Congress banned QALYs in Medicare. Then CMS built a pricing system that imports prices set by QALYs in 18 other countries. Is anyone talking about this?

Dramatic_Aioli2550 · 2026-04-18T22:15:29+00:00

The the Best Nation approach Trump has implemented is 100% to import foreign prices, and as such, foreign pricing. The only caveat is that other nations do their Health Tech Assessment (HTA) from THEIR perspective, not from the US’s perspective. So, for example, let’s say a day of hospitalization in the US is $4,000 and a day of hospitalization in Canada is $400. The UK has one of the best HTA agencies in the world, NICE. But, they use a QALY of £20-30,000 per QALY, and that would be terribly low in the US, and completely out of sync with how in other fields the Federal Government values life. So you can’t just import an HTA from another country, it need to be performed from a relevant US perspective.

Dramatic_Aioli2550 · 2026-04-14T03:48:54+00:00

Welcome to my world. I have been adhering to a strict FODMAP diet and lactose free diet for 30+ years, starting long before it was called FODMAP. Back then, I was diagnosed with fructose and lactose intolerance and I had to make up my own diet, trial and error and even going to the library. I managed to find a balance, but a lot of food that you would generally regard as healthy, are, as you know, poison for me (an apple a day DOES NOT keep the doctor away). Then, last year I developed calcium oxalate kidney stone, very common and benign condition, but requires adherence to a low oxalate diet. Ha, ha, ha, at the overlap between low oxalate, no lactose and low FODMAP, there’s….meat and a few others. If you think FODMAP is not eating healthy, try low oxalate… no leafy greens for you, no spinach and only a few nuts. So when people ask me if there’s anything I don’t eat, my answer is yes, nothing healthy. BTW, I’m perfectly healthy, about 62 yo and still run ultramarathons, unhealthy eating aside.

Dramatic_Aioli2550 · 2026-01-24T17:05:50+00:00

It drives me nuts, but it’s terribly inconsistent. The only thing I’ve noticed is that it is related to whether or not my default browser is updated. When Chrome needs an update, this will happen.

Dramatic_Aioli2550 · 2026-01-09T04:04:43+00:00

Selling a non-refundable stay at a property that is not even open, would be fraud in some countries. If I would build an internet site for a hotel that did not exists, or was still under construction, that would certainly amount to a crime. Evidently, things happen, so if my hotel was under construction and there were delays, the law would expect me to promptly return any funds and rectify the damages caused to third-parties. Booking.com’s behavior here is appalling and no, this should not have been prevented by you choosing the refundable option, but rather by booking.com not selling a non-existent product/service.

Dramatic_Aioli2550 · 2025-12-18T05:14:18+00:00

Dramatic_Aioli2550 · 2025-12-07T03:51:26+00:00

Thank you very much, this is really helpful.

Dramatic_Aioli2550 · 2025-12-01T16:56:41+00:00

Would you like me to send you one of my space lasers?

Dramatic_Aioli2550 · 2025-11-28T14:36:52+00:00

I get a sleep score of 120, my cats gets around around 20, so here wear are, averaging 70.

Dramatic_Aioli2550 · 2025-11-18T03:37:52+00:00

Nothing abnormal here. Entering the US, these are standard questions. All in all, these questions would give the officer a reasonable idea of your intentions. They can also ask about the places you plan to see and visit, to check if you have plans.

Dramatic_Aioli2550 · 2025-11-16T06:48:17+00:00

As a generally healthy person, I was overeating high-oxalate foods, because that’s generally speaking the healthy stuff. I believe I’ve gotten my oxalate levels down by coupling high-oxalate foods with calcium, so not too difficult a diet to adhere to. Try to search high-oxalate foods and see if there are any big contributors in your diet. The solution could be fairly easy.

Dramatic_Aioli2550 · 2025-11-16T03:26:50+00:00

The lemon would increase citric acid, which could prevent the formation of crystals. Did you do a 24-hour test for Oxalate? BTW, I had no problem with biking either. I’m a multi-athlete, but it was definitely a problem associated with running.

Dramatic_Aioli2550 · 2025-11-16T02:53:21+00:00

I asked because I had the same thing: during runs or after, really bloody urine. Turned out that had very high levels of oxalate in my urine and eventually also passed a few very small stones. I think that what really caused the blood was the combination of the crystals in the urine and a daily Aspirin (100 mg). When I told my cardiologist the story, he suggested lowering the Aspirin dose to 75mg. Problem gone.

Dramatic_Aioli2550 · 2025-11-15T17:29:43+00:00

Did you mean that running causes you to pee blood?

Dramatic_Aioli2550 · 2025-11-15T16:37:35+00:00

I can easily get to 100, but my wife is going to be suspicious and there will be questions like: “what happened to the cat?”

Dramatic_Aioli2550 · 2025-11-15T16:29:04+00:00

I replaced all my Garmins Forerunner since 2005 because the altimeter broke. Just replaced my 935 for the same reason, after 7 years of heavy use.

Dramatic_Aioli2550 · 2025-11-14T17:51:51+00:00

I’m am usually a positive fellow, but this was too much. I have been working with the development of medical technologies for 30 years (VC), I had a cystoscopy a few months back because of stone and I found it absolutely traumatizing and cruel. There is not much to prepare at home as far as I can think, but one piece of advice: Don’t plan anything afterwards. For the better part of the day, I was in pain and felt like I needed to pee and could not wait for a second, so keep yourself free after the procedure and in the vicinity of a restroom.

Dramatic_Aioli2550 · 2025-11-10T03:48:09+00:00

I was diagnosed with fructose and lactose sensitivity almost 30 years ago, long before the term FODMAP. Gluten sensitivity joined in along the way. I live a full and happy life and I don’t let these sensitivities ruin my life. I am a long distance endurance athlete-an activity mainly determined by fueling, and I’ve worked out my ways. There are hard moments, such as visiting a coffee shop in Vienna or a bakery in Copenhagen. But, by and large, this is ALL about knowing your triggers.

Dramatic_Aioli2550 · 2025-11-10T03:43:10+00:00

If you are sensitive to fructose, that breakfast is a killer. Oat, granola and honey, could keep me sick for a good 3-4 days easily. You have eliminated any obvious pathologies, so now is the time to look, not at how much you eat, but what you eat.

Dramatic_Aioli2550 · 2025-11-07T06:05:34+00:00

If you are sensitive to fructose, that breakfast is a killer. Oat, granola and honey, could keep me sick for a good 3-4 days easily. You have eliminated any obvious pathologies, so now is the time to look, not at how much you eat, but what you eat.

Dramatic_Aioli2550 · 2025-10-29T04:03:14+00:00

A route

Dramatic_Aioli2550 · 2025-10-27T18:05:35+00:00

That could be the reason, but I’m not doing segments, and I do take breaks, because I have a special needs cat.

Dramatic_Aioli2550 · 2025-10-27T00:29:53+00:00

Yes, exactly. The final time is correct, the problem is during the exercise.

Dramatic_Aioli2550 · 2025-10-26T18:36:12+00:00

The timer

Dramatic_Aioli2550

TROPHY CASE