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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.

by: kleinbl00

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Disconnected Connected Thoughts

I got a hysterical call from my girlfriend in '99. I was mixing at the club and she was getting ready to go out with a girlfriend when someone tried to break into the house. They yelled and screamed and he went to the house next door where he pulled a knife off the kitchen counter and held a little Vietnamese woman hostage by holding it across her throat while SWAT tried to talk him out for five hours. No guns involved, nobody died. Did she want a gun? Yes. Was she the exact wrong person to own one? Yes. Did I own one at the time? Yes. Did I tell her? No.

I bought a Chinese SKS at 18 out of the Little Nickel. The dealer lived in a trailer in the desert and had Rottweilers named after Hitler's inner circle. Back then $79 would buy you an SKS, $59 would buy you 1440 rounds of Chinese steel-core and $9 would buy you a 30-round banana clip. It was a shitty gun and shitty ammo and I mostly used it for plinking (stealing shit from Ed Grothus and annihilating it at the pumice mines). My dad knew about it, my mom didn't.

I bought it because I was depressed, angry and powerless. Owning a Chinese assault rifle made me depressed, angry and powerful.

I took it to college. No assault rifles in the dorms; I had to keep it at the campus police. Which was inconvenient most of the time because chinese steelcore is corrosive and if you don't clean the gun within several hours of shooting, it'll pit the barrel and your pattern ends up worse than a Mossberg 12ga, rather than on par with. Meant that there were times I was literally cleaning an assault rifle in my dorm room. My roommate's best friend was an RA; he came by one time looking for my roommate while I was cleaning. I couldn't hide it. He said "you know what would happen if I reported that, right? Since I'm not, can I hold it?"

So you get sloppy and you end up with an assault rifle under your bed. Which isn't really a problem until the rival dorm sets a time bomb under your dorm such that at 2am during Finals Week you end up with about a hundred dollars worth of firecrackers and whistles going off and a bunch of chuckleheads across the canyon laughing at you.

And your first instinct is to grab the assault rifle. Why? Because you're angry and powerless and a gun makes you powerful.

I didn't. I had the forethought to go "these are fireworks, this is stupid" but not the forethought to go "these are fireworks, you've been punk'd" so I ran out with a claw hammer. Apparently I'm pretty scary at 2am with a claw hammer. Thank god I had the presence of mind to leave the SKS under the bed.

It broke something. I realized that I was allowing my emotions to be controlled by a cheap-ass $80 piece of Chinese junk - and that the only thing that piece of junk would ever get me was prison. So the last time I went plinking I left the gun with my cousin. he may still have it; he may not. He's got an FN-FAL and a couple AR-15s and a Barrett light 50 and a Desert Eagle and god knows what else. And you know what? He's a lot angrier and a lot more powerless than I am.

I was out with some buddies night before last. Friend's wife is on crutches; she's got a torn ACL. And it was 11:30 and Ventura was empty and they were hobbling across the street and some doofus in a Datsun 1600 comes screaming up, drunk, and he didn't see them so of course he leans on his horn because he's scared and pissed off and nearly killed somebody.

My friend's wife is also scared and also pissed off so she started beating on the dude's hood with her crutch. So he gunned the engine and scooped 'em both up onto the hood, drove 'em about 20 feet, then slammed on the brakes. Then he drove off. Whole thing took maybe 7 seconds. I was 50 feet away for the whole thing.

HERE'S THE THING

There are legitimate reasons to buy a gun. "Because I'm scared" isn't one. A gun is a terrible responsibility - it wants to be used. The Sikhs have a rule - you can't resheath the kirpan until you've drawn blood. This generally keeps the sikhs from carving the shit out of people who piss them off. Not always, but mostly in the US. But they also practice like 3 hours of martial arts per day. They've got discipline.

A gun will not teach you discipline. It will not make you hesitant to use deadly force. It will not de-escalate your problems, it will not simplify your life. A gun is a rhetorical nuclear option - "Yeah you maybe didn't really mean to do much but steal my liquor and credit cards but now you're dead."

Yesterday, you didn't have a gun. If you had, you'd still be talking to the police. You'd be looking down the barrel of a months-long investigation at best and somebody, who has a mother and probably brothers and sisters and people who love them, would be forever dead.

OR your girlfriend would have scared off the intruder.

Which - let's be real - is exactly what she did without the gun.

The difference between yesterday and today is today you're scared and flirting with destiny.

Used to go plinkin' with a buddy. He probably had two dozen guns. I looked at them admiringly once and he said "yeah, I prolly coulda won Waco."

Somebody pissed off one of his friends once. Everyone got upset. So they emptied out the rec room and went out to straight shit out. Armed standoff - 6 people on one side, 4 on the other, probably 12 weapons in the field. It's a miracle nobody died. Three of them have since, two by gun violence.

My buddy? His family stopped collecting assault weapons and started collecting livestock. And the world is a better place.

    How does obesity happen?

Pearl Harbor. Walk with me.

______________________________________________________

There are well-known and less-well-known consequences of American involvement in WWII. It's common knowledge that the eventual nuclear annihilation of Hiroshima and Nagasaki set up the Cold War which was the ultimate battleground between capitalism and communism. Less well-known is the fact that the United States didn't ultimately win the war because of the atom bomb but because of our powers of industrial and agricultural production.

Marc Reisner argued that the Army Corps of Engineers won WWII with Grand Coulee Dam. It produced an impossible surplus of power when it was brought online; it had no customers. Then the war broke out and Americans were able to refine aluminum (an electrically-intensive process; the Intalco plant in Blaine, WA uses more electricity than Los Angeles) at a fraction of the price of anyone else in the world.

But in addition to aluminum, the impossible edge in oil refining really took off in WWII. Germany ground to a halt when we took their oil fields in North Africa. Meanwhile our fields in California and Texas turned out gasoline in quantities unmatched anywhere else in the world. And when you make gas, you can also make fertilizer. And when you've converted the Great American Desert to "the Heartland" you make food. You make food that travels. You make corn, potatoes and rice. And you feed that corn and rice to chickens, cows and pigs. And you drop food on the Russians, you drop food on the Chinese, you ship food to England and Australia, and while Germany and Japan are wracked with famine you share your American bounty around.

An interesting side note: because it was a Japanese attack, the safe thing to do, obviously, is lock up all the Japanese. Especially as they're sitting on a bunch of plum farmland on the West coast. You know, the one closest to the Japanese Empire. The one full of refugees from the Dust Bowl. Itinerant farmers from the South and the Midwest who came to California and starved because there are only so may people to pick oranges and strawberries. The ones who will thank you and vote for you and keep growing oranges and strawberries and everything else on formerly-Japanese farms they bought for pennies on the dollar when their original owners get shipped off to Manzanar.

So now Europe is in ruins and the Marshall Plan is going to make everything better. Ship that food out. Soft power! But it's got to travel. Hedgerow to Hedgerow we'll even push the Soviets around by selling it when they behave and withholding it when they don't. But it's got to travel. So corn, rice, soy and potatoes are food. We'll do anything we can to grow more food so that we can influence the behavior of the world with food. We'll subsidize the shit out of food so that everyone is growing food. Meanwhile those now-rich farmers on the West Coast who are growing carrots and olives and lettuce and spinach and oranges and apples? Yeah, they don't need any competition. They don't grow food because then those uppity black folx might go into competition with them for the high-value stuff. So they grow specialty crops. And it's assigned a fair market value.

A market value that goes up because you don't need to eat "specialty crops," not really. After all, the Irish subsisted off of potatoes and potatoes are food. And corn can be made into anything, man. It can be made into sugar - sugar that's way cheaper than cane sugar! It can be fed to cows - way cheaper than grass! It can be fed to chickens! Pigs are less likely to eat it, so pig farming largely goes away (it's come back with a vengeance because the Chinese have a preference for pork but as a foodstuff it's consumption by Americans has plummeted). But Americans eat corn, and things that eat corn, and there's so much excess corn and rice and soy when we're not shipping it all over the world to cajole our foreign policy needs through soft power that there are entire divisions of the USDA trying to figure out what to do with all the stuff.

And you know capitalism. Make more money. Finished products make more money than raw ingredients; you'll get so much more for a box of macaroni and cheese than you will for wheat and milk. Process the shit out of it and it'll keep forever. Process the shit out of it and it'll travel far. Process the shit out of it and you can turn it into whatever flavor you want it to be. Process the shit out of it and you can sell it to anyone, anywhere forever.

Somewhere around here we've got an article that argues the dominant species on earth isn't humans, it's corn. After all, we've basically given over our food production to it. A Wendy's meal, if I recall correctly, was ultimately about 80% corn (including the French fries). And against that we've got "specialty crops" that we have to refrigerate to get them across country and there are vast swaths of the US where "specialty crops" aren't even sold because it's so easy and cheap to get food. A box of Little Debbie snack cakes costs less than a head of lettuce. And a box of Little Debbie snack cakes will keep you alive if you're starving. And a box of Little Debbie snack cakes will sit on the shelf for nine months or more and nobody will be the wiser. The power goes out on that head of lettuce and it's garbage before morning.

And it's fuckin' lettuce.

Meanwhile we're all working harder for less, working longer for less, driving farther for less. The calories are easy and the nutrition is hard and that's before you recognize that we've arranged our entire food economy around food not "specialty crops." Reuters pointed out yesterday that one in three workers also has some form of job in the gig economy; even if we're working 40 hours a week (we're not, we're working 47) we're also filling our spare time with TaskRabbit, with Uber, with Mechanical Turk. And as humans, we're biologically programmed to pack on pounds when we're stressed because stress means starvation. I think it was Richard Wrangham who pointed out that there have only been about 125,000 generations since homo habilus split off from Australopithecus. Homo Sapiens is only 7500 generations. Go to Mile High Stadium, start "The Wave" and by the time it makes its way back round to you, the person next to you is a Neanderthal.

So here we are. Impossibly cheap calories, impossibly sedentary lifestyles, impossible stressors. Fight or flight doesn't care if it's a mastodon or an impending bankruptcy they'll both keep you up at night. At least if it's a mastodon you can run. We can't. So we get fat. And because we're Americans, and we've got a nice Protestant work ethic, and because we're rugged individualists, if you're fat it's a personal failing. Society hasn't let you down, the system hasn't failed you, you're a glutton and you should feel bad.

    Is there any solution?

Well, I'd start with

1) Take it the fuck easier on the poor and lower middle class.

2) Prioritize nutrition over calories. Know who used to be in charge of school nutrition? The goddamn Department of Defense. Then Nixon kicked 'em out and Reagan categorized ketchup as a fruit.

3) Make healthcare a nonprofit industry again. Know what's stupid cheap? Diet, exercise and sleep. Know what's crazy expensive? The time of medical professionals. Know where you can't make any money? Diet, exercise and sleep. Know where your profit centers are? Prescription drugs.

Weight Watchers costs around $700 a month - including food. They get an extra $13 a week to tell you "atta boy! You're doing good!" Insulin costs around $500 a month. No food. Insurance pays for insulin, usually. It rarely pays for Weight Watchers. Can you imagine what our society looked like if we had, you know, nutrition?

The fundamental basis of this article is "we know how to make people healthier, but we don't give a shit." I think it's more than that. It's more than tradition. It's that in order to solve the problem, we have to break capitalism.

And nobody wants to break capitalism.

kleinbl00  ·  link  ·  parent  ·  post: Pubski: August 1,2018

OH FUCK MUTHERFUCKER NOW YOU'RE WINDING ME UP

Because beer fucking sucks right now.

You know it, you just don't want to admit it - beer is straight-up bullshit at the moment. Yeah, sure there's a million tiny shitty little breweries out there but they're all being bought up one by one by AB InBev or SAB Miller and they all make fucking IPA. You know what IPA is? It's the beer you make when you don't have the room to make beer - IPA requires no refrigeration to make. It's that shit you made in your dorm room when the RA wasn't watching. It's that swill that tastes the same whether it's turned or not because they sell it to you pre-turned. It's that shit you drink because hefeweizens are too heavy - you know, the beer that they've convinced you to put an orange slice in it so it doesn't taste quite so much like pruno.

Fortunately for the beer companies, your tiny shitty little IPA from bumblesquatch colorado can be sold for fuckin' $2.50 a bottle because it says you need a lumberbeard to drink it or some shit, as opposed to $1.25 a bottle for pilsners that you're shipping from Canada or Copenhagen (or brewing down the street, but as we all know your dad's macrobrews have been fucking terrible for decades, that's why we started down this road). Unfortunately for the beer companies, nobody wants to spend fucking $9 for a sixer of Fat Tire anymore and the alternative you're offering them is fucking Michelob Ultra Organic or some shit which tastes about the same as Zima without the sugar, assuming you remember what Zima is. Fortunately nobody remembers Zima or Bartles & Jaymes so let's try selling them "summer shandy" or "radler" because a wine cooler by any other name would taste as cloyingly sweet.

LOOK AT THIS PICTURE.

LOOK AT IT.

Bud. Light. Lime. STRAW ber RITA. "Try it over ice!" What. The Actual. Fuck. This is AB InBev throwing their hands in the goddamn air and saying "we never knew why they liked our swill in the first place, mix a Kool-Aid packet in there and see if they buy it." Meanwhile the beer that everyone drank forever is fucking gone, yo. When was the last time you saw an Anchor Steam? I mean, I live 150 miles from the brewery and I have a hard time finding Weinhard's.

I used to drink Kirin Light. Now I can't even find Kirin.

I used to drink Amstel Light. I haven't seen it at the market in three years.

I'm drinking Sam Adams Light - and that'll work - but it is literally the only drinkable light beer left at my supermarket. They generally have three cases of Sam Adams, two cases of Sam Adams Light, five cases of Heineken, two cases of Heineken light, and an entire aisle of various and sundry IPAs.

And those fucking "summer shandys."

You know what I drink down here in LA?

They've got me drinking Russian beer, yo. I live in goddamn America, home of the macrowbrew and because the industry is pushing trasherita premix I'm drinkin' shit that's been shipped from SAINT FUCKING PETERSBERG.

Let's drive a stake through the heart of the whole goddamn industry. I'm so completely fucking over the direction it's taken. Kill this bitch so we can bury it and move the fuck on.