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Gouging the Gougeable: Yet Another Triumph of the American Health Care System

| Tue Dec. 16, 2014 12:12 PM EST

Len Charlap has had a couple of outpatient echocardiograms recently. Elisabeth Rosenthal tallies up the damage:

The five hospitals within a 15-mile radius of Mr. Charlap’s home here charge an average of about $5,200 for an echocardiogram, according to an analysis of Medicare’s database. The seven teaching hospitals in Boston, affiliated with Harvard, Tufts and Boston University, charge an average of about $1,300 for the same test. There are even wide variations within cities: In Philadelphia, prices range from $700 to $12,000.

....In other countries, regulators set what are deemed fair charges, which include built-in profit. In Belgium, the allowable charge for an echocardiogram is $80, and in Germany, it is $115. In Japan, the price ranges from $50 for an older version to $88 for the newest, Dr. Ikegami said.

Because Mr. Charlap, 76, is on Medicare, which is aggressive in setting rates, he paid only about $80 toward the approximately $500 fee Medicare allows. But many private insurers continue to reimburse generously for echocardiograms billed at thousands of dollars, said Dr. Seth I. Stein, a New York physician who researches data on radiology. Hospitals pursue patients who are uninsured or underinsured for those payments, he added.

This is now such a common story that it's hard to work up the outrage it deserve. Is this practice corrupt? Merely venal? Or just crazy? I don't even know anymore. What I do know is that if an outpatient echo costs $80 in Belgium and $500 via Medicare, there's no conceivable justification for a $5,200 charge. It bears no relationship to the actual cost of the test, and is designed primarily to gouge the occasional uninsured patient who has no choice in the matter along with the (inexplicable) occasional insurance company willing to pony up even for obviously outrageous charges. One of the hospitals that performed an echocardiogram on Charlap didn't even bother denying that this is what they're doing:

In a statement, the hospital in Princeton that performed Mr. Charlap’s first, more expensive echocardiogram noted that “the vast majority of customers” paid much less than the listed prices. It added that its pricing reflected the need to offset losses because many programs, including Medicare, reimburse less than the cost of delivering services.

I doubt that Medicare is reimbursing less than the cost of performing an echocardiogram, but you can see what's going on here. The "vast majority" of patients do indeed pay far less than list price. So why have such a high list price? In order to gouge the tiny minority who are gougeable.

It's lovely the way American medicine works, isn't it?

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These Are the Cutest Animal Videos of 2014, According to the World's Leading Science Journal

| Tue Dec. 16, 2014 11:08 AM EST

Nature is one of the world's flagship peer-reviewed scientific journals, a venue for some of our best new ideas about the world. Sometimes, those ideas are about animals that also happen to be outrageously, unconscionably cute. I'm talking baby-penguins-and-pomeranians-and-monkeys-cute. This morning the ingenious folks in Nature's video department rounded them all up into one face-melting video.

Here's how to put a YouTube video on endless loop. You're welcome.

The Ruble Continues Its Free Fall

| Tue Dec. 16, 2014 10:50 AM EST

Well, we have our answer: the Russian central bank's last-ditch effort to stop capital flight didn't work. It was indeed taken by the market as a sign of desperation, not strength. The ruble recovered a bit right after the surprise interest hike in the middle of the night, but by mid-morning panic had settled back in and the ruble was once again in free fall. Even the enticement of 17 percent interest wasn't enough incentive for people to keep their rubles in Russian banks:

By early afternoon in Moscow, the ruble dropped sharply, reaching 80 to the dollar, a record low and a 35% decline from opening levels when it rallied briefly. At 1630 local time, the dollar was trading around 73 rubles....Deputy Chairman Sergei Shvetsov called the situation “critical,” the Interfax news agency reported. “At lot of (market) participants are in serious condition because of these events.”

“The choice the central bank made (to raise rates) was between very bad and very, very bad,” he said, noting that the bank could yet take more measures to stabilize the market....Economists warned that the central bank appeared to be losing control of the market and might have no alternative but to restrict trading. “Capital controls as a policy measure cannot be off the table now,” said Citigroup’s Mr. Costa.

Stay tuned.

Pakistani Taliban Kills At Least 145 People—Including More Than 100 Kids—in Savage School Massacre

| Tue Dec. 16, 2014 10:43 AM EST

The Pakistani Taliban is claiming responsibility for a deadly attack inside a military-run school in Peshawar, in northwestern Pakistan, on Tuesday, that has left as many as 145 dead, more than 100 of them students. The BBC has described the attack as the deadliest massacre ever carried out by the Taliban in Pakistan.

Gunmen entered Army Public School and Degree College by scaling the walls of the campus' main building. The attackers held students hostage for more than eight hours, as they moved systematically from classroom to classroom firing at children. Reuters quoted a local hospital as saying that the dead and injured were aged between 10 and 20 years old.

Six gunmen were reportedly killed in the gunfire. A spokesperson for the  terrorist group says the massacre was a retaliation against earlier Pakistani military activities against militants in North Waziristan.

"We selected the army's school for the attack because the government is targeting our families and females," Taliban spokesman Muhammad Umar Khorasani said, according to Reuters. "We want them to feel the pain." 

Prime Minister Nawaz Sharif, who has traveled to Peshawar, has called for three days of national mourning.

Will Private Prisons Finally Be Subject to the Freedom of Information Act?

| Tue Dec. 16, 2014 6:45 AM EST

Anyone can use the federal Freedom of Information Act to request records about prisons owned and operated by the government. Information about prisoner demographics, violent incidents, and prison budgets are all obtainable. But privately run facilities—even those that hold federal prisoners—are exempt from the law. Last week, Rep. Sheila Jackson Lee (D-Texas) introduced legislation to change that. On December 10, she introduced a new bill, the Private Prison Information Act. If passed, it would force any nonfederal prison holding federal prisoners to comply with the Freedom of Information Act.

In 2013, 41,200 federal convicts—19 percent of the entire federal prison population—were housed in private facilities. That year, Corrections Corporation of America, the largest prison contractor in the United States, collected more than $584 million from the federal government.

Passing Lee's bill will be difficult, if not impossible. From 2005 to 2012, Democrats (including Lee) introduced five separate bills that aimed to apply FOIA to private prisons. All of them failed. With the GOP—which has been generally friendly to the prison industry—controlling both houses of Congress beginning next year, the new bill will likely meet a similar end.

Meanwhile, increasing numbers of prisoners are locked up in facilities that are legally immune to open-records requests. From 2000 to 2009, the number of people locked up in private facilities at every level of the justice system increased 37 percent, to 129,336, according to the Department of Justice. By the end of 2013, 133,000 inmates—about 8 percent of the entire US prison population—were housed in private prisons. The figure is on par with the entire California prison population at that time.

The Federal War on Medical Marijuana Is Over

| Tue Dec. 16, 2014 6:00 AM EST
Steven D'Angelo's Harborside Health Center in Oakland, California, was a target of the federal government.

Good news for medical pot smokers: The $1.1 trillion federal spending bill approved by the Senate on Saturday has effectively ended the longstanding federal war on medical marijuana. An amendment to the bill blocks the Department of Justice from spending money to prosecute medical marijuana dispensaries or patients that abide by state laws.

"Patients will have access to the care legal in their state without fear of federal prosecution," Rep. Sam Farr (D-Calif.), a supporter of the rider known as the Hinchey-Rohrbacher amendment, said in a statement. "And our federal dollars will be spent more wisely on fighting actual crimes and not wasted going after patients."

The DOJ's earlier pledge not to interfere with state pot laws left it plenty of wiggle room.

The Department of Justice last year pledged not to interfere with the implementation of state pot laws, but the agency's truce left it with plenty of room to change its mind. Earlier this year, for instance, the DOJ accused the Kettle Falls Five, a family in Washington State, of growing 68 marijuana plants on their farm in Eastern Washington, where pot is legal. Members of the family face up to 10 years in jail—or at least, they did; the amendment may now stop their prosecution.

More broadly, the change provides some added peace of mind for pot patients in California, where the DOJ's pledge appeared not to apply. The Golden State's 1996 medical pot law, the first in the nation, has long been criticized by the DOJ as too permissive and decentralized.

Medical marijuana activists hailed the amendment's passage as a landmark moment for patients' rights. "By approving this measure, Congress is siding with the vast majority of Americans who are calling for change in how we enforce our federal marijuana laws," said Mike Liszewski, Government Affairs Director for Americans for Safe Access.

The CRomnibus spending bill wasn't a universal victory of marijuana advocates, however. Another rider aims to prevent the District of Columbia from legalizing marijuana; it prohibits federal funds being "used to enact any law, rule, or regulation to legalize or otherwise reduce penalties associated with the possession, use, or distribution of any schedule I substance." But Reason's Jacob Sullum notes that the rider may be moot because DC's pot law has already been "enacted" by voters—it passed at the polls in November by a 2-to-1 margin.

Whatever the outcome in DC, the appropriations bill is an undisputed win for pot smokers. As Slate's Josh Voorhes points out, "the District is home to roughly 640,000 people; California, one of 23 states were medical pot is legal, is home to more than 38 million." In short, Congress has done a bit of temporary weed whacking in its backyard, but it's acknowledging that stopping the repeal of pot prohibitions by the states is all but impossible.

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These Ubiquitous Chemicals May Be Making Us Stupid

| Tue Dec. 16, 2014 6:00 AM EST

You may not think much about the class of industrial chemicals called phthalates, which are used both to make plastics more flexible and to dissolve other chemicals. But you're quite likely on intimate terms with them. According to the Centers for Disease Control, they're found in "vinyl flooring, adhesives, detergents, lubricating oils, automotive plastics, plastic clothes (raincoats), and personal-care products (soaps, shampoos, hair sprays, and nail polishes)."

Because of their ubiquity, researchers routinely find phthalate traces in people's urine, CDC reports. Does it matter? "Human health effects from exposure to low levels of phthalates are unknown," the agency claims. But a growing body of research—summarized here and covered on Mother Jones here, here, here, and here—suggests they're causing us subtle but significant harm.

Kids exposed to the highest levels of two common phthalates in the womb had an IQ score, on average, more than six points lower than children exposed at the lowest levels.

The latest: A study from a team of Columbia University and CDC researchers, published in the peer-reviewed PLOS-One, found that higher levels of exposure to phthalates at the prenatal phase is correlated to lower IQ scores for kids at age seven. The researchers tracked 328 New York City women and their children through a project called the Columbia Center for Children’s Environmental Health (CCCEH). They took urine samples during the third trimester of pregnancy, looking for traces of five different phthalates. Nearly all of the samples contained them. They divided the women into four groups, ranging from the lowest to the highest phthalate readings. Then they subjected their kids to intelligence tests at age seven, and—controlling for socioeconomic and lifestyle factors—found that the ones exposed to the highest levels of two common phthalates in the womb had an IQ score, on average, more than six points lower than children exposed at the lowest levels.

None of the exposure levels, the authors report, were unusually high—they fell "within the range previously observed among general populations."

The study builds on a similar one by the same team, published in 2012, that found that the preschoolers with the highest prenatal levels of exposure to phthalates showed lower mental and motor development than less-exposed toddlers. The new study suggests that these effects persist into school age—a disturbing finding. "We note that the consistency of the associations over time has implications for public health and regulatory policy," the authors declare. That's science jargon for: "shouldn't the the feds be doing something about this?" Currently, phthalates are banned from kids' toys, but beyond that, neither the Food and Drug Administration for the Environmental Protection Agency has taken any action to rein in their use.

In a press release from Columbia University that accompanied publication of the study, the researchers say that while it's "impossible" to completely avoid phthalates, we can minimize our exposure to them by "not microwaving food in plastics, avoiding scented products as much as possible, including air fresheners, and dryer sheets, and not using recyclable plastics labeled as 3, 6, or 7." That's great advice—for consumers in the know. But in the absence of federal action, the vast majority of people, including pregnant women, will continue being exposed to them, unaware of their potential downside. After decades of federal campaigns, excessive drinking while pregnant has acquired the whiff of social stigma. Using plastic in the microwave while expecting—much less using dryer sheets and air fresheners—not so much.

Quote of the Day: Russian Central Bank Decides It Needs to Destroy the Economy In Order to Save It

| Mon Dec. 15, 2014 9:05 PM EST

From Neil Irwin, commenting on the huge interest rate jump announced by Russia's central bank in the wee hours of the morning:

It may go without saying, but a 6.5 percentage point emergency interest rate increase announced in the middle of the night is not a sign of strength.

Roger that. Russian central bankers hope that this will be an incentive for people to keep their money in Russia, earning high interest, instead of shipping rubles out of the country at warp speed and squirreling them away in any safe haven that comes to hand. And maybe it will work. Alternatively, as Irwin suggests, it may be viewed as a sign of desperation, causing Russia's oligarchs to pile on the dilithium crystals and ship out their money even faster. You never know what's going to work when a currency crisis goes into panic mode.

In any case, even if it works, the price is going to be high. Here in America, we argue about whether the Fed will choke off recovery if it raises interest rates to 2 percent. Russia is now at 17 percent. Even if this puts a halt to currency flight, it's going to kill their economy. In Russia tonight, there are no good options left.

This Video Reveals Just How Degrading Professional Cheerleading Really Is

| Mon Dec. 15, 2014 4:08 PM EST

Earlier today I published a timeline that chronicles the history of cheerleading, featuring everything from the debut of the Washington Redskinettes to Robin Williams' cameo as a Denver Broncos cheerleader. But for all the confounding moments in the hundred-plus years of cheerleading, this clip of a reality TV show called Making the Team might take the cake.

Now in its ninth season on Country Music Television, the show follows candidates as they try out for the famous Dallas Cowboys Cheerleaders. In the clip above, from August, team director Kelli Finglass performs "uniform checks," which she punctuates with choice comments like, "Today, we had a little bit of thigh and butt running together, so we're calling it a 'thutt.' Megan had a little bit of a thutt. We can cover cankles with boots, but we can't cover thutts."

Keep in mind: Finglass has said that she wants her cheerleaders to be "role models" who are a "cross section of the American woman." Also, it's 2014.

The Lima Climate Talks Actually Produced Something Important: An Idea

| Mon Dec. 15, 2014 3:42 PM EST

So what should we think about the recently concluded climate talks in Lima? They were, as usual, a dog's breakfast. Rich countries fought their usual battles with poor ones. The talks nearly foundered completely. Over the weekend the wording of the draft agreement went from "weak to weaker to weakest," in the words of Sam Smith, chief of climate policy for the environmental group WWF. And in the end, no legally binding limits were set on greenhouse gas emission.

That sounds pretty bad. And yet, something important happened in Lima. As weak as the final language turned out, it does do one thing: it asks every country on the planet to submit a plan to reduce its greenhouse gas emissions. It doesn't mandate what the plans should be. It doesn't require any independent review of the plans. It doesn't set out any timetables. But it does require a plan from everyone.

This is something new. It may not be legally binding, but then, no agreement was ever likely to be. For the first time ever, though, Lima enshrines the idea that every country should have a plan to fight climate change. This is similar to Obamacare, which is flawed in dozens of ways but, for the first time in American history, enshrined in law the idea that everyone should have access to affordable health coverage. Once you do that—once you get that kind of public agreement to an idea—you can use it as a building block. Eventually Obamacare will become universal health care. In the same way, Lima may eventually be the building block that produces a universal agreement to fight climate change on a global scale.

This is a fairly rosy view of the Lima agreement, and I don't want to oversell it. Still, the mere principle that every country on the globe should have a formal plan to reduce greenhouse gas emissions is important. Once the plans are in place, they become a concrete starting point for climate activists everywhere. And then they go from weakest to weaker to weak to something that's actually meaningful. Everywhere.

It's not enough. But it's something.