Looks like it’s Washington, Idaho, North Dakota, Missouri, Michigan, and Mississippi.
Have at it!
Archives for 2020
Doctor, My Eyes
I had my annual eye exam today. I go to the big teaching hospital here in Rochester because I think they’re good, and because I have some minor issues that I want them to monitor.
Our health plan recently added a new eye care option. I reviewed it when it was first offered and, to me, it appeared to be a way to buy glasses on what was essentially an installment plan. So we opted for the low-level option of the plan, the benefits of which I promptly forgot.
When I checked in, there was a big hassle to make sure that the information about this new plan was in their system. As the young and obviously very good optometrist assigned to my case examined my eyes, she thought that one of my optic nerves was bigger than the other. Then, instead of having a discussion about what that means, we had a discussion about the fucking insurance. You see, the new eye plan is for regular checkups, but the imaging she wanted to order was not covered by the eye insurance, it was covered by our general medical plan. And was it a high deductible plan, she asked with baited breath? No, I said, to her palpable relief. I also noted that whatever plan I have, I also have thing called “cash”, so let me have the study and we’ll deal with the fallout later. Sure, she told me, but be sure to have the receptionist change your billing to bill your medical insurance instead of the eye plan.
Long story short, I had the study, there was no issue with my eyes, but now there’s a baseline in my chart in case anything changes. I received good quality care, because I have good insurance and the money to pay for a few extra tests if my insurance doesn’t cover it.
I realize this is a nothingburger story compared to what some of you have shared in the comments, and what I have shared about my family. Still: every. fucking. thing. — everything — about our healthcare system includes an insurance-related hassle. Think of the bandwidth occupied in my smart young optometrist’s brain — places in her brain that should be used to remember new therapies and advances in care — that are instead housing little details about insurance plans.
Democrats just have to do something about this. And, I realize it sounds simplistic, but Medicare for All or something like it is a fine platform to run on. I make my living understanding complex software, and consulting with companies and individuals who want me to create or modify complex software. I explain the basics to them and then they ask me what to do. The subtext of most conversations I have with clients is “just fucking fix it.” In the end, despite the nit-picking and concern trolling that every Democratic healthcare plan receives, that’s what people want. Just fucking fix it. Take away the anxiety that we feel about cost every time we enter a doctor’s office. Take away the sword of Damocles — the fear of financial ruin — hanging over our heads when we get a serious diagnosis from a physician. My main concern about Biden is simply that he doesn’t understand that we’re 10 years out from Obamacare and the electorate is ready for the next step.
(And, yes, I went to a teaching hospital during the start of a pandemic. My hands are chapped by the hand sanitizer I used, but Rochester hasn’t had a confirmed case yet, so I’m hoping this is still the calm before the storm. I have an annual physical tomorrow, so I’m living on a prayer, I guess.)
White House Covid Briefing
Looks like they are going to do these every day at this time. Pence is now doing his obligatory paen to the Dear Leader and also telling us it’s not really a problem.
Do you want the video posted every day?
Surprise billing in a pandemic?
The major insurers are acting in good faith in that they are moving to waive member cost sharing for COVID-19 testing.
BREAKING: tonight @UnitedHealthGrp joins @Cigna and @Aetna and several Blue Cross plans waiving #COVID19 cost-sharing. Self-insured employer plans they administer will likely follow as more firms take measures to contain outbreak. $UNH https://t.co/qn9TfICXjv
— Bertha Coombs (@berthacoombs) March 7, 2020
All Blues are waiving the cost sharing.
This is a needed step so that testing and treatment do not face cost barriers.
But this is only on the consumer-insurer cost-sharing interactions. No cost-sharing on needed testing effectively makes the demand curve nearly vertical.
However, it is an incomplete step as these actions are not addressing the insurer-provider contractual relationships of in network or out of network charges. OON charges lead to balance billing opportunities. Balance bills consist of the difference in what an OON provider charges and what an insurer pays. That increment can be sent to the patient. Not all OON provider groups will balance bill but some do and may.
The Health Care Cost Institute (HCCI) examined out of network (OON) billing for commercial groups last year. They found different prevalence of OON billing that varied by geography and specialty. OON billing is an opportunity for a provider group to engage in balance billing and therefore the creation of surprise bills. I want to examine specialty.
From their data, the most common specialty to have an OON bill is an independent lab. The second most common Emergency Medicine.
COVID-19 requires a lot of testing. Some people will be using lots of emergency services provided by EM docs.
We should expect a significant amount of testing and ED services to be provided by OON providers.
Some of them will be reasonable decent actors. Others will have a strong incentive to balance bill and hope that they can get to the airport before either a mob with pitchfork and hot torches or the FBI can reach them.
About Robert Redfield, Director Of The CDC
We still don’t know why the CDC decided to develop its own test for SARS-CoV-2. If the dysfunction persists, it’s a danger to other decisions being made about the epidemic. But, like the number of Covid-19 cases in the United States, we just don’t know.
The director of the CDC, Robert Redfield, was involved in the decision, but we don’t know how. It could be anything from a definitive order to passing it off to someone else, which is a decision too.
Redfield’s background is in the military and a university, as a clinician and researcher. Before he came to CDC, he had no experience in directing a public health agency. His research is in the area of HIV/AIDS. While in the military, in the 1980s, he called for mandatory HIV testing of recruits and segregating HIV-positive personnel, a move opposed by medical authorities at that time.
Also in the 1980s,
Redfield worked closely with W. Shepherd Smith, Jr. and his Christian organization, Americans for a Sound AIDS/HIV Policy, or ASAP. The group maintained that AIDS was “God’s judgment” against homosexuals, spread in an America weakened by single-parent households and loss of family values.
With ASAP, Redfield backed a House bill that would have effectively quarantined people with HIV. The bill died in Congress. Redfield also backed a developmental AIDS vaccine, lobbying Congress to fund a $20 million clinical trial. The vaccine and Redfield’s lobbying failed. ASAP is now known as the Children’s AIDS Fund, and Redfield was on its board in 2018 when he was named CDC director.
In last Friday’s press conference at the CDC, Redfield offered his adulation to Trump. Not a good look for someone who is supposed to be a scientific advisor.
Before Redfield was made director, the CDC was in turmoil from a poor decision on its director and continuing budget cuts. Thomas Frieden, appointed by Barack Obama, resigned in 2017. Six months later, Donald Trump appointed Brenda Fitzgerald, state health commissioner in Georgia. Fitzgerald’s directorship dissolved in revelations of a grant to a company that she and her husband held stock in and other conflicts of interest.
Those disruptions may have made CDC more susceptible to poor decision-making.
Cross-posted to Nuclear Diner
About Robert Redfield, Director Of The CDCPost + Comments (258)
Voter Purge: Check Your Registration
I made a video this morning about the importance of voting and then got turned away because I wasn’t in the system even though I’ve voted there for 11 years, including for myself four times! Go figure, but that’s okay. We’ll be back later today! #Vote #KCMO pic.twitter.com/3mYNrO6jmC
— Mayor Q (@QuintonLucasKC) March 10, 2020
Hmmm…I wonder why he was purged. Can’t quite put my finger on it.
This is a crisis in this country and we all need to work to solve it. Until legislation is passed to address this form of voter suppression, check your registration and help your family and neighbors check theirs.
Here is a one of the best resources I’ve found:
https://twitter.com/bodner_h/status/1228034468008595456?s=20
Also, if you want to actively affect change All On The Line is the grassroots advocacy campaign supported by the National Redistricting Action Fund. More information here.
One person.
One vote.Whether you care about providing access to affordable health care, reducing the gun violence that plagues our schools and communities, protecting voting rights, achieving equal pay, or solving the urgent threat of climate change, there is a fundamental structural barrier that prevents progress: rigged electoral maps drawn with surgical precision by politicians to preserve their party’s political power and silence the will of the people.
Open thread
Sundown, you better take care
Hard for me to believe that Trump attacking Biden for being senile is effective, given how obviously senile Trump is. I also question the wisdom of idiotic personal attacks during what could be the beginning of a pandemic that the Trumpies have aided and abetted with their incompetence.
Here’s the music topic of the day….The other day at the supermarket I heard the One Eskimo song “Kandi”, which samples from Candi Staton’s cover of Patsy Cline’s “He Called Me Baby”. It got me to thinking of one of my favorite musical topics: soul covers of country songs. My favorite of all time is the holiest of holies, Al Green doing “For the Good Times”. Second is Etta James doing “Almost Persuaded”. What are your favorites?
Any good examples of country covers of soul songs — there’s a bunch of Gram Parsons related ones both with the Byrds and the Flying Burrito Brothers…any others? And what do people think of that cover of “Tennessee Whiskey” Chris Stapleton does where he changes the tune so that it sounds like “I’d Rather Go Blind”? It’s halfway to being a soul cover of a country song, and I like it a lot.
Trying to double down on the Senate fundraising here. I think it’s the most important thing we can do right now for November.
Give here to the Balloon Juice Senate fund which is split between the eventual Democratic nominees in Maine, Iowa, NC, Arizona, Georgia, and Colorado and….just added Montana! Feel free to split it up however you like. And you can use a burner email, as the kids say, if you don’t want to get too much campaign email. (You can also unsubscribe.)
