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Another Terrible Health Care Problem Which is Easily Solved — But Won’t Be

By: Monday September 22, 2014 7:15 am

The hospital brought in a surprise out-of-network doctor while they patient was unconscious

The New York Times has a great article about how hospital secretly use out-of-network providers to screw over patients in which they describe a surprise $117,000 bill for an “assistant surgeon.” From the NYT:

In Mr. Drier’s case, the primary surgeon, Dr. Nathaniel L. Tindel, had said he would accept a negotiated fee determined through Mr. Drier’s insurance company, which ended up being about $6,200. (Mr. Drier had to pay $3,000 of that to meet his deductible.) But the assistant, Dr. Harrison T. Mu, was out of network and sent the $117,000 bill. Insurance experts say surgeons and assistants sometimes share proceeds from operations, but Dr. Tindel’s office says he and Dr. Mu do not. Dr. Mu’s office did not respond to requests for comment. [...]

A New York State law that will take effect in March — one of a few nationally — will offer some protection against many surprise charges and require more advanced disclosure from doctors and hospitals on whether their services are covered by insurance. It states, for example, that patients are not responsible for unforeseen out-of-network charges beyond what they would have paid in-network. It directs insurers and hospitals to negotiate any further payment or enter mediation.

This story illustrates two important points. The first is it shows how idiotic the concept of consumer-driven medicine really is. Here is a man who aggressively tried to shop around but the hospital, which has way more power and knowledge, was able to bring in a surprise out-of-network doctor while they guy was unconscious. Smart shopping around for health care would be hard enough given its complexity even if every provider was an angel. It is impossible when the system is actively trying to screw people.

It also sadly highlights how terribly the health care industry has corrupted our politicians because this problem is so easily solvable. Every other health care system which uses private insurers has some all-payer function to set reasonable prices for procedures. It should be criminal for anyone to try to charge $100,000 for an hour of work. If American politicians really wanted to fix this and many other problems they would have the solution after a 10 minute phone call with any of the health secretaries from a dozen other countries.

Instead all we get is whac-a-mole solution in New York that hospitals will find a way around.

Majority Who Tried the Exchanges Didn’t Find It Easy or Affordable

By: Friday September 19, 2014 8:36 am

The Affordable Care Act was sold as giving regular people an easy way to get affordable insurance. That is not exactly how it has worked out for people using the program, according to a new report for the Commonwealth Fund.

It found that that 62 percent of people who tried to get insurance through the new exchange ranked the experience as poor or fair. Only 38 percent ranked it as good or excellent. Ratings were slightly better on state-run exchanges than on federally-run ones.

More importantly, they found 54 percent said it was difficult to find a plan they could actually afford. It was easier for people with lower incomes, those who are entitled to large tax credits, to afford insurance but even among this groups many found it difficult.

One upside is that among people who actually ended up getting a plan via the exchanges 61 percent say they have found it at least somewhat easy to afford the premiums, while 37 percent have found it somewhat difficult. In addition 68 percent rate their plans as at least good, which is a decent number, but significantly less than the 86 percent of Americans who rate their employer coverage positively. Because of the better subsidies, people with lower incomes rank their exchange plans as more affordable and better than middle class Americans.

The bizarre decision by Democrats to make keeping the official CBO price tag under $1 trillion their top priority, which led them to reduce subsidies and allow higher deductibles, will stop the law from ever living up to its name. It also created a system that seems to have shortchanged many middle class Americans, which is a bad idea if you want to build lasting popular support for a program.

As We Go to War, Congress Goes Home

By: Friday September 19, 2014 7:42 am

Congress runs out on their responsibility

As President Obama gets the nation involved in a comprehensive and sustained counterterrorism strategy war in Syria, Congress is leaving the capital for the next two months to campaign for re-election to the job they refuse to do.

They left without actually voting on a declaration of war as is required by the Constitution. The closest they got was a quasi-proxy vote for funds to arm “moderate” rebels. Even this only got a standalone vote in the House.

In the Senate it was just part of the continuing resolution to keep the entire government funded. That means the only way to vote against arming the rebels was to technically vote against funding basically every government function. A fact that I suspect we will hear a lot if things go badly. I won’t be surprised if Senators end up defending their vote by saying, “I didn’t vote for funding the rebels, I voted to prevent a government shutdown.”

There are some who claim we can still have a debate about authorizing the war after the election, but taking a congressional vote on war after the war has started is like putting a condom on after you’ve had sex. It provides none of the protection it was designed to.

The power of the presidency expands further, a scary new precedent is set, and it becomes even easier for Americans to get accidentally dragged into yet another war.

We Are Arming All Sides

By: Thursday September 18, 2014 1:12 pm

UPDATE: Obama Delivers Statement on Continuing Resolution
Audio link

If we just pour enough weapons into the region peace will magically emerge.

Before sending more weapons to so-called “moderate” rebel groups in Syria, let’s just take a moment to consider the pernicious arms cycle we perpetuate.

Previously, we armed rebels in Libya. That helped overthrow the dictator there but also destabilized the country. As a result of the instability in Libya, a number of these weapons appeared in conflicts in other places like Mali and Syria.

I persume at least some of these weapons from Libya ended up in the hands of ISIS. ISIS then used these weapons to help beat the Iraqi army, which had been armed by the United States. When the Iraqi army fled, ISIS grabbed a large number of these American weapons.

So now to beat ISIS armed with American weapons we are arming a loose configuration of “moderate” rebels with even more American weapons. We are hoping these “moderate” rebels defeat ISIS because if they don’t then ISIS might end up grabbing even more American weapons from these dead “moderates.”

Of course, even if the “moderate” rebels beat ISIS there is no guarantee some group(s) within these rebels, now heavily armed with American weapons, won’t use this newly gained firepower to takeover using tactics we find equally horrific. If that happens, I assume we will then send even more weapons to their opponents as well keeping the cycle going, hoping that eventually some group we can tolerate ends up briefly on top .

Apparently, if we just pour enough weapons into the region peace will magically emerge.

Whistleblower Mark Klein: Oppose the USA Freedom Act

By: Wednesday September 17, 2014 1:11 pm

Note: Whistleblower Mark Klein has signed our letter opposing the current version of the USA FREEDOM Act. Please add your name to our letter to congress.

AT&T Whistleblower Mark Klein

AT&T Whistleblower Mark Klein

I support the letter calling on Congress to reject Senator Leahy’s so-called USA Freedom Act. The bill is a fraud, a pretense at “reform” which leaves in place all the main elements of the NSA’s surveillance program. (Needless to say, Senator Feinstein’s alternative bill is even worse.) The bill tinkers around the edges of the phone call records collection while leaving untouched the meat of the “program,” the vast, unconstitutional dragnet collection of internet data which I helped expose. To top it off, the bill now includes the renewal of the Patriot Act, thereby institutionalizing the entire monstrous apparatus.

It’s no wonder that James Clapper, the current Director of National Intelligence who lied to Congress about what the NSA was doing, has now endorsed the Leahy bill–evidently he feels no threat from it, and that should be a warning to all who defend civil liberties.

The “president’s program,” as it was called under Bush, has now been in place, with some changes, for over 12 years. It has been eight years since I went public with my evidence in 2006, and in that time Congress has twice (in 2007 and 2008) passed so-called “FISA reform” bills which actually strengthened and legalized the NSA’s surveillance apparatus. Parallel to that, the judiciary has carefully avoided fundamentally challenging the executive’s program (with some notable but impotent exceptions). What’s more, many of the key political players who passed those bills are still in power (e.g., president Barack Obama, Senator Dianne Feinstein, Democratic leader Nancy Pelosi, Republican leader John Boehner, etc.) not to mention the top bureaucrats of the NSA who have escaped any punishment.

The only reason Congress now goes through the motions of another “reform” is because of the damning revelations made by Edward Snowden in 2013 which shocked millions of people. Yet the political leaders have denounced Snowden as a “traitor” and want to prosecute him under the Espionage Act (as they’ve done to other brave whistleblowers like Thomas Drake), instead of welcoming him home as a hero.

So one must conclude that the present political institutions led by the two parties are inextricably entwined systemically with the interests of the “national security state” which threatens our civil liberties. It is futile, in my view, to attempt to rein in the NSA by clever legal wording in a reform bill written by these parties. In any case, they have made it clear that when it suits their desires they will ignore the law, as they have many times in recent years.

Fundamental change in the interests of the vast majority of working people, in this issue as in all the others, now requires casting aside these two parties who represent no one but a tiny, rich elite.

Mark Klein is a former AT&T technician who blew the whistle on the company’s cooperation with the NSA to spy on Americans in 2006.

More on Private Insurance Whac-A-Mole

By: Wednesday September 17, 2014 11:47 am

The Affordable Care Act banned some of the private insurance industry’s worst practices, like denying coverage based on preexisting conditions, but that doesn’t mean they were just going to stop trying to find ways to get out of paying for customers’ health care. It simply started a game of consumer protection whac-a-mole where the industry comes up with innovative ways to screw sick people.

Over at The Upshot Charles Ornstein looks at how insurance companies are designing their drug plans to discourage people with serious illness from signing up or make them pay more. From NYT:

Insurers have long tried to steer their members away from more expensive brand name drugs, labeling them as “non-preferred” and charging higher co-payments. But according to an editorial published Wednesday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs.

The Affordable Care Act bans insurance companies from discriminating against patients with health problems, but that hasn’t stopped them from seeking new and creative ways to shift costs to consumers. In the process, the plans effectively may be rendering a variety of ailments “non-preferred,” according to the editorial.

Theoretically, it might be possible to have a decent health care system using only private insurance companies with broad latitude if you have a system of extremely good regulators and highly responsive lawmakers who would diligently work to whack each new mole as soon as it emerged. A system of regulators so strong, incorruptible, and flawless that insurance companies wouldn’t even try to game the system, having concluded it was impossible. Of course that is not what America has, especially with Congress stuck in a state of gridlock and many Republican state officials who don’t like the law.

Instead, we have system that forces people to buy insurance from these very unpopular private companies, and is not going to be quick or easy to address their game playing.

Call Congress: Oppose the Syria War Amendment

By: Wednesday September 17, 2014 11:10 am

The House of Representatives is expected to vote today on an amendment to give President Obama power to arm Syrian rebels as part of his military plan to fight ISIS.

The president has already ordered airstrikes using his supposed authority under the 9/11 and Iraq War resolutions. That means this vote may be anti-war activists’ only chance to voice their opposition to the U.S. latest misadventure in the Middle East.

Call your representatives today and tell them to vote no on the Syria amendment today.

America appears to be once again heading towards a bloody, open-ended conflict in a new country.

Most reports show this amendment will pass and the Senate already has an agreement in place to approve it as well — so lawmakers can return home for the final stretch of the midterm elections.

Activists should take this opportunity to remind those lawmakers that we’ll be considering this vote in the midterms.

Visit our action page: Find your members’ phone numbers, a sample script and call your reps before today’s vote.

NSA Reform – Real or Imaginary?

By: Tuesday September 16, 2014 1:16 pm

Note: Whistleblowers Edward Loomis and J. Kirk Wiebe have signed our letter opposing the current version of the USA FREEDOM Act. Please add your name to our letter to congress.

NSA Headquarters

The ACLU noted in November that approximately 30 bills had been proposed in Congress to reform National Security Agency (NSA) surveillance and Foreign Intelligence Surveillance Court (FISC) processes that authorize such programs. Few provide for the complete restoration of freedoms guaranteed under the U.S. Constitution. The amended Leahy/Sensenbrenner USA Freedom Act actually perpetuates the retroactive “legalization” of unconstitutional activities Congress has permitted since 2006. Speaker Boehner’s favored House Intelligence bill sponsored by Reps. Rogers and Ruppersburger and labeled the Stop Bulk Collection Act also perpetuates the nebulously low standard of “reasonable articulable suspicion” for analyzing metadata of private U.S. citizens. Both bills were drafted by the Intelligence Committees charged with overseeing the operations of the NSA and upholding the U.S. Constitution. For 12 years we were unaware our own government had secretly amassed individual dossiers of metadata on virtually all its citizens, so much so that costly data centers were constructed to store the data for secretive purposes. How are we to trust reform legislation authored by those who failed both their oversight and Constitution protection responsibilities?

With public outcry opposing the present surveillance practice that presumes all U.S. citizens are potential terrorists or accomplices, Congress has an obligation to pass meaningful legislation to reverse the government’s betrayal of our Fourth Amendment privacy protections. With so many competing bills, the sponsors of each bill owe it to the public to consolidate and deconflict the bills and restore the Constitution to its proper place as the quintessential law of the land. The consensus reform bill should allow ample debate time and freely permit amendments during debate, and roll call votes, so citizens know how their elected officials voted.

H.R. 2818, sponsored by Rep. Rush Holt, D-NJ, would be an excellent basis for reform. Its short title – Surveillance State Repeal Act – is no misnomer. H.R. 2818 was introduced the very day the Amash/Conyers amendment to the 2014 House Defense Appropriations bill was narrowly voted down. That amendment would have halted funding of NSA collection of all U.S. citizen phone records but was defeated following just 15 minutes of floor debate. H.R. 2818 extended the reform intended by the Amash/Conyers Defense bill amendment, and as we’ve all learned, complete reform is indeed necessary. It repeals the Patriot Act and almost all provisions of the Foreign Intelligence Surveillance Amendments Act of 2008. There remain only two sections providing for Attorney General semi-annual reports to Congress and certain key definitions.

Importantly, H.R. 2818 also provides for the inclusion of technology Special Masters in an advisory capacity to Foreign Intelligence Surveillance Court (FISC) proceedings; it also:

  • clarifies Foreign Intelligence Surveillance Act (FISA) warrants’ electronic surveillance compliance directions;
  • strengthens the constitutionality of FISA by specifically imposing the “probable cause” standard for any and all FISC-approved warrants;
  • prohibits the Federal Government from imposing requirements on electronic devices and/or software “backdoors” intended to defeat encryption or privacy protection;
  • imposes an annual FISA-compliance reporting requirement by the Comptroller General;
  • provides an official path for whistleblowers by authorizing Intelligence Community employees or contractors to report violations of law, rule, or regulation; gross mismanagement or waste of funds; abuse of authority; or substantial danger to public health or safety related to programs and activities authorized by FISA; and
  • imposes administrative sanctions against Intelligence Community officers or employees who take retaliatory action against employees or contractors who report such wrongs.

Unsurprisingly, Rep. Holt’s bill has not seen the light of day and has been referred to eight committees and five subcommittees where it has languished since July. House officials, led by Speaker Boehner, steadfastly support NSA despite the Agency’s assault on the Constitution, and the lesser reform imposed by the Leahy/Sensenbrenner or Rogers/Ruppersberger bill would be far preferable to House leadership than the comprehensive Holt bill. While the amended USA Freedom Act halts bulk collection of US records beyond two degrees from known or suspected targets, it does nothing to provide continuous, independent technical probes inside NSA to determine whether there are other illegal programs and ensure that any arising in the future are uncovered and reported.

Before new legislation is set in stone, those who claim to be the stewards of the United States and the human rights it represents on the world stage should contemplate an important fact. For fully 60% of its existence, the NSA has operated outside the Constitution. What is needed now is congressional fortitude – the dedication to uphold the Constitution and our rights in the digital age – something all too rare in Washington DC these days. The position our representatives assume on the USA Freedom Act must serve as a wedge issue in congressional elections in November. If no true reform legislation is passed, it’s time for new leadership in Congress and new representatives to fill the ranks of those who oppose serious reform.

Edward Loomis worked as a NSA Cryptologic Computer Scientist for 37 years and Systems Architect contractor there for five additional years. He led the SIGINT Automation Research Center’s development of THINTHREAD, a constitutional processing and analysis tool for Internet data scuttled by NSA 2 months prior to 9-11.

J. Kirk Wiebe worked at NSA for 32 years as a Senior Intelligence Analyst and five years as a private contractor for the Intelligence Community. He is a recipient of NSA’s second highest award, the Meritorious Civilian Service Award and the Meritorious Unit Citation awarded by the Director, CIA.

Because Libya Worked Out So Well….

By: Tuesday September 16, 2014 7:42 am
Tomahawk missile launched Libya

Tomahawk missile launched over Libya

The more we learn about President Obama’s strategy for Syria the more it sounds almost exactly like his previous war plan in Libya. The basic idea is to use a combination of heavy airstrikes, limited assets on the ground, training/arming/aiding “moderate” rebels with the help of other countries in the Middle East, and working against the current dictator.

It is then worth looking to see how well that has turned out in Libya long term. Yesterday the top U.N. official in Libya said “a faltering political process that has brought the country closer to the brink of protracted conflict and civil strife.” He also reported that recent shelling in Tripoli has resulted in many civilians losing their lives and tens of thousands fleeing their homes. The country is in the midst of a civil war and Tunsia has practically been overwhelmed with refugees in the past few years.

In additional the U.N. previously concluded that the war in Libya helped fuel the violence in Mali and Syria when weapons used in the war flooded in to neighboring areas.

Libya is in very bad shape as groups fight over power, tribal allegiances and ideology.

Apparently, though, we are expected to believe this same strategy will work much better in Syria — which in addition to have many armed groups with tribal and ideological differences also has centuries-old sectarian divides.

Small Majority Backs Obama’s Plan Against ISIS for Now

By: Monday September 15, 2014 11:11 am

Majorities in Both Parties Back Obama’s Plan for Military ActionFor the moment President Obama enjoys majority support for his plan to go after ISIS. According to a new Pew Research poll, 53 percent approve of his plan for a military campaign against Islamic militants in Iraq and Syria while 29 percent disapprove and another 19 percent are undecided.

The problem for Obama is that this support seems built on sand. The group that currently most strongly supports Obama’s plan against ISIS is regular Republicans and that is unlikely to last. Already Republican members of Congress are attacking Obama’s strategy from multiple angles. Some because it is not aggressive enough, or others based on issues with its possible execution. Most Republicans aren’t attacking him for taking action but they are already starting to picking out how he is doing it wrong.

When something goes wrong, which is almost guaranteed to happen eventually, there is a good chance Republicans will turn against Obama on this. We need to only look at Libya and the Republicans obsession with Benghazi for an example of how things could turn.

If, after weeks of the media focusing on how terrible ISIS is and a prime time sales pitch by Obama, support for this new war starts at just barely over fifty percent that should be a real warning, since that is likely to be the peak.

It is unlikely support is going to increase as we hear more stories about how difficult it will be to actually fix this civil war and our efforts begin to drag on for months.

Perhaps the most telling sign that support for this effort could start dropping quickly is how most politicians of both parties in Congress are trying to avoid being on record voting to authorize it before the election.