Pluralistic: 02 Jul 2021

doctorow · 2 July 2021 15:56

Originally published at: https://pluralistic.net/2021/07/02/spoil-the-surprise/

Today's links

Nominate for the EFF Pioneer Awards: Who will win this year's Barlow?
Biden admin orders an end to surprise billing: But without legal reform, the next president could reverse it.
I'm Sorry I Haven't a Clue is back: The funniest thing on the radio, anywhere in the world, now in its 75th series.
This day in history: 2006, 2011, 2016, 2020
Colophon: Recent publications, upcoming/recent appearances, current writing projects, current reading

Nominate for the EFF Pioneer Awards (permalink)

Nominations are now open for the EFF's annual Pioneer Awards, AKA the Barlow Award, now it its 30th year!

https://www.eff.org/nominations-open-2021-barlows

The Barlow recognizes people, projects and groups who "have contributed substantially to the health, growth, accessibility, or freedom of computer-based communications. The contribution may be technical, social, economic, or cultural."

Past winners include Aaron Swartz, Chelsea Manning, Citizen Lab, Limor Fried, danah boyd, William Gibson, and many others (including, to my enduring honor and gratitude, me).

Anyone can nominate, and you may nominate more than one person or group.

Nominations close on July 15!

Biden admin orders an end to surprise billing (permalink)

Of all the dysfunctions of the famously cursed US healthcare system, few are so obviously a total scam as "surprise billing." Here's how that works: you go to a hospital (often its ER) that is covered by your insurer, and then, despite this, you get a giant bill. Surprise!

How can a hospital covered by your insurer hit you – and not your insurer – with a bill? Simple. A private equity company has convinced each of the medical professionals you interact with to secede from the hospital's payroll and form an LLC.

The hospital contracts with your anesthesiologist's LLC, your trauma surgeon's LLC, the radiologist's LLC – sometimes the WHOLE ER is amputated from the hospital and then grafted back on in LLC form, under contract to the hospital as a standalone independent business.

Your insurer has a deal with the hospital, but all of these artificial persons that have been Frankensteined together by private equity have no deal with your insurer. What's more, they can charge many multiples of the "negotiated rate" for your care and bill you for it.

So after the ambulance brings you, bleeding and unconscious to the hospital and you wake up and ascertain that they lucked into bringing you to an ER that has a deal with your insurer, you're still in for a surprise. Surprise!

The surprise keeps on coming. First you get a bill from the ER itself as a "facilities fee," like the cover charge at a bar, except it's hundreds or thousands of dollars and it applies whether you got any care at all.

Then you get the radiologist's bill, which might be $12 or $200, depending on some invisible, inscrutable negotiation between their LLC and your insurer. Then comes the aneasthesiologist. Then the orthopedist.

Despite outward appearances and the sign over the door, the hospital isn't a unitary entity. It's a colony organism, a kind of rich Galapagos of intertwined, symbiotic, standalone entities that somehow produce care as an emergent property.

It's like a hollow, rotten log, teeming with independent, variegated lifeforms that trickle bills into your mailbox without end, for months after your trauma, adding up to hundreds or thousands or tens of thousands of dollars.

Even the $12 invoices take an hour to pay as you set up an account with the exotic payment processor that contracts with the chiropodist's LLC, whose website and phone-tree were designed by a GPT-3 procedural dungeon generator.

This is a system of absolute and manifest terribleness, and it's also illegal. US medical practices are legally required to be run by licensed doctors, but the doctors who get sucked into these scams quickly discover that they're only nominally running the business.

The PE "investor" actually calls the shots, and any doctor "owner" who bucks the system gets fired from their own medical practice.

This worked well for PE companies during the pandemic, as they raked in millions in federal PPP loans while slashing doctors' pay and denying medical staff access to PPE.

https://www.nakedcapitalism.com/2020/04/what-wall-street-doesnt-want-you-to-know-about-hospital-emergency-rooms.html

All attempts to end surprise billing, were sabotaged by the PE giants who created it – Blackrock, KKR and co. They were long on surprise billing and spending millions to keep the racket intact was a rational investment.

https://pluralistic.net/2020/02/21/pluralist-a-daily-link-adose-21-feb-2020/#sickening

Surprise billing was a 2020 election issue. The same PE-backed LLCs (who'd cut doctors' pay and demanded billions in bailouts) found vast sums to spend on astroturf campaigns where "patients" insisted surprise billing was great, actually.

https://pluralistic.net/2020/04/21/all-in-it-together/#doctor-patient-unity

And they pumped huge amounts to support the campaigns of ghouls like Richie Neal, whose progressive primary challenger was sidelined via a homophobic smear campaign, and who rode to office on promises of maintaining surprise billing.

https://pluralistic.net/2020/07/13/youre-still-the-product/#richie-neal

For those of us who despaired of ever being shut of this predatory scam, the news that the Biden administration is issuing an interim order barring surprise billing could not be more welcome.

https://www.nakedcapitalism.com/2021/07/biden-administration-issues-interim-rule-barring-surprise-billing.html

"[The rule] bars surprise billing for emergency services and high out-of-network cost-sharing for emergency and non-emergency services… out-of-network charges for ancillary services like those provided by anesthesiologists or assistant surgeons…"

https://www.modernhealthcare.com/finance/cms-bans-surprise-billing

But the rule still offers a chance to do some price gouging. It follows the contours of the No Surprises Act (which passed the House in Dec 2020), "with baseball-style arbitration to settle payment disputes between providers and insurers."

We got hit by a wave of surprise bills last year after our daughter broke her wrist, with dozens of bills totalling thousands arriving in the mail for months after. The experience prompted us to switch from Cigna to Kaiser in January.

Kaiser is as close to the Canadian and British health care I used for most of my life, but every now and again you'll get a reminder that the best for-profit health-care in America is much worse than the state-run care elsewhere.

Just yesterday I got a letter from a private insurance investigator deputized by Kaiser to investigate the circumstances of an "injury" I experienced to see if someone else could be sued or threatened to pay for the resulting care.

Not only is this seven kinds of fucked up, but I don't have a knee injury. I woke up with a mysterious pain in my knee, and, after it persisted for a week, I had a telephone call with a Kaiser doc to determine whether I should be worried. He said it was fine.

The letter from Kaiser's bounty-hunters was plastered in dire warnings to the effect that I'd lose my health care if I didn't cooperate with them in their hunt for someone to terrorize into recouping the cost of this phone-call.

Ladies and gentlemen, the efficiencies of the free market.

An executive order is a nice start here, but we need actual legislative reform.

I'm Sorry I Haven't a Clue is back (permalink)

One of the sweetest pleasures in this life is the astoundingly funny, long-running BBC Radio 4 comedy quiz show, I'm Sorry I Haven't A Clue. It is back for a 75th (!!!) series and:

It.

Is.

Amazing.

https://isihac.net/

I'm Sorry I Haven't A Clue is very hard to describe. Essentially, it's a bunch of mock competitive quiz-show "games" that are both incredibly silly and incredibly weird, and (this is the magic bit), they never get tiresome.

Now, much of that is down to the amazing comedians who use these games as frameworks for hilarious sketches (and, of course, the comedy writers who back them up).

For many years, the show was helmed by the fabulous Humphrey Lyttelton ("Humph") and after his death in 2008, many of us despaired of the show ever finding a suitable person to fill his seat. But after Stephen Fry stepped in, it became clear that ISIHAC had a future.

Today, the show is hosted by Jack Dee, who is so goddamned bone dry in his delivery that you need to apply moisturiser after his best lines. You can listen to his masterful chairmanship in Episode 1, courtesy of the Comedy of the Week podcast:

https://www.bbc.co.uk/programmes/p09mjl7b

The episode features Tony Hawks, Marcus Brigstocke, Vicki Pepperdine (who combines a posh accent with superb delivery and had me doubled over with laughter) and Henning Wehn (a one-man rebuttal to "Germans have no sense of humour).

Two more episodes in the series are now available to stream on the BBC's website:

https://www.bbc.co.uk/programmes/m000x501

Listening to these episodes has me puzzled about how the games can be so durably funny – how "Swanee Kazoo" (two comedians on slide-whistle and kazoo mangle a pop song) can be funny three times in a single episode, and then in many episodes.

https://isihac.net/popup-humpth_trumpet_audio.html

I mean, it's easy to see what makes "Uxbridge English Dictionary" (comedy definitions of English words, often turning on a regional British accent) work – it's the sheer brilliance of the writing, which set up all these slow-burn gags.

https://isihac.net/popup-ued_video.html

But Sound Charades (two comedians obliquely act out the name of a TV show, movie, etc)? That's all in the delivery. How do they get such consistently funny sketches out of this weird bit?

https://isihac.net/popup-sound-charades_video.html

The supreme mystery of ISAHAC is Mornington Crescent, which is literally comedians pretending to play an imaginary board game with farcically complicated rules consisting of reciting London Tube stations until someone shouts "Mornington Crescent!"

https://isihac.net/mornington_crescent.php

It's a scary time. Things are on fire. The Delta variant is raging. New historic and recent atrocities come to light every day. ISAHAC is no antidote to all this, but it is a respite. I can't remember when I last laughed so hard.

(Image: isihac.net)

This day in history (permalink)

#15yrsago Sen. Stevens’ hilariously awful explanation of the Internet https://web.archive.org/web/20060704034735/http://blog.wired.com/27BStroke6/?entry_id=1512499

#10yrsago Peruvian TV station owners held out for bribes that were 100X larger than those received by judges https://fsi.stanford.edu/publications/how_to_subvert_democracy_montesinos_in_peru/

#5yrsago London luxury property prices plummet after Brexit vote https://www.standard.co.uk/news/london/london-house-prices-slashed-after-brexit-vote-a3285731.html

#5yrsago Paralyzed, partially deaf-blind teen with brain tumor beaten bloody by TSA https://www.wreg.com/news/disabled-st-jude-patient-sues-airport-and-tsa-after-bloody-scuffle-with-airport-police/

#1yrago Roller derby's brilliant re-opening plan https://pluralistic.net/2020/07/02/big-river/#derby

#1yrago A grifter's border wall is about to fall into the Rio Grande https://pluralistic.net/2020/07/02/big-river/#god-hates-walls

#1yrago Don't Believe Proven Liars https://pluralistic.net/2020/07/02/big-river/#big-lie

#1yrago 1000+ accidental trigger-phrases for smart speakers https://pluralistic.net/2020/07/02/big-river/#triggered

#1yrago Hong Kong law threatens people all over the world https://pluralistic.net/2020/07/02/big-river/#be-water

#1yrago Unauthorized seat https://pluralistic.net/2020/07/02/big-river/#beemers

Colophon (permalink)

Currently writing:

Spill, a Little Brother short story about pipeline protests. Yesterday's progress: 279 words (8162 words total).
A Little Brother short story about remote invigilation. PLANNING
A nonfiction book about excessive buyer-power in the arts, co-written with Rebecca Giblin, "The Shakedown." FINAL EDITS
A post-GND utopian novel, "The Lost Cause." FINISHED
A cyberpunk noir thriller novel, "Red Team Blues." FINISHED

Currently reading: Analogia by George Dyson.

Latest podcast: Inside The Clock Tower https://craphound.com/news/2021/06/21/inside-the-clock-tower/
Upcoming appearances:

Launch for Neil Sharpson's When the Sparrow Falls (Mysterious Galaxy), Jul 10, https://www.mystgalaxy.com/sharpson71021

Recent appearances:

3D Printing Sci-Fi, 3DPOD:
https://3dprint.com/282547/3dpod-episode-68-3d-printing-sci-fi-with-cory-doctorow/
Big Tech Fix, Feet to the Fire podcast:
https://www.feet2fire.net/e/a-bigtech-repair-kit-cory-doctorow/
The ACCESS Act, Consumer Reports:
https://www.consumerreports.org/digital-rights/an-interview-with-tech-activist-and-author-cory-doctorow-a1943952645/

Latest book:

"Attack Surface": The third Little Brother novel, a standalone technothriller for adults. The Washington Post called it "a political cyberthriller, vigorous, bold and savvy about the limits of revolution and resistance." Order signed, personalized copies from Dark Delicacies https://www.darkdel.com/store/p1840/Available_Now%3A_Attack_Surface.html
"How to Destroy Surveillance Capitalism": an anti-monopoly pamphlet analyzing the true harms of surveillance capitalism and proposing a solution. https://onezero.medium.com/how-to-destroy-surveillance-capitalism-8135e6744d59 (print edition: https://bookshop.org/books/how-to-destroy-surveillance-capitalism/9781736205907) (signed copies: https://www.darkdel.com/store/p2024/Available_Now%3A__How_to_Destroy_Surveillance_Capitalism.html)
"Little Brother/Homeland": A reissue omnibus edition with a new introduction by Edward Snowden: https://us.macmillan.com/books/9781250774583; personalized/signed copies here: https://www.darkdel.com/store/p1750/July%3A__Little_Brother_%26_Homeland.html
"Poesy the Monster Slayer" a picture book about monsters, bedtime, gender, and kicking ass. Order here: https://us.macmillan.com/books/9781626723627. Get a personalized, signed copy here: https://www.darkdel.com/store/p1562/_Poesy_the_Monster_Slayer.html.

Upcoming books:

The Shakedown, with Rebecca Giblin, nonfiction/business/politics, Beacon Press 2022

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