Later On

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

Archive for April 20th, 2022

The Air-Ambulance Vultures: How American capitalism harms the public

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Chris Stanton reports in New York:

Kathleen Hoechlin was in the intensive-care unit, wondering if she would ever walk again, when she and her husband, Matt, started receiving the phone calls. It was January 2018, and the couple had just gone skiing in Mammoth Lakes, California. On the last run of the day, Kathleen skied over a small jump and landed on her back, shattering the L1 vertebra in her lower spine. With the nearest hospital ill equipped to handle the required surgery, she was loaded onto a small plane and flown 300 miles south over the Sierra Nevada mountain range to Loma Linda, where she underwent 12 hours of surgery to replace the vertebra with a metal implant. The phone call, which the Hoechlins received less than a day after the surgery, was from the air-ambulance provider, Guardian Flight, informing them that the plane ride had cost $97,269.

The couple tried not to panic, holding out hope that their insurance policy would cover the cost. But when the explanation of benefits finally arrived, it showed that Guardian Flight was out of network and that their policy would cover only $17,569, leaving the Hoechlins responsible for the remaining $79,700. Guardian Flight continued to hound them, with Kathleen not yet out of the full-body brace she was sent home in. “They were calling the week I got home,” she says. “I just told them, ‘How can you sleep at night? I can’t talk to you when you’re asking me for this money while I’m trying to learn to walk again.’”

From then on, Matt dealt with the incessant phone calls himself and managed to negotiate the remaining balance down to $20,000 after telling Guardian Flight that he and Kathleen would have to file for bankruptcy if it were any higher. Between their savings, gifts from family members, and a GoFundMe campaign, the Hoechlins managed to pay off the remainder. “It left me with a lot of trauma and a lot of ‘aha’ moments,” Kathleen says. “Why is this happening, and why should patients have to go through this?”

I first came across Kathleen’s story after being transported by an air ambulance myself last April, albeit under less severe circumstances. I was also on vacation in Mammoth Lakes when I experienced intense chest pain that was later diagnosed as myocarditis. After keeping me for a night at Mammoth Hospital, the staff there ordered that I be transferred via air ambulance to a medical center in Reno, Nevada, where a cardiology team could do the required testing. I pushed back initially, worried about the potential cost of the flight, but the doctors insisted it was necessary. Within a few hours, I was strapped to a gurney with tubes in my nose, flying over Lake Tahoe in a small plane while two paramedics sat nearby, ready to administer nitroglycerin in case my chest pain flared up again. The air-ambulance provider, REACH Air Medical Services, sent me a letter two months later saying the flight had cost me $86,184.

I spent the next eight months fending off letters and phone calls from REACH requesting full payment. Eventually, my employer intervened and got my insurance company, Cigna, to renegotiate with REACH, leaving me responsible for a co-pay of only $132 on the out-of-network claim. Even so, the experience left me with some of the same questions as Kathleen Hoechlin: Why is this happening, and how could something as essential as an air ambulance possibly be so expensive, especially when an estimated 550,000 patients in the U.S. require one each year? That line of questioning led to at least one culprit: private equity.

At the start of the aughts, private-equity firms conducted about $5 billion worth of deals in the U.S. health-care sector each year. By 2019, that figure had jumped to an estimated $120 billion, a result of deep-pocketed firms looking to park their money in a sector perceived as recessionproof (people get sick even when the economy is bad) and ripe for consolidation. When major private-equity firms started buying up air-ambulance companies, it set off a flurry of acquisitions. In 2010, . . .

Continue reading. There’s much more.

Later in the article:

As private equity tightened its stranglehold on the industry, it jacked up the already-high prices. Between 2008 and 2017, the median price charged by providers for helicopter air ambulances nearly tripled, jumping from $12,500 to $35,900 per flight, according to a study by the Health Care Cost Institute. As the Hoechlins and I experienced, air-ambulance providers are often out of network with private insurance companies. That’s not by accident: Private-equity-backed and publicly traded air-ambulance providers in particular tend to remain out of network to charge higher rates than what may be allowed under an in-network contract. Since patients don’t decide when or where they have a medical emergency that requires them to be airlifted to a hospital, they don’t have a choice in which air-ambulance provider they use. As a result, competition in the marketplace does little to keep prices down — the higher providers set the price, the more they may be able to get paid. When insurers deem the cost too high, they pass the enormous remaining balance on to the patient, a practice known as “balance billing.” Among privately insured patients, an estimated two in five air-ambulance flights result in a potential balance bill. About half the time, though, the insurance companies simply pay up, according to Loren Adler, associate director of the USC-Brookings Schaeffer Initiative for Health Policy. Private equity “saw an opportunity to say, ‘Look, the existing companies aren’t leaning into the surprise-billing threat enough from a moneymaking perspective,’” says Adler, who co-authored a white paper last year about private equity’s impact on the air-ambulance industry. “If you really lean on that a lot, sometimes you can fight with the patient to get paid. But I think a bigger part of the money thing is often you can cajole the employer to pay because they don’t want their employee getting stuck with an $80,000 bill.”

Written by Leisureguy

20 April 2022 at 8:16 pm

Better than goji berries

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Eddie of Australia pointed out an article on the benefits of berberine for diabetics. The article talks about a supplement, but I’m wary of supplements, especially since often the special ingredient works much better in the context of the whole food that contains it. 

So I did a search for foods high in berberine, and it turns out that dried barberries are very high in it. I’d never heard of dried barberries, but it was noted that they are used in Mid-Eastern cuisine, so I went to a couple of Mid-Easter shops here (deli + grocery), and both had dried barberries. So now I’m well stocked and figuring out how to consume them. One idea is using them in a smoothie. Another (though not for me) is to mix them in softened vanilla ice cream.

Update: They look like tiny little raisins, so I put a few in a bowl and ate them like raisins. They feel like (tiny) raisins in one’s hand and in one’s mouth, and they taste good — tart, but tasty. I think I’ll simply eat them like raisins, as a snack. I’ll start with 1/4 cup a day, and may cut that back to 2-3 tablespoons. /update

I found this brief video particularly interesting:

The info on Indian gooseberries in the video is especially striking. I eat Indian gooseberries regularly in the form of amla (dried Indian gooseberries crushed to a powder). I mix one teaspoon into whatever I’m having for breakfast.

I’m now very interested in trying dried pomegranate seeds.

Written by Leisureguy

20 April 2022 at 7:14 pm

Yet another good walk, with cadence of 113 steps/minute

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Good walk at a brisk speed on a overcast day that was a little chilly. 

Written by Leisureguy

20 April 2022 at 1:15 pm

Lead-infused crime led to super-predators

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Kevin Drum has a very interesting post in which the above chart appears. He writes:

In the New York Times today, James Forman Jr. and Kayla Vinson take another shot at the “superpredator” theory of the mid 1990s:

In January the Connecticut Supreme Court reversed the 60-year sentence imposed on Keith Belcher, a Black teenager, for sexual assault and armed robbery committed when he was 14. Mr. Belcher was sentenced in 1997, at the height of the superpredator panic….Judge Michael Hartmere [] said this at Mr. Belcher’s sentencing hearing:

Professor DiIulio of Princeton University has coined the term “superpredator,” which refers to a group of radically impulsive, brutally remorseless youngsters who assault, rape, rob and burglarize. Mr. Belcher, you are a charter member of that group. You have no fears, from your conduct, of the pains of imprisonment, nor do you suffer from the pangs of conscience.

Judge Hartmere then imposed a sentence that could have kept Mr. Belcher incarcerated until his mid-70s….But Mr. Belcher got lucky. Because the trial judge explicitly cited a theory that had been proved wrong (in 2001, Professor DiIulio acknowledged as much), Mr. Belcher’s court-appointed attorneys, Natalie Olmstead and Alexandra Harrington, challenged the sentence on the grounds that it was based on “materially false information.” What could be more false, they asked, than a theory widely disavowed, including by its own author?

I hate to see this. But then again, I also hate to debunk it.

But let’s review the whole dreary mess. First off, DiIulio wasn’t wrong: The . . .

Continue reading.

Written by Leisureguy

20 April 2022 at 11:54 am

How Ukraine Won the Battle for Kyiv

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Oz Katerji reports in Rolling Stone:

Before Russia launched a full-scale military invasion of Ukraine on 24 February 2022, intelligence assessments coming out of Washington and London were bleak about Kyiv’s chances of survival. It and the rest of Ukraine were set to be outmanned, outgunned and surrounded by one of the most powerful modern military forces ever assembled, they believed.

As Russian troops were advancing on the city, US officials even offered to evacuate Ukraine’s president Volodymyr Zelensky from Kyiv, only for him to shoot back: “The fight is here; I need ammunition, not a ride” in what is now one of the most famous political quotes of the 21st century.

According to reports, Moscow’s plan was to encircle and capture Ukraine’s capital within a matter of days before carrying out a campaign of executions of Ukrainian politicians, journalists and human rights activists. But 37 days after the invasion began, Russian forces were driven out of the Kyiv Oblast in its entirety, with Ukrainian deputy defence minister Hanna Maliar releasing a statement on 2 April that Kyiv had been liberated from Russian invaders.

Ukraine’s decisive victory in the Battle for Kyiv was an audacious and impressive military accomplishment. Russia’s loss in Kyiv came not only as a surprise to Moscow, but also to Ukraine’s allies in western capitals. But how could Ukraine’s smaller army inflict such a humiliating blow against the Russian Goliath in Kyiv when so few thought it was possible?

The day before the invasion felt like any other winter’s day in central Kyiv as I made my way through the throng of a bustling metropolis, the beautiful and vibrant capital of a fledgling Eastern European liberal democracy. But what followed was a night like no other. A dark foreboding hung heavy in the air as the streets emptied and late-night bars brought down their shutters as what little hope of averting a major European war was extinguished. The cacophony of artillery fire, air strikes and air-raid sirens that erupted in the early hours of 24 February left nobody in doubt: the invasion had begun.

Within hours, makeshift barricades had been erected across the famous cobblestone streets of Kyiv’s old town, and decrepit Soviet cars and shopping trolleys were reinforced with hurriedly filled sandbags. The boutique shops and international retail brands that sit in between the ancient blue-and-gold domes of Kyiv’s Orthodox churches were boarded up, and the streets that only hours before had been filled with such energy and life were now deserted.

Beneath them, in old Soviet bomb shelters and miles upon miles of central Kyiv’s metro network, tens of thousands of people sought shelter from the incoming Russian bombardment. A family could be found crammed into every corner of every station as – remarkably – the trains still ran. The highways out of the city were gridlocked as much of Kyiv’s population fled, but, as the Russians started cutting off the main arteries out of the city, the country’s railway network bravely kept running, shuttling millions of civilians across the country to the relative safety of the west. There the new arrivals faced the uncertainty and cruelty that comes with a life displaced.

Those who remained in Kyiv were met with  . . .

Continue reading.

Written by Leisureguy

20 April 2022 at 11:44 am

Posted in Daily life, Unions, War

Black-eyed pea & peanut tempeh after 48 hours

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I see some sporing — grey spots — in this new batch of tempeh but I’m going to let it go another day anyway. Slab is now reasonably rigid, but another day will help solidify the mass.

Written by Leisureguy

20 April 2022 at 10:20 am

Achilles and the Baby Smooth

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My RazoRock Amici brush was easily loaded with Van Yulay’s Achilles shaving soap, though the soap in the tub is now just a ring as I slowly use up this soap. I might replace it — I do like it.

Three passes with the Baby Smooth did a fair job, but post-shave I decided it was time for a new blade, so I replaced the Gillette Silver Blue that was in the razor with a Treet Platinum. The next shaves should be much better.

A splash of Achilles aftershave, and this is another aftershave that requires no hydrating boost.

The tea this morning is Murchie’s 1894 Select Orange Pekoe: “1894 Select Orange Pekoe is one of Murchie’s original blends, named after the year of our founding. A union of bright Ceylon and rich Assam teas, this strong, traditional blend is designed to celebrate and elevate the everyday ‘cuppa’ tea.” It is indeed a good, sturdy, no-nonsense tea.

Written by Leisureguy

20 April 2022 at 10:09 am

Posted in Caffeine, Shaving

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