Later On

A blog written for those whose interests more or less match mine.

Archive for November 16th, 2019

Best Healthcare System in the World™ brings you: Surprise medical bills!

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I recently had pains in my chest, and since I’m a type 2 diabetic (controlled now, with no need for medication, but still: I have type 2 diabetes) and am almost 80, I thought I should pay attention. The Wife was away, so I called her, and she insisted that I immediately call 911 and request an ambulance. I did, and everything turned out to be fine, and I learned some interesting things I had not known.

  1. Do call an ambulance. If you are potentially having a heart attack, a special cardio ambulance (with med techs having specialized training) is dispatched. This will cost a fee: it’s a flat-rate $80, I’m told, though there’s no sign of a bill so far. (This was a few weeks ago.)

  2. The dispatcher told me to chew an aspirin. I learned that aspirin is absorbed much faster if you simply chew up the tablet, particularly if the tablet is coated. It is absorbed through the lining of your mouth and gets into system pronto. This has proved useful — a couple of days ago I had a headache, so I chewed the aspirin. Prompt relief. From now on, when I take aspirin, I’ll chew it.

  3. The ambulance takes you to a special ambulance entrance and you go immediately into the ER and start getting treatment: no finding parking, no waiting in lobby or speaking to reception. You’re there, hooked to a ECG machine, and getting blood drawn. (A heart attack results in certain enzymes entering the bloodstream.)

And, of course, now that I live in Canada, no suprise hospital bills and in fact no hospital bills at all. $0.00. That’s Canadian dollars, but in this case the US$ equivalent is also $0.00. That is not unique to Canada, of course. That’s the way it works in all advanced countries.

Carol Sottili writes in the Washington Post about how, in contrast, it works in the US:

My descent into health insurance hell started innocuously enough.

Visiting my 94-year-old mother in October last year, I casually leafed through her checkbook. Still living independently in her Long Island condo, traveling with friends and active in the community, Mom was also very much in charge of her finances, but she welcomed my second glance. All was in order, except for a $603.12 check paid to an emergency room doctor. What was that all about?

I knew she had been treated for vertigo in a hospital ER in August. But why hadn’t her health insurance covered this?

My mother, Pauline Gulotta, an Austrian war bride, was old-school. When she received a demand for payment from a doctor, she paid it without question. So when the bill arrived for services provided by a physician who, we eventually surmised, was not a participant in her Medicare Advantage plan, she wrote out the check and put it in the mail. That simple act would send me on a nine-month journey involving countless hours on the phone, endless letters and emails, and a formal complaint to the New York State Attorney General’s Office in an effort to get my mother’s money returned.

The bill my mother paid, and subsequent bills she received for additional hospital visits, are termed “surprise medical bills.” They are often sent by ER physicians and medical test providers who don’t have negotiated agreements with the patient’s insurance, even though the hospitals where they practice are typically “in network.” In a normal world, patients check to make sure a doctor they want to see accepts their insurance. But taken by ambulance with the world spinning out of control, my mother didn’t question the ER doctor who treated her, especially since she knew the hospital was in network.

She is not alone. Several recent studies have concluded that millions of hospital patients are faced with surprise bills, often for similar reasons to my mother’s. And those numbers and the bill amounts grow larger each year.

A recently published study by Stanford University researchers of 13.6 million ER visits concluded that, in 2010, 32.3 percent resulted in a surprise medical bill averaging $220. By 2016, that percentage had grown to 42.8 percent, with the average bill at $628. Inpatient jumps were even more substantial, according to the study. Of 5.5 million inpatient visits, surprise bill percentages increased from 26.3 to 42 percent, with the average out-of-network bill rising from $804 to $2,040.

“It’s obvious from our study that if you go to the hospital, there is a pretty good chance you’re going to be hit with a surprise bill,” said study co-author Michelle Mello, a professor of law and of health research and policy at Stanford. These bills hit the low-income the hardest, she added, pointing to a recent Federal Reserve survey that concluded 4 in 10 people would not be able to readily cover an unexpected $400 bill.

Public opinion is clear on the topic: According to multiple surveys, a clear majority want surprise bills to end. But efforts to pass federal legislation so far have gone nowhere.

Twenty-eight states have taken matters into their own hands, passing laws that offer at least some restrictions on surprise billing, but federal regulations limit their reach. For example, those covered under self-insured group health plans, which apply to employees of most large corporations, are not protected by state laws. In the D.C. region, only Maryland is among the 28.

As a New York resident, my mother was covered by one of the country’s strongest surprise-bill laws, so I naively believed that her honest mistake would be quickly remedied. Within a few weeks, I realized she might have a better chance of winning the Powerball jackpot.

Her health insurance company pointed me to the provider, while the provider sent me back to the health insurance company. They both threw up privacy roadblocks, claiming they couldn’t talk with me as my mother’s health declined; copies of my power of attorney were lost and “appointment of representative” forms routinely disappeared.

The waters got even muddier when the insurance company tried to slough me off on an affiliated company that processed claims. Voice-mail menus became my diabolical purgatory. Meanwhile, more and more surprise bills arrived, emanating from three visits my mother made to the same emergency hospital, and phone calls threatening collection started.

My increasingly frail mother was becoming distraught and often told me she wanted to just pay them so she could rest. From hundreds of miles away, I urged her to dig in her heels and stay strong. And I continued to do battle on her behalf.

In my mother’s situation, the out-of-network ER doctor had already received a $179.88 reimbursement on the $783 bill. That should have been the end of the story. Instead, the doctor’s billing service sent a “balance bill” stating, “The remaining balance due is your responsibility.”

In February, I filed a complaint with the N.Y. State Attorney General’s Office. By early March, I received a letter stating that they had intervened on my behalf and that the billing service had agreed to send a full refund, which my mother would receive within 60 to 90 days.

On June 2, my mother died. She had never received that refund.

My grief turned into anger at a health system that, even after death, kept sending her surprise bills. Instead of letting it go, I became obsessed. I sent letters to each of the hospital’s board members and to the religious organization that runs the hospital, mailed dozens of official forms disputing the charges and emailed elected officials. Crickets. . .

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Written by LeisureGuy

16 November 2019 at 3:51 pm

Big Tech’s Bust Out

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In this post yesterday I commented on how the GOP’s looting of the US reminded me of how the Mafia would extract all possible money from a legitimate restaurant. Matt Stoller describes exactly that in his column today:

There’s a scene in the classic mafia movie Goodfellas, where the mobsters pledge to protect the owner of a restaurant at which they hang out. In return for protection they get a regular payment. Whether business is good or bad, it doesn’t matter, their line to the owner is, “Fuck you, pay me.”

At first they get paid out of profits, but sometimes the restaurant doesn’t do well.

Fuck you, pay me.

Tax problems? Rent problems? Doesn’t matter.

Fuck you, pay me.

And so forth. As the owner begins bleeding cash, the mobsters begin working with the owner to liquidate what they can. They run down the restaurant’s credit by buying liquor and selling it half off. Finally they burn down the restaurant for the insurance money. This is called a ‘Bust Out,’ which is the final attempt to steal everything in sight before the game is up.

I’m reminded of this dynamic as I watch merger activity and expansion by big tech firms under scrutiny. A lot of people wonder why Google is, say, buying Fitbit, or going into banking, or collecting health data. Or why Facebook is launching payments, a new and obvious monopoly leveraging play. The DOJ and FTC are snooping around, Congress’s Antitrust Subcommittee is doing a thorough investigation, state AGs may sue, not to mention that global regulators at the EU level, France, Germany, Japan, and Australia are beginning to take action. In this context, the aggressiveness seems… odd, almost as if they are intentionally provoking a political reaction.

I have a theory that what we are seeing right now is the final attempt by big tech to capture as much territory as they can before political leaders clamp down on them. This is, in other words, their ‘Bust Out’ moment. In September, here’s what David Faber on CNBC said:

“By the way, I hear it too, and it’s another reason why companies are being implored to do things now if you want to get done—M&A or anything—think about doing it soon because come early to mid-2020, if Elizabeth Warren is rolling along, everyone is going to be like ‘that’s it.’”

Faber’s point is more general, but it applies to big tech more than anywhere else, because these are the companies in the crosshairs.

This theory is just that, a theory. Maybe Google would have bought Fitbit anyway, and Zuckerberg’s desire to conquer the world is well known. But perhaps there’s a bit of a deadline looming, which is 2021. If a new President gets in office, the game for them might be over. There’s a paradox here. Scrutiny now makes it more likely that the next President goes after big tech, which makes the period right now before the next President takes office far more important for mergers and strategic expansion. In other words, the scrutiny may not be slowing them down, but speeding them up.

In Disney CEO Bob Iger’s book, Iger mentions a surprising reason George Lucas sold Lucasfilm. Tax law. As Iger and Lucas negotiated the merger, George Bush’s tax cuts were set to expire. Congress and the President arranged a deal to raise capital gains rates, which meant that Lucas would forego a lot of money if he waited to sell the business. So he sold quickly, and pocketed an extra $500 million that would have gone to the taxman. It’s easy to act like corporate behavior is some apolitical phenomenon driven by technology and the leadership of heroic CEOs, but the reality is politics determine business strategy.

I’m not persuaded that the ‘big tech bust out’ is 100% accurate, but I suspect in executive office suites in California, there’s a lot of planning going on to address the rapidly changing political environment. There are likely different factions, some trying to speed up and some trying to slow down the aggressiveness.

Still, until policymakers do actually start to wield power, we’re going to hear one thing and one thing only.

Fuck you, pay me…

Continue reading.

Written by LeisureGuy

16 November 2019 at 10:44 am

First natural brush in this series, and an overlooked witch-hazel-based aftershave

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I’m runniing through my natural-bristle brushes and today I encounter my first natural brush: natural bristles and natural handle. This Plisson, a High Mountain White 12, has a horn handle, a legacy of France’s exploitation of Vietnam which it occupied as a colonial power before being thrown out by the Vietnamese (with the US then stepping in until the US, too, was thrown out).

It’s quite a nice brush, and today I got a fine lather from Declaration Grooming’s wonderfully fragrant Yuzu/Rose/Patchouli shaving soap — which, if I’m not mistaken, includes clay, based on the way it loaded. Let’s see… Yes. This soap is the Icarus formula:

Stearic Acid, Water, Castor Oil, Avocado Oil, Vegetable Glycerin, Mango Seed Butter, Potassium Hydroxide, Sodium Hydroxide, Fragrance, Bison Tallow, Lamb Tallow, Colloidal Oatmeal, Goat’s Milk, Lanolin, Bentonite Clay, Tocopheryl Acetate, Hippophae Rhamnoides (Sea Buckthorn) Fruit Extract, Salix Alba L. (White Willow) Bark Extract, Vitis Vinifera (Grape) Seed Extract, Tetrasodium EDTA, Tussah Silk

Clay makes a noticeable difference in how a shaving soap loads, mainly in requiring a small increase in the amount of water used.

In looking that up, I notice they have a new formula, called the milksteak formula:

Stearic Acid, Water, Castor Oil, Potassium Hydroxide, Vegetable Glycerin, Bison Tallow, Mango Butter, Avocado Oil, Shea Butter, Sodium Hydroxide, Lanolin, Bentonite Clay, Yogurt, Buttermilk, Egg Whites, Coconut Milk, Goat’s Milk, Tocopheryl Acetate, Maltodextrin, Milk Protein, Salix Alba L. (White Willow) Bark Extract,  Arctium lappa (Burdock) Root Extract, Hippophae Rhamnoides (Sea Buckthorn) Fruit Extract, Vitis Vinifera (Grape) Seed Extract, Silk Amino Acids

That sounds quite interesting, and I notice that they currently offer Yazu/Rose/Patchouli in this formula. Of the fragrance, they write:

Henry Shaw is responsible for Tower Grove Park and the Missouri Botanical Garden in Saint Louis. In that garden, flowers and plants from the Far East coexist to species native to the Saint Louis area. In this scent, reflective of Shaw’s oasis in South City, the uniquely distinct smell of yuzu citrus, enveloping the unmistakably recognizable smell of rose and the dry, woody scent of patchouli come together so all three work together in unison to create something greater than the sum of their parts.

Chatillon Lux is located in Saint Louis and is attuned to the early history of the city and area, so I suspect they were the driving force behind the fragrance.

The lather was truly excellent — despite using slightly more water, the lather’s consistency was perfect — and three passes with the Parker Semi-Slant (a superb razor, less demanding of a light touch than the iKon stainless slant) left my face perfectly smooth.

A splash of Chatillon Lux’s matching aftershave finished job. I noticed that I should have included this when I was running through my witch-hazel-based aftershaves:

Denatured alcohol, chamomile extract, calendula extract, witch hazel, aloe vera, cat’s claw bark extract, polysorbate 20, fragrance, vegetable glycerin, menthol

However, given the order of ingredients, perhaps it’s right to call this an alcohol-based aftershave with witch hazel simply being one ingredient. The menthol is very light, so light that I did not detect it.

Now this is the way to begin the weekend!

Written by LeisureGuy

16 November 2019 at 8:20 am

Posted in Shaving

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