April 2024
Contents
Happenings
April 26 is Arbor Day. Join in the celebration at Red Butte Garden and plant a tree. Arbor Day is sponsored by ZAP and admission is free! April is a beautiful spring time to visit the Garden AND get a free tree seedling of your choice!
Visit the Utah Museum of Contemporary Art exhibit of the Biocrust Project and As the Lake Fades, open through June 1.
Visit the Jane Goodall special exhibit at the Natural History Museum of Utah, open through May 27. Learn about Jane’s groundbreaking work with chimpanzees and her world environment/climate initiatives. While you’re there, check out the new Climate of Hope exhibit.
Expanded Medicare
Path to Universal Health Care Coverage
Lauren Florence, MD
The organization that I belong to, PNHP, which stands for Physicians for a National Health Program, was founded in 1987 with the goal of getting affordable health care coverage for everyone in the United States.
PNHP saw that 70% of health care is paid for with public funds, i.e. Medicare, Medicaid, Veterans benefits, public employee benefits (including State and Federal Legislators), as well as tax deductions for employers to buy health insurance for their workers.
Compared to any of the developed countries in the world, we are paying more. Those other countries cover all of their people. The US does not.
Medicare came into being in 1966 when Congress passed a bill to create it. To expand 2 Medicare, Congress again needs to pass legislation. There is a bill, HR 676, Medicare for All, which has been wending its way through Congress for decades. The intent of HR676 is to expand Medicare to cover all medically necessary services for everyone, automatically, at birth. Under HR676 patients would have free choice of doctor and hospital.
HR676 would institute large scale cost controls (i.e. there would be a negotiated fee schedule with physicians, bulk purchasing of drugs, hospital budgeting, capital planning, etc.) to ensure that benefits are sustainable over the long term.
Medicare pays for health care for every senior and runs with a 3% administrative overhead. HR 676 redirects public funding for health care in the US to Medicare for All. The administrative overhead beyond 3% would be redirected to actual care with no net increase in spending.
In HR676, premiums and out-of-pocket costs are replaced with progressive income and wealth taxes. 95% of Americans would pay less for care than they do now. In April, 2010, President Obama signed the Affordable Care Act. One important feature was the restriction on how much profit the private health care administrators could garner. Under the ACA, these private companies could charge no more than 30% for “administrative overhead”. (Please remember that Medicare operates with a 3% overhead, no profit, no shareholders.)
Before the ACA, the private companies administering health care payments were allowed to extract MORE than 1/3 of every health care dollar for administrative overhead. When the ACA limited the private corporations’ abilities to get large chunks of the $4.5 trillion that goes to pay for Medicare, they made up a new program,
Medicare Advantage, to get a larger portion of that big pot of money. Medicare Advantage is not a supplement to Medicare. A Medicare supplement fills the gaps and holes in the Medicare safety net that were put in as a compromise in order that the bill would pass to create Medicarel A supplement plan leaves Medicare functioning as it has traditionally and then supplements the gaps in care from payments by patients. On the other hand, Medicare Advantage plans take advantage of the patients and providers. These plans take money from the Medicare public funds using various tactics. i.e. Medicare Advantage plans decide who gets paid and who doesn’t. They create restricted panels of providers with which they contract. They don’t pay any provider who is not on the panel or who delivers care outside the state where the MA is incorporated.
With Traditional Medicare (+/- supplements), a patient can go to any provider in the US. The MA plan can contract to pay less to the providers than Medicare pays. About ½ the rural hospitals in Utah are having financial trouble. Medicare Advantage Plans are seeing a rapid increase in enrollment rurally. The hospitals can’t make it on the amount MA pays. Some are closing. Medicare Advantage plans can decide to delay when a provider gets paid just by holding the billing invoice or tossing it out for no reason. Many, many phone calls and repeat invoices from the provider can be required to get payments. Prior authorization is also a delay tactic. Hospitals have tripled the size of their billing departments to deal with the delays.
The MA’s also deny care. Getting them to pay for a covered procedure can be extremely difficult. I signed a contract with Cigna once that said that if I hadn’t been paid in 6 months, they did not have to pay me. An MA plan also upcodes billing codes for both diagnosis codes and procedure codes in order to get paid morel For example, to bill, providers are required to use a standardized billing form. Billing forms use standardized 6-digit codes to indicate what procedure was done and what diagnosis made that procedure necessary.
Upcoding diagnoses is adding more actual codes to the diagnosis OR more complicated diagnosis codes. Metastatic cancer as a diagnosis gets a bigger payment than a small, contained cancer. To upcode a procedure code, the MA plan picks a code for a more complicated procedure, or repair of a bigger injury to send to Medicare for collection. Payment to repair a longer cut is bigger than for a smaller cut. This upcoded payment is not passed along to the provider.
The MA plans also make money using favorable selection. That means MA tries to enroll only the healthy seniors but gets paid, on the capitated system, for the average amount of illness that seniors have. Case in point: One company held the orientation and enrollment for the MA plan on the top floor of a building with no elevator. Who can get to that meeting? Healthy folks who will cost the Advantage plan less than the average patient costs.
They also de-select the sick ones. Anyone in a MA plan who is requiring a lot of care costs the plan money. Those patients are treated to the tactics of delayed and denied payments until they fear that the plan won’t pay for the care that they need. Then they go back to traditional Medicare. About half of Medicare beneficiaries go back to Traditional Medicare in the last year of their lives. Traditional Medicare always pays for a covered procedure.
We have a lot of work to do to get everyone healthcare coverage. PNHP is leading the way.
The Gulf Stream
By Wayne Wilson
The first thing I learned about the Gulf Stream was in high school history classes, that it is a river in the Atlantic Ocean that early European adventurers used to sail to and around the American continents. Recently I have discovered that it is also called the Atlantic Meridional Overturning Circulation (AMOC) because it mixes warm water flowing northward towards the pole where it cools and sinks, which actually drives the Atlantic currents. But an influx of fresh water from the accelerating melting of Greenland’s ice cap and other sources in increasingly smothering the currents.
According to The Guardian “a collapse of AMOC would have disastrous consequences around the world.” AMOC has collapsed and restarted repeatedly during the ice ages that occurred from 115,000 to 12,000 years ago but scientists are very worried about rains that billions of people depend on for food in India, South America, and west Africa. It would likely increase storms and drop temperatures in Europe and lead to rising sea level on the eastern coast of North America. Global Climate Change is a many faceted challenge on numerous fronts.
Born a Skeptic
My Journey to Humanism
By Robert Lane
This month I think I will start to redo, “My Journey to Humanism.” As I mentioned last month, I decided to change it from journey to discovery, in that I didn’t one day after a long journey discover humanism and turn into a humanist. But rather, after about 50 years or so of thinking like a humanist and for the most part acting like a humanist, I was made aware of Humanists of Utah and have been a member since that time. It’s not surprising that I didn’t know about humanism because it wasn’t something discussed or even known about by my Mormon family or even know or talked about in the community back in the 1950s or 60s.
As I mull over my childhood, I remember that I was more interested in Flash Gordon than the Mickey Mouse club. Plus, a friend of mine’s father had a fairly decent telescope that he let us kids use (with some supervision). To actually be Looking at the moon and some of the planets was awesome for me and reinforced my love of science and science fiction. As an adolescent another happening that made me turn to science was a Christmas gift, I received at about age 10. The gift was a Microscope and chemistry set. It came in a metal box with a microscope (which I still have) and some chemicals to mix and have them foam up or turn different colors. One of the mixtures would grow crystals in a few days. It also had some brine shrimp eggs that you could put on a slide with a couple drops of water and then watch them hatch. Amazing! My brother was influential without really trying. He was eight years older than me but he tolerated me if I kept my ands of his stuff. His stuff was the model airplanes he made which were powered with small gas engines. He even had one that was a two-engine craft that won a prize in a contest. Watching him and helping him fly these planes was far more interesting than what most eight-year-old kids were doing.My mother and step-father were devout LDS, so at the same time I was becoming scientific minded, there was what I later started calling the “Sunday Syndrome.” That is, where everyday life gets suspended one day a week and you dress up and go to Sunday school in the morning and then in the afternoon attend sacrament meeting. You had to play the role of a good little Mormon boy destined for a mission somewhere and a temple wedding soon after your mission.
The above accounts, for the most part, the way my mind was heading in a scientific way. Next month I will write about the time in my life (early and mid-teen years) when I began to pay more attention to religion and being skeptical of its claims and deciding it was not for me. Also, next month I plan to start saying a few things about politics and such. Like Donald Trump hocking bibles. Ya can’t make this shit up.
Bye for now.
Cosplay Your Better Self
Chaplain Jared Anderson
“Well if I’m going to dress up as Thor, I’m going to have to hit the gym hard for the next six months!”
One of my favorite things about popular culture and art in general is how it can inspire us and even change our lives. As best as we can tell, the ability to imagine things that don’t exist and then make them real is uniquely human. Foundational to Humanism is the insight that we can imagine a better world, and then work together to make that world a reality.
Back to Thor. This kind of statement is not uncommon in popular culture circles. Undoubtedly influenced by film representations of super heroes, geekdom has become much more mainstream, increasing the power of popular culture to motivate and inspire. It’s worth noting that there are male and female versions of Thor, and adapting fictional characters in many ways is a common element of “CosPlay”, dressing up as a favorite character, often for conventions, and often with a tremendous amount of investment, preparation, and care). Fans sometimes spend months preparing their costumes, which often rival the work of professionals. For other fans, conventions are just a low key opportunity to have fun.
That’s the powerful thing about play–we can engage at a range of levels, from children on playgrounds to the world class athletes at the Olympic games. An odd challenge about being human is that we are often more motivated to play than we are to work! As I read a book about the psychology of belief in unseen agents (“How God Becomes Real,” by T. M. Luhrmann), I was struck by her framing of “serious play”, which I updated in my mind to “rigorous play”. Play bridges imagination and reality, delight and work. When we play, we nurture our relationships and increase our capacity to engage in our real lives, including our work. I believe that in a sense, everything we do within human civilization can qualify as play, each interaction holding its own rules that go beyond the requirements of nature.
Back to Thor, but Thor in the Army. I imagine someone has combined those elements at some point. The soldiers that I talk to have differing responses on my proposal that military is also cosplay. But it undeniably is, right? Military uniforms track levels/ranks, class, assignment, and experience. Most significantly, uniforms impact the way that we behave, and the way that we feel about ourselves.
Not only are uniforms costumes, but the way that we dress from day to day, the way that we present ourselves, is always a costume. We see a standard like “business casual”, and our clothes become an expression of the conversation between that standard and our own preferences. I will share that my personal preference is what I call “tactical Mr. Rogers”–a comfortable and stylish button up and socks along with tactical pants, belt, and combat boots. At a glance, it looks like regular business casual, but two glances reveal the more tactical nature.
I have found that almost always, the next best step toward self-improvement or increasing quality of life is a better, more effective version of what you already love, what you already are doing. We already use clothing to shift from context to context, to remind ourselves of our roles and responsibilities, or the freedom of comfort and fun. It gets even more significant–how we dress not only impacts the way that we feel, it impacts the way we behave, and even the way our minds and bodies work. The placebo effect provides its own superpower. For example, experiments have shown that wearing a white lab coat increases attentiveness and focus, because of the popular associations with lab coats, expertise, and authority. “Enclothed cognition” has been suggested as a term to describe this phenomenon, and draws on both symbolic meaning of clothes and the physical experience of wearing them.
Realizing that we are always in costume can help us in multiple ways. We experience different versions of ourselves. We experience more confidence. We feel connection with others who wear similar costumes. Costumes associated with excellence not only motivate to push ourselves, but increase our ability to do so!
One of my favorite uses of costume is to metabolize stress, grief, and other emotions. I think many of us change into cozy, comfortable clothing as soon as we get home (if you don’t, I highly recommend it). This shift reminds us that we are in recovery mode rather than work mode, that we can be safe in our own spaces. For those of us in high intensity contexts, our work costumes remind us that when we wear those clothes, we are acting in a specific role that is larger than us.
The awareness that we are cosplaying different versions of ourselves reminds of just that, that we are different versions of us in different contexts. This insight can be very empowering. We can change, update, and improve, training ourselves into those better versions like upgrading the costumes we all wear. And if we are into it, we can even look a bit more like our favorite fictional character.
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