Ron Freeman MD

“I felt a bit like an accessory to a crime” - Dr. Keith Smith

[zooko🛡🦓🦓🦓 ⓩ @zooko]

I’ll bet there are a *lot* of people who think that the supply of ZEC *might* be secretly inflated, and that we’ll have to wait months/years to find out. If so, they’re wrong. You can verify for yourself, on your local computer, today, that the supply of ZEC is 16,848,458.

[Jared Rhoads @jaredrhoads]

Real price transparency is an outcome of competition, just as advertising is a byproduct of competition. Businesses don't advertise because they're legally obligated to. They advertise because they have something to gain. The goal shouldn't be to force hospitals to disclose prices. The goal should be to make them WANT to.

[Ron Freeman MD @RonFreemanMD]

Biggest barrier for me as a normie to use Zodl daily as money is taxes. Using Zodl for real daily money becomes tax-painful, so I stay in Coinbase and just hodl.

Ideally should be as easy as using shop/shopify app when checking out, and when paying taxes I should get numbers to fill out TurboTax.

[Ron Freeman MD @RonFreemanMD]

@QuaiNetwork Ok so maybe Qi is harder for Palantir to trace compared to Monero mixing? And Quai is 100% transparent, no?

[Ron Freeman MD @RonFreemanMD]

@blockchain Yes, I prefer that everyone know my salary and what I recently purchased.

[Mark Cuban @mcuban]

Then I asked for a simplified version of the above :

Here it is in plain English. Denver hired UnitedHealthcare to run its employee health plan. Denver pays the actual medical and drug bills itself — United just processes them. That’s what “self-funded” means. The problem is that Denver can’t see what it’s actually paying for drugs.

1. United buys the drug for one price and charges Denver a different price. It keeps the difference. Say the pharmacy gets paid $40 for a prescription. United bills Denver $100. United keeps $60. Denver never sees the $40. The contract says this out loud in three different places — it’s not hidden, it’s just written in language nobody reads. There’s no cap on how big that gap can be.

2. Drug companies pay rebates. United keeps all of them and hands Denver a flat number instead. United collects rebate checks from drug manufacturers. Instead of passing those through, it promises Denver a fixed amount per brand prescription (about $740 in 2023). If the actual rebate was $1,500, United keeps the extra $760. The contract literally says any rebates above the fixed amount belong to United. Denver has no right to know what the real number was.

3. United decides which drugs are “specialty” — and specialty drugs are where the money is. The contract defines a specialty drug as, essentially, “whatever United’s own specialty pharmacy sells.” United also reserves the right to reclassify drugs whenever it wants. Once a drug is labeled specialty and filled at United’s own pharmacy, it drops out of the normal price guarantees entirely. So the most expensive drugs are the least protected.

4. The most expensive drugs of all — the ones given in a doctor’s office or infusion center — have no price guarantee at all. The contract flatly excludes them. Cancer drugs, infusions, injections administered by a provider. Zero pricing protection.

5. Denver can’t shop around, and it can’t leave without a penalty. Denver isn’t allowed to negotiate directly with any drug manufacturer. It must use United’s mail-order pharmacy exclusively. And if Denver hires an outside vendor that steers employees to cheaper drugs or cheaper pharmacies, United can cancel all the pricing guarantees. If Denver ends the drug program early, United keeps every rebate it owes.

6. Denver can’t audit its way out of this. Denver is allowed one audit a year, capped at 300 prescriptions, using a random sample United has to approve. No auditors paid on commission. No computer-based searches for errors. You cannot find a pricing problem across hundreds of thousands of claims by randomly checking 300 of them. The audit rules exist to make sure nothing gets found.

Is any of it illegal? Almost none of it. It’s a legal contract that Denver signed. The one thing that might cross a line: federal law since 2021 bans “gag clauses” — contract terms that stop an employer from seeing its own cost and claims data. This contract says United may let Denver see its pricing information, at United’s discretion. Federal regulators have said that “only if the vendor allows it” language is exactly what the gag-clause ban prohibits. And Denver has to certify to the government every year that it has no gag clauses in its contracts.

The one thing Denver could actually do about it: Colorado banned this drug markup practice, effective January 2025, and self-funded employers like Denver can opt in. It’s an election, not a lawsuit. Somebody should check whether Denver ever filed it.

The bottom line for an HR person: the drug program looks free. There’s no fee for it anywhere in the contract. That’s the tell. United isn’t working for free — it’s getting paid out of the drug prices, and the contract is built so Denver can’t measure how much.

[Ron Freeman MD @RonFreemanMD]

@jeremiahrogers Didn’t the Thai royal navy chase Chad and Nadia out of Thailand waters for seasteading as a violation of national security with threats of potential death penalty?

[Ron Freeman MD @RonFreemanMD]

@SallyMayweather @zano_project Not a fan of Zcash?

[Ron Freeman MD @RonFreemanMD]

@BitcoinCom Only coin with true fungibility is Zcash, which might be the worlds first true peer to peer electronic cash

[Christine Price @HEALTHCOSTtruth]

I have no words. This presented by a broker. albendazole 200mg - shows PBM cost would have been $22,524.74.

They "saved the client" $15,299.44 for each of the 3 prescriptions by sourcing it elsewhere.

They PAID $7225.30 for two of the Rx's and $7197.10 for the third.

The problem? The cost for the SAME Rx - same number of pills @costplusdrugs would have been $202 for each prescription!!

This company spent nearly $22K of a client's money for $606 worth of meds.

[Ron Freeman MD @RonFreemanMD]

@Vladcostea @ComicDaveSmith to discuss zcash

[Ron Freeman MD @RonFreemanMD]

@MrBeast 12,960,000

[Ron Freeman MD @RonFreemanMD]

@mattman @blippay How do you track this transaction for taxes? Honestly I have no idea how people are spending crypto

[Ron Freeman MD @RonFreemanMD]

@zooko @sufialhussaini With crosslink, would something like the Quai/Qi mining energy flatcoin be possible or desirable for ZEC? Or would it just poke the bear and cause US gov to inject some “freedom” into zcash for challenging the dollar?

[Ron Freeman MD @RonFreemanMD]

@vizorwallet @Zcash Any tracking of transactions for tax purposes?

[Ron Freeman MD @RonFreemanMD]

@zodl_app @theblockprof @flexa Sure would like to but accurate tax accounting creates way too much friction.

[Ron Freeman MD @RonFreemanMD]

@GoodTexture @HPeters20217098 My gut feeling is this is correct. Does this mean ethereum will win because stable coins? What about flat coins?

[Ron Freeman MD @RonFreemanMD]

@noahkaufmanmd Cash based hospital is needed. Seems like an insurmountable startup cost

[Ron Freeman MD @RonFreemanMD]

@askOkara Okara

[Ron Freeman MD @RonFreemanMD]

@jeremiahrogers Agree about adoption > speculation

As a regular person, the convenience of transactions tracked by Coinbase for taxes, and that I am unable to figure out how to do cost basis on my own (and it sounds tedious), is the biggest roadblock for me using with friends and family