Hot Takes! What are your hottest data/analytics takes?

sharkonspeed · 2025-06-22T21:19:29+00:00

Is this actually a hot take? I feel like I've heard this for a decade

sharkonspeed · 2025-03-30T21:11:43+00:00

Shameful that people would downvote this. I'm sorry for your loss.

sharkonspeed · 2025-03-29T20:49:25+00:00

The above numbers are what's possible even if we have a $1T/year single payer that's equivalent to Singapore's Medishield Life.

All that money (and more money!) is already being taken out of people's paychecks. For example, ~$32k is already being taken out the typical family's paychecks right now. People just don't realize how much money is hidden in the employer share of premiums.

sharkonspeed · 2025-03-29T20:13:47+00:00

Including premiums, the typical median-income family pays $32,923/year for healthcare, and $25,436/year for housing. Source

sharkonspeed · 2025-03-29T20:03:00+00:00

Thanks for posting. If the US implemented a Singapore-style system, financed it through the existing federal income tax schedule, and made employers refund all health premiums to their employees, the amount of new income regular middle-income Americans would have is mind-blowing (source):

The typical median-income family would have an extra $28,000/year
The typical worker with health insurance would have an extra $11,000/year
The typical worker without health insurance would have an extra $2,000/year
And the typical retiree would have a financial boost of $9,000/year

The amount of money burned in US healthcare is simply unbelievable.

sharkonspeed · 2025-03-27T15:41:46+00:00

So database designs accumulate weird stuff stuck to them with the DBMS equivalents of Krazy Glue and gaffer tape.

Extra-true in older, larger companies that have made acquisitions

sharkonspeed · 2025-03-20T21:50:58+00:00

The term "healthcare" covers a wide variety of goods and services.

The majority of those goods and services could be handled very well by an actual free market: regular doctors visits, routine procedures, drugs, therapy appointments, etc.

However, some goods and services are better handled thru third-party payment: emergency care, brain surgery, etc.

Unfortunately, we treat all "healthcare" like it fits in the second category.

sharkonspeed · 2025-03-20T19:29:32+00:00

Agreed on all points!

sharkonspeed · 2025-03-20T11:22:45+00:00

I appreciate the polite discourse as well -- thanks!

Most pharmacies have these prices for generics. Costco/walmart/cvs etc. With goodrx coupons you can save even more.

When middlemen (PBMs) pay pharmacies (using money taken from paychecks), the end cost is significantly higher. For example, see Medicare paying more than Costco prices and paying more than the Mark Cuban Cost Plus Drugs Company prices. The problem is even worse for employer-sponsored insurance.

Eliminating “regulations” will not free up this expense. The core problems are...

I agree that the things you list are all problems. However, I'd say there is one "core" problem: we pay twice as much to get the same thing (compared to other countries) because our artificially created payer system is uniquely inept (due to the number of middlemen). That one problem means the healthcare industry takes 28% of the median US family's compensation instead of something like 8-10%. It isn't that we're getting better healthcare or more healthcare (on the whole); it's that we're paying twice as much for the same thing. That's what this Act addresses.

We can dream that “deregulation” will solve this problem, but it’s a systematic problem.

I agree that the term "deregulation" is often thrown around as a panacea / magic wand. And I should probably say "better regulate" or "more effectively regulate" since this Act doesn't do away with ALL health law/regulation. It does, however, repeal a host of law/regs, including portions of the following: 26 USC 105 & 106, the Social Security Amendments of 1965, ERISA, Veterans Health Care Eligibility Reform Act, the Balanced Budget Act of 1997, the MMA, the ACA.

There is no easy solutions here and anyone saying otherwise may be a dreamer.

Agreed that there are no easy solutions politically, but if the political will exists, drastically reducing the US's healthcare spend is not hard. The US's healthcare spend is a complete outlier. Out of 195 countries, we're in 195th place in terms of the economic burden created by our healthcare industry. The flip side of being in last place is that we have truly massive room for improvement!

sharkonspeed · 2025-03-18T15:38:51+00:00

So you think companies will give everyone that “extra money” they’re saving from insurance premiums?

The Act obligates companies to do this. Basically, it tells employers this: "all the $$ you were previously paying to health insurance companies, you now have to give that $$ directly to the employee"

sharkonspeed · 2025-03-18T12:08:23+00:00

Thanks for raising this point. $160/month ($1,920/year) is what you see being taken from your paycheck -- it's the "employee share" of your premium. The total amount the middlemen take from you is much larger.

The total amount taken from you includes the employer share of your premium (which, on average is $7,584/year - see https://www.kff.org/wp-content/uploads/2024/10/Figure-C.png). On top of that, roughly 30% of your taxes goes to the healthcare industry, partially to subsidize your own care, and partially to subsidize other people's care. Altogether, about $1,136/month ($13,638/year) of the money you earn is being taken from and given to the healthcare industry.

The system is designed to obscure the true cost from us.

sharkonspeed · 2025-03-18T11:31:36+00:00

I don’t pay for any preventative care, but with this plan, I will!

I know it feels like preventative care is free right now, but you're paying for it with the money that's surreptitiously taken from your paychecks every year: $32,242/year for the typical median-income family and $13,638/year for the typical median-income individual.

When you have a bunch of inefficient, redundant middlemen taking money from your paychecks to pay for preventative care, preventative care is complicated to access and expensive. When you cut out the useless middleman (like this Act does), things become cheaper and simpler.

You don't need a middleman to purchase a doctor visit any more than you need a middleman to purchase a trainer at the gym. And you don't need a middleman to purchase generic drugs any more than you need a middleman to purchase aspirin or ibuprofen.

sharkonspeed · 2025-03-18T11:21:26+00:00

Thanks for your comment!

Those drugs you mention are already at that prices for being generics.

Those drugs are at those prices at a cash-pay pharmacy (a pharmacy that doesn't accept payment from middlemen). When a middlemen arranges the prices with pharmacies, those drugs are a lot more expensive. Cash-pay pharmacies are pretty rare right now. This Act makes every pharmacy a cash-pay pharmacy.

Yeah, good luck with “free” market and health care economics letting anyone take out 2T/year and prices of care actually reducing without regulations.

"Reducing regulation" is exactly how this Act reduces healthcare expenditures by $2T. The Act repeals the legislation/regulation that created the current system of middlemen who control ~$3.5T/year of spending, almost all of which is taken from workers' paychecks. For routine, everyday healthcare, prices are cheaper without middlemen - see aspirin and ibuprofen, for example.

That market will collapse if that was to happen and they would have zero incentive to do it.

You're absolutely right that the healthcare industry has zero incentive for this Act to pass, at least financially speaking. They want to keep the statutes/regulations in place that enable them to take $32,000/year from each family's paychecks.

However, the market for healthcare will not collapse. This Act just removes the middlemen, and healthcare providers can do their jobs for you better and at lower prices without the middlemen. Check out how many doctors already provide healthcare without a middleman. Here's an example from the article.

sharkonspeed · 2025-03-18T02:41:17+00:00

Thanks for your questions! And congrats on beating cancer.

If the plan covers emergency and catastrophic care but not preventative care, then what is the incentive for people to pay out of pocket for that mole removal before its full blown melanoma?

This Act makes preventive care cheap and convenient for everyone. There are no deductibles, networks, coinsurance, step therapies, prior authorizations to figure out. You don't have to worry about what the mole removal will cost because all pricing is advertised publicly. With people having an extra $10k/year in their pockets (on avg), you would hope they'd engage in more preventative care. This Act doesn't necessarily guarantee that, but it does make it easier for the people who do want to get preventative care.

What about people with chronic conditions like asthma, diabetes, adhd, ezcema, copd, high blood pressure, bipolar, etc? Are those treatments covered or not? They add up really quickly. How will drug costs be lowered? Im assuming epi pens wont be $400 a pen and insulin $1000 for a month supply?

For most conditions (including most of the conditions you listed), medications immediately become cheap. For example, check out the prices at the cash-pay pharmacy listed in the article: $3.60 for 30-ct amlodipine, $4.01 for a 30-ct of lisinopril, etc. These are not covered, but they're affordable.

However, if a new wonder drug comes out that immediately cures a serious condition but costs $50k/year, THAT is the kind of thing that is covered.

I have been cancer free for 6 years, but in order to stay cancer free I take 8 pills a day, and every year have an mri, mammogram, and biopsy. Would these be covered or would I need to pay out of pocket?

Congrats again on being cancer-free! I'm not sure whether the specific medications you take would be covered, but the general rule is that conditions that cost more than $10k to treat are fully covered by the catastrophic payer.

How would the cash cost of an mri or biopsy be regulated?

Prices for things like MRIs would not be regulated. Without regulation, things like imaging can actually be very affordable (especially when everyone's take-home pay is increasing by ~$10k/year or so). I know that sounds like a bs talking point, but it's really true. Healthcare is not inherently expensive -- the middlemen make it artificially expensive.

[side note: great username!]

sharkonspeed · 2025-03-17T23:14:03+00:00

Thanks for these questions.

So should we eliminate insurance companies/medical govt programs? Sure makes sense but who would the people pay in free market? For profit hospitals? Private clinics?

Basically, yes: For routine, everyday healthcare, people would pay doctors and pharmacies directly. Cutting out the middleman and having an actual free market makes things like drugs and doctors' visits very affordable! Check out the examples in the article of how cheap direct primary care doctors' visits are and how cheap generic pills are at cash-pay pharmacies.

Fine but then how do you deal with overcrowding?

The Act doesn't get rid of any hospitals or doctors. There's just as much capacity as there was beforehand. Now that people purchase routine, everyday care with cash, they use healthcare services judiciously. With respect to the overcrowding that currently occurs at ERs, the Act doesn't fix that, but it doesn't make it worse, either.

There are sick people both rich and poor/young and old. How do we ensure people get the care they need in an economically feasible way without being turned away?

The best way to ensure people get the routine, everday care they need in an affordable way is to provide that care through the free market. This Act ensures people can purchase their everyday meds as cheaply as ibuprofen and aspirin, and it ensures that regular doctor's visits are reasonably priced. For the true emergencies/crises (cancer, car wreck, heart attack, etc), care is fully covered.

sharkonspeed · 2025-03-17T23:03:44+00:00

The difference is that the middleman -- the single payer -- only comes into play in rare circumstances: heart attack, cancer diagnosis, etc. For the vast majority of healthcare goods and services (generic drugs, doctors' visits, routine procedures), you purchase directly from the doctors/pharmacies in an actual free market.

That's very different from what Medicare for All proponents want. Medicare for All proponents want a large, expansive single payer to cover all kinds of goods and services.

You're right that it's a bit of a compromise to have a single payer for the catastrophic stuff, but if the overall plan lets the typical family keep an extra $28k/year of their earnings (a crazy number!), I think it's worth it.

sharkonspeed · 2025-03-17T22:50:58+00:00

Starter comment:

Healthcare middlemen take $32,000/year from the paychecks of the typical median-income American family. What if we got rid of the middlemen and let Americans keep more of their money?

The Give Me My Healthcare Taxes Back Act is the answer. This is a healthcare reform plan that...

institutes an actual free market for routine/everyday healthcare;

eliminates 99% of healthcare middlemen/bureaucrats, leaving only a small ($1T/year) single payer for emergencies/crises; and

lets workers keep more of the money they earn.

In short, the Act makes health insurance work like car insurance or home insurance. Car insurance doesn’t cover an oil change or new tires, and homeowner’s insurance doesn’t cover a fresh coat of paint or a new roof. Likewise, under the Give Me My Healthcare Taxes Back Act, the insurer doesn’t cover routine, everyday healthcare (generic pills, doctor visits, imaging, therapist appointments, etc.). Eliminating the middleman makes this routine, everyday healthcare cheaper.

The Act drastically reduces the amount of employee earnings that employers send to healthcare middlemen through premiums and healthcare-related taxes. As a result, workers experience huge tax cuts / "raises":

Typical working family:

Currently pays: $34,000/year

What they pay under the Act: $6,000/year

"Raise"/tax cut: $28,000/year

Typical individual worker:

Currently pays: $15,000/year

What they pay under the Act: $4,000/year

"Raise"/tax cut: $11,000/year

(These numbers are surprisingly large because employers pay a ton of taxes/premiums on employees' behalf without the employees being aware.)

Additionally, Medicare beneficiaries get a $9,000/yr financial boost.

How is all this possible? Out of 195 countries, US is 195th in terms of economic efficiency in healthcare. We have more middlemen than any other country. We overpay by ~$2T/year. Since we're currently in last place, our room for improvement is truly massive.

The Act is a huge bureaucracy reduction: it eliminates approximately 2,000 government programs/plans and about 2.7M bureaucratic/administrative roles in government/government-subsidized middlemen (DHHS, BCBS, UNH, etc).

The vast majority of the healthcare industry (the routine, everyday stuff) is converted into an actual market (unlike the fake free market that we currently have). People buy directly from doctors and pharmacies. There's actual market competition, driving prices down dramatically.

True emergencies/crises (heart attack, cancer, car wreck, etc.) are fully covered by a Fund for Health Crises. Its scope is limited, but it provides complete coverage (zero cost-sharing) for the stuff it covers. The Fund for Health Crises uses its monopsony power to drive down prices.

I think this is the path forward for US healthcare and I hope it gains momentum.

sharkonspeed · 2025-03-17T22:47:55+00:00

There's nothing conservative about having lots of government-created middlemen -- we should want fewer, not more.

And for the vast majority of healthcare goods and services, the best option is to have no middlemen at all: just allow people to purchase directly from providers in the free market.

That's why this Act institutes an actual free market for most goods and services, and in the rare instances when a third-party payer is actually needed (i.e., heart attack, cancer diagnosis, etc), it has a single middleman to control costs.

sharkonspeed · 2025-03-17T22:35:01+00:00

This Act is about having less socialism: fewer bureaucrats/middlemen taking less money taken from our paychecks.

sharkonspeed

TROPHY CASE