A Common Sense Approach To Lowering Medical Bills

Common sense approaches work well.

Unfortunately, common sense isn’t so common, anymore.

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Why Medical Bills Can Be Lower in Maryland

Dr. Elisabeth Rosenthal, MD

October 24, 2021

Guest Essay

Dr. Rosenthal is the Editor in Chief of Kaiser Health News. She was an Emergency Room physician before becoming a journalist.

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A $1,775 Doctor’s Visit Cost About $350 in Maryland. Here’s Why.

Illustration by Alvaro Dominguez

For the past 18 months, while I was undergoing intensive physical therapy and many neurological tests after a complicated head injury, my friends would point to a silver lining: “Now you’ll be able to write about your own bills.” After all, I’d spent the past decade as a journalist covering the often-bankrupting cost of U.S. medical care.

But my bills were, in fact, mostly totally reasonable.

That’s largely because I live in Washington, D.C., and received the majority of my care in next-door Maryland, the one state in the nation that controls what hospitals can charge for services and has a cap on spending growth.

Players in the health care world — from hospitals to pharmaceutical manufacturers to doctors’ groups — act as if the sky would fall if health care prices were regulated or spending capped. Instead, health care prices are determined by a dysfunctional market in which providers charge whatever they want and insurers or middlemen like pharmacy benefit managers negotiate them down to slightly less stratospheric levels.

But for decades, an independent state commission of health care experts in Maryland, appointed by the governor, has effectively told hospitals what each of them may charge, with a bit of leeway, requiring every insurer to reimburse a hospital at the same rate for a medical intervention in a system called “all-payer rate setting.” In 2014, Maryland also instituted a global cap and budget for each hospital in the state. Rather than being paid per test and procedure, hospitals would get a set amount of money for the entire year for patient care. The per capita hospital cost could rise only a small amount annually, forcing price increases to be circumspect.

If the care in the Baltimore-based Johns Hopkins Medicine system ensured my recovery, Maryland’s financial guardrails for hospitals effectively protected my wallet.

During my months of treatment, I got a second opinion at a similarly prestigious hospital in New York, giving me the opportunity to see how medical centers without such financial constraints bill for similar kinds of services.

Visits at Johns Hopkins with a top neurologist were billed at $350 to $400, which was reasonable, and arguably a bargain. In New York, the same type of appointment was $1,775. My first spinal tap, at Johns Hopkins, was done in an exam room by a neurology fellow and billed as an office visit. The second hospital had spinal taps done in a procedure suite under ultrasound guidance by neuroradiologists. It was billed as “surgery,” for a price of $6,244.38. The physician charge was $3,782.

I got terrific care at both hospitals, and the doctors who provided my care did not set these prices. All of the charges were reduced after insurance negotiations, and I generally owed very little. But since the price charged is often the starting point, hospitals that charge a lot get a lot, adding to America’s sky-high health care costs and our rising insurance premiums to cover them.

It wasn’t easy for Maryland to enact its unique health care system. The state imposed rate setting in the mid-1970s because hospital charges per patient were rising fast, and the system was in financial trouble. Hospitals supported the deal — which required a federal waiver to experiment with the new system — because even though the hospitals could no longer bill high rates for patients with commercial insurance, the state guaranteed they would get a reasonable, consistent rate for all their services, regardless of insurer.

The rate was more generous than Medicare’s usual payment, which (in theory at least) is calculated to allow hospitals to deliver high-quality care. The hospitals also got funds for teaching doctors in training and taking care of the uninsured — services that could previously go uncompensated.

In subsequent decades,

A Compendium of Events Leading Up to Trump’s Insurrection January 6, 2021

As a treasonously wicked, son of perdition and Manipulator in Chief, Trump’s planned corruption played out in public, in print and broadcast news reports (he’s a media whore), on Twitter (he’s a narcissist), on other social media, like FaceBook, and Parler, the favorite of White Supremacists, neo-Nazis, and other right-wing extremists.

His followers are rightly called the “Cult of Trump.”

Recall what he’d said to Chris Wallace of Fox News in an interview July 19, 2020 at the White House:

WALLACE: In general, not talking about November, are you a good loser?

TRUMP: I’m not a good loser. I don’t like to lose. I don’t lose too often. I don’t like to lose.

WALLACE: But are you gracious?

TRUMP: You don’t know until you see. It depends. I think mail-in voting is going to rig the election. I really do.

WALLACE: Are you suggesting that you might not accept the results of the election?

TRUMP: No. I have to see. Look, Hillary Clinton asked me the same thing.

WALLACE: No, I asked you the same thing at the debate.

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77 Days: Trump’s Campaign to Subvert the Election

Within a few hours after the United States voted, the President declared the election a fraud — a lie that unleashed a movement that would shatter democratic norms and upend the peaceful transfer of power.

By Jim Rutenberg, Jo Becker, Eric Lipton, Maggie Haberman, Jonathan Martin, Matthew Rosenberg and Michael S. Schmidt
January 31, 2021

By Thursday the 12th of November, President Donald J. Trump’s election lawyers were concluding that the reality he faced was the inverse of the narrative he was promoting in his comments and on Twitter. There was no substantial evidence of election fraud, and there were nowhere near enough “irregularities” to reverse the outcome in the courts.

Mr. Trump did not, could not, win the election, not by “a lot” or even a little. His presidency would soon be over.

Allegations of Democratic malfeasance had disintegrated in embarrassing fashion. A supposed suitcase of illegal ballots in Detroit proved to be a box of camera equipment. “Dead voters” were turning up alive in television and newspaper interviews.

The week was coming to a particularly demoralizing close: In Arizona, the Trump lawyers were preparing to withdraw their main lawsuit as the state tally showed Joseph R. Biden Jr. leading by more than 10,000 votes, against the 191 ballots they had identified for challenge.

As he met with colleagues to discuss strategy, the president’s deputy campaign manager, Justin Clark, was urgently summoned to the Oval Office. Mr. Trump’s personal lawyer, Rudolph W. Giuliani, was on speaker phone, pressing the president to file a federal suit in Georgia and sharing a conspiracy theory gaining traction in conservative media — that Dominion Systems voting machines had transformed thousands of Trump votes into Biden votes.

Mr. Clark warned that the suit Mr. Giuliani had in mind would be dismissed on procedural grounds. And a state audit was barreling toward a conclusion that the Dominion machines had operated without interference or foul play.

Mr. Giuliani called Mr. Clark a liar, according to people with direct knowledge of the exchange. Mr. Clark called Mr. Giuliani something much worse. And with that, the election-law experts were sidelined in favor of the former New York City mayor, the man who once again was telling the president what he wanted to hear.

Thursday the 12th was the day Mr. Trump’s flimsy, long-shot legal effort to reverse his loss turned into something else entirely — an extralegal campaign to subvert the election, rooted in a lie so convincing to some of his most devoted followers that it made the deadly Jan. 6 assault on the Capitol almost inevitable.

Weeks later, Mr. Trump is the former President Trump. In coming days, a presidential transition like no other will be dissected when he stands trial in the Senate on an impeachment charge of “incitement of insurrection.” Yet his lie of an election stolen by corrupt and evil forces lives on in a divided America.

A New York Times examination of the 77 democracy-bending days between election and inauguration shows how, with conspiratorial belief rife in a country ravaged by pandemic, a lie that Mr. Trump had been grooming for years finally overwhelmed the Republican Party and, as brake after brake fell away, was propelled forward by new and more radical lawyers, political organizers, financiers and the surround-sound right-wing media.

In the aftermath of that broken afternoon at the Capitol, a picture has emerged of entropic forces coming together on Trump’s behalf in an ad hoc, yet calamitous, crash of rage and denial.

But interviews with central players, and documents including previously unreported emails, videos and social media posts scattered across the web, tell a more encompassing story of a more coordinated campaign.

Across those 77 days, the forces of disorder were summoned and directed by the departing president, who wielded the power derived from his near-infallible status among the party faithful in one final norm-defying act of a reality-denying presidency.

Throughout, he was enabled by influential Republicans motivated by ambition, fear or a misplaced belief that he would not go too far.

In the Senate, he got early room to maneuver from the majority leader, Mitch McConnell. As he sought the president’s help in Georgia

When Will Hillary Go Away?

Hillary Clinton continues to show her ass, and her most recent inane comment via Twitter (“Either Tim Kaine and I had a very vivid shared hallucination four years ago or Maureen had too much pot brownie before writing her column again.“) about Maureen Dowd’s column just proves how classless that conniving, subterranean racist, political wanna-be is. She might as well have called her a “racially disparaging term beginning with the letter ’N’ and ending with the letter ‘R’.”

Why?

Well, it was under her husband’s administration that private prisons popped up like mushrooms after a spring shower, which were then just as quickly populated with Blacks and Hispanics courtesy of his “Three Strikes” law – a law he championed which mandated a life sentence for anyone convicted of a violent crime after two prior convictions for any crime, including drug crimes – many of whom had been arrested on low-level, nonviolent drug charges – most typically as marijuana possession.

Mass incarceration was a Clinton concept.

He later admitted it was a bad idea and said, “I signed a bill that made the problem worse and I want to admit it.”

Brother Bill also was the architect behind the idea to “end welfare as we have come to know it,” which was formerly a robust social safety net.

So yeah… my opinion of them both is lower’n a snake’s belly.

Of course, there’s been “bad blood” between Dowd and Hillary for quite some time.

The Daily Mail wrote that “In 2014 Dowd wrote a series of articles about

Sarah Huckabee Sanders: “I’ve Been Called” (By God) To Be Arkansas Governor

Recently, Sarah Huckabee Sanders, the once-and-former White House mouthpiece-Press Secretary for the Liar in Chief, Current White House Occupant Donald J. Trumpanzee, and daughter of Arkansas Preacher-Governor POTUS-wannabe Mike Huckabee, a Republican, had a sit-down interview with the Associated Press and New York Times in the quaint little state capitol town of Little Rock.

As described by New York Times writer Annie Karnie, (aka “the failing New York Times,” as POS45 says – of course, this is all “fake news, folks… fake news”) she and Sanders had breakfast tacos, and obliquely suggested at what she has plans to do in 2023 when current Republican Arkansas Governor Asa Hutchinson’s term is complete.

“I think there are two types of people that run for office: people that are

United Airlines Fly Flap Grounded In Written Policy

Like many, I recently read a couple articles about the dust-up involving United Airlines and their Dress Code for Employees who fly off-duty.

Most notably, the New York Times reported on the story, as of course, did others, and another unrelated passenger who took to Twitter to express their thoughts. The Times even interviewed the unrelated passenger, of whom they wrote, “The incident was first reported on Twitter by Shannon Watts, a passenger at the airport who was waiting to board a flight to Mexico. In a telephone interview from Mexico on Sunday afternoon, Ms. Watts said she noticed two visibly upset teenage girls leaving the gate next to hers. Both were wearing leggings.”

I confess that, in my haste, I made some remarks, in the form of questions, and later found a site which

Russian Meddling in U.S. Presidential Election: How Should Congress Proceed?

There is clear, unambiguous evidence that “Russian efforts to influence the 2016 US presidential election represent the most recent expression of Moscow’s longstanding desire to undermine the US-led liberal democratic order, but these activities demonstrated a significant escalation in directness, level of activity, and scope of effort compared to previous operations.”

“Assessing Russian Activities and Intentions in Recent US Elections” is a declassified version of a highly classified assessment that has been provided to the President and to recipients approved by the President.”

A header appears upon EVERY page and states: “This report is a declassified version of a highly classified assessment; its conclusions are identical to those in the highly classified assessment but this version does not include the full supporting information on key elements of the influence campaign.”

Several “Key Judgments” are made in the report issued by the Office of the Director of National Intelligence which is dated 6 January 2017.

Among them:
We assess Russian President Vladimir Putin ordered an influence campaign in 2016 aimed at the US presidential election. Russia’s goals were to undermine public faith in the US democratic process, denigrate Secretary Clinton, and harm her electability and potential presidency. We further assess Putin and the Russian Government developed a clear preference for President elect-Trump. We have high confidence in these judgments.

• We also assess Putin and the Russian Government aspired to help President-elect Trump’s election chances when possible by discrediting Secretary Clinton and publicly contrasting her unfavorably to him. All three agencies agree with this judgment. CIA and FBI have high confidence in this judgment; NSA has moderate confidence.

• Moscow’s approach evolved over the course of the campaign based on Russia’s understanding of the electoral prospects of the two main candidates. When it appeared to Moscow that Secretary Clinton was likely to win the election, the Russian influence campaign began to focus more on undermining her future presidency.

• Further information has come to light since Election Day that, when combined with Russian behavior since early November 2016, increases our confidence in our assessments of Russian motivations and goals.

Moscow’s influence campaign followed a Russian messaging strategy that blends covert intelligence operations — such as cyber activity — with overt efforts by Russian Government agencies, state-funded media, third-party intermediaries, and paid social media users or “trolls.” Russia, like its Soviet predecessor, has a history of conducting covert influence campaigns focused on US presidential elections that have used intelligence officers and agents and press placements to disparage candidates perceived as hostile to the Kremlin.

• Russia’s intelligence services conducted cyber operations against targets associated with the 2016 US presidential election, including targets associated with both major US political parties.

• We assess with high confidence that Russian military intelligence (General Staff Main Intelligence Directorate or GRU) used the Guccifer 2.0 persona and DCLeaks.com to release US victim data obtained in cyber operations publicly and in exclusives to media outlets and relayed material to WikiLeaks.

• Russian intelligence obtained and maintained access to elements of multiple US state or local electoral boards. DHS assess es that the types of systems Russian actors targeted or compromised were not involved in vote tallying.

• Russia’s state-run propaganda machine contributed to the influence campaign by serving as a platform for Kremlin messaging to Russian and international audiences.

We assess Moscow will apply lessons learned from its Putin-ordered campaign aimed at the US presidential election to future influence efforts worldwide, including against US allies and their election processes.

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Obama Administration Rushed to Preserve Intelligence of Russian Election Hacking

President Obama in December. Some in his administration feared that intelligence about Russian interference in the 2016 election could be covered up or destroyed. Credit Al Drago/The New York Times

By MATTHEW ROSENBERG, ADAM GOLDMAN and MICHAEL S. SCHMIDT

MARCH 1, 2017

WASHINGTON — In the Obama administration’s last days, some White House officials scrambled to spread information about Russian efforts to undermine the presidential election — and about possible contacts between associates of President-elect Donald J. Trump and Russians — across the government. Former American officials say they had two aims: to ensure that such meddling isn’t duplicated in future American or European elections, and to leave a clear trail of intelligence for government investigators.

American allies, including the British and the Dutch, had provided information describing meetings in European cities between Russian officials — and others close to Russia’s president, Vladimir V. Putin — and associates of President-elect Trump, according to three former American officials who requested anonymity in discussing classified intelligence. Separately, American intelligence agencies had intercepted communications of Russian officials, some of them within the Kremlin, discussing contacts with Trump associates.

Then and now, Mr. Trump has denied that his campaign had any contact with Russian officials, and at one point he openly suggested that American spy agencies had cooked up intelligence suggesting that the Russian government had tried to meddle in the presidential election. Mr. Trump has accused the Obama administration of hyping the Russia story line as a way to discredit his new administration.

At the Obama White House, Mr. Trump’s statements stoked fears among some that intelligence could be covered up or destroyed — or its sources exposed — once power changed hands. What followed was a push to preserve the intelligence that underscored the deep anxiety with which the White House and American intelligence agencies had come to view the threat from Moscow.

It also reflected the suspicion among many in the Obama White House that the Trump campaign might have colluded with Russia on election email hacks — a suspicion that American officials say has not been confirmed. Former senior Obama administration officials said that none of the efforts were directed by Mr. Obama.

President Vladimir V. Putin of Russia. Credit Alexei Nikolsky/Sputnik

Sean Spicer, the Trump White House spokesman, said,

Answering @chrkirk: Electoral College’s Voting Problems Violates Equal Protection Clause

How Much Is Your Vote Worth?
From: New York Times Op-Chart November 2, 2008
This map shows each state re-sized in proportion to the relative influence of the individual voters who live there. The numbers indicate the total delegates to the Electoral College from each state, and how many eligible voters a single delegate from each state represents.
Source: The United States Election Project at George Mason University.

Having read the article How Powerful Is Your Vote? by Chris Kirk several times, I still disagree with it. The article’s premise is that by using the Electoral College (EC) system, the votes cast in less populated states are somehow “more powerful” than those in more populated states. To posit such an assertion is to demonstrate a wholesale lack of understanding of the system. That is not to say the EC system is perfect, nor that changes to it are not needed; rather, it only acknowledges the author’s fundamentally deep misunderstanding of the manner in which the system is established, and a virtually wholesale ignorance of the Constitution.

Apparently, as evidenced by the graphic seen herein, others are similarly misguided. However, one would expect more from George Mason University. Much more, in fact. However, to understand – as I mention later – the bias is strictly and exclusively from including 2 Senators in the number of Electors. Dr. Mark Newman, PhD, who is the Anatol Rapoport Distinguished University Professor of Physics in the Department of Physics and Center for the Study of Complex Systems at the University of Michigan correctly writes that “The electors are apportioned among the states roughly according to population, as measured by the census, but with a small but deliberate bias in favor of less populous states.”

According to the Constitution in Article II, Section 1, Clause 2 & 3, Electoral Votes in each state are equal to