Man, insurance sucks
And other healthcare news.
Good afternoon, Sunday afternoon. It’s rainy and miserable here but it’s been getting warmer over the past week, and I can’t stop thinking about spring, flowers, and whenever I get vaccinated so I can go home and see my mum. Light at the end of the tunnel, and all that.
I made these blueberry cornmeal pancakes for breakfast today, and they were fantastic. I’ve been making a lot of pancakes recently, for some reason, and they keep coming out good, but not great. A bit too dense, or a bit too eggy, or with—if you can imagine it—a bit too many chocolate chips. These, though, were great. I ate three and finished off my husband’s too. I added the zest of a small lemon, which I think made a huge difference, as well as some freshly grated nutmeg and a shake of cinnamon to the batter. (I also didn’t mix the bluebs directly into the batter, since I wanted to save most of it, and I enjoy the thrill of sprinkling them directly onto the pancake while it’s cooking. I used frozen wild blueberries, which are tiny and adorable.) Anyway, can’t recommend them enough.
Here’s some healthcare news from this week. But first: Digby, looking like a real turkey.
I guess this whole setup looks insane if you aren’t a member of our household, so let me explain. I got her that scratcher-tunnel thing she’s sitting on during a Target run, and my excitement quickly turned to horror when she started scratching and tearing off hundreds of little pieces of cardboard that traveled all over the apartment. They got enmeshed in our couch blankets, stuck to the bottoms of my socks, in our clothes. But throw out the whole damn tunnel? I couldn’t bear it. So I fashioned this large cardboard tray out of a cardboard box and lots of tape, and would you believe it, it works! It traps almost all the little pieces of cardboard, Digby still gets to enjoy scratching and chewing, and I feel victorious. It looks ridiculous but we aren’t the sort to care much about how our living space looks. (That purple thing she’s standing on is a cat toy that purrs if you press his head—she doesn’t care about this at all, she just likes standing on him. We call him The Man.)
Before we get into it, make sure you read my story about a Connecticut woman whose pharmacy canceled her Covid vaccine appointment because her Medicare address was wrong and therefore, they said, they wouldn’t be able to bill for it. A real administrative nightmare, with no obvious explanation.
The Biden administration will now require health insurers to cover Covid-19 tests for asymptomatic patients. The Families First Coronavirus Response Act, passed at the beginning of the pandemic, only required insurers to cover “medically appropriate” tests, according to guidance issued by the Trump administration; according to Axios, insurers claimed this didn’t necessarily include tests for asymptomatic people. This whole thing really bugs me. We know that many people are contagious without having symptoms; we know that isolating those people is important to stop them spreading the virus to others, particularly without the existence of financial support to keep more people at home. If we are going to continue to force people to show up to work, they should at least be getting tested! The public health value of asymptomatic testing is obvious. And it took a year for insurers to be made to cover it.
But the bigger point here comes down to the backwards way we pay for healthcare. Take this NPR piece from last year, which explained that insurers were worried about their ballooning costs if, for example, employers were to “start to institute testing requirements for everyone returning to work. AHIP projects it could cost health plans $25 billion a year if the government doesn't step in to defray the cost.” But if we accept that asymptomatic testing is good, then someone has to pay for it. I’m certainly not going to cry about Aetna’s profits, but if they want to whine about footing the bill, fine, I agree; let’s abolish them and replace private insurance with single-payer, then. A robust testing regime, including of asymptomatic people, is clearly a public health need, one that is worthy of government spending and far better addressed by direct government spending than by offloading some of the cost onto the private health insurance system. Which is all paid for by our premiums anyway. Think about how inefficient that is! This is a pandemic that affects everyone. Get rid of insurance companies and just pay for healthcare with taxes. For God’s sake.
Read this Washington City Paper report on how Black DC residents were left behind in the vaccine rollout, with difficulties accessing and using the web-based vaccine signup portal. A key line: “More people have died of COVID-19 in Ward 8 than in Ward 3, and more people have access to the internet in Ward 3 than in Ward 8.” (You might remember my interview with Sheila Herring, a DC public housing resident in Ward 7, which had the second lowest rate of vaccination after Ward 8, as of February 14. Her public housing was riddled with mice and mold, triggering her asthma—conditions that would make her more susceptible to the coronavirus.) Who could have predicted that just chucking up a website and waiting for people to find out and register—instead of, for example, having a healthcare system that could proactively reach out to the people who are eligible for the vaccine—would privilege the better-off and more-online. (In fact, that’s exactly what happened in DC when places like Bread for the City just started vaccinating their own patients instead of accepting appointments made via the portal.)
The New York Times reports on the horrible conditions for medically vulnerable prisoners, who should have been eligible for home confinement due to the pandemic—including many who eventually caught the virus. Inmates report things like bright lights being turned on in their makeshift quarantine areas at 6am, and not receiving basic pain relievers, or being able to take their prescribed medications. Only 5 percent of those serving federal sentences have been granted home confinement, according to the Times.
In Jacobin, Alex Press interviews a Tyson poultry processing worker about conditions during the pandemic, and the lack of protection he and his coworkers have received. My favorite quote: “I don’t understand why we’re called ‘essential workers.’ Really, for the company, we’re more like ‘essential machines.’”
And, an important and devastating look at the medical workers who have died since the vaccines were released in mid-December, at Kaiser Health News.
As of a few days ago, over a million Texans were still without drinking water, over a week after the deadly winter storm. Again: The effects of these sorts of disasters create long-term health effects, which we don’t have a system to address, especially in states like Texas with incredibly limited Medicaid programs.
Universal Health Services, which owns hundreds of hospitals and other healthcare providers around the country, made almost one billion dollars in profit last year—a 15.8 percent increase over the previous year, despite the pandemic. Nice, bro!!
IN A TOTAL COINCIDENCE, a new report from the Office of the Inspector General at the Department of Health and Human Services finds that American hospitals are probably “upcoding” their Medicare billing to a significant degree. Upcoding refers to medical providers billing for a more expensive level of healthcare than was actually provided. (For example, they might bill for additional services a patient didn’t receive, or bill the medical care that was received as being more complicated than it was, resulting in higher reimbursement.) In this case, the OIG report found that “high severity” hospital stays had increased by 19 percent between 2014 and 2019, while medium and low severity stays declined by 12 and 22 percent respectively. Interestingly, the report found 30 percent of hospital stays billed at the highest severity level were also shorter than average—which wouldn’t be consistent with patients who were sicker, you would think.
That’s it this week. As I typed this, I realized I almost forgot your Digby photo and went back to add it in. You’re welcome. See you next week.