The Strange World of Medical Pricing | Why I Gave Up Football

This week, I got a call from the nursing supervisor at my mom’s assisted living community. She told me that my mom needed to have a minor outpatient procedure performed, and asked if I wanted to take her. I did, which was how I spent most of my Friday morning.

In thinking about the experience, a few things struck me. First, when the nursing supervisor called, she simply told me where the procedure would be taking place, and I automatically accepted that. It didn’t even occur to me to ask why that was the outpatient center her doctor had chosen and what, if any, other options there were. I’m someone who comparison shopped for days before buying a new laptop, but when it came to an invasive (albeit minor) medical procedure, I didn’t shop around at all. But even if I had, it would have been incredibly difficult for me to get any solid information about pricing and quality, because that’s just not how things work in American medicine.

The last thing I did before my mom had her procedure was to pay the bill. Except it wasn’t a bill – not exactly. When the administrative person told me there would be a charge of $127.19, the oddness of that number struck me and so I asked her how she arrived at that figure. “It’s our best guess as to what you mother will owe after insurance.” Best guess – that was the phrase she used. How absolutely bizarre, and yet I accepted it and paid the ‘best-guess bill’.

People can – and have – written books about this craziness. I’ve even taught an entire course about the extreme weirdness of American health care policy. I’m planning on doing a series of blog posts that examine various aspects of our broken health care market (blog posts that will later become short podcast episodes). For now, I’ll recommend this article from the always excellent Kaiser Health News site (my go-to place for health policy news) about why doctors and hospitals are pushing back hard against attempts to make medical pricing more transparent.

I’ve also been thinking a lot about football. It’s NFL playoff season, which would normally mean that I’d be glued to my TV set. But this year something changed. Over the last few years I’ve been reading plenty of articles about football and brain trauma. It seems very clear to me that professional football, as it’s currently played, is very bad for the long-term health of players. Yet I kept on watching, though with a growing sense of discomfort. But something changed after I witnessed the awful spinal injury suffered by Steelers’ linebacker Ryan Shazier. From that point on, I found that I could no longer enjoy the game like I used to. And so I quit watching.

It may seem strange to non football fans, but the decision has left a noticeable void in my life. I know that there are inherent risks in football, but I also know that the rules could be changed to far better protect players. And the government could play an important role in this, like it did back in 1905, when President Theodore Roosevelt (my all-time favorite president, if you didn’t already know), brought top college coaches together to make the sport less brutal. Some even claim that by doing so, T.R. saved the game.

I say it’s time for the federal government to once again intervene. It seems unlikely that President Trump will do so, as he’s actually remarked that today’s NFL is too soft, and that the game has been ‘ruined’ by ruled designed to better protect players.  But under a different president (something I hope will be the case in January of 2021), Congress could pressure the NFL to make some major player-safety changes by threatening to revoke the league’s anti-trust exemption.  What sort of changes might make a real difference? Physician Paul Auerbach has what I think are some good ideas concerning that.

PG134: Government Shutdown, March for Life, NC Gerrymandering

This week’s show starts off with the story everyone’s been talking about – the government shutdown. Mike and Jay largely stay away from the blame game consuming most of the media, and try to focus on why both parties did what they did and the role President Trumps leadership (or lack thereof) played.

Next, Mike and Jay discuss the 2018 March for Life, as well as some recent actions taken by the Trump administration and the House of Representatives in support of the pro-life movement. While Mike believes that women have a fundamental right to make reproductive decisions prior to fetal viability, he’s sympathetic to pro-life people who see essentially all terminated pregnancies as needless deaths. Jay makes the case that in this area, the law is on Mike’s side, but that he doesn’t find the fundamental right Mike does in the Constitution.

Finally, the Guys turn once again to gerrymandering, in light of the Supreme Court overturning the 4th Circuit Court of Appeals’ order that North Carolina redraw its Congressional districts by the end of January. Mike agrees with Jay that the Supreme Court made the right call, though they disagree concerning how the Court should ultimately rule.

What Mike’s Reading
Trump’s Basic Instincts About the Political War Are Essentially Right, and The Establishment’s Sense of It Is Essentially Wrong.

What Jay’s Reading
Bad Weather Is No Reason For Climate Alarm.

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GOP vs Facts, Politics Guys vs Diversity, Jay’s Burkean Ideals, 2020 Contenders

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In this listener mail episode (really more of a listener mail, Facebook, Twitter, and politicsguys.com site comment episode) Mike and Jay respond to listener comments concerning:

  • Why Republicans like Jay aren’t nearly as respectful of facts as Democrats are (Jay disagrees, as you might expect.)
  • Why The Politics Guys isn’t more diverse, and whether or not the lack of a liberal further to the left of Mike is a problem.
  • How Jay’s Burkean ideals match up to the modern-day GOP. (And Mike points out that he’s got Burkean ideals too!)
  • Who Mike and Jay think might run for president in 2020

During this episode, Mike waxed rhapsodical about the amazing economic data site put together by the St. Louis branch of the Federal Reserve – here’s the link.

Listener support helps make The Politics Guys possible. If you’re interested in supporting the show, go to politicsguys.com and click on the Patreon or PayPal links.

The Politics of Farm Labor

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Mike’s back with his second food politics episode. This time, he reads his post on the politics of farm labor , getting into who works on America’s farms (mostly immigrants), how willing Americans are to do farm labor (not very, for understandable reasons), why nearly half of all farm labor is done by undocumented immigrants, abuses of immigrant laborers, and the connection between immigrant labor and food prices.

If you’d like to let Mike know what you think about this episode, or if you have any ideas, suggestions, or you just want to say ‘hi’, you can reach him at mike@politicsguys.com.

The generous support of listeners is what helps keep The Politics Guys going. If you’d interested in becoming part of our great group of Politics Guys financial supporters, go to politicsguys.com and click on either the Patreon or PayPal links you’ll find there.

Putting Faces to Voices, Recommended Reading, Big Changes Coming

Putting Faces to Voices
When I teach online classes, one of the first things I do is post a picture of myself so that students can see who’s teaching them and to try to make more of a connection. Strangely, in the over two years we’ve been doing The Politics Guys, I’ve yet to do the same thing here.

Recently, a listener mentioned that we needed to get some pictures of ourselves up on the Politics Guys website, which finally prompted me to action. Here’s what The Politics Guys look like (for better or worse). I’m first, followed by Jay, then Trey.

What I’m Reading
I think I may have mentioned Jonah Goldberg from time to time on the show. If not, I should have, because he ‘s one of the most interesting and engaging conservative columnists around. For years, Jonah has been writing a column for National Review called ‘The G-File’. I frequently disagree with him, but I value his perspective and his humor – so much so that I’ve subscribed to The G-File in order to ensure that I see it every week.

As many of you know, Jay is a big fan of the Wall Street Journal. I have a subscription as well, but I understand that not everyone is interested in shelling out money to support a Murdoch-owned media outlet. So if you’re looking for solid, conservative commentary but you don’t want to get a WSJ subscription, I highly recommend National Review. They feature a range of interesting and thoughtful articles and they don’t have a paywall, like the Journal does.

Finally, I’m going to re-recommend Tyler Cowen – more specifically ‘Stubborn Attachments’, his recent long essay on morality and economic growth. I just finished reading it and ended up taking a ton of notes (I’m hoping to get Tyler on the show). In the essay, he makes what I think is the best ethical argument I’ve seen for focusing on sustainable economic growth over everything other than fundamental human rights.

Big Changes Coming to The Politics Guys
On February 8, our contract with audioBoom runs out, which means that we’ll be ad-free. It also means we’ll be free to pursue our efforts to turn The Politics Guys into a nonprofit organization. We’ve already chosen a name – the Bipartisan Political Education Project – reserved a web domain (bipartisanproject.org – which isn’t active yet, so you won’t see anything if you go there), assembled a board of directors, and filed for nonprofit status.

We’re still keeping ‘The Politics Guys’ name and there shouldn’t be any big changes to the podcast – at least not at first. There may be a few technical glitches as I move everything over from audioBoom, so if you run into any issues with shows not downloading or anything else, please let me know.

Our plan is to not only keep on doing the podcast, but to expand and improve our politicsguys.com website, branch out into video on YouTube, and even work with schools on helping to improve political media literacy.

It’s an ambitious agenda, and we’re going to be doing it without the support of advertisers. If this is something you’d be willing to get behind financially, we could most definitely use your help. To contribute, just go to politicsguys.com and click on either the Patreon or PayPal links you’ll find there.

PG133: Immigration, Is Trump a Racist?, Medicaid, Surveillance Law

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Mike and Jay open the show with a discussion of everything that’s been happening on the immigration front this week, including the Trump administration’s decision to not extend temporary protected status to nearly 200,000 Salvadorians, a federal judge’s ruling that DACA must continue until the courts rule on it, and the potential immigration deal that blew up amid President Trump’s remarks about ‘shithole’ countries. Mike argues that President Trump is both a racist and an impediment to the Republican party. Jay agrees that Trump makes the job of Congressional Republicans much harder, but won’t go so far as to call the president a racist.

After that, it’s a look at the administration’s announcement that it will allow states to impose work requirements on Medicaid recipients. Mike says that this is the Trump version of Obama’s DACA – implementing a program that contravenes legislative intent. Further, he argues that the work requirements arise more out of states’ desire to save money (at the expense of the poorest and most vulnerable) than out of concern for the people who will be affected. Jay disagrees, arguing that there are significant differences between DACA and this, and that states are ultimately helping people by imposing a work requirement.

Next, Mike and Jay discuss the bipartisan House vote approving a six-year renewal of the NSA’s warrantless wiretapping authority. Mike says this is not only bad for civil liberties, but is yet another example of President Trump’s disturbing lack of policy knowledge and his equally disturbing ability to be influenced by the last person he hears. Jay agrees with Mike’s point about President Trump, but feels that the NSA program is important and that renewing it without significant changes was the right move.

What Mike’s Reading:
The Decline of Anti-Trumpism. David Brooks

What Jay’s Reading:
The Cold War: A World History. Odd Arne Westad

Today’s show is sponsored by DaVinci, providing you with incredibly affordable access to meeting rooms in every city. Politics Guys listeners get 50% off their first purchase at davincimeet.com/TPG

Listener support helps make The Politics Guys possible. If you’re interested in supporting the show, go to politicsguys.com and click on the Patreon or PayPal links.

Whistleblowing, Leaking, and Employment Discrimination

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Mike talks with attorney Scott Oswald, a managing principal at The Employment Law Group. Scott has extensive experience with whistleblower, employment discrimination, and wrongful termination cases, regularly lectures on employment and whistleblower law, and has authored numerous articles on federal and state whistleblower and employment law protections.

Mike and Scott discuss the differences between whistleblowing and leaking, protections for whistleblowers, leaking of classified information, the magnitude of the employment discrimination problem, whether things are getting better, and differences between the Trump and Obama administrations in employment discrimination enforcement.

The Employment Law Group on Twitter

Listener support helps make The Politics Guys possible. If you’re interested in supporting the show, go to politicsguys.com and click on the Patreon or PayPal links.

PG132: Korea Talks, Iran Protests, DOJ on Marijuana, Wolff’s Book and Offshore Drilling

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In our first show of 2018 Mike and Trey look at what they thought would be a quiet week in the news that quickly exploded. First they look at the unexpected offer by Kim Jong Un to talks between North and South Korea. Then the hosts turn their attention to the emergence of protests in Iran and look at the similarities and differences between the 2009 and 2018 protests. After this weeks foreign policy questions are finished Trey and Mike discuss domestic policy beginning with Session’s DOJ memo on marijuana. They briefly discuss the more substantive outcomes of Michael Wolff’s upcoming book on the Trump White House before turning their attention to changes to offshore drilling.

Mike’s Recommended ReadingNational Review: ‘Can America Survive as a Post-Christian Nation?

Trey’s Recommended Reading: The Storm Before the Storm

This episode of The Politics Guys is sponsored by Policy Genius the free way to compare insurance quotes made simple.

New Year’s Resolutions

Over the past few weeks, I’ve mainly been focusing on my classes at Northern Kentucky University, both the super-intense three week class I’m currently teaching (American Politics in Film) and the four classes I’ll be teaching when our spring semester starts on Monday.

But in addition to that, I’ve been thinking about something lots of people think about this time of year: resolutions for the new year. I have some personal resolutions (none of which I’ve broken – at least not yet) as well as a couple of resolutions for The Politics Guys, which I’d like to share with you.

My first resolution is to use social media more thoughtfully. Last year, I too often succumbed to the temptation to post something inflammatory, or superficial, or snarky. Now, don’t get me wrong, I enjoy inflammatory, superficial, snarky stuff as much as the next guy, but Facebook and Twitter are already overflowing with that. You don’t need more of it from me, and this year I’m resolving to limit my social media posts to things that pose thoughtful questions or somehow serve to advance political conversation in a sane and rational manner.

My second resolution is to give Politics Guys listeners more in-depth debate. Back in the early days of the show, Jay and I regularly featured mid-week shows in which we picked out an issue or two and really dug into it. Last year, we turned almost exclusively to interviews and listener question shows. I think they were some great shows, but a number of listeners have told me that they missed those in-depth debates. You’ll get more of those in 2018.

I’m telling you about these resolutions because I’m hoping you’ll hold me to them. If you think I’m slacking, please let me know. And if you have any suggestions for debate shows, definitely pass those along (you can reach me at mike@politicsguys.com).

I’ll close with a new year’s recommendation. I’m sure you know the importance of seeking out views that conflict with your own – if you didn’t, you wouldn’t listen to the Politics Guys podcast or read this blog. But I know how difficult it is to commit to following ‘the other side’. Here’s a suggestion: pick out one decent columnist whose views tend to differ from yours and make a point of reading them on a regular basis. I’d suggest making it someone who isn’t a ‘paint-by-numbers’ ideologue: you know the type – someone whose views you know even before you hear from them. Find someone decent and respectable and – most important – someone who might just surprise you every once in a while.

I’ve got a couple of suggestions here. My fellow liberals might want to give Tyler Cowen a try. He’s a hugely intelligent conservative economist who I hold in the highest regard, even though I think he’s off-base about plenty of things. He blogs at Marginal Revolution as well as at Bloomberg View. (He’s also written a great mini-book call Stubborn Attachments that I’m currently in the middle of. He posted the whole thing on Medium, so you can check it out for free.)

If you’re a conservative, you might want to give Jonathan Bernstein a try. He’s a political scientist who used to run a blog called ‘A Plain Blog About Politics’ until the folks at Bloomberg View plucked him out of semi-obscurity to give him the platform his well-reasoned, thoughtful articles and links deserved.

One final thing before I sign off. Listener response to my food politics mini-podcast episode was very positive, and so I’ve decided to record more. One thing I’m not sure of is the best day to release them. Our weekend news analysis shows drop on Saturday afternoon and our midweek show hits your podcast app Wednesday morning. When would you like to see a food politics episode? (And while I’m thinking of it, what do you think of my spinning off the food politics show and making it its own thing?)

I hope you had a great 2017 and that you’re looking forward to the new year as much as I am. (I can’t wait for those elections in November!)

Political Bribery, Corruption, Secret Money, and Broken Elections

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Mike talks with Josh Silver, Director and co-founder of Represent.Us, a nonprofit organization that brings together conservatives, progressives, and everyone in between to pass powerful anti-corruption laws that stop political bribery, end secret money, and fix our broken elections.

Mike and Josh discuss why so many reformers take a left-wing approach, how big of a problem political corruption is, secret money and political speech, how to improve elections, and lots more.

Episode Links
The ‘Unrig the System’ Summit

The American Anti-Corruption Act

Lawmakers fighting Citizen Election Initiatives

Represent.us on Twitter

This episode of The Politics Guys is sponsored by SeatGeek, the easiest way to buy tickets to live events. Politics Guys listeners get $20 off their first SeatGeek purchase by downloading the SeatGeek app or going to seatgeek.com and entering promo code POLITICSGUY

Listener support helps make The Politics Guys possible. If you’re interested in supporting the show, go to politicsguys.com and click on the Patreon or PayPal links.