OT: Ray, how's your Bitcoin investment going?

[PQJ]

Malcolm,

From the outside looking in - ie, as a consumer only and not someone really involved in the industry - it seems very, very dishonest. Again, not the providers, but the system/big corporate interests.

I'm currently working with some doctors who are setting up a specialized surgery practice. A few doctors combining assets and resources with a view to building something much, much bigger. There are some complex issues but none so much as the various billing arrangements. It's been quite an eye-opener to get into the reeds and see how these things really operate. Let me be clear: the doctors are all excellent professionals and good people; everything they are doing/looking to do is perfectly legal and squarely within the bounds of what they can do and what they and others are doing. From my perspective, however - and again, as a lay person with heretofore very limited knowledge about the system and process - I am left with the distinct impression that it's a game, a giant scam where the biggest losers are the patients. The next biggest losers are the medical professionals themselves.

The winners? I've read that health insurance companies and drug companies aren't profitable, or aren't that profitable. Maybe. Maybe. But the cynic in me says they are simply 'engineering' their poor profits. The insurance companies are far and away the worst actors and I believe we'd all be better off if we could get rid of them entirely.

As for drug companies, I get that the process of developing drugs is expensive. I get that drug companies need to be invented to develop the drugs we need (and those we don't - hello psychopharma, I'm looking squarely at you). But how is it that this year, the same person (me), with the exact same condition I had last year, is all of a sudden paying 1/10 of the cost for the exact same drug I purchased not two months ago. Dat sh1t just does not make sense! I'm the lucky winner (this year), but it makes me feel all the more a loser for the 5 years I was on a different frikkin plan. Drug companies should develop the drug, recoup their costs, make a nice profit, and all of us should pay about the same for said drug, not somewhere between a 1% difference and a 1000% difference. It just does not compute.

[malcolm]

Originally Posted by PQJ

Malcolm,

From the outside looking in - ie, as a consumer only and not someone really involved in the industry - it seems very, very dishonest. Again, not the providers, but the system/big corporate interests.

I'm currently working with some doctors who are setting up a specialized surgery practice. A few doctors combining assets and resources with a view to building something much, much bigger. There are some complex issues but none so much as the various billing arrangements. It's been quite an eye-opener to get into the reeds and see how these things really operate. Let me be clear: the doctors are all excellent professionals and good people; everything they are doing/looking to do is perfectly legal and squarely within the bounds of what they can do and what they and others are doing. From my perspective, however - and again, as a lay person with heretofore very limited knowledge about the system and process - I am left with the distinct impression that it's a game, a giant scam where the biggest losers are the patients. The next biggest losers are the medical professionals themselves.

The winners? I've read that health insurance companies and drug companies aren't profitable, or aren't that profitable. Maybe. Maybe. But the cynic in me says they are simply 'engineering' their poor profits. The insurance companies are far and away the worst actors and I believe we'd all be better off if we could get rid of them entirely.

As for drug companies, I get that the process of developing drugs is expensive. I get that drug companies need to be invented to develop the drugs we need (and those we don't - hello psychopharma, I'm looking squarely at you). But how is it that this year, the same person (me), with the exact same condition I had last year, is all of a sudden paying 1/10 of the cost for the exact same drug I purchased not two months ago. Dat sh1t just does not make sense! I'm the lucky winner (this year), but it makes me feel all the more a loser for the 5 years I was on a different frikkin plan. Drug companies should develop the drug, recoup their costs, make a nice profit, and all of us should pay about the same for said drug, not somewhere between a 1% difference and a 1000% difference. It just does not compute.

Very well said and I agree. Most doctors I've known and I've known many are incredibly hard working dedicated and try to do the right thing.

I was always the guy that said the pharma industry had no impact on what I did at all. As I've been doing this awhile I realized that my view was way to simplistic and I now believe pharma and insurance controls it all but not with direct interaction with the individual practitioner but with far more insidious and subtle financing and support of research that furthers their interests and suppression of research to the contrary. It can be difficult to publish in a meaningful journal something that goes against the dogma. Also with massive advertising manipulating the customer or patient.

I'm proud of my profession and my career. I've seen human beings at their very best and worst. I've seen more than my share of life go and some snatched from the brink. Medicine has been a blessing and I'm sad to see us losing our way.

[1centaur]

I agree that all these billing codes are a giant productivity suck at the very least and that costs money which indirectly reduces care. Thus my thought that single administrator (government sponsored entity would be OK) with unified billing codes would be a help.

One of the problems is that each insurance company devises its own billing codes and has its own standards and definitions around those codes, a morass that can quickly overcome any doctor's office and lead to hiring third parties to deal with billing, which third parties try hard to maximize the billing for their doctor clients, while the insurance company (and sometimes THEIR third party helpers) try to make sure they are not being gamed in a way the insurance actuaries did not contemplate when pricing the policies. No wonder patients have no clue what's going on. It's not necessarily some nefarious corporate game so much as a very human level of confusion at way too much data and confusing rules.

Your eye drops prescription cost you that much because your employer had a crappy (cheap) plan. They chose not to have the sort of plan that leads to $10 co-pays for its employees. There are pharmaceutical benefit managers (PBMs) that negotiate volume discounts with drug manufacturers in return for administering drug coverage for insurance plans. There are 3-5 large PBMs that do this for most plans; that's whom CVS's computers are interacting with when you get a prescription. Some employers get plans that are great for generics and lousy for brand name drugs. More expensive plans may be $5 for generics and $10 for brand name drugs on the contracted PBM's formulary. When a patient need drugs not on that list, the prices can sky rocket quickly, soaking up the max out of pocket number quite quickly (good reason to have a flex spending account as well).

[PQJ]

We agree that it was a crappy plan. Cheap? Not so much; quite expensive, actually. It also wasn't sold to us as crappy or cheap, not that that matters. Fwiw, I'm talking about a very well regarded regional enterprise with north of 500 employees. Maybe it has something to do with the regulatory environments where you and I live, a blue state (you) that looks out for the consumer and a red state (me) that looks out for corporate interests? That's a genuine inquiry, not red meat. That also gets at one of the points I'm making - the differences in coverage from state to state, company to company, just don't make sense. Too arbitrary. Too much like there's a giant team of very smart people looking to see how best to screw the consumer. I'll concede that complexity and confusion are part of the problem, but given what I know about private enterprise in a capitalist system (and which, I suspect, you know as well), I think it is naive to think there isn't also a very real nefariousness at play as well.

[Kirk Pacenti]

Originally Posted by PQJ

think it is naive to think there isn't also a very real nefariousness at play as well.

.

[harlond]

Hope Ray already sold:

http://finance.yahoo.com/news/bitcoi...105751675.html

[Ahneida Ride]

Stayed in frns (fed reserve non notes)

[christian]

Originally Posted by cfox

The theory breaks down if new, healthy membership lags and people pay the penalty rather than join the pool. The people who don't qualify for the subsidy but still buy insurance make up a large part of the difference (me). Honestly, I'd be okay with it if I were confident the % of uninsured would be reduced by a significant margin, but so far that is not the case.

There are obvious ways to address this; single-payer, or allowing other people to opt out of their company-sponsored plans in order to sign up for plans on the exchange. If provided that opportunity, my family would, despite the fact that I get good insurance through work. Coupling insurance to work, and providing tax incentives to employers on that basis is one of the key issues here.

[verticaldoug]

http://dealbook.nytimes.com/2014/02/...-struggles/?hp

We have Reg T, Reg Sho, Fail-Deliver-Rules for buy-in, counter party risk and all sorts of other regulations in security markets designed to help prevent fraud and systemic risk. A lot of this stuff is referred to as the back-office in the markets. If settlesments don't work smoothly, the financial markets quickly grind to a halt. It looks like MtGox is getting a lesson on how important and hard the back office is to get right. It's not sexy like the front office, but just as important and even more important for preventing fraud.

This could be lights out for MtGox and maybe fatal to some of the bitcoin realm.

[R2D2]

Originally Posted by verticaldoug

http://dealbook.nytimes.com/2014/02/...-struggles/?hp

We have Reg T, Reg Sho, Fail-Deliver-Rules for buy-in, counter party risk and all sorts of other regulations in security markets designed to help prevent fraud and systemic risk. A lot of this stuff is referred to as the back-office in the markets. If settlesments don't work smoothly, the financial markets quickly grind to a halt. It looks like MtGox is getting a lesson on how important and hard the back office is to get right. It's not sexy like the front office, but just as important and even more important for preventing fraud.

This could be lights out for MtGox and maybe fatal to some of the bitcoin realm.

It is worse than just correctly implementing a system:

undetected glitch in the basic Bitcoin protocol that made it possible for users to falsify transactions.

Now Bitcoin counters:

“The issues that Mt. Gox has been experiencing are due to an unfortunate interaction between Mt. Gox’s highly customized wallet software, their customer support procedures, and an obscure (but long-known) quirk in the way transactions are identified and not due to a flaw in the Bitcoin protocol,” Mr. Andresen said in a statement.



Either way Bitcoin could be on shaky ground. Users need to have confidence in the currency and exchanges. I have written software all my working life. Words like glitch and quirk are BS. Either the application code or protocol have flaws.

[FlashUNC]

Hope nobody here had Bitcoins at Mt.Gox. You're hosed:


http://valleywag.gawker.com/mt-gox-d...arah-hedgecock

[christian]

Anyone who poses for a picture of a plastic coin to promote a virtual currency should be punched in the face, sort of on principle.

[R2D2]

Originally Posted by christian

Anyone who poses for a picture of a plastic coin to promote a virtual currency should be punched in the face, sort of on principle.

If you can find him.

[Tony T]

WSJ: Mt. Gox Disappears From Web in New Setback
Trading of Bitcoin Via Exchange Appears to Halt

Londoner Kolin Burges protests outside Mt. Gox's offices in Tokyo earlier this month.
Takashi Mochizuki/The Wall Street Journal

As difficulties accumulated at Mt. Gox—until recently the dominant bitcoin trading platform—the wider bitcoin community sought to both distance itself from the Tokyo-based exchange and offer reassurance about the virtual currency's future.

Underlining a wider worry in the industry that the upheaval at Mt. Gox has caused significant harm to the bit coin business, the chief executives of six major bitcoin exchanges and businesses pledged in a joint statement to coordinate efforts to assure customers of the security of their funds.

Investors have been unable to withdraw funds from Mt. Gox since the beginning of this month. The exchange has said that a flaw in the bitcoin software allowed transaction records to be altered, potentially making possible fraudulent withdrawals. No allegations have been made of wrongdoing by the exchange, but the potential for theft has raised concern that the exchange wouldn't be able to meet its obligations.

A report widely circulated online since Monday in the U.S. said Mt. Gox had lost almost 750,000 bitcoin to long-running theft. Though the value of the alleged loss is difficult to quantify because of bit coin price fluctuations, that amount would represent around 6% of bitcoin in existence and a value of around $365 million at Monday's prices.
"This tragic violation of the trust of users of Mt. Gox was the result of one company's actions and doesn't reflect the resilience or value of bitcoin and the digital currency industry," the statement said. "As with any new industry, there are certain bad actors that need to be weeded out, and that is what we are seeing today."

The firms' statement didn't offer specific details on what they would do to reassure bitcoin investors.

Reached by phone later Tuesday, BTC China CEO Bobby Lee said the latest signs of trouble at Mt. Gox were no surprise: "This has been in the making for a good six to nine months," he said.

He said he doesn't see Mt. Gox's difficulties as opening up more business for any particular exchange, given the way the bitcoin business is spread around the globe. He said BTC China currently trades around 10,000 bitcoin a day, which is up since January but down since December, when Chinese regulators restricted banks and payment platforms from engaging in bitcoin-related activities in China.

—Chao Deng in Shanghai contributed to this article.

[jpw]

now might be a good time to buy, from the right seller, and through the right platform.