ControlsFreak
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User ID: 1422
ControlsFreak
1yr ago
That some providers sometimes drop some charges is pretty irrelevant to either the question of whether there is any meaningful legal risk to providing price estimates or the question of whether it is socially good for them to do so. If, as the good doctor says, there has never actually been a case of a patient suing a provider because an estimate didn't match the ultimate bill, then the liability concern is fake. It's fake even if they sometimes drop some charges because of their fake worry for a fake concern. Honestly, I can't even see what legal theory one would try, because it's so incredibly easy and obvious how to make estimates in a way that doesn't produce any legal liability. Basically every other industry that has estimates does it just fine.
Just a heads up, though, this is just part of the gish gallop. There are seventeen other fake reasons doctors give for why they can't provide prices. And frankly, just like with a Holocaust denier, you can spend your time focusing on one or two of them, really showing that they're totally fake, and then they'll just shift to some of the other ones for the next week or so, and in two weeks, these ones will pop right back up, as if nothing was ever said on them.
ControlsFreak
1yr ago
Ok, so it is a totally fake "liability concern", and to your knowledge, no patient has ever sued a provider over a bad estimate. Care to weigh in on whether you think this commonly happens in other industries where providing estimates is routine?
You're sort of running out of excuses to not provide prices if you're all the way down the list to fake "liability concerns".
ControlsFreak
1yr ago
ROFL. You got me. Oh boy, did you get me. It uses the term "specific selectors" and often just the unqualified "selector" to refer to them. I see just how much you weigh being intentionally obtuse versus actually understanding how things work.
So now that we've all had a little laugh, perhaps you could now describe what you think specific selectors are and what their role is in the program? And perhaps try to be serious this time, moving the conversation toward a shared understanding of how the world works.
ControlsFreak
1yr ago
I would expect that most people who get into the military or intelligence game (or, frankly, politics) have to at some point wrestle significantly with morality/their soul. Taking a brief look at his career on Wikipedia, I wouldn't be surprised if "didn't blow a classified program when a Senator went rogue, but still obviously kept the public representatives informed" didn't rank in the top ten of situations where he might have thought there was moral difficulty in doing what he thought was in the interest of protecting you and yours.
I should at some point note that I'm saying this as someone who detests his politics. Honestly, some of the political stuff he did was significantly worse than "not blowing a classified program when a Senator went rogue, but still obviously kept the public representatives informed".
Now, you're telling me that you've read the PCLOB report on the program that collected the contents of internet communications, the program that is the subject of this conversation, and you can't find anything about specific selection terms in it?
EDIT: Remember, you had said that the role was, "Nothing".
ControlsFreak
1yr ago
Senate Intelligence Committee
It's good that you're aware of who this was. Now think about it for a minute. Clapper was the Director of National Intelligence. In that role, he would have routinely given classified briefings to the Senate Intelligence Committee. I don't believe that anyone has ever claimed that he ever lied to them in any of those briefings. Those classified briefings are for the purpose of informing SSCI on what's actually going on.
This briefing was different. It was an unclassified, public briefing. The purpose was not to inform SSCI, especially not to inform them about classified matters. One might honestly wonder what the point of it even was... or whether it's even almost a contradiction in terms to have an unclassified, public briefing on covert intelligence programs. So when you think about it, you realize that the point of this briefing was not to inform SSCI about what's going on; the point of it was for the government to sort of get together and try to somewhat inform the public about what's going on. Doing so on a covert intelligence program sort of requires that everyone plays well together to inform on the things that "should" be publicly revealed, while avoiding things that "should" stay classified and secret.
Of course, the rub is that folks might have different perspectives on "should". Perhaps Wyden genuinely thought that it "should" become public. But the fact of the matter is, from Clapper's seat, it was classified. I think almost no theory of how the government should operate is such that it should be really relying on him to make that determination on his own. Yes, he has Original Classification Authority, but in reality, that's still pretty limited. For matters concerning significant programs like this, frankly, he shouldn't be out on his own in up and deciding to declassify it in the middle of a random briefing. That sorta thing should mostly be a matter for the President, possibly in consultation with folks like SSCI, with plenty of secret deliberation before pulling the trigger.
As such, Wyden was basically the turd in the punchbowl, preferring to pursue his own vision of "should" over the purpose of what those sorts of hearings are about. That's fair enough; he's a Senator. But it makes it more difficult for future such hearings to do the job as intended; if there's a real concern that even a single Senator will go rogue, I imagine they're probably going to pull back and be less informative generally.
I think the follow-on of what happened afterward is mostly just noise; again, there's no doubt that SSCI received the correct answer, both before and after this one briefing. They certainly already knew exactly what these programs were doing; they certainly had already gotten classified briefings telling them such; afterward, I highly doubt anyone had any real claim to having been misled... except of course, if you're a Senator talking the press, trying to drum up votes for yourself or trying to make something that is classified unclassified. Wyden even gave up the game with responding to it with a request for DNI to officially correct the public record (that is, put classified information in the public record).
It's hard to tell if Wyden genuinely thought it should be public, but didn't want to take the hit of actually revealing it himself... or if he was just trying to figure out a way to drum up more votes by playing the anti-SIGINT character. Whereas it's much easier to figure out that Clapper was just trying to keep classified stuff classified, play along with the supposed point of such an unclassified briefing, and then ultimately end up scrambling to perform damage control from such a bizarro event.
ControlsFreak
1yr ago
Nobody who understands banking thought at the time that banks were making sensible commercial decisions to debank gun shops...
"Online smut generates high chargeback rates" is, among banking risk and compliance professionals, a notorious fact that no longer requires a citation. "Gun shops generate high chargeback rates" is something that would be surprising, if true. (AFAIK, it isn't, and the regulators pushing Chokepoint didn't claim it was).
Yup. They went with "reputational risk", which is overtly admitting that the only 'problem' that could be in play is that some people would disapprove of the banks doing business with gun shops. One may still not think that "online smut generates high chargeback rates" is a sufficient reason to pull back, but it's genuinely a qualitatively different type of reasoning, and the two cases don't really stand/fall together by analogy.
ControlsFreak
1yr ago
I'm not aware of any laws typically preventing someone from answering the question "Do you beat your wife?".
True, but irrelevant to the point. I'll ask again. Do you beat your wife? Is the correct answer to that, "I cannot answer that"?
ControlsFreak
1yr ago
Charitably, your comment is acknowledging that there is a difference between the CDR program and the program that collected the contents of internet communications. Moreover, your comment acknowledges that this conversation is about the program that collected the contents of internet communications. To all of this, I agree.
Now, you're telling me that you've read the PCLOB report on the program that collected the contents of internet communications, the program that is the subject of this conversation, and you can't find anything about specific selection terms in it?
ControlsFreak
1yr ago
The foreigners are the ones on foreign soil. The Fourth Amendment attaches to people.
Congress gave retroactive immunity to telecoms for potential violations of statutes. Congress can provide such immunity with a further statute. Congress cannot, with a further statute, simply provide an exception to the Fourth Amendment. So, the 4A question remains separately.
ControlsFreak
1yr ago
Do you beat your wife? Is the correct answer to that, "I cannot answer that"?
lying to Congress
This is pretty loaded terminology. Is it "lying to Congress" to say one thing about a classified program in a public Congressional forum and then give to Congress the correct, classified answer thereafter? Has Congress been lied to? Like, I get it. You're wanting to say that he lied to the public, and that may be true and scandalous, but it still doesn't sound as bad, so you have to juice it up a bit.
under oath
As I wrote here, when I tried to trace back this claim, I couldn't find good evidence for it. TBH, I think it would be kind of unusual for people to be under oath in those types of hearings.
ControlsFreak
1yr ago
The Ninth and Second Circuits were both okay with it. Would it be nice to get it up to SCOTUS? Sure. I don't recall if any of those plaintiffs petitioned for cert.
One note is that your analysis actually needs to start a step earlier. They are collecting the contents of communications of foreigners on foreign soil. We have black letter Supreme Court precedent that the Fourth Amendment doesn't apply to them. So, your challenge (which has so far failed in the circuit courts) is to demonstrate that one even needs to parse that text in the first place.
ControlsFreak
1yr ago
Clapper was under oath
I tried to follow this claim back when the event happened. I couldn't find any authoritative source that actually claims it. I even went back and watched the CSPAN feed of the event, and there was no oath taken or shown. But it's sort of meaningless, anyway. He also took an oath to not divulge classified information outside of narrow circumstances.
Clapper is a clown, and I don't care about him generally, but it's a stupid stupid hill to die on to claim that anyone should be put in that situation. Frankly, that's Wyden's fault, and he should know better.
ControlsFreak
1yr ago
Nope. Still wrong. Please just educate yourself on this. I've been over this with you before. There's a nice PCLOB report and everything that detailed how it actually worked. You just need to read it. As a quick check to see if you have read enough to have any idea how any of it works, what is the meaning of "specific selection term" and what role does it play in this supposed "wholesale collection"?
ControlsFreak
1yr ago
wholesale spying on the contents of almost everyone's Internet traffic --- see Snowden, et al
That's not what Snowden showed. Like, not even close.
Clapper lying to Congress about it
Clapper gave the correct, classified answer to Congress after the unclassified, televised to the public, hearing was completed.
However as this is America many places will prohibit providing this type of information as a matter of policy because of the risks associated with doing so (like being sued if the bill is higher than the estimated number).
Cite one example of a provider being sued because a bill was higher than an estimate. Do you think this commonly happens in other industries which provide estimates, even though the final bill might end up higher? (E.g., auto mechanics, plumbers, etc.) Fake "liability concerns" is a common excuse for shady practices in a variety of industries. In fact, it's funny that you bring up realtors, because they definitely bring up fake "liability concerns" for all sorts of shady practices.
It's actually extra funny, because realtors did just last year have a huge, billion dollar lawsuit because of their attempts to hide prices. It resulted in industry-wide practice changes, the largest of which is that they now give people prices up front, in writing.
ControlsFreak
1yr ago
You are correct. I didn't realize that "reddit" looked like it does. I totally just picked "dark" and didn't cycle through a bunch of others to see. I think I'll try "reddit" for a while. Thanks a bunch for the tip and the code!
ControlsFreak
1yr ago
Seven years ago, I saved this @JTarrou comment, for the purpose of remembering to monitor future developments:
The current Republican president is always the worst person in history. The last one is always surprisingly human. The one before that is always a pretty decent dude.
The current Democratic president is Star Trek Jesus with sprinkles, the last one was a corrupt liar who wasted his vast potential, and the one before that was a Republican.
I'd say that Obama is probably still well-regarded, possibly having something to do with some people thinking that he was pulling the strings during the Biden Administration. I'll be interested to watch his future trajectory as years continue to pass, but I do think it might be hard for people who lean left to say much that is negative about the first black president. I suppose I've heard some criticisms from the left that he "was a Republican" in terms of his national security policies, but I certainly don't think I've seen him go through a "corrupt liar" phase. At least not as of yet.
ControlsFreak
1yr ago
Small request from a scientific coder, not a web page coder. In dark mode, the visible change when I upvote a comment is basically imperceptible to me. (I don't think I'm color blind.) Can you whip up what I need to adjust it?
ControlsFreak
1yr ago
If you show up the ED with diverticulitis you could be seen in the ED and sent home with conservative management. You could be put in obs for a day and started on Zosyn and fluids and kept NPO, you could have a perf leading to surgical management, necrosis, and a 3 month hospital stay. Nobody knows any of the numbers associated with this visit until it's done.
What is the number for the next procedure that you are just about to get informed consent for?
Physicians aren't in control of this.
Then you should have no problem supporting a requirement that your employer figure it out.
Health systems aren't in control of this. Most importantly we can't control insurance.
No one has asked you to.
ControlsFreak
1yr ago
I mean, sure? Got any suggestions for how to do that? I don't think, "Do everything you can to make sure patients never get prices," is particularly helpful for that problem.
ControlsFreak
1yr ago
They may send it to a collector. They may also just sue you directly, which is apparently a thing that has been happening more often. One of those things where, sure, if you're flat broke and judgment proof, then perhaps you can 'get away with something'. I was under the impression that you were inclined to disfavor systems that inherently gave free stuff to broke, judgment proof folks and crushed upstanding citizens with assets to lose.
I mean, the patient likely can get the treatment regardless (see also the main NYT article). Doing so with a not-yet-settled pre-auth battle is approximately equivalent to doing so without a pre-auth battle at all.
Also without pre-auth, the patient has more leverage; it's the provider who is on the hook if nothing is done
This isn't really true, though. If they get the treatment without the pre-auth completed and agreed (or none done at all), and the insurer ultimately denies it after-the-fact, the patient still owes the bill. There's still a whole range of things that can occur with the resulting cluster of a negotiation after-the-fact. The only thing that I see that has changed is that services have already been rendered, the patient is now potentially liable for a gigantic bill, and the negotiation for who actually pays what just hasn't happened yet. The patient has even less leverage, because they've already agreed to buy the thing. They almost certainly can't un-buy the thing. They're purely at the mercy of the other parties to decide how much they're going to get stuck paying.
ControlsFreak
1yr ago
I don't think I'm being naive enough to say that the providers and insurers will sing kumbaya and everything will get happily approved perfectly as it should be. As evidenced by the doctor's comments elsewhere in this thread, both parties take every single interaction as a chance to negotiate and improve their take. If anyone has an idea to fix this, I'm all ears. But I'm certainly not counting on it.
Consider the case without the pre-auth. Services are rendered, a bill exists that shall be paid, one way or another. Nothing really stops the insurance company from just saying "no" regardless of whether the policy covers the thing or not... at which point, either the provider will argue with them, or the provider will say that the insurance company said "no" and leave the patient to argue with them if they care to. (Otherwise, of course, they must pay the bill themselves.) But now, all of this happens after the fact. What have we improved?
Instead, the only choice I think we have much hope of making is whether they have to hash out their beef before or after patients have to make decisions that could bankrupt themselves because of the crossfire. I'm certainly open to ideas for reforming pre-auths, so that they get that hashed out before patients have to make these decisions. Time limits, whatever. Any ideas for how to do any better?
Please find that part in the document. It appears that you have not yet read the document. We've made progress in that it seems that you have found it... but you haven't read it.
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