#or buy from the amish. unfortunately we live in california

[gender-trash]

wheres my fucking post about how to buy non-shitty furniture you have to either make it yourself or shell out $$$$$ for an Artisanal Custom Piece or buy one made during a time when you could actually purchase a new consumer-grade durable good that was not a complete piece of shit

#or buy from the amish. unfortunately we live in california #i think that sort of falls under Artisanal Custom Piece tbh #the trashcan speaks #me in scandinavian designs: perhaps the kiss of sandpaper on the INSIDE of the drawer front! would not go amiss!! #tomorrow we will try danish concepts tho. danish concepts wont let me down #okay also im not currently in the market for a desk but scandinavian designs has a REALLY fun one #with a cute little 2 inch tall tambour door situation that you can close over the little 2 inch tall shelf under the desktop #ITS SO!!!

[kristinsimmons]

A Full-Scale Assault on Medical Debt, Part 1

By BOB HERTZ

The recent proposal by Sen. Bernie Sanders to cancel $81 billion of medical debt is a very good start—but it is only a start.

The RIP Medical Debt group—which buys old medical debts, and then forgives them—is absolutely in the right spirit. Its founders Craig Antico and Jerry Ashton deserve great credit for keeping the issue of forgiveness alive.

Unfortunately, over $88 billion in new medical debt is created each year; most of it still held by providers, or sold to collectors, or embedded in credit card balances.

Tragically, none of this has to happen! In France, a visit to the doctor typically costs the equivalent of $1.12. A night in a German hospital costs a patient roughly $11. German co-pays for the year in total cannot exceed 2% of income. Even in Switzerland, the average deductible is $300.

U.S. patients face cost-sharing that would never be tolerated in Germany, says Dr. Markus Frick, a senior official. “If any German politician proposed high deductibles, he or she would be run out of town.”

In Australia, a recent proposal to establish the equivalent of a $5 co-pay for primary care visits fueled such an outcry that the federal government was forced to withdraw the idea.

Americans may be forced to take second jobs just to pay medical debt; meanwhile, the highly-taxed Europeans get free medical care and are counting their weeks of paid vacation. What is wrong with this picture?

These nations have shown that cost sharing is not necessary to keep health care spending at a level well below that of the United States. They rely on higher taxes and price controls…and yet, are those really worse than widespread patient debt?

U.S. Medical debt comes primarily from these sources:

the uninsured

high deductibles

out-of-network bills

claim denials

specialty drugs

emergency room care

‘zombie debts’ purchased by collectors

In this essay, I will show that a substantial number of these debts can be cancelled or greatly reduced.

Today, these groups run up the most medical debts:

Group No. 1. The poor and the uninsured, including those who still do not get Medicaid in red states.

 A Tennessee couple earning $13,000 annually gets no help whatsoever on medical bills. They can barely afford food or rent; so of course they incur medical debt every time they are sick.

Over 20% of these families do not have a checking or savings account. Over 30% are not working at all.If they do work, they cannot afford to join the employer’s plan.

Six full years after the ACA, there are still close to 30 million adults in the US who are uninsured. About seven million are undocumented immigrants. Another seven million are actually eligible for Medicaid, if they do get sick.

About four million could benefit from the ACA, but many are unaware of the exchanges. Up to five million are very poor, but are kept out of both Medicaid and the ACA in the red states described above. Another two to three million make too much for ACA subsidies.

This is a hard group to help. No states besides California want the undocumented to get insurance. No cities outside liberal enclaves like Seattle and New York care about health insurance for restaurant and service workers.

The poor rarely vote, so ignoring them does not trouble conservatives. Politics are often dominated by seniors—who will approve a conservative message about  ‘getting rid of socialized medicine’—while they themselves enjoy the federal socialism of Medicare.

(Not to mention Social Security, electricity, phone infrastructure, and the defense spending that comes to red state residents from the federal government,)

Group No. 2.  The under-insured, who have high deductible insurance but no savings.

Why are they walking around with deductibles they cannot afford?

At some employers, this is the only health insurance which is offered.

Even where there is a choice of plans, people with smaller incomes often select the cheaper high-deductible coverage.

If you are healthy, a high deductible plan to save money on insurance premiums may be a decent gamble at first.. But if you have a chronic illness, you will pay the entire deductible each year, and  will probably build up debt. Only a minority of employers offer  assistance to pay the deductibles.

Sometimes this group pays $500 a month or more for a porous health plan, which then leaves them with thousands in debt if they are hospitalized. 

Many families are living right on the edge financially, and they have trouble with all their debts, not just medical. Default rates are growing on their car loans and credit cards as well. They often face utility shutoffs and repossessions.

A recent study of insurance claims showed that 49% of patient out-of-pocket costs per healthcare incident were below $500; 39% were $501-$1,000; and 12% were more than $1,000. That generates an enormous amount of medical debt.

Group No. 3. The well-insured, who may still get huge out-of-network bills.

Some of their debts are out-and-out fraud. If a hospital says they are in-network, then all their contractors should be in-network – or else we have an illegal bait-and-switch. These surprise bills should be cancelled (details to follow).

In 2011, (9 years ago) New York studied more than 2,000 complaints involving surprise medical bills, and found the average out-of-network emergency bill was $7,006. Insurers paid an average of $3,228 leaving consumers, on average, “to pay $3,778 for an emergency in which they had no choice.”

Out-of-network assistant surgeons, who often were called in without the patient’s knowledge, on average billed $13,914, while insurers paid $1,794 on average.  Surprise bills by out-of-network radiologists averaged $5,406, of which insurers paid $2,497 on average.

Medical debt can be cruel and dispiriting—and it is also incredibly inefficient! The cost of creating a bill, sending a bill, following up, negotiating a settlement, paperwork for charity care, financial counseling, a possible lawsuit, and (rarely) getting repayments over years… The sheer administrative expense is staggering.

The average recovery on hospital bills sent to individuals is 15.3%. Non-hospital providers recover an average of 21.8% of each bill. No wonder some providers prefer Medicaid—it only pays about 50% or less of their normal charges, but that is far more than they will get in actual collections.

There are two overarching models for financing health care:

One is the Bernie Sanders model:

Paternalistic – you get insurance whether you choose it or not

Sympathy for the poor, minorities, and migrants (you never know when you might be among them)

Collectively bargained – usually with large payroll taxes

No pre-existing conditions clauses

Hospitals are financed mainly by taxes, not user fees

Patients are not in debt (though governments often are)

Cost control through price controls and rationing

The Sanders model accepts the use of coercion to pay for health care. (For that matter, the Singapore health model that is praised by conservatives is filled with coercion, including public hospitals, forced savings for HSA’s and taxes for catastrophic insurance.) At some point we are all going to get sick, so letting us decide when to buy insurance is somewhat of a fool’s paradise. Millions will always make bad choices and be left to suffer; we need to be protected against our own stupidity. Coercion is —the only real issue is when and where. Even wealthy societies can benefit from forced savings. For example, a mandatory HSA deposit of 3% of income would eliminate most of the medical debts discussed in this essay.          

The other is the Paul Ryan-Newt Gingrich model:

Based on Individual choice

No mandates on employers to provide quality coverage

No mandates on individuals to buy quality coverage; if they want to gamble going uninsured in order to save money, that is their call.

Hospitals financed by user fees, insurance premiums and private savings

No interference with anyone making money on health care – even those who prey on medical debtors

Medical bankruptcy is OK, because the fear of it motivates the purchase of health insurance.

Cost control (theoretically) through competition – faith in free markets

Taxes on workers are lower – although the savings seem to be siphoned off in premiums, co-pays, and deductibles.

The Ryan model is frankly Darwinian when you get close to it. The uninsured, frankly, are usually people who make mistakes – like poor budgeting, failing in school, losing their jobs, or being born to non-rich parents. Persons with no money get much less care, and will die sooner. Those who do not buy insurance when they are healthy will suffer later on. Eventually it all starts to sounds like “culling the herd.”

The Ryan model therefore expects a lot from private charity. (Begging is preferable to new taxes.) Democratic legislators have also established Medicare, Medicaid, and SCHIP to smooth out the inevitable rough edges.

Medical debt is an obvious consequence of the libertarian model. It can only be reformed by importing controls and rules from the Sanders model.

The ideal image of high-deductible insurance features a judicious patient with at least $10,000 in HSA savings, getting bids on each procedure and therefore driving down costs. They might even have non-urgent care done abroad, which would force American hospitals to compete on price. They might decline an unnecessary treatment or diagnostic test, to save money.

Even if hospitalized, they can say to the provider, “I am paying cash, what is your best offer?” The Amish – who do not buy insurance, but save prodigiously – actually use this method.

This has some basis in fact. Cash for medical care is more efficient and will over time lead to lower prices.

However, millions of Americans have no cash, and no bargaining skills. Some diseases may not wait for patient ‘shopping.’ A desperate patient goes to the nearest hospital and then juggles utility bills and high-interest charge cards to pay down medical bills, and then begs for help from relatives or (even sadder) from GoFundMe.

The average holder of an HSA account is under age 45, healthy, and with an average income of $75,000. Whereas in low-wage America, a ‘consumer-driven’ health plan is a ‘consumer-indebted’ reality. 

Financial casualties among patients do not seem to lead to lower health care prices. Providers are just as likely to raise their prices, in order to cover the bad debt they are taking on. (Drug companies certainly do not lower their prices when their customers suffer.)

Doctors may want to forgive some patient debts, but there is a limit how often they can do this and still cover the expenses of their practice. In some cases, it is actually (and idiotically) illegal for physicians to waive the deductibles.           

Bob Hertz is a retired insurance broker. He learned about health care from Uwe Reinhardt, Joseph White, Dr. Robert Evans, and George Halvorson a fellow Minnesotan.

The post A Full-Scale Assault on Medical Debt, Part 1 appeared first on The Health Care Blog.

A Full-Scale Assault on Medical Debt, Part 1 published first on https://wittooth.tumblr.com/

[lauramalchowblog]

A Full-Scale Assault on Medical Debt, Part 1

By BOB HERTZ

The recent proposal by Sen. Bernie Sanders to cancel $81 billion of medical debt is a very good start—but it is only a start.

The RIP Medical Debt group—which buys old medical debts, and then forgives them—is absolutely in the right spirit. Its founders Craig Antico and Jerry Ashton deserve great credit for keeping the issue of forgiveness alive.

Unfortunately, over $88 billion in new medical debt is created each year; most of it still held by providers, or sold to collectors, or embedded in credit card balances.

Tragically, none of this has to happen! In France, a visit to the doctor typically costs the equivalent of $1.12. A night in a German hospital costs a patient roughly $11. German co-pays for the year in total cannot exceed 2% of income. Even in Switzerland, the average deductible is $300.

U.S. patients face cost-sharing that would never be tolerated in Germany, says Dr. Markus Frick, a senior official. “If any German politician proposed high deductibles, he or she would be run out of town.”

In Australia, a recent proposal to establish the equivalent of a $5 co-pay for primary care visits fueled such an outcry that the federal government was forced to withdraw the idea.

Americans may be forced to take second jobs just to pay medical debt; meanwhile, the highly-taxed Europeans get free medical care and are counting their weeks of paid vacation. What is wrong with this picture?

These nations have shown that cost sharing is not necessary to keep health care spending at a level well below that of the United States. They rely on higher taxes and price controls…and yet, are those really worse than widespread patient debt?

U.S. Medical debt comes primarily from these sources:

the uninsured

high deductibles

out-of-network bills

claim denials

specialty drugs

emergency room care

‘zombie debts’ purchased by collectors

In this essay, I will show that a substantial number of these debts can be cancelled or greatly reduced.

Today, these groups run up the most medical debts:

Group No. 1. The poor and the uninsured, including those who still do not get Medicaid in red states.

 A Tennessee couple earning $13,000 annually gets no help whatsoever on medical bills. They can barely afford food or rent; so of course they incur medical debt every time they are sick.

Over 20% of these families do not have a checking or savings account. Over 30% are not working at all.If they do work, they cannot afford to join the employer’s plan.

Six full years after the ACA, there are still close to 30 million adults in the US who are uninsured. About seven million are undocumented immigrants. Another seven million are actually eligible for Medicaid, if they do get sick.

About four million could benefit from the ACA, but many are unaware of the exchanges. Up to five million are very poor, but are kept out of both Medicaid and the ACA in the red states described above. Another two to three million make too much for ACA subsidies.

This is a hard group to help. No states besides California want the undocumented to get insurance. No cities outside liberal enclaves like Seattle and New York care about health insurance for restaurant and service workers.

The poor rarely vote, so ignoring them does not trouble conservatives. Politics are often dominated by seniors—who will approve a conservative message about  ‘getting rid of socialized medicine’—while they themselves enjoy the federal socialism of Medicare.

(Not to mention Social Security, electricity, phone infrastructure, and the defense spending that comes to red state residents from the federal government,)

Group No. 2.  The under-insured, who have high deductible insurance but no savings.

Why are they walking around with deductibles they cannot afford?

At some employers, this is the only health insurance which is offered.

Even where there is a choice of plans, people with smaller incomes often select the cheaper high-deductible coverage.

If you are healthy, a high deductible plan to save money on insurance premiums may be a decent gamble at first.. But if you have a chronic illness, you will pay the entire deductible each year, and  will probably build up debt. Only a minority of employers offer  assistance to pay the deductibles.

Sometimes this group pays $500 a month or more for a porous health plan, which then leaves them with thousands in debt if they are hospitalized. 

Many families are living right on the edge financially, and they have trouble with all their debts, not just medical. Default rates are growing on their car loans and credit cards as well. They often face utility shutoffs and repossessions.

A recent study of insurance claims showed that 49% of patient out-of-pocket costs per healthcare incident were below $500; 39% were $501-$1,000; and 12% were more than $1,000. That generates an enormous amount of medical debt.

Group No. 3. The well-insured, who may still get huge out-of-network bills.

Some of their debts are out-and-out fraud. If a hospital says they are in-network, then all their contractors should be in-network – or else we have an illegal bait-and-switch. These surprise bills should be cancelled (details to follow).

In 2011, (9 years ago) New York studied more than 2,000 complaints involving surprise medical bills, and found the average out-of-network emergency bill was $7,006. Insurers paid an average of $3,228 leaving consumers, on average, “to pay $3,778 for an emergency in which they had no choice.”

Out-of-network assistant surgeons, who often were called in without the patient’s knowledge, on average billed $13,914, while insurers paid $1,794 on average.  Surprise bills by out-of-network radiologists averaged $5,406, of which insurers paid $2,497 on average.

Medical debt can be cruel and dispiriting—and it is also incredibly inefficient! The cost of creating a bill, sending a bill, following up, negotiating a settlement, paperwork for charity care, financial counseling, a possible lawsuit, and (rarely) getting repayments over years… The sheer administrative expense is staggering.

The average recovery on hospital bills sent to individuals is 15.3%. Non-hospital providers recover an average of 21.8% of each bill. No wonder some providers prefer Medicaid—it only pays about 50% or less of their normal charges, but that is far more than they will get in actual collections.

There are two overarching models for financing health care:

One is the Bernie Sanders model:

Paternalistic – you get insurance whether you choose it or not

Sympathy for the poor, minorities, and migrants (you never know when you might be among them)

Collectively bargained – usually with large payroll taxes

No pre-existing conditions clauses

Hospitals are financed mainly by taxes, not user fees

Patients are not in debt (though governments often are)

Cost control through price controls and rationing

The Sanders model accepts the use of coercion to pay for health care. (For that matter, the Singapore health model that is praised by conservatives is filled with coercion, including public hospitals, forced savings for HSA’s and taxes for catastrophic insurance.) At some point we are all going to get sick, so letting us decide when to buy insurance is somewhat of a fool’s paradise. Millions will always make bad choices and be left to suffer; we need to be protected against our own stupidity. Coercion is —the only real issue is when and where. Even wealthy societies can benefit from forced savings. For example, a mandatory HSA deposit of 3% of income would eliminate most of the medical debts discussed in this essay.          

The other is the Paul Ryan-Newt Gingrich model:

Based on Individual choice

No mandates on employers to provide quality coverage

No mandates on individuals to buy quality coverage; if they want to gamble going uninsured in order to save money, that is their call.

Hospitals financed by user fees, insurance premiums and private savings

No interference with anyone making money on health care – even those who prey on medical debtors

Medical bankruptcy is OK, because the fear of it motivates the purchase of health insurance.

Cost control (theoretically) through competition – faith in free markets

Taxes on workers are lower – although the savings seem to be siphoned off in premiums, co-pays, and deductibles.

The Ryan model is frankly Darwinian when you get close to it. The uninsured, frankly, are usually people who make mistakes – like poor budgeting, failing in school, losing their jobs, or being born to non-rich parents. Persons with no money get much less care, and will die sooner. Those who do not buy insurance when they are healthy will suffer later on. Eventually it all starts to sounds like “culling the herd.”

The Ryan model therefore expects a lot from private charity. (Begging is preferable to new taxes.) Democratic legislators have also established Medicare, Medicaid, and SCHIP to smooth out the inevitable rough edges.

Medical debt is an obvious consequence of the libertarian model. It can only be reformed by importing controls and rules from the Sanders model.

The ideal image of high-deductible insurance features a judicious patient with at least $10,000 in HSA savings, getting bids on each procedure and therefore driving down costs. They might even have non-urgent care done abroad, which would force American hospitals to compete on price. They might decline an unnecessary treatment or diagnostic test, to save money.

Even if hospitalized, they can say to the provider, “I am paying cash, what is your best offer?” The Amish – who do not buy insurance, but save prodigiously – actually use this method.

This has some basis in fact. Cash for medical care is more efficient and will over time lead to lower prices.

However, millions of Americans have no cash, and no bargaining skills. Some diseases may not wait for patient ‘shopping.’ A desperate patient goes to the nearest hospital and then juggles utility bills and high-interest charge cards to pay down medical bills, and then begs for help from relatives or (even sadder) from GoFundMe.

The average holder of an HSA account is under age 45, healthy, and with an average income of $75,000. Whereas in low-wage America, a ‘consumer-driven’ health plan is a ‘consumer-indebted’ reality. 

Financial casualties among patients do not seem to lead to lower health care prices. Providers are just as likely to raise their prices, in order to cover the bad debt they are taking on. (Drug companies certainly do not lower their prices when their customers suffer.)

Doctors may want to forgive some patient debts, but there is a limit how often they can do this and still cover the expenses of their practice. In some cases, it is actually (and idiotically) illegal for physicians to waive the deductibles.           

Bob Hertz is a retired insurance broker. He learned about health care from Uwe Reinhardt, Joseph White, Dr. Robert Evans, and George Halvorson a fellow Minnesotan.

The post A Full-Scale Assault on Medical Debt, Part 1 appeared first on The Health Care Blog.

A Full-Scale Assault on Medical Debt, Part 1 published first on https://venabeahan.tumblr.com

[simplyadorkable-blog1]

Season 6, Episode 17 - “Rumspringa”

Jess is nervous about starting her new role as principal, so Nick and Schmidt take her on a relaxing day trip to Solvang; Cece helps Winston try to finalize his divorce from Rhonda.

“Welcome to Big Dinner, where the news is big and the dinner is regular sized. Not be confused with Big Supper, where we eat dinner and we watch the movie Big.” Jess welcomes us to the episode and I welcome you to this breakdown. Let’s just ignore that they watch Big often enough that they have a name for when they do so. Anyways, Jess and Schmidt have gathered the remaining roomfriends to announce their new promotions and as Schmidt puts it, “celebrate [their] final weekend inside the chrysalis of professional mediocrity before Monday, when [they] burst forth in fully pupated positions.” Let’s all give Jess and Schmidt a round of applause for their new positions as Principal Day and the Director of Non-Television, Non-Radio West Coast Marketing, respectively. Congratulations!

Winston interrupts their proud announcement with an announcement of his own: he has to divorce his wife, Rhonda. To be honest, I totally forgot about her. But Cece clearly has not because she tells Winston that she hates her. “Hey, that’s my wife!” Winston growls back, catching me entirely off guard and sending me into a fit of laughter. Nick comments that it was, “Such a good Harrison Ford.” Great point. Nick then interrupts the celebration to complain that Raisin said his room is stupid. Schmidt is livid that everyone keeps interrupting with all of their common topics. This is why he proposed Common Lunch! Too bad nobody showed up.

Jess tries to put the conversation back on the rails. She points out that she’s so happy and has been preparing for this job ever since she was young enough to believe leprechauns were real. Nick interrupts again to argue that they are real, Winston caught one. Before they can get into the leprechaun debate, Schmidt declares that it’s time for the rites of passage. To the tune of Pomp and Circumstance, Jess presents Schmidt with a new set of business cards and Schmidt presents her with her principal’s blazer. The thought that these two had this entire performance planned out might be funnier than the actual act. It’s quickly made clear that her blazer doesn’t fit and we skip to the middle of the night when Nick finds a frazzled Jess crazily adjusting it.

The next day, Nick approaches Schmidt to get a second opinion on his bedroom. Schmidt agrees with Raisin that it looks like he lives in an abandoned daycare. Nick disagrees because he knows exactly what that looks like. Queue flashback of little Nicky left in an abandoned daycare which is totally plausible considering his dad. “Okay, we need to talk about that a lot more later,” Schmidt is alarmed, as if he was also transported into the flashback. Nick changes the subject to Jess and how she is freaking out about work because he’s still the sweet, attentive guy we know and love.

The pair check on Jess in the kitchen, where she’s still crazily working on her blazer. She unconvincingly tells them that’s she’s “gawd.” Concerned, Nick and Schmidt retreat to his room to figure out how they are going to help. Nick reminds Schmidt of when he helped Schmidt in college by taking him on boy rides Rumspringa. We’re also informed that Schmidt took an Intro. to Environmental Feminism class—what even? Anyways, the decide to take Jess on a little Rumspringa of their own.

Meanwhile Cece is at the bar with Winston and Aly as they wait for Rhonda. Aly cutely coos over her ring and Winston grosses us out by saying, “I love that ring on your finger. I want to bite it off, and swallow it, and then digest it properly. And give it back to you in a day and a half.” This moment is interrupted by Rhonda’s sudden entrance. She’s holding a baby. Hopefully everyone caught onto her prank immediately because if not, Winston’s, “Now you listen to me, baby. My father walked out on me, and I swear I will never do that to you,” line will break your heart. Hell, I even knew it was a prank right away and I was still in awe over Winston’s sweetness. Thankfully Rhonda doesn’t string Winston along and reveals her prank. As we know, Winston’s taste in pranks is terrible so he is the only one to laugh along with Rhonda. Rhonda explains that she borrowed the baby from her obstetrician cousin, Dave, who is also in the bar. Cece points out that that’s a felony, not the two police officers in the room. Aly tries to play nice and introduces herself to Rhonda. She congratulates the engaged couple, signs the divorce papers, and leaves. Can we all agree that despite how annoying her pranks are, her enthusiastic tone is hilariously perfect? Unfortunately, Winston opens to the folder to see that she used disappearing ink and effectively pranked them.

Back at the loft, Nick and Schmidt barge into Jess’ room where she has unknowingly added two additional sleeves to her blazer. How did that happen? Wasn’t she just letting it out? Anyways, the guys suggest a boy ride/Rumspringa to take her mind off of her first day jitters. Jess adamantly refuses, citing, “Rumspringa is a hallowed Amish tradition, not a one-day buddy comedy. Second of all, I don’t want to go to a casino or a sexual petting zoo.” Schmidt explains that’s why they’re going to an old-timey Danish town oddly located in California wine country called Solvang.

At the craft fair in Solvang, Jess continues to pout and tries to leave. Schmidt tells her he paid for all-day parking so she’s out of her mind if she thinks they’re going to leave. That statement is vaguely paternal so we better get a Schmece baby in season 7 (#reNewGirl). Nick encourages Jess to have fun and picks up a sign from a nearby vendor. “Look at this sign: “When has it become a crime to rhyme all the time?” So true! And it’s really funny.” “Somebody just thought of that,” Schmidt chimes in. Nick’s truly grasping at straws, but it’s so endearing, I wish Jess would open her unusually large eyes! Instead, she wants to go home and practice her morning announcement voice. Schmidt thinks she’s overthinking this and tells her to exude confidence all the time like him. Jess tells him he can’t skate by on confidence alone since he’s the boss now. This scares Schmidt so they’re both freaking out when Nick reappears with a folksy, old-timey reenactment guy. This somehow convinces Jess to stay—Nick knows her so well—and she springs into Leslie Knope mode and starts firing off questions. But if you ask me, I’m 99.9% that’s not the real Ben Franklin. Wait, what? Before she can get through all 87 of her questions, he offers them Aquavit, which is a flavored spirit from Scandinavia, according to a quick Google search.

I guess Rhonda is still close to the bar because she’s already back and laughing at Winston for falling for her disappearing ink trick. Aly is justifiably furious and demands that Rhonda grow up and stop acting like Dennis the freaking Menace. Rhonda thinks Aly’s dislike of pranks is basic and is worried about Winston marrying her. She goes on say she’s never going to give Winston a divorce and she’ll prank him for life. Winston tries to reassure Aly and they’ll figure something out. It turns out that that something is agreeing to help pull a group Rhonda so she’ll sign the papers with permanent ink.

At Solvang, Jess gets hammered on Aquavit and Nick buys a quilted jacket that he wants to make into a throw pillow. Nick is going full country-living. When Jess tries to buy more Aquavit, the vendor informs her that it’s 4:30 pm and they close early on Sunday. Nick tries to keep the party going by taking them to the Aquavit cellar and inadvertently locks them in. To be fair, he really does keep the party going. Jess immediately starts shouting out the tiny window in the door that they need to pupate. “They don’t know what that means. Say something more accessible. Help!” Yes, much better, Schmidt.

After over an hour of being trapped, Nick is still trying to distract Jess like the perfect boyfriend we all wish he currently was. “Our bodies are trapped in this cellar, but our minds can go anywhere.” He switches his attention to Schmidt, who’s shouting that he’s the Director of Marketing for Associated Strategies out the tiny window, and asks him to pick a number. Schmidt picks 23, which is wrong. Jess picks 19, which is right. Same wavelength, those two. Nick tries to entertain them by saying a bird is going to pop out from the cuckoo clock that is for some reason in the cellar. Jess rips out the bird in anger and yells at Nick that they’re adults and can’t handle their problems by forgetting about them. Nick finally cracks, saying, “You’re right. Maybe I handle my problems like a child. Maybe I decorate my room like a child. I mean, I even undress like a child.” His flashback of trying to kick off his pants has me in stitches. Does he do that every time? “I’m usually the rock of this group. Once you lose old Nicky Miller, the whole thing falls apart,” He continues and starts to drink a bottle of Aquavit.

We return to Rhonda’s prank where Cece and Winston, dressed as nurses, rush into a delivery room with Rhonda covering her face on the bed. Dave, our second favorite New Girl female health practitioner, is in the room and lifts up the sheet to take a look. Aly’s jelly-covered head is poking up through a hole in the cart and scares Dave. She deadpans, “Wah. I’m a baby. I’m coming out.” Rhonda then reveals herself and “Rhonda’s” Dave. Aly crawls out from under the cart and starts to freak out that her skin in burning. Winston rushes to Aly’s side, worried. Rhonda apologizes to Aly. Rightfully so, because she just got Aly’d. Rhonda is impressed with her prank game and agrees to sign the papers and gives the couple her blessing.

Back in the cellar, it’s now 4:00 am. The guys have been peeing in bottles for hours and Jess is sad that she’s missing her first day. Nick promises that once they get out, he’s going to start growing up. He says there’s so much he wants to do like try cilantro, figure out what NASDAQ means, and not shimmy out of his pants. He also apologizes to Jess for kidnapping her, he just hated to see her with first-day jitters. Can they just start dating already? Jess realizes she’s being silly, she’s been preparing for this job her entire life. Nick suggests they toast with a bottle of champagne, which Schmidt points out has a wire around the cork. He channels his inner Nancy Drew and picks the lock, allowing them to rush out. Upon arriving at their car, they realize that they’re all too drunk to drive. Thankfully, Schmidt exchanged numbers with the reenactment guy and he comes to the rescue with the promise of getting on The Price Is Right.

Cece, Winston, and Aly’s storyline wraps up back at the the loft. The divorce papers are finally finalized. Winston assures the ladies that they’re good since the longest disappearing ink on record is only 42 minutes. Shouts to the blog I follow who pointed out that Winston has that memorized. Aly admits that she actually had a good time pranking Rhonda and that they could get into it as a couple. They can prank, have sex, and pet the cat. #RelationshipGoals. Remember when Winston’s proposal included his complicated relationship with God? Well it’s true, because he goes off on a tangent about how we are pranks because God pranked the animals with us. Aly finds this endearing and they kiss. Meanwhile Cece notices that there are adoption papers among the divorce papers and that Rhonda adopted Aly in Liberia. I guess she got the last laugh…? I hope that’s just a throw away line because I’ve had enough incestual relationships this season.

Jess makes it to her school just in time for morning announcements, but when Nick encourages her to get out of the car and be principal, she suddenly gets nervous again. Nick, like the sweetheart he is, asks Schmidt for a minute alone with Jess. Schmidt exits, saying, “Sure. A grown man standing around a bunch of ten-year-olds, holding bottles of his own urine. What could go wrong?” Now alone, Nick tells Jess he knows what’s wrong with her. She’s scared that she’s reached her goal. Jess admits it’s stupid, but Nick disagrees. “And as a guy who has never had a path like that, I’m personally really excited to see what happens next.” Then they stare into each other’s eyes. Jess, freshly emboldened, gets out of the car. She takes a few steps before realizing she forgot her blazer. When she turns back to the car, Nick gives her his new, quilted jacket. “But I thought you were going to make a pillow out of that,” Jess tries to give it back. “Ah, it won’t fit in my room. It’s not a good style for me. It looks great on you.” Jess thanks him and says, “And, Nick, I… I like your room the way it is. It already has a style. It’s… it’s you.” They smile at each other again and my heart breaks that they’re not together yet.

Originally Aired 2/21/2017

#New Girl #Season 6 Episode 17 #Rumspringa #Recap #Breakdown #Spoilers #Zooey Deschanel #Jake Johnson #Hannah Simone #Max Greenfield #Lamorne Morris #Nasim Pedrad #Episodes #simplyadorkable

[kristinsimmons]

A Full-Scale Assault on Medical Debt, Part 1

By BOB HERTZ

The recent proposal by Sen. Bernie Sanders to cancel $81 billion of medical debt is a very good start—but it is only a start.

The RIP Medical Debt group—which buys old medical debts, and then forgives them—is absolutely in the right spirit. Its founders Craig Antico and Jerry Ashton deserve great credit for keeping the issue of forgiveness alive.

Unfortunately, over $88 billion in new medical debt is created each year; most of it still held by providers, or sold to collectors, or embedded in credit card balances.

Tragically, none of this has to happen! In France, a visit to the doctor typically costs the equivalent of $1.12. A night in a German hospital costs a patient roughly $11. German co-pays for the year in total cannot exceed 2% of income. Even in Switzerland, the average deductible is $300.

U.S. patients face cost-sharing that would never be tolerated in Germany, says Dr. Markus Frick, a senior official. “If any German politician proposed high deductibles, he or she would be run out of town.”

In Australia, a recent proposal to establish the equivalent of a $5 co-pay for primary care visits fueled such an outcry that the federal government was forced to withdraw the idea.

Americans may be forced to take second jobs just to pay medical debt; meanwhile, the highly-taxed Europeans get free medical care and are counting their weeks of paid vacation. What is wrong with this picture?

These nations have shown that cost sharing is not necessary to keep health care spending at a level well below that of the United States. They rely on higher taxes and price controls…and yet, are those really worse than widespread patient debt?

U.S. Medical debt comes primarily from these sources:

the uninsured

high deductibles

out-of-network bills

claim denials

specialty drugs

emergency room care

‘zombie debts’ purchased by collectors

In this essay, I will show that a substantial number of these debts can be cancelled or greatly reduced.

Today, these groups run up the most medical debts:

Group No. 1. The poor and the uninsured, including those who still do not get Medicaid in red states.

 A Tennessee couple earning $13,000 annually gets no help whatsoever on medical bills. They can barely afford food or rent; so of course they incur medical debt every time they are sick.

Over 20% of these families do not have a checking or savings account. Over 30% are not working at all.If they do work, they cannot afford to join the employer’s plan.

Six full years after the ACA, there are still close to 30 million adults in the US who are uninsured. About seven million are undocumented immigrants. Another seven million are actually eligible for Medicaid, if they do get sick.

About four million could benefit from the ACA, but many are unaware of the exchanges. Up to five million are very poor, but are kept out of both Medicaid and the ACA in the red states described above. Another two to three million make too much for ACA subsidies.

This is a hard group to help. No states besides California want the undocumented to get insurance. No cities outside liberal enclaves like Seattle and New York care about health insurance for restaurant and service workers.

The poor rarely vote, so ignoring them does not trouble conservatives. Politics are often dominated by seniors—who will approve a conservative message about  ‘getting rid of socialized medicine’—while they themselves enjoy the federal socialism of Medicare.

(Not to mention Social Security, electricity, phone infrastructure, and the defense spending that comes to red state residents from the federal government,)

Group No. 2.  The under-insured, who have high deductible insurance but no savings.

Why are they walking around with deductibles they cannot afford?

At some employers, this is the only health insurance which is offered.

Even where there is a choice of plans, people with smaller incomes often select the cheaper high-deductible coverage.

If you are healthy, a high deductible plan to save money on insurance premiums may be a decent gamble at first.. But if you have a chronic illness, you will pay the entire deductible each year, and  will probably build up debt. Only a minority of employers offer  assistance to pay the deductibles.

Sometimes this group pays $500 a month or more for a porous health plan, which then leaves them with thousands in debt if they are hospitalized. 

Many families are living right on the edge financially, and they have trouble with all their debts, not just medical. Default rates are growing on their car loans and credit cards as well. They often face utility shutoffs and repossessions.

A recent study of insurance claims showed that 49% of patient out-of-pocket costs per healthcare incident were below $500; 39% were $501-$1,000; and 12% were more than $1,000. That generates an enormous amount of medical debt.

Group No. 3. The well-insured, who may still get huge out-of-network bills.

Some of their debts are out-and-out fraud. If a hospital says they are in-network, then all their contractors should be in-network – or else we have an illegal bait-and-switch. These surprise bills should be cancelled (details to follow).

In 2011, (9 years ago) New York studied more than 2,000 complaints involving surprise medical bills, and found the average out-of-network emergency bill was $7,006. Insurers paid an average of $3,228 leaving consumers, on average, “to pay $3,778 for an emergency in which they had no choice.”

Out-of-network assistant surgeons, who often were called in without the patient’s knowledge, on average billed $13,914, while insurers paid $1,794 on average.  Surprise bills by out-of-network radiologists averaged $5,406, of which insurers paid $2,497 on average.

Medical debt can be cruel and dispiriting—and it is also incredibly inefficient! The cost of creating a bill, sending a bill, following up, negotiating a settlement, paperwork for charity care, financial counseling, a possible lawsuit, and (rarely) getting repayments over years… The sheer administrative expense is staggering.

The average recovery on hospital bills sent to individuals is 15.3%. Non-hospital providers recover an average of 21.8% of each bill. No wonder some providers prefer Medicaid—it only pays about 50% or less of their normal charges, but that is far more than they will get in actual collections.

There are two overarching models for financing health care:

One is the Bernie Sanders model:

Paternalistic – you get insurance whether you choose it or not

Sympathy for the poor, minorities, and migrants (you never know when you might be among them)

Collectively bargained – usually with large payroll taxes

No pre-existing conditions clauses

Hospitals are financed mainly by taxes, not user fees

Patients are not in debt (though governments often are)

Cost control through price controls and rationing

The Sanders model accepts the use of coercion to pay for health care. (For that matter, the Singapore health model that is praised by conservatives is filled with coercion, including public hospitals, forced savings for HSA’s and taxes for catastrophic insurance.) At some point we are all going to get sick, so letting us decide when to buy insurance is somewhat of a fool’s paradise. Millions will always make bad choices and be left to suffer; we need to be protected against our own stupidity. Coercion is —the only real issue is when and where. Even wealthy societies can benefit from forced savings. For example, a mandatory HSA deposit of 3% of income would eliminate most of the medical debts discussed in this essay.          

The other is the Paul Ryan-Newt Gingrich model:

Based on Individual choice

No mandates on employers to provide quality coverage

No mandates on individuals to buy quality coverage; if they want to gamble going uninsured in order to save money, that is their call.

Hospitals financed by user fees, insurance premiums and private savings

No interference with anyone making money on health care – even those who prey on medical debtors

Medical bankruptcy is OK, because the fear of it motivates the purchase of health insurance.

Cost control (theoretically) through competition – faith in free markets

Taxes on workers are lower – although the savings seem to be siphoned off in premiums, co-pays, and deductibles.

The Ryan model is frankly Darwinian when you get close to it. The uninsured, frankly, are usually people who make mistakes – like poor budgeting, failing in school, losing their jobs, or being born to non-rich parents. Persons with no money get much less care, and will die sooner. Those who do not buy insurance when they are healthy will suffer later on. Eventually it all starts to sounds like “culling the herd.”

The Ryan model therefore expects a lot from private charity. (Begging is preferable to new taxes.) Democratic legislators have also established Medicare, Medicaid, and SCHIP to smooth out the inevitable rough edges.

Medical debt is an obvious consequence of the libertarian model. It can only be reformed by importing controls and rules from the Sanders model.

The ideal image of high-deductible insurance features a judicious patient with at least $10,000 in HSA savings, getting bids on each procedure and therefore driving down costs. They might even have non-urgent care done abroad, which would force American hospitals to compete on price. They might decline an unnecessary treatment or diagnostic test, to save money.

Even if hospitalized, they can say to the provider, “I am paying cash, what is your best offer?” The Amish – who do not buy insurance, but save prodigiously – actually use this method.

This has some basis in fact. Cash for medical care is more efficient and will over time lead to lower prices.

However, millions of Americans have no cash, and no bargaining skills. Some diseases may not wait for patient ‘shopping.’ A desperate patient goes to the nearest hospital and then juggles utility bills and high-interest charge cards to pay down medical bills, and then begs for help from relatives or (even sadder) from GoFundMe.

The average holder of an HSA account is under age 45, healthy, and with an average income of $75,000. Whereas in low-wage America, a ‘consumer-driven’ health plan is a ‘consumer-indebted’ reality. 

Financial casualties among patients do not seem to lead to lower health care prices. Providers are just as likely to raise their prices, in order to cover the bad debt they are taking on. (Drug companies certainly do not lower their prices when their customers suffer.)

Doctors may want to forgive some patient debts, but there is a limit how often they can do this and still cover the expenses of their practice. In some cases, it is actually (and idiotically) illegal for physicians to waive the deductibles.           

Bob Hertz is a retired insurance broker. He learned about health care from Uwe Reinhardt, Joseph White, Dr. Robert Evans, and George Halvorson a fellow Minnesotan.

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