Andrew Liu-Chen MD

Northwestern University | LKSOM at Temple University | Robotic urologic oncology fellow at USC | Interested in AI, systems improvement, and robotic surgery

[Andrew Liu-Chen MD @andrewchenb]

@JohnHCochrane @benconomics Pet health insurance is free market and minimally regulated.

[Andrew Liu-Chen MD @andrewchenb]

@astrodanish You don't? If you have a PPO, you can self-refer yourself to a majority of specialists.

[Andrew Liu-Chen MD @andrewchenb]

@CliffordAsness Respect you even more 🫡

[Andrew Liu-Chen MD @andrewchenb]

@nikillinit Nothing that is proven to work so you end up getting all the difficult patients who will be unhappy with the results and will suffer reputational damage

[Andrew Liu-Chen MD @andrewchenb]

@nocorporatemed @EdGainesIII I agree that we are underpaid but these anecdotes all appear to be true and are detrimental to the rest of us. Getting 600x Medicare is not going to keep it alive for the average Joe doctor

[Andrew Liu-Chen MD @andrewchenb]

Is it not counter productive to have outliers ruin said leverage for the rest of us actually trying to help people? What’s wrong with fixing this egregious manipulation of the law? @EdGainesIII

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Yeah let’s go after the one piece of leverage keeping independent practices afloat.

[Andrew Liu-Chen MD @andrewchenb]

@mcuban @BradSpellberg Your Baylor Scott and White rates are bonkers. It's because commercial plans like yours subsidize Medicare/Medicaid that the system works. Look at Maryland, they tried to pay Medicare/Medicaid more, comm less and just cost the federal govt billions extra with their experiment

[Andrew Liu-Chen MD @andrewchenb]

@mcuban @BradSpellberg I like the overall idea but
1. The largest companies then grow an ins arm
2. Your co will probably learn to have to do utilization management or get defrauded
3. The devil hospitals know now may be better than the unk if they get stiffed by new players with no/painful recourse

[Andrew Liu-Chen MD @andrewchenb]

@patio11 Fair enough, I also see plenty of cases that would trigger own occupation. However, I have yet to see a person get paid out.

[Andrew Liu-Chen MD @andrewchenb]

This thread is important. Term life insurance is important. But! The fact that the insurer readily agreed to own occupation on something that would trigger so easily should make it clear that there is an imbalance in the transaction and it does not favor the purchaser.

[Patrick McKenzie @patio11]

You will not always get asked what specific job duties are material to your occupation but this tech worker thinks it is material that he be able to type 100+ WPM, do 12+ hour days as dictated by business necessity, and travel internationally. Insurer readily agreed.

[Andrew Liu-Chen MD @andrewchenb]

@patio11 Would love to chat to see if you've done further digging. I've tried to see if I can get actuarial tables regarding this but have not even heard of many anecdotal stories in favor of own occupation disability.

[Andrew Liu-Chen MD @andrewchenb]

@patio11 Own occupation long term disability is marketed to physicians. But, I think it doesn't really make a lot of sense especially for a tech employee or a non-surgeon. Obviously, every person has their own risk but there's a reason why they market to healthy residents.

[Andrew Liu-Chen MD @andrewchenb]

Maybe this is a feature, not a bug. Perhaps the rationing creates a steady inflow of youth willing to sacrifice, thus leading to more acceleration in the Bay.

[YIMBYLAND @YIMBYLAND]

Dog, this is so sad.

Imagine all the lives that were never had in San Francisco because it refused to build housing. Multiple lost generations of artists, writers and creatives.

Not to mention the literal lives that were never conceived because couples couldn’t afford a home.

[Andrew Liu-Chen MD @andrewchenb]

@zachweinberg Was recently discussing Medicaid cuts with colleague stating that we shouldn't be using Medicaid for immigration assistance, food etc and got pushback. Every $ there is one $ less for actual clinical care. We can't have it all! Or at least separate out what you really prioritize.

[Andrew Liu-Chen MD @andrewchenb]

@lee_c_zhao @lukha33 I'll have to remember to try this the next time the Hoover access sheath gives me a bloody URS field

[Andrew Liu-Chen MD @andrewchenb]

@alexmd2 @ianlarkin @xVexity @mcuban I think the nuance is that a Hospital would prefer a Medicaid underpaying patient over a *non paying* patient which is what the uninsured would be. The sick aren’t going to not come to the hospital because they have no insurance.

[Andrew Liu-Chen MD @andrewchenb]

@wcdispatch There is no way that California hospitals pay 10-15x for everything. I can guarantee you that many LA hospitals do not do certain procedures on Medicaid patients because there is no reimbursement to even cover the cost of an equipment rental.

[Andrew Liu-Chen MD @andrewchenb]

I can’t believe @Healthnet would deny my patient a surgery using an Interqual for a completely different surgery. Terrible care for patients and makes no sense.

[Andrew Liu-Chen MD @andrewchenb]

Students were responding in 12 hours in 1949! Before email! Before the internet! When phone calls were expensive!

[Andrew Liu-Chen MD @andrewchenb]

It’s sad to see physicians and residents not understand the history of the match. Do some reading and you’ll see that prior to the match it was an absolutely mad world. Alvin Roth literally won a Nobel Prize for fixing the situation.

[Rep. Scott Fitzgerald @RepFitzgerald]

The Match, shielded by a medical residency antitrust exemption, controls where future doctors train and what they’re paid. This monopoly leaves thousands of qualified applicants without a residency slot each year. ⬇️

[Andrew Liu-Chen MD @andrewchenb]

A recap here https://t.co/20YN00XSuG. The current overriding sentiment is indicative of the poor understanding of the value that trainees provide and the unintended consequences of a change from this standard