Archives for September 2020

7 years ago, I wrote, for the first time, at Balloon-Juice.  I had a fairly straight-forward objective:

I’m a bureaucrat at a health insurance company which most of you have never and will never hear about. My job is to be a subject matter expert on a fairly arcane set of knowledge. I have seen some posts and some great comment threads at Balloon Juice where great questions are being asked and basic mechanical knowledge would be very useful. I will be writing a series of posts over the next couple of weeks/months that attempts to explain why a profit seeking insurance company does what it does.

And yes, before I get started, I agree with the vast majority of the commenteriat here that absent massive path dependency and being able to make policy behind a veil of ignorance, I would not choose the US model or the modifications to the model that are being made by Obamacare. I would have chosen a far more comprehensive single payer system that is not a kludge of multiple previous kludges. However, that is not the world that we live in, so I am assuming profit seeking insurance companies will be around for a while.

I think that has stood up pretty well even as my life has changed dramatically over the course of 2,000 posts.

I’m no longer a mid-level bureaucrat at a regional insurer writing behind a pen name.

I’m an accidental academic working at Duke thinking about the ways payments are structured for care, behavioral choice eddies people get stuck in and over the past eight months, all sorts of things about infectious diseases and pandemic responses due to COVID.

I’ve written in the New York Times, JAMA-Internal Medicine, JAMA Forums, Health Affairs.  I’ve been quoted in the LA Times, Washington Post, Politico and Axios.  I’ve talked with senior policy makers, key staff and high profile policy entrepreneurs to pitch ideas and get policy moved in directions that I think are superior to other options.  I’ve screamed my head off for years and have begun to build an academic career on the very simple point that price linked subsidy systems, especially oddly means tested price linked subsidy systems, do very weird things to pricing dynamics.

I’ve been able to help people through confusing and complex situations. I’ve talked to people who are facing immense pain and stress and hopefully was able to give some advice that made their life a little bit easier and clearer.  I’ve been on conference calls with advocates to figure out what an actionable ask could be.  I’ve pitched ideas that were useful and interesting and have gone nowhere.

Yet, except for the “next couple of weeks/months” part, I think my 2013 me would recognize in kind if not degree my 2020 me.

As I said last year, I love writing here and I want to keep writing for and at Balloon-Juice until one of the following happens:

• My wife tells me to stop.
• My boss tells me to stop.
• You all tell me to stop.
• I tell myself to stop as I don’t find joy in thinking and writing about these problems any more.

None of those things are likely to happen any time soon.

So, you guys are stuck with me for at least another year and a few more hundred exceedingly wonky, geeky and esoteric posts about the US healthcare finance and risk distribution systems.

2,000 posts on insurance and more to come….Post + Comments (83)