Network information

Loren is a healthcare wonk. He knows this shit cold and he is right, no one in their right mind would think to call the in-network hospital to see if the anesthesiologist would be in-network if a laboring mother to be needed/wanted an epidural.

As other wonks in the tweet stream noted, the best that he could hope for is the hospital to give him a non-binding informational advisory that their anesthesiologists were or were not in network. And even here, the information is incomplete. Many carriers will offer a number of different networks in the employer and individual markets. Some carriers will tell providers that they are in seven of the twelve networks offered. In those cases, the office manager or the billing clerk might be able to tell an interested patient who is trying to effectively shop for planned care whether or not Dr. Smith is in-network for them. Here the system may not be working but it is not flailing around completely in a fireball of fail.

However not all carriers will do this. Instead they’ll send Dr. Smith seven contract amendments for the seven current networks that they want Dr. Smith in. They will never send him the other five narrow network amendments to sign or reject. So when a patient is trying to conform to the system that we impose on them, the billing manager will honestly say “Yep, we take all plans from Mayhew Insurance….” and three months later as the claim is submitted and everyone expects an in-network charge, the patient gets whacked with an out of network bill.

Our provider information systems are designed to fail in a Kafka-Goldberg-Dilbert menage a trois.



#NotallAssholes

Besides either pointing and laughing or cringing and looking at our fellow countrymen with abject fear and uncertainty, what is on the agenda today

#NotAllAssholes



Dumb idea of the week

And this is not even directly related to Trump.

my first response is to ask if Ryan Lizza guzzles anti-freeze for breakfast as this is breathtakingly stupid.

Let’s make a few assumptions that I think are verifiable within reality.

a) Hillary Clinton has in all projection systems been favored to win the White House at all points to varying degrees (except the 538 click-bait now-cast)
b) A Republican appointed or de facto appointed Supreme Court median judge produces significantly different policy and political outcomes than a median Supreme Court justice that represents a typical Democratic nominee.
c) The Clinton campaign is better run than the Trump campaign.

Now let’s make a few more slightly shakier assumptions.

d) The Democratic coalition has good reason to believe it is a dominant Presidential level coalition ( 5 out 6 most recent elections had Dem popular vote pluralities etc)
e) The Republican coalition is a maxed out coalition with significant headwinds due to higher death and lower replacement rates of their core voters compared to Democratic core voting blocks.
f) The Donald is a dumpster fire which excerbates E

In football analytics terms, Clinton is ahead and she can win with a good, productive 8 minute offense of low variance but efficient plays. There is little reason for the Clinton campaign to adopt high variance vertical shots down the field to score when she is already up 9 with a better quarterback and a better defense. Scoring point is nice but running time off the clock and winning field position works almost as well. Interceptions and fumbles would dramatically drop win probability compared to a counterfactual of boring productive plays.

Promising to nominate a typical Republican judge as the median SCOTUS vote in order to try to capture 2% to 5% of the core Republican vote is a high variance play for a Democratic nominee. It could be worth it if the nominee was down 9 points with three months left. But that is not the case. Promising to nominate a Kennedy clone or more likely a Roberts clone may or may not get any Republican votes as a Trump Administration would nominate at least a Roberts if not an Alito clone anyways while it would cause a lot of trouble on the left flank. That could be acceptable if the left flank was legitimately faced with a “this sucks but it is the only chance to avoid the true suckage of four years of Trump” choice but that is not the choice out there.

Therefore this is the stupidest thing I’ve read this week.



Please Proceed, Republicans

More of this please:

The scene on the floor was chaotic when the vote on the convention’s rules was called. The anti-Trump delegates, many of them clustered around the Virginia delegation, began chanting “Dump Trump,” only to be met by chants of “USA, USA.”

Sen. Mike Lee (R-UT) made a motion for a roll call vote, but it was announced that the movement had lost the three of the nine delegations it needed to force a vote. [via Tierney Sneed at TPM]

Jheronimus_Bosch_011

A little more detail from Hunter over at DKos:

After the initial uproar, the Colorado and Iowa delegations walking out, the chair left the podium for 5 or 10 minutes. Meanwhile, there was a lot of lobbying happening apparently. The Chair came back, declared that three of the 9 states that had petitioned for a roll call vote on the rules—their chance to basically “vote their conscience” on Trump—had withdrawn their petitions, and the minimum number of states is six. Sen. Mike Lee of Utah disputes that. He says he heard there are 10 or 11 states with petitions, so there should still be enough states to order the roll call.

 



Got to kill em to civilize em

Or asshole of the week award nomination:

Hmm, isn’t he supposed to be a conservative with a respect for institutions that work even if they don’t work well and a healthy suscipian of outsider experts smashing a system and imposing externally solutions that don’t have internal stakeholder buy-in.

Nope, just Col. Blimp at work.



Satire is alone in the corner now

At some point the Irish bookies will establish a line on the probability that Trump’s entire acceptance speech in Cleveland is “The Aristocrats…”



They Are Who We Thought They Were: Georgia Senator Edition

I know that for some people it is literally impossible to get over their core belief:  presidenting while Black is a mortal sin.  But I have to admit that I haven’t lost all of my capacity to feel shock, outrage, loathing, whenever I hear something like this:

“In his role as President, I think we should pray for Barack Obama. But I think we need to be very specific about how we pray,” Perdue told the audience at the Faith and Freedom Coalition conference in Washington, D.C. “We should pray like Psalm 109:8 says, that says, ‘let his days be few.’”

 That’s a United States Senator representing a former Confederate state praying for the death of the President of the United States, someone who, it need not and must be said, happens to be the first African-American to hold that office.
Those who get the reference — which would certainly include Mr. Perdue’s audience of ostentatiously and ostensibly religious believers — would certainly get the reference in all its full flavor:

8: May his days be few;

may another take his office.

9: May his children be fatherless,

his wife, a widow.

10: May his children wander and beg,

driven from their hovels.

11: May the usurer snare all he owns,

strangers plunder all he earns.

12: May no one treat him with mercy

or pity his fatherless children.

13: May his posterity be destroyed,

their name rooted out in the next generation.

What kind of person wishes on President Barack Obama death and the utter destruction of his family?

Senator Perdue, that’s who.

It’s not just him, of course. Perdue didn’t come up with this “joke” on his own.  Via Wikipedia:

In 2009, the media has reported more widely on its usage in reference to President Barack Obama,[3] by those such as Pastor Wiley Drake.[4]

In January 2010, a Florida Sheriff’s officer was suspended from his force for circling the passage in a bible and scrawling “The Obama Prayer” beside it.[5]

In January 2012, Kansas Speaker of the House Michael O’Neal sent an email quoting Verse 8 to his Republican colleagues that stated:[6]

At last — I can honestly voice a Biblical prayer for our president! Look it up — it is word for word! Let us all bow our heads and pray. Brothers and Sisters, can I get an AMEN? AMEN!!!!!!

Assholes.  Vicious weasels.  The kind of people who claim the mantle of religion, and yet, as Charles Pierce says of Ralph Reed, are all “future timeshare owner[s] in Hell.”

Hieronymus_Bosch_-_The_Garden_of_Earthly_Delights_-_Hell

Senator Perdue does get a gold star, though:  he’s the most senior Republican elected official to offer up this knee-slapper. Remember him every time anyone tries to tell you that Trump is an aberration; that the Party of Lincoln™ would never truly condone his viciousness and vulgarity.

Trump’s only real diversion from GOP orthodoxy lies in his ill-mannered refusal to use the proper codes when spewing bile.

To echo Deuteronomy.  I do not wish their deaths — not Perdue’s, not the rest of the GOP thugocracy who just can’t seem to get past their fear of this president.

No. This is what I want:

I want them to suffer through Barack Hussein Obama’s brilliant post-presidency — and the reality of his successor’s ability to govern, despite her obvious chromosomal deficiencies.

IOW:  May they experience nether probing by oxidized agricultural implements.  (Which I believe is the central message aimed at falsely religious poseurs in Psalm 151.)  In aeternum.

Image:  Hieronymous Bosch, The Garden of Earthly Delights — Hell (inner right wing), between 1480 and 1505.