Archive for the ‘Healthcare’ 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 . . .
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. . .
The Oatmeal Diet for diabetics — a surprise
The brief video below describes rigorous testing of the oatmeal diet and what those tests reveal. This video is third in a trilogy: first, Is Oatmeal Good for People with Diabetes?; second, How Does Oatmeal Help with Blood Sugars?; and third, Oatmeal Diet Put to the Test for Diabetes Treatment, the video below.
When Greger refers to “oatmeal,” he seems to mean old-fashioned rolled oats. I’m going to try this, but I think I’ll cook up a batch of oat groats (intact whole-grain oats) and see what that does.
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.
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 . . .
Bari Weiss Is Full of Shit
Katherine Krueger writes in Discourse Blog:
Recently, Bari Weiss’ blog published an account from a “whistleblower” who used to work at a transgender healthcare clinic associated with Washington University’s children’s hospital. Unsurprisingly, the story depicted the clinic as a house of horrors.
Equally unsurprisingly, when some actual reporters examined the deeply alarmist, one-sided story Weiss was pushing, they found it to be total nonsense. It’s just the latest in a long pattern that proves one incontrovertible fact: Bari Weiss is completely full of shit, and you shouldn’t trust a thing she publishes.
The original first-person story, written by Jamie Reed, a former case manager whom Weiss pointed out is a “progressive” and “a queer woman married to a transman,” was published earlier this month by the Free Press, a site founded by the disgraced ex-New York Times opinion writer.
Reed portrayed the trans clinic as unrelentingly barbaric: “mentally ill” children misguidedly looking to transition rather than treat the root causes of their issues, a trans kid’s gender transition weaponized as part of a custody dispute between parents, children being prescribed hormone blockers and other medications willy-nilly and with little regard for side effects, both long and short term, and much more.
Reed wrote: “I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to ‘do no harm.’ Instead, we are permanently harming the vulnerable patients in our care.”
But a deeply reported story published on Monday by the St. Louis Post-Dispatch—which involved interviews with some two dozen parents whose children sought treatment at the center—painted a starkly different picture, one that runs completely counter to Reed’s account.
Here are just a few highlights from the reporting (emphasis mine throughout):
Explosive allegations made public last month about a St. Louis clinic that treats transgender children have flung parents into a vortex of emotions: shock, confusion, anger, fear.
Kim Hutton, among those confused by the reports, views the treatment her son, now 19, received from Washington University’s Transgender Center at St. Louis Children’s Hospital as vital to making him the outgoing college freshman he is today.
“The idea that nobody got information, that everybody was pushed toward treatment, is just not true. It’s devastating,” Hutton said. “I’m baffled by it.”
Patients recounted that the staff explained procedures using both medical and everyday vocabulary.
“The doctor reached out to me after hours to answer my questions and make sure I understood what my treatment plan was,” said a 16-year-old from the St. Louis area.
Rather than the “rapid medicalization” and “poor assessment of mental health concerns” that Reed cited in a complaint sent to Bailey in January, parents reported a well-defined, step-by-step approach that could be halted at any time.
Slow, methodical adjustments began . . .
First They Got Long Covid. Then, It Made Them Homeless
Governments are failing at their job. Elizabeth Yuko reports in Rolling Stone:
COLD WEATHER IS brutal for Wendi Taylor. After living with long Covid for two years, she knows that when the temperature drops, the pain and discomfort increases. This is especially true because of the severe arthritis in her hands, which only developed following her initial Covid-19 infection.
Taylor, who lives in Houston and is among the estimated millions of Americans living with long Covid, says that doing dishes during cold weather is probably the hardest part about living in the makeshift cabin she built from tarps and an 8×8 metal pop-up awning frame she found in the garbage.
“I heat water on the stove, but when it’s below freezing, it cools down quickly, and contact with the water causes extreme pain in my hands,” says Taylor. “It feels like being burned and smashed with a sledgehammer at the same time, and takes a long time for the pain to stop. Even just going outside can cause my hands to turn red and swell and have pain like that. It has made me curl up on my bed and cry more than once.”
At the foot of her twin mattress, atop a small table, sits a small green camping stove she uses both to cook and heat her 64-square-foot living space. A row of plastic storage cabinets is situated at the head of her bed. “Arranging it this way leaves room in the center to sit in a folding chair, or stand up to change clothes, or set groceries down when I come in from the store,” Taylor explains.
After riding out last year’s historic ice storm — which left at least 246 Texas residents dead — in a previous camp, when Taylor found out about the major winter storm at the beginning of this month, she went in prepared. She reinforced the tarps that function as the walls of her cabin, and ensured that the poles of its frame were firmly anchored into the ground.
One of Taylor’s biggest concerns this time was having the propane she needed to operate her stove. “Power outages matter little to me, but ‘they’ will buy all the propane if their electric heat goes off,” Taylor, 41, tells Rolling Stone, referring to housed individuals. “This is one of the biggest issues we face: Supplies we depend on daily become unavailable when they’re hoarded for emergencies.”
Fortunately, 2022’s storm ended up being far less severe than the one in 2021. Instead of having to go weeks without propane, stores near Taylor’s camp in Houston were restocked within days. “That made it far easier to stay warm,” she explains. “I could just hole up inside and avoid opening the door at all, for the most part.”
This isn’t what Taylor’s life was like prior to Covid-19. In fact, things were starting to look up during the first week of March 2020. She was working steadily as a day laborer in construction and landscaping in the Houston area, and was living in an extended-stay motel, saving up to get an apartment. “I was one paycheck away from being able to do so when I got sick,” Taylor says, noting that her first Covid-19 symptoms (a sore throat, fever, and hacking cough) began on March 7.
Although Taylor still felt run-down weeks later, she wasn’t initially alarmed by her lengthy convalescence: After all, it took her several months to recover after she contracted the H1N1 flu in 2009. “I figured this would be the same kind of thing,” she says. “Lots of comparisons were being made to that pandemic.” But nearly two years later, Taylor is still sick.
“One day I saw . . .
Christians amaze me: A Christian Health Nonprofit Saddled Thousands With Debt as It Built a Family Empire Including a Pot Farm, a Bank, and an Airline
Ryan Gabrielson and J. David McSwane report in ProPublica:
Bonnie Martin kept the bleeding secret for as long as she could. Her sisters, boyfriend and sons knew nothing of her illness until suddenly, during a family gathering in October 2018 at a diner in Annapolis, Maryland, she began hemorrhaging.
A tumor had burst through the wall of her uterus. Doctors performed an emergency hysterectomy and removed what cancer they could reach. She needed multiple rounds of chemotherapy and radiation, expensive stuff. As her family grew fearful, Martin walked that fine line between resilience and denial — she’d beat this, she said. She focused instead on fun things ahead, a trip to Ireland with her boyfriend and sisters, for instance, and a Rolling Stones concert.
Luckily, or so Martin thought, she had placed her trust — and her money — in Liberty HealthShare. Liberty is what’s known as a health care sharing ministry, a nonprofit alternative to medical insurance rooted in Christian principles. Hundreds of thousands of people rely on such organizations for basic health coverage. They promise no red tape, lower costs and compassion for the sick. Although Martin wasn’t religious, she found comfort in Liberty’s pledge to “carry one another’s burdens.”
Martin received treatment that pushed her cancer into remission. But 18 months later, it returned, this time in her lungs. She was dying.
Liberty covered her bills at first, but then, without warning or explanation, the payments stopped. Suddenly, she faced $10,000 in unpaid charges. Her whole life, she’d had pristine credit. Now creditors called constantly and sent harassing letters.
Martin refused to accept that her cancer was terminal. She was going to survive, and when she was rid of it, she needed those bills paid. She spent hours pleading over the phone with Liberty, straining to focus as the toxic drugs she was taking sapped her energy. Martin’s long, auburn curls fell out, and her memory was slipping.
Martin forwarded the overdue notices to Liberty, writing on one in pen, “WHY HAS THIS NOT BEEN PAID?” In emails Martin’s family shared with ProPublica, she pleaded, “I am asking for your help and compassion. Help me, I don’t know what else to do. … I CANNOT deal with this stress and fight cancer. You say you are a ministry and want to help people. THEN HELP!!!”
Martin died in July 2022 at age 63. Liberty never settled the bills that she had begged them to pay.
What Martin didn’t know when she joined Liberty was that she was sending her money to members of a family with a long and well-documented history of fraud.
For generations, members of the Beers family of Canton, Ohio, have used Christian faith to sell health coverage to more than a hundred thousand people like Martin. Instead they delivered pain, debt and financial ruin, according to an investigation by ProPublica based on leaked internal documents, land records, court files and interviews. They have done this not once but twice and have faced few consequences.
Patriarch Daniel J. Beers, 60, lies at the center of the family network. He was a leading figure in a scheme in the 1990s involving a health care sharing ministry that fraudulently siphoned tens of millions of dollars from members, court records show. Two decades later, he played a key role in building Liberty into one of the nation’s largest sharing ministries, several of the nonprofit’s current and former employees told ProPublica.
Four years after its launch in 2014, the ministry enrolled members in almost every state and collected $300 million in annual revenue. Liberty used the money to pay at least $140 million to businesses owned and operated by Beers family members and friends over a seven-year period, the investigation found. The family then funneled the money through a network of shell companies to buy a private airline in Ohio, more than $20 million in real estate holdings and scores of other businesses, including a winery in Oregon that they turned into a marijuana farm. The family calls this collection of enterprises “the conglomerate.”
Beers has disguised his involvement in Liberty. He has never been listed as a Liberty executive or board member, and none of the family’s 50-plus companies or assets are in his name, records show.
From the family’s 700-acre ranch north of Canton, however, Beers acts as the shadow lord of a financial empire. It was built from money that people paid to Liberty, Beers’ top lieutenant confirmed to ProPublica. He plays in high-stakes poker tournaments around the country, travels to the Caribbean and leads big-game hunts at a vast hunting property in Canada, which the family partly owns. He is a man, said one former Liberty executive, with all the “trappings of large money coming his way.”
Despite abundant evidence of fraud, much of it detailed in court records and law enforcement files obtained by ProPublica, members of the Beers family have flourished in the health care industry and have never been prevented from running a nonprofit. Instead, the family’s long and lucrative history illustrates how health care sharing ministries thrive in a regulatory no man’s land where state insurance commissioners are barred from investigating, federal agencies turn a blind eye and law enforcement settles for paltry civil settlements.
The Ohio attorney general has twice investigated Beers for activities that financial crimes investigators said were probable felonies. Instead, the office settled for . . .
Continue reading. Another product of the American approach to healthcare.
Just a reminder: “No true Scotsman” arguments are fallacious.
Lee County GOP passes ‘Ban the Jab’ resolution to ban COVID vaccines in Florida
:sigh: Many in the Republican party seem to have lost their mind. From the report:
Dr. Joe Sansone, the man who wrote the resolution, is a licensed psychotherapist (with no formal expertise related to vaccines or epidemiology) and believes in absolutes.
“The Lee County Republican Party is going to be on the vanguard of this campaign to stop the genocide because we have foreign non-governmental entities that are unleashing biological weapons on the American people,” Sansone said. “If you got this shot, you go home and hug your pregnant wife—she can have a miscarriage through skin contact,” Sansone said.
Psychotherapist, heal thyself!
Wow! – New Synthetic Antibiotic “Cures Superbugs Without Bacterial Resistance”
This is a great relief, given the increasing number of antibiotic-resistant pathogens. Jason Kottke blogs:
Well, this is potentially a huge deal:
In a potential game changer for the treatment of superbugs, a new class of antibiotics was developed that cured mice infected with bacteria deemed nearly “untreatable” in humans — and resistance to the drug was virtually undetectable.
Developed by a research team of UC Santa Barbara scientists, the study was published in the journal eBioMedicine. The drug works by disrupting many bacterial functions simultaneously — which may explain how it killed every pathogen tested and why low-level of bacterial resistance was observed after prolonged drug exposure.
Huge if true, etc. What really caught my attention is how they discovered this in the first place…they were working on a way to charge cell phones:
The discovery was serendipitous. The U.S. Army had a pressing need to . . .
UnitedHealthcare Tried to Deny Coverage to a Chronically Ill Patient. He Fought Back, Exposing the Insurer’s Inner Workings.
Healthcare in the US is dismal, but that is how the medical establishment, the insurance companies, and the Republican party want it. David Armstrong, Patrick Rucker, and Maya Miller report in ProPublica about one case.
In May 2021, a nurse at UnitedHealthcare called a colleague to share some welcome news about a problem the two had been grappling with for weeks.
United provided the health insurance plan for students at Penn State University. It was a large and potentially lucrative account: lots of young, healthy students paying premiums in, not too many huge medical reimbursements going out.
But one student was costing United a lot of money. Christopher McNaughton suffered from a crippling case of ulcerative colitis — an ailment that caused him to develop severe arthritis, debilitating diarrhea, numbing fatigue and life-threatening blood clots. His medical bills were running nearly $2 million a year.
United had flagged McNaughton’s case as a “high dollar account,” and the company was reviewing whether it needed to keep paying for the expensive cocktail of drugs crafted by a Mayo Clinic specialist that had brought McNaughton’s disease under control after he’d been through years of misery.
On the 2021 phone call, which was recorded by the company, nurse Victoria Kavanaugh told her colleague that a doctor contracted by United to review the case had concluded that McNaughton’s treatment was “not medically necessary.” Her colleague, Dave Opperman, reacted to the news with a long laugh.
“I knew that was coming,” said Opperman, who heads up a United subsidiary that brokered the health insurance contract between United and Penn State. “I did too,” Kavanaugh replied.
Opperman then complained about McNaughton’s mother, whom he referred to as “this woman,” for “screaming and yelling” and “throwing tantrums” during calls with United.
The pair agreed that any appeal of the United doctor’s denial of the treatment would be a waste of the family’s time and money.
“We’re still gonna say no,” Opperman said.
More than 200 million Americans are covered by private health insurance. But data from state and federal regulators shows that insurers reject about 1 in 7 claims for treatment. Many people, faced with fighting insurance companies, simply give up: One study found that Americans file formal appeals on only 0.1% of claims denied by insurers under the Affordable Care Act.
Insurers have wide discretion in crafting what is covered by their policies, beyond some basic services mandated by federal and state law. They often deny claims for services that they deem not “medically necessary.”
When United refused to pay for McNaughton’s treatment for that reason, his family did something unusual. They fought back with a lawsuit, which uncovered a trove of materials, including internal emails and tape-recorded exchanges among company employees. Those records offer an extraordinary behind-the-scenes look at how one of America’s leading health care insurers relentlessly fought to reduce spending on care, even as its profits rose to record levels.
As United reviewed McNaughton’s treatment, he and his family were often in the dark about what was happening or their rights. Meanwhile, United employees misrepresented critical findings and ignored warnings from doctors about the risks of altering McNaughton’s drug plan.
At one point, court records show, United inaccurately reported to Penn State and the family that McNaughton’s doctor had agreed to lower the doses of his medication. Another time, a doctor paid by United concluded that denying payments for McNaughton’s treatment could put his health at risk, but the company buried his report and did not consider its findings. The insurer did, however, consider a report submitted by a company doctor who rubber-stamped the recommendation of a United nurse to reject paying for the treatment.
United declined to answer specific questions about the case, even after . . .
It’s worthwhile to read the entire report since it spells out so clearly the gross failings and defects of how healthcare is run in the US. Later — much later — in the report:
On May 21, 2021, United sent the case to one of its own doctors, Dr. Nady Cates, for an additional review. The review was marked “escalated issue.” Cates is a United medical director, a title used by many insurers for physicians who review cases. It is work he has been doing as an employee of health insurers since 1989 and at United since 2010. He has not practiced medicine since the early 1990s.
Cates, in a deposition, said he stopped seeing patients because of the long hours involved and because “AIDS was coming around then. I was seeing a lot of military folks who had venereal diseases, and I guess I was concerned about being exposed.” He transitioned to reviewing paperwork for the insurance industry, he said, because “I guess I was a chicken.”
When he had practiced, Cates said, he hadn’t treated patients with ulcerative colitis and had referred those cases to a gastroenterologist.
He said his review of McNaughton’s case primarily involved reading a United nurse’s recommendation to deny his care and making sure “that there wasn’t a decimal place that was out of line.” He said he copied and pasted the nurse’s recommendation and typed “agree” on his review of McNaughton’s case.
Cates said that he does about a hundred reviews a week. He said that in his reviews he typically checks to see if any medications are prescribed in accordance with the insurer’s guidelines, and if not, he denies it. United’s policies, he said, prevented him from considering that McNaughton had failed other treatments or that Loftus was a leading expert in his field.
“You are giving zero weight to the treating doctor’s opinion on the necessity of the treatment regimen?” a lawyer asked Cates in his deposition. He responded, “Yeah.”
Attempts to contact Cates for comment were unsuccessful.
I wonder if any of these people working for the insurance company are capable of feeling any shame.
Interesting thread on the Covid-cancer connection
I came across a thread that begins with this post:
Epstein-Barr virus, human papillomavirus, hepatitis B and herpes virus-8 are all viruses that can increase the risk of cancer. There is preliminary evidence #COVID19 could also. We won’t know for many years, by which time, many will have been convinced to repeatedly be infected because they were told it was safe & they didn’t like masks. An ounce of prevention today could be worth a ton of cure later. Why be a lab rat and only find out later you should’ve been more cautious today? #WearAMask
Along the way, someone commented:
my 3 cats got covid when I did in 2020. Now 2 are dead from cancers, and the 3rd has kidney disease
One was only 30, in human years
And see also this article in Nature: “COVID drug drives viral mutations — and now some want to halt its use.” The Eldest tells me that that particular drug is already highly restricted exactly for the reasons described in the article. Moreover, as she points out, “Now that COVID is in animals (deer, cockroaches, etc) and so many people are having second and third rounds of infections because they have discontinued masking, there will be many, many new mutations in any case, sadly. Each new infection is a chance for a successful mutation.”
Be careful out there. Wear an N95 mask in indoor public places.
Antidepressants help bacteria resist antibiotics
— Credit: Steve Gschmeissner/Science Photo Library
Liam Drew writes in Nature:
The emergence of disease-causing bacteria that are resistant to antibiotics is often attributed to the overuse of antibiotics in people and livestock. But researchers have homed in on another potential driver of resistance: antidepressants. By studying bacteria grown in the laboratory, a team has now tracked how antidepressants can trigger drug resistance1.
“Even after a few days exposure, bacteria develop drug resistance, not only against one but multiple antibiotics,” says senior author Jianhua Guo, who works at the Australian Centre for Water and Environmental Biotechnology at the University of Queensland in Brisbane. This is both interesting and scary, he says.
Globally, antibiotic resistance is a significant public-health threat. An estimated 1.2 million people died as a direct result of it in 20192, and that number is predicted to climb.
Early clues
Guo became interested in the possible contributions of non-antibiotic drugs to antibiotic resistance in 2014, after work by his lab found more antibiotic-resistance genes circulating in domestic wastewater samples than in samples of wastewater from hospitals, where antibiotic use is higher.
Guo’s group and other teams also observed that antidepressants — which are among the most widely prescribed medicines in the world — killed or stunted the growth of certain bacteria. They provoke “an SOS response”, Guo explains, triggering cellular defence mechanisms that, in turn, make the bacteria better able to survive subsequent antibiotic treatment.
In a 2018 paper, the group reported that Escherichia coli became resistant to multiple antibiotics after being exposed to fluoxetine3, which is commonly sold as Prozac. The latest study examined 5 other antidepressants and 13 antibiotics from 6 classes of such drugs and investigated how resistance in E. coli developed.
In bacteria grown in well-oxygenated laboratory conditions, the antidepressants caused the cells to generate reactive oxygen species: toxic molecules that activated the microbe’s defence mechanisms. Most prominently, this activated the bacteria’s efflux pump systems, a general expulsion system that many bacteria use to eliminate various molecules, including antibiotics. This probably explains how the bacteria could withstand the antibiotics without having specific resistance genes.
But exposure of E. coli to antidepressants also led to an increase in . . .
Good info on Paxlovid
Judith Graham writes in Medscape:
A new coronavirus variant is circulating, the most transmissible one yet. Hospitalizations of infected patients are rising. And older adults represent nearly 90% of U.S. deaths from covid-19 in recent months, the largest portion since the start of the pandemic.
What does that mean for people 65 and older catching covid for the first time or those experiencing a repeat infection?
The message from infectious disease experts and geriatricians is clear: Seek treatment with antiviral therapy, which remains effective against new covid variants.
The therapy of first choice, experts said, is Paxlovid, an antiviral treatment for people with mild to moderate covid at high risk of becoming seriously ill from the virus. All adults 65 and up fall in that category. If people can’t tolerate the medication — potential complications with other drugs need to be carefully evaluated by a medical provider — two alternatives are available.
“There’s lots of evidence that Paxlovid can reduce the risk of catastrophic events that can follow infection with covid in older individuals,” said Dr. Harlan Krumholz, a professor of medicine at Yale University.
Meanwhile, develop a plan for what you’ll do if you get covid. Where will you seek care? What if you can’t get in quickly to see your doctor, a common problem? You need to act fast since Paxlovid must be started no later than five days after the onset of symptoms. Will you need to adjust your medication regimen to guard against potentially dangerous drug interactions?
“The time to be figuring all this out is before you get covid,” said Dr. Allison Weinmann, an infectious-disease expert at Henry Ford Hospital in Detroit.
Being prepared proved essential when I caught covid in mid-December and went to urgent care for a prescription. Because I’m 67, with blood cancer and autoimmune illness, I’m at elevated risk of getting severely ill from the virus. But I take a blood thinner that can have life-threatening interactions with Paxlovid.
Fortunately, the urgent care center could . . .
What to Do if You Have COVID
Covid is still here, still spreading fast, and still doing great damage to people’s immune systems, cardiovascular systems, and bodies in general. Useful information from People’s CDC:
A guide for preparing for illness, preventing spread to others, managing symptoms, and recovery
Table of Contents
- Summary
- Layers of Protection
- Planning Ahead
- When & How to Isolate
- Short Term Recovery
- Exiting Isolation
- Long Term Recovery
- Sources
1. Summary
View our abbreviated guide and full list of sources as well.
While you are healthy, it is important to plan ahead for illness. Despite the government consistently downplaying the disease and removing COVID protections,1 sustained high community transmission is all too common, increasing the risks of infection and reinfection for everyone. If you’re reading this guide before needing it, you are taking an important step towards being as prepared as possible!
The People’s CDC has reviewed up-to-date research to create evidence-based guidelines and recommendations for what to do if you have COVID.
Layers of Protection
You can help prevent the spread of COVID by using multiple layers of protection. These layers include: ventilating and filtering air; masking with well-sealed and high filtration masks; staying up to date with vaccines and boosters; testing before seeing others; testing and isolating after possible exposures; and physical distancing and limiting time indoors. If you’re at home with others while isolating due to infection or exposure, you can implement additional household-specific layers of protection. These include creating isolation zones, minimizing time spent in shared zones, and clearly communicating the use of layers of protection within your household.
Planning Ahead
Improve the air quality of your home with humidifiers, purifiers, and open windows. Have supplies, contact information (medical provider, testing, social supports), and a plan of action ready in case of illness. Familiarize yourself with your work or school’s COVID policy and devise ways to extend the 5-day isolation period, if possible.
Exposure and Testing
If you’ve been exposed to someone who has COVID via shared air, you should isolate yourself for a minimum of 7 days. You should use multiple tests over the course of 5-7 days to determine if you are negative (1-2 tests over the course of the same 24 hours is not adequate). If you test positive, you should isolate yourself for a minimum of 10 days after your first positive result. After 10 days, use rapid tests to find out if you are negative. If you are experiencing symptoms, but do not have access to adequate testing, you should isolate yourself for a minimum of 10 days after the first day of symptoms.
Short and Long Term Recovery
If you have COVID, we encourage you to . . .
Seniors Are More Conservative Because the Poor Don’t Survive to Become Seniors
Ed Kilgore wrote in New York in 2018, on what was once Memorial Day (May 31):
One of the abiding realities of our political era is a major generational split anchored on the right by disproportionately conservative seniors and on the left by disproportionately progressive millennials and post-millennials. This is often thought of as a perfectly natural, even inevitable, phenomenon: Young people are adventurous, open to new ways of thinking, and not terribly invested in the status quo, while old folks have time-tested views, assets they want to protect, and a growing fear of the unknown and unfamiliar.
There is some truth in those stereotypes, though different cohorts of young people in the past have been far more conservative than today’s, and on non-cultural matters, seniors have sometimes been as or even more progressive than their children or grandchildren (e.g., the so-called Greatest Generation, which mostly came of age during the Great Depression, was persistently Democratic-leaning politically).
But it is important to note that some generational disjunctions in political behavior are driven by demography. It’s well understood that millennials are significantly more diverse than prior generations. But there is something else driving the relative homogeneity of seniors: Poorer people are often hobbled by chronic illness, and succumb to premature death. A new academic study featured at the Washington Post’s Monkey Cage blog explains:
Political participation of the poor is overall lower because of poverty, bad health and many other factors, but millions of impoverished Americans across the country also die prematurely. For instance, in 2015, research funded by the National Institutes of Health and the Social Security Administration revealed that, since 1990, among the bottom quarter of Americans with the least education, life expectancy has either stagnated or decreased. That’s for well over 40 million people.
Add to this negative trend the fact that mortality among the poor increases during middle age — which is when citizens generally get more involved in politics. The premature disappearance of the poor, then, occurs precisely at the moment when they would be expected to reach their “participatory peak” in society. But they don’t live long enough to achieve that milestone.
Since white people suffer proportionately less from poverty than nonwhite people, they do tend to live longer, and in better health, which is conducive to political and other civic activism. The most politically left-bent demographic racial group, African-Americans, has made progress recently in reducing the gap in life expectancy with white peers, but still lags in both lifespans and health, as a 2017 CDC study showed: . . .
If you do get Covid…
Note this research report: “Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients.” I’m buying some saline nasal spray tomorrow.
Everything You Know About Obesity Is Wrong, revisited
I blogged some years back about Michael Hobbes’s lengthy and interesting article on how medical doctors in general get an F on their approach to obesity.
I stumbled over one thing in the article:
For 60 years, doctors and researchers have known two things that could have improved, or even saved, millions of lives. The first is that diets do not work. Not just paleo or Atkins or Weight Watchers or Goop, but all diets.
Since I have found that a whole-food plant-based diet has indeed worked — it controlled my type 2 diabetes, helped me lose weight, and enabled me to discontinue the medications I formerly had to take — his statement did not make sense to me. (And, BTW, it is not just me who has had success with a whole-food plant-based diet in treating type 2 diabetes: see this article.) Moreover, research has shown that the Mediterranean diet is much healthier than the Standard American Diet (SAD).
His statement seemed to me to say “It doesn’t matter what you eat.” And yet we know that eating a substantial amount of ultraprocessed foods — foods manufactured using industrial processes from refined ingredients, including a lot of additives like refined sugar, salt, preservatives, and artificial flavorings and colorings — causes weight gain compared to a diet that focuses who whole foods, including a hefty amount of fruit and fresh vegetables. How can he say that diet does not matter?
The Wife pointed out that diet has two meanings:
- Diet can mean “what you eat,” meaning the range of foods that you routinely consume — for example, the Mediterranean Diet, the whole-food plant-based diet, or a vegetarian diet, or in a statement like “His diet includes too many ultraprocessed foods.”
- Diet can also mean restricting oneself to a specialized and temporary list of foods for the specific goal of losing weight, with the idea that — once the weight is lost — one returns to their normal eating pattern (i.e., their normal diet, in the first sense of the word “diet”).
Hobbes seems in the quoted passage to be talking about this second meaning of “diet,” but it’s confusing because the Paleo Diet and the Atkins Diet are not temporary diets but are proposed as permanent alterations in one’s eating patterns — that is, they are presented as diets in the first sense.
Perhaps the goal (particularly for the Atkins Diet) is weight loss, but the Paleo Diet is offered as a healthy (and permanent) alternative. Moreover, WW changed its name from Weight Watchers (in September 2018, the very time Hobbes’s article was published) specifically to reflect “its focus on overall health and wellness, and not just shedding pounds.” (CNN) That is, WW moved from being the Weight Watchers diet (in the second meaning: temporary) to being a permanent approach to food (“diet” in the second sense, as a permanent change in the foods one consumes and also considering exercise and other components of the program).
Because “diet” is so ambiguous, the word in the first sense — the range of foods one eats on a daily basis — is now often called one’s “lifestyle,” though that word generally also includes the type of exercise in one’s regular routine and also often addresses stress reduction.
I would have been happier (and understood better) if Hobbes had not written “The first is that diets do not work,” but instead had written “The first is that the temporary restriction of one’s diet in accordance with some fad plan does not work,” which seems to be what he means. And then he should also have omitted from his list those diets intended as a permanent change in eating habits (paleo, Atkins, and WW). When he includes those total and permanent changes in one’s diet, then the reader (at least, this reader) naturally thinks of other basic, permanent changes to one’s eating patterns, like the Mediterranean diet and thewhole-food plant-based diet.
With that exception, his article is straightforward, interesting, and informative. It begins:
From the 16th century to the 19th, scurvy killed around 2 million sailors, more than warfare, shipwrecks, and syphilis combined. It was an ugly, smelly death, too, beginning with rattling teeth and ending with a body so rotted out from the inside that its victims could literally be startled to death by a loud noise. Just as horrifying as the disease itself, though, is that for most of those 300 years, medical experts knew how to prevent it and simply failed to.
In the 1600s, some sea captains distributed lemons, limes and oranges to sailors, driven by the belief that a daily dose of citrus fruit would stave off scurvy’s progress. The British Navy, wary of the cost of expanding the treatment, turned to malt wort, a mashed and cooked byproduct of barley which had the advantage of being cheaper but the disadvantage of doing nothing whatsoever to cure scurvy. In 1747, a British doctor named James Lind conducted an experiment where he gave one group of sailors citrus slices and the others vinegar or seawater or cider. The results couldn’t have been clearer. The crewmen who ate fruit improved so quickly that they were able to help care for the others as they languished. Lind published his findings, but died before anyone got around to implementing them nearly 50 years later.
This kind of myopia repeats throughout history. Seat belts were invented long before the automobile but weren’t mandatory in cars until the 1960s. The first confirmed death from asbestos exposure was recorded in 1906, but the U.S. didn’t start banning the substance until 1973. Every discovery in public health, no matter how significant, must compete with the traditions, assumptions and financial incentives of the society implementing it.
Which brings us to one of the largest gaps between science and practice in our own time. Years from now, we will look back in horror at the counterproductive ways we addressed the obesity epidemic and the barbaric ways we treated fat people—long after we knew there was a better path. . .
Later On 