you're not fixing the distortive incentives with this scheme, just transforming them. 'capitation' incentivizes hoarding of patients, most obviously by incentivizing the minimization of treatment times and associated costs but also through outright fraud (by falsifying records, etc.). so you're essentially trying to maximize patient outcomes by capping costs, which is a terrible proxy metric all around.

to actually improve healthcare, we'd need to increase spending per person (by an order of magnitude or more, using more team-based medical care rather than 1-on-1), for not only direct care costs, but also research and development. what we absolutely need none of is deadweight losses, like profit-maximizing medical administration, big pharma, and the whole medical insurance industry. medical 'insurance' has become a complete misnomer, as it no longer serves to mitigate the distasterous effects of low probability, high impact events, but as a socialization of routine medical care, which is not insurance at all.

Huh, I didn't expect to come across something I have such direct knowledge of.

I used to work with this data directly - I worked with MACPAC to prepare reports for the CBO on the efficacy of pay-per-performance programs, especially as it pertained to the possibility of switching Medicaid from a fee-for-service model to a pay-for-performance model. (6-9 years ago)

I just wanted to chime in on this one quote:

> We have all the data we need to know what the outcomes should be for a provider over the course of a year.

The data here is exceedingly low quality, especially for Medicaid. Medicare is in a better state due to being centrally administered. We do *not* have all the data we need to make pay-for-performance more than an extremely rudimentary approach. Is that rudimentary approach still better than fee-for-service? Maybe - that's a complicated question I let the public health PHDs write very long reports on.

Well, the idea is probably not to gain weight in the first place. Once you gain weight it is very hard to lose it. Many people manage naturally to keep perfect BMI by eating healthy diet and having enough exercise or by just moving around. Exercise will have more health benefits than just keeping your body weight low.

IME exercise (combined with appropriate diet, mind you), actually reduces food intake for me. Or at least, makes it so I eat less net calories after removing the expenditure. But otherwise agreed, diet is the foundation.

all the nutrition info is on the labels yet people knowingly overeat. different type of problem.

I am only replying to your incendiary comment to say that your characterization is insulting and wrong, "fucking keto diet"(s) are having results for many people, whether you like it or not

Others, please research this person further, he's not a "loon" / "crackpot" just a regular smart young person who also happens to be a cancer researcher.

BTW, keto also cures epilepsy, and that's known since the early 20th century, is that also triggering to you?

Third point, and I'm going to end it here: I myself suffered from Multiple Sclerosis when I was younger; it was retrospectively very easy to correlate, at least in a large part, with diet and lifestyle. The changes I had to make to be in remission were DRAMATIC but worth it. I don't think I would've been insulted to read about people in similar situations experiencing remission from lifestyle adjustments, in fact, I would have been extatic to find out I'm not condemned to slowly drift into being eventually wheelchair-bound, as my doctors were predicting.

Also, re: this caricature you make of these "keto" diet cancer plans, it's not true that the "body still runs on glucose", in fact only 25 grams of glucose are manufactured by the liver per day in the absence of dietary carbohydrates. And I don't claim to know the mechanisms, but I know FOR SURE that human beings (and no other animal for that matter) evolved to live on candy bars and sugar water, and that replacing one's diet with something species-appropriate and nutritionally replete is bound to have some effect.

Lol "sometimes is enough, sometimes not" is a bit of a backpedal from definitively putting cancer into remission.

If it's an area of legitimate research for cancer treatment, then why do you lead with a reference to an individual crackpot - instead of even a poorly designed peer-reviewed study in a low impact forum.

Of the millions of possibilities, why do you assume that it was the keto diet of this individual that lead to their remission? Do you lack the imagination that it would likely be something else?

Because it’s not misinformation - the body absolutely needs glucose homeostasis to survive - if you don’t eat carbs it will make it out of protein. The body has numerous mechanisms and basically dedicated organs for the conversion, metabolism, storage, and production of glucose. The whole Krebs cycle is built around the processing of byproducts of glucose - so you’re utterly full of shit that it’s “only safe in a tight band”. That the body can additionally use fatty acids in the form of ketone bodies as a stopgap is a testament to adaptability - but even people on keto require a homeostasis of a close to normal level of blood glucose. And how do they get this? Through the metabolism of proteins which can be amazingly converted to the glucose the body needs to survive.

This is high school level biology, and easily reviewed with 10 minutes on Wikipedia.

You said "at the end of the day your body still runs on glucose" which is NOT true on a ketogenic diet, as a mere 25 grams are manufactured by the liver as needed for (apparently) red blood cells.

Yes, I agree that ketogenic dieters still have glucose, obviously, my point was about CHRONICALLY ELEVATED glucose being deleterious for blood vessel health, which is widely known and, again, cause of the necrosis seen in late-stage diabetes.

I know of at least one T1 diabetic that is OFF INSULIN on a ketogenic (carnivore) diet.

I read the blog post once and concluded this poor chap was confusing type 1 and type 2 diabetes - because really the first paragraph is silly - that testimonial is classic for type 2 diabetes.

I’m still a bit skeptical this dude actually has true type 1 diabetes, when it fits more likely that it is LADA, latent autoimmune diabetes of adulthood - maybe look it up.

But in any event, everything I could find is that this guy is still using insulin. So that doesn’t really change anything - he’s still insulin dependent - and he “hopes” that it can be reversed. But why? Not based on anything logical I can see. He reduced his insulin requirements - by reducing his dietary carbohydrate intake - well duh that is a mainstay of diabetes management for years - you don’t have to go full blown keto to realize decreasing insulin requirements with lower dietary carbs.

So your example doesn’t even demonstrate your point. And even if it did, your fundamental line of reasoning is flawed - you keep bringing up examples - these people might as well be medical outliers - this has no generalizability and you don’t have any justification to even suspect that their diet had any effect on their health outcomes.

Edit: also please read the comments carefully on “vlads” post - lol he’s been diagnosed type 1 at age 40 - more likely it’s lada. And he’s only been diagnosed 2 months - yeah maybe he still has some functioning islet cells left - look where he is in 2 to 3 years. I appreciate the commenters that basically call him out on his bullshit.