Derek Thompson

And if we're gonna understand how to hunt for waste and even fraud in government health spending, I think we should understand a little bit about how government spending on healthcare actually works. So, Tim, let's say I go to the doctor with chronic leg pain.

And if we're gonna understand how to hunt for waste and even fraud in government health spending, I think we should understand a little bit about how government spending on healthcare actually works. So, Tim, let's say I go to the doctor with chronic leg pain.

The doctor could prescribe me Tylenol, or he could send me off to get five blood scans, an MRI scan, a CT scan, and a prescription for new nerve pain therapy that costs $10,000 a month, right? Washington doesn't know what treatment plan is right. Is it the Tylenol that's like two cents? Or is it this other plan that's like 20,000 bucks a month?

The doctor could prescribe me Tylenol, or he could send me off to get five blood scans, an MRI scan, a CT scan, and a prescription for new nerve pain therapy that costs $10,000 a month, right? Washington doesn't know what treatment plan is right. Is it the Tylenol that's like two cents? Or is it this other plan that's like 20,000 bucks a month?

The doctor could prescribe me Tylenol, or he could send me off to get five blood scans, an MRI scan, a CT scan, and a prescription for new nerve pain therapy that costs $10,000 a month, right? Washington doesn't know what treatment plan is right. Is it the Tylenol that's like two cents? Or is it this other plan that's like 20,000 bucks a month?

So how does the government, acting on behalf of the taxpayer, approaching this very challenging question of how to reimburse good care with an eye toward controlling costs?

So how does the government, acting on behalf of the taxpayer, approaching this very challenging question of how to reimburse good care with an eye toward controlling costs?

So how does the government, acting on behalf of the taxpayer, approaching this very challenging question of how to reimburse good care with an eye toward controlling costs?

It seems to me like you're outlining two ways that healthcare spending can go awry. In a fee-for-service, FFS system, doctors or insurers are biased to deliver more and more and more services even when patients don't need it, and that drives up costs across the system. But in the alternative scenario of capitation, now you're encouraging healthcare

It seems to me like you're outlining two ways that healthcare spending can go awry. In a fee-for-service, FFS system, doctors or insurers are biased to deliver more and more and more services even when patients don't need it, and that drives up costs across the system. But in the alternative scenario of capitation, now you're encouraging healthcare

It seems to me like you're outlining two ways that healthcare spending can go awry. In a fee-for-service, FFS system, doctors or insurers are biased to deliver more and more and more services even when patients don't need it, and that drives up costs across the system. But in the alternative scenario of capitation, now you're encouraging healthcare

insurers to turn away or find ways to deny care for the sickest patients. And that means, you know, not including oncologists in your network. So there's these two rocks that we're trying to navigate between. Mike, I want to keep the explanatory pace here slow and steady so everyone's on the same page. But what Tim has outlined is that the government has a very serious interest

insurers to turn away or find ways to deny care for the sickest patients. And that means, you know, not including oncologists in your network. So there's these two rocks that we're trying to navigate between. Mike, I want to keep the explanatory pace here slow and steady so everyone's on the same page. But what Tim has outlined is that the government has a very serious interest

insurers to turn away or find ways to deny care for the sickest patients. And that means, you know, not including oncologists in your network. So there's these two rocks that we're trying to navigate between. Mike, I want to keep the explanatory pace here slow and steady so everyone's on the same page. But what Tim has outlined is that the government has a very serious interest

in properly reimbursing doctors who care for sick patients. We want to align government payments with actual patient illness. Like that's the gold standard here, right? But that means that the government needs a way of actually determining, actually seeing which patients are actually very sick and need more treatment. So how are doctors telling the government how sick their patients are?

in properly reimbursing doctors who care for sick patients. We want to align government payments with actual patient illness. Like that's the gold standard here, right? But that means that the government needs a way of actually determining, actually seeing which patients are actually very sick and need more treatment. So how are doctors telling the government how sick their patients are?

in properly reimbursing doctors who care for sick patients. We want to align government payments with actual patient illness. Like that's the gold standard here, right? But that means that the government needs a way of actually determining, actually seeing which patients are actually very sick and need more treatment. So how are doctors telling the government how sick their patients are?

Let's use, say, a diabetes patient as an example.

Let's use, say, a diabetes patient as an example.

Let's use, say, a diabetes patient as an example.