Shopping for health insurance on healthcare.gov

Our government has decided that it is okay for a doctor or hospital to charge an uninsured customer 10X what an insurance company would pay for a service. Thus, an American who doesn’t want to pay 10X the fair price and risk bankruptcy has no choice but to sign up for health insurance. He/she/ze/they cannot pay the $25,000 that an insurance company would pay for a serious issue and defer the purchase of a new car. Instead, he/she/ze/they must deal with a bill for $200,000 and aggressive bill collectors and lawyers from the hospital.

I recently decided to see if it would make sense to get a policy from healthcare.gov for our family. There are three big providers in eastern Florida: Mayo Clinic, Cleveland Clinic, and University of Miami. The site has a way to enter these providers and see if they’re in the network for the plan. Here are some of the quotes:

The consumer is supposed to evaluate 174 alternatives, build a spreadsheet and run a Monte Carlo experiment to figure out which is likely to result in minimum spending? You’d be a fool to have insurance that didn’t cover these three networks, as we discovered to our chagrin last year with Humana. Healthcare.gov offers to help you register to vote, but it doesn’t offer to limit results to insurance policies that will pay these essential providers.

I thought that Blue Cross had deals with everyone and yet this $66,000+/year policy ($72,000 including the out-of-pocket maximum) is presented as not covering any of the places that you’d want to go if you needed a specialized specialist:

Perhaps we could work it from the other side? Here’s what Mayo Jacksonville says they’ll take:

The consumer is supposed to recognize, therefore, that Mayo takes “Aetna” and “Blue Cross Blue Shield” but not the versions of “Aetna” and “Blue Cross” that are sold on healthcare.gov? How many people are this sophisticated? Mayo Jacksonville takes “Cigna EPO”, but, according to healthcare.gov, not “Cigna Connect 900 EPO”:

As Obama said, if you like your doctor you can keep your doctor so long as your doctor doesn’t work at any of the good clinics or hospitals in the nation’s third largest state. I scrolled through all of the 174 plans and never found one that covered more than University of Miami (and that was rare).

Maybe this is peculiar to Florida? Friends in Maskachusetts who had been paying $30,000 per year to Blue Cross (in pre-Biden dollars) switched to MassHealth (Medicaid; there was an income test, but no asset test on the MA signup web site) and found that their choice of doctors was much wider. That seems to be the case in Florida as well. Mayo Clinic is happy to accept Medicaid. Cleveland Clinic says they take Medicaid. University of Miami takes Medicaid. In other words, Americans have voted to set up a system in which a person who works and pays $72,000 per year for health insurance has inferior access to health care compared to what someone who has never worked enjoys.

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Breakthrough technology according to MIT: “Abortion pills via telemedicine”

The smartest people in the world have put together their list of the 10 most important “breakthrough technologies” of 2023. This appears in the Jan/Feb 2023 issue of Technology Review, published by MIT:

There’s been no change to how life-saving abortion care is delivered into a pregnant person’s body, but being able to get abortion care pills after a text message conversation is a “breakthrough technology.”

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The CDC supports my neo-prohibitionist philosophy

Loyal readers will remember that I’ve long been an advocate of alcohol prohibition:

The increased power of government that I noted in 2016 was tremendously amplified between 2020 and 2022. Americans are much less tolerant of the negative effects of alcohol (sexual assault, other violent crimes, death) than ever before and coronapanic showed that there is almost no price that Americans are willing to pay in an attempt to save even one life.

Readers have heaped scorn on my dream. Yet this month fair Science is on my side. “Estimated Deaths Attributable to Excessive Alcohol Use Among US Adults Aged 20 to 64 Years, 2015 to 2019” (CDC employees are the first two authors).

The estimates in this cross-sectional study of 694 660 mean deaths per year between 2015 and 2019 suggest that excessive alcohol consumption accounted for 12.9% of total deaths among adults aged 20 to 64 years and 20.3% of deaths among adults aged 20 to 49 years. Among adults aged 20 to 64 years, the proportion of alcohol-attributable deaths to total deaths varied by state.

These findings suggest that an estimated 1 in 8 deaths among adults aged 20 to 64 years were attributable to excessive alcohol use and that greater implementation of evidence-based alcohol policies could reduce this proportion.

(Note that this doesn’t cover the lockdown years in which Americans pounded back way more alcohol in response to governors making it illegal to work and “essential” to sell and buy liquor. Presumably the percentage of young people killed by this chemical menace is even higher now.)

The death count is shocking:

an estimated 12.9% (89 697 per year) were attributable to excessive alcohol consumption

In terms of life-years lost, this is far more than are taken away by SARS-CoV-2 because a person 20-64 has many more years of life expectancy than a person whose death was tagged as COVID-19-related (median age 80-82). And this CDC study didn’t even look at those over 64 who are killed by alcohol consumption. I’m sure that there are plenty! (A CDC web page says more than 140,000 total among all ages.)

I trust and hope that everyone had a safe and alcohol-free Thanksgiving!

And if Thanksgiving depressed you because you learned that some of your relatives do not support President Biden’s inflation reduction system, his transfer of student loan obligations to those who did not attend college, and his support for Science-based COVID policies… “Tequila Fixes Everything,” a Jupiter, FL restaurant reminds us:

As a reminder of the potential economic savings of Prohibition, discount red wine at Costco (Waltham, Maskachusetts 2013), below. Note that these are pre-Biden prices:

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The Brits don’t love the world’s best health care system

From a bookstore in Kensington:

A Guardian review says it is all about the death panels:

Side Effects forces us to face up to – rather than ignore or deny – the realities of balancing the vast sums that can be spent on a single, seriously ill patient against the “distressing conditions in which many frail and elderly people live out their final years, often as a result of lack of adequate funding”. It is all too tempting, Haslam recognises, to dismiss as abhorrent the act of attaching a price tag to a person – as though their worth can be measured in pounds and pence. A human life, surely, is priceless? No amount of mere money or stuff comes close? But anyone who is actually involved in the real, messy world of healthcare knows full well this is nothing but rhetorical posturing.

Later that afternoon I was talking to a guy who is married to an emergency medicine doc in London. With the cost of living adjustment, she can expect to earn 80,000 pounds per year (i.e., $80,000!) after 15 years of slavery for the NHS (age 40). “A train driver will earn more,” he noted, “because their union is actually effective.”

Who is smarter than the Brits for running a universal health care system that doesn’t bankrupt everyone? Africans! “Middle class Nigerians who need any kind of advanced medical treatment will come here on a tourist visa,” my friend explained, and go straight from Heathrow to an NHS hospital. Once they’re in the system they get treated just like anyone else. After consuming what might be hundreds of thousands of pounds in services and recovering, they go back to Nigeria.”

What else did they have in the bookstore? It’s “smart thinking” to fight structural racism:

An American hero who inspires Biden voters can also inspire the British:

Although the age of consent in the UK is 16 (e.g., a 16-year-old could consent to have sex with a rich guy after a Gulfstream flight to somewhere luxurious) and prostitution is a legal career for an 18-year-old, the British are apparently shocked about what Jeffrey Epstein was allegedly up to:

Anyone who isn’t a cisgender heterosexual white male is in trouble:

England was saved from German invasion by women of color who were willing to risk their lives in combat while white men relaxed in the safety of their country homes:

Despite the fact that some heroines exist, the entire Earth is, literally, toast because of those who Deny the Science (i.e., unlike World War II, this is not a war that can be won by women alone):

An entire section of the front of the bookstore was devoted to a personage who by right should have been King of England and was denied this position purely on account of her gender ID:

Circling back to the British health care system… if we aren’t willing to use death panels or at least a quality-adjusted life year calculation the way that the Brits do, how are we going to keep health care from growing to consume 25 percent of American GDP (a shrinking quantity in the aggregate and, since the population continues to grow via immigration, an even more dramatically shrinking quantity on a per-capita basis)?

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Science in the US, Denmark, and the UK

The US has a history of enthusiasm regarding whatever is new and shiny from the pharmaceutical industry (see Book review: Bad Pharma, about a book by a British doc). So it isn’t surprising that the CDC recommends emergency use authorized COVID-19 booster shots for anyone 5 or older:

People ages 5 years and older are recommended to receive 1 bivalent mRNA booster dose after completion of any FDA-approved or FDA-authorized monovalent primary series or previously received monovalent booster dose(s). This new booster recommendation replaces all prior booster recommendations for this age group.

Note that the difference between FDA-approved and emergency use authorized is now irrelevant. The CDC also recommends flu shots for all Americans 6 months and older.

Let’s check in with Science in Denmark. The COVID-19 shots are recommended for those age 50 and older. What about the flu vaccine, that cornerstone of American public health? Denmark says it is for the old and the young:

We recommend influenza vaccination for everyone aged 65 and over as well as for persons with certain chronic diseases, children aged between 2 and 6, pregnant women in the second and third trimesters and staff in the healthcare and elderly care sector and selected parts of the social services sector.

Let’s go to the UK and see what Science has decided there. The flu vaccine is for those 65 and older and also children from 2 to the end of “primary school” and, depending on how much they have left over, maybe some child in secondary school (Science is all about the leftovers!). How about the miracle COVID shots? A “1st booster” for those 16 and older and “seasonal booster” for those over 50.

As a humble engineer, of course, I cannot say which of the policies described above is best. But I am capable of noticing that they’re different, which is not what one would expect for policies for which a Scientific basis is claimed.

Maybe we should celebrate diversity, as London did in 2015:

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Feel better about your next colonoscopy: you’ll die in a state of grace

Let’s see how the War on Cancer that Richard Nixon started is going… “In gold-standard trial, invitation to colonoscopy reduced cancer incidence but not death” (STAT):

For decades, gastroenterologists put colonoscopies on a pedestal. If everyone would get the screening just once a decade, clinicians believed it could practically make colorectal cancer “extinct,” said Michael Bretthauer, a gastroenterologist and researcher in Norway. But new results from a clinical trial that he led throw confidence in colonoscopy’s dominance into doubt.

The trial’s primary analysis found that colonoscopy only cut colon cancer risk by roughly a fifth, far below past estimates of the test’s efficacy, and didn’t provide any significant reduction in colon cancer mortality. Gastroenterologists, including Bretthauer, reacted to the trial’s results with a mixture of shock, disappointment, and even some mild disbelief.

… So Bretthauer, of the University of Oslo and Oslo University Hospital, and several colleagues started one a decade ago, recruiting more than 80,000 people aged 55 to 64 in Poland, Norway, and Sweden to test if colonoscopy was truly as good as they all believed. Roughly 28,000 of the participants were randomly selected to receive an invitation to get a colonoscopy, and the rest went about their usual care, which did not include regular colonoscopy screening.

The researchers then kept track of colonoscopies, colon cancer diagnoses, colon cancer deaths, and deaths from any cause. After 10 years, the researchers found that the participants who were invited to colonoscopy had an 18% reduction in colon cancer risk but were no less likely to die from colon cancer than those who were never invited to screening.

Five colonoscopies will cost our society (private insurance or Medicaid/Medicare) about the same as 5 cruise vacations. Is it still worth getting 5 colonoscopies before finally dying (maybe of colon cancer)? Wouldn’t we be better off if we invested these resources in something enjoyable? “Pfizer CEO Albert Bourla tests positive for Covid-19 again” (CNN) can inspire us. His reported COVID-19 symptoms were exactly what same-age rednecks who never got any shots or pills reported. However, unlike the rednecks, he followed the Science and, pumped full of multiple “vaccine” shots and an experimental pill, went through COVID-19 in a state of grace.

Now colon cancer screening can go through the same statistical mill as breast cancer screening via annual mammograms. Here in the U.S. we convinced ourselves that annual X-rays were helpful. Then we realized that the improved 5-year survival rates for breast cancer were primarily due to treating “patients with breasts” (formerly known as “women”) for cancer when they didn’t have cancer. Since these victims of overdiagnosis never had cancer to begin with, they were unlikely to have died of cancer 5 years later. “Benefits and Risks of Mammography Screening in Women Ages 40 to 49 Years” is a 2022 article explaining the settled Science:

The American College of Obstetricians and Gynecologists (ACOG), American College of Radiology (ACR), American Cancer Society (ACS), National Comprehensive Cancer Care Network, and U.S Preventative Services Task Force (USPSTF) all reach different conclusions about when and how often to recommend screening mammography. Each organization places different relative weights on the benefits and risks of screening and uses different standards for evidence.

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Science helps a depressed teenager

“This Teen Was Prescribed 10 Psychiatric Drugs. She’s Not Alone.” (New York Times, yesterday):

One morning in the fall of 2017, Renae Smith, a high school freshman on Long Island, N.Y., could not get out of bed, overwhelmed at the prospect of going to school. In the following days, her anxiety mounted into despair.

Given the constant doomsaying of the NYT, wouldn’t the above be a sign of mental health, rather than of mental illness? Ms. Smith was informed that the Earth was melting and that her home in Long Island would be reclaimed by the ocean. Ms. Smith was informed that U.S. democracy was at an end and that Donald Trump would be ruling as a dictator indefinitely. Only a fool wouldn’t be anxious and desperate after reading these truths.

Intervention for her depression and anxiety came not from the divine but from the pharmaceutical industry. The following spring, a psychiatrist prescribed Prozac. The medication offered a reprieve from her suffering, but the effect dissipated, so she was prescribed an additional antidepressant, Effexor.

A medication cascade had begun. During 2021, the year she graduated, she was prescribed seven drugs. These included one for seizures and migraines — she experienced neither, but the drug can be also used to stabilize mood — and another to dull the side effects of the other medications, although it is used mainly for schizophrenia. She felt better some days but deeply sad on others.

Her senior yearbook photo shows her smiling broadly, “but I felt terrible that day,” said Ms. Smith, who is now 19 and attends a local community college. “I’ve gotten good at wearing a mask.”

Here’s her list of meds:

Let’s keep in mind that these are the same folks who say that they can tell when it is time for a teenager to transition, via drugs and irreversible surgery, to a different gender ID (from among the 74 recognized by medicine). And their brothers, sisters, and binary-resisters in other branches of medicine claim to know when it is time to shut down schools, forbid those who aren’t employed in marijuana stores from going to work, order the general public to wear masks, force people to take experimental drugs, etc.

This story, at least, seems likely to have a happy ending:

Her definition of success has changed. too. Whereas she had once thought about “being a doctor or a lawyer or things like that,” she said, now she works in a plant nursery and is applying to a four-year college with a focus on environmental and wildlife sciences.

“I like working with my hands,” Ms. Smith said. “I don’t want to work at a desk, and that’s what I thought I should be doing.” She added, “I’m not the same person that I was a year ago.”

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A gathering of 20 kindergartners was a Scientifically unacceptable public health risk…

…. but Science doesn’t have a problem with an upcoming gathering of more than 275,000 mostly shirtless adults at Southern Decadence (September 1-5, 2022). Neither the CDC nor Louisiana’s public health officials, who eagerly shut down the New Orleans Public Schools, have made any attempt to shut down this event due to the potential for spreading SARS-CoV-2, monkeypox, and any other viruses that can spread from one shirtless human to another.

Science closed the Atlanta kindergartens as recently as January 2022 (NYT), but Science will soon welcome 100,000+ adults for all-day/all-night parties during Atlanta Black Pride.

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Is the CDC running a bathhouse?

Everything that the CDC says or does is, by definition, scientific. Science requires that hypotheses be tested and data gathered. The CDC is now offering scientific advice on how to have sex in group settings without contracting monkeypox. Ergo, the CDC must either be running its own bathhouse or gathering data in a bathhouse run by others. Let’s look at “Safer Sex, Social Gatherings, and Monkeypox” (CDC, August 5):

Spaces like back rooms, saunas, sex clubs, or private and public sex parties where intimate, often anonymous sexual contact with multiple partners occurs—are more likely to spread monkeypox.

Unless the CDC is running a bathhouse, how has it determined, scientifically, that the bathhouse lifestyle is more likely to spread monkeypox than some other lifestyle?

Condoms (latex or polyurethane) may protect your anus (butthole), mouth, penis, or vagina from exposure to monkeypox. However, condoms alone may not prevent all exposures to monkeypox, since the rash can occur on other parts of the body.

Where is the CDC doing its scientific testing with condoms?

Consider having sex with your clothes on or covering areas where rash is present, reducing as much skin-to-skin contact as possible. Leather or latex gear also provides a barrier to skin-to-skin contact; just be sure to change or clean clothes/gear between partners and after use.

Has the CDC tested washed versus unwashed leather and latex gear to determine, scientifically, if the suggested cleaning makes a difference? Where has the CDC done the experiments of a leather party versus a non-leather party and a clothes-on versus a clothes-off party in order to have a scientific basis for the above statements?

A rave, party, or club where there is minimal clothing and where there is direct, personal, often skin-to-skin contact has some risk. Avoid any rash you see on others and consider minimizing skin-to-skin contact.

The CDC has done experiments with laypeople and discovered that they are able to recognize rashes in dimly lit clubs? If it doesn’t run its own bathhouse, how can the CDC know that “see and avoid” is an effective means of avoiding monkeypox?

Separately, what would the CDC’s bathhouse be called? All of the people on the “Meet the Staff” page appear to identify as “women”. Would it make sense to have a bathhouse for the 2SLGBTQQIA+ named after a woman?

I already suggested that “Karen’s” be the name of a restaurant chain in which masks and vaccine papers are required. So the CDC bathhouse can’t be named after those who would seek to keep others on the path of righteousness. The CDC is headquartered in Atlanta and is run by the Feds. Combining that fact fact with the above text, how about “Sherman‘s House of Latex”?

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Should we not pay rent due to the COVID-19 public health emergency…

… or should we instead not pay rent due to “Biden administration declares the monkeypox outbreak a public health emergency” (CNN):

The declaration follows the World Health Organization announcement last month that monkeypox is a public health emergency of international concern. WHO defines a public health emergency of international concern, or PHEIC, as “an extraordinary event” that constitutes a “public health risk to other States through the international spread of disease” and “to potentially require a coordinated international response.”

Some cities and states, including New York City, San Francisco, California, Illinois and New York, have already declared monkeypox an emergency, allowing them to free up funding and resources for their responses to the outbreak.

On Tuesday, President Joe Biden named Robert Fenton as the White House’s national monkeypox response coordinator. Fenton — a regional Federal Emergency Management Agency administrator who oversees Arizona, California, Hawaii and Nevada — will coordinate the federal government’s response to the outbreak.

Monkeypox can infect anyone, but the majority of cases in the US outbreak have been among men who have sex with men, including gay and bisexual men and people who identify as transgender. Close contact with an infected individual is required for the spread of the monkeypox virus, experts say.

Concentrating on that last paragraph, now that Science has declared an emergency, should we start wearing protective cloth masks on visits to the local bathhouse?

Separately, one of my most COVID-concerned Facebook friends has been posting images of himself and his wife, fully masked, at a 70,000-person indoor board game convention. Apparently, there was a one-hour process for scrutinizing vaccine papers (Science says that there is no way to transmit a SARS-CoV-2 infection if a person has been injected with proven-by-Science COVID-19 “vaccines”). The same guy posted some rage against convention attendees who did not Follow Science by attending a 70,000-person indoor event while wearing a mask of some sort:

This guy and similar are endlessly fascinating to me. He is concerned enough about COVID-19 to wear a mask and post about others’ mask-wearing. But he is not concerned enough about an aerosol respiratory virus to refrain from attending a 70,000-person indoor event that attracts diseased individuals from all around the world.

Finally, when will the CDC announce a hangar rent moratorium? That’s the kind of COVID-19/monkeypox relief that I feel would be most beneficial.

Related:

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