To Save Administrative Costs, Health-Care Providers Give Discounts for Paying Out-of-Pocket

(p. R6) As consumers get savvier about shopping for health care, some are finding a curious trend: More hospitals, imaging centers, outpatient surgery centers and pharmacy chains will give them deep discounts if they pay cash instead of using insurance.
When Nancy Surdoval, a retired lawyer, needed a knee X-ray last year, Boulder Community Hospital in Colorado said it would cost her $600, out of pocket, using her high-deductible insurance, or just $70 if she paid cash upfront.
When she needed an MRI to investigate further, she was offered a similar choice–she could pay $1,100, out of pocket, using her insurance, or $600 if she self-paid in cash.
Rather than feel good about the savings, Ms. Surdoval got angry at her carrier, Blue Cross Blue Shield of Arizona. “I’m paying $530 a month in premiums and I get charged more than someone who just walks in off the street?” says Ms. Surdoval, who divides her time between Boulder and Tucson. “I thought insurance companies negotiated good deals for us. Now things are totally upside down.”
Deep discounts
Not long ago, hospitals routinely charged uninsured patients their highest rates, far more than insured patients paid for the same services. Now, in the Alice-in-Wonderland world of health-care prices, the opposite is often true: Patients who pay up front in cash often get better deals than their insurance plans have negotiated for them.
That is partly due to new state and federal rules aimed at protecting uninsured patients from price gouging. (Under the Affordable Care Act, for example, tax-exempt hospitals can’t charge financially strapped patients much more than Medicare pays.) Many hospitals also offer discounts if patients pay in cash on the day of service, because it saves administrative work and collection hassles. Cash prices are officially aimed at the uninsured, but people with coverage aren’t legally required to use it.
Hospitals, meanwhile, have sought ever-higher rates from commercial insurers to make up for losses on other patients. Insurers pass those negotiated rates on to plan members, and given the growth in high-deductible plans, more Americans are paying those rates in full, out of pocket, than ever before.

For the full story, see:
Beck, Melinda. “Here’s a Way to Cut Your Health-Care Bill: Pay Cash.” The Wall Street Journal (Tues., Feb. 16, 2016): R6.
(Note: bold heading in original.)
(Note: the online version of the story has the date Feb. 15, 2016, and has the title “How to Cut Your Health-Care Bill: Pay Cash.”)

Glorious Colors of Fall Leaves Last Longer with Global Warming

(p. A20) IONA, Nova Scotia — A century ago, the flaming fall foliage in Nova Scotia would have long faded by early November. But today, some of the hills are still as nubbly with color as an aunt’s embroidered pillow.
Climate change is responsible, scientists say. As the seasonal change creeps later into the year, not only here but all across the northern United States and Canada, the glorious colors will last longer, they predict — a rare instance where global warming is giving us something to look forward to.
“If climate change makes eastern North America drier, then autumn colors will be spectacular, as they are on the Canadian Shield in dry summers, especially the red maples,” said Root Gorelick, a biology professor at Carleton University in Ottawa. The Canadian Shield is a broad ring of forests and ancient bedrock that extends hundreds of miles from the shores of Hudson Bay.
Over the very long term, the warming planet may have a negative effect on fall foliage, but even then any adverse impact is uncertain. It is not just an aesthetic question, but an economic one as well: The changing colors drive billions of dollars in “leaf peeping” tourism in Canada and the United States.
“From a peeper’s point of view, it’s good news,” said Marco Archetti, the lead author of a 2013 paper at Harvard on predicting climate change impacts on autumn colors in New England.
. . .
The Harvard study, which looked at the percentage and duration of autumn color in Harvard Forest in central Massachusetts from 1993 to 2010, predicted that with current climate change forecasts, the duration of the fall display would increase about one day for every 10 years. Look at it this way: Children born this year could have an extra week to enjoy the colors by the time they are 70.
The study further analyzed data for trees that turn red: red maple, sugar maple, black gum, white oak, red oak, black oak, black cherry and white ash. Only in white ash trees did the duration and full display of color decrease. In the others, the amount and duration of red leaves increased over the course of 18 years.
The Harvard study used data collected by John O’Keefe, the museum coordinator, now emeritus, at Harvard Forest, who made his observations by eye — estimating the percentage of colored leaves for each species and the duration from when 10 percent of a tree’s leaves turned color to when 90 percent had turned.
Those observations have been validated by Andrew Richardson, a professor of evolutionary biology at Harvard, who has since set up a network of 350 “phenocams,” cameras that quantify the duration and intensity of autumn colors in locations from Alaska to Hawaii, Arizona to Maine and up into Canada.
“John’s direct observations on the ground line up pretty well with the camera data,” Professor Richardson said.

For the full story, see:
CRAIG S. SMITH. “How a Changing Climate Helps Add Color to a Leaf Peeper’s Paradise.” The New York Times (Thurs., NOV. 3, 2016): A20.
(Note: ellipsis added.)
(Note: the online version of the article has the date NOV. 2, 2016, and has the title “How a Changing Climate Is Shaping a Leaf Peeper’s Paradise.” )

Giving $10,000 to Each Adult American Would Cost 13% of GDP

(p. A2) Imagine you’re president and Congress gives you a huge chunk of money to spend as you wish. Instead of cutting taxes or splashing out more on health care, infrastructure and defense, why not send a check to every adult?
That’s the essence of universal basic income, a centuries-old idea now enjoying a revival across the political spectrum.
. . .
To send every American adult $10,000 a year would cost $2.4 trillion, or 13% of gross domestic product. Junking the current safety net wouldn’t come close to paying for this: Scrapping income support for the poor, disabled and unemployed would save just $500 billion. Get rid of health care for the poor (mostly Medicaid), and the savings rise to only $900 billion. Getting rid of Medicare and Social Security would balance the costs, but that would leave the average retiree considerably worse off–politically (and ethically) a nonstarter.

For the full commentary, see:
Ip, Greg. “CAPITAL ACCOUNT; Payout Proposal Ignores Labor Needs.” The Wall Street Journal (Thurs., July 14, 2016): A2.
(Note: the online version of the commentary has the date July 13, 2016, and has the title “CAPITAL ACCOUNT; Revival of Universal Basic Income Proposal Ignores Needs of Labor Force.”)

Empathy Is “a Poor Moral Guide”

(p. C4) “Against Empathy” is an invigorating, relevant and often very funny re-evaluation of empathy, one of our culture’s most ubiquitous sacred cows, which in Mr. Bloom’s view should be gently led to the abattoir. He notes that there are no less than 1,500 books listed on Amazon with “empathy” in the title or subtitle. In politics, practically no higher value exists than being empathetic: Think of the words “I feel your pain” coming from Bill Clinton through a strategically gnawed lip.
. . .
Mr. Bloom, a psychology professor at Yale, is having none of it. Empathy, he argues, is “a poor moral guide” in almost all realms of life, whether it’s public policy, private charity or interpersonal relationships. “Empathy is biased, pushing us in the direction of parochialism and racism,” he writes.
. . .
His point, . . . , is that empathy is untempered by reason, emanating from the murky bayou of the gut. He prefers a kind of rational compassion — a mixture of caring and detached cost-benefit analysis. His book is a systematic attempt to show why this is so.
To those who say empathy is essential to morality, he’d reply that morality has many sources. “Many wrongs” — like littering or cheating on your taxes — “have no distinct victims to empathize with.” Nor does it appear that the most empathetic people behave the most ethically. “There have been hundreds of studies, with children and adults,” he writes, “and overall the results are: meh.”

For the full review, see:
JENNIFER SENIOR . “Books of The Times; Have a Heart, but Be Careful Not to Lose Your Head.” The New York Times (Weds., December 7, 2016): C4.
(Note: ellipses added.)
(Note: the online version of the review has the date Dec. 6, 2016, and has the title “Books of The Times; Review: ‘Against Empathy,’ or the Right Way to Feel Someone’s Pain.”)

The book under review, is:
Bloom, Paul. Against Empathy: The Case for Rational Compassion. New York: Ecco, 2016.

Doctors Lack Incentives to Use Best Ovarian Cancer Treatment

(p. 22) In 2006, the National Cancer Institute took the rare step of issuing a “clinical announcement,” a special alert it holds in reserve for advances so important that they should change medical practice.
In this case, the subject was ovarian cancer. A major study had just proved that pumping chemotherapy directly into the abdomen, along with the usual intravenous method, could add 16 months or more to women’s lives. Cancer experts agreed that medical practice should change — immediately.
Nearly a decade later, doctors report that fewer than half of ovarian cancer patients at American hospitals are receiving the abdominal treatment.
“It’s very unfortunate, but it’s the real world,” said Dr. Maurie Markman, the president of medicine and science at Cancer Treatment Centers of America. He added, “The word ‘tragic’ would be fair.”
Experts suggest a variety of reasons that the treatment is so underused: It is harder to administer than intravenous therapy, and some doctors may still doubt its benefits or think it is too toxic. Some may also see it as a drain on their income, because it is time-consuming and uses generic drugs on which oncologists make little money.

For the full story, see:
DENISE GRADY. “Ovarian Cancer Treatment Is Found Underused.” The New York Times (Tues., AUG. 4, 2015): A1 & A13.
(Note: the online version of the story has the date AUG. 3, 2015, and has the title “Effective Ovarian Cancer Treatment Is Underused, Study Finds.”)

Winemakers Adapt to Global Warming with Owls and Technology

(p. 7) As California heats up, winemakers are confronting new challenges large and small — some very small.
Mice, voles and gophers love vineyards. “We’re seeing more pest pressures due to warmer winters,” Ms. Jackson said, walking through rows of cabernet grapes. Another emerging issue: Grapes ripen earlier, and swallows and crows are eating fruit before the harvest. “It’s a big problem,” she said.
That explains the owls. Sixty-eight boxes are occupied by hungry barn owls; during the harvest, a falconer comes to some vineyards every day, launching a bird of prey to scare away other birds with a taste for grapes.
The Jacksons have also begun analyzing their crops with increasingly sensitive tools. Ms. Jackson recently installed devices that measure how much sap is in the vines. They transmit the data over cellular networks to headquarters, where software calculates how much water specific areas of vineyards do or don’t need. “Data-driven farming,” Ms. Jackson said.
The Jacksons are also monitoring their crops using drones equipped with sensors that detect moisture by evaluating the colors of vegetation. The wrong color can indicate nutritional deficiencies in the crops, or irrigation leaks.
“Previously, it would require an experienced winemaker to go and look at the grapes,” said Clint Fereday, the company’s director of aviation. “Now we can run a drone, tag an area of the vines with GPS, and go right to the spot that has a problem.”
The drones have other uses, too. An infrared camera can scan for people guarding illicit marijuana operations on nearby lands.
Not all the changes being made on the Jackson vineyards involve advanced technology. Some are simply ancient farming techniques that the drought has made increasingly relevant.
Field hands plant cover crops, like rye and barley, between every second row of vines, to help keep the soil healthy. The family is stepping up its composting program. Pressed grapes are composted, then placed beneath rows of vines, since the organic matter is better at retaining moisture than soil.
Ms. Jackson’s husband, Shaun Kajiwara, is a vineyard manager for the company, overseeing the grapes that go into many of the upscale labels.
. . .
Ultimately, Mr. Kajiwara believes that with the right mix of new rootstocks, cover crops and fortuitous rainfall, some of the Jackson vineyards might not need irrigation at all. “In a few years, I think we could be dry-farmed up here,” he said. “Our reservoir will just be insurance.”
It is a snapshot of the future for the Jackson family: a vineyard north of traditional wine country, where natural features might offset some of the deleterious effects wrought by climate change. And, in combination with the adaptations Ms. Jackson has put in place, it might just be enough to allow the company to keep making fine wines for many years to come.

For the full story, see:
DAVID GELLES. “A Winery Battles Warming.” The New York Times, SundayBusiness Section (Sun., JAN. 8, 2017): 1 & 6-7.
(Note: ellipsis added.)
(Note: the online version of the story has the date JAN. 5, 2017, and has the title “Falcons, Drones, Data: A Winery Battles Climate Change.”)

Cuban Entrepreneurs Lost Faith in Fidel’s Revolution

(p. 22) Ihosvany Oscar Artiles Ferrer, 44, a veterinarian who worked in Camag├╝ey but recently moved to Queens, said the lack of wholesalers to buy supplies from made it difficult to eke out a profit.
“The private business is like a handkerchief the government puts over everything to be able to say to the United Nations that in Cuba people own small businesses,” Mr. Artiles said.
“In the beginning, almost all of us were revolutionaries,” he added. “But now, we quit all that because we don’t believe in Fidel, in the revolution, in socialism or anything.”

For the full story, see:
FRANCES ROBLES. “Stay or Go? Cuban Entrepreneurs Are Divided on Where to Stake Futures.” The New York Times (Tues., MARCH 22, 2016): 22.
(Note: the online version of the story has the date MARCH 21, 2016, and has the title “Stay or Go? Cuban Entrepreneurs Divided on Where to Stake Futures.”)