The 18-year-old chooses a primary care physician

A local 18-year-old, raised on a steady diet of social justice messages delivered by unionized employees at the public school he has attended, asked his mom for help in choosing a primary care physician now that he has aged out of pediatrics.

Perhaps he didn’t absorb what the school was trying to teach. He told his mother that he didn’t want a female physician or a doctor of color because “they get into medical school easier.”

As it happens, mom is a cisgender female physician of color (Chinese-American, which is “of color” by today’s standards).

Full post, including comments

Why not a one-month shutdown of casual sex?

PeterReed’s comment on Why don’t migrants get COVID vaccines at the border? (which references an Atlantic magazine article by a fat guy complaining that the righteous vaccinated Americans will be paying for COVID-19 treatment for Republicans (mentioned 12X in the article) who refuse to #FollowExperts and take the vaccine):

This future burden from lack of covid vaccine is no different than similar righteous talk about smoking, overeating or reckless lifestyle. It is convenient to bring this objection out now for a certain political view about vaccines, but better not bring it up about drug use or casual sex.

My response:

That’s a great point. : In certain circles of San Francisco, a case of syphilis can be as common and casual as catching the flu, to the point where Billy Lemon can’t even remember how many times he’s had it. “Three or four? Five times in my life?” he struggles to recall. “It does not seem like a big deal.” At the time, about a decade ago, Lemon went on frequent methamphetamine binges, kicking his libido into overdrive and silencing the voice in his head that said condoms would be a wise choice at a raging sex party.

If a hater were to complain that Mr. Lemon should have cut back on his recreational meth and trips to the local bathhouse so that our society’s spending on health care could be reduced, we would all condemn that hater.

Similarly, in

Meanwhile, approximately 31% of chlamydia, gonorrhea and primary and secondary syphilis cases were among non-Hispanic Black individuals, although they accounted for only 12.5% of the U.S. population, according to the report. Men who have sex with other men were also disproportionately impacted by STDs, the report says.

These disparities likely aren’t caused by differences in sexual behavior, but “rather reflect differential access to quality sexual health care, as well as differences in sexual network characteristics,” the report says.


It is fine to shut down schools for a year or more, but it is certainly #NotOK to suggest telling people to have sex with just one other person (or none, in the case of many married individuals; see below) for a month so that everyone could be tested and treated.

I hope that we can all agree that nothing is more important than preventing deadly disease. A month with a single boring partner will be a sacrifice for a happy Tinder user, but, as with American schoolchildren, we should be able to find experts to tell us that he/she/ze/they can make up for this after the shutdown.

Readers: What is the justification for allowing this expensive and destructive plague of STDs to continue? (If the objection is that the shutdown won’t end the plague forever, the same can be said for coronapanic interventions, including the vaccines.)


Full post, including comments

Mass vaccination campaign meets American health insurance (and Happy Freedom Tax Day!)

From my inbox:

An Explanation of Benefits (EOB) has been posted to your *** Plan online member portal. To log into your account and review your explanation of benefits (EOB):

Go to https://****.com/login

Enter your Username (email address) and Password

Click on the Claims tab at the top of the page, choose claims.
Member claims are listed by date, with the most recent claim appearing at the top of the list. To view an EOB, click on the claim you want to view, then click on the pdf icon under View EOB.

(name hidden to protect the guilty)

So an Explanation of Benefits is available from my vaccine shot? Let’s actually log in…

Even if the promised Explanation of Benefits did not exist, there was a page devoted to my Moderna shot. Two claims hit the insurer’s computer systems, one for $0 (the vaccine itself? Which Donald Trump arranged for the government to pay for?) and one for administering the vaccine:

The actual price is $33.50 to deal with me? But why bill $67? This is one of those rare situations in which there is no way to cheat the uninsured by hitting them with 2X or 5X the “negotiated” price that 98% of customers pay.

(Separately, I’m not sure how $33.50 makes this profitable for the clinic. They paid someone to build a web site where I could register and schedule, paid for a receptionist to check me in, paid an RN to ask me some medical questions, paid for a place where I could sit for 15 minutes after the vaccine, paid for people and systems to send this $67 bill to the insurance company, etc. Unless the Feds are giving them additional money for each shot, why do they want to be in this business?)

I wonder if the goal of the American health insurance system is to make our federal tax system seem logical, clear, and simple. Happy Tax Freedom Day to everyone! (filing is extended this year to May 17 #BecauseCoronapanic)

Note that Tax Freedom Day, on which you stop working for the government (pay all of those government workers who sat home for the past year!) and begin to work for yourself varies from state to state. It is May 3 in New York, April 23 in Maskachusetts, and April 20 in California. It was April 5 in Texas and April 4 in Florida. Before World War I, Tax Freedom Day was in January:

As best historians can tell, the American colonists-turned-rebels-and-traitors were paying roughly 2 percent of their total income for all taxes. So they achieved Tax Freedom about one week into January while complaining that being British subjects was oppressive (the Brits, meanwhile, were shelling out huge $$ to fight with “Indians” on all of the borders).

How about going forward? If Presidents Biden and Harris spend $1.9 trillion every few months on coronapanic Band-Aids, would the “deficit inclusive Tax Freedom Day” move to mid-summer, or, for those here in MA, into foliage season?

Full post, including comments

Cost of being continuously stoned: $7,400 per year

From “Medical marijuana patients just got huge win as N.J. court says company must pay injured worker’s bills” (

The New Jersey Supreme Court dealt medical marijuana patients a big victory Tuesday, ruling unanimously that a construction company must pay for an injured employer’s medical cannabis bills.

The decision upheld an Appellate Division ruling from January 2020. That court said Vincent Hager’s former employer, M&K Construction, must foot the monthly bill for medical marijuana he uses to treat injuries he sustained on the job in 2001. As of early 2020, those costs were about $616 a month, according to court documents.

New Jersey’s medical marijuana patients have long complained of high costs. Prices have averaged between $350 to $500 an ounce. The law allows them to purchase up to 3 ounces each month, though most use less.

Only in America could we figure out a way for a literal “weed” to cost $7,400 per year per person!

Full post, including comments

Pharma ads on TV will turn our kids into the biggest hypochondriacs in human history?

I like to limit my TV viewing to content targeted at 5-year-olds, generally streaming and ad-free. However, the kids sometimes hear about a big tennis tournament that is going on and ask to see parts of it. What do they see? About 30 percent of the ads seem to be for drugs that treat medical conditions afflicting older adults. Perhaps this isn’t surprising in a country where health care is 20 percent of GDP (and 40 percent of profits?). Each of these ads leads to a question: “What’s that for?” So they’re getting a much earlier education in all of the ways that the human body can fail than we Boomers did (we saw ads for cars, packaged food, toys, beer and wine, etc.).

I know a lot of people who are 10 to 30 years old and are afraid to leave their homes because of a virus that kills 82-year-olds. I wonder if these folks were already preconditioned to be anxious about their health by the preponderance of TV ads for medication.

I’m thinking that it will be even worse for kids currently 0-10. The only world that they’ve known looks like an Ebola clinic and, in addition to all of the masks, gloves, face shields, obsessive surface cleaning, and shutdowns of which they’ve become aware, they’re spent a lot of time at home seeing TV ads for all of the conditions that were considered serious prior to coronapanic.

Here’s an example…

Lots of good questions for an early reader… “What’s HIV?”, “What’s getting HIV through sex?”, “What’s people assigned female at birth?”

A still frame from the above in case it disappears from YouTube:

Another example:

Full post, including comments

Medicare focuses on end-of-life because we do too?

The death of my father was sad, but it was also illuminating. Relatives who hadn’t paid much attention to my parents for years suddenly sprang into action, on hearing that my father had gone sharply downhill (perhaps coincidentally, but it was one week after the second Pfizer Covid vaccine shot).

People were desperate to show up in person, get on Zoom or FaceTime, or talk on the phone. The neglect of the elderly in America reached a state of perfection starting in March 2020. People who hadn’t visited relatives in retirement homes suddenly had a perfect excuse: #AbundanceOfCaution #BecauseCorona. Even when the inmates were released to meet friends and family on outdoor terraces in masks, the Coronarighteous refrained from visiting (often while posting on Facebook photos of themselves enjoying various activities with other potentially infected humans, going out to get food at/from restaurants #BecauseTooLazyToCook, etc.). All of that changed once my dad slipped toward unresponsiveness.

Apparently I am always out of step with my fellow(?) humans. I was happy to have talked on the phone with my parents every day or two for the preceding 10 years. I was happy that we’d been able to visit them (from Boston to DC) every few months, including amidst “the global pandemic”, over the same period. As it happened, I was also able to be there during my father’s final week, but I didn’t consider that essential or important compared to what had transpired over the preceding 10 years.

Folks often decry the huge expenses that Medicare is willing to incur even when it is obvious that death of the beneficiary is imminent (see “Medicare Cost at End of Life” for some data; as much as 25 percent of spending is during the last year of life). But now I’m thinking that this is a feature and not a bug. If Medicare is a reflection of ourselves and what is important to us, it actually make sense for Medicare to pull out all of the stops when the end is near and certain.

Readers: What have you seen in your own families when the end is plainly near for an older relative? Do folks who’ve not been interested in the soon-to-be-deceased suddenly come out of the woodwork?

Full post, including comments

The idiots who said that marijuana legalization would be the gateway for harder drugs…

For those fools who objected to legalizing marijuana because it would open the door to social acceptance of more harmful drugs…. “This Heroin-Using Professor Wants to Change How We Think About Drugs” (New York Times, April 10, 2021):

Carl L. Hart, a neuroscientist at Columbia University, … confides that he has used heroin regularly for the last four years and describes the time he took morphine daily for three weeks in order to experience withdrawal.

Dr. Hart argued that most of what you think you know about drugs and drug abuse is wrong: that addiction is not a brain disease; that most of the 50 million Americans who use an illegal drug in a given year have overwhelmingly positive experiences; that our policies have been warped by a focus only on the bad outcomes; and that the results have been devastating for African-American families like his own.

Unlike past academic advocates for drug use, like Timothy Leary and Baba Ram Dass, who both experimented with L.S.D. at Harvard University, Dr. Hart rejects as “self-serving” the distinction between so-called good drugs, like psychedelics, and more maligned substances, like heroin and methamphetamine. All, he said, have their place.

What to do with all of the COVID vaccination sites once smart humans have shown the dumb virus who is boss?

A next step, Dr. Hart said, should be setting up testing sites nationwide where users can determine the purity and strength of their drugs — anathema to researchers like Dr. Madras, who say that anything that “normalizes” drug use leads to more use by adolescents — but essential for saving lives, Dr. Hart said.

He held out little hope that such sites would appear any time soon.

But he noted a twist during his time in the field. When he started, his students wanted to explore the dangers of drugs. Now they see more harm in drug prohibitions, he said.

(For the record, I am personally against the War on Drugs because it leads to an expansion of the government in general and the police state in particular. But I do think that alcohol should be cut way back (see Reintroduce Prohibition for the U.S.? and Use testing and tracing infrastructure to enforce alcohol Prohibition?) and I wouldn’t be telling folks to pick up heroin at the Safeway.)

Full post, including comments

Public health, American-style: Donuts at the vaccine clinic

Public Health 101: When confronted with a virus that attacks the obese and unfit, lock people next to their refrigerators for a year.

Public Health 102: When the local government runs a COVID vaccine clinic, make sure that it is amply supplied with donuts.

From a town-run COVID-19 vaccine clinic in the Boston suburbs:

Readers might reasonably ask how many of these health-enhancing items I consumed personally. Answer: zero. I was merely there as driver for a 92-year-old and therefore did not feel that I had earned one. Separately, what’s the process for becoming a volunteer driver in our all-white all-heterosexual town? Look for the rainbow flag and “Black History Month” stickers to find the “Council on Aging” door. Knock and receive a Criminal Offender Record Information (CORI) form to fill out and also a form in which one must supply one’s pronouns and gender ID.

The vaccination process itself was efficient. We arrived at 11:55 am for a noon appointment and were fully checked out by 12:25 pm. My old-but-fit neighbor noted that she hated wearing a mask, but otherwise was happy with her experience.

Readers: Who has vaccination stories to share?


Full post, including comments

Should a rich person on Medicare buy supplemental insurance?

A friend is turning 65. If he can easily afford the co-pays (20 percent for most things), does it make sense for him to buy insurance to supplement Medicare?

From a reasonably wealthy consumer’s point of view, the main advantage of health insurance in the U.S. is that the insurance company will defend against the providers’ attempts to steal via fake rates. See America’s Efficient Health Care System: my $15 bill for a checkup (2010), in which the doctor charges a fictitious $510 fee for a checkup that is actually valued at $83 (the insurance company’s “negotiated rate”). If you don’t have insurance, you will be attacked by the health care industry with rates that are 5-10X higher than what 95% of patients are paying. No other part of the U.S. economy works like this and I am not even sure how it is legal. The fictitious prices aren’t quoted to the patient in advance. How can it be legal to hit someone with a bill for 5-10X the real price after the visit? If you take your car in for dealer service and the dealer can’t reach you to get authorization for replacing the bald tires, the dealer can’t charge you $5,000 for a set of tires that 95 percent of the dealer’s customers are paying $500 for, right?

[Related question: Why is the uninsured rate only $510 for an $83 service? Why isn’t it $5,100, for example? The insurance company will still pay $83 and the uninsured can be pursued for $5,100. There isn’t a better rational basis for $510 versus $5,100 or vice versa.]

So… if this guy and his wife will be on Medicare, which is doing the negotiation dance with providers, if he doesn’t buy supplemental coverage is there any circumstance in which he’ll be exposed to this kind of systemic crime by the U.S. health care industry? Or will Medicare always negotiate a normal rate for him even if he ultimately has to pay whatever Medicare has negotiated? (In the latter case, it doesn’t make sense for him to buy insurance because he doesn’t need the insurance part of the insurance.) Is there any convenience benefit to having supplemental insurance, e.g., one doesn’t get annoyed via mail with $10 or $15 hardcopy bills?

A couple of Medicare beneficiaries and their pup, enjoying a misty day at the beach in Hilton Head, South Carolina (January 2021):

And the South Carolina license plate motto (“While I Breathe, I Hope”), perfect for the Age of COVID-19:

Also of interest from Hilton Head…

Full post, including comments

Why you can’t get vaccinated by your local dentist

A dentist friend (yes, even dentists need friends!) looked into becoming a COVID-19 vaccination center. She’s amply qualified to inject people (“so is a janitor,” says a med school professor friend). She earns her high income by serving a low-income high-risk population so it would make perfect sense for the parents of her patients to come in and get stuck.

What’s stopping her? “It costs $12,000 for the fridge and I don’t think I’d be able to get reimbursed for giving shots. I’m set up to bill for dental services and being able to bill for medical is a whole different procedure.”

(How is it possible to prosper when the patients are poor? Medicaid doesn’t pay quite as much as private dental insurance for any given procedure, but it is common for children on Medicaid to need $10,000+ in dental surgery due to candy+lack of brushing. An upper middle class child might yield a slightly higher payment for a cleaning, but that is the only revenue that can be obtained from treating the upper middle class child.)

Marketing to MassHealth (Medicaid) customers in Worcester, Maskachusetts, a city whose entire economy consists of mining poor people (medical, dental, criminal prosecution and divorce/custody/child support litigation in a magnificent brand new courthouse).

Full post, including comments