Once, Twice, Three Times a Vegas
Vegas is an adult wonderland full of giant buildings, auditoriums for senescent stars, and unnecessary but sweet fountains – all inside the literal desert. People visiting will sometimes ask in wonder, “how did all this come to be?” The answer is a straight answer – money. Lots and lots of money.
Vegas does not publish its percentages of winning, but it’s about 10%. Roulette is lower (1\37 goes to the house) and sports betting varies according to the bets, but 10% is a very fair assumption in toto.
So, what would Vegas look like if just as many people bet, but their take was 30%. The roller coaster on top of a building? Not 900 feet but 2700 feet. Fountains? No 1000 jets, but 3000. The enormity and glamor and outright waste would be hard to imagine if you tripled Vegas. Even harder to imagine would be people putting up with getting back so little. It would and should become a desert again.
So why even imagine a Vegas giving back only 70% to its customers? The Obama healthcare reform included a percentage requirement for healthcare insurance companies. 70% of the money you take in must go back to customers as benefits, and their percentage to keep could not exceed 30%.
Immediately many small insurance companies folded. Immediately. The big companies scrambled because they were nowhere near that 70 – so we started getting idiotic “Quality Consideration” faxes, our patients started getting pestered with visiting nurses, and whole departments were created to ostensibly give back benefits to its customers. I did not see prior authorizations decrease, my fees increase, my anything increase except more work in approvals, and more narrow networks for referrals.
Many may have mixed feelings about Obamacare – but this rule was perfectly appropriate, and could easily have been 80, or dare I even say 90? No one should give to any charity that has operating expenses above 10% – and yet we all tolerate our insurance companies. My family insurance is $1300 a month, with each of us having a $4000 deductible. We all sit around hoping to get cancer or a car wreck so that the insurance will actually pay something. But someone has to own Wall Street, someone has to build those skyscrapers, and we as a country have decided to let the insurance companies be that somebody. I do wish they would at least put in those cool dancing fountains in front of their buildings so we could all oooh and ahhh.
I want your insurance! My family had decent coverage for ~$600/month prior to Obama. Now, after the ‘Affordable Care Act’ it’s >$2800/month with $6000pp deductible and doesn’t pay for anything! Someone has to pay for the abortions. I suppose it was ‘affordable’ to someone, namely those on public assistance that clog the ED with PCP issues because it’s ‘free’. To see the PCP is a $2 copay, and they could buy cigarettes or Meth with that. Ambulances come in with people that have had a sore throat for a week. I have become cynical. I once loved this profession, now I just want out.