The direction of society lately

[thollandpe]

All the war talk. Using the “Shock and Awe” doctrine not against a military enemy but against the American people. Steve Bannon’s podcast is called the “War Room.” Musk said, “I will go to war on this issue the likes of which you cannot possibly comprehend.” Hegseth is trying to re-image our Department of Defense as “warfighters.”

Well the war is on. They attacked the T in LBGTQ+ first. Federal employees and veterans are under siege. Public health and the environment are two other fronts. And pubic education and higher education are absolutely under fire now.



Je suis Canada?

[72gmc]

If you reduce the options for smart people, maybe fewer of them stick around to tell you that you can’t reroute a hurricane with a sharpie.

[vertical_doug]

If you reduce the options for smart people, maybe fewer of them stick around to tell you that you can’t reroute a hurricane with a sharpie.

Yes, but the ones that stick around will tell you the sharpie is right.

If you recall the President's speech where he claimed NIH was funding transgender research on mice. This was discovered by DOGE. The reality was they were funding transgenic research.
But the White House press office had to issue a clarification, and the boss was right. It was transgender research not transgenic regardless of what the research papers say.

[Tom]

UMASS Chan is where my brother's lab is. I'll be seeing him next week, he is speaking at a conference in Vilnius, I'm meeting him there along with a cousin coming over from Poland. Vilnius is where my dad went to high school for a couple of years in a program to identify talented students and give them the opportunity to continue school past the 6th grade. All the schools closed with the onset of the 2nd world war and he wound up in a German labor camp after avoiding the Russians who wanted him dead. My brother and cousin, mostly my cousin, have been researching the family history. The archives in Vilnius are incredible, detailed records for all the time periods back hundreds of years where some invasion didn't cause a total blank spot. My cousin has even located some of my dad's report cards.

[Scott G.]

[snip]
But the White House press office had to issue a clarification, and the boss was right. It was transgender research not transgenic regardless of what the research papers say.

Rumor has it Trofim Lysenko is the new White House Science & Agriculture Advisor.

[vertical_doug]

Rumor has it Trofim Lysenko is the new White House Science & Agriculture Advisor.

His cousin is running the FDA

[j44ke]

Rumor has it Trofim Lysenko is the new White House Science & Agriculture Advisor.

His cousin is running the FDA

Wow - you guys get an honorary degree from MIT on that one.

[Paul Jacobs]

From the i newspaper, today.

[BBB]

From the i newspaper, today.

Dumb and dumber?

[jmgorman]

Rumor has it Trofim Lysenko is the new White House Science & Agriculture Advisor.

Not a chance - he was Ukrainian

[j44ke]

[echappist]

Ugh, speaking as someone who could potentially be affected by a potential shutdown, I think Schumer folded like a cheap suit.

Damn, at least wring some concessions out of this, as opposed to simply rolling over.

[j44ke]

Ugh, speaking as someone who could potentially be affected by a potential shutdown, I think Schumer folded like a cheap suit.

Damn, at least wring some concessions out of this, as opposed to simply rolling over.

I hear you.

There is a big argument among Dems whether or not the funding bill was a Trojan Horse to shutdown the government indefinitely.

[BBB]

If it did shutdown, does that make the country technically insolvent?

Maybe a creditor could appoint an administrator of some sort to assume control...

[vertical_doug]

To return to the original roots of this thread, I came across this musing about the Thompson murder and found it thought provoking…
https://nymag.com/intelligencer/arti...-thompson.html

David Pietrowski

Profit-Enhancing Middlemen’ Fuel $200 Billion Health-Care Chaos
2025-03-13 21:00:19.825 GMT


By John Tozzi
(Bloomberg) -- After she was diagnosed with advanced breast
cancer, Julie Simons and her doctor sought approval from her
insurance company to pay for a form of precise, high-dose
radiation treatment.
The confusing responses they received presaged a struggle
to come. UnitedHealth Group Inc.’s insurance division told the
doctor that type of radiation wouldn’t be covered during a phone
call in February 2024, according to the company. The same day,
it sent Simonstwo conflicting letters: One denying the request
as “not medically necessary” and another that approved it.
Relying on the approval letter, Simons got the treatment.
Months later, the insurer declined to pay for it, leaving her on
the hook for more than $100,000 in medical bills from ProHealth
Care, the cancer center where she was treated in Waukesha,
Wisconsin, according to a lawsuit Simons filed in federal court
in January.
Like countless Americans, Simons was caught in a conflict
between her insurer and her provider. These clashes, long a
fixture of the US health-care system, are intensifying as both
care providers and insurers employ supercharged tactics to
maximize their financial advantage. They’re turning to a growing
brigade of middleman companies that face off over prior
authorizations, denials, appeals and payments.
Those businesses — sometimes backed by private equity,
sometimes units of powerhouse incumbents — police the money
insurers pay out or, on the other side, help hospital systems
and medical practices boost their revenue.
The result is a medical billing arms race that increases
friction for patients and doctors. It has fanned some of the
widespread frustration with insurers that erupted on social
media after the December killing of a UnitedHealth executive.
About 12% of medical claims were denied in 2023, according to
data from UnitedHealth’s Optum subsidiary, up from 9% in 2016.
The data is based on claims from more than 1,400 hospitals, and
describes denial rates across the industry, not just
UnitedHealthcare plans.
Facing rising constraints from insurers, providers invest
in new ways to capture revenue. “These equal and opposite forces
increase each year while canceling each other out and creating
no aggregate value,” according to a viewpoint in JAMA in 2021
coauthored by Bob Kocher, a physician and venture capitalist.
In Simons’ case, UnitedHealth — which operates the biggest
US insurer — is involved on all sides. The company wasn’t just
her insurer, it was her employer, too. Simons works for the
company’s Optum Insight division, which also does the billing
for the health system where she was treated.
The system, ProHealth Care, announced a deal with
UnitedHealth in 2023 to “enhance the health care experience” and
turn over some operations to Optum, according to a news release.
Those included “revenue cycle management,” industry jargon for
the systems hospitals and doctors use to get paid. Simons was
one of hundreds of employees of ProHealth Care who joined the
Optum payroll in the outsourcing arrangement. Her coverage on
the company’s UnitedHealthcare plan began weeks after she was
diagnosed, according to her lawsuit.
After Bloomberg News inquired about Simons’ case, a
UnitedHealth spokesperson said her situation had been
“resolved.” The spokesperson said in an email that “there was an
administrative error that caused some confusion regarding the
coverage” of Simons’ claim and that it had been paid in full.
Layers of Complexity
The administrative sludge that patients must slog through
to get care — and doctors must wade through to get paid — drives
staggering costs in US health care. The costs of billing, claims
processing and prior authorizations doctors must get for
treatments have soared to around $200 billion a year — about as
much as the US spends to treat cancer.
A raft of companies has sprung up in that morass. Some help
hospitals bill top dollar for their services and navigate
insurance bureaucracies. Others help insurers review claims and
requests for care, and audit payments after they’ve been made.
Some, including Optum, do both.
Together, these little-known businesses add fresh layers of
complexity and expense to an already convoluted system.
“It’s like paying an arsonist to put out fire”
“They’re making money on both sides and driving up the
costs across the board,” Linda Blumberg, a Georgetown University
expert on health insurance, said of the growing number of
intermediaries in the health-care payments chain.
She calls them “profit-enhancing middlemen” and says
they’ve escapedscrutiny from regulators and the public. Because
there’s no limit to the prices providers can charge, and little
oversight of insurers’ denials, each side has turned to these
companies to counter the other side’s practices.
In some cases, the same companies are selling software or
services to both providers and insurers. “It’s like paying an
arsonist to put out fire,” said Kevin Schulman, a Stanford
University doctor and economist who has studied administrative
costs.
An Optum spokesperson said the company has “firewalls
between provider billing and payer services” and that the
company aims to reduce administrative waste.Apparent
Contradiction
Sometimes divisions of the same business are dueling over
the same claims.
Before it was purchased by UnitedHealth, the health tech
company Change Healthcare bought up a series of businesses in
obscure corners of the health-care payments and technology
world.
One of its services for health plans sent letters warning
doctors that they were billing costly visits far more often than
their peers, according to three former employees who asked not
to be named discussing private information.But some of those
doctors relied on a different Change Healthcare service to
submit their bills, the people said.

Doctors getting the letters were frustrated by the apparent
contradiction that bills submitted by one arm of the company
were being questioned by another, they said. One unit of Change
Healthcare even avoided using the parent company’s branding on
its letterhead, so providers wouldn’t realize that letters
questioning their payments were coming from the same company
that some of them used for billing, two of the people said.
A spokesperson for UnitedHealth said those practices
predated the company’s ownership of Change Healthcare and are no
longer in place.‘Growth Opportunity’
Hospitals and providers spend more than $170 billion per
year on revenue cycle management, which includes everything from
verifying patients’ benefits at the front desk to chasing
payments after the visit. On the other side, $9 billion a year
goes into payment integrity companies that help insurers keep a
lid on how much they have to pay out.
While that may sound like insurers are overmatched, the
figure doesn’t count the billions spent on processes like prior
authorizations and claims denials that are built into their day-
to-day operations. Major insurers including Elevance Health Inc.
and Cigna Group have units devoted to reviewing requests for
care, for their own health plans and external clients.
Investors are putting big money behind these businesses. In
2024 alone, the revenue cycle company Waystar Holding Corp. went
public in one of the year’s largest initial offerings by a US
company; it’s now valued at $6 billion. Private equity firms
took a rival, R1 RCM, private in an $8.9 billion purchase.
Another deal by KKR & Co. reportedly valued payment integrity
company Cotiviti at $11 billion, while New Mountain Capital
formed a new $3 billion payment integrity firm from existing
assets.
It’s a business expected to gobble up more and more money.
“We see a material long-term growth opportunity” for revenue
cycle management software, William Blair analysts wrote in a
July report on Waystar. Investing in the software was a top
priority for health-care executives, a survey from Bain &
Company found.
Provider Strategies
Much of the recent spate of consumer outrage about the
health sector was focused on claims denials by insurance
companies. They are the ones saying no, sometimescontradicting a
doctor’s judgment.
But the strategies that providers — and the large health
systems that increasingly employ them — use to boost their own
profits have gotten less attention.
In November, UCHealth in Colorado agreed to pay $23 million
to resolve allegations brought by a whistleblower who accused
the hospital system of fraudulently billing patients for
emergency care. According to the settlement, UCHealth billed
emergency visits at the highest, most costly level of care
automatically if a patient had their vital signs checked more
than once an hour.
The billing system inflated patients’ costs by thousands of
dollars,according to the whistleblower complaint. UCHealth
didn’t admit liability in the settlement. A spokesperson said
the hospital system denies the allegations but settled to
resolve costly litigation.
“The cost of an MRI in the whole scheme of cancer is like
nothing”
While doctors and patients chafe at insurers’ efforts to
manage costs, some constraints on care exist for good reason.
The US health-care industry is rife with exorbitant prices,
inappropriate care and outright fraud. Improper payments in the
Medicare and Medicaid programs alone top $100 billion a year,
according to the Government Accountability Office.
That means health plans must balance getting their members
access to care with safeguards against overpaying — and they’re
often relying on middlemen to do it.
Angela Riley is a physician who oversees coverage for Unite
Here Health, a union health plan for hospitality workers that
covers 200,000 people nationwide. She’s had to intervene when,
for example, a company hired by one of the plan’s insurers
denied requests for scans to diagnose possible cancers in the
name of containing costs.
“The cost of an MRI in the whole scheme of cancer is like
nothing,” Riley said.

The group is beginning to contract directly with cancer
centers and lift prior authorization requirements for those that
have demonstrated top quality, eliminating the companies in the
middle. “We can cut all that out,” she said.
Still, she sees the need for prior authorizations and other
checks to ensure the plan doesn’t waste money that ultimately is
part of the union members’ compensation.
Unite Here Health recently added prior authorization
requirements for certain surgeries after it found procedures
performed in hospital outpatient departments were costing far
more than in other settings.
Physicians say the same factors driving the billing arms
race are encroaching on how they practice medicine. They say
they face increasingly burdensome requirements for prior
authorizations and approvals.
“The insurance companies are now in my clinic,” said Jerome
Cohen, a gastroenterologist in Loch Sheldrake, New York, who
leads the state medical society. Often, he said, they’re
“directly in the way.”
More than three-quarters of US doctors work for hospitals
or corporate bosses. They’re losing professional autonomy to
“profit-making corporate entities,” says Barak Richman, a health
policy expertat George Washington University Law School.
In Wisconsin, Simons’ claim was ultimately paid — after she
filed a lawsuit that drew media scrutiny. Though her lawsuit
sought additional damages, her attorney Daniel Schlessinger said
federal law limits what plaintiffs like Simons can pursue in
such cases beyond the cost of the treatment. That it took a
lawsuit to resolve the mess “is not how the system is supposed
to work,” he said in an email.

[Saab2000]

If it did shutdown, does that make the country technically insolvent?

Maybe a creditor could appoint an administrator of some sort to assume control...

No. These “shutdowns” are unfortunately political theater and happen every few years or so one party or the other (usually the same one) can create drama.

[gregl]

No. These “shutdowns” are unfortunately political theater and happen every few years or so one party or the other (usually the same one) can create drama.

Yes, but the current majority party, with control over (essentially) all three branches of Government, is authoritarian in nature. There is a valid concern that the current regime could use a shutdown to further dismantle our increasingly fragile democratic republic. We are living in a dictator’s playbook. It’s very dangerous to dismiss things as “normal” right now.

Greg

[thollandpe]

There is a big argument among Dems whether or not the funding bill was a Trojan Horse to shutdown the government indefinitely.

There is a valid concern that the current regime could use a shutdown to further dismantle our increasingly fragile democratic republic.

There is also a theory about negotiation with terrorists.

The Republicans are driving this runaway train, or at least can get to the brake handle.

[thollandpe]

Sen. Warnock says it well. I like his suit (video link below) but not the center-justified text:



Video: https://bsky.app/profile/warnock.sen.../3lkcemztbns2e

[echappist]

I hear you.

There is a big argument among Dems whether or not the funding bill was a Trojan Horse to shutdown the government indefinitely.

I wish Schumer articulated his position in the way you couched it. I understand that there's almost always a good level of game theory involved in such negotiations, but until I saw your post, I didn't quite understand the full extent of it.

I also wish the two newspapers I read framed his decision as that of his personal vote, not that of the entire Dems caucus in the Senate. Due to that, a retraction of my initial post to which you responded.