Andrew

[Andrew @ASmithson1987]

Yes they definitely stole more. The $40 trillion is the extra on top of what they stole from us. The $40 trillion is borrowed and to be paid back through theft of future generations. Until that doesnt work anymore. Then we learn Chinese and start making shitty plastic toys for them.

[Andrew @ASmithson1987]

That would be great. If landlines were still $15 a month - the monthly taxes are more than $15 now. You weren’t required to have a home office with high bandwidth internet to hold a corporate job. If an oil burning heater didn’t cost $20k used with 100k miles. If you could buy food at a grocery store that isn’t pumped with preservatives and poisons for 10x the cost of fresh regionally sourced produce. If healthcare wasn’t a mandatory $1,000 premium with a $6k deductible. If a year of college cost a few thousand dollars and a college degree meant a professional career. Before the dollar was decimated.

[Andrew @ASmithson1987]

@IanCarrollShow @BrilynHollyhand Deport those politicians too.

[Andrew @ASmithson1987]

@Giannoulias How will you make Chicago safe and affordable enough to bring back businesses and opportunities to make the city livable again?

[Andrew @ASmithson1987]

@ChicagosMayor I can’t tell this from the satire accounts anymore.

[The Rational Animal 🤔 @theobjectivist]

Where do you think the $10.5 billion sits, Bernie? That's your problem. You don't think.

It sits in Meta stock. That number is not a pile of cash. It is the market's price on his share of the servers, the data centers, and the paychecks of 75,000 employees.

To pay your tax he must sell. His basis is near zero, so after federal and California capital gains he must dump roughly $17 billion in stock to net your $10.5 billion. Now multiply by 200 billionaires liquidating at once to raise the full $100 billion.

Who takes the markdown when they all sell in the same window? The owners of the other 86% of Meta. CalPERS. CalSTRS. Every index fund, teacher's pension, and 401(k) in the country.

And it is a one-time tax funding permanent spending. California's own analyst projects the state loses income tax revenue every year afterward as the billionaires leave. Eat the seed corn once, then explain the famine.

This is what concrete-bound means. You see a number on a list and mistake it for money in a room. You cannot think ten seconds past the confiscation.

[Andrew @ASmithson1987]

@IlliniJen @JBPritzker I’d bet it doesn’t actually go to migrant daycare. Probably just a NGO laundering money back to donors. Otherwise there wouldn’t be migrant children on the streets, right?

[Andrew @ASmithson1987]

You have Medicaid funded by the states. Medicare funded by the Feds. ACA funded through a mix of subsidies. Employer sponsored funded by the employer.

Turn all the funding into vouchers and have an open exchange. Regulate the exchange to a very limited extent to prevent “those same companies” from taking advantage of individuals. Have them compete for members across a single set of administrative regulations.

Instantly cut $500B in administrative costs. Encourage competition within the risk management function of the system (instead of removing it completely and watching costs unforeseeably skyrocket…). That alone probably ends up shaving $1T-$1.5T annually out of the total healthcare spend by 2030. The VBC initiatives being pushed currently, if done well, would pretty easily remove another $500B-$$1T from projected spending.

Single payer through the removal of the insurers would at best be cost neutral. That would be horrible for everyone honest left in system. Likely lead to significant increases in fraud & waste. Outcomes and quality would lag. Costs continue rising and quality of life diminishes.

[Andrew @ASmithson1987]

@mormorlady @EricTopol This one in particular is extremely dangerous. Orthopedic surgeons could suffer immense financial strain as surgical intervention rates drop.

[Andrew @ASmithson1987]

@DrTessaT @DrDiGiorgio The card can only provide or deny coverage, not care. The provider has to choose to accept or deny care.

[Dutch Rojas @DutchRojas]

Everyone in healthcare says they’re data-driven.

Ask for the source document.

Silence is an underappreciated metric.

[Andrew @ASmithson1987]

@terriraimondi @mcuban @redlgb1969 @claudeai Discounts are completely separate. Based on charges. Which are arbitrary. Not sure how you got there but ok. This is kinda unnecessarily complicated. Most do t get it.

[Andrew @ASmithson1987]

@JBPritzker You mean politicians, right?

[Andrew @ASmithson1987]

@ThomasEWoods @Ashl75 Happy to opt out.

[Andrew @ASmithson1987]

You’re not finding a TPA with the leverage of the blue card. That’s why Aetna didn’t work. It’s difficult and frustrating but that’s economics. It’s about as efficient as it can be under the current regulations. That’s just the unfortunate web the industry’s built. Everyone rent seeks. Some do it at a better margin. Focusing effort there would go a shit ton further.

Make patents value based. Pharma can recoup R&D then a cost plus model, but then they have to compete. 15 yr patent windows are driving Rx spend. Specialized hospital spend drives the majority of the rest of the cost.

A system that reinsures trauma, and burns universally with a market for all other insurance is the answer. Get rid of employer sponsored, Medicaid, and Medicare. Keep them as funders through a voucher system, but then have an open exchange with plans that are able to innovate and design products that meet specific needs. It will surpass the best universal care in a decade and at a fraction of the cost. Have to adjust ERISA and a few other regs first though.

[Andrew @ASmithson1987]

That’s an interesting thought. But can they administer the plan and obtain the same network adequacy as BCBSNC? Claude’s analysis makes it seem like they looked for a cut on admin with Aetna and Aetna wasn’t able to get better rates than the blues so the state paid all their savings on admin on additional medical expense.

Additionally to building the network, they would need to administer the plan. 740k members wouldn’t get you close to the economies of scale needed to compete with the low fee they’re paying Aetna.

[Andrew @ASmithson1987]

@ChicagosMayor Nope. We don’t have rich people to tax dude. They moved. We should just cut the budget and recoup what’s left of the stolen funds from politicians and the CTU.

[🩺 Dr. Napervillain Bunny🐰 @Type07Safety]

Unpopular opinion:

While I don't agree that illegal immigrants should be able to come here and have their children benefit from being born on US soil, I think the Supreme Court made a decision that is probably best in that case.

No president should have the power to alter the meaning of constitutional amendments. If there is ambiguity, then it is the responsibility of Congress to ensure that the law is changed.

We cannot afford to have a future President Newsom rule by executive order in a way that can alter our inalienable rights. Allowing Trump to be the arbiter of the 14th Amendment now may allow Newsom to be the arbiter of the 2nd later.

[Andrew @ASmithson1987]

@ChicagosMayor @ChicagoParks @chicago New tents for all residents of the parks!

[Andrew @ASmithson1987]

@Vision33X @mcuban They go a little more smoothly if you upgrade for fax machine.