Shady Practice Sees ERs, Docs Billing Patients Separately


It’s hard to decide which is worse: The fact that this problem exists, or the fact that Congress seems disinclined to fix it.

The problem, as reported on by The New York Times, is being billed after an emergency room visit by the doctor(s) who treated you because, while the visit itself was covered by your major medical insurance, the service of the doctor(s) was not. Why? Because they aren’t employed by the ER, but work there as contractors not recognized by your health care plan.

I ran into an odd variation on that theme some years ago when I went to a certain hospital in White Plains NY for an x-ray – only to be billed, a few weeks later, for the reading of the x-rays, apparently because the x-ray reader was a contractor not recognized by my health care coverage company. (This actually happened on more than one occasion.)

Arguing the absurdity of that situation, because an x-ray is useless unless it is read, I simply refused to pay the bill. ‘Never heard from them again! And rightly so.

My point to the hospital and the x-ray reader was, ‘This is between you; Don’t try to drag me into your territorial dispute or whatever it is. With those ‘others,’ I didn’t play well at all, at least not by their rules.

Health-care billing in the U.S. has become ludicrously complicated, with patients being, for the most part, totally unable to comprehend why they are being billed X for Y service. Consequently, I have developed a not-altogether-fair, very cavalier attitude to the original ‘overage’ bills I receive and all the subsequent follow-up bills from the provider organization and, eventually, one, another or a series of bill collectors: I ignore them.

I assume, at this point, one of three things to be the truth: [1] I’m an exception to the rule, and most people simply pay up – or the system could have collapsed by now (as I’ve been ignoring bills for years!); or [2] the bill collecting system truly is broken, and uncompensated hospitals and and doctors are living on borrowed time; or [3] somewhere in the collection system someone came to the realization that I was either unfairly billed – not a likely possibility, from the biller’s perspective – or mine was a bad debt that needed to be written off.

I consider [3], particular the second possibility under it, to represent the least likely scenario of those I’ve listed. The most likely scenario, I fear, is that the collections system truly is broken. But the billing system is, too, with people being charged outrageous sums for the likes of a couple of aspirins, the equivalent of a consumer level ‘Band-Aid’, or a charge for a television one was too ill to watch.

The likelihood that the latter supposition is correct is pointed to, indirectly, in the Times article, which noted that when the subject patient went to one of those billing him and asked for a reduction in the bill, it was halved! Clearly, it was unnecessarily high in the first place.

But now (not a moment too soon, I imagine you’re thinking), on to the second concern: That Congress seems to be totally disinclined to address an issue that, for complicated reasons, is best dealt with at the national level, as opposed to local ones.

Lloyd Doggett, a Democratic Congressman from Texas, last year introduced a bill that would require hospitals and doctors working in them to be ‘related,’ for billing purposes. (As you’d suspect, the legislative proposal is far more complex than that!) But as The Times put it, “he experienced a ‘healthy dose of indifference’ from his colleagues on the Ways and Means Committee” – the elite group responsible for seeing that money-related bills do, or don’t, move forward to the Congress as a whole.

Doggett plans to reintroduce the bill, but he’ll be doing so into a climate probably more, not less, likely to move the issue along – thanks to party and representative shifts created by the just-past (but hardly forgotten!) elections.

As has been noted elsewhere – a lot of elsewheres – lately, members of the American Congress are great at paying lip-service to serving the public, the people who elect them, but the members of that august body tend to vote where the money is. And on issues such as this one and most others, there are few lobbyists for John Q. Public, but a whole lot (with gobs of money) speaking out in favor of the status quo, or, at the least, again any idea that might upset it.

The patient cited in The Times article was seen by a doctor who “gave him some medication and tests, and let him go.” Shortly thereafter, the guy was billed for $1,620. And that, of course, doesn’t have anything do with what the ER billed and was paid.

The guy’s appeal to the doctor’s private practice, the group that had billed him, was successful, but only to a point:

They knocked half off the bill,” he told the paper. “Which is great. It’s like, would you rather get punched four times or two times? I guess two times is better.

But hardly better than being treated fairly in the first place!


GMO Bill Heads To White House – Why?



With both the Senate and the House of Representatives signed off on it, a much-discussed, somewhat controversial bill concerning the labeling of genetically modified foods is on its way to the White House for signing by President Obama.

The bill has been hailed by some in the food industry and soundly decried by others. And an

‘interactive feature’ in The New York Times last week gave consumers pause to consider how much better off, or wiser, they’ll be (or not) with this or any other GMO-oriented legislation.

The July 11 New York Times piece (cited above) pretty much sums up what consumers need to know, right now, or in the foreseeable future, on the GMO issue. (Spoiler: The issue isn’t as big a deal many would have you believe.)

The problem comes with the concept of genetic manipulation of food, and where it happens in the food chain. At first glance, if you were unfortunate enough to see a ‘modern’ bred-for-cooking chicken in the flesh, as it were, your first reaction no doubt would be, ‘nature would never make something that looks, and is, by design, as physically challenged as this poor creature is’. And you’d be right.

An unfortunately large number of the chickens bred these days for eating – so called ‘food chickens – are a far cry, physically, from their ancestors of half a century ago. They’ve been dramatically ‘modified’ by selective breeding – not by having their genes manipulated. The objective has been to satisfy the public’s desire for white, as opposed to dark, chicken meat, and the best white meat – in terms of quantity and solid volume, is found in the breast. So, chickens have been selectively bred to have enormous breasts – to a point, as The Times interactive feature notes, its “legs can barely support.”

An article linked-to at that point in the ‘interactive’ article goes so far as to describe the selective breeding of chickens – “modern chicken genetics” – as “a form of abuse”: Chickens today, the linked-to piece says, “stagger about, sometimes on splayed legs, or mostly just sit down.”

A good share of the corn grown in the U.S. today is genetically modified so it resistant to the chemical glyphosate, the active ingredient in the Monsanto herbicide Roundup. This gene modification was necessary because Roundup is designed to travel down through a broad spectrum of plants, killing them all the way down to their root system. So, it can  keep corn fields pretty clear of weeds that grab moisture the corn needs, etc. Some think the chemical (glyphosate) is toxic, possibly contributing to the development of cancer, in humans.

But the point of the corn gene manipulation was to enable the plant to defeat the chemical’s objective, and it works. As or more important, though, is the fact that in the course of traveling down through a plant to its roots the glyphosate apparently in no modifies the corn in a way that could be harmful to humans.

(Full disclosure: For the better part of a year, in the mid-1970’s, shortly after Roundup was first marketed, I helped promote it by producing, at Monsanto’s expense, ‘user stories’ from wheat farmers, municipal and state roadside maintenance authorities, NASA, the Orange Bowl, cemetery managers, wholesale plant growers, lawn care professionals, and many others from one side of the U.S. to the other. The articles were placed in trade magazine serving specific trades – and they were glad to get them, because Roundup was, and still widely is, considered to be something of a ‘miracle product’ that cuts labor costs by vastly reducing the amount of time it takes to clear away unwanted plants.

(A Monsanto sales rep I traveled with in Texas told me a story of an instance where a woman complained to him that Roundup was “killing my dogs, my chickens and my kids; Notice the priorities, there, he said.” His response: He pulled out a sample size of the product – a couple of ounces – and promptly drank it! “She all but fainted,” he laughed.)

Another issue, also pointed out in The Times’ interactive piece, is the fact that, with GMOs being talked about by some as posing health risks (no proof, so far) et cetera, some manufacturers are sticking ‘GMO free’ and similar labels on products – including ground oats, and water – where GMOs are not an issue!

Sadly, there is no ‘safe source’ of authoritative information on whether or not, ultimately, some GMOs might be found to be less than beneficial, without posing any risk to humans.

Chickens are routinely fed genetically modified grain – modified to help chickens ward off diseases. No one has ever suggested that GMO grain, or the breeding manipulations causing chickens to grown far faster and end up with far great breast weights than nature intended, is causing fried chicken eaters to gain weight or developed clogged arteries. Both have a far more direct relationship to the cooking fat that favorite food is cooked in.

People notoriously try to blame ‘something else’ on such conditions as having high blood pressure (cut your salt intake!) water retention (ditto’) or being too ‘bulky’ (you can see where this is going!).

In the grand scheme of things, as we can see that scheme today, GMOs are the least of the worries of people who consume way too much salt, and sugar (in the form of soft drinks, candy, etc.) and fail to exercise.

For the moment, it would be best to keep the GMO ‘threat’ in perspective: It ain’t one, that anyone’s been able to pin down.

The president can sign the bill, creating a new law, and the food industry can say – or it could, if the language of the bill were clear enough – ‘see, we’re doing what you want! Isn’t that wonderful?’

No, in fact, it isn’t.

I’ve worked (as a writer) on the fringe of the food industry for the better part of forty years. The technological changes in that time – what’s known now that wasn’t even imaged then – is mind boggling. Maybe there’s some reason why, in some instances, genetically modified foods might pose a risk of some sort to people. Maybe there isn’t. But none of what I regularly read about developments in the trade suggest there’s any reason why careful manipulations shouldn’t continue, when risk are clearly evaluated and taken into consideration.

A lot of what Congress does is wheel-spinning, or publicity-oriented. This bill may represent one, the other or both of those. What it doesn’t represent is a viable means of addressing what may, or may not,  be an issue worth getting excited about. Or wasting all the Congressional time and energy this bill has.

While some Congressional bills may require as few as two pages  – the one authorizing President Obama to give gold metals to the Apollo astronauts on the 40th anniversary of the moon landing – many spending bills and some others are notorious for filling 1,000 or more pages, as was the one authorizing The Affordable Care Act.

Multiply than times 500 or so – for 435 members of Congress plus other need-to-see’s. That amounts to 1,000 reams of paper – at 500 pages per ream – per bill. And that’s just the House version.

Every month, I attend meetings of county-level Board of Supervisors in Virginia meetings where the agenda, including multiple pages of explanatory files and charts, etc., is readily available on tablet-sized computers placed conveniently in front of each Supervisor. Small towns, as mine is (at 4,000 or so souls), and right-thinking counties really need to watch their expenditures, and it’s pretty obvious that using even a few reams of paper to duplicate, every month, something stored in an electronic file, is beyond wasteful: It’s an irresponsible use of public money.

Call me stupid, but I have enough faith that those who produce the food we eat, have no interest whatsoever in poisoning us. I can’t imagine any major (or even a minor) food producer introducing GMO ingredients into what they intend to market if they had the least suspicion the GMO aspect could put their customers – members of the shopping and consuming public – at risk.

All else aside, doing so would be illegal under existing law. The about-to-be GMO labeling law is highly unlikely to have any positive effect, but certainly could have some negative ones: Companies charged with mislabeling when the ‘facts’ are, between the complainant  and the accused, are, well, disputable.