Pulmonary/Critical Care MD | Econ & Policy Insights | Dad, Photographer | CaptionSmith App Creator | MD➡️TX | Discussing healthcare, innovation, geopolitics.
Joined January 2010
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Pinned Tweet
Jan 13
HIPAA’s messaging rules ban some of the most secure tools we have, while leaving the real attack surface exposed.
There’s a better model: harden the charts, free the clinicians.
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x.com/AriReddy/status/201109…
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Ari Reddy MD retweeted
Jun 10
Critical care isn't hard because the problems are hard.
It's hard because the fixes fight each other.
The pressor that holds the pressure starves the gut.
The fluid that saves the kidney floods the lung.
The sedation that syncs the vent drops the pressure you just bought back.
You're not solving one problem.
You're solving all of them against each other, on a clock, with half the data.
That's the part I love.
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May 22
Rent extraction by a credentialed class on a government-enforced captive market produces the same thing whether the credential is board certification or party membership. More of itself, until exit becomes the only available reform.
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May 22
Medical bureaucracy and political collectivism look like opposites. They run on the same machinery. The features map onto each other without translation.
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May 22
The people who design these systems do not live inside them. TJC consultants, CMS rule-writers, ABIM board members. Western academics theorizing collectivist economies from tenured posts. None ends up on the receiving end of what they propose.
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May 22
Both arrangements are rent extraction by a credentialed class on a state-created captive market. The medical version sells itself as patient safety. The political version sells itself as equality. Neither has produced what it promised. Both have produced more of themselves.
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May 21
The experts who design medical bureaucracies and the experts who design collectivist economies share one trait: neither has to live inside what they design. The committee that mandates ICU sepsis protocols has never written a sepsis order at 3 AM. The tenured professor advocating asset confiscation has never built the assets being confiscated. Both classes write papers about the people their systems hurt. Neither has to read them.
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May 21
The "Nordic model" most US progressives invoke does not match the actual countries. Sweden abolished its wealth tax in 2007 and its inheritance tax in 2004. Denmark abolished its wealth tax in 1997. The corporate tax rates in Sweden and Denmark are lower than the United States. School choice has been universal in Sweden since 1992. The tax revenue funding the welfare states comes from broad-based consumption taxes paid by everyone, not from extracting from the rich. The Nordic model is closer to a market economy with a generous transfer system than to anything Bernie Sanders has ever described.
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May 21
Three companies control roughly 80% of US prescription drug spend: CVS Caremark, Express Scripts, and OptumRx. Each is vertically integrated with a major commercial insurer. The Federal Trade Commission's 2024 staff report on pharmacy benefit managers documented the structural problems in detail.
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May 21
The empirical result is documented. Independent pharmacies close at higher rates than the chains affiliated with PBMs. Drug prices at the counter remain among the highest in the developed world. The PBMs report rising profits each year. The patient sees none of the negotiated savings. The independent pharmacist sees a reimbursement below cost. The PBM keeps the spread.
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May 21
This is what a private monopoly looks like when the market it sits on is created by federal drug benefit policy. The Joint Commission has its CMS reimbursement chokehold. The PBMs have ERISA and Medicare Part D. Different statute, same monopoly.
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May 21
Argentina under Milei is the live counterexample. Annual inflation peaked at 211% in 2023 under the previous government. Monthly inflation is now running below 3%. The fiscal balance is in surplus for the first time in roughly 15 years. Poverty initially spiked from the austerity, then declined faster than under any administration since the 1990s. The intellectual class spent two years predicting collapse. The collapse is on the other side of the policy choice they were defending.
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May 21
Prior authorization is the rationing mechanism in American healthcare. "Death panels" were a distraction. The rationing already existed. UM departments at commercial insurers run on denial-rate KPIs. They ration by delay, not refusal. Patients call it "the slow no." Doctors call it ten hours a week defending care they already know is indicated. Nobody who designed it has to live inside it.
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May 21
Most medical quality metrics never have to prove they work. They survive because the system that imposed them is the same system that audits them. Every collectivist project ran the same defense. Within the system, the criterion for keeping a policy is whether it exists, not whether it produces what it promised. The mechanism is the same. The barbed wire is just smaller.
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May 20
Show me a 20th century socialist project before the famine, and I'll show you a Western academic publishing a paper defending it. Show me one after the famine, and the same academic has moved on to defending the next one. The empirical record is one of the most thoroughly documented in modern history. The professors keep writing.
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