Archive for the ‘Business’ Category
Suspicions confirmed: How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them
Patrick Rucker, Maya Miller, and David Armstrong report in ProPublica:
When a stubborn pain in Nick van Terheyden’s bones would not subside, his doctor had a hunch what was wrong.
Without enough vitamin D in the blood, the body will pull that vital nutrient from the bones. Left untreated, a vitamin D deficiency can lead to osteoporosis.
A blood test in the fall of 2021 confirmed the doctor’s diagnosis, and van Terheyden expected his company’s insurance plan, managed by Cigna, to cover the cost of the bloodwork. Instead, Cigna sent van Terheyden a letter explaining that it would not pay for the $350 test because it was not “medically necessary.”
The letter was signed by one of Cigna’s medical directors, a doctor employed by the company to review insurance claims.
Something about the denial letter did not sit well with van Terheyden, a 58-year-old Maryland resident. “This was a clinical decision being second-guessed by someone with no knowledge of me,” said van Terheyden, a physician himself and a specialist who had worked in emergency care in the United Kingdom.
The vague wording made van Terheyden suspect that Dr. Cheryl Dopke, the medical director who signed it, had not taken much care with his case.
Van Terheyden was right to be suspicious. His claim was just one of roughly 60,000 that Dopke denied in a single month last year, according to internal Cigna records reviewed by ProPublica and The Capitol Forum.
The rejection of van Terheyden’s claim was typical for Cigna, one of the country’s largest insurers. The company has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials. Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show. The company has reported it covers or administers health care plans for 18 million people.
In the two minutes and 45 seconds you’ve been on this page, Cigna’s doctors could have denied 198 claims, according to company documents.
Before health insurers reject claims for medical reasons, company doctors must review them, according to insurance laws and regulations in many states. Medical directors are expected to examine patient records, review coverage policies and use their expertise to decide whether to approve or deny claims, regulators said. This process helps avoid unfair denials.
But the Cigna review system that blocked van Terheyden’s claim bypasses those steps. Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”
Not all claims are processed through this review system. For those that are, it is unclear how many are approved and how many are funneled to doctors for automatic denial.
Insurance experts questioned Cigna’s review system.
Patients expect insurers to treat them fairly and meaningfully review each claim, said Dave Jones, California’s former insurance commissioner. Under . . .
AI warning: “You Can Have the Blue Pill or the Red Pill, and We’re Out of Blue Pills”
A very interesting column in the NY Times by Yuval Harari, Tristan Harris, and Aza Raskin.
Mr. Harari is a historian and a founder of the social impact company Sapienship [and the author of the (very interesting) book Sapiens – LG]. Mr. Harris and Mr. Raskin are founders of the Center for Humane Technology.
The column begins:
Imagine that as you are boarding an airplane, half the engineers who built it tell you there is a 10 percent chance the plane will crash, killing you and everyone else on it. Would you still board?
In 2022, over 700 top academics and researchers behind the leading artificial intelligence companies were asked in a survey about future A.I. risk. Half of those surveyed stated that there was a 10 percent or greater chance of human extinction (or similarly permanent and severe disempowerment) from future A.I. systems. Technology companies building today’s large language models are caught in a race to put all of humanity on that plane.
Drug companies cannot sell people new medicines without first subjecting their products to rigorous safety checks. Biotech labs cannot release new viruses into the public sphere in order to impress shareholders with their wizardry. Likewise, A.I. systems with the power of GPT-4 and beyond should not be entangled with the lives of billions of people at a pace faster than cultures can safely absorb them. A race to dominate the market should not set the speed of deploying humanity’s most consequential technology. We should move at whatever speed enables us to get this right.
The specter of A.I. has haunted humanity since the mid-20th century, yet until recently it has remained a distant prospect, something that belongs in sci-fi more than in serious scientific and political debates. It is difficult for our human minds to grasp the new capabilities of GPT-4 and similar tools, and it is even harder to grasp the exponential speed at which these tools are developing more advanced and powerful capabilities. But most of the key skills boil down to one thing: the ability to manipulate and generate language, whether with words, sounds or images.
In the beginning was the word. Language is the operating system of human culture. From language emerges myth and law, gods and money, art and science, friendships and nations and computer code. A.I.’s new mastery of language means it can now hack and manipulate the operating system of civilization. By gaining mastery of language, A.I. is seizing the master key to civilization, from bank vaults to holy sepulchers.
What would it mean for humans to live in a world where a large percentage of stories, melodies, images, laws, policies and tools are shaped by nonhuman intelligence, which knows how to exploit with superhuman efficiency the weaknesses, biases and addictions of the human mind — while knowing how to form intimate relationships with human beings? In games like chess, no human can hope to beat a computer. What happens when the same thing occurs in art, politics or religion?
A.I. could rapidly eat the whole of human culture — everything we have produced over thousands of years — digest it and begin to gush out a flood of new cultural artifacts. Not just school essays but also political speeches, ideological manifestos, holy books for new cults. By 2028, the U.S. presidential race might no longer be run by humans.
Humans often don’t have direct access to reality. We are cocooned by culture, experiencing reality through a cultural prism. Our political views are shaped by the reports of journalists and the anecdotes of friends. Our sexual preferences are tweaked by art and religion. That cultural cocoon has hitherto been woven by other humans. What will it be like to experience reality through a prism produced by nonhuman intelligence?
For thousands of years, we humans have lived inside the dreams of other humans. We have worshiped gods, pursued ideals of beauty and dedicated our lives to causes that originated in the imagination of some prophet, poet or politician. Soon we will also find ourselves living inside the hallucinations of nonhuman intelligence.
The “Terminator” franchise . . .
They raise an interesting point. Vision is a key sense for humans — “seeing is believing” — and in matters of our relationship and decisions, language plays the role of vision: we depend heavily on language to “see” in the sense of understanding, of persuading and being persuaded. When AI gets a little better, it will be able use language to play us like a violin.
The Future Is Handmade
Craftsmanship Quarterly has an interesting article with a video. Todd Oppenheimer writes:
One day in December, 2003, when he was a young archaeology student, Maikel Kuijpers was attending a workshop at the Netherlands’ National Museum of Antiquities, and was handed a sword made during the Bronze Age. The workmanship of the ancient weapon immediately captured him. “The lines, the details, the fine balance when holding it,” he recalls. “The attention put into its making was still resonating three thousand years later.”Kuijpers realized that this ancient weapon posed enough questions about the nature of knowledge—how it’s produced over time, and why knowledge matters—that it could inspire a long-term program of study. Over the next 15 years, as he developed a master’s thesis on metalworking technology, Kuijpers thought about almost nothing else. His journey took him from excavation sites and artisans’ studios to the heights of academia, eventually earning him a Ph.D. in Archaeology from Cambridge University.
The dissertation for that Ph.D. turned into a 318-page addition to the annals of academic research on the nature of craft and skill. Kuijpers’ case study for this inquiry was “Bronze Age Metalworking in the Netherlands”, which became a book entitled “An Archaeology of Skill” (Routledge, 2017). Along the way, with help from the Netherlands’ Centre for Global Heritage and Development, Kuijpers also produced a remarkable documentary, called “The Future is Handmade.” Running just over 12 minutes, the documentary features interviews with several of the world’s leading experts on craftsmanship, played over scenes of various master artisans at work. The cast includes a tailor, a violin maker, a ceramicist, a winemaker, and a barber. The resulting film, brief as it is, is nothing short of a tour de force—both intellectually and emotionally.
THE HIERARCHY OF SKILL
During his explorations, Kuijpers was continually surprised by what he saw in the workshops he visited. “When you watch artisans at work,” he told me, “in a strange way it’s very calming.” Time after time, Kuijpers noticed a lack of stress in these workshops. One reason, he concluded, is that when people are working with their hands, quality can’t be rushed; nor can it be faked. “Masters don’t need to say they’re the masters—it’s obvious in the work.”He also noticed an atmosphere of order, which seemed to arise from a shared sense of the hierarchy in these workshops. “I’m Dutch,” he says, “and we pride ourselves in having a very egalitarian society, so we don’t generally see hierarchy as a good thing.” Much of that view, he believes, comes from the very different atmosphere that tends to dominate white-collar offices, where there is often confusion about whether the boss really deserves to be in charge. “In an artisan’s workshop, it’s perfectly clear who the master is, and where everyone else stands on the hierarchy of skill.”
The power structure that hierarchy created inside artisan workshops left Kuijpers feeling surprisingly impressed, and hopeful that we can somehow find a way to spread its virtues. “It’s more stable, more easily accepted,” he told me. “It’s very clear, and it exists outside of social influences.”
CREATIVITY AND THE HANDS
Throughout Kuijpers’ film, one expert after another talks about . . .
Update: This account seems relevant.
The TikTok Hearing Revealed That Congress Is the Problem
Dell Cameron reports in Wired:
IN ONE SENSE, today’s US congressional hearing on TikTok was a big success: It revealed, over five hours, how desperately the United States needs national data-privacy protections—and how lawmakers believe, somehow, that taking swipes at China is a suitable alternative.
For some, the job on Thursday was casting the hearing’s only witness, TikTok CEO Shou Zi Chew, as a stand-in for the Chinese government—in some cases, for communism itself—and then belting him like a side of beef. More than a few of the questions lawmakers put to Chew were vague, speculative, and immaterial to the allegations against his company. But the members of Congress asking those questions feigned little interest in Chew’s responses anyway.
Attempts by Chew, a 40-year-old former Goldman Sachs banker, to elaborate on TikTok’s business practices were frequently interrupted, and his requests to remark on matters supposedly of considerable interest to members of Congress were blocked and occasionally ignored. These opportunities to get the CEO on record, while under oath, were repeatedly blown in the name of expediency and for mostly theatrical reasons. Chew, in contrast, was the portrait of patience, even when he was being talked over. Even when some lawmakers began asking and, without pause, answering their own questions.
The hearing might’ve been a flop, had lawmakers planned to dig up new dirt on TikTok, which is owned by China-based ByteDance, or even hash out what the company could do next to allay their concerns. But that wasn’t the aim. The House Energy and Commerce Committee was gathered, it said, to investigate “how Congress can safeguard American data privacy and protect children from online harms.” And on that, the hearing revealed plenty.
For one thing, it’s clear that the attempts to isolate TikTok from its competitors—to treat it differently than dozens of other companies with atrocious records of endangering kids and abusing private data—is a pointless exercise. Asking about TikTok’s propensity for surveilling its own users, Chicago congresswoman Jan Schakowsky warned Chew against using legal, typical industry practices as a defense against these wrongs. “You might say, ‘not more than other companies,’” she said, adding that she preferred not to “go by that standard.”
OK. But why not?
The truth is that if TikTok were to vanish tomorrow, its users would simply flock to any number of other apps that have no qualms about surveilling the most private moments of their lives and amassing, manipulating, and selling off sensitive information about them. Excluding the most serious but largely unsubstantiated allegations leveled at TikTok—that it is acting or will act in coordination with Chinese intelligence services—there wasn’t a concern about privacy raised by lawmakers Thursday that couldn’t be addressed by existing legislation supporting a national privacy law.
Ensuring that companies and the data brokers they enrich face swift reprisals for blatantly abusing user trust would have the benefit of addressing not only the accusations levied against TikTok, but deceitful practices common across the entire social media industry.
The irony of US lawmakers pursuing a solution to a problem that’s already been solved by draft legislation—but not actually fixed due to its own inaction—wasn’t entirely lost on the members. While primarily focused on a single company, the hearing, Florida congresswoman Kathy Castor said, should really serve as a broader call to action. “From surveillance, tracking, personal data gathering, and addictive algorithmic operations that serve up harmful content and have a corrosive effect on our kids’ mental and physical well-being,” she said, Americans deserve protection, no matter the source.
This issue, Castor added, goes far beyond TikTok and China. “There are other malign actors across the world who gather data, who use it as an element of social control, influence peddling, and worse,” she said. “Big Tech platforms profit immensely from keeping children addicted … They are the modern-day tobacco and cigarette companies.”
The conflation of data privacy concerns—that is, the surveillant threat posed by Beijing—and the ways in which TikTok fails its underaged users was a theme throughout the hearing, with both topics puzzlingly discussed interchangeably. In reality, . . .
“Fact-checking” is a feeble, inadequate way to respond to racist, antisemitic incitement
Dan Froomkin writes in Press Watch:
I’m not sure there has ever been a major-media “fact check” that more completely, ludicrously, and appallingly missed the point than the one the New York Times published on Thursday about the vile, scurrilous, racist, antisemitic Republican claims aimed at demonizing and linking a Black district attorney and a prominent Jewish funder.
Appearing under the headline “Explaining the Ties Between Alvin Bragg and George Soros,” the “fact check” by Linda Qiu addressed whether there were, in fact, any links between the Manhattan DA who may be on the verge of indicting Trump for fraud and campaign-finance violations, and the left-wing philanthropist and noted target of antisemitic slander.
There are, strictly speaking, some things you could call links between the two men. But they are inconsequential.
Concluding that “These claims are exaggerated” is to entirely miss the actual meaning of the claims. It minimizes them. It whitewashes them. It virtually endorses them.
The journalistic issue should not be whether there is some factual basis in there somewhere, but that Trump and congressional Republicans are engaging in deceitful racist incitement.
The article’s acknowledgment that Soros is “a boogeyman on the right” and that attacks on him “often veer into antisemitic tropes” is a criminal understatement. Soros has become well known right-wing shorthand for Jewish cabal.
In a social media missive Friday that elite political reporters utterly failed to explain amounted to incitement and extortion, Trump also referred to Bragg as a “Soros backed animal.”
It’s beyond disgusting.
So here is how a journalist should respond: . . .
Biden Plan to Cut Billions in Medicare Fraud Ignites Lobbying Frenzy
As Dan Froomkin notes, “Health insurers are spending millions to protect their ability to overbill billions to the government. Doesn’t that make you angry?” Reed Abelson and Margot Sanger-Katz report in the NY Times:
“How’s the knee?” one bowler asked another across the lanes. Their conversation in a Super Bowl ad focused on a Biden administration proposal that one bowler warned another would “cut Medicare Advantage.”
“Somebody in Washington is smarter than that,” the friend responded, before a narrator urged viewers to call the White House to voice their displeasure.
The multimillion dollar ad buy is part of an aggressive campaign by the health insurance industry and its allies to stop the Biden proposal. It would significantly lower payments — by billions of dollars a year — to Medicare Advantage, the private plans that now cover about half of the government’s health program for older Americans.
The change in payment formulas is an effort, Biden administration officials say, to tackle widespread abuses and fraud in the increasingly popular private program. In the last decade, reams of evidence uncovered in lawsuits and audits revealed systematic overbilling of the government. A final decision on the payments is expected shortly, and is one of a series of tough new rules aimed at reining in the industry. The changes fit into a broader effort by the White House to shore up the Medicare trust fund.
Without reforms, taxpayers will spend about $25 billion next year in “excess” payments to the private plans, according to the Medicare Payment Advisory Commission, a nonpartisan research group that advises Congress.
The proposed changes have unleashed an extensive and noisy opposition front, with lobbyists and insurance executives flooding Capitol Hill to engage in their fiercest fight in years. The largest insurers, including UnitedHealth Group and Humana, are among the most vocal, according to congressional staff, with UnitedHealth’s chief executive pressing his company’s case in person. Doctors’ groups, including the American Medical Association, have also voiced their opposition.
“They are pouring buckets of money into this,” said Mark Miller, the former executive director of MedPAC, who is now the executive vice president of health care at Arnold Ventures, a research and advocacy group. Supporters of the restrictions have begun spending money to counter the objections. . .
How the NRA Rewrote the Second Amendment
Michael Waldman, president of the Brennan Center for Justice at NYU School of Law and author of The Second Amendment: A Biography, has a good article — presumably an extract from his book — in Politico:
“A fraud on the American public.” That’s how former Chief Justice Warren Burger described the idea that the Second Amendment gives an unfettered individual right to a gun. When he spoke these words to PBS in 1990, the rock-ribbed conservative appointed by Richard Nixon was expressing the longtime consensus of historians and judges across the political spectrum.
Twenty-five years later, Burger’s view seems as quaint as a powdered wig. Not only is an individual right to a firearm widely accepted, but increasingly states are also passing laws to legalize carrying weapons on streets, in parks, in bars—even in churches.
Many are startled to learn that the U.S. Supreme Court didn’t rule that the Second Amendment guarantees an individual’s right to own a gun until 2008, when District of Columbia v. Heller struck down the capital’s law effectively banning handguns in the home. In fact, every other time the court had ruled previously, it had ruled otherwise. Why such a head-snapping turnaround? Don’t look for answers in dusty law books or the arcane reaches of theory.
So how does legal change happen in America? We’ve seen some remarkably successful drives in recent years—think of the push for marriage equality, or to undo campaign finance laws. Law students might be taught that the court is moved by powerhouse legal arguments or subtle shifts in doctrine. The National Rifle Association’s long crusade to bring its interpretation of the Constitution into the mainstream teaches a different lesson: Constitutional change is the product of public argument and political maneuvering. The pro-gun movement may have started with scholarship, but then it targeted public opinion and shifted the organs of government. By the time the issue reached the Supreme Court, the desired new doctrine fell like a ripe apple from a tree.
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The Second Amendment consists of just one sentence: “A well regulated militia, being necessary for the security of a free state, the right of the people to keep and bear arms, shall not be infringed.” Today, scholars debate its bizarre comma placement, trying to make sense of the various clauses, and politicians routinely declare themselves to be its “strong supporters.” But in the grand sweep of American history, this sentence has never been among the most prominent constitutional provisions. In fact, for two centuries it was largely ignored.The amendment grew out of the political tumult surrounding the drafting of the Constitution, which was done in secret by a group of mostly young men, many of whom had served together in the Continental Army. Having seen the chaos and mob violence that followed the Revolution, these “Federalists” feared the consequences of a weak central authority. They produced a charter that shifted power—at the time in the hands of the states—to a new national government.
“Anti-Federalists” opposed this new Constitution. The foes worried, among other things, that the new government would establish a “standing army” of professional soldiers and would disarm the 13 state militias, made up of part-time citizen-soldiers and revered as bulwarks against tyranny. These militias were the product of a world of civic duty and governmental compulsion utterly alien to us today. Every white man age 16 to 60 was enrolled. He was actually required to own—and bring—a musket or other military weapon.
On June 8, 1789, James Madison—an ardent Federalist who had won election to Congress only after agreeing to push for changes to the newly ratified Constitution—proposed 17 amendments on topics ranging from the size of congressional districts to legislative pay to the right to religious freedom. One addressed the “well regulated militia” and the right “to keep and bear arms.” We don’t really know what he meant by it. At the time, Americans expected to be able to own guns, a legacy of English common law and rights. But the overwhelming use of the phrase “bear arms” in those days referred to military activities.
There is not a single word about an individual’s right to a gun for self-defense or recreation in Madison’s notes from the Constitutional Convention. Nor was it mentioned, with a few scattered exceptions, in the records of the ratification debates in the states. Nor did the U.S. House of Representatives discuss the topic as it marked up the Bill of Rights. In fact, the original version passed by the House included a conscientious objector provision. “A well regulated militia,” it explained, “composed of the body of the people, being the best security of a free state, the right of the people to keep and bear arms shall not be infringed, but no one religiously scrupulous of bearing arms, shall be compelled to render military service in person.”
Though state militias eventually dissolved, for two centuries we had guns (plenty!) and we had gun laws in towns and states, governing everything from where gunpowder could be stored to who could carry a weapon—and courts overwhelmingly upheld these restrictions. Gun rights and gun control were seen as going hand in hand. Four times between 1876 and 1939, the U.S. Supreme Court . . .
Top 10 Inventions of the Industrial Revolution
World History Encyclopedia has an interesting article by Mark Cartwright discussing the top 10 inventions of the Industrial Revolution. It begins:
The British Industrial Revolution transformed life at work and at home for practically everyone. Noise, pollution, social upheaval, and repetitive jobs were the price to pay for labour-saving machines, cheap and comfortable transportation, more affordable consumer goods, better lighting and heating, and faster ways of communication.
Any shortlist of inventions is bound to be far from complete, but the following have been chosen not only for what they could do but also for how they permitted other inventions to become possible and how they transformed working life and everyday living for millions of people. The period under consideration is also important and here is taken as 1750 to 1860. With these criteria in mind, the top 10 inventions of the Industrial Revolution were:
- The Watt Steam Engine (1778)
- The Power Loom (1785)
- The Cotton Gin (1794)
- Gas Street Lighting (1807)
- The Electromagnet (1825) . . .
Elon Musk knocked Tesla’s ‘Full Self-Driving’ off course
Faiz Siddiqui reports in the Washington Post:
Long before he became “Chief Twit” of Twitter, Elon Musk had a different obsession: making Teslas drive themselves. The technology was expensive and, two years ago when the supply chain was falling apart, Musk became determined to bring down the cost.
He zeroed in on a target: the car radar sensors, which are designed to detect hazards at long ranges and prevent the vehicles from barreling into other cars in traffic. The sleek bodies of the cars already bristled with eight cameras designed to view the road and spot hazards in each direction. That, Musk argued, should be enough.
Some Tesla engineers were aghast, said former employees with knowledge of his reaction, speaking on the condition of anonymity for fear of retribution. They contacted a trusted former executive for advice on how to talk Musk out of it, in previously unreported pushback. Without radar, Teslas would be susceptible to basic perception errors if the cameras were obscured by raindrops or even bright sunlight, problems that could lead to crashes.
Musk was unconvinced and overruled his engineers. In May 2021 Tesla announced it was eliminating radar on new cars. Soon after, the company began disabling radar in cars already on the road. The result, according to interviews with nearly a dozen former employees and test drivers, safety officials and other experts, was an uptick in crashes, near misses and other embarrassing mistakes by Tesla vehicles suddenly deprived of a critical sensor.
Musk has described the Tesla “Full Self-Driving” technology as “the difference between Tesla being worth a lot of money and being worth basically zero,” but his dream of autonomous cars is hitting roadblocks.
In recent weeks, Tesla has recalled and suspended the rollout of the technology to eligible vehicles amid concerns that its cars could disobey the speed limit and blow through stop signs, according to federal officials. Customer complaints have been piling up, including a lawsuit filed in federal court last month claiming that Musk has overstated the technology’s capabilities. And regulators and government officials are scrutinizing Tesla’s system and its past claims as evidence of safety problems mounts, according to company filings.
In interviews, former Tesla employees who worked on Tesla’s driver-assistance software attributed the company’s troubles to the rapid pace of development, cost-cutting measures like Musk’s decision to eliminate radar — which strayed from industry practice — and other problems unique to Tesla.
They said Musk’s erratic leadership style also played a role, forcing them to work at a breakneck pace to develop the technology and to push it out to the public before it was ready. Some said they are worried that, even today, the software is not safe to be used on public roads. Most spoke on the condition of anonymity for fear of retribution. [Musk seems extraordinarily given to retribution. – LG]
“The system was only progressing very slowly internally” but . . .
Later in the article:
“No one believed me that working for Elon was the way it was until they saw how he operated Twitter,” Bernal said, calling Twitter “just the tip of the iceberg on how he operates Tesla.”
This Georgia County Spent $1 Million to Avoid Paying for One Employee’s Gender-Affirming Care
Aliyya Swaby and Lucas Waldron report in ProPublica:
When a sheriff’s deputy in Georgia’s Houston County sought surgery as part of her gender transition, local officials refused to change the department’s health insurance plan to cover it, citing cost as the primary reason.
In the years that followed, the central Georgia county paid a private law firm nearly $1.2 million to fight Sgt. Anna Lange in federal court — far more than it would have cost the county to offer such coverage to all of its 1,500 health plan members, according to expert analyses. One expert estimated that including transition-related care in the health plan would add about 0.1% to the cost of all claims, which would come to roughly $10,000 per year, on average.
Since at least 1998, the county’s plan has excluded coverage for “services and supplies for a sex change,” an outdated term to refer to surgeries or medications related to gender transition. In 2016, the county’s insurance administrator recommended changing the policy to align with a new federal nondiscrimination rule. But Houston County leaders said no.
The county argued that even if the cost of expanding its insurance coverage to include transition-related health care was low on average, it could amount to much more in some years. The county also claimed that expanding the plan’s coverage would spur demands to pay for other, currently excluded benefits, such as abortion, weight loss surgery and eye surgery.
“It was a slap in the face, really, to find out how much they had spent,” said Lange, who filed a federal discrimination lawsuit against the county. “They’re treating it like a political issue, obviously, when it’s a medical issue.”
Major medical associations recognize that access to transition-related care, also known as gender-affirming care, is medically necessary for transgender people, citing evidence that prohibiting it can harm their mental and physical health. And federal judges have consistently ruled that employers cannot categorically exclude gender-affirming care from health care plans, though prior to Lange’s suit, there hadn’t been a ruling covering Georgia. The care can include long-term hormone therapy, chest and genital surgery, and other services that help transgender people align their bodies with their gender identities.
But banning gender-affirming care has become a touchstone of conservative politics. At least 25 states this year are considering or have passed bills that would ban gender-affirming care for minors. Bills in Oklahoma and Texas aim to ban insurance companies from covering transition-related health care for adults as well.
At the same time, state and local government employers are waging long legal battles against covering gender-affirming care for their employees. With recent estimates showing that 0.6% of all Americans older than 13 are transgender, these employers are spending large sums to fight coverage for a small number of people.
ProPublica obtained records showing that two states — North Carolina and Arizona — have spent more than $1 million in attorney fees on legal fights similar to the one in Houston County. Both have claimed in court filings that the decisions they made not to cover the care for employees are purely financial and not discriminatory.
But budget estimates and real-world examples show that the cost of offering coverage of gender-affirming care is negligible. When the state of North Carolina briefly covered gender-affirming care in 2017, the cost amounted to $400,000 — just 0.01% of the health plan’s $3.3 billion annual budget. . .
Continue reading. There’s much more.
Wealthy Executives Make Millions Trading Competitors’ Stock With Remarkable Timing
Robert Faturechi and Ellis Simani report in ProPublica:
On Feb. 21, 2018, August Troendle, an Ohio billionaire, made a remarkably well-timed stock trade. He sold $1.1 million worth of shares of Syneos Health the day before a management shake-up caused the company’s stock to plunge 16%. It was the largest one-day drop that year for Syneos’ share price.
The company was one Troendle knew well. He is the CEO of Medpace, one of Syneos’ chief competitors in a niche industry. Both Syneos and Medpace handle clinical trials for biopharma companies, and that year they had jointly launched a trade association for companies in the field.
The day after selling the Syneos shares in February 2018, Troendle bought again — at least $3.9 million worth. The value of his Syneos stake then rose 75% in the year that followed.
In February 2019, Troendle sold much of that position, netting $2.3 million in profit. Two days later, Syneos disclosed that the Securities and Exchange Commission was investigating its accounting practices. The news sent the company’s shares tumbling. Troendle’s sale avoided a 25% loss, the stock’s largest decline in such a short period during either that or the previous year. (Troendle declined to comment.)
The Medpace executive is among dozens of top executives who have traded shares of either competitors or other companies with close connections to their own. A Gulf of Mexico oil executive invested in one partner company the day before it announced good news about some of its wells. A paper-industry executive made a 37% return in less than a week by buying shares of a competitor just before it was acquired by another company. And a toy magnate traded hundreds of millions of dollars in stock and options of his main rival, conducting transactions on at least 295 days. He made an 11% return over a recent five-year period, even as the rival’s shares fell by 57%.
These transactions are captured in a vast IRS dataset of stock trades made by the country’s wealthiest people, part of a trove of tax data leaked to ProPublica. ProPublica analyzed millions of those trades, isolated those by corporate executives trading in companies related to their own, then identified transactions that were anomalous — either because of the size of the bets or because individuals were trading a particular stock for the first time or using high-risk, high-return options for the first time.
The records give no indication as to why executives made particular trades or what information they possessed; they may have simply been relying on years of broad industry knowledge to make astute bets at fortuitous moments. Still, the records show many instances where the executives bought and sold with exquisite timing.
Such trading records have never been publicly available. Even the SEC itself doesn’t have such a comprehensive database. The records provide an unprecedented glimpse into how the titans of American industry make themselves even wealthier in the stock market.
U.S. securities law bars “insider trading” — buying or selling stocks based on access to nonpublic information not available to other investors — under certain circumstances. Historically, insider trading prosecutions and SEC enforcement have both focused on corporate employees, and those close to them, trading in the stock of their own companies.
But executives at companies can also have extensive access to nonpublic information about rivals, partners or vendors through their business. Buying or selling stock based on that knowledge can run afoul of insider-trading law, according to experts. ProPublica described multiple trades, without mentioning names, to Robert Zink, a former chief of the Justice Department’s criminal fraud section, who responded that if he were still at the Justice Department, “of course we would look at it.” He added that the key to ProPublica’s findings is “the trading doesn’t appear to be a one- or two-time thing. It’s happening a lot.” . . .
SVB’s investors will get $2b in public bailout money
Cory Doctorow writes in Medium:
We were told that the Silicon Valley Bank bailout wasn’t a bailout: in a bailout, it’s the investors who get public money; but with SVB, it was the depositors. But, of course, the owners of SVB were also depositors in their own bank. All in all, SVB’s owners are entitled to $2B in public money.
When Biden said, “investors in the banks will not be protected. They knowingly took a risk and when the risk didn’t pay off, investors lose their money. That’s how capitalism works,” he was ignoring the fact that this isn’t how the law works.
Writing on Credit Slips, the incomparable Adam Levitin — the best source on bankruptcy law writing on the web today — breaks it down: “creditors of a subsidiary have no claim on the assets of a parent.” That means that the FDIC has no claim on the assets of the now-bankrupt holding company that owned SVB:
Which means that when the FDIC makes all the depositors at SVB whole, they will transfer $2b to the “investors” whom Biden promised “will not be protected.” If you’re interested in the minutiae of this, Levitin’s piece is short and clear — there’s no automatic tort-based claim that would let the FDIC get the money back from the investors, because SVB isn’t classed as a really big bank (a “G-SIB”).
As for Dodd-Frank’s “source of strength” doctrine, it “doesn’t create any concrete financial liability — it’s just exhortatory.”
Bankruptcy law does give priority to regulators seeking capital to keep depositors whole, but that applies only when the bank makes “a specific promise to do so.” All this means that “the FDIC seems to have accidentally guarantied $2 billion for the creditors of SVB Financial Group without any offsetting claim.”
No source has been better for understanding the SVB debacle than Credit Slips, asking questions and raising issues that . . .
Emergency rooms seem to be heading toward trouble
Kevin Drum points out what seems to be an emergency room emergency:
The Washington Post has a story today about the demise of ER physicians. It used to be a coveted position for residencies, but now senior doctors are warning against it:
They warn of burnout after covid and patients’ increasing suspicion of doctors. The pay is not as good, they say, especially as hospitals rely more on nurse practitioners and physician assistants to staff emergency departments. And job prospects may be grim, they caution, as emergency medicine residency programs aggressively expanded in recent years.
….Emergency departments are under strain as they become congested with patients waiting for beds, veteran providers quit and violence against the remaining staff grows. These factors are damaging the emergency room’s reputation as an ideal place to learn by caring for a steady stream of patients with a wide range of problems.
Every year, graduating students apply for residencies and are matched with programs that are interested in hiring them. [see chart above – LG]
Emergency medicine was in the SOAP in 2023. That is, there weren’t enough applicants for all the open positions, which means that some ER residency programs had to hire doctors from the Supplemental Offer and Acceptance Program, a sort of second-round draft for everyone who didn’t get an offer from the first round of matching.
Of course, it’s worth noting that . . .
California tackles the greed of Big Pharma
and
California Gov. Gavin Newsom announced on Saturday that the state will cut insulin costs by 90% and that it will start manufacturing naloxone, a nasal spray used to reverse opioid overdoses.
The lower insulin cost results from a collaboration between CalRx, a California Department of Health Care Services program, and the non-profit drug manufacturer Civica Rx, according to a news release from the governor’s office. A 10-milliliter vial of insulin will be available for no more than $30, pending approval by the US Food and Drug Administration, says the release.
Though insulin was discovered more than a century ago and costs little to make, brand-name insulin is often sold for roughly $300 per vial, CNN has reported. The high cost has forced many people with diabetes to ration or skip drug doses, which help the body manage blood sugar.
Civica Rx is a non-profit generic drugmaker that focuses on manufacturing drugs that are in short supply or may experience price spikes. The organization is backed by hospitals, insurers, and philanthropies.
“People should not be forced to go into debt to get life-saving prescriptions,” said Newsom in the release. “Through CalRx, Californians will have access to . . .
Price-gouging on life-saving drugs like insulin highlights the moral depravity of capitalism in general and Big Pharma in particular.
A Sandwich Shop, a Tent City, and an American Crisis
The US — and Canada, I have to say — seem to lack the competence or perhaps the will to deal with the crisis at hand. I believe that part of the problem is that the ruling oligarchy doesn’t really care about such problems, being focused instead on how to extract more money from the people and not really concerned about the consequences.
Eli Saslow reports in the NY Times:
He had been coming into work at the same sandwich shop at the same exact time every weekday morning for the last four decades, but now Joe Faillace, 69, pulled up to Old Station Subs with no idea what to expect. He parked on a street lined with three dozen tents, grabbed his Mace and unlocked the door to his restaurant. The peace sign was still hanging above the entryway. Fake flowers remained undisturbed on every table. He picked up the phone and dialed his wife and business partner, Debbie Faillace, 60.
“All clear,” he said. “Everything looks good.”
“You’re sure? No issues?” she asked. “What’s going on with the neighbors?”
He looked out the window toward Madison Street, which had become the center of one of the largest homeless encampments in the country, with as many as 1,100 people sleeping outdoors. On this February morning, he could see a half-dozen men pressed around a roaring fire. A young woman was lying in the middle of the street, wrapped beneath a canvas advertising banner. A man was weaving down the sidewalk in the direction of Joe’s restaurant with a saw, muttering to himself and then stopping to urinate a dozen feet from Joe’s outdoor tables.
“It’s the usual chaos and suffering,” he told Debbie. “But the restaurant’s still standing.”
That had seemed to them like an open question each morning for the last three years, as an epidemic of unsheltered homelessness began to overwhelm Phoenix and many other major American downtowns. Cities across the West had been transformed by a housing crisis, a mental health crisis and an opioid epidemic, all of which landed at the doorsteps of small businesses already reaching a breaking point because of the pandemic. In Seattle, more than 2,300 businesses had left downtown since the beginning of 2020. A group of fed up small-business owners in Santa Monica, Calif., had hung a banner on the city’s promenade that read: “Santa Monica Is NOT safe. Crime … Depravity … Outdoor mental asylum.” And in Phoenix, where the number of people living on the street had more than tripled since 2016, businesses had begun hiring private security firms to guard their property and lawyers to file a lawsuit against the city for failing to manage “a great humanitarian crisis.”
The Faillaces had signed onto the lawsuit as plaintiffs along with about a dozen other nearby property owners. They also bought an extra mop to clean up the daily flow of human waste, replaced eight shattered windows with plexiglass, installed a wrought-iron fence around their property and continued opening their doors at exactly 8 each morning to greet the first customer of the day.
“Hey, bro! The usual?” Joe said to a construction worker who always ordered an Italian on wheat.
“Love the new haircut,” Joe said a few minutes later to a city employee who came for meatballs three days each week.
Debbie arrived to help with the lunch rush, and she greeted customers at the register, while Joe prepared tomato sauce and weighed out 2.2 ounces of turkey for each chef’s salad. Their margins had always been tight, but they saved on labor costs by both going into work every day. They remodeled the kitchen to make room for a nursery when their children were born and then expanded into catering to help those children pay for college. They kept making the same nine original house sandwiches for a loyal group of regulars even as the city transformed around them — its population growing by about 25,000 each year, inflation rising faster than in any other U.S. city, housing costs soaring at a record pace, until it seemed that there was nowhere left for people to go except onto sidewalks, into tents, into broken-down cars, and increasingly into the air-conditioned relief of Old Station Subs.
“I need to place a huge order,” a woman said as she walked up to the counter wearing mismatched shoes and carrying a garbage bag of her belongings. “I own Dairy Queen.”
“Oh, wow. Which one?” Debbie asked, playing along.
“All of them,” the woman said. “I’m queen of the queen.”
“That’s wonderful,” Debbie said as she led the woman to a table with a menu and a glass of water and watched as the woman emptied her bag onto the table, covering it with rocks, expired bus passes, a bicycle tire, clothing, 17 batteries, a few needles and a flashlight. “Would you like me to take an order?” Debbie asked.
“You know why I’m here,” the woman said, suddenly banging her fist against the table. “Don’t patronize me. The king needs his payment.”
Debbie refilled the woman’s water and walked behind the counter to find Joe. For the past several months, she had driven into work with stomach pain and stress headaches. She had started telling Joe that she was done at Old Station, whether that meant selling the restaurant, boarding it up or even moving away from Phoenix for a while without him. She had begun looking at real estate in Prescott, a small town about 100 miles away with a weekly art walk, mountain air, a few lakes.
“What am I supposed to tell this lady?” she asked him. “I can’t keep doing this. Every minute it’s something.”
Joe reached for her hand. “It’ll get better. Stick with me,” he said, but now they could hear the woman tossing some of her belongings onto the floor.
“The king needs his ransom!” she shouted.
“I’m sorry, but it’s time to go,” Debbie told her.
“You thieves. You devils,” the woman said.
“Please,” Debbie said. “This is our business. We’re just trying to get through lunch.”
Their restaurant was located a half-mile from the Arizona State Capitol in . . .
FCC orders phone companies to block scam text messages
Some progress. Now block scam voice calls. Jon Brodkin reports in Ars Technica:
The Federal Communications Commission today finalized rules requiring mobile carriers to block robotext messages that are likely to be illegal. The FCC described the rules as the agency’s “first regulations specifically targeting the increasing problem of scam text messages sent to consumers.”
Carriers will be required to block text messages that come from “invalid, unallocated, or unused numbers.” Carriers must also block texts from “numbers that the subscriber to the number has self-identified as never sending text messages, and numbers that government agencies and other well-known entities identify as not used for texting,” the FCC said.
Carriers will have to establish a point of contact for text senders so the senders can inquire about blocked texts. The FCC already requires similar blocking of voice calls from these types of numbers.
The FCC still has a 2-2 partisan deadlock more than two years into Joe Biden’s presidency, but the robotext order was approved 4-0. The FCC sought public comment on the rules in September 2022 before finalizing them today. The order will take effect 30 days after it is published in the Federal Register, according to a draft of the order released before the meeting.
More robotext rules on the way
More robotext rules may be on the way because today’s “action also seeks public comment on further proposals to require providers to block texts from entities the FCC has cited as illegal robotexters,” the FCC said. For example, the FCC proposes to clarify that Do Not Call Registry protections apply to text messaging.
The FCC said it’s further proposing to close the . . .
Fire the Fed
Matt Stoller has a strong column in BIG, one with which I have considerable sympathy:
In 1969, then-Citibank CEO Walter Wriston tried to radically upend more than a hundred years of banking law by offering to buy the large insurance company, the Chubb Corporation. He did so by using a loophole in banking law that allowed banks to form a holding company and diversify into non-banking industries. Such a purchase would entangle banking and commerce in a manner traditionally prohibited by the rules establishing the national banking system in the 1960s, and reinforced by the Glass-Steagall Act in the 1930s. And it was utterly shocking to the political establishment, from bank regulators all the way up to President Richard Nixon.
Citibank’s move was part of a wave of big banks and conglomerates, which were an early type of private equity fund, trying to break this barrier, and use the special government guarantees for cheap credit as a competitive advantage over industrial firms in the real economy. Smaller banks were unhappy, as were many businesses, about what Wriston was doing. Still, the banks had an immensely powerful lobby. Yet over the course of the next two years, populist Banking Committee Chair Democrat Wright Patman, and his allies in business, at Federal regulatory agencies and in the Nixon administration, fought back.
Patman held hearings to expose the problems, hearings that today show what it means when core infrastructural platforms – in this case banks – could exploit their market position. A Pennsylvania entrepreneur testified about pressure put on him by banks to buy alternative services when he needed financing. An Indianapolis travel agent, Othmar Grueninger, talked about how bank-owned travel agencies were driving independent agencies out of business because of their unparalleled access to data about who traveled and who was creditworthy. “Any time I deposited checks from my customers,” he said, “I was providing the banks with the names of my best clients.”
But the big banks were powerful, and controlled a majority of votes on the House Banking Committee, despite Patman’s Chairman position. So the committee passed a version of the bill that legalized what Wriston and various conglomerates were doing. Executives at the American Bankers Association, the lobbying group based in New York, celebrated. Then, lobbyists for insurance and travel agencies, data processors, and industry groups mobilized. On the floor of the House, Patman and his staff completely re-wrote the bill that had come out of committee, and passed it out of the House. Lobbyists at the American Bankers Association had stopped paying attention, and didn’t even learn what happened until the next day.
The fight went over to the Senate, where it became even more brutal, involving bribery, threats to campaign contributors, and shouting matches. The progressive National Farmers Union, in hock to a Denver bank that had been acquired by a conglomerate, persuaded liberals like Senator George McGovern to back a big bank-friendly amendment. The negotiations for the final bill between the House and Senate were, according to American Banker magazine, among “the most contentious ever held on banking legislation.”
In that conference committee, Patman pulled perhaps the pettiest yet most impactful political maneuver I’ve ever seen. Attached to the bill was a noncontroversial provision to coin 150 million commemorative Eisenhower dollars with 40% silver content. A major contractor for the silver jacketing material for the coins was a company owned by a contributor to a key Senator on the conference committee, New Jersey’s Harrison Williams, who had previously backed the banks and conglomerates. Patman threatened to strip the commemorative coin provision, and Williams quickly caved and dropped his support for the bank-friendly version of the bill. And thus a key protection of the middle class from financiers was preserved for another thirty years.
Ultimately, the 1970 Amendments to the Bank Holding Company Act empowered the Federal Reserve to prohibit banks from co-mingling with commerce through holding companies. In the next two years, the Fed broke up 89 conglomerates, and stopped big banks from buying their way into insurance, land development, data processing, and management consulting. Everyone who had formed a bank holding company starting in 1968, when the rush began, had to divest their non-bank assets. I went into more details of this episode in my book Goliath; suffice to say it was one of the most important political fights of the 1960s that most of us know nothing about.
What Is Federal Reserve Independence?
What was most striking to me about this episode, having worked on the financial crisis of 2008 as a Congressional staffer, was not the fights within Congress. That made sense, the pettiness, corruption, good faith and big decisions all in one wrapper. It was the behavior of . . .
Continue reading. This is an important column — but unfortunately, the House is in the grip of the GOP now.
50 Years Later, We’re Still Living in the Xerox Alto’s World
David C. Brock writes in IEEE Spectrum:
I’M SITTING IN FRONT of a computer, looking at its graphical user interface with overlapping windows on a high-resolution screen. I interact with the computer by pointing and clicking with a mouse and typing on a keyboard. I’m using a word processor with the core features and functions of Microsoft Word, Google Docs, or LibreOffice’s Writer, along with an email client that could be mistaken for a simplified version of Apple Mail, Microsoft Outlook, or Mozilla Thunderbird. This computer runs other software, written using object-oriented programming, just like the popular programming languages Python, C++, C#, Java, JavaScript, and R. Its networking capabilities can link me to other computers and to high-quality laser printers.
You are probably thinking, “So what? My computer has all that too.” But the computer in front of me is not today’s MacBook, ThinkPad, or Surface computer.
Rather, it’s half-century-old hardware running software of the same vintage, meticulously restored and in operation at the Computer History Museum’s archive center. Despite its age, using it feels so familiar and natural that it’s sometimes difficult to appreciate just how extraordinary, how different it was when it first appeared.
I’m talking about the Xerox Alto, which debuted in the early spring of 1973 at the photocopying giant’s newly established R&D laboratory, the Palo Alto Research Center (PARC). The reason it is so uncannily familiar today is simple: We are now living in a world of computing that the Alto created.
The Alto was a wild departure from the computers that preceded it. It was built to tuck under a desk, with its monitor, keyboard, and mouse on top. It was totally interactive, responding directly to its single user.
In contrast, the dominant mainframe at the time—IBM’s hugely popular System 360, heavily used by big organizations, and the Digital Equipment Corp.’s PDP-10, the darling of computing researchers—were nothing like the Alto. These and the other mainframes and minicomputers of the era were room-size affairs, almost always located somewhere away from the user and almost always under the control of someone else. The many simultaneous users of one such computer shared the system as a common resource. They typically connected to it with a teletypewriter, though the most avant-garde users may have employed simple text-only video terminals.
The people who developed the Alto came to Xerox PARC from universities, industrial labs, and commercial ventures, bringing with them diverse experiences and skills. But these engineers and programmers largely shared the same point of view. They conceived and developed the Alto in a remarkable burst of creativity, used it to develop diverse and pathbreaking software, and then moved out of Xerox, taking their achievements, design knowledge, and experiences into the wider world, where they and others built on the foundation they had established.
The computer, and the office, of the future
Broadly speaking, the PARC researchers set out to explore possible technologies for use in what Xerox had tagged “the office of the future.” They aimed to develop the kind of computing hardware and software that they thought could be both technologically and economically possible, desirable, and, perhaps to a lesser extent, profitable in about 10 to 15 years.
The type of computing they envisioned was . . .
Continue reading. And there’s a video at the link.
Later On 