Medicare for All – Part 2

With all the campaign promises about Medicare for all, I took the opportunity about two months ago to explain how Medicare actually works. Politicians give the impression that it’s a totally free health insurance program. Just walk into the doctor’s office or emergency room, tell them your number, get fixed up and leave with no expectation of receiving a bill. 

Real Medicare today is not like that at all. Why would they spend time on TV and in mailings advertising supplemental insurance that “helps pay some of the health care costs that Original Medicare doesn't cover, like: Copayments, Coinsurance, Deductibles”? Those extra costs can only be avoided by paying money up front as a premium for the additional insurance.

From recent news, though, it’s clear that this misimpression is not the only problem. Medicare fraud is another big issue. Sometimes this is a critical thinking issue where patients are lured in as unwitting participants. Sometimes it goes deeper.

Late last month, thirty-five individuals associated with dozens of telemedicine companies and laboratories were charged with fraudulently billing Medicare more than $2.1 billion for expensive cancer genetic tests. Nine of the defendants are medical doctors. “In addition, the Centers for Medicare & Medicaid Services, Center for Program Integrity (CMS/CPI), announced…adverse administrative action against cancer genetic testing companies and medical professionals who submitted more than $1.7 billion in claims to the Medicare program.”

One of the defendants in this case, who cost taxpayers more than $1 billion in illegal Medicare reimbursements, “has been under near-constant federal scrutiny for the past five years and was supposed to have been deported more than a decade ago.” That was billions lost to fraud as a result of only one investigation, due in part to government inaction.

Meanwhile, the U.S. Department of Health and Human Services Office Inspector General has issued an alert to the public about other genetic testing schemes. Medicare eligible patients are offered a free genetic screening for undetected conditions, but the real motive is to get their Medicare information “for identity theft or fraudulent billing purposes.” The screenings are unnecessary and are usually denied by Medicare. When they are, the individual could be responsible for the entire cost of these useless tests, sometimes thousands of dollars. 

They get nothing but the promise of some new information about their health with the selling point that, as Medicare recipients, it may be free to them. This promise of something for nothing – free testing or free devices all paid for by Medicare – is used so often it’s beginning to sound stale, but it must be working.

Advice from the Inspector General is to not volunteer any information to these genetic testers, don’t stop at their booths at health conferences, ignore their ads, and return unopened any testing kits received in the mail.

Medicare fraud is a huge problem. The AARP reported in March of last year “roughly 10 cents of every dollar budgeted for the giant health insurance program is stolen or misdirected before it helps any enrollee. Looked at another way, about $1,000 is lost per Medicare member through theft or waste each year.” That estimate is based on government reports, but a leading expert from Harvard University believes the real number could be much higher, 20% or more.

AARP used the figure of $60 billion in fraud for the 2018 calculations cited above. Other sources show exactly the same estimate for 2015 and 2011. The number hasn’t changed in eight years. Apparently as fast as they can lock people up or put them out of business, more fraudsters spring up to take their place.

Would the general public as a whole be less likely to become victims of Medicare-for-All fraud schemes? That’s doubtful, and it leads to so much waste. 

Salt is Salt - Part 2

Almost seven years ago I wrote here about the sea salt scam. In that piece I quoted Mayo Clinic as saying, “Sea salt and table salt have the same basic nutritional value, despite the fact that sea salt is often marketed as a more natural and healthy alternative.” The American Heart Association (AHA) agreed.

But then a few weeks ago, I ran across an article with the headline: “How Pink Salt Took Over Millennial Kitchens.” Immediately it goes on to explain that, like sea salt, it’s not healthier than common table salt. It’s labeled as Himalayan, but does not come from the Himalayas. “Most of that comes from the enormous Khewra Salt Mine, situated between Islamabad and Lahore in Punjab, a bit south of the actual Himalayas in Pakistan.” 

Despite that, it has become another foodie fad, skyrocketing in popularity, featured at Trader Joes with it’s own grinder. The popularity stems not only from the color – it’s prettier than plain old white salt – but because it’s also rumored to be healthier. Take the warnings from the AHA and others about salt consumption, combine that with the fact that salt makes food taste good, mix that with the mistaken notion that this special salt is really healthy because of some mythological “trace minerals” and voila! - gullible people are willing to pay $2.70 a pound at Costco in bulk. For comparison, sea salt at Costco goes for 1.76 per pound and Morton Salt at a restaurant wholesale site is $0.38. Those must be some expensive trace minerals!

Contrary to what pink salt enthusiasts claim, real nutritionists agree that the amount of trace minerals in any salt “is too minuscule to make any difference, and we already get plenty of the same trace minerals from other foods.” Another site confirms that “The ‘84 minerals’ in himalayan salt is an unsupported claim.” It’s all marketing hype.

It’s so easy to go on line, though, to find glowing endorsements of pink salt pushing these imaginary health benefits. This one is a good example: “Many people believe that this pink salt is the purest salt that can be found on the planet.” Maybe so, but many people believe a lot of things that aren’t true.

In case you aren’t convinced by the purity and naturalness alone, it goes on to claim that pink salt stores “vibrational energy,” whatever that is. Supposedly it aids vascular health, supports respiratory functions, reduces the signs of aging, promotes healthy sleep patterns, increases libido, lowers blood pressure, and detoxifies the body of heavy metals – among other benefits. (Apparently, to get some of these benefits, we must add it to our bath water.)

First, the word detoxify should raise warning flags to anyone with any scientific understanding of how the human body functions. Second, the idea that any salt lowers blood pressure flies in the face of all medical understanding. Increased salt consumption increases the risk of high blood pressure. Finally, supports and promotes are words often used by snake oil salesmen regarding all sorts of magical supplements, potions and ointments to cure all sorts of ailments. Promoting and supporting cannot be measured, thus they are meaningless. It’s junk science at it’s finest.

But don’t let that stop Millennials searching for the magic potions allowing them to live forever. Set the grinder of pretty pink salt on the table to impress friends and mix it with the bathwater to increase libido and conquer aging. Then wonder why you are no healthier or younger looking and can’t afford to retire when you expect to. They fall for hype and fads in the same way their parents do. Gullibility must be hereditary.

Behavior and Consequences

An article in one of my news feeds caught my eye recently. The title was “How To Predict Your Future.” It was based somewhat on the same premise as this blog, except that it concerns itself with predicting individual futures, whereas I have generalized it to apply to the future of society as a whole. Past behavior predicts future behavior, and those behaviors almost always dictate how satisfactory the results will be.

About individual results he says, “It’s not about what you want — it’s about what you do.” Look at your habits and decide whether they are the ones needed to reach goals. Don’t just set goals and assume the good intentions will see you through. The same can be said of societies. 

Just because a couple of us agree doesn’t convince me, so I dug deeper. 

This Psychology Today article claims the maxim is too simplistic and depends on a lot of factors:

•        High-frequency, habitual behaviors are more predictive than infrequent behaviors.
•        Predictions work best over short time intervals. 
•        The anticipated situation must be essentially the same as the past situation that activated the behavior.
•        The behavior must not have been extinguished by corrective or negative feedback.  
•        The person must remain essentially unchanged. 
•        The person must be fairly consistent in his or her behaviors. 

These are reasonable objections. Of course if a person is not exposed to the same situations or if he has gone through a  change brought about by a personal realization or outside intervention, the same actions will not repeat. People can quit smoking, give up drugs or turn away from a criminal lifestyle.

But these arguments apply more to an outside authority or counselor using records to judge whether someone needs professional help (or incarceration). In daily life though, there are people who almost always drive too fast regardless of the number of tickets issued and people who don't pass up the snack food aisle or the corner coffee shop. It's not the big things that catch up to people in the long run; it's the accumulation of small habits with unnoticeable consequences the lead to obesity, retirement insecurity and car crashes.

An example comes from the medical field.  A study to determine which was a better predictor of statin patients’ adherence to their prescriptions found that attitudes about taking medicine as directed were not as strong as past medication-refill behavior. The conclusion was “that past prescription-refill behavior is a better predictor of medication adherence,” which is fortunate since the refills can be tracked electronically.

In academics a 2018 article states, “Your behavior in high school could predict your income.” The study began in 1960 with 345,000 American high school students, following up with “about 80,000 of them 11 years later and another [follow up] for nearly 2,000 of them 50 years later.” Those who performed well “were all associated with career prestige at the 11-year mark and higher income at the 50-year mark.”

Of course past behavior is not a perfect predictor of future behavior (and the consequent future outcomes), but we don’t usually need to be perfect when dealing with individuals or groups. General trends are enough to predict whether America will continue to head in what most consider to be the wrong direction. Several times in the past eight years I have written about predicting outcomes months in advance. Here is just one called "How to Predict the Future." 

In another case I criticized the panic resulting from an investigative report dubbing lean beef trimmings as pink slime. Anyone with a trace of critical thinking would have passed it off as ridiculous; but people did react, and a few years later ABC News settled a defamation case with the meat processor for $177 million.

Last spring I argued that constantly telling children scary lies is a form of abuse. One example I used was the story about the dwindling polar bear population. This week news broke with the headline: Canadian “University dumps professor who found polar bears thriving despite climate change.” (The university apparently favors such abuse.)

Likewise, I wrote in early 2015 that we must deal with our own problems by choosing healthier behavior and not “wait for the next election” to solve everything.  How right I was!

There are far too many examples bearing out the behavior/consequences link for it to be ignored or dismissed.

Some Odd Thoughts

As I write these little essays, I get the impression that I often have thoughts that are out of sync with the rest of the world. Perhaps I think too hard about things, but here are a few more random observations.

I picked up a small card advertising a kind of school system open house and presentation. In part it read, “Come hear about some of the new and exciting things happening at our schools.” This is probably a symptom of current advertising where everything has to be new and exciting or new and improved or innovative and sustainable. Buzzwords fill all advertising from shoes to cars to doctor’s offices.

But if I were a parent of a child attending one of these schools, I wouldn’t care two pins about new and exciting. I would want the school to teach my children how to read, write, add and subtract. These are basic skills that anyone needs in any profession or just to live a reasonably stress-free life. Instead, in another case I see a television news segment featuring kids in the early grades crawling around on the floor to get an appreciation of STEM subjects with “educators” gushing about how wonderful it is and how it “keeps them engaged.”

Shouldn’t it be the child’s responsibility to learn and the parent’s responsibility to ensure they do? It seems in too many cases teachers are entertainers, the students are the audience and the parents are automatic advocates for their children when they step out of line, setting up an unproductive dynamic.

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Some research shows that patients in nursing homes can be comforted by dogs and other pets, but can be equally comforted and cheered up by mechanical dog-like robots. What if airlines developed a policy that so-called support animals were no longer allowed on planes. Instead people could rent a teddy bear of other stuffed comfort animal at the departing airport and turn it in when they landed. (This would not apply to legitimate service animals.) That’s never going to happen. Society is headed in the opposite direction.

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CBS Sunday Morning ran a segment a few weeks ago about the $450 million makeover of the Museum of Modern Art (MOMA) in New York City. In it the museum director mentioned that they “will also increase the number of works by female artists – five times as many [as] before.” Wow, that’s really a good thing – or is it?

Apparently the art world today harbors some resentment that the art world of the past judged art, at least in part, on the basis of whether the artist was a man or a woman, giving preference not to the quality of the art but to the sex of the artist. The quality of the art (as subjective as that can be) should be the criterion for judging what gets displayed and what is rejected, not the appearance, the status, the reputation or the political connections of the artist. That would be the really good thing.

So why is MOMA making it a point to call attention to the number of female artists? Isn’t that the same kind of objectionable thinking that prevailed in the past dressed up in a different costume? They express their objection to past flaws in the system by doing the same thing in the opposite direction and call it progress.

Is This Still A Free Country?

A brief review of the Bill of Rights, the first ten amendments to the Constitution, brings up several interesting thoughts, realizations and questions. (Read the Bill of Rights in full here.) 

The first is about freedom of speech, religion, assembly and the press. It should mean that people are allowed to say and write what they want within broad limits. Others can raise reasonable objections and counter arguments, or at least accept apologies. But today we find that  speakers are banned from campuses or shouted down by those who believe words are the same as weapons. We have large, powerful social media corporations expected to censor comments and pictures posted by private citizens based on arbitrary standards. We have Ellen DeGeneres scorned for attending a football game in the company of George W. Bush. Say the wrong thing, even in the form of a question and risk personal attack, silencing, losing a job or boycotts of your product.

The Second is about the right to bear arms. That really means the right to carry them not even to own them. Today arms means guns and the nation is split. Clearly the right to carry has been infringed at various levels in various places.

Some states have passed a Red Flag Law, Extreme Risk Protection Order (ERPO), with strong approval of the electorate. If a person is considered a danger to himself or others, authorities can show up and confiscate weapons for one week, no questions asked. A judge can extend this for up to six months where there is “good cause.” At that point the accused can finally respond at a hearing, but has no legal right to representation. In Maryland, for example, the initial complaint can come not only from law enforcement, physicians, and mental health workers, but also from family members, housemates or dating partners. The list in other states is more inclusive, and the gun owners have no recourse in cases of false accusations.

The Third is about housing soldiers without consent – no problem there.

The fourth prohibits unlawful search and seizure. This is about privacy; but with the social media-driven desire to be famous, Americans are becoming more casual about their own privacy and take for granted the idea of being constantly under surveillance. Compound that lax attitude with new technology: facial recognition software and proliferating security cameras; possible leaks through computer cameras and microphones; personal assistants listening in on conversation; ISPs and grocery stores tracking our on-line activity and purchases; and other examples – privacy is ebbing away. (For an interesting description of possible future threats, see the book, Eyes in the Sky.) 

The Fifth Amendment is well known for protection against self-incrimination and the right to due process, but the public tends to decide guilt or innocence based on news reports and political affiliation. “No comment” is often assumed to be an admission of guilt. 

Consider also the current practice of Civil Asset Forfeiture where authorities can confiscate personal property on the basis of accusation, not conviction. There are many horror stories of abuse where innocent people must fight the system to reclaim seized property.

The first part of the Sixth Amendment guarantees a speedy trial. Many of the convictions on the local news are for crimes committed in years past. The right to “be confronted with the witnesses against him” seems to fly in the face of the idea of being attacked from a distance as rumors spread on social media. Transgressors of cultural values don't even get a trial, no less a speedy one.

The Seventh, the right to a jury trial in certain civil cases seems OK, but the complexity of modern cases and the lack of economic understanding continues to result in unreasonably high awards or settlements driven by the threat of litigation in front of a "compassionate" jury. 

The Eighth prohibits excess bail, which has been a matter of some discussion lately. Excessive is not the same for everyone. Poor people who are not a flight risk can spend months behind bars waiting for a trial, a handy tool to coerce them into pleading guilty. Like Civil Asset Forfeiture, this practice is a boon to the authorities at the expense of the innocent.

Nine and Ten are instructive. The Tenth addresses the idea of “Undelegated Powers [being] Kept by the States and the People.” The word delegated implies that the states and people are in a superior position to the Federal Government. They hand down powers to them! That certainly isn’t the way it works today!

One problem with these rights is that they apply to the government not depriving people of them. That’s the excuse used when one citizen or group tries to shut up or railroad those they disagree with. That punitive attitude is true to the letter, but contrary to the spirit.

Another problem is that they are so easy to take for granted or ignore. These are not obsolete ideas; they must be respected. Freedom is always linked to responsibility.

Climate Change and Real Science

I’ve written recently how promoters of the man-made climate change concern tend to dismiss those who want to continue the debate as being unscientific and deniers. But some of the real impediments to dealing with greenhouse gases don’t come from a lack of science. The solutions are based in science but find stumbling blocks in popular trends and fear mongering.

Two or three current articles lead to this conclusion. 

The latest idea to come out of the UN to reduce our carbon footprint is to eat less meat. If everyone adopted a vegan lifestyle, putting all the cows, pigs, chickens and sheep out of work, they claim we could effect a significant change. But this Reason Magazine article crunches the numbers and the results are disappointing. “In their 2017 Proceedings of the National Academy of Sciences study, agronomists Robin White and Mary Beth Hall reached a similar conclusion [to several others], calculating that the total elimination of animal husbandry would reduce U.S. emissions by 2.6 percent.” 

In other words, nagging the public to reduce or even completely stop eating meat pursues a negligible effect on climate change. Of course, the facts should not stand in the way of the popular feel-good trend, where the burger giants are playing to the crowd by offering Impossible Whoppers and McVegans. A big pain yields little gain.

On another front, strong arguments in favor of nuclear power as a means of producing electricity without releasing carbon dioxide into the air fall on deaf ears. Increasing the number of nuclear reactors would be the ideal solution to climate change. In addition to the lack of pollution, they have a much smaller physical footprint than other sources such as wind and solar. 

But say the word nuclear and people panic. They start talking about Chernobyl, Fukushima, and Three Mile Island as if they were typical rather than extreme outliers. “These are the only major accidents to have occurred in over 17,000 cumulative reactor-years of commercial nuclear power operation in 33 countries.” The World Nuclear Association summarizes the safety by saying, “The evidence over six decades shows that nuclear power is a safe means of generating electricity. The risk of accidents in nuclear power plants is low and declining. The consequences of an accident or terrorist attack are minimal compared with other commonly accepted risks. Radiological effects on people of any radioactive releases can be avoided.”

To counter these facts the uniformed cite the problem of nuclear waste. The truth is that “all the used fuel ever produced by the commercial nuclear industry since the late 1950s would cover a football field to a depth of less than 10 yards.” That’s one single football field for the entire world. Furthermore, much of it can be processed for reuse as they do in France and “after 7,000 shipments total of used fuel by the worldwide nuclear industry since 1970, there have been no leaks of radioactive material or personal injuries.”

The biggest truth is that people refuse to consider it as an alternative due to unfounded fear. In Germany the anti-nuclear movement kicked into high gear with mass protests after Fukushima promoting a phase out of nuclear energy by 2022 while still moving off fossil fuel-based energy generation. Should America follow this wanting-my-cake-and-eating-it too philosophy?

The final piece came from an interview published at foreignpolicy.com featuring research to growing better vegetation. 

Plants naturally draw CO₂ from the atmosphere. “Every year, humanity emits 37 gigatons of carbon dioxide; photosynthetic life can process and capture nearly half of that amount.” The theory is that plants can be made a little more productive. Since the amount of carbon dioxide released naturally is so much greater, plants operating at only a 2% or 3% increase in efficiency could pick up the other half of human emissions.

One problem is that the effort to “come up with a cost-effective and efficient way of actually pulling carbon dioxide down from the atmosphere and sequestering it down into the soil—where it should be” requires genetic engineering to create this “Ideal Plant.” If breeding could do it, it would take much longer. Many people and governments would have to overcome their irrational fear of GMOs, but that should be much easier than the alternative, the standard of living hardships that would result from severe reductions in energy availability.

The answers to fighting climate change likely come from real science, not a pick and choose kind of science that follows the fear mongering and fashions of the day.

Puzzling Mail

I got some strange mail earlier in the week. It was a small postcard apparently from a group of lawyers telling me that I could be reimbursed if I bought towels made by a company called Welspun between the beginning of 2012 and last July, approximately seven and a half years. 

As I looked into it, just out of curiosity, I discovered that Welspun Group is a multinational company founded in India in 1985. It does business in over 50 countries in steel, energy, and textiles, employing about 24,000 people. 

The reason for the settlement is that they have been accused of fraud. According to Fortune, “an internal investigation revealed it misrepresented its 100% Egyptian cotton sheets.” When this came to light, several retailers including Target, Wal-Mart, Bed Bath and Beyond and J.C. Penney either had or was considering severing ties with the company. In addition, two class action lawsuits had been filed.

The postcard must have proceeded from one or both of those lawsuits. It says that the company has set aside $36 million to pay “Valid Claims.” If I have a proof of purchase, I “may receive up to $2.30 for Subject Product towels and pillowcases and up to $9.20” for all other products. Subject products are those labeled as “Egyptian Cotton” or “Pima Cotton.” If I don’t have a proof of purchase, the payments are cut in half.

Again according to the September 2016 Fortune article, “Welspun has committed to implementing new labeling practices.” Furthermore, their website boasts of many quality awards in 2018. So why does the Class Period last until July 2019? I don’t have a clue. The company has also been ordered to clean up their marketing and labeling practices.

Welspun financials show over $100 million net profit in the last 6 months reported, so the settlement shouldn’t be devastating.

After going through all that, I wondered who has really been harmed and what is the value of this entire exercise. Consumer fraud is a bad thing. Ordinarily some government agency would send out warnings or apply fines and require the company to straighten out their practices. In serious cases, some people might go to jail. But does forcing the company to provide the funds so that an administrator can reimburse customers with seven-year-old receipts $2.30 per towel make any sense at all?

 A quick shopping trip on Amazon reveals that 4-packs of 27x54 Egyptian cotton towels are on sale for $43 (regular price $60). A 4-pack of comparable 27x54 luxury towels with the same GSM (grams per square meter) sells for $28. Someone who may or may not be able to tell the difference could have paid $3.75 too much per towel. They now can reclaim some of the difference thanks to $9 million worth of attorney work. The situation is probably the same for sheets.

The whole thing leaves me wondering how expecting Egyptian cotton and getting some other kind of cotton in one’s sheets and towels can mean enough to go through all this trouble. If a company commits fraud, either intentionally or unintentionally, it should be fixed and possibly punished. In large matters consumers ought to be made whole, but for sheets and towels? – Where is the perspective?