth is an individual, especially an unwell individual unfamiliar with medical billing practices supposed to obtain this information? This is not a case of faulty assumption, it is a case of malevolence. The intent of cost-sharing is to discourage people from receiving healthcare. Period.

  23. 23
    Mike J says:

    When there’s one price if you walk in off the street and another price you never see but is what actually gets paid by the insurance company, how are you to comparison shop?

  24. 24
    azlib says:

    I had a HDP with and HSA for a number of years when I was self-employed. In my case I had enough finacial resources to pay the deductible out of pocket. It turned out the HSA was useful, but only because I could put away a fair number of dollars into it to use later on when I had real employer insurance.

    I always thought of this model as a SOP to the upper middle class and upper class, since they were the only groups who could take advantage of the tax deductiblity of the HSA. I figured the Feds paid aorund 25% of my out of pocket medical costs for about 4 years.

  25. 25
    jl says:

    @Brachiator:

    ” I also do not see how the problem goes away under alternative health systems. Would all hospitals charge the same price? Even if the government simply pays for the procedure, how would anyone know whether the price paid was reasonable? ”

    If we take Switzerland, the system that most resembles the private sector health care market we have here:

    Insurance coverage: everyone has identical mandatory basic insurance policy, don’t have to worry about in or out of network stuff
    Quality: all procedures and protocols have to pass a cost-effectiveness test or they are not covered
    Price: all providers are allowed to have set prices within a range deemed reasonable by federal government. If a provider requests a price for a service outside that range, it has to undergo a complete audit to uncover reason for exception before approval.

    So, that takes care of a lot of the problem. A remaining problem is variation in quality of provision of federally approved drugs, procedures and protocols covered services.

    I heard a news report about a study of price variations for outpatient services of identical services within metropolitan areas. Prices for the same service can vary by a factor of 7 or 8.

    And as a commenter mentioned above, impossible to get anything resembling a price quote for something that requires admission to a hospital. Insurance companies and medical clinics can get a binding ‘price quote’ for a unit of service if they promise to make a certain quantity of referrals (aka I’ll send you all the appendectomy cases you want, but you have to provide them at grand a pop), but not an individual.

    When ‘consumer driven health care’ is used in the sense of shopping around for care like you do for cars or furniture, the word ‘scam’ comes to my mind.

  26. 26
    beltane says:

    @jl:

    When ‘consumer driven health care’ is used in the sense of shopping around for care like you do for cars or furniture, the word ‘scam’ comes to my mind.

    You are kind. For many Americans, “Consumer driven healthcare” is the functional equivalent of “murder committed during the commission of a robbery.”

  27. 27
    jl says:

    @beltane: You are correct, some scams are deadly.

    Forgot to say that Switzerland does not allow anything like our high deductible high cost sharing in its mandatory insurance plan. But those 3 policies would make shopping around for care here less intractable.

  28. 28
    Schlemazel says:

    People do not shop for medical care. You choose a doctor and if s/he tells you you need an appendectomy you go the the hospital they used & have it done. You don’t ask for an estimate and then call 10 other doctors to compare. Nobody does that.

    Add to that the simple fact that all medical costs are pure bullshit to start with (yes, the bill comes to $186,000 but the insurance company agrees to pay $1860 and your co-pay is $500 and the rest just disappears for some odd reason. Of course if you don’t have insurance you are screwed because they want their full amount from you. What you end up with is a system where the user has no control over the actual costs.

  29. 29
    SatanicPanic says:

    This is one of those things where they’re like “Freedom!” but fuck that, if doctor shopping is freedom then I don’t want freedom

  30. 30
    Edmund Dantes says:

    This one falls under “water is wet”. It’s only when you divorce yourself completely from people that actually make decisions that you get anywhere near the idea of a HDP leading to better more informed medical choices.

    The tell (and is always the tell in any of these it’ll be better things) is what are the assumptions they are using. As soon as I saw the assumption was it’ll force people to shop around (independent of any ability to actually shop around), I know the fix was in.

    It was like Roberts and the rest of the SC saying “this is unconstitutional, it’ll cause pain, and it just requires congress to fix it, so no worries” when they know it’s not going to happen.

  31. 31
    joel hanes says:

    Market price signalling produces only perverse results in healthcare.

    This principle appears to be almost as inescapable as the Second Law of Thermodynamics.

    Republicans will ignore or deny it to their last breath.

  32. 32
    SatanicPanic says:

    @Brachiator: yes everyone gets paid the same for the same procedure. If enough doctors go out of business, you’re not paying enough and you raise payment rates. I’m pretty sure that’s how it works in Japan.

  33. 33
    Shana says:

    @japa21: Not to mention that it’s not just what the doctor charges, there’s also the anesthesiologist, the room charges at the hospital, etc. etc. etc. And, you need that operation NOW, not after you’ve spent several days or weeks trying to get the right people on the phone to tell you what they charge, which IS F’ING IMPOSSIBLE.

  34. 34

    @Mike J:

    Add in the fact that every insurance company has a different negotiated price for that procedure, and it gets even more complicated. My spouse worked in healthcare for 20 years and can tell you firsthand that there’s no such thing as “the price.” Even the list price isn’t necessarily what you’d pay if you had no insurance — there’s usually a separate “cash payment” price that you can ask about when you’re uninsured IF you know to ask.

  35. 35
    SRW1 says:

    OT:

    Apparently, several Brinks trucks full of cash have failed to find their way to JEB! HQ.

    Paging R2R: your help needed to form a search party!

    (Trigger warning: Politico link!)

  36. 36
    Villago Delenda Est says:

    You’re not buying a fucking portable hard drive, here.

    You’re not going to cost compare on something like this. You go to your doctor you trust, he sends you to a specialist, and you don’t dicker over the bill…as if anyone can tell you up front what the bill will be in the first place.

    This is not like shopping for cans of beer at the Piggly Wiggly, for the love of Adam Smith…

  37. 37
    Southern Goth says:

    @Schlemazel: Insurance companies have largely pushed the idea that charging a person without insurance less than what the provider would bill to the insurer as fraud.

    In some states, like Texas, it is even criminal to do so under insurance fraud laws.

    This is of course bullshit, since most providers and payers have negotiated contractual amounts in advance for services. This is a loose use of negotiated. More like payers have mandated the contractual amounts for individual providers and smaller groups.

    It turns out the larger groups of providers and hospitals have the clout to negotiate higher contractual amounts.

  38. 38
    Bobby Thomson says:

    It’s rationing and death panels. And frankly, I think the people designing it don’t really care that is the result, to the extent they don’t see it as a feature.

  39. 39
    Karen says:

    I wonder what would happen if MSM asked the RWNJ what will happen to the cute little girl with leukemia whose family’s is unable to afford insurance, then show little Molly? That’s what you do. It’s easy to say, “Let them die” when it’s an abstract human they can shape into whatever stereotype they want. But when you have actual photogenic children as the victims?

    PEOPLE CARE.

  40. 40
    jl says:

    @Edmund Dantes:

    ” This one falls under “water is wet”.”

    Maybe so. The important policy question is whether the cut back in utilization reduces welfare or not. if it does not, then consumers consume too much unneeded care, and this has been the unstated assumption of most US health care policy analysis from mid 1970s to ACA passage. If it does, then this kind of consumer driven health care policy does not work and we should not do it.

    The Rand health study had data on outcomes in addition to data on prices and choices. Most policy wonks and pundits taking a superficial look at the outcomes concluded that the reduction in care did not result in reduction in overall health, so the Rand health experiment was used to support idea that there was a huge amount of unneeded care in US, and making consumers put more skin in the game was a good idea.

    But, the PI, Joseph Newhouse pointed out this was not really justified for several reasons. For ethical reasons the Rand subjects were all relatively healthy, and the plans with the highest deductibles and cost sharing were less stringent than seen in the market place (they had lower stop loss than actual real world plans, and exceptions for those whose health may have become at risk during the experiment). And finally, there was evidence that among the poor who were sick, the cut back in utilization increased mortality rate, especially for those with chronic illness like serious hypertension.

    I suppose what is not ‘water is wet’ about both results is the indiscriminate nature of the cutbacks in utilization, consumers don’t seem to cut back on care that is most optional and care that is most needed to maintain health. They just blow off everything.

    Newhouse has done a lot of follow up work on why this is. Most of it seems to be information problems, difficulty in finding a binding quote and lack of market transparency, and part of it is difficulty in understanding the benefit design, that is pretty complicated.

    Thanks to RM for pointing out an interesting paper.
    A free version is available at one of the author’s websites:

    BEN HANDEL
    http://eml.berkeley.edu/~bhandel/

  41. 41
    Roger Moore says:

    @Keith G:

    Having shopped around for a medical professional do a simple procedure, I have found that one can spend hours and then more hours and still not reach the desired end goal.

    And heaven help you if you want a complicated procedure. A friend of mine had surgery and wound up getting adjustments to her bill one and two years after the procedure. If the hospital where the procedure is performed can’t tell you how much it cost until years after it was done, how can you possible compare prices?

  42. 42
    Keith says:

    Lower utilization is another way of saying patients are not getting the care they need.

    Now, in the days pre-ACA, our system was tagged as forcing the under- and uninsured to leave off needed care. Which was bad. Because a health condition can become worse. At which point the patient needs care – only now with procedures that are more expensive, because the condition is worse.

    Having “skin in the game” is a piss-poor way of controlling costs, it is an even worse means of dispensing care.

  43. 43
    Roger Moore says:

    @mtiffany:

    1) all parties in the market have equal access to all the information necessary to make a rational decision and the same intellectual capacity to reach it

    And equal negotiating leverage. You can be rational, perfectly informed, and still unable to negotiate effectively if you’re dealing with a monopoly or oligopoly, under extreme time pressure, or otherwise at the mercy of your negotiating counterpart.

  44. 44
    jl says:

    @jl:

    meant to type

    ” I suppose what is not ‘water is wet’ about both results is the indiscriminate nature of the cutbacks in utilization, consumers don’t seem to cut back MOST on care that is most optional and LEAST ON care that is most needed to maintain health. They just blow off everything. “

  45. 45
    Southern Goth says:

    I’d add that generally the provider performing the service has no idea even exactly how a procedure is going to be coded. This is in no small part because payers are often the arbitrators to how something is coded, that is, different payers will apply different criteria to the same procedure to determine the code they will pay for.

  46. 46
    Villago Delenda Est says:

    @Karen: If the photogenic little toddler is blah or brown, the teabaggers would still say “let them die”.

    Even if the kid is white, and parents can’t afford the treatment, well, that’s God’s way of culling the herd of the immoral poors.

  47. 47
    jl says:

    @Southern Goth: That’s a good point, and I wonder if anyone has taken a careful look at that provider strategy. They can adjust their total reimbursement to account for patients who bargain with them for a lower price, or if they have a lower public ‘list price’ by up-coding.Maybe the latter approach would be considered fraud, or maybe no, I don’t know. But seems like it could be used for patients who somehow bargain for lower prices.

  48. 48
    trollhattan says:

    O/T I have long {heart} Julianne Moore, but now just that much more. This, of course, will only feed Huckabee’s (et al) contention that the out-of-touch coastal elites render their states irrelevant in the national conversation on why America is the most awesomest, full stop (never mind the Elite States comprising vastly more Americans than his flyover mouth-breather cohort).

    A group of Hollywood stars, led by Oscar-winner Julianne Moore, have launched a campaign to raise awareness for the importance of gun safety.

    According to BBC News, Moore said she and her colleagues started the campaign because they were “shocked and saddened by the loss of life, and the daily increase of gun violence in our beautiful country.”

    79 high-profile actors and artists have signed up to the Everytown Creative Council movement that Moore chairs, including Jennifer Lawrence, Steve Carrell, Yoko Ono, Gwyneth Paltrow and Ellen DeGeneres. “I was going through my address book alphabetically. That’s all I did. ‘Please, are you interested,’ and the response has been overwhelming,” Moore said in an interview with People magazine.

    “This year it’s expected that gun deaths will overtake traffic fatalities in America,” reads a statement on Everytown Creative Council’s website. “We’ve taken deliberate action to help reduce motor vehicle deaths—adopting seatbelts and airbags, cracking down on texting while driving and holding drunk drivers accountable. And it made a big difference. We know how to save lives from gun violence, too.”

  49. 49

    @japa21: Exactly. This has always been about businesses passing costs on to employees.

  50. 50
    Eric S. says:

    @Shana: Even if you could do around for the doc, the Anesthesiologist, the hospital, etc, etc, now try to get them to coordinate schedules.

  51. 51
    Brachiator says:

    @jl:

    If we take Switzerland, the system that most resembles the private sector health care market we have here:

    Interesting info. Thanks.

  52. 52
    Southern Goth says:

    @jl: “List price” is Usual and Customary. It is a number usually keyed into the system based on some number like 7 to 20 times Medicare contractual amounts. Providers almost never expect to collect that, but want to make sure that they’re charging more (on paper at least) so that they are above whatever contractual amounts they have negotiated with each payer. Otherwise, the payer will probably pay the smaller of the two.

  53. 53
    Gian says:

    @hoodie:

    when you see what looks like a stupid frivolous study done to prove something obvious, you have to stop and think “why did they take time and money to do this study?”
    the answer is that there’s a common sense solution to the problem addressed in the study but some assholes don’t want to do it.

    See the GOP and global warming. My first realization of this was in high school when I read there was a study which showed homeless kids get sick more often than kids with homes, I mean that’s f-n obvious, but if you can’t prove it, getting some GOPer to agree to spend money to get healthcare to homeless kids will get you a “it’s not a problem” answer

  54. 54
    Baud says:

    I got a great deal on my vasectomy.

  55. 55
    jl says:

    @Southern Goth: Thanks. I am not an expert on the administrative details of billing, but when I look at those lists, there are usually several almost identical procedures often with quite different ‘list prices’. And for any complicated service with several separately billable items, the provider can play billing code game with services that have different deductibles and co-pays.

    @Gian:
    Also, if you are forced to kluge up something that halfway works in a crummy system, you need to know how people make decisions, and what changes will help rather than make the situation worse.

    I think Health Affairs is free to public, and if you look around the articles that look at what puzzling decisions patients make when they do have to shop for insurance or care with skin in the game. Some of it shows where the information break down occurs. Can start by searching for recent articles with Joseph Newhouse as author and then go from there.

    http://www.healthaffairs.org/

  56. 56
    hells littlest angel says:

    If I’ve got a $5000 deductible, what the hell difference does it make to me if I take the $10,000 appendectomy or the $150,000 appendectomy?

    A $1,500 appendectomy? Who does that? Dr. Nick Riviera? Doc Benway?

  57. 57
    BillinGlendaleCA says:

    @Baud: Sure it works(or doesn’t it this case)?

  58. 58
    Germy Shoemangler says:

    @hells littlest angel:

    Doc Benway?

    With his teeth.

  59. 59
    raven says:

    Great sports night getting underway!

  60. 60
    Baud says:

    @BillinGlendaleCA:

    I’ll let you know when the itching and swelling subside.

  61. 61
    Germy Shoemangler says:

    @Baud: in time for the next debates?

  62. 62
    Baud says:

    @raven:

    How much you think Atlanta will beat my Saints by?

  63. 63
    Baud says:

    @Germy Shoemangler:

    I’ll tape it up if I need to.

    My campaign has become a little moribund. I need to do something splashy.

  64. 64
    Southern Goth says:

    @hells littlest angel: The spoon used will cost another $1000.

  65. 65
    Germy Shoemangler says:

    Elvis Costello has written a memoir.

    Also, Bruce Thomas (former bassist for the Attractions) has written a memoir.

  66. 66
    Monala says:

    This doesn’t even address the fact that it’s not always possible to find out in advance how much something will cost. When I’ve asked doctors about the cost of the procedure, they tell me they have no idea, and to talk to my insurance company.

    When I ask my insurance company, they also say they have no idea (they can tell me how much of the procedure they will cover, but not the total cost). They say this is because doctors charge different prices, and they have no way of knowing in advance whether the doctor will tack on additional services or tests, or if something will go wrong that drives up the cost, etc.

  67. 67
    GHayduke (formerly lojasmo) says:

    I’m waiting for A Guy to weigh in.

  68. 68
    PurpleGirl says:

    @Karen: The RWNJs would say the family and their community can hold spaghetti dinners and pancake breakfasts to raise the money or the doctor can try to get the kid taken care at St. Jude’s Children Hospital. (Family still needs those dinners and breakfasts to afford their hotel/motel accommodations while the kid in the hospital, however.)

  69. 69
    Mike J says:

    @PurpleGirl:

    or the doctor can try to get the kid taken care at St. Jude’s Children Hospital.

    Note that if the family has any insurance, St Jude will bill them until the insurance goes away (which I guess under ACA could be a lot longer). But the family won’t have to pay anything.

  70. 70
    raven says:

    @Baud: Any given day. Auburn is running up and down on a pretty goof UK D.

  71. 71
    Roger Moore says:

    @Keith:

    Lower utilization is another way of saying patients are not getting the care they need.

    Not necessarily. Some patients are probably getting unnecessary care, especially unnecessary lab tests that just coincidentally happen to be performed by a lab that their doctor has an equity stake in. The real problem is that even if patients are getting unnecessary care, they’re probably poorly situated to tell which care is and isn’t needed. They’ll skip going to the doctor because they think something is minor, only for it to blow up into a serious problem, but they’ll accept what their doctor tells them they need even when he’s just milking them for profit.

  72. 72
    Germy Shoemangler says:

    @PurpleGirl: I see that all the time on my local news. Some big charity event to help cover treatments for children with life-threatening illnesses, or firefighters who have been hurt on duty.

    Always makes me wonder what a visitor from Canada or the UK thinks about our system.

  73. 73
    redshirt says:

    One of the benefits of being immortal, that you don’t often consider, is the 0$ dollar health care needs. No cancer no diabetes no leprosy etc. Clean living forever. BUT!

    Maybe you have some emergency insurance, just in case some weirdo has that sword that can maybe kill you according to some destined health insurance policy?

    Should I just contact Lloyd’s of London for the strange policy? Or can my neighborhood State Farm or competitor take care of it?

    – Asking for a friend in Topeka

  74. 74

    @Germy Shoemangler:

    Since Costello and Thomas hate each other, it should make for an interesting compare and contrast.

    It’s generally accepted that Costello’s scathing pop song “How To Be Dumb” is about Thomas. He’s also the only member of the Attractions that Costello hasn’t worked with again.

  75. 75
    Ella in NM says:

    This was, however, just a theory. And a massive new study suggests it might have been all wrong….

    It wasn’t a “theory”, it was a frigging rationalization, a pipe dream, a delusion in the minds of anyone who thought that the majority of Americans had even a TIDBIT of choice in what they end up paying for their health care. $3500 and $5500 and $12000 dollar deductibles paired with 20-30 or 50% coinsurance costs were dreamed up by people who know just exactly how to squeeze the toothpaste tube from the bottom up, to enrich the CEO’s/CFO’s, board members and shareholders.

    And not only that, they put the cart in front of the horse, asking consumers to be “penny-wise” with these outrageous deductibles and coinsurances long before they made the providers have transparency and accountability for the costs they bill patients.

    This is why “Obamacare” as it is cannot stand. It’s morally indefensible, unjust and economically wasteful. And it’s why healthcare simply MUST be as “socialized” and non-profit in it’s overall function in a modern society, just like Social Security and the public schools. Yes, there can be and are opportunities within that framework for private competition and innovation, but never the main system and NEVER more important than the health and welfare of the people receiving healthcare.

  76. 76
    Germy Shoemangler says:

    @Mnemosyne (iPhone): In one review I read (rollingstone) it seems Elvis speaks kindly of Thomas. Praises his bass playing and what he brought to the band.

    I’m interested in reading them both.

  77. 77
    PurpleGirl says:

    @Mike J: Yes, I know that St. Jude’s provides basically free care, but you still have to get the kid into St. Jude’s. I don’t know what that process is, but there is a process and it isn’t a complete solution for every sick kid.

  78. 78
    trollhattan says:

    @Germy Shoemangler:
    We had a big fundraiser for a friend with cancer. He was self-employed and ACA was not yet off the ground. It was well attended, folks bid like crazy on the auction items and our friend was astonished and grateful for the tremendous support, but I felt wow, is this the actual cost of becoming terribly ill in the US? How do the shy and the unpopular get help?

  79. 79
    Mike J says:

    @Germy Shoemangler:

    Always makes me wonder what a visitor from Canada or the UK thinks about our system.

    The biggest show on TV for years was about an American who needed health care and turned to dealing meth.

  80. 80
    Germy Shoemangler says:

    @trollhattan:

    How do the shy and the unpopular get help?

    It’s interesting you mention that. I remember wondering the same thing.

    I have contributed to pancake breakfasts and purchased raffles to help the ill and injured. But there are folks who keep to themselves who would not enjoy the same “outpouring of support” I always read about in my local news. It would be more “we didn’t even know he was sick!” accompanied by a photo of the deceased being carried out in a stretcher.

    It’s a disgusting system. I should go and call a bunch of doctors and hospitals and see if I can get some price quotes from the idiots they barely pay to answer the phones. Or maybe I can get answers from the automated voice systems.

  81. 81

    @Germy Shoemangler:

    Costello can afford to be nice since the song probably still stings Thomas in a delicate place on inclement days:

    https://countdownkid.wordpress.com/2013/02/15/elvis-costello-countdown-24-how-to-be-dumb/

    But it should definitely be interesting to read both books.

  82. 82
    Mike J says:

    @PurpleGirl: I was actually pointing out that it’s not really “free”, just no direct cost to the patient. Back when your insurance could be cancelled if you dared to use it, it sort of sucked that they would bill your insurance company until they dropped you.

  83. 83
    Roger Moore says:

    @Mike J:

    The biggest show on TV for years was about an American who needed health care and turned to dealing meth.

    Hence this classic cartoon.

  84. 84
    John Revolta says:

    @Germy Shoemangler: I read Thomas’ book (The Big Wheel) some years ago. I think it was a big part of why he became the Former Bass Player.

  85. 85
    Germy Shoemangler says:

    @John Revolta: Thomas’ new book is called “Rough Notes: Dancing About Architecture”

  86. 86
    PhoenixRising says:

    @Ella in NM:

    This is why “Obamacare” as it is cannot stand. It’s morally indefensible, unjust and economically wasteful.

    Think your talking points got scrambled en route there.

    Presbyterian’s HDHP, which was the only insurance I could afford before the subsidy from ‘Obamacare’, tried to kill me, when I was finally too scared about my symptoms to *not* go get diagnosed by an in-network provider.

    Because I had a rare disease that no provider in their network was unwilling to treat, they told me to go pound sand. Have a bake sale. Borrow from my relatives. Use the money in my HSA and then declare bankruptcy when the bills came in.

    While HDHPs indeed discourage use of medical care, the point is that I was discouraged all the way to a DX *after* the disease became life-threatening. And that ended up costing everyone more.

  87. 87
    mclaren says:

    Economists Zarek Brot-Goldberg, Amitabh Chandra, Benjamin Handel, and Jonathan Kolstad studied a firm that, in 2013, shifted tens of thousands of workers into high-deductible insurance plans. This was a perfect moment to look at how their patterns of care changed — whether they did, in fact, use the new shopping tools their employer gave them to compare prices.

    Turns out they didn’t. The new paper shows that when faced with a higher deductible, patients did not price shop for a better deal. Instead, both healthy and sick patients simply used way less health care.

    Anyone with a nervous system realizes this. The entire purpose of high deductibles is to shut off access to health care to low-income people, thereby killing them as quickly as possible. The American health care system has a simple philosophy: if you get sick and don’t have lots of money, you need to die as quickly as possible.

    Richard Mayhew has been energetically arguing for this broken model of healthcare delivery for years now. How about we just jump to the chase? A new nationwide insurance system in which, as soon as a hospital or doctor report that a patient has become sick, a corporate SWAT team gets dispatched to murder hi/r.

  88. 88
    PurpleGirl says:

    @Mike J: Ah. Okay. I didn’t know that, only what you hear on the commercials and when they are asking for donations.

    I know back in the mid-1970s when I did an internship at Memorial Sloan Kettering (in the Pediatrics Playroom) there was a young child there who had cancer in her jaw. She came from Baltimore and her parents couldn’t come and visit her all that often, she had an Aunt in NJ, but again the woman wasn’t able to visit all that often. (I have no idea how the bills were being covered.) But I know that she attached herself to me and the nurses asked me to visit her in her room after she had surgery. She was lonely and the nurses were concerned about her feelings. My supervisor in the playroom scolded me for visiting her but I replied that I was visiting her on my OWN time and I wouldn’t stop. Misty perked up after I visited her and the nurses were so thankful I was willing to help.

    I’ve known for a long time how messed up our “systems” and “processes” are.

  89. 89
    Bobby Thomson says:

    The whole idea of Welfare Queen patients is just disgusting. Other than most cosmetic surgery, people get medical treatment because they need it, not because it’s recreation. If you want to lower costs, either increase supply or artificially cap prices – don’t tell sick people they can’t use the services.

  90. 90
    C.V. Danes says:

    After having my multibillion dollar, multinational conglomerate push everyone to high deductible plans, I can state first hand how much they truely suck.

  91. 91
    C.V. Danes says:

    @Ella in NM: Yup. Same people who dreamed up the great 401k experiment. With the same results.

  92. 92
    John Revolta says:

    @Germy Shoemangler: Mmm. Based on the other one I may have to give it a pass.

  93. 93
    Mike J says:

    @PurpleGirl:

    Okay. I didn’t know that, only what you hear on the commercials and when they are asking for donations.

    Don’t get me wrong, they do great stuff. My little brother got 8 years he wouldn’t have had without them. Even so, my family’s finances were completely screwed from having no insurance, even though the free hospital was in my hometown.

  94. 94
    Shana says:

    @PurpleGirl: Bless you for that.

  95. 95

    @C.V. Danes:

    I’ve really lucked out — probably due to existing union contracts, the Giant Evil Corporation I work for has not forced us all onto high deductible plans. I was able to add my (now) graduate student spouse to my plan (which is equivalent to Gold) for less than a Bronze Exchange plan would have cost him (we are not eligible for subsidies). If I did not work in an industry that still has strong unions, we would probably be screwed.

  96. 96
    WereBear says:

    It’s flat out ridiculous to talk about healthcare as a consumer item.

    No one wants to consume it. There is no way to figure out the prices. And if you get something on super sale it can kill you.

    The concept is stupid and should be called out as such.

  97. 97
    All In says:

    GOP platform: let them die unless they’re our elderly supporters, then keep your government mitts of my Medicare.

  98. 98
    BillinGlendaleCA says:

    @WereBear:

    No one wants to consume it. There is no way to figure out the prices. And if you get something on super sale it can kill you.

    Well said.

  99. 99
    Germy Shoemangler says:

    @WereBear: And when a person is at their most vulnerable… sick, elderly, dying, in crisis, severely injured, unconscious… we’re still regarded as “consumers” who are expected to make rational decisions (without all the necessary information of course) about healthcare.

    It’s a disgusting, rigged game.

  100. 100

    @John Revolta:

    Click on my link above — Costello wrote his song in response to Thomas’s first book. One of my favorite parts:

    Trapped in the house of the perpetual sucker
    Where bitterness always ends so pitifully
    You always had to dress up your envy
    In some half-remembered philosophy

    Ouch.

  101. 101
    Germy Shoemangler says:

    @Mnemosyne (iPhone): Yes! Basically calls him a coward; tells him “you could have walked out anytime”

    … Makes Lennon’s “How Do You Sleep” sound like a love song to Paul.

  102. 102
    Thoughtful Today says:

    “People [who are not Doctors, which most ‘people’ aren’t,] suck at deciding whether or not a procedure, process, prescription or surgery is high value care of meaningless care.”

    The insurance system is a predatory system that enriches leaches.

    Some are paid to tell you otherwise.

  103. 103
    redshirt says:

    Injuries in the NFL equal commercial timeouts ergo the networks must root for them, and thus the NFL.

  104. 104
    beltane says:

    If healthcare is a consumer item, why do we have EMT’s maintained at the public expense? I don’t believe we do this for broken consumer items. Anyone arguing that healthcare is a consumer item like a car or espresso maker is a dishonest ghoul using the threat of death to extort as much money as possible from the non-wealthy.

  105. 105
    hilts says:

    When will someone put up a thread for the Dodgers Mets game?

  106. 106
    PurpleGirl says:

    @Shana: Misty would come in to the Playroom and want to play Super Heroes — she loved comics and Superman and all the others and envisioned herself as one. I found her delightful and lively and was sorry she didn’t often has visitors.

  107. 107
    All In says:

    @SRW1:

    R-E-L-A-X. Relax.

    That’s all I have to say to those that think Jeb is dropping out or in trouble.

    He’s in it for the long haul, and after we get a real poll out of NH since the #AdSurge we will get a true picture. There has not been a poll in NH since October 8th.

    #AllInForJeb

  108. 108
    John Revolta says:

    @Mnemosyne (iPhone): Well in The Big Wheel he (Thomas) comes off like a bit of a supercilious snot………..the title of the new one obviously refers to the old saw “Writing about music is like dancing about architecture” and is somehow not encouraging.

  109. 109
    redshirt says:

    @All In:

    @SRW1:

    R-E-L-A-X. Relax.

    That’s all I have to say to those that think Jeb is dropping out or in trouble.

    He’s in it for the long haul, and after we get a real poll out of NH since the #AdSurge we will get a true picture. There has not been a poll in NH since October 8th.

    #AllInForJeb

    Is this the new and improved Right to Rise?

  110. 110
    Baud says:

    @redshirt:

    Who knew trolls etch-a-sketch?

  111. 111
    beltane says:

    @redshirt: New maybe, I’m not sure about the improved part.

  112. 112
    gene108 says:

    @Mingobat f/k/a Karen in GA:

    No offense, but what choice do businesses have other than dumping costs on employees, when the cost of health insurance has triple or quadrupled for many employers over the last 15 to 20 years?

    I am just looking at premiums and not comparable benefits.

    The $10 co-pay plan, with no deductible cost an employer $100/month in 1998 for a single employee. In 2015, a high deductible plan, with a $2000 deductible for an employee and 80/20 co-insurance after the deductible costs $350/month.

    If we can bring down the cost of health care, we can have better insurance policies.

  113. 113
    Southern Goth says:

    @All In: Jeb?’s campaign is looking like Terry Schiavo, except when he’s ready to pull the plug, no one will stop him.

  114. 114
    Mike J says:

    @All In:

    since the #AdSurge we will get a true picture

    Politico

    In New Hampshire, seen by many as a must-win for Bush, Bush and the Right to Rise super PAC backing him have spent at least $4.8 million on TV and radio to support him since early September. One ad-tracking firm produced an analysis for POLITICO that showed pro-Bush spots in the past three weeks have occupied about 60 percent of the political ad air-time in the state. Bush’s numbers have moved from 9 percent to 8.7 percent since the ad blitz began, according to the Real Clear Politics averages of polls in the GOP primary.

    (emphasis added)

    If he buys enough airtime, he could go into negative numbers.

  115. 115
    All In says:

    @redshirt:

    I got banned.

    But I’m back. And I’m back y’all. I’m backity-bickity-backit back back cause I’m BACK.

    And soon Jeb will be BACK in NH after the #AdSurge.

    So what else is up my niggas?

  116. 116
    redshirt says:

    @beltane: New is always improved.

  117. 117
    All In says:

    @Mike J:

    No poll since 10/8. We don’t know the true impact yet.

  118. 118

    @John Revolta:

    And since there’s a famous Costello quote with him using that phrase …

    (Though Costello denies inventing it and Martin Mull appears to be the actual originator.)

  119. 119
    redshirt says:

    @All In:

    @redshirt:

    I got banned.

    But I’m back. And I’m back y’all. I’m backity-bickity-backit back back cause I’m BACK.

    And soon Jeb will be BACK in NH after the #AdSurge.

    So what else is up my niggas?

    I wonder who banned you. It doesn’t seem fair.

  120. 120
    some guy says:

    Breaking: Jeb donors continue to flee ship. resident rats demand equal access to the emergency exits.

    Developing…..

  121. 121
    some guy says:

    Breaking: Bush donors refuse to shovel money at ad campaigns that push jeb poll numbers down. rubio fundraisers happy to take their hedge.

    Developing….

  122. 122
    JPL says:

    @redshirt: Holy Smokes.. There have been no polls for a week and we at BJ are already discounting him. A whole week and the brinks trucks haven’t arrived yet. Give the guy a break. The brinks are coming.

    Plus or also, too. Jeb’s health care plan is sooo good for those wealthy, healthy and wise.

  123. 123
    beltane says:

    @JPL: Jeb! seems flat lately. Maybe the Brinks trucks ran him over.

  124. 124
    some guy says:

    Breaking: Bush staffers declare the lodgings at Iowa Motel 6 are quite adequate for a National Brinks Trucks Funded campaign. “The breakfast cheerios and frozen bagels are actually yummy, if you just give it a chance” the Bush national director of strategic planning told Politico.

    developing…

  125. 125
    Baud says:

    @All In:

    Why’d you name yourself after Chris Hayes’s show?

  126. 126
    Right to Rise says:

    Just wait until the #AdSurge works. No real polls of New Hampshire have been done for a week.

    Wait until the next poll of NH. #AllInForJeb

    The Scott Walker donors are going to roll in and maybe even Sheldon Adelson will come onboard.

  127. 127

    @Southern Goth:

    The good news is, the troll will slink away again after Jeb announces he’s dropping out.

    The bad news is, the troll will re-appear under a new name but with the same old catchphrases and pretend he was all in behind the eventual nominee.

  128. 128
    some guy says:

    After reporting Thursday that he has less cash in the bank than three other Republican candidates, Bush effectively cemented his status as just another aspirant in a presidential race where the surest predictions have been proven wrong time and again.

    “Our Brinks Trucks are stuck in traffic” Bush told the Post.

  129. 129
    Mike J says:

    @All In:

    No poll since 10/8. We don’t know the true impact yet.

    Actually, RCP has a poll from the 12th included in the average now, and it is true that Bush is no longer polling at 8.7.

    He’s now at 7.3.

    http://www.realclearpolitics.c.....-3823.html

  130. 130
    Right to Rise says:

    It was 10/10-10/12.

    That’s like discounting the Packers because they start 2-2.

    R-E-L-A-X. Relax.

    Jeb is in it for the log haul.

    When, when Jeb is the nominee you will understand my foresight.

  131. 131
    beltane says:

    @Right to Rise: Wait, you just told us you were banned. How can you lie to us like this.

  132. 132
    JPL says:

    @Right to Rise: Gotta say I’m going to repeat my comment from above
    Holy Smokes.. There have been no polls for a week and we at BJ are already discounting him. A whole week and the brinks trucks haven’t arrived yet. Give the guy a break. The brinks are coming.

    Plus or also, too. Jeb’s health care plan is sooo good for those wealthy, healthy and wise.

    I’m not a fan of Alan Grayson but he was correct about one thing, the Republican plan is let them die. If you don’t believe that, then read the blog and the Rand report.

  133. 133
    Right to Rise says:

    @Mnemosyne (iPhone):

    Jeb is the nominee.

    Is. The. Nominee.

    Remember when people wrote off John McCain in ’08?

  134. 134
    some guy says:

    “Some donors are really nervous,” said one top Bush fundraiser. “They think they bought into a winner… Donors want to see him campaign to win.” Senior members of Bush’s finance team acknowledged that the campaign has struggled to broaden its network much beyond family loyalists.

    Tis the season of our discontent.
    developing….

  135. 135
    JPL says:

    @Right to Rise: He did lose, you know.

  136. 136
    some guy says:

    @Mike J:

    Bush Downward Slide Continues.

    Developing

  137. 137
    redshirt says:

    @Right to Rise: I thought you were banned?

    Or are you spelling your name slightly different than before?

  138. 138
    Right to Rise says:

    We will have Jeb Bush in until 2024…then a placeholder…it was supposed to be Rubio but that’s gone down the drain, we will find someone else. After that, George P. Bush runs. The Fourth Bush. He will be only 48.

    That’s the plan.

  139. 139
    some guy says:

    Despite a heavy onslaught of television ads in Iowa and New Hampshire by the pro-Bush super PAC, Right to Rise, his standing in public opinion surveys has remained relatively static or has even fallen.

    “The needle hasn’t moved an inch — and he may be worse. That’s what’s scaring folks,” said a second top Bush fundraiser.

    “I don’t think Jeb’s getting out of the race, but it’s certainly sinking in that he can’t revive himself just from the ads,” this person added. “He can’t buy his way back. The [poll] numbers are beginning to get hard. The candidate has to have a moment out there, and if that doesn’t happen, I just don’t know.”

  140. 140
    Right to Rise says:

    @redshirt:

    Seems I’ve been unbanned!

    This blog loves me too much.

  141. 141
    raven says:

    How bout a fucking sports thread? These right wing sissy asshole don’t know shit about the rock.

  142. 142
    Mike J says:

    @some guy: The more he’s on TV, the more people hate him.

  143. 143
    JPL says:

    @raven: I’m watching.

  144. 144
    some guy says:

    Breaking: Bush slides to Fifth place:

    On Jul. 1, the first day of the recent fundraising quarter, Bush was the top polling Republican nationally, scoring 15 percent in the RealClearPolitics average. But on the final day of the quarter Bush had drifted to fifth place, at 9 percent and well behind front-runners Donald Trump and Carson.

  145. 145
    Elizabelle says:

    Do we have no frontpagers?

  146. 146
    Gin & Tonic says:

    @Right to Rise: Maybe you’re just a moron.

  147. 147
    Right to Rise says:

    @some guy:

    Relax.

    It’s All About the Benjamins, Baby!

    The stuff about cutting back is to reassure donors. There’s no cutting back in reality, let me assure you. It’s symbolic.

    Let the good times roll…

  148. 148
    some guy says:

    @Mike J:

    He’s tired and weak. Nobody but his paid shills like him. he is despised in Florida, and if you can’t win your own home state, well, there will always be Texas.

    His burn rate on donors cash is simply amazing. For every 20 million he spends on TV ads he drops another point in the RCP average. Babs was right, Jeb! can’t win it, even if he really wanted to.

  149. 149
    JPL says:

    @JPL: The blocked punt hurt, but at least they are only down one t.d.

  150. 150
    Right to Rise says:

    @some guy:

    In 2000 I’m sure you were saying “George W. is too stupid to win. C student. Makes funny grammatical errors. Did cocaine. Who would vote for HIM?”

    Lol. Keep “misunderstimating” the Bush family moron.

    It’s going to be a loooong eight years for the likes of you.

  151. 151
    JPL says:

    @Elizabelle: Richard is a front pager and the rest went to bed early. Actually Richard has disappeared also. In answer to your question, probably not.

  152. 152
    Richard mayhew says:

    @efgoldman: that is true almost everywhere for a variety of reasons

  153. 153
    Mike J says:

    @some guy: Momma Bush knows more about dirty campaigning than most people can only dream of, and even she thinks Jeb? is a loser. Which is a pity, since I think he’s the easiest to beat in the general.

  154. 154
    Right to Rise says:

    @efgoldman:

    Isn’t nigga with an “a” on the end just like saying “dude” or “man”?

    After all, Rachel Jeantel said it could be some “Chinese guy”.

  155. 155
    Gimlet says:

    http://www.politico.com/story/.....sed-214845

    Jeb Bush’s campaign raised about $13.4 million in the third quarter, outpacing both Marco Rubio and Ted Cruz but falling far short of Ben Carson’s reportedly $20 million haul.

    Bush’s campaign said he had $10.3 million in the bank – providing a stark contrast with fellow Floridian Rubio’s campaign, which raised only $6 million last quarter but reported having $11 million cash on hand. Cruz’s available cash at the end of the quarter was larger still at $13.5 million.

  156. 156
    some guy says:

    Bush’s vast family network of donors was far more willing to write big checks to his super PAC earlier this year, when he still looked every bit the dominant front-runner and likely GOP nominee. Now, though, as his campaign is in desperate need of hard dollars in order to cover its day-to-day costs — staff salaries, travel expenses, paid media — those same donors aren’t as eager to double down on an underperforming candidate.

    Brinks trucks delayed in traffic jam on I-95, will get to NH “real soon” said one Bush staffer from the new Jeb! regional office at the Petersborough Motel 6

  157. 157
    Elizabelle says:

    @JPL: Richard is a great frontpager. Just startled to not see something newer up. Perhaps the revamp continues.

  158. 158
    raven says:

    @JPL: Watching what?
    Auburn-KY is 23-17 War eagle in the 3
    Dodgers Mets 2-1 LA in the 3d

  159. 159
    Right to Rise says:

    @Gimlet:

    The burn is a sign of confidence “We know there’s more where that came from” etc.

  160. 160
    JPL says:

    @Richard mayhew: To me, Bush’s plan is similar to Price’s plan. If you have time, would you compare the two.

  161. 161
    some guy says:

    @Right to Rise:

    Breaking: Motel 6 demands all Bush staff bills be paid in advance after local catering company stiffed on pizza bill. “before any more rooms are rented we want to see a valid credit card” said Wayne Deutschberger, Motel 6 spokesman.

    Developing

  162. 162
    JPL says:

    @raven: I’m on antenna.

    falcons

  163. 163
    Right to Rise says:

    @some guy:

    LOL. Motel 6? Pizza? Are you talking about the O’Malley campaign?

    We’re livin’ it up fuckers.

  164. 164
    Elizabelle says:

    I feel so badly for Lamar Odom. If he’s got brain damage, maybe death is not the worst outcome. Tragic situation. And this is someone who was already married into the Kardashian media complex.

    So sad. Sounds like a nice guy.

  165. 165
    raven says:

    @JPL: I thought so. I have the PIP and the Dish anywhere on the iPad.

  166. 166
    amk says:

    @Right to Rise:

    People did write off mcangry in 2008. By 7 points, you idjit.

  167. 167
    some guy says:

    @Right to Rise:

    Cheerios and defrosted bagels each morning for all Bush staffers staying at the Motel 6 are complimentary, as long as they pay, in advance, according to the Motel 6 spokesman quoted in Politico

  168. 168
    JPL says:

    @Elizabelle: It is sad.

  169. 169
    Mike in NC says:

    @Right to Rise: George P. Bush inherited his father’s brains and his mother’s looks. Ain’t going nowhere.

    Meanwhile, moron JEBzzz stuck on an elevator with only a DOWN button.

  170. 170
    Right to Rise says:

    @some guy:

    As I type this I’m staying at a Hampton Inn. Lol.

  171. 171
    Right to Rise says:

    @Mike in NC:

    Oh, look. A racist comment. He’s brown so he must be ugly, right? And of course it comes from the Mexican side.

  172. 172
    some guy says:

    @Right to Rise:

    so the “no more hotel rooms for Bush staffers until they pay their bill” comment from Motel 6 was a legit threat? wait until Team Jeb stiffs the Hampton Inn next week. Don’t worry, there will always be Super 8,

  173. 173
    Anoniminous says:

    JEB! Standing:

    Iowa: 5.9%
    NH: 8%
    Nevada: 6%
    SC.: 5.7%

    This is not the stuff from which Presidential Nomination Wins are made. The RomBot was polling in the mid-20s by this time, last time.

  174. 174
    Southern Goth says:

    Jeb? was supposed to be the more moderate, moneyed frontrunner, but it turns out that no one likes him. Not even his mother.

    The funny thing is that now he’s cock-blocking anyone else in the repub primary who might have stood a snowball’s chance of winning the general.

    So by all means, keep those Brinks trucks rolling.

  175. 175
    GHayduke (formerly lojasmo) says:

    @Right to Rise: don’t you mean President McCain?

  176. 176
    RSA says:

    @Roger Moore:

    And heaven help you if you want a complicated procedure. A friend of mine had surgery and wound up getting adjustments to her bill one and two years after the procedure.

    I’ve been there. I’ve mentioned in the past that my wife had two surgeries to remove brain tumors. Our insurance claims for the first surgery were denied, a total of around $75K, before her second surgery. I seriously had to consider medical bankruptcy. The claims were all eventually covered, months later, because some of the codes were incorrect. But one’s decisions are based on what one knows at the time.

    I wasn’t in a state to think much about the big picture, but I do remember wondering what sick people without family do.

  177. 177
    Right to Rise says:

    Love the mocking of Jeb.

    Keep it up.

    Remember when you mocked George W. in 2000? How’d that turn out for you?

  178. 178
    Mike in NC says:

    @Right to Rise: And you get off calling people “niggaz”, motherfucker?

    What is the best feature of George P?

    His greasy receding hairline, his beady eyes, his crooked yellow teeth, or the permanent 5 O’clock shadow? Bastard looks like a low level hitman for a cartel. Yeah, he’ll go far.

  179. 179
    sukabi says:

    @redshirt: yep, his head is finally All up in his ads.

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    Southern Goth says:

    @Right to Rise:

    Even if Jeb? managed to spend enough money to make people like him and somehow win, I would still mock him.

    But I’m not too worried about that scenario.

  181. 181
    hellslittlestangel says:

    @Roger Moore: Not a dealer, a manufacturer! You don’t want to get Heisenberg mad at you.

  182. 182

    @Right to Rise:

    That’s right, President McCain is about to complete his second term.

    And a few things may have happened between 2000 and 2015 that would make it difficult for another Bush to run. Just one or two.

  183. 183
    Right to Rise says:

    @Mike in NC:

    “Cartel”. “Greasy”.

    Racist dogwhistles, much?

    ‘Progressives’ really hate conservative People of Color above all others.

  184. 184
    amk says:

    @Right to Rise:

    How’d that turn out for you?

    now, let’s see

    9/11- the first terrorist act in US of A

    illegal wars that darth profiteered from

    thousands of americans dead along with hundreds of iraqis

    crushing debt

    stock market crash

    world economy collapse

    katrina

    over 8% unemployment

    yeah, dumbya3 reminds people of that list and hence his sucky numbers despite brink trucks.

  185. 185

    Speaking of broken systems:

    This is a GoFundMe for the father of a friend of mine. The family is being billed for (some of the) costs of his stay at a nursing home while his case was “Medicaid Pending”. He is destitute: He has no savings, no credit cards, and his Social Security and VA benefits are paid directly to Woodridge Terrace as his contribution to costs (per Medicaid’s ruling on his case).

    Nonetheless, the family is (if you ask me) being blackmailed to pay almost $8K by November 1, lest their father be discharged with no place to go, no capability of taking care of himself, and mental health issues that make it impossible for him to live with his family, who he treated horribly over the years.

    If any of you can put something in the hat, that would be great. Even better would be if you can tell the family something they can do to get the bloody nursing home to write off the costs, or to bill someone else.

  186. 186
    redshirt says:

    @amk:

    thousands of americans dead along with hundreds of iraqis

    You mean hundreds of thousands of Iraqis, right?

  187. 187
    amk says:

    @redshirt:

    Right. My bad.

  188. 188
    Villago Delenda Est says:

    @Gin & Tonic: No maybe about it.

  189. 189
    boatboy_srq says:

    @Schlemazel: This.

    Patients don’t shop for coverage; they shop for physicians. The entire analysis model is backward: healthcare shopping is done by MD reputation, bedside manner and quality of care, and insurance is obtained based on what network the chosen MD accepts (or OTOH healthcare “shopping” is done by clinic proximity and whatever insurance purchased is based on what the clinic’s staff suggests). The statisticians are all jumping on how to the control costs from an insurer-side selection angle, when the customer base is controlling quality of care (and not necessarily pricing) from the physician-side and selecting from a subset of the insurance plans based on what the physician can accept.

  190. 190
    Applejinx says:

    @some guy: I think this motel 6 stuff must be snark, but a friend of mine set up a PA system for Jeb Bush in New Hampshire last week.

    It was at Smiths Medical. Jeb was there making some sort of presentation, perhaps trying to fundraise. He tried to start with a joke and nobody laughed. My friend was extremely annoyed that he’d been dragged away from real work in order to set up microphones for Jeb Bush, whose presentation apparently sucked.

    I told him hey, he got to see somebody out of a real live dynasty :)

    If we all REALLY fuck up, he might even have got to see a President o_O

    More like, if we’re really really REALLY not in control of any of this… because to get that guy (who doesn’t even want to be there) into the Presidency, the Village and MSM will have to completely run over both left and right wing America and install him as a freakin’ King. Otherwise it’s not gonna happen.

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