As Donald Trump was fighting with Congress over the shutdown and funding for a border wall, his administration implemented a new rule that could be a game-changer for health care.
Starting this month, hospitals must publicly reveal the contents of their master price lists — called “chargemasters” — online. These are the prices that most patients never notice because their insurers negotiate them down or they appear buried as line items on hospital bills. What has long been shrouded in darkness is now being thrown into the light.
For the moment, these lists won’t seem very useful to the average patient — and they have been criticized for that reason. They are often hundreds of pages long, filled with medical codes and abbreviations. Each document is an overwhelming compendium listing a rack rate for every little item a hospital dispenses and every service it performs: A blood test for anemia. The price of lying in the operating suite and recovery room (billed in 15-minute intervals). The scalpel. The drill bit. The bag of IV salt water. The Tylenol pill. No item is too small to be bar coded and charged.
But don’t dismiss the lists as useless. Think of them as raw material to be mined for billing transparency and patient rights. For years, these prices have been a tightly guarded industrial secret. When advocates have tried to wrest them free, hospitals have argued that they are proprietary information. And, hospitals claim, these rates are irrelevant, since — after insurers whittle them down — no one actually pays them.
Of course, the argument is false, and our wallets know it.
First of all, hospitals routinely go after patients without insurance or whose insurer is not in their network. When Wanda Wickizer had a brain hemorrhage in 2013, a Virginia hospital billed her $286,000 after a 20 percent “uninsured” discount on a hospital bill of $357,000 — the list price, according to chargemaster charges. Medicare would have paid less than $100,000 for her treatment.
Second, those list prices form the starting point for negotiations, allowing hospitals and insurers to take credit for beneficence, when there is none.
I recently received an insurance statement for blood tests that were priced at $788.04; my insurer negotiated a “discount” of $725.35, for an agreed upon price of $62.69 “to help save you money.” My insurer’s price was around 8 percent of the charge. Since my 10 percent co-payment amounted to $6.27, my insurer happily informed me, “you saved 99 percent.”
.. Just as airlines have been shown to exaggerate flight times so they can boast about on-time arrivals, hospitals set prices crazy high so they can tout their generous discounts (while insurers tout their negotiating prowess).
Apr 24, 2018 – Environmental Protection Agency chief Scott Pruitt listens to President … Scott Pruitt moved Tuesday to limit what science can be used in writing … The proposed rule would only allow the EPA to consider studies where the …
Even when the Facebook leaders understood the problem, they tried to hide it.
Right after the election Zuckerburg was dismissive of the idea that Fake News influenced the election.
People within the company thought he was out of touch.
At the time Facebook was under pressure.
Trump had won the election using social media, but Facebook was dismissive.
Facebook employees saw the tip of the iceberg . They had been following Russian
Mark wanted to find a technical fix.
Sheryl was thinking about the legal risk and was wondering whether they would find out things they didn’t want to know. Sheryl was thinking about what the consequences would be.
Sheryl yelled at the security team for investigating Russian interference without formal approval.
The leadership was concerned that Washington was controlled by conservatives who would have an adverse reaction to an investigation or efforts to curb this activity. Conservatives already think Silicon Valley is a bunch of hippies.
There was pressure within Facebook not to publish anything linking activity back to Russia. Sheryl(?) also signed off on a policy not to take down the Russian troll accounts.
Mark Zuckerburg was traveling the country, milking cows, and acting as though he wanted to run for President.
Sheryl Sandberg was running her own “Lean-In” brand.
Alex Stamos (Security Chief) briefs the audit committee and the board’s response is to yell at Mark(?) and Sheryl(?)
The leadership holds a big meeting and Sheryl yells at Alex Stamos for
- not briefing her fully
- admitting that they hadn’t fully got a grip on the situation
- suggesting that Russia would likely do this again in the future
Alex has gotten in trouble in the past for being too transparent
The Cambridge Analytical Scandal illustrates:
- The consequences of surveillance capitalism
- The potential of Facebook to influence elections
Apple CEO Tim Cook castigates Facebook for their business model.
Facebook conducts an advertising campaign and privately goes on attack using the Washington PR opposition research campaign, which uses the NTK network which publishes propaganda.
Confronted with a Propaganda Scandal, they turn to a PR campaign to create their own Propaganda.
Attacks Apple and Tim Cook. Attack George Soros, arguing the Facebook’s criticism was masterminded by George Soros. In taking on Soros they are getting into the smear and conspiracy business.
Last summer one of his senior schedulers, Madeline G. Morris, was fired by Mr. Pruitt’s former deputy chief of staff, Kevin Chmielewski, who said he let her go because she was questioning the practice of retroactively deleting meetings from the calendar. Mr. Chmielewski has emerged as a harsh critic of Mr. Pruitt after a bitter falling out that led to his departure from the agency as well.
.. Madeline G. Morris, was fired by Mr. Pruitt’s former deputy chief of staff, Kevin Chmielewski, who said he let her go because she was questioning the practice of retroactively deleting meetings from the calendar.
.. One case involved the deletion of several of Mr. Pruitt’s meetings during a spring 2017 trip to Rome, including one with a controversial cardinal then under investigation for sexual assault.
.. The E.P.A. acknowledged in a series of legal memos last year that it did in fact direct an agency scheduler — although it did not name the person — to revise Mr. Pruitt’s daily calendar retroactively. The agency said it was doing so to remove errors that had been left in the electronic record after various events were canceled or happened differently than expected.
.. Ryan Jackson, Mr. Pruitt’s chief of staff, dismissed Mr. Chmielewski’s criticism as a fabrication by a disgruntled former employee. “Whatever he’s telling you about altering calendars is not correct,”
.. Ms. Morris was called last July by two agency lawyers, who told her that the changes she was making to Mr. Pruitt’s schedule might be illegal, according to a person familiar with the conversation. The following month, Ms. Morris noticed that a number of changes had been made to the record of a trip Mr. Pruitt had taken to Italy. Ms. Morris questioned the legality of the changes to Mr. Chmielewski and Mr. Jackson, and a few days later was fired, he said.
.. In another potential violation of federal law, the E.P.A. continued to pay Ms. Morris for six weeks after she was fired from the agency.
.. In July 2017, according to Mr. Chmielewski, Ms. Morris was instructed by him and Mr. Jackson to retroactively delete some meetings Mr. Pruitt held with lobbyists and replace them with staff meetings in the calendar, which was maintained in Microsoft Outlook. He and other people familiar with the calendar also said Ms. Morris was asked not to enter some of Mr. Pruitt’s meetings on the official calendar.
.. Mr. Chmielewski cited an August 2017 meeting with billionaire Denver-based businessman Philip Anschutz, a prominent donor to Republican Senate candidates and owner of an energy company regulated by the agency. Mr. Pruitt’s calendar for that day, which was publicly released, does not include the meeting.
.. including a special tour of the necropolis below St. Peter’s Basilica — as well as one meeting with Cardinal George Pell, a prominent Vatican leader who was then being investigated on allegations of sexual abuse.