Available Care Act – Beyond “Coverage”

Much talk about insuring people for healthcare needs.  The giant bedpan in the room is availability.  What good is having Medicare, Medicaid, exchange plans, if you cannot find a doctor for hundreds of miles who will accept your provider’s coverage?  Just look.

The pundits talk about providing millions of people “access” to healthcare; however, they cannot explain why many of the “covered” still do what they did when they had no insurance, go the emergency room of the public hospital known to be the one that cannot turn them down.

Health insurers specify what they will cover and what the insured must pay, in terms of dollars and percentages.  What they do not spell out, is the amounts they are willing to pay the doctors and hospitals for various treatments.  The doctors and hospitals that are willing to accept the insurer’s terms are added to a “network.”  If the insured uses these doctors and hospitals, “in network,” the patient pays less; “out-of-network” providers, the insured pays much more.

Medicare, and the related private insurance plans are shunned by many healthcare providers because of the intense complexity of coding rules, poorer reimbursement rates, and 6-month slow-pay of claims.  I cannot blame them for wanting the easiest, most profitable patients, but look at what that does to retirees:  it shoves them into the offices of the newest, least experienced doctors, who do not have privileges at the best hospitals.

Another specious barrier doctors erect is “not accepting new patients.”  If that is true, why do they prominently promote their doctors, facilities, and services?  Why do they list the insurance plans they accept, on fancy websites?  What do they do when patients get well, move, change, outgrow their need, or die?  Who takes their places?  Are there waiting lists?  This policy seems wildly inconsistent, and dubious to me.

Today’s labyrinth of laws, maze of insurance coverages, intricacies of medical practice, incorporation of hospitals, vast array of medical devices, tests, and procedures, and incomprehensible myriads of drugs and medicines, are the starting point of future choices.  The concept of choosing your doctors, clinics, and hospitals still appeals to me.  If all health insurance policies must meet some minimum standards of coverage, why should health providers exclude any of them?

We have a historic opportunity to put features into the fabric of healthcare; the federal government has more incentives and flexibility to “get it right” as they formulate new laws.  Why not pass a new law called “The Available Care Act?”  If you accept anything except cash for medical services or goods, you accept the coverage of any patient who walks in your door.

 

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Children Threatened in Public School Classrooms – Federal Laws Deny Them Protection from Disruption

Civilized societies set behavioral norms, and prescribe consequences for violating those norms.  For example, it is not okay to harm another person without cause; it is not alright to harass someone, or “disturb the peace.”  Families can set broader boundaries inside their homes, but not in public.  However, sadly misguided federal laws and rules subject public school children and their teachers to violent, threatening, disturbing, unpredictable, disruptive behavior every day, in the name of “equal education.”  This violates common sense and the rights of the other children to a peaceful education.

In the so-called “real world” normal people do not put up with violent or disruptive people.  The disruptive person is usually fired from a job in a work environment, ejected or arrested in social or public environments.  Medical treatment is indicated, to the extent emotional disabilities or mental illness are involved; punishment and fines are indicated otherwise.  In other words, society separates or isolates disturbed citizens and insulates normal citizens from their disruptions.

I do not know any normal, emotionally healthy people who are made to endure the disturbances of disruptive adults.  Why do we subject our children and public school teachers to behavior normal society does not allow?  Most teachers are not trained psychologists, and none of the students are trained to accept and deal with such frightening, threatening behavior either.  Even if they were, there is no excuse for making public school so trying, and perhaps harmful.

 The current federal laws paint children with “disabilities” and public schools with a broad brush when they require inclusion and mainstreaming without stipulation.  Do they think normal classrooms are therapy for violent and disturbed students?  Do they think the distress and disruption help normal students learn?  Disturbed, violent, and disabled students need added, special resources and treatment that normal students do not.  Why subject the whole class to special efforts that scare them, delay normal learning and deny them the knowledge they are present to obtain?

Special needs children deserve to be taught the same knowledge as other kids.  Many special needs children are not disruptive.  However, their special needs may require different teaching approaches and intensive, trained, instruction to attain that knowledge.

The advocates of “mainstreaming” tout the marginal benefits to special needs students, but blithely avoid discussion of the serious detriment to “mainstream” students and the teachers that must cope with the stress and interference required to produce those benefits.  This attempt at social engineering is so obviously lame, it cannot stand a reality check.  Does anyone remember when even whispering in class, and passing notes were punishable infractions?  They were infractions because they distracted students and teachers from the purpose of the class.  Has this idea expired from political correctness?

If the needs of the few can be met without expense to the many, I say, so be it.  Find another way to fulfill the needs of violent, threatening, and disruptive students.

This Blog Is Fake News

Not really, but language is our primary way to communicate.  “This statement is false,” is a classic example of recursive writing.  Sometimes I enjoy annoying, contradictory statements; these conundrums are good exercise for our understanding of language, our value judgements and our unchallenged intellectual sides.  Fake news is fiction dressed up in the trappings of fact.  Those who are fooled operate on faulty assumptions.  Snopes may not be enough to save us.

How important is what we believe?  We make choices every day based on information from others. For long stretches of our history, Americans expected, and demanded professional journalism; we challenged the news with research of our own; we relied on professional information gatherers and presenters; we cherished objectivity.  Walter Cronkite is the example that comes to mind.  He and his news team did not editorialize; they presented the facts they could verify plainly; even when the news was painful, such as the Kennedy assassination, he held his emotions in check, almost.

As the era of journalism fades in our collective awareness, we stumble into an epoch of opinion; the 24-hour news age Ted Turner invented is voracious; anything to fill the hours.  The demand grew for titillating, shocking, insidious, intentional, or just stupid, public lying; I guess there was not enough honest scandal, hyperbole, deception, libel, and defamation.

Now we find completely fabricated articles, meant to harm specific people or raise undue alarm among us. Free speech, or libel?  First Amendment rights, or vicious cowardice?  It seems we are reaping what we have sown.   We have become victims of our society’s lax attitude towards rigor and honor.  We have grown lazy and unwilling to check the things presented to us.

Frankly, I am glad.  Not for the bad things that follow such propaganda, but for the possible reawakening of doubt, curiosity, and inquiry.  Of all the innovations of the 20th century, the internet connection of millions of individuals is the most important, because it reveals and magnifies our human nature and limits. Our naivete allowed us to be fooled by sources we trusted. At last, we know we must check the sources and validity of our vast ocean of daily information.

Humans are suspicious by nature; evolution has left this trait engraved in our genes.  But we can be lulled into gullibility, and we have been.  The opinions of writers and editors may vary all along the spectrum of belief; perspectives may open many windows of human experience; but some grounded facts must be present to sort and distort.  Fake news is just written lies and gossip without honest attribution.

Millions of Americans Install Russian “Spyware” on PC’s

Update 9/15/17: https://www.washingtonpost.com/news/checkpoint/wp/2017/09/14/why-the-u-s-government-is-moving-to-ban-this-russian-software-company/?utm_term=.829b6e95c13f

At last, DHS decided to plug a possibly benign hole in our info-armor, by requiring removal of Kaspersky software from government computers.

They only have authority in the executive branch of government, but “the cat is out of the bag,” and NOBODY in the other branches dares defend the cat.  I wonder what CNN, MSNBC, NPR, and the rest of the media will do?  The “Russia” thing has grown so prevalent, toxic, and taboo, that I bet vodka sales are down, at least vodka made by Russia and it’s satellites.  Fortunately, with the exception of borscht, cossacks, and the nested wooden dolls, I cannot think of any other “things” in American society that are possibly associated with Moscow, except maybe Hillary.

 

Update 7/2/17: http://www.miamiherald.com/news/politics-government/article159342929.html

In the 21st century, anyone in America, without awareness and knowledge of computers, is as vulnerable as a “babe in the woods.”  The information age has vaulted into predominance of American’s attention without the benefit of requisite education, warnings, and orientation.  And this extends to all the people who, together, run our government.

Unfortunately, computers have become easy to use too quickly, and recklessly; it is like giving a hammer to a baby.  Americans can send and receive emails, visit on Skype, download free “stuff,” shop til their fingers or credit cards give out, bare their most intimate and inane secrets and weaknesses, seek love, watch videos, etc.

Americans are as ignorant about “hacking,” as they are about “fracking.”  “Hacking” sounds like chopping away at something like wood, or meat.  The concepts of computer hacking are not too different, except computer hackers are trying to log in to computer networks by trying to identify an administrative  user account; otherwise they test countless combinations of usernames and passwords.  They are burglars trying to steal valuable information, such as Ms Clinton-related emails, or damage, or hijack your system for ransom.  They look for anyone who has access to everything interesting and “hack” their account.

Hackers count on users being careless and simple in choosing their log in credentials. Sometimes users use their home computers or laptops to connect to their work computers. That means a “hacker” can find out how to connect to other network computers through your computer using your credentials.

How do they get into your system?  Through the internet, mostly through email links or attachments, otherwise they use multiple login attempts.  Sometimes, seemingly innocent emails or downloads can install software that gives a hacker the keys to everything on your computer, including your identity information, accounts, and financial information.

So, we take steps to protect ourselves with anti-virus, and anti-malware programs.  These programs learn and have access to every intimate detail about your computer and its connections to the internet.  They are supposed to detect, deter, and destroy any harmful files that come your way.  But wait; what if this software is turned against you?

How asleep at the switch, clueless, and careless can we be?  Millions of Americans have blithely installed Russian software on our own computers, supposedly, to protect us from malicious intrusions, and we are surprised when we are violated?  Really?  This software holds the keys to access everything on any computer that uses it, and any computer that connects to it or its networks.

We could have, should have looked beyond the advertising, (even ads on public radio,) and no cost downloads to the company that offers it; but we have not.  Even if you uninstalled the software, did it really remove every trace of itself?  Or, could it have left some tiny, hidden, latent elements designed to give itself a “back door” to your computer?  How would you know?

Anti-virus and anti-malware software is supposed to guard our computers from harm; it has access to everything on our computers and everything from other computers that communicate with; email, surfing, contacts, documents, programs, firewalls, passwords, yes, everything.  It is supposed to identify and neutralize threats from people and programs that seek to ransom, destroy, and steal our most valuable, sensitive information.  How carefully have we researched the sources of the programs and data we have on our computers?

Did you know that Kaspersky Labs, renowned for its anti-virus/malware powers, is owned by Russians and headquartered in Moscow?  Check out this link.  https://en.wikipedia.org/wiki/Kaspersky_Lab

I wonder, how many Democrats, Republicans, Independents, Greens have Kaspersky software on their computers?  I wonder how many other programs we might have downloaded that could be secret agents for our enemies?

 

The Fight for Eyes

Political parties beware: the 2016 presidential election could stimulate American fact-checking and critical thinking – or not.  Why?  Could It be, we are awake and paying attention?  Could it be, we just want to be “right?”  Could it be, “We’re as mad as hell, and we’re not going to take this anymore.”?

In 2016, American information media reflect our mindsets.

  • We have boundless channels of 24/7 content battling for “eyes,” and “market share.”
  • We are so numb, it takes lurid, “mind bites” of “shocking facts” to get our attention.
  • Our jaded, fickle brains are addicted to “breaking news and “editorial reporting.”

Then comes the election.  How do we decide?  The battle lines are drawn.  The news media have abandoned objective balance in the fray.

It is natural for people with strong political bias to seek news sources that support their current views, and to ignore, avoid, or distain sources that reflect contrary, or impartial thinking.

Lord knows, we have enough choices (e.g. newspapers, magazines, radio, television, internet, social media).  Which do we choose: “bread and circuses,” or brains?  Do we swallow our favorite- flavored propaganda, or chew on the tough, tasteless truth?

Seven questions we can ask about what we call “news:”

  • Which sources provide complete, unbiased information and analysis?
  • Which sources provide incomplete, biased information and editorials?
  • Can we discern where information stops and persuasion starts?
  • Did we get all the information we need to understand?
  • Do we know enough to understand the context and importance of the information?
  • Do we have enough sources to verify or complete the information?
  • Do we care?

Few of the major news organizations remain credibly neutral or balanced.  Here are 10 news sources accepted as trustworthy by people across the political spectrum.

  1. The Wall Street Journal
  2. The Economist
  3. BBC
  4. Google News
  5. The Guardian
  6. Associated Press
  7. Reuters
  8. C-SPAN
  9. ABC
  10. USA Today

Here is an informative graphic from    showing the political positions of the various major news outlets.

news politics

Good thinking everyone.

Doctors & Hospitals Reject Pre-existing Fedicare

Health care providers are rejecting people with Obamacare policies, Medicare, and Medicaid because of reimbursement rates, and the financial inabilities of Obamacare patients to pay their share.

Context

Insurance spreads large financial risks over a pool of people who face that risk.  Only some of the people will actually experience the losses.  Members of the pool pay “premiums” to pay the losses, administer the process, and provide a profit to the owners of the insurance company.

Insurance companies use “underwriters” to:

  • Measure the potential financial risks of issuing policies
  • Set the conditions included and excluded
  • Set the premiums and duration of coverage

The idea is to:

  • Keep premiums low for normal risk people
  • Set higher premiums for people with higher risks
  • Limit coverage for conditions that already exist
  • Decline people who are high risk

Obamacare Reality

Obamacare health insurance plans cannot decline people with pre-existing conditions, by law.  The medical costs are not a risk for these people, they are an enormous, financial certainty.  These high costs must be covered by premiums paid by other insured policy holders, or absorbed by the insurance company.

Obamacare prohibits “marketplace” insurers from rejecting high-risk applicants, and people with preexisting conditions.  However, not all policies are created equal.  The variables are:

  • Premiums
  • Government premium subsidies
  • Patient co-payments
  • Patient and family deductibles
  • Reimbursement rates (the amounts insurers pay the doctors, laboratories, imaging clinics, and hospitals)

Service providers need to get paid an acceptable amount, in an acceptable amount of time.  Insurers offer reimbursement levels, but providers do not have to accept them.  Providers can set the minimum for their services, but the insurers do not have to include them in their “network.”

The medical community now does what insurance companies used to do – when in doubt, decline Obamacare, Medicare, and Medicaid patients.

The top quality insurance companies are withdrawing from the marketplaces to avoid the losses they experience from the pre-existing condition patients.  The insurers are limiting the types of plans to Health Maintenance Organizations (HMO’s) which only use selected providers.  They are eliminating Preferred Provider Organizations (PPO’s) which give the insured choices of providers within a selected “Network,” and “Out of Network” for higher copays.

People are dropping their health insurance because the combined costs of premiums, co-pays, deductibles; the lack of providers who accept their insurance contributes to this attrition.

What if Trump Wants to Lose? – Reality TV at its Finest

Interesting; both candidates for President are set for life, no matter who wins.  Aside from political ambitions, what other consequences can we think of?  Speaking engagements, books, endorsements; contributions to “selected” organizations, trust, foundations?

I think that is why Trump keeps upping the ante.  He is probably just as surprised as the pundits that he is the Republican candidate for president.  He is geared to parlay events that favor him into big wins.  But what if he does not want to win?  Could he be testing the limits of our national appetite for trash talk?

And, what about his campaign team?  In mid-August, Donald shrugs off the RNC “sheeps clothing” and resumes his “Wolf of Pennsylvania Avenue” regime.  An experienced manager tries to get him to smooth public dismay, and assume RNC campaign strategies; Trump demotes him and resumes fraying the tightrope to the White House.

Back to the show without protagonists; it must be amusing and frightening to watch our silliness.  All our military power, all our amazing creativity, dimmed by this imbroglio.

Timid, cowering politicians, showing everyone we have no cohesion, no clear direction, no acceptable answers to quell the “masses” who intuit the vacuum of power in our country.  Since 9/11 we have been “dazed and confused;” what should we do, whom should we trust; whom should we fear?

Flaying with “Shock and Awe;” useless, ignorant “boots on the ground” in places rich in resources, but impoverished in modernity.  We have shown our naiveté by superimposing our values and culture on 7th century tribal people.  Iraq was not even a country before Churchill drew a line around three feuding ethnic groups and assigned a titular government.  Afghanistan is the graveyard of many invading armies.

Donald Rumsfeld’s endorsement of Donald Trump is emblematic; the man who almost single-handedly emasculated Americas military, feebly blesses a novice in military affairs.  Sad, sad, sad.

I always thought of America in superlatives; strong, honest, forthright, steadfast, resourceful, courageous, and blessed come to mind.  Our moral infrastructure is in such disrepair, that we cannot stand for anything as a nation.  We have such weak bonds with each other, that we waste our energy and resources on things of little consequence in the world.  We blame each other for problems no one could create or solve.  We are frustrated with the impotence of government to do what it cannot.

  • Are we still recovering from the shock of a homeland attack?
  • Have our imaginations and fortitude been diverted to virtual reality?
  • Are we happy that we chose two weak candidates for President?
  • Are we that detached from reality?
  • Do we think this is just another show on TV?
  • Is our decline that obvious to the rest of the world?
  • Are Russia and China taking advantage of our frazzled reticence?
  • Where are the serious leaders we need?

We need citizens to accept individual responsibility and to participate in the things that matter – the true threats and vital problems; not bathrooms and weddings.

As in the TV series House of Cards, the voters are not in charge of anything. If we remain the audience for a reality TV Show, it should be called Decline.  You are never fired; in fact, you are stuck in a job you cannot afford to lose.  We could wake up like Gregor Samsa in Kafka’s Metamorphosis; no control over, and less understanding of what is happening to us.

Saul Alinsky was an important personal mentor to Hillary; his books are modern, grass roots, activist versions of Machiavelli’s The Prince, and Karl Marx’s Manifesto of the Communist Party.  Listen to the rhetoric of semi-incumbent,Hillary Clinton, and parse out the words that are not in Rules for Radicals.  She does not have any answers that were not available to another Alinsky apostle, Barack Obama; how can anyone believe she can do what he could not?  Not that Trump has any silver bullets either; but voting does not have to be rational; and so it is not.

Kizr Khan waved the Constitution on TV, but he must not have read the powers of the Congress, the President, and the Supreme Court. Had he read and understood Articles I, II, and III, he would know that all these sweeping promises candidates make are not within the powers vested in the Presidency.  If they could have, they would have.  Obama has stretched every possible executive power; what can any president do without Congress and the rest of the nation?  Read the Constitution and the Bill of Rights.

But I digress.  Just think; what if what Donald Trump never intended to become President. It has cost Donald Trump virtually nothing to become a famous world figure and a national icon.  He definitely, upset the powers-that-be in the RNC.  He awakened an army of citizens who have suffered too long from economic and government impoverishment.  Even if the presidency goes to the second most unpopular, and widely distrusted candidate, both she and Trump are set for life.