John Asghar
@JahangirAsgha10
Sports Fanatic, ⚾️⚽️🏈🏀, Educator, Dad, Husband, ‘leave it better than you found it’ Don’t like my tweets, blame my children
769 Following 4.6K Followers
@JahangirAsgha10 Here’s a great one for ya, local nonprofit CEO, 25 bed critical access hospital, 25 beds, salary is 1.6 million with guaranteed bonus of $500k+ annually. So 2.1million, plus very large house overlooking hospital. Physicians are the problem.
Show more
Excited for the women’s team!!!
Basketball is better with JuJu Watkins on the court ❤️
Welcome back, 12 ✌️
@JahangirAsgha10 You're seeing the behavioral side of a math problem. Hitting the deductible feels like a win, but care only saves money if it was needed anyway. The better question is what the whole year costs, premiums included, not whether the deductible was met.
Show more
There is no critical mistake. When I talk about supply, I’m talking about the system, not simply the number of doctors.
That means better access to existing physicians, more places to receive care and fewer barriers to direct relationships. Removing administrative waste is part of fixing supply. Medicare itself creates barriers through restrictions on private contracting.
Orthopedic Medicare opt outs are already increasing. Silvestre et al. reported average annual growth of 11% in opt outs from 2000 to 2024, reaching 1.9% of orthopedic surgeons. Nearly one third of those opting out were spine surgeons (JAAOS, 2026).
You cannot keep squeezing reimbursement, adding administrative burdens and undermining the people delivering care while expecting access to improve. Medicare for All will make those problems worse by concentrating control over payment in a single federal payer. The physicians, nurses and practices expected to deliver that care still have to function.
Show more
You're making a critical mistake treating healthcare as exclusively a supply problem. Supply matters, but so do prices, physician reimbursement, financing, and administrative waste.
And reducing administrative waste actually increases effective healthcare supply. Every hour doctors and nurses recover from unnecessary paperwork, billing disputes, and insurance bureaucracy is an hour they can spend treating patients. We can expand clinical capacity without adding a single new physician.
How does our healthcare system manage limited supply today? By leaving millions uninsured and making deductibles so unaffordable that sick people simply go without care? Reduce demand by making healthcare financially inaccessible, then pretend supply is adequate.
That's rationing healthcare by bank balance, then congratulating ourselves for eliminating the demand.
Show more
I love the attempt to demonize me
by conflating getting screened which is a personal obligation with running everything through insurance which is a financial mechanism to pay for that service.
For your knowledge…
Locally, a cash mammogram can cost around $75 dollars and breast MRI can be around $400. Cash prices are substantially lower than insurance billed prices. Paying directly also eliminates the insurer’s authorization process for the MRI, which can mean faster scheduling and less hassle.
Insurance coverage does not guarantee that screening happens. You still need to make the appointment and get it done.
Paying directly changes how the service is financed. The need for screening remains. You pay the provider instead of routing the transaction through a third party.
Show more
@JahangirAsgha10 So finding a malignant lump in your breast that can be removed is no better or cheaper than treating you for Stage 3 breast cancer? Or how about my friend who died of colon cancer because she wouldn't get a colonoscopy. Is that better?
Show more
Let’s not conflate getting screened which is your personal obligation with running everything through insurance.
Locally, a cash mammogram can cost $75 to $100. A breast MRI can be around $400. Cash prices can be substantially lower than insurance billed prices. Paying directly also eliminates the insurer’s authorization process for the MRI, which can mean faster scheduling and less hassle.
Insurance coverage does not guarantee that screening happens on time. You still need to make the appointment and get it done.
Paying directly changes how the service is financed. The need for screening remains. You pay the provider instead of routing the transaction through a third party.
Show more
Let’s not conflate getting screened which is your personal obligation with running everything through insurance.
Locally, a cash mammogram can cost $75 to $100. A breast MRI can be around $400. Cash prices can be substantially lower than insurance billed prices. Paying directly also eliminates the insurer’s authorization process for the MRI, which can mean faster scheduling and less hassle.
Insurance coverage does not guarantee that screening happens on time. You still need to make the appointment and get it done.
Paying directly changes how the service is financed. The need for screening remains. You pay the provider instead of routing the transaction through a third party.
Show more
My goodness, I despise our physician “leaders.” A middle school understanding of economics combined with the oversized ego of someone convinced a medical degree makes them an expert in everything.
The value based care crowd belongs here too. More bureaucracy and intermediaries sold as progress, while practicing physicians are expected to absorb more financial risk and surrender more control.
Show more
My goodness, I despise our physician “leaders.” A middle school understanding of economics combined with the oversized ego of someone convinced a medical degree makes them an expert in everything.
The value based care crowd belongs here too. More bureaucracy and intermediaries sold as progress, while practicing physicians are expected to absorb more financial risk and surrender more control.
Show more
I once tried to explain Bayesian reasoning at a dinner party. By dessert, everyone had updated their beliefs about inviting me again.
Sam Altman when he sees how much compute I have withheld from the cloud
RAM must be collectivized to ensure that AGI benefits all of humanity
Having government compel people people to buy broader coverage does not save them money either
KFF’s 2023 data show the lowest spending half of the population averaged $433 a year in care, including insurer payments. The highest spending 5% accounted for nearly half of all spending.
Risk pooling does not eliminate administrative costs. We still pay for claims processing and insurer overhead through premiums.
I favor direct pay for routine care, catastrophic insurance, and medical savings accounts for higher need years, with help for those who need it. Compare the total cost of premiums and care.
More mandated benefits means more expensive care
Show more
The problem is that anything beyond one or two annual Dr's visits and a generic drug or two is beyond what most people can afford. This is why we have healthcare plans vs insurance now.
Not a huge Ann coulter fan…
But here we agree!
The NYT's attack on Sen. Roger Marshall is outrageous.
Why are doctors the only people in the country who don't deserve to be paid? How about editors and reporters - why don’t they give their salaries to these layabouts on "disability" who demand medical services, and then refuse to pay?
The average OB/GYN sees a thousand patients a year. That means Dr. Marshall probably saw 25,000 patients and THE NEW YORK TIMES IS DISGUSTED that he submitted 700 unpaid bills to his lawyers.
SEVEN HUNDRED out of 25,000 - that means he pursued unpaid bills from LESS THAN 3% OF HIS PATIENTS.
I like the woman who refuses to pay for her C-section and complains she got served by a lawyer two years later WHEN SHE WAS PREGNANT AGAIN. Uh, miss — if you can’t afford to pay for the delivery of your first child, how about learning to use birth control?
Not only that, but she irresponsibly failed to sign up for Medicaid which would have paid all medical bills related to her pregnancy FREE. ("Free” meaning: "Ann Pays More.”)
Oops, she f-ed up, so the doctor doesn't get paid.
And this arrogant, entitled narcissist complains about having to pay for the birth of her child: "I had to choose whether I’d pay my electricity or pay $50 to a doctor who didn’t need it.”
After practicing obstetrics for a quarter century and being part owner of the hospital, Dr. Marshall’s combined salary was $780,000. What's Pinch Sulzberger’s salary? How about Maureen Dowd?
Why don't you guys pay for these slackers, instead of a rural doctor who delivered thousands of babies and -- unlike a lot of doctors -- accepted Medicaid patients.
Or Sarah Kliff -- who can't deliver babies, but DID review "thousands of pages of court records and interviewed eight people whom Roger Marshall sued over medical debt."
The Times should refuse to pay you for your work, Sarah.
It's bad enough that these layabouts think they have a God-given right not to pay doctors, but appalling that overpaid journalists think it's a moral crusade to back them IN NOT PAYING FOR SERVICES THEY ACCEPTED.
Explore this gift article from The New York Times. You can read it for free without a subscription.
Show more
It did help…
Just not the patient or the physician
And it padded the pockets of health systems, and their administrators
@DutchRojas And Congress believed banning physicians would help. Perhaps Congress would consider banning ineptitude.
Run like NGOs. No accountability. Too many and overpaid administrators.
@JahangirAsgha10 Meeting your deductible is the only goal in life where crushing it means you had a terrible year.
I use a similar graph when discussing the NSA. When insurers say that the NSA is driving costs, look at this graph. It’s a near straight line change from 2000. The spike after 2020 is the COVID utilization spike. If anything, it’s actually slightly slowing here in 2026. NSA is a convenient scapegoat for insurers who want complete pricing control but it’s not the driver of healthcare premium or cost increases no matter what you hear.
Show more
As @DrBruggeman discussed on latest @DRsLoungePod since NSA, the payouts on OON for many specialties went down, not up. This means insurers paid out less than before, so why wouldn’t they support the NSA? Because the INS co want to control pricing for all doctors in the US. Have those savings mentioned above been passed along to the already insured or did we see premiums go up? Do we really believe that when insurers can price fix and limit doctor fees, those savings will get passed onto patients in form of lower premiums? Don’t believe the false narrative pushed by INS. Many of us have offered real tangible, implementable ways to lower healthcare costs, but no takers.
Show more
People’s thought process when it comes to deductibles is super interesting…
I see this routinely with my patients and in discussions on X: people feel obligated to meet their deductible, as though reaching it automatically means saving money.
Once they meet it, they want everything squeezed in before January to “get their money’s worth.” Talking someone out of surgery they don’t need can become a significant task late in the year because they’ve already met their deductible.
That’s where mental accounting and sunk cost thinking come in. Money already spent becomes a justification for maximizing care before it resets.
Timing necessary care can make financial sense. Meeting your deductible doesn’t make an unnecessary procedure worthwhile.
Show more
Not to sound rude, but I don’t think people understand what insurance is. Its core purpose is to protect against financial risk.
Using it as a third party payer for every routine expense adds administration, billing costs and overhead. We still pay for all of that.
Running a bill through an insurance company does not automatically make the care cheaper.
It’s why cash will always be cheaper.
Show more
The more I look at healthcare, the more I see unfairly generated pools of profit disguised as affordability issues.
Having insurance should mean you pay less than someone without it. When the cash price beats the insured price, the system is fundamentally broken.
Show more
