Whitcomb: Medicare Claims Review; But Not Here, Please; Rx for Paralysis
Robert Whitcomb, Columnist
Whitcomb: Medicare Claims Review; But Not Here, Please; Rx for Paralysis
“Best of all is to be idle,
And especially on a Thursday,
GET THE LATEST BREAKING NEWS HERE -- SIGN UP FOR GOLOCAL FREE DAILY EBLASTAnd to sip wine while studying the light….’’
From “Against Whatever It Is That’s Encroaching,’’ by Charles Simic (1938-2023), Serbian-American poet
“The screech and mechanical uproar of the big city turns the citified heads, fills citified ears—as the song of birds, wind in the trees, animal cries, or as the voices and songs of his loved ones once filled his heart. He is sidewalk happy.’’
-- Frank Lloyd Wright (1867-1959), famed American architect
(Would he have liked leaf blowers?)
“There are places one comes home to that one has never been to.’’
-- Barbara Grizzuti Harrison (1934-2002), American essayist, memoirist and journalist
A few swamp maples, a couple of dozen miles up north, are turning red, and we’ll soon smell the must of fallen leaves and maybe pick a few wild Concord grapes. Swallows are roosting. Wild grass remains buff-colored because we still need more rain. Some kids trudge along with their book bags. Nice to see that not everything they read is on their cold screens.
Soon we’ll be turning on those desktop light boxes.
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Note that Medicare Advantage costs taxpayers an estimated 22 percent more per enrollee than traditional Medicare.
And now, The New York Times reports, the Centers for Medicare and Medicaid Services will start a pilot program in traditional Medicare with a review process similar to Medicare Advantage’s. It’s called the “Wasteful and Inappropriate Service Reduction Model.’’ As The Times noted, the artificial intelligence companies that would oversee the program “would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections” of claims.
Of course, there are many medically inappropriate and some out-and-out fraudulent claims in this country, which has the highest medical costs in the world and very low rankings for health compared to other developed nations; that will likely worsen with the Trump regime. And partly because few people covered by Medicare or other health insurance challenge what common sense would tell them are exorbitant charges, the taxpayers get huge bills. I have seen bills for treatment of myself that are extreme – say a bill for $3,000 for a 10-minute procedure. The runaway cost of American health care could be braked if more patients covered all or in part by insurance looked closely at their bills and challenged things that looked dubious. But few will bother.
Here's The New York Times story:
Fore!
To no one’s surprise, the Westerly Planning Board, now backed by a state court decision, rejected Winn Properties’ proposal to create a 2,300-unit housing project to replace the well-known 18-hole Winnapaug Country Club; some 30 percent are supposed to fall under that oft-nebulous term “affordable."
Of course, most Westerly folks back the idea of affordable housing – somewhere. But the proposed project would be mighty big for the town of about 23,000, which has a lot of rich people, many of them seasonal and most near or along water, as is the golf course. The richest are in the Watch Hill section. And rich people generally don’t want poorer, let alone truly poor, people near them. Further, they pay big piles of property taxes, drawing the affectionate attention of local officials.
One reason that foes presented for opposing the project was fear of pollution into Winnapaug Pond. But most golf courses, for all their verdant beauty, are sources of much pollution from fertilizers, pesticides, and herbicides.
In any event, I wouldn’t be surprised if the golf course eventually becomes a development of McMansions and/or some big resort spa. Maybe with a nine-hole course to aid marketing.
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I enjoy (to a point!) watching people using, or trying to use, those self-service checkouts to buy stuff at CVS drugstores. The process often takes longer, sometimes much longer, than with a human clerk. But CVS’s aim is to lay off as many people as it can to make Wall Street happy. It’s the American way!
FBI data studied by CNN show that at least 10 cities in states whose Republican governors – to suck up to Trump -- have sent troops to Washington, D.C., had higher violent-crime rates than the nation’s capital. For example, Jackson, Miss., the state capital, had “the nation’s highest homicide rate in 2024 for cities with at least 100,000,’’ the news service noted.
“That’s about 77 homicides for every 100,000 residents, while DC had only about 27.’’
Trump’s aim in sending troops into Washington and other cities in Blue states is to try to humiliate Democrats and, like any hyper-narcissist, show off his power. It might be good prep for declaring martial law.
By the way, you won’t see Trump’s troops in the highest crime part of Washington, D.C. – its southeast. Lousy place for photo ops. It’s better showbiz to show them near famous federal buildings.
Last Tuesday, I saw a PBS documentary about Richard Nixon. I closely watched Watergate unfold from my perch as a junior editor at The Wall Street Journal in New York, where I sometimes wrote the World-Wide column, on Page One, and copy-edited numerous stories about the mess. Of course, I had to put many items in the column about the scandal, as it developed from June 1972 to Nixon’s resignation, on Aug. 8, 1974.
Nixon was power-obsessed, mildly financially corrupt, vengeful and pathologically insecure, though he had some fine foreign and domestic policies, and some idealistic aims. But what struck me most while walking down memory lane last week was how much, much worse the current regime is, soaked in tyrannical ambition, fraud, nonstop lies, treason and using its power for massive self-enrichment, and buttressed by the most sycophantic lackeys in American history. (Some are now hard at work trying to cover up their leader’s activities in the Jeffrey Epstein empire.) Okay, nobody’s perfect….
But then, much of the electorate is more corrupt and less informed now than back then. There’s been a vast expansion of media outlets, first on cable and then on the Internet. But this expansion seems to have served more to spread disinformation, misinformation and confusion in politics than enlightenment.
I increasingly think that Nixon’s successor, the amiable Gerald Ford, should not have pardoned him. He should have been made an example.
The show brought back memories of New York in the ‘70s – in all its grittiness and glamour. I liked working in Lower Manhattan, especially on Sundays. It was a light day in office and hardly anyone was in that part of the city on weekends then. Now lots of people live there. I still haven’t figured out why there was so often the smell of wet stale bread as I walked down Broadway.
During my lunch break, I’d often stroll to The Battery, buy a hot dog with sauerkraut, fend off the seagulls and pigeons, sit on a bench and watch the action on the harbor, off which there was usually a southwesterly breeze, more fragrant than now because much dirtier. The brand-new Environmental Protection Agency hadn’t yet had the time to fully enforce new rules about coastal pollution.
Those of a certain age might feel some nostalgic pangs about “The City’’ while reading Alex Ross’s new tragic-comic semi-autobiographical novel Playworld. It’s the story of an adolescent’s adventures and misadventures as son, brother, student, TV actor, school wrestler and romantic partner of a married woman two decades older than him. Set mostly on Manhattan Upper West Side, it can sometimes be called haunting.
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Will students’ critical thinking and ability to teach themselves how to remember be severely damaged by artificial intelligence? Had those qualities already been badly undermined by the likes of Google? And what happens if Putin or some other dictator decides to take down our electric grids?
Anyway, here’s a less than depressing take on the situation: CLICK HERE.
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The only “security guarantees” that will help Ukraine defend itself from Russia are many more and better weapons. Going forward, they’ll mostly have to come from European Union members. Trump fears and envies mass murderer Putin and has little conception of what it means to be part of “The West,’’ culturally, politically or otherwise. Including those pesky things called human rights and the rule of law.
Of course, the Europeans are animated by the knowledge that Putin would not stop with defeating Ukraine, but would continue to try to re-establish a version of the brutal Soviet Empire, in which he got his start as a KGB operative. That means threatening Poland, the Baltic Republics, Romania and Bulgaria.
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The dictators’ summit in Beijing last week – party like it’s 1938! -- must have made our Orange Oligarch jealous. Fear of missing out! Putin, Xi, Kim, et al., didn’t seem to care much about the nonstop chaotic mix of threats and flattery flowing from the White House.
When in Command, Command
Philip K. Howard, the New York-based civic philosopher, lawyer, author and photographer, has come out with another pithy, common-sensical and psychologically astute book to address the public anger and frustration about the failures and paralysis of government at all levels. That anger and frustration explains more than a little of the harsh populism, much of it fueled by dangerous far-right demagoguery, that has swept the country in recent years.
Yes, I know I’ve promoted my old friend’s books before, but his very unusual take on what ails America leads me to do it one more time. (I should note that I’m not quite as, er, romantic about our country as he is, maybe in part because I ruminate more on its manifold historical hypocrisies and maybe also because I lived abroad for a few years.)
The new book is Saving Can-Do: How to Revive the Spirit of America. Its prescriptions are centered on how to make government far more effective by streamlining the many-layered (and sometimes contradictory) bureaucracies and codes that drown attempts at decision-making in molasses. Crucially, this means giving officials far more authority to get things done on our behalf. This is essential to improve such key services as public education and health care, as well as transportation and other physical infrastructure. In our demands for impossible perfect decisions, we’ve too often ended up with big nothings.
The "when in command, command" leadership principle means when you are in a position of authority, you must take charge and make clear, decisive decisions. But too many honest, hard-working and well-meaning officials have not been allowed to. And the delays caused by regulatory paralysis that result cost taxpayers many billions.
Mr. Howard has noted, “Ironically, the paralytic quest for perfect process has driven officials back to zero process as the only viable way to make timely infrastructure decisions, ‘’ as with {very quickly} fixing I-95 after it collapsed in Philadelphia, in 2023. One wonders why Rhode Island’s Washington Bridge, on Route 195, partly closed since December 2023, won’t be fully fixed until late 2028!
His drolly related encounter with the federal FAST Act, signed into law in 2015 and meant to speed road and rail approvals but hasn’t done so, displays the bureaucratic quandary.
Mr. Howard, a conservative, has some nice things to say about the speed with which New Deal projects were done.
The book, as always with much of Philip Howard’s writing, is filled with examples, current and historical, and seasoned with darkly entertaining and/or maddening horror stories, but also with inspiring stories, such as Success Academy Charter Schools, in the New York City area.
He proposes three major changes: “a new legal framework, a new institution that can inspire trust in ongoing decisions, and a special commission to design the details of these changes.’’ All this is inflected with Mr. Howard’s effort for us to “reclaim morality in American culture.’’ He notes: “While law sets the framework for a free society, moral character within that framework is the basis for trust, and therefore usually a prerequisite for sustained success.’’
You won’t find much “moral character’’ or ethics in the White House these days, but there are many other places with public officials who seek to do the right thing for us. Reform must start at the local and state levels.
Now about those public-employee unions….