Monthly Archives: December 2017

Prove They’re Serious

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Russian President Vladimir Putin and his satrap, Bashar al Assad, want to hold peace talks in Sochi with a view to ending the fighting in Syria.  At least 40 groups in the al Assad opposition demur and are refusing Putin’s attempt.

“We reject this, and we affirm that Russia is an aggressor that has committed war crimes against Syrians,” the statement signed by 40 rebel groups said. “Russia has not contributed with a single move to alleviate the suffering of the Syrian people and it has not pressured the regime it claims it guarantees to move an inch toward any real path toward a resolution.”

These groups would rather continue the UN’s efforts to mediate, even though the UN has been useless futile since its mediation attempt began in 2014.

My suggestion: don’t go running off to the comfort of a resort town as many as 800 miles away from the theater. Putin and his satrap should offer to hold the talks in Idlib or Kobane or Ghouta.  Ghouta even is convenient to al Assad’s capital.

So should the UN’s “negotiators,” come to that, prove they’re serious.

A Thought on Student Loans

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Education Secretary Betsy DeVos is taking steps to redress the Obama administration travesty of a student loan program, but these can only be interim steps and by themselves are entirely insufficient.

Unfortunately, the student loan programs are entirely dysfunctional and want complete revamping. My high-level suggestions:

  1. student loan discharge only via bankruptcy, no special treatment of these loans
  2. let schools and students write their own loan agreements, including interest rates and payback provisions, without Government interference
  3. hold those schools and students to those agreements
  4. if Government guarantees any student loans, do so IAW the following:
  • interest rates charged must be commensurate with the employability and median first-five-year pay of the major being pursued; higher rates for lower employability and median pay. Higher risk loans should pay higher rates
  • in the event of bankruptcy discharge of a loan, the school floating the loan must completely reimburse the government, NLT the following fiscal quarter, for the taxpayer loss from the bankruptcy discharge.

The EPA Failed Again

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Quite apart from the pseudo-science that the Environmental Protection Agency’s previous Administrator, Gina McCarthy, so cynically used to rationalize her agency’s rules, and the frequent eschewing of the cost effectiveness analysis that’s supposed to underwrite or block Agency rules, the Obama administration personnel in management positions in that facility have routinely and for the duration ignored basic security rules and practices.  According to the EPA’s Inspector General,

Hundreds of contractors holding important information security jobs at the US Environmental Protection Agency have for years been working as high-level operators of its computer systems without the appropriate security background checks—a situation the agency is still scrambling to correct.

During all that time, the agency apparently did not even have a complete list of all the “high-risk” positions where detailed background investigations of outside contractors were required.

Among the IG’s findings:

As recently as last February,

nearly 70% of 484 contractors carrying a special, embedded-chip card allowing “elevated access” to EPA computer systems for their work still had not gotten their higher-level background checks.

In one sample,

five of nine contractor personnel were given sensitive access to EPA computer systems without strict background checks, even though they had worked for the EPA “for over five years.”

And

  • “a lack of oversight by responsible offices” within EPA to confirm that background investigations were initiated and eventually completed when contractors got the supposedly temporary right to special access cards
  • conflicting totals among various EPA offices about how many working contractors would require high-level background checks
  • a “breakdown in communication” among various EPA computer system managers and oversight personnel over verification of the checks
  • a refusal on the part of one EPA bureau to provide a listing of personnel who did not even have the special computer access cards but nonetheless still had privileged access to EPA computers.

Note to the IG: offices don’t do anything; the personnel manning those offices do things.  Name names.

Regarding that fourth bullet, it’s a mystery to me why the management personnel running that bureau, blatantly insubordinate as they are, haven’t been fired for cause.

Come to that, the management personnel in those other bullets also should have been fired long ago for their failure to perform, whether deliberate or not.

It’s also a mystery to me why those without the required background checks or clearances haven’t had their accesses canceled.

This is one more reason to abolish the EPA altogether.

The Veteran’s Choice Program

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This is a program that would give veterans the option of going to a private sector doctor in lieu of playing the delay wait game at a Veterans Administration facility, after the veteran has jumped through the requisite VA hoops.  After a political tussle in Congress over increasing/renewing its funding, some additional money was provided.  That additional funding was necessitated because

its popularity depleted the allocated funds more quickly than anticipated. Patient visits through the program increased more than 30% in the first quarter of fiscal year 2017, according to the VA.

Extra points for those of you who can say why the program is so popular.

Despite the success of this limited program, the Progressive-Democrats in Congress want to get rid of it.  Congressman Mark Takano (D, CA), for instance,

argued on the House floor in July that it’s a “mistaken belief that the private sector is better equipped to care for our nation’s veterans than specialized VA doctors.” But while the VA provides high-quality specialized care in certain areas, for the most part veterans’ needs are similar to everyone else’s.

Indeed.  Takano and his fellow Progressive-Democrats just want to maintain control over OPM. It’s a mistaken belief that the private sector cannot care for our nation’s veterans better than specialized VA doctors. As Burgess and Cleland (authors of the piece at the link) note, mostly our veterans’ needs are similar to everyone else’s.

Those few specialized needs unique to a veteran’s particular military history? The VA’s specialists, functioning in the private sector, can deal with those at least as well as they do now, and probably better and faster without the VA’s bureaucratic impediments.

Make the Veteran’s Choice Program functionally universal: privatize the VA, and use its current and what would have been its future budgets for veterans’ vouchers.

Veteranos Administratio delende est.

“Insurance” Costs

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My Medicare-aged wife broke her wrist, which necessitated surgery, and our health plan provider sent us an accounting of the costs involved.  Following are the high points of those costs.  It’s necessary to emphasize that the surgery is relatively routine following a wrist “fracture,” since the wrist is little different from a sack of pig’s knuckles, and where the arm bones, the ulna and radius join the wrist is more of an abutment than a joining.  The “fracture” was more of a slight jumbling of those pig’s knuckles and small breaks of the ends of the ulna and radius; the surgery was to rearrange the knuckles and repair the fractures with a plate and some bolts.  Really quite routine and minor (save the post-op pain and the long recovery time and discomfort); that emphasizes the nature of the costs.

The initial care was in the ER of a hospital not “in network;” the injury occurred, also, 100 miles from home.

ER Service Provider’s bill to the Plan Total cost
(Plan approved)		 Plan paid We paid
Wrist X-ray $342.31 $0 $0 $0
Apply splint $479.34 $0 $0 $0
ER Visit $764.99 $193.01 $115.65 $75.00
Totals $1,586.64 $193.01 $115.65 $75.00

 

Actual treatment:

Service Provider’s bill to the Plan Total cost
(Plan approved)		 Plan paid We paid
Wrist X-ray $33 $873 $8.56 $0
Surgery* $24,691 $1,021 $757 $264
New Office Outpatient $285 $166.51 $143.58 $20**
Follow-up X-ray $94 $30.74 $30.13 $0
Elbow X-ray $102 $27.04 26.50 $0
Long arm splint $132 $90.13 $88.13 $0
Cast supporting splint $125 $12.27 $12.27 $0
Totals $738 $326.69 $300.81 $20

*Two separate charges, for two separate actions in the wrist’s surgery. I’ve lumped them together here.
**Copay

Just summing those high points, here are the totals.

ER Service Provider’s bill to the Plan Total cost
(Plan approved)		 Plan paid We paid
Totals $27,316.64 $2,413.70 $1,182.02 $359

Notice that: the hospitals and the surgeon paid that vast majority of the costs of the provided health services.  Our health plan provider refused to pay them and the health providers were not allowed to bill us under the terms of their contract with the plan provider.  There’s no doubt, too, that the basic charges are inflated to cover those lost costs and the costs these entities incur when patients are uncovered or prove to be scofflaws.

Compare, in particular, the cost of similar surgery—nearly all inclusive—at a cash only (no health coverage plans) hospital in Oklahoma.  While the procedure listed isn’t exactly comparable to my wife’s situation, it’s close enough for this exposition.  The Surgery Center of Oklahoma’s price is $4,300; although the pre-op diagnostics like those initial X-rays are not included in the charge.

Keep in mind, too, that while Obamacare has made this situation far worse (and worsening), this sort of thing has been happening much longer than Obamacare’s existence.

One more thing.  A Medicare patient paying cash for a procedure in lieu of a Medicare plan’s coverage in order to get a lower total cost?  My GP tells me that it’s illegal for her to accept cash from a Medicare plan-covered patient.  I have to be uncovered altogether, beyond basic Medicare A, before she can accept legal tender.

It’s time we moved to a market-oriented system of health care and of health insurance.  See that Oklahoma hospital.