08 September 2017

On my high horse about medical billing practices

I wrote this to the administrator of a for-profit Catholic medical group (which is well-known and widespread in the Pacific Northwest and also operates a chain of for-profit hospitals that are known to be a bit on the "pricey" side).


 Dear Dr. XX, 

I am writing to you about a matter of great concern to me, as a patient and spouse of another XX Medical Group patient. This is a concern that affects much of the for-profit and even non-profit private health care delivery system in this country, and I believe that it is a specific area where financial practices which are immoral and unethical are being commonly not only tolerated but actively engaged in, including by your organization. It is an area where I strongly believe that right-thinking medical administrators can and should voluntarily institute a simple reform for the good of all the citizens of our country, but most particularly for those who are unfortunate enough to have inadequate or no health insurance at all. I hope to at least suggest to you that this is something worth thinking seriously about. While the ultimate resolution of our ongoing national health care reimbursement policy crisis will almost certainly be political in nature, in the meantime, there are specific actions which providers can take which would increase equity and reduce the adverse impact of our medical cost crisis, especially on those least able to shoulder the burdens. Until our nation faces up to the necessity of ensuring health care as a right not a privilege, it is unfortunately incumbent on health care providers to ensure some degree of equity, to see to it that costs do not fall disproportionately on those least able to bear them.


I need hardly belabor the point that health care expenses are a major source of anxiety and stress for the shrinking middle class in our country. In some ways it is they, as opposed to the actual poor (who receive Medicaid), who are most affected by the problems I am talking about. Unexpected and inadequately insured medical expenses are the leading cause of personal bankruptcy in our country, as I'm sure you know.


The practice I am referring to is that of billing uninsured patients far more than would be reimbursed if they had insurance. I know that your organization offers to work with patients, but merely receiving a bill for $500 when the insurance would pay $350 (or even less) for the same services is a shock and assault on people's well-being. And this doesn't even address the fundamental inequity of the default expectation, contrary to any ordinary sense of fairness, that patients who lack coverage should pay, or at least be presented with the expectation that they pay, more for the same services than those who have coverage. And we should not pretend that it's easy or routine to secure reductions of these "full ride" costs. The entire burden of trying to get out from under enormous medical debts falls on the patient, when frequently the patients are at a point in their lives where they are least able to cope with such considerations and the necessity of negotiation and wrangling over medical bills. People routinely get unexpected bills in the mail that cause them huge distress, only to have to spend time, effort, and mental anguish trying to figure out how to cope with them.


And this is just plain wrong. My attention was drawn to this situation again, when, recently, my spouse went in for a wellness visit, and apparently the insurance was slow to adjust the billing. Upshot: we received a bill for $527, the non-discounted sum, with no explanation, no attempt to call us to explain that there was a delay with the insurance, just a bill. And it turned out that the EOB had crossed in the mail, and the insurance had already paid in full: $398 (the insurance discounted amount). My spouse presented as an insured patient, and even so was billed the full amount. Patients who have no insurance, or coverage problems, who are typically people with fewer financial resources than more fortunate insured patients, are expected to shoulder more than their proportionate share of health care costs. Of course some cannot pay, but that doesn't make it ethical to expect and dun people of limited means to pay more than others who have more resources. I put it to you, Dr. XX: such practice is both immoral and contrary to the tenets of every traditional religion, not least Christianity. I say this flatly and bluntly, and I hope you will consider seriously what I am saying. It is wrong to perpetuate a system that shifts greater financial burdens onto the less well off and the sick. Period. What must be done is that a program be instituted to make sure patients whose costs are not reimbursed receive bills which are no more than the typical insurance reimbursement. No other practice can be tolerated.


In our case, the matter was resolved, and we are not victims of the anomalous inequity I am complaining about, although we were exposed to it. We are fortunate enough to be adequately insured, even if the claim administrator was slow to process the claim. But many people are not, and bills like this are a serious burden on the finances of many who are least able to afford those burdens. Health care providers should never bill uninsured patients more than what insurers would ordinarily pay for the same services. Period. It's wrong, and it's one of the immoral practices that have tainted the entire profession of medicine in our country.


To the counterargument that health care providers as squeezed in all directions and costs for them are spiraling too, I can only say, this may be true, but it does not excuse disparate billing practices that disadvantage the less well off and the sick. Some other ways of meeting expenses simply must be put in place, because this practice is wrong.


Thank you.

Sincerely,  XX


06 September 2017

Oregon fires

I haven't read any scientific analysis, but is sure seems to me that Oregon's climate is rapidly transitioning to a hotter, dry summer, colder, wet and snowier winter regime. The summer is more like California, the winter more like someplace like Arkansas. In comparison to formerly I mean. I can't but assume that if this persists the forest environment here will change, because I don't think it can withstand three months without rain (like this year) every year. 

Not to mention the wildfires, which are truly terrible. Fortunately, it's finally cooler and moist air from the ocean has moved in, to mitigate the smoke. What we need though is a drenching rain, and that's not in the forecast. 

02 September 2017

Three Laws of AI ? Nah

I read this article in the NYT with some bemusement. (It's an attempt to codify a more modern version of Asimov's "Three Laws of Robotics," which were his attempt to imagine how a superior artificial life form might be permanently controlled by its creators, us).

As someone who spends a certain amount of mental energy thinking about the future, and the future of technology, let me propose a truism:

The possible manifestations, both for better and for worse, in terms of human outcomes, of any new technology, will eventually emerge, regardless of any attempts to control or regulate them.

So, control genetic manipulation, even the creation of new species? Forget it. That ship is on its way out of the berth. And that means that future human evolution, way on down the road, perhaps, but inevitably, will be artificially guided. A very discomfiting thought, but count on it.

But I don't worry about AI robots taking over and supplanting us. If I'm wrong, well, they will, and RIP human race, our successors will be cyborgs. Get over it. But I don't think it will happen. And here's why.

Despite what people like Ray Kurzweil and Marvin Minsky say, I don't know of any evidence that artificial machines have ever been developed that have ANY self-awareness. Complex computational ability, yes. Modeling ability, which can look like an internally aware system, sure, but there is no suggestion that there is awareness "behind the eyes." The idea that a sufficiently complex, recursive computational system inevitably becomes self aware is actually just an assumption, a bias, even, for which, to my knowledge, there is not only scant evidence, there is NO evidence.

We really don't know what consciousness is. The problem of studying it objectively is not trivial. B. Alan Wallace and Daniel Dennett have grappled with it, but not come up with any definitive empirical view. The problem is that it's virtually impossible to examine something that is definitionally subjective and internal by using methodologies (Western scientific procedure) that are definitinally objective and external. So our only real knowledge of consciousness is experiential. We do know that artificial computing systems work very, very differently from biological ones, and that an advanced working model of a biological type brain is not even close to having been created artificially.

So, I don't worry about robots taking over. As long as we remember to always install a kill switch.

A casual report

Things are odd, as usual, en Amerique. Yesterday in San Francisco was the hottest day ever recorded there, 106° (41° in real). But the Russian consular annex, having just been given 48 hours to vacate, as part of the ongoing retaliatory tiff (wherein the Russians slashed American embassy staff in retaliation for sanctions which were in retaliation for the most serious cyber attack on another country in history, so somewhat asymmetrical, but I digress)...anyway, they started a fire in an outside bin and an inside fireplace. The fire department was called but was told "Zdes' nechegto smotret" ... "nothing to see here..." the Russians were obviously burning sensitive documents. Don't they know about shredders? 

The West Coast's epic heat wave (not yet arrived in the Portland or Seattle areas but expected shortly), is yet another instance of extremes of weather that climate scientists like Michael Mann and James Hansen are no longer equivocating over: they are definitely being caused by increases in atmospheric CO-2 over the last century or so in particular. 

This all contrasts with the continuing obsession of Toddler/Man president, who still has never actually criticized Putin or his government in public since declaring his then seemingly quixotic run for office now more than two years ago.  Toddlerman is now widely expected to cancel the DACA orders put in place by Obama in 2012... despite strong support among even many Republicans (such as Dippy Paul of Janesville) for keeping them. Apparently just out of spite. He delayed the announcement just to keep hundreds of thousands on edge over a holiday weekend. Former (R) Sen. John Danforth of Kansas put it quite bluntly the other day in an op-ed:  "Our party has been corrupted by this hateful man." 

Meantime the Mueller investigation continues apace. They have brought in CI, the elite criminal investigations unit of the IRS to help untangle financial crimes (probably focusing on Manafort). They also, weirdly, apparently unsolicited, received briefs from Trump's defense lawyers as to why firing Comey wasn't obstruction of justice (presumably under the specific circumstances, because without them it's kind of an empty issue). Jill Wine Banks, a Watergate era prosecutor, commented that the Trump defense people appear to be "on their heels." We don't actually know what evidence there is of actual collusion with the Russians, but the circumstances and timing of the release of the hacked emails to Wikileaks is looking really suspicious, and the conduct of the president, including his comments to Lester Holt about the Comey firing and repeated conversations with various people where quid pro quos were broadly implied viz. the Russia investigation, looks more and more like a plausible bill of particulars for impeachment. If the Republicans in the House ever get to the point where they have any stomach for that. At least Mueller will likely give them a report that will be damning in the extreme and if they don't impeach, their failure to do the obviously right thing will be there for history's judgment. 

I still don't think it's the right strategy for Democrats to put a lot of stock in the Mueller investigation to "save us." We have, as a party, failed miserably, and we must rebuild our message and present candidates, especially for the House, who present an obviously superior alternative to the chaos and corruption of the Republicans. If we do not do this, and just rely, as Clinton did, on "they're awful, and we're not so bad," we will lose many of these elections and our democracy, which I really believe is currently in greater peril than at any time in the last 150 years, will remain in great and increasing peril. This isn't tiddlywinks: we should be fighting for our political lives as a Center Left political movement. Fortunately, there are many in our party who see it in just these terms, and things are happening. I am optimistic.