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This is a good summary of the problem, objective without putting all of the blame on payers or providers. The "risk adjustment specialists" and consultants are a problem, looking at you some of my actuary friends, billing $500+/hour to add a bunch of bloat to the system

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Many papers I see: A global problem Search for modifiable "risk factors" A cohort study sorry I mean real-world data "Multivariate" regression Some associations Can't say cause Residual confounding Policy must change in ways having nothing to do with our findings More research is needed

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This NEJM "Clinical Decisions" is about whether you should do a physical exam in an otherwise healthy person. How about the TOTALLY UNNECESSARY testing that's being done here. "Pursue a laboratory workup"?! For what!? ht: @ishaniganguli.bsky.social www.nejm.org/doi/10.1056/...

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THE PART THAT'S SO INSANE HERE ISN'T JUST THAT OBVIOUSLY, YOU INSURE AGAINST RISKS YOU HOPE NEVER MATERIALIZE, IT'S THAT THE HEALTHY PEOPLE WHO DON'T FILE CLAIMS ARE THE REASON PREMIUMS ARE CHEAPER FOR THE SICK PEOPLE HOLY SHIT

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