Archive for July, 2008

Balance Billing and Means Testing

Tuesday, July 22nd, 2008

Health Business Consultant David E. Williams looks at Medicare.

What’s to be done? I don’t have a comprehensive solution, but here are a couple of ideas that are too radical even to be considered right now, never mind put into place:

These “radical” ideas might put you to sleep because they are pretty tame compared to what I’d like to do. In fact, they seem anything but radical:

Means Testing:
Make sure the person getting Medicare isn’t sitting on money they should be using to pay for their own health care. (This would be a great job for me… a few more weeks at the Physicians Neck and Back Clinic, and I’ll be able to hold old people upside down by their ankles and shake coins out)

Balance Billing: This means that hospitals charge what they wish with the stipulation that they must charge all patients the same. They are allowed to bill for the balance. That is, they can charge Medicare patients more than what Medicare will reimburse and bill them for it. I didn’t realize this, but THIS IS A HUGE CONTROVERSY…. because what a terrible thing to present someone with a bill for a service provided.
In some states, “balance billing” is synonymous with fraud:

The Medicare Balance Billing Program works to protect Medicare beneficiaries from being billed by health care practitioners for amounts beyond those approved by Medicare. The program investigates complaints and takes action against those practitioners who violate the law.

What if Eleanor Roosevelt could fly?

Wednesday, July 16th, 2008

I checked No Ordinary Time by Doris Kearns Goodwin out of the library. I’m fascinated by Eleanor. Eleanor spent a lot of time “touching the people” so she could report back to FDR, who could not travel easily. She was a complex person who was forced to remake herself several times in her life. One of them was when FDR had an affair. This left her despondent for a time, but she was able to reconstruct herself into the hard working independent partner in the presidency because of it.

It really gets at the intimate details of FDR and Eleanor, and their relationships with the supporting cast at the White House. I’m reading the book like I’m watching a horror movie and shouting at the characters not to go into the basement alone, for God’s sake. “Fire Woodring!” I shouted helplessly at the page.

The onset of war changed everything for anyone near the White House long before we actually entered the war. Before the war, Eleanor felt like one of the team, helping to guide New Deal policy. When the war came along, it seemed to her like the boys all abandoned social reform and went to play with maps and destroyers. Her attempts to save boatloads of refugees were often sabotaged by one serious asshole named Breckenridge Long.

FDR surrounded himself with good advisers, seeming to choose those likely to disagree with him. What a contrast to Bush, who surrounded himself with fanatics.
In understanding why the Bush administration seems so incompetent, willfully ignorant and thuggish all at the same time, it helps to realize that this is a regime of fanatics and we have had little experience with fanatical presidencies until now.

Scanimation Childrens Book a Hit With Kids and Adults

Tuesday, July 15th, 2008

Gallop!

Created by Rufus Butler Seder, an inventor, artist, and filmmaker fascinated by antique optical toys, Scanimation is a state-of-the-art six-phase animation process that combines the “persistence of vision” principle with a striped acetate overlay to give the illusion of movement. It harkens back to the old magical days of the kinetoscope, and the effect is astonishing.

Here is an example. (You have to click on the stripped image to the right and drag it over the black and white design.) Of course, results vary wildly by browser and version.

H is for Hygiene

Sunday, July 13th, 2008

Earlier this week, I lost my bond with my toothbrush. I totally lost faith in the cleanliness and effectiveness of that toothbrush. Besides the usual bent bristles and discoloration, Mo was recently discovered with it and was not forthcoming when asked what she was doing with it. I could hardly face sticking that thing in my mouth twice a day. This led to a lot of procrastination: “Should I brush my teeth now, or give this raisin bagel I just ate some time to dissolve on its own?”

I gotta tell you, getting a new tooth brush really gives a guy the energy he needs to do basic hygiene. I can tell I’m going to bound out of bed tomorrow morning.

This brings me to another issue. Now that I have a new toothbrush, I cannot find a place I feel comfortable leaving it. I have a traveling plastic toothbrush holder. My bond with that was broken long ago. You say have a cup in your bathroom where your toothbrush stands, exposed to the bathroom air? Uh huh. Maybe you have a ceramic toothbrush holder coming out of your wall. Yeah, those stay clean.

WHERE DO YOU LEAVE YOUR TOOTHBRUSH?

Catholics Go Bananas

Saturday, July 12th, 2008

One of my readers, you know who you are, will be shitting in his pants when he sees this:

Fatwa over cracker

“Cook, who was raised Catholic, said he decided to bring the Eucharist home after a church leader tried to physically pry it from his hand. Cook broke Church rules by failing to consume it immediately during communion and then removing it from his mouth once seated.

Cook said he just wanted to show the Eucharist to a friend he brought with questions about Catholicism before consuming it. But outraged Catholics across the globe didn’t believe him and suspected he intended all along to steal the Eucharist and bloggers sent out e-mail messages damning him to Hell.”

When people lose sight of the meaning of their religion, they tend to fixate on the physical trappings of their religion and feel the need to defend them with threats and violence. It is much easier and more gratifiying to the ego to go berserk and issue death threats to some kid (and others, including my favorite science blogger) than to really try to follow Jesus.

Where is piss-christ when you need him?

fail

Friday, July 11th, 2008


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Watch Over Your Gmail Account Activity

Wednesday, July 9th, 2008

Hey! They implemented a security dashboard in gmail, just like I wished for in this previous post.
Watch Over Your Gmail Account Activity

GMAILrolled out a new feature which you’ll find at the bottom of the application (if you have it already): account activity information. You’ll see an info text like “Last account activity: 0 minutes ago on this computer” with a Details link. This information is supposed to help you find out when fishy things go on with your Gmails… like when your password has been discovered by someone else, who now browses through your private messages.

here it is on the official gmail blog.

Will Congress Cut Physicians’ Fees? Will Physicians Stop Taking Medicare Patients?

Tuesday, July 8th, 2008

Get the popcorn.

This week, conservatives and liberals will face off on a question that has divided the Senate—and united the House:

* Should Medicare slash the fees that it pays physicians, across the board, by more than 10 percent?
* Or should it try to save money by trimming the subsidy that it now shells out to private insurers who offer Medicare Advantage? (Medicare pays private insurers 13 to 17 percent more than it would lay out if the government program cared for seniors directly. In theory, patients receive extra benefits that equal the bonus, though skeptics say insurers are simply pocketing extra profits. )

The battle began, in earnest, on Tuesday, June 24, when the House voted 355-59 to block a 10.6 percent pay cut for physicians which was scheduled to kick in on July 1.

In a stunning bi-partisan vote, the House decided to raise the money Medicare needs another way—by ending the private fee-for-service version of Medicare Advantage by 2011. (For Medicare, this is the most expensive version of Medicare Advantage: it costs the program 17 percent more than traditional Medicare, and as I wrote in December, insurers are not providing the quality of care that the Medicare Payment Advisory Commission (MedPac) expected. According to the Washington Post, the legislation could result in $14 billion less for insurers over five years.

Seems like a pretty good solution. Trim the fat… but

President Bush has already said that he will veto any bill that touches the insurers’ subsidy. With that in mind, liberals and conservatives in the Senate Finance Committee didn’t even wait for a House vote: they worked out a bi-partisan compromise that would freeze 2009 physicians’ payments and make no changes to Medicare Advantage.

Someone elegantly framed the debate as being between insurance companies and an angry coalition of seniors and their doctors. This should be a cool little skirmish, but the bigger battle is between seniors and today’s children.
The story behind all this is that Medicare is going broke and people are looking for ways to fix it without pissing off masses of constituents. The insurer’s subsidy seems like the least protected meat and that will probably go first. The story behind THAT is that the default fix turns out to be covert rationing. Make the system so full of mysterious bottlenecks and shortages that seniors won’t even be able to put the problem into words, much less punish the engineers that invented it. Every so often, a vote like the one in the house will shine a bright light on one small part of the mystery and send everyone running for cover, as they are now.
Dr. Rich says, “It turns out that this incomprehensible physician reimbursement system was set on its current path by one simple desire: to force doctors to covertly ration healthcare.”
he goes on to say:

This is all to say that the real issue is not so much with the government or with the private insurers. Whatever travesties these entities perpetrate simply follows from the job we’ve all given them, which is, to ration our healthcare covertly. Covert rationing is rationing by whatever means you can get away with, and so utterly requires head fakes, misdirection, systematized inefficiencies, complexity, delusion (of self and others) and flat out lies. These things simply cannot be accomplished in a system characterized by transparency and smooth efficiency.

If he is right, then we are witnessing a grand experiment to see if a free society can fool itself into saving money on health care.

Certainly, we all should contact our representatives, but I’m not sure what to say when I do.

pause to appreciate your fellow humans

Monday, July 7th, 2008

fail owned pwned pictures
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Al-Queda’s Clown Ministry

Monday, July 7th, 2008

Every page of “The Looming Tower” reveals fascinating details about the history of modern Islamic extremism. The book renders the characters alternately as cartoons, murderous lunatics, and caring family men.

It punctures the myth of thousands of battle-hardened Arabs making a difference in the war against the soviets in Afghanistan. The Arab militants that made it to Afghanistan were largely in the way, often getting blown up and leaving Arab-shaped silhouettes on the walls of blasted canyons.

In May 1986, bin Laden led a small group of Arabs to join Afghan forces in Jaji, Sayyaf’s territory near the Pakistani border. One night the Arab tents were pelted with what seemed to be rocks, perhaps debris thrown from the occasional distant bombs. When a Yemeni cook got up to prepare the pre-dawn meal, there was a huge explosion. “God is great, God is great!” the cook cried out. “My leg! My leg!” The Arabs awakened to find mines strewn around their encampment, although they were difficult to see because they were green and disappeared in the grass. As they were evacuating the site, a guided missile struck a few yards from bin Laden. Then a huge explosion on the mountaintop spewed boulders and splintered timber upon the besieged Arabs. Three were wounded and one, an Egyptian graduate student, was killed. The Arabs were thrown into panic, and they were further humiliated when the Afghan forces asked them to leave because they were so useless.

Bin Laden comes off like a dithering clown in the first half of the book. Smarter men fought for control of his money and his image.

He went to Sudan and showed more poor decision making skills combined with credulity that left him completely broke by the time he left.

He walked a jittery path between clever manipulation of his public persona and believing in that persona too much. He was a earnest wanna-be who stumbled onto the world stage at just the right time and was lifted higher because of American mistakes, which are themselves cartoonish.

The most precise tool we had in dealing with these people turns out to be Tomahawk missiles. Picture a lonely night watchman at a pharmaceutical plant in Khartoum, checking his watch, looking forward for his shift to be over. In the cartoon version, there is a whistling sound and the watchman looks at the audience, eyes widening. He jumps up and begins pinwheeling his legs but stays in one place as the sand beneath him is displaced. Then, as viewed from about a mile up, the entire area disappears in a big mushroom cloud. The night watchman is shot through the cloud in charred robes.. In Afghanistan, continuing the cartoon, we blew the living shit out of some kitchen tents. Down the road, two Jihadis sit down for some late-night tea and after they clink their mugs and raise them to drink, an expensive Tomahawk embeds itself in the dirt right in front of them. The tea pours into their laps. Then they jump up, pinwheel their legs with their arms stretched out in front of them and hide behind some rocks looking at the missile. The scene cuts to the same Jihadis selling the missile, now strapped to the back of a llama, to the Chinese military(which is, in fact, what happened).

After this, Bin Laden and his people, reviled for blowing up the embassies and killing innocent people, are suddenly back in vogue because of the heavy-handed American response.

This book, more than any other, drove home the fact that we are fighting a fourth generation war, in which our Tomahawks are the enemy’s most effective weapons.

The most interesting theme in the book is the controversy within the movement about Takfir, which, loosely translated, means, “if you disagree with someone about the correct way to practice Islam, you get to kill him.” You are excluded from guilt about killing a fellow Muslim because through some magic of logic, the other guy ceases to be a Muslim.

Bin Laden would go around supporting the Takfiri elements of any Islamic movement he could find and often blanched when the Muslim bodies started to stack up. A horror show that the book touches on are the national “kill everybody” experiments in Algeria and Egypt. There, tourists, respected Muslim scholars, and innocent villagers alike topple like bowling pins in self-destructive civil wars that were barely reported in American newspapers.

I finished the book feeling that the story is of the burning out of these mad sparks. As Wright mentions in this book and establishes in later articles, many Islamic fundamentalists are turning against the Takfir notions of the Bin-Laden/Zawahiri camp. It is easy to see that while Al-Queda managed to strike some painful blows against the west, their main victims have been Muslims.

Pain Clinic

Thursday, July 3rd, 2008

I’ve been spending some time at the Physicians Neck and Back Clinic. Their philosophy about back pain is that Americans just need to have their asses kicked. Until today, I was kind of wondering when the ass kicking would begin. It came in the form of a sarcastic therapist who joshed, “On this machine, you should be lifting about your body weight and you’re almost there! …assuming you weigh 130 pounds”. Brilliant man. He honed in on exactly the kind of insinuations that would motivate me.

Some of the PNBC research is outlined here. Basically, the sedentary life that most of us lead makes our backs go to pot. We try to mitigate this with operations, pills, avoiding activity, and, god help us all, expensive cushions. Instead, we should be working the very muscles that are failing us. So they have a bunch of weight machines that isolate various neck and back muscles and they have a bunch of supportive therapists that stand next to you and tell you how good you are doing. And they also have the guy who I had today.

I’ve been feeling significantly stronger in what they call the “core” - hips, thighs, back and abs - from their workouts, but today is the first day I’ve felt pushed past my own protection of my lower back. The first day I’ve felt that floppy flat tire feeling of exhausted muscles.