Gary Ratner
@garyratner.bsky.social
Atty. Biochemist. Practiced law @ SCOTUS + xray xtallography @ Advanced Photon Source, Argonne Natl Lab. Health care policy hobbyist with a blog about direct primary care. dpcreferee.com
Collins will vote as allowed by the results of Republican whipping; for the three-year extension, once it becomes clear that her vote won't actually matter; against it, if needed to deafeat the extension.
December 11, 2025 at 3:15 PM
Collins will vote as allowed by the results of Republican whipping; for the three-year extension, once it becomes clear that her vote won't actually matter; against it, if needed to deafeat the extension.
I thought the GOP gained filibuster power in the Senate. But Dems still held the majority in Senate and were thus able to do what needed be done.
November 6, 2025 at 3:28 PM
I thought the GOP gained filibuster power in the Senate. But Dems still held the majority in Senate and were thus able to do what needed be done.
The most honorable of Honorable Mention should go to the Yale Bowl. As architecture it is the original "bowl" stadium. And it is closely connected to Walter Camp, the architect of American Football.
October 22, 2025 at 6:48 PM
The most honorable of Honorable Mention should go to the Yale Bowl. As architecture it is the original "bowl" stadium. And it is closely connected to Walter Camp, the architect of American Football.
Costco in Portland is now Monday to Friday only, 1100am to 1pm, and sells only the $1.50 hot dog/soda combo, 32 inch televisions, and Kirkland branded chese (limit 1 per customer).
October 11, 2025 at 3:22 AM
Costco in Portland is now Monday to Friday only, 1100am to 1pm, and sells only the $1.50 hot dog/soda combo, 32 inch televisions, and Kirkland branded chese (limit 1 per customer).
I'm not that keen on scenarios in which an evil king is struck down but "Jr." becomes the next king.
October 6, 2025 at 2:29 PM
I'm not that keen on scenarios in which an evil king is struck down but "Jr." becomes the next king.
Obvious investigative reporting expense, BUT ONLY IF your receipts demonstrate that you ordered one of everything on the menu.
September 21, 2025 at 2:39 PM
Obvious investigative reporting expense, BUT ONLY IF your receipts demonstrate that you ordered one of everything on the menu.
Read your seeming spoiler, streamed some comfy crime instead, went to sleep, got up, decided to watch the ninth inning anyways. Lucky me.
August 21, 2025 at 2:09 PM
Read your seeming spoiler, streamed some comfy crime instead, went to sleep, got up, decided to watch the ninth inning anyways. Lucky me.
Zuchini is very good at administative assisting. As if born to the role.
August 19, 2025 at 11:34 PM
Zuchini is very good at administative assisting. As if born to the role.
But, might just be that the very sick/complex, the 5% who account for 1/2 of all medical spend, predictably hit max OOP regularly - no matter how they pay their PCPs. Sad, but largely obviates the $$ incentive for the most complex, expensive patients to extract value from “unlimited” DPC.
August 15, 2025 at 4:33 PM
But, might just be that the very sick/complex, the 5% who account for 1/2 of all medical spend, predictably hit max OOP regularly - no matter how they pay their PCPs. Sad, but largely obviates the $$ incentive for the most complex, expensive patients to extract value from “unlimited” DPC.
I know you are joking, BP. But I am old enough to remember how, when Adashi et al wrote in JAMA that "DPC presents physicians with an incentive structure built on accepting healthier patients . . ..", the then-president of DPC Alliance excoriated them and accused them academic dishonesty.
August 14, 2025 at 11:13 PM
I know you are joking, BP. But I am old enough to remember how, when Adashi et al wrote in JAMA that "DPC presents physicians with an incentive structure built on accepting healthier patients . . ..", the then-president of DPC Alliance excoriated them and accused them academic dishonesty.
Miliman - Society of Actuaries study
www.soa.org/globalassets...
Schwartzman PhD
openscholarship.wustl.edu/cgi/viewcont...
Brekke PhD
kuscholarworks.ku.edu/bitstream/ha...
www.soa.org/globalassets...
Schwartzman PhD
openscholarship.wustl.edu/cgi/viewcont...
Brekke PhD
kuscholarworks.ku.edu/bitstream/ha...
www.soa.org
August 14, 2025 at 9:21 PM
Miliman - Society of Actuaries study
www.soa.org/globalassets...
Schwartzman PhD
openscholarship.wustl.edu/cgi/viewcont...
Brekke PhD
kuscholarworks.ku.edu/bitstream/ha...
www.soa.org/globalassets...
Schwartzman PhD
openscholarship.wustl.edu/cgi/viewcont...
Brekke PhD
kuscholarworks.ku.edu/bitstream/ha...
THIN is the actual evidence of that DPC reduces downstream or overall care costs. Actuarial studies show very much the opposite.
dpcreferee.com/2024/09/26/u...
dpcreferee.com/2024/11/19/n...
DPC's accessibility cuts down ED/UC visits, which helps some. But access is expensive. Net gain near $0
dpcreferee.com/2024/09/26/u...
dpcreferee.com/2024/11/19/n...
DPC's accessibility cuts down ED/UC visits, which helps some. But access is expensive. Net gain near $0
August 14, 2025 at 9:09 PM
THIN is the actual evidence of that DPC reduces downstream or overall care costs. Actuarial studies show very much the opposite.
dpcreferee.com/2024/09/26/u...
dpcreferee.com/2024/11/19/n...
DPC's accessibility cuts down ED/UC visits, which helps some. But access is expensive. Net gain near $0
dpcreferee.com/2024/09/26/u...
dpcreferee.com/2024/11/19/n...
DPC's accessibility cuts down ED/UC visits, which helps some. But access is expensive. Net gain near $0
Only 3 actuarially credible studies touch on the health characteristics of those electing D-PC versus FFS-PC: PhD dissertations by Schwartzman and by Brekke; and a major Society of Actuaries report ("Milliman"). All 3 found those electing DPC to be significantly healthier than their counterparts.
August 14, 2025 at 8:54 PM
Only 3 actuarially credible studies touch on the health characteristics of those electing D-PC versus FFS-PC: PhD dissertations by Schwartzman and by Brekke; and a major Society of Actuaries report ("Milliman"). All 3 found those electing DPC to be significantly healthier than their counterparts.
The case for replacing fee-for-service, insurance-funded primary care with a capitation/subscription model is a bit persuasive. But experience in the rest-of-the-industrialized world (and the VA at home) suggest that government-funded health services can deliver quality primary care.
August 14, 2025 at 6:17 PM
The case for replacing fee-for-service, insurance-funded primary care with a capitation/subscription model is a bit persuasive. But experience in the rest-of-the-industrialized world (and the VA at home) suggest that government-funded health services can deliver quality primary care.
By $$ volume, the "other" 60% is probably closer to 80% on average. If you see "60" in your own DPC's patient panel, it is likely because your panel is significantly younger and healthier than average; you may also be seeing atypically healthy lifestyles of your outdoorsy Down East neighbors.
August 14, 2025 at 1:45 PM
By $$ volume, the "other" 60% is probably closer to 80% on average. If you see "60" in your own DPC's patient panel, it is likely because your panel is significantly younger and healthier than average; you may also be seeing atypically healthy lifestyles of your outdoorsy Down East neighbors.
Potential silver lining. Proximity to armed federals of all types presents an opportunity for DC local law enforcers to recount the terror of Jan 6 and make a strong, deeply personal case for those federals to resist unlawful orders.
August 13, 2025 at 6:33 PM
Potential silver lining. Proximity to armed federals of all types presents an opportunity for DC local law enforcers to recount the terror of Jan 6 and make a strong, deeply personal case for those federals to resist unlawful orders.
The supposed buddy-ship of Bork and Bickel did not prevent Bickel from breaking from Bork, in a open community forum at Yale Law School, in the days following the Saturday Night Massacre (aka, the day "the King summoned the cruel Black Bork from the dungeon to banish the traitors from the kingom").
August 13, 2025 at 6:25 PM
The supposed buddy-ship of Bork and Bickel did not prevent Bickel from breaking from Bork, in a open community forum at Yale Law School, in the days following the Saturday Night Massacre (aka, the day "the King summoned the cruel Black Bork from the dungeon to banish the traitors from the kingom").
Insurer's multiple plans differ in whether the insured's cost share is a copayment with a fixed maximum dollar amount, or a coinsurance at a fixed percentage. Since insurer must make available some very pricey drugs, the coinsurance method may be less risky and would justify the lower premium.
July 27, 2025 at 12:44 PM
Insurer's multiple plans differ in whether the insured's cost share is a copayment with a fixed maximum dollar amount, or a coinsurance at a fixed percentage. Since insurer must make available some very pricey drugs, the coinsurance method may be less risky and would justify the lower premium.
operas, especially verdi's rigoletto and puccini's turandot, bizet's carmen. Works with or without libretto or translation, but probably best with a plot summary. Get the hang of it, then expand the canon.
March 31, 2025 at 5:05 AM
operas, especially verdi's rigoletto and puccini's turandot, bizet's carmen. Works with or without libretto or translation, but probably best with a plot summary. Get the hang of it, then expand the canon.