How Medicare Advantage Plans Use Algorithms To Cut Off Care For Seniors In Need
https://www.statnews.com/2023/03/13/medicare-advantage-plans-denial-artificial-intelligence/
Statnews is subscriber based.
Excerpt:
Health insurance companies have rejected medical claims for as long as they’ve been around. But a STAT investigation found artificial intelligence is now driving their denials to new heights in Medicare Advantage, the taxpayer-funded alternative to traditional Medicare that covers more than 31 million people. Behind the scenes, insurers are using unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an older patient’s treatment. The denials that follow are setting off heated disputes between doctors and insurers, often delaying treatment of seriously ill patients who are neither aware of the algorithms, nor able to question their calculations. Older people who spent their lives paying into Medicare, and are now facing amputation, fast-spreading cancers, and other devastating diagnoses, are left to either pay for their care themselves or get by without it. If they disagree, they can file an appeal, and spend months trying to recover their costs, even if they don’t recover from their illnesses.
The algorithms sit at the beginning of the process, promising to deliver personalized care and better outcomes. But patient advocates said in many cases they do the exact opposite — spitting out recommendations that fail to adjust for a patient’s individual circumstances and conflict with basic rules on what Medicare plans must cover. “While the firms say [the algorithm] is suggestive, it ends up being a hard-and-fast rule that the plan or the care management firms really try to follow,” said David Lipschutz, associate director of the Center for Medicare Advocacy, a nonprofit group that has reviewed such denials for more than two years in its work with Medicare patients. “There’s no deviation from it, no accounting for changes in condition, no accounting for situations in which a person could use more care.”
STAT’s investigation revealed these tools are becoming increasingly influential in decisions about patient care and coverage. The investigation is based on a review of hundreds of pages of federal records, court filings, and confidential corporate documents, as well as interviews with physicians, insurance executives, policy experts, lawyers, patient advocates, and family members of Medicare Advantage beneficiaries. It found that, for all of AI’s power to crunch data, insurers with huge financial interests are leveraging it to help make life-altering decisions with little independent oversight. AI models used by physicians to detect diseases such as cancer, or suggest the most effective treatment, are evaluated by the Food and Drug Administration. But tools used by insurers in deciding whether those treatments should be paid for are not subjected to the same scrutiny, even though they also influence the care of the nation’s sickest patients.
The bipartisan effort in congress to lift sanctions on Cuba is corporate welfare
https://mailchi.mp/bostonglobe/arguablea-scandal-at-stanford
Op-ed is at link, but have to scroll down link to read it. Link doesn’t segregate op-eds.
Excerpt:
Corporate welfare and the Cuban embargo
The dictatorship in Cuba is the oldest and cruelest in the Western Hemisphere. The island’s people live under bitter oppression and the regime in Havana reserves its most poisonous attacks for the United States — the nation to which hundreds of thousands of Cubans have fled, often at the risk of their lives. Yet that never seems to dissuade some US politicians from seeking to reward Cuba’s despots with commerce and new wealth.
Last week, Senators Amy Klobuchar of Minnesota, Roger Marshall and Jerry Moran of Kansas, Chris Murphy of Connecticut, and Elizabeth Warren of Massachusetts introduced legislation to lift the Cuba trade embargo and make it easier to subsidize Cuba’s dictatorship. Their pitch is that the measure would make it easier for US businesses and farmers to trade with Cuba, a market from which American exporters are supposedly excluded.
“By ending the trade embargo with Cuba once and for all, our bipartisan legislation will turn the page on the failed policy of isolation while creating a new export market and generating economic opportunities for American businesses,” Klobuchar said in a press statement. Added Moran: “It is time to amend our own laws to give US producers fair access to market to consumers in Cuba.” Nothing in their bill, the senators insist, would impede the ability of the United States to hold Cuba accountable for its human rights enormities.
The only thing wrong with that is — well, everything.
To take the last point first, we have already sat through this feature and we know how it turns out. It was less than a decade ago that President Barack Obama and Secretary of State John Kerry vigorously set about normalizing relations with Cuba. The US embassy in Havana and the Cuban embassy in Washington were reopened. Obama removed Cuba from the State Department list of terror-sponsoring regimes, attended a Major League Baseball game in Havana as the guest of Cuban President Raúl Castro, lifted most restrictions on travel to Cuba by Americans, and dispatched top officials to the island on trade missions.
Result? The regime’s repression intensified. Beatings and arrests of dissidents soared. There was a crackdown on churches and religious groups. By relaxing restrictions on US trade with and travel to Cuba, as I wrote at the time, Obama’s policy made life worse for ordinary Cubans, not better. The reason was straightforward: Because the Cuban government owns or controls virtually every major business in the country, doing more business with Cuba meant putting more wealth into the coffers of the regime. A richer dictatorship became, by definition, a stronger dictatorship. “Everybody shares a little bit of disappointment about the direction that the government in Cuba chose to go,” Kerry later said. But the outcome was entirely predictable.
US farmers and other producers are not barred by the embargo from selling food and other products to Cuba. In 2022, US exports to Cuba totaled $328.5 million, according to the US-Cuba Trade and Economic Council, up from $304.7 million the year before. Most of those exports were foodstuffs, especially poultry and soybeans. One source quoted by CBS News last year, Yale professor Carlos Eire, even described the United States as “the largest supplier of food to Cuba.”
What the embargo prevents is not selling to Cuba but selling to Cuba on credit. American producers are free to export agricultural commodities to Cuba, as long as the terms are cash on the barrelhead. Exports to Cuba do not qualify for federal credit guarantees and US Agriculture Department export promotion programs — highly lucrative forms of corporate welfare. American agribusiness keeps clamoring for the right to sell more commodities to Cuba on credit terms backed by the federal government, secure in the knowledge that if Cuba fails to pay its bill, some other entity will pick up the tab. The problem is that the communist regime will fail to pay its bills — it is a notorious deadbeat — and US taxpayers will be stuck with the check.
A weirdly persistent myth about the US embargo, one repeated over and over, is that if only it were repealed, Cuba would be inundated by a gush of tourists, consumer imports, and democratic ideas from America that would topple Havana’s communist walls. The silliness of the claim is evident from the energy with which Havana fulminates against the embargo. Besides: If commerce and tourism had the power to undo the regime, it would have been undone long ago. Millions of tourists from around the world, including hundreds of thousands from America, visit Cuba each year. And the US embargo affects only the United States — it doesn’t hamper Cuba from trading with scores of countries. If the island remains a despotic economic basket case, that is because it is ruled by a communist police state.
In 2021, when courageous Cubans by the thousands surged into the streets in the biggest anti-government demonstrations in two decades, they cried “Abajo la dictadura” (“down with the dictatorship”) and “Libertad!” Some waved American flags. Cuba’s people know that their misery is the fault of the oppressive regime that for six and a half decades has kept them in chains. The time to treat Cuba as a normal trading partner will come when that oppression ends — when political prisoners are freed, when emigrants can leave, when political parties are legalized, and when democratic elections are scheduled. That is what Klobuchar and her colleagues should be focused on, not how to sell more soybeans to Havana’s ruling thugs.
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Trump’s return will start the death count for Castrogonia IMO.