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I tried to create a spreadsheet that would guide readers through the appeals process for all the different types of insurance and circumstances. When a patient needs care urgently, for instance, an appeal follows a different track. But with each day of reporting, with each expert interviewed, it got more and more confusing. There was a point when I thought I was drowning in exceptions and caveats. Some nights were filled with a sense that I was trapped in an impossible labyrinth, with signs pointing to pathways that just kept getting me further lost

You may think that UnitedHealthcare is your insurer because that’s the name on your insurance card, but that card doesn’t tell you what kind of plan you have. Your real insurer may be your employer.

Government insurance is its own tangle. I am a Medicare beneficiary with a supplemental plan and a Part D plan for drug coverage. The appeals process for drug denials is different from the one for the rest of my health care. And that’s different from the process that people with Medicare Advantage plans have to follow.

The federal government sets minimum standards that each state Medicaid program has to follow, but states can make things more complicated by requiring different appeal pathways for different types of health care. So the process can be different depending on the type of care that was denied, and that can vary state to state.

I sought help from Jack Dailey, a San Diego attorney and coordinator for the California Health Consumer Alliance, which works with legal-aid programs across the state. On a Zoom call, he looked at an Excel spreadsheet I’d put together for Medi-Cal, California’s Medicaid program, based on what I had already learned. Then he shook his head. A few days later, he came back with a new guide, having pulled an all-nighter correcting what I had put together and adding tons of caveats. It was seven single-spaced pages long. It detailed five layers of the Medi-Cal appeals process, with some cases winding up in state Superior Court. There were so many abbreviations and acronyms that I needed to create a glossary. (Who knew that DMC-ODS stands for Drug Medi-Cal Organized Delivery System?) And this was for just one state!

It’s especially complicated in oncology, said Dr. Barbara McAneny, a former president of the American Medical Association who runs a 6,000-patient oncology practice in Albuquerque, New Mexico. “My practice is built on the theory that all the patients should have to do is show up and we should manage everything else … because people who are sick just cannot deal with insurance companies. This is not possible,” she said. McAneny told me she spends $350,000 a year on a designated team of denial fighters whose sole job is to request prior authorization for cancer care — an average 67 requests per day — and then appeal the denials. For starters, she said bluntly, “we know everything is going to get denied.” It’s almost a given, she said, that the insurer will lose the first batch of records. “We often have to send records two or three times before they finally admit they actually received them. … They play all of these kinds of delaying games.”

McAneny thinks that for insurance companies, it’s really all about the money. Her theory is that insurance companies save money by delaying spending as long as possible, especially if the patient or the doctor gives up on the appeal, or the patient’s condition rapidly declines in the absence of treatment. For an insurance company, she said, “you know, death is cheaper than chemotherapy.”

Before we have sorted out who or what failed and why, many people have focused on restricting gun access. I will not blithely dismiss that discussion. There is simply no getting around the fact that America has a lot of guns, and it would not be intellectually honest to dispute that the mass availability of guns makes attacks like this easier to commit. Were there to be a wholesale gun confiscation in America, there would doubtless be fewer attacks like this.

The inability of society to properly monitor and manage people experiencing mental health crises is behind many problems, and is largely attributable to the well-intentioned but ultimately problematic choice to deinstitutionalize mental health care in favor of a model of community-based management.

I’m certainly not advocating for “re-institutionalization” but clearly something has to change, and the pendulum needs to swing back toward stronger interventions. Maine and the nation can design a better system that preserves humane treatment while simultaneously taking seriously the need to protect both society, and those like Card who desperately needed help and didn’t get it.

the IRS has hitherto set up neither a direct-filing system nor an automatic one, because of lobbying and conservative ideology. Intuit and its ilk have pressured both Congress and the IRS to head off such systems, and then taken the resulting profits to lobby for the tax code to be made more complicated, so ordinary Americans are even more tempted to pay to avoid the headache. One particularly evil objective in this area has been to make claiming the Earned Income Tax Credit as complex as possible, to prey on poor people who tend not to have the skill or time to fill out difficult forms. Roughly between 13 and 22 percent of EITC benefits are gulped down by tax prep companies.

Inuit is a freaky company. For decades, its defining CEO Brad Smith ran the company as a cult of personality organized around his trite sayings, like "Do whatever makes your heart beat fastest," stenciled on t-shirts worn by employees. Other employees donned Brad Smith masks for selfies with their Beloved Leader.

the cartel sabotaged Free File from the start. They blocked search engines from indexing their Free File services, then bought Google ads for "free file" that directed searchers to soundalike programs ("Free Filing," etc) that hit them for hundreds of dollars in tax-prep fees. They also funneled users to versions of Free File they were ineligible for, a fact that was only revealed after the user spent hours painstaking entering their financial information, whereupon they would be told that they could either start over or pay hundreds of dollars to finish filing with a commercial product.

"e-file…is wholly redundant": Well, no, Rick, it's not redundant, because there is no existing Free File system except for the one your corrupt employer made and hid "in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying 'Beware of the Leopard.'"

"nothing more than a solution in search of a problem": The problem this solves is that Americans have to pay Intuit billions to pay their taxes. It's a tax on paying taxes. That is a problem.

Now I want to address the reply guys who are vibrating with excitement to tell me about their 1099 income, the cash money they get from their lemonade stand, the weird flow of krugerrands their relatives in South African FedEx to them twice a year, etc, that means that free file won't work for them because the IRS doesn't actually understand their finances. That's a hard problem, all right. Luckily, there is a very simple answer for this: use a tax-prep service. Actually, it's not a hard problem. Just use a tax-prep service. That's it. No one is going to force you to use the IRS's free e-file. All you need to do to avoid the socialist nightmare of (checks notes) living with less red-tape is: continue to do exactly what you're already doing.

Money became increasingly fake-seeming as it diverged more and more from a hard day’s work and most conventional wisdom.

The growing number of people taking chances that they barely believed in (starting an Onlyfans, going all in on a memecoin, becoming a performative racist for clicks) reflected a rational response to seeing absurd and/or conventionally shitty ideas have outsized success (Bored Apes, Trump, the Babyccino).

bucking conventional wisdom in any direction became the order of the day. Contrarianism became incredibly popular. Taking the diametrically opposed position to consensus as a shortcut to standing out in a crowded and volatile field was a key Clown Town strategy.

As a subset of contrarianism, Hot Sauce Behavior became especially popular. Hot Sauce involves taking something basic or mid and applying a socially forbidden or mysterious spice to it (in place of, or to function as, the X factor or the je ne sais quoi). This element had to be shocking, bad, atavistic, or otherwise “not normal”—it could be Nazism, grooming, the Occult, Catholicism, outright aggression, the threat of violence, or the attitudes of obscure-to-you political groups—but in smallish amounts. It made peoples’ hearts race and adrenaline pump while they consumed something otherwise bland. (This was the Tension Economy as the new Attention Economy.)

If the 2020 degen was a gambler willing to go all in on a whim… …the 2023 degen is a sophisticated risk manager We have found ourselves in a new cultural era in which multiple overlapping crises and rising interest rates have led to an emergent reckoning. It is now widely understood that it was very stupid to play crazy games with tons of excess money instead of actually improving material reality. But certain questions remain: What the fuck is anything worth today? What’s the best way to manage risk while it all comes falling down?

In chess, today’s average player is more skilled than the one from yesteryear because online exposure of advanced theory has led to regular players making the moves of masters. As Virgil once said, “One kid does a new skateboard trick, then hundreds more can do it the next day around the world.”

Everyone should be able to use their increased intelligence and awareness to better navigate the world. In reality, the irony is painful: When everyone gets smarter, things get harder. If everyone is reassessing the most-effective-tactics-available all the time, it gets harder and harder to win, even though you’re smarter and “should be in a better position.” The Yale admissions office realizes thousands of applicants have watched the same obscure how-to-get-into-Yale TikTok, and decides to change the meta: Leadership is no longer a valuable quality.

Max Pain means, even when you’re right, you’re wrong; it describes a climate in which everyone’s opinion is right at some point, but never at the right time.

Coping with things is the prevailing mood in my corner of the universe. As I write this, America has just completed an election in which many people voted primarily for the idea of voting. The prevailing candidate? Less an individual than an avatar of civility and liberalism.

We are a country founded on an idea and not an identity.

Americans have a way of obscuring reality through grand symbolism and none of the accompanying semiotic rigor. As if the facade of democracy can be upheld by not looking too closely at increasingly undemocratic outcomes — our high tolerance for multiculturalism tenuously predicated on everyone struggling equally. The difference between idea and identity is both our saving grace and our downfall. Democracy: watch the gap.

The idea of the American individual, part of the national optimism that fueled the Space Race, is far less prominent than the citizen-consumer. Attaining a degree of celebrity, still a coveted means to financial stability, thrusts one into the category of “celebrity,” where image overtakes personhood.

Lifestyle, like work, is something we can only see in aggregate. Technological gains don’t relieve the pressure for ownership; they merely reinforce it.

The number one thing UBI doesn't handle well is rent inflation. You hand out $1000 dollars per person monthly, expect rents to go up by about $1000 monthly as landlords realise there is all this extra disposable income in peoples' hand right now.However, this is just an exaggerated effect of monopolies sucking out all aggregate disposable income out of economy that is already happening. Monopolies by definition don't have price down pressures, so they always price expand to capture anything people might have extra. Since landlording is the biggest aggregate monopoly in the world, landlords capture any disposable workers' income. No matter if they get a raise from their boss, the landlord always takes it away.

One of the biggest strengths of UBI is that it eliminates the beurocracy and waste associated with determining who "deserves" assistance. The dominant model in the US is expecting homeless people with drug problems to solve both their addiction and homelessness at the same time by themselves before they are deemed worthy of being helped, which needless to say is barely assistance at all. Having a gaurenteed income stream would make it easier to gain a foothold.

A common example of diminishing returns is choosing to hire more people on a factory floor to alter current manufacturing and production capabilities. Given that the capital on the floor (e.g. manufacturing machines, pre-existing technology, warehouses) is held constant, increasing from one employee to two employees is, theoretically, going to more than double production possibilities and this is called increasing returns. If we now employ 50 people, at some point, increasing the number of employees by two percent (from 50 to 51 employees) would increase output by two percent and this is called constant returns. However, if we look further along the production curve to, for example 100 employees, floor space is likely getting crowded, there are too many people operating the machines and in the building, and workers are getting in each other's way. Increasing the number of employees by two percent (from 100 to 102 employees) would increase output by less than two percent and this is called "diminishing returns."

the police are at wits’ end. It all speaks to the desperate need for a statewide mental health system, funded with help from the feds. The problem is just too big for San Francisco to solve on its own.

Why costs are so high: The simplest answer is that schools have had little incentive to control costs, particularly when abundant student loans — both public and private — can make tuition rates appear more affordable than they really are.Moreover, some schools are motivated to spend on high-ticket items like new construction, because that can attract wealthier students (including from overseas) who don't request financial aid. In the end, however, those costs often get passed down to everyone.This is a systemic issue, which explains why most politicians have preferred to play along the easier margins.

There are possible solutions that have been circulating among education experts, not all of which rely on taxpayer largesse like making public college free for lower-income students.One would be to limit loans tied to education at schools that have a demonstrated history of onerous student debt burdens. In other words, if most of a school's students aren't receiving the sort of education that allows them to pay off their loans, cut it off at the source.This could include a gainful employment rule focused on career programs, which is favored by the Biden administration but languishing in Congress.Another would be to deny federal research grants to schools whose tuition rates increase at an unacceptably high level. This would be particularly impactful at large public and private universities.The federal government also could consider revoking the tax-exempt status of schools that exceed tuition inflation limits, although that likely would face court challenges.

The whole public-facing system of college admissions—in which admissions decisions are based on rigorous academic standards and financial aid is supposedly provided to those who are most academically and financially deserving—is an elaborate stage play meant to flatter privileged families and the reputations of colleges themselves. The real system, hidden behind the scenery, is much closer to the mechanics of pure capitalism, driven by an industry of for-profit consultants and relentlessly focused on the institutional bottom line.

A spokesman from Clark University, which tried to entice Ethan with a “$68,000 Robert Goddard Achievement Scholarship,” told me that the school “does not rely on an enrollment management consultant.” Instead, they said, it “occasionally” hires “outside analytical support” that does “not tell us how much aid to offer any student or group of students” but does “crunch large volumes of data in a timely manner that we then use to assess our progress toward our enrollment goals and estimate/project our total aid expenditure through that enrollment cycle.”

So, not an enrollment management consultant. Just, you know, a consultant that helps them manage enrollment.

As DiFeliciantonio wrote: “Wealthy families are more able and less willing to pay for college while the poorer families are more willing and less able.” In other words, parents of means who themselves have finished college are often sophisticated consumers of higher education and are able to drive a hard bargain, whereas lower-income, less-educated parents feel an enormous obligation to help their children move farther up the socioeconomic ladder and blindly trust that colleges have their best financial interests at heart. So colleges obey the algorithm and offer more financial aid to the Ethans than to the Ashleys, one of many problems identified in a recent Brookings Institution report.

Ashley submitted financial aid forms with information about her family’s modest income because everyone and everything about the process told her college aid is based on how much money you need, or deserve. She had no idea that information could be used against her. In May, New York University offered her admission if she would agree to delay enrollment until spring 2023—when, maybe not coincidentally, her good-but-not-stellar academic record would not count in the rankings data NYU submits to U.S. News & World Report. Their price? $79,070. Their aid offer? $0, take it or leave it, with 96 hours to respond.

as the countless individual stories that compose the nation’s $1.7 trillion student loan crisis show, many families make different choices. They are drawn in by a combination of optimism, blind faith, and familial obligation, and end up with debts they cannot repay. Colleges know this will happen.

Nobody is really judging your worthiness for financial aid. College is just another service with a price.

The goal? To make new green energy production cheaper for utilities to build than fossil fuel plants are.

Although Amazon has clocked staggering growth, it generates meager profits, choosing to price below-cost and expand widely instead. Through this strategy, the company has positioned itself at the center of e-commerce and now serves as essential infrastructure for a host of other businesses that depend upon it. Elements of the firm’s structure and conduct pose anticompetitive concerns—yet it has escaped antitrust scrutiny.

This Note argues that the current framework in antitrust—specifically its pegging competition to “consumer welfare,” defined as short-term price effects—is unequipped to capture the architecture of market power in the modern economy. We cannot cognize the potential harms to competition posed by Amazon’s dominance if we measure competition primarily through price and output. Specifically, current doctrine underappreciates the risk of predatory pricing and how integration across distinct business lines may prove anticompetitive.

These concerns are heightened in the context of online platforms for two reasons. First, the economics of platform markets create incentives for a company to pursue growth over profits, a strategy that investors have rewarded. Under these conditions, predatory pricing becomes highly rational—even as existing doctrine treats it as irrational and therefore implausible.

Second, because online platforms serve as critical intermediaries, integrating across business lines positions these platforms to control the essential infrastructure on which their rivals depend. This dual role also enables a platform to exploit information collected on companies using its services to undermine them as competitors.