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kleinbl00  ·  6 days ago  ·  link  ·    ·  parent  ·  post: I watched my patients die of poverty for 40 years. It’s time for single-payer.

I firmly believe that "single payer" would get a lot more support if people stopped talking about it in grandiose themes and noble vignettes and started talking about it in real terms. All the liberals I know are in heavy favor of "single payer" without any of them knowing what the fuck it is.

HERE'S WHAT THE FUCK IT IS.

I've got a medical facility - Al's Medicine. Al's subcontracts to Betty the Biller and Cindy the Client Specialist. I operate in a state where my medical facility is covered by Medicaid. We also take private (employer-provided) insurance, which is underwritten by the following insurance firms: Q, R, S, T, U, V, W, X, Y and Z.

Al's must sign individual contracts with Q, R, S, T, U, V and W. These contracts are "take it or leave it" binding: they say that for ICD code 1, Q will pay Al's $7.50 but for ICD code 1.000000001, Q will pay Al's $0.00 because fuck you, Al's. Note that Q might pay Joe's $6.50 or $9.50 or pi.ie^2 for ICD code 1. Q is entirely within its rights to do so. Al and Joe, on the other hand, are contractually forbidden from discussing their rates for ICD Code 1. If Q gets wind that Al and Joe know what the other are getting, they can drop both because fuck you, Al and Joe. Also know that Joe might not get anything for ICD Code 1 because Q has decided that all of Q's contracted healthcare clients can drive 75 miles to Al's for those services because fuck you, Joe. Also know that Q can tell Al's they'll pay $7.50 for "services" verbally and in writing, but when the actual contract comes through the actual number listed is $2.25 because fuck you, Al's. Also know that they won't tell you what ICD codes they'll pay for, they'll just say "services" and let you resubmit your bills over and over and over again until you find the ICD code that pays out the most because fuck you. Also know that the ICD code they choose to pay for can and will also change because fuck you.

A few other notes: Al's might have to provide, for example, rhogam shots to prevent babies from dying from blood type incompatibiliy. These rhogam shots might cost Al's $28 but Q is going to pay $7 because fuck you, Al's. If you ever wondered why hospitals charge you $40 to hold your baby it's because they're trying to claw back the $21 the insurance company isn't paying for medicine they're required by law to administer (for example). Also note that your involvement, gentle consumer, starts when you get an "explanation of benefits" from the insurance company listing all the outrageous charges the doctor hit you with. It will provide no explanation. It will show how generous they were in all their disbursements and then show you that your doctor's office is going to bill you STILL MORE MONEY because they're such bloodsuckers.

This is where Betty Biller and Cindy Client Specialist come in. Betty makes 10% by pickaxing all the money she can get out of Q. Betty's whole job is knowing what Q pays out on. Betty knows which ICD codes Q pays out what on, and can turn your "normal child checkup" into 42 different codes that pay the maximum rate Q has contracted to pay. She is literally a medical billing bounty hunter. Betty is the back office side while Cindy talks to you, the client - here's what's coming, here's what it means, here's how to get your insurance to pay for this ahead of time, here's how to get preapproval for that.

For those keeping track at home, billing specialists outnumber doctors 2:1 in this scenario.

Multiply times insurance companies R, S, T, U, V and W, who all have their own rates, all have their own codes, all have their own geographic exclusion areas, and probably have seven or eight sub-plans so that it's not actually "V" it's V.a, V.b, V.c, V.d, V.e, V.f and so on. Suddenly, Betty and Cindy look positively useful and you will pay them gladly because the act of billing for care takes three to four times as many man-hours as actually providing that care. Betty and Cindy make good livings and their existence is entirely parasitic on the insurance companie's deliberately opaque, byzantine and antagonistic reimbursement practices.

Not Y and Z, though. Y and Z contract through Medicaid. Medicaid has no patience for that bullshit. They will pay the following amounts on the following ICD codes. Anybody who contracts through Medicaid bills those codes and gets that money. It is known. Y knows, Z knows, Al knows, Joe knows, and all of Al and Joe's clients can fuckin' look it up. And when Medicaid's reimbursements lag behind the real world, it gets turned into a bill that goes to the legislature that raises the rates for everyone.

Al's, in fact, might get better reimbursements out of Y and Z (because of medicaid) than they get out of Q, R S, T, U or V.

Unfortunately you as a patient don't get your insurance through Y and Z because you make more than the poverty level for your county. You get whatever insurance your job provides, which might be V.c, might be Q, might be nothing because you drive for Uber and fuck you.

As a provider, we get to choose who we contract with. We do not get to choose what those providers pay us. And if 50% of your clients work for Microsoft, you bloody well better be able to take V.c, despite the fact that they reimburse at exactly half what Medicaid reimburses at (which is funny, because all your Microsoft mommies make six figures). R, on the other hand, may decide that they'll never cover you because they have enough of your specialty in network, never mind that the nearest provider is a ferry ride away (because this way they don't have to pay for those services).

As an insurer, you get to decide who you contract with. You can pick the providers that are the stupidest, that will accept the lowest rates, that have the lowest conflict rate of you arguing over charges. And you get to discuss this with the HR reps of companies large and small, none of which have any background in medicine, medical billing, accounting or statistics. To no one's surprise, they choose on price.

But the poor people? They pay what the state says they pay, the insurance companies collect what the state says they collect, and they contract with the providers the state says they contract with.

THEY STILL MAKE MONEY.

They're still private insurance companies, privately managing your health care, privately paying out private doctors. It is not "socialized medicine." It is not "universal healthcare." It is not the National Health Service. The healthcare industry is something like a tenth of the US economy; you're never getting that. But you go single payer and all of a sudden things go from back-room knife fights between Q, R, Betty and Cindy to state-mandated pricing and state-mandated coverage.

My future is tied to health care. I've got more in a medical practice than you have in your house.

And I'm a big booster of single payer.

And so's Aetna, who in this example is R.

qrguy  ·  12 days ago  ·  link  ·    ·  parent  ·  post: Pubski: May 24, 2017

Your original transaction sent 0.00859833 BTC to your new address, paid 0.00025 BTC in miner fees, and sent the remaining 0.0002924 BTC in "change" back to the original paper wallet.

Of that remaining 0.0002924 BTC, I sent 0.0002424 BTC to myself, and paid the last 0.00005 in miner fees. The paper wallet now has nothing left. I probably could have used a lower fee, if I had been willing to wait longer. The transaction backlog isn't as bad as when you tried it.

I also stole your 0.0002924 in Bitcoin Cash from the same address.

I recovered the private key by filling in the blanks in your picture. The private key was on your receipt twice -- once as a barcode and once as text. You covered up part of each, but not the same parts -- QR codes actually start laying out the data from the bottom right. So I could reconstruct that corner using the beginning of the text.

This was how far I got before my phone could scan it (with a bit of difficulty):

Even if I hadn't been able to fill that much in, the combination of you showing most of the QR code, plus its built in redundancy, means that it would likely have been feasible to brute force the remaining bits of the key.

elizabeth  ·  28 days ago  ·  link  ·    ·  parent  ·  post: Pubski: August 23, 2017

Had a great time yesterday watching the eclipse! And apparently the blog post featuring my photos and videos is beating all kinds of view records: http://blog.polycor.com/the-day-white-marble-turned-black-photos

It's been a really fun summer so far, and it's only gonna get better with burning man next week. I don't think I've ever been more exited.

Even had an unexpected bonding moment with this lady that works at the Georgia office yesterday that not only knew what burning man was (that I so far had to explain as going camping at an art festival in the desert to everyone else at the company) but has been at many festivals before and had some great tips to share.

Will be in LA the week after that (sept 4th to 12th at least). WHO'S IN TOWN? kleinbl00?

http://www.stuartmcmillen.com/comic/rat-park/

Every time I see a solution like this, I just think about how little we learned from rat park.

tacocat  ·  35 days ago  ·  link  ·    ·  parent  ·  post: Pubski: August 16, 2017x 2

I may just ramble here for a second to see how people reply because I don't want to specifically talk about my life right now and I've learned to accept the blunt tool aspect that language has and I don't know if that is a fact many people understand explicitly.

There is just no way to apply logic to my behavior or reactions and I'm not sure that doesn't apply to everyone. I'm pretty certain of it in fact. Sometimes I fold entirely under pressure that may not seem very intense from the outside and sometimes I can soldier through objective tragedy. I don't exactly remember what's on this list and I looked at it again because it's meant to be amusing in part:

http://www.cockeyed.com/magic/bad_4.php

But there's more than a few things on there that have happened to me, even in the last year. It's hard to explain how that feels because it's just complicated.

I feel like I deserve a gold fucking star sometimes for just waking up or not crying at a given moment when that's a hard thing to resist. Everyone deals with things they aren't appreciated for that are internally important. Difficulties that are not important enough to mention but would be so greatly appreciated if anyone noticed at all the level of a quiet struggle.

And that seems to be my life. A very slow process of coming to be grateful for anything I have or am afforded and the smallest recognitions of any signal from someone about how hard it can be for me just to not accept failure or any number of undesirable things that would be easy to give in to. This is something that is in large part my fault. But there are a lot of difficult to recognize or understand factors in my life that I deal with every day that I cannot overestate the amount of effort it's been to function at a level where if I fold it's a goddamn surprise to everyone looking at me. And that has forced me to educate myself and accept faults of my own that people who have them can exist easily without recognizing and just generally be open to the fact that I don't often know what the fuck is even happening. But that has given me an empathy that I do want a gold fucking star for one day towards people who no one even wants to look at and people who are easily dismissed for reasons that I've learned to see as incredibly judgemental because I have a taste of how bad life can be in ways that people in the first world have no appreciation for since they've never, for example, had to weigh the benefit of carrying everything you own against its weight and the stress that will create to hold on to objects that are not very basically essential. I have done that.

And I have not given up and when I've tried to I've failed. Just general advice I've learned through experience, personal or by observation, smiling itself can be nearly impossible sometimes so. Or comforting in its ease at a moment. I feel like people in America sprint through life and are surprise how short it is when they accelerated its speed by worrying about duvet covers or taking cold water for granted. Everyone reading this should understand the levels of grace they've been afforded just by having electricity and internet access. Billions of people right now are comfortable being unsure how they will next eat.

I want a gold star sometimes because the very low level of optimism I seem to put off is a lot more than people who I think have none and whatever level of give a fuck I have left is important and probably hard fought.