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Time for a System Change ?
You know I’m a political agnostic…..and I was having an adventure at that particular time back in the US where I had to literally escape the clutches of wokedom, sometimes in the middle of the night. Thankfully I escaped back to Thailand before the election….only to have to hastily depart for Da Nang where I’m wating out the 180 day Thai tax rule. You should come on over….boy do I have some stories to tell! Speaking of taxes (as the OP seems to be quite fond of them for others)…do you think he’ll pay them to Thailand for living here over the 180 day limit? I’m betting not….but surely, if he has 80k to spare feeding dogs, he must have enough to pay his fair share. Or will he choose the “rules for thee but not for me” that I find so prevalent in the mindset of the filthy leftists that I have known throughout life? -
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I've had enough of the Tourist Ghettos in Thailand!
May I suggest the lakeside City of Phayao with it's views of the Kwan Phayao and mountain ranges to the west. Yes, there are a few tourists that stop off on their way to The Golden Triangle, but otherwise very much a "locals" resort. Situated on Highway Number 1 in Northern Thailand, 100kms south of Chiang Rai in Lanna. -
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The ENTIRE US Healthcare system is broken, not just health insurance companies
Source: https://www.sensible-med.com/p/the-entire-healthcare-system-is-broken My comment > The assassination of the Insurance CEO last week did trigger a firestorm of reactions, and Prof Vinay Prasad's analysis that the entire US Healthcare system is broken is correct. It has become a system in which its prime purpose of preserving health of people has been totally wiped away and has become a money-generating system that provides little value to health and prefers expensive and harmful treatments over effective ones. = = = The American health care system is profoundly broken. We spend more than any peer nation, and have worse outcomes. Worse, for what we pay, the system is not even user friendly. I am a practicing oncologist, health policy expert and professor, and I have difficulty navigating the complex world of in-network, co-pays and billing. Toss on training modules and EPIC, and I get pissed off trying to provide care, receive care, and study health care. That’s the trifecta. Who is at fault? Here is the thing: everyone is at fault. Pharmaceutical firms - Pharma firms routinely run seeding or uninformative trials and ram through unproven medical products. Because of how they have lobbied, they ensure that Medicare and insurance will reimburse for these things. They drive up health care spending. PBMs - these middlemen often exploit inequities in the market, and collect a pretty penny for little added value. FDA/ CMS - these government officials live through the revolving door. They often have little incentive to be a tough regulator because they benefit (in terms of future employment from lowering the bar). Lately, under Marks/ Califf, they have done a particularly <deleted> job: exondys, lartruvo, aducanumab, covid boosters, paxlovid, melflufen, selenexor the list goes on and on. Insurance companies - make no mistake, insurers would love to see not 20, but 50% of US GDP spend on health care. What people don’t realize is that insurers make more TOTAL PROFITS the more we spend on healthcare, not the less we spend. The Affordable care act caps their profit on revenue, depending on the plan, at 15-20%. In other words, insurers can only take this maximal percentage of all the money that passes through them. (currently, they are often lower than this). While they do want to control year to year variability— through annoying things like denials and prior auth— that is mostly to make behavior predictable. In the long run, they want health care spending to grow. If we go out to pizza and I say: you can only eat 20% of the pie, what size should I buy? What do you think you will say?….. extra large. Hospitals/ academic centers - the behavior of hospitals is predatory, and they swallow the most cash in the entire system. They use their academic names to hide that they are working as prostitutes for pharma, running unethical trials. They gobble up small practices to consolidate market share. They charge ridiculous rates, and engage in deceptive practices. How often do we discharge a patient after chemo to get Neulasta in clinic, so we can bill it as an outpatient? Places like UPMC are 4 billion dollar juggernauts which are more akin to a leech sucking the blood out of the catchment area than a medical center. Doctors - sorry, doctors are completely complicit in the broken system. They order unnecessary tests, they consult for Pharma companies, they push for unproven things— like a double lung transplant in a person with Stage IV cancer. This was what Vandy advocated for— totally insane medicine, and worse, they want to tax plumbers and janitors to pay for their experimental science. Doctors don’t want to learn evidence based medicine. They are entirely unwilling to self-regulate. Yes, we are often treated poorly, and certainly the glory days are gone, but we are entirely complicit in the high and unsustainable price of health care. Let me be crystal clear: A lot of health care that doctors want to give, but insurers don’t want to cover is 100%, complete and total bu11<deleted>. This is the system. It is broken. Worse, no one will fix it. Prior FDA commissioners and CMS directors are spineless jellyfish, worried more about their future consulting than reforming the system. The American People are rightly frustrated. The voted for Trump with RFK Jr at his side because they know that, unlike the typical sell-out (think Scott Gottlieb), RFK Jr is the most likely to make a lot of changes. And even if 3 out of 10 changes is harmful, Americans will accept it, in the hope 7 are good. And if some changes make the system worse or break it entirely, perhaps, they think, so be it, that only means reform must come sooner. Against this backdrop, you have doctor influencers and others who choose to point the finger at one entity. An easy scapegoat is the insurance industry because they issue denials and make our life harder. And don’t get me wrong, I hate prior auth just like all my friends because I don’t want to explain myself to a m0r0n, and that is who is on the other end of the line, but this is a classic scapegoat. An innocent made to take the blame for a broader problem. The SYSTEM is broken, and insurance companies are not the SOLE villain. Also, imagine for a moment, if we made a law saying insurers could NOT decline any service. First, several would go bankrupt in a stochastic way. The ones that happen to have docs who are insane and order a lot of useless <deleted> first will go bankrupt. But those who survive the initial earthquake will crank up their premiums. They will obliterate you with their premiums. You will drown in those premiums. You will be eating canned tuna like the apocalypse is here, but have access to prenuvos and a rectal MRI and sequencing your literal <deleted>. GDP spending on health care will explode. The US will likely collapse as Rome did before. In the Roman city before the fall 50% of days were holidays— we will collapse when 50% of GDP is on health care. Doctors who advocate for this are ignorant and typically online influencers, perhaps even comedians, who know very little, and stoke popular flames. > The above is the jist of the article with Prasad's imo correct analysis, and you can read the remainder of the article that addresses the assassination of the Insurance CEO and the task of RFK jr to change course of the system, here > https://www.sensible-med.com/p/the-entire-healthcare-system-is-broken- 1
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Is there anything good about getting old?
Very simple to answer, yes you got old, many people don't! -
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Thailand Launches Tourist Police App to Aid Visitors
Please stop being so negative. It is an attempt to help and it may save lives. I say thank you! -
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Mysterious objects from sky leave Thai couple on cloud nine
About the same level as you... I guess. -
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