Exposing the Libyan Agenda: A Closer Look at Hillary’s Emails

WEB OF DEBT BLOG

Critics have long questioned why violent intervention was necessary in Libya. Hillary Clinton’s recently published emails confirm that it was less about protecting the people from a dictator than about money, banking, and preventing African economic sovereignty.

The brief visit of then-Secretary of State Hillary Clinton to Libya in October 2011 was referred to by the media as a “victory lap.” “We came, we saw, he died!” she crowed in a CBS video interview on hearing of the capture and brutal murder of Libyan leader Muammar el-Qaddafi.

But the victory lap, write Scott Shane and Jo Becker in the New York Times, was premature. Libya was relegated to the back burner by the State Department, “as the country dissolved into chaos, leading to a civil war that would destabilize the region, fueling the refugee crisis in Europe and allowing the Islamic State to establish a Libyan haven that the…

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Economic Incentives for Administrative Simplification • JAMA Network

Source: JAMA

Administrative complexity in the US health system has been identified as the source of enormous spending and potential cost savings.1 In a new report, Sahni and colleagues2 provided a detailed evaluation of administrative cost-savings opportunities, including an estimated $175 billion that could be addressed without new laws or regulatory changes.

Health care is complicated because complexity is profitable. In the US health care system, payers, health systems, physicians, other clinicians, drug companies, pharmacies, and pharmacy benefit managers all earn more revenue because of administrative complexity. Moreover, unlike virtually any other sector of the economy, except higher education, health care can raise prices annually faster than inflation.3 This means that revenues, margins, and profits can all improve without addressing administrative efficiency. In most other sectors, organizations can only improve margins if they improve labor productivity or simplify administration.4

That administrative spending is greater in health care than other service industries is not new. Of the $3.8 trillion spent in 2019, an estimated $935 billion was on administrative spending.1 This percentage, approximately 25%, has been roughly constant for more than a decade.5 This Viewpoint explores the misaligned incentives that have made it difficult to make progress in reducing administrative spending and suggests potential changes necessary for administrative simplification to occur.

The Economic Incentives of High Administrative Spending

First, the current health care administrative system is the natural byproduct of economic forces rewarding payers, health systems, physicians, other clinicians, drug companies, pharmacies, and pharmacy benefit managers to maximize their profits. For example, payers profit from administrative complexity, using prior authorization and claims processes to reduce medical costs and designing custom benefit designs to achieve a specific premium price. Health systems profit from administrative complexity such as through opaque pricing, differential prices based on insurance coverage, and coding or risk adjustment activities to increase revenue.

The way health care services in the US are most often reimbursed with the fee-for-service payment system fuels this wasteful administrative give-and-take between payers and health entities. For instance, health care organizations are motivated to spend money on more sophisticated billing strategies to capture more revenue from payers, and payers are motivated to spend money on sophisticated review strategies to avoid paying claims to health care organizations and clinicians. These equal and opposite forces increase each year while canceling each other out and creating no aggregate value. While organizations innovate to improve the productivity of these billing or claims review activities, productivity improvements generally drive more activity rather than reduce total expense. For example, as offshore labor made medical claim reviews and denial appeals less expensive, payers have used this approach to review more claims, and health care organizations and clinicians have appealed claim denials more frequently. At times, the same business-process-outsourcing firm may provide services (such as call centers) for payers as well as services (such as call centers) for health care organizations.

Second, regulators (such as state departments of insurance and the Centers for Medicare & Medicaid Services) add administrative complexity as they act to protect patients from harm, ensure access and fairness, and protect public health. To achieve these goals, regulators collect data and quality metrics, formalize appeal and grievance processes, monitor payment accuracy, and conduct audits. Even regulations that require insurers to spend 85% of premiums on medical care—intended to cap administrative costs plus profits at 15%—decrease insurers’ incentive to reduce medical expenses, which in turn weakens the incentive for health care organizations to reduce their administrative costs.

Third, the US health care market structure blocks attempts to standardize. Payers are governed and organized at the state and county levels, whereas many health systems are primarily local organizations with concentrated market power in a single medical service area. Health plans need local health systems to join their networks to create marketable insurance products and do not have much leverage to force health care centers and clinicians to adopt processes or technologies that could lower administrative spending.

Aligning Technology With Economic Incentives to Help Lower Administrative Costs

Against these challenges, health care organizations are applying new technologies like remote process automation and artificial intelligence to address administrative processes and costs. Remote process automation is an approach for automating recurring processes, and because it is inexpensive to set up, it could be applied to many different processes. A common use is to manage prior authorization requests across many different payers. Artificial intelligence is also frequently deployed against complex administrative processes because it can iteratively solve problems and “learn.” A common administrative use for artificial intelligence is to assist with coding because the software can learn from payment and denial experiences that codes maximize revenue. Still, these technologies are ultimately workarounds, automating how the structural complexity is handled but not simplifying health care.

Although both artificial intelligence and remote process automation technologies have received much attention, another approach for addressing administrative complexity involves building technology-enabled customer service organizations. For example, in Medicare Advantage, some companies like Humana are offering one-stop patient “navigator” service functions that can handle nearly any question or problem. These approaches attempt to buffer patients, health care centers, and clinicians from insurance benefit design, network, and payment complexity. Even with these approaches, the underlying complexity persists, and the navigator services may increase administrative spending on customer service in exchange for higher satisfaction scores.

Reducing administrative spending will require changes in the regulation of and payment for health care. Actions to limit price increases, perhaps by indexing health care prices to the consumer price index, could also substantially increase motivation to reduce administrative spending. The Center for Medicare and Medicaid Innovation could pursue programs to test all-payer prices, hospital price oversight (such as adopted in Maryland), or Medicare–indexed hospital price caps based on local market dominance to drive margin pressure, motivating health care organizations to manage administrative expenses.6 Another policy lever could be enhanced Federal Trade Commission–Department of Justice enforcement and surveillance of hospital mergers at the local level, which would make it more difficult for health systems to raise prices.

Because incentive alignment is an effective mechanism for large and rapid change, one of the most important actions is to coordinate and accelerate the move away from fee-for-service payment models. Multipayer coordination could create an even stronger incentive. If payers adopt model contracts with the same quality metrics and definitions, data extraction and reporting could be automated. Standard prior authorization lists mandated electronic prior authorizations, and standardized payment denial and appeal protocols could all enable technology to automate these labor-intensive processes and reduce cost and complexity. Another cost-saving approach would be to reduce from 1400 the number of quality metrics reported.7

Conclusions

The US health care system is complicated but can be made simpler. To achieve this goal, the most important contributing factor is to make simpler, less expensive administration a profit imperative. All payers need to be enlisted in support of standardization around payment models, payment rules, and reporting metrics. Additionally, policies that limit price increases to the rate of inflation could create the profit margin pressures that have led to ongoing labor productivity and administrative simplification in other sectors.

Article Information
Corresponding Author: Bob Kocher, MD, Venrock, 3340 Hillview Ave, Palo Alto, CA 94304 (bkocher@venrock.com).

Published Online: October 20, 2021. doi:10.1001/jama.2021.18292

Conflict of Interest Disclosures: Dr Kocher reported being a partner at Venrock, which invests in technology and health care companies including Devoted Health, and serving on the boards of Devoted Health, Premera Blue Cross, and several other companies. Mr Chigurupati reported being an employee of and holding stock options in Devoted Health.

References

  1. Kocher RP. Reducing administrative waste in the US health care system. JAMA. 2021;325(5):427-428. doi:10.1001/jama.2020.24767
  2. Sahni NR, Mishra P, Carrus B, Cutler DM. Administrative Simplification: How to Save a Quarter-Trillion Dollars in US Healthcare. McKinsey & Company. October 20, 2021. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/administrative-simplifaction-how-to-save-a-quarter-trillion-dollars-in-US-healthcare
  3. Perry MJ. Chart of the day…or century? Carpe Diem AEI blog. January 14, 2020. Accessed August 27, 2021. https://www.aei.org/carpe-diem/chart-of-the-day-or-century-3/
  4. Kocher R, Sahni NR. Rethinking health care labor. N Engl J Med. 2011;365(15):1370-1372. doi:10.1056/NEJMp1109649
  5. Angrisano C, Farrel D, Kocher R, Laboissier M, Parker S. Accounting for the cost of health care in the United States. McKinsey Global Institute. Published January 1, 2007. Accessed August 27, 2021. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/accounting-for-the-cost-of-health-care-in-the-united-states
  6. Kocher RP, Shah S, Navathe AS. Overcoming the market dominance of hospitals. JAMA. 2021;325(10):929-930. doi:10.1001/jama.2021.0079
  7. Wilensky G. The need to simplify measuring quality in health care. JAMA. 2018;319(23):2369-2370. doi:10.1001/jama.2018.6858

Auction: Short Story

The Sperg Box

An audience gathered in a smoke lit auditorium, whose dimly lit apertures seemed to pulse beyond the smoke and steam and sound of laboured, rasping breathing. The hulking mass of those gathered came in their uniforms, tailored for maximum social capital: sweat pants, track suits and yoga tights sheathed the quivering throng as they sat upon their Adirondack thrones.

There they sat with bated, uncertain breath watching the stage. There upon the stage whose laminate veneer had been scuffed by the shined soles of 10,000 basketball-american feet was a podium. There behind the podium stood the unmasked man. Dapper. A debonair.

Here was a man with his twirled moustache and pressed tuxedo, of slight build and loathsome, oozing charm. When he spoke it was with the practised diction of the television-american, perfectly rootless, sublimely indistinct. Designed, as it were, for perfect ubiquity. The new Everyman, sold to the crowd on…

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SACRED GEOMETRY: ‘The Matrix of Four’, The Philosophy of the Duality of Polarity

RIELPOLITIK

Source – wakeup-world.com

  • “…The Matrix of Four expands universalism and connectivity as a whole while at the same time instigating individuation through spiritual, philosophical and metaphysical relationships towards united humanity, toward associated internalized consciousness”

The Essence of The Matrix of Four

The Matrix of Four is frequently and obviously at the basis of innumerable philosophical systems, and it is nearly as frequently covertly so. The Matrix of Four forms principal basis for so many philosophical and metaphysical systems that to understand it and its corresponding lessons is to better comprehend tremendously diverse subjects and objects including the mystery of our very own consciousness.

In fact, the number of philosophical systems of which The Matrix of Four is a principal idea or outright basis, is so overwhelming that much like air being everywhere its true significance is often overlooked and unseen. The stunning amount and the nature of the corresponding lessons…

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THE MEDIA MONOPOLY: ‘Psy-Ops’, The Deep State’s Imperative to Colonize Independent Media is Now Before Us – By Patrick Lawrence

RIELPOLITIK

Source – consortiumnews.com

  • “…Ressa and The Rappler, each insisting on independence just as the ICIJ does, are straight-out lying on this point. The Rappler recently received a grant of $180,000 from the National Endowment for Democracy, a CIA front — this according to an NED financial report issued earlier this year. None other than Pierre Omidyar and a group called North Base Media own nonvoting shares in the publication. Among North Base’s partners is the Media Development Investment Fund, which was founded by George Soros to do what George Soros likes to do in other countries. Does a picture begin to emerge?”

PATRICK LAWRENCE: Psy-ops

The Deep State’s imperative to colonize independent media is now before us.

(U.S. Embassy in Chile)

By Patrick Lawrence

Watch and listen, O you with open eyes and ears. The national security state’s long, very long campaign to control our press and broadcasters has…

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Pouring petrol on the distraction blaze can’t hide the Truth about killer vaccines

The Slog

Every new excuse for State control is like every variant of Covid – more feeble than the last one

On and off yesterday, I kept dipping into MSM, contrarian news points and blogsites to try and get properly to grips with what exactly the cause(s) of Britain’s “petrol shortage” might be.

All of them sounded variously silly, counter-intuitive, contrived or unfathomable: a mass exodus of migrant drivers, sudden retirement plans among the HGV class, ‘there’s long been a shortage of drivers’, post Covid oil shortages, Covid bleeping HGV drivers and – of course – Brexit. As usual, Granite Schnapps is hiding behind the sofa, but his 2iC at Transport let the cat out of the bag when he said yesterday, “There are queues at petrol stations because people think there’s a petrol shortage, but there isn’t”.

The media had, in one form or another, added a generous dollop of ‘shock-horror-panic’…

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WIIT PINNED POST … 30 facts you NEED to know: Your Covid Cribsheet … from Off Guardian

Wirral In It Together

You asked for it, so we made it. A collection of all the arguments you’ll ever need.

Kit Knightly

We get a lot of e-mails and private messages along these lines“do you have a source for X?”or“can you point me to mask studies?”or“I know I saw a graph for mortality, but I can’t find it anymore”. And we understand, it’s been a long 18 months, and there are so many statistics and numbers to try and keep straight in your head.

So, to deal with all these requests, we decided to make a bullet-pointed and sourced list for all the key points. A one-stop-shop.

Here are key facts and sources about the alleged “pandemic”, that will help you get a grasp on what has happened to the world since January 2020, and help you enlighten any of your friends who might be still trapped…

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Capitalism and Communism are a Ying and Yang With Ultimate Identical Hidden Masters.

@worldtdolphins

The rise of capitalism started with the Protestant reformation and wars and decreased charity from the rich resulting in early deaths of the poor. Henry the 8 violence and plunder of monasteries and resulting social catastrophe of poverty, starvation, homelessness death by cold and crime. That is history of capitalism rise is violence and expanded fratricidal wars are well linked to capitalism as is the French Revolution whose liberalism ideals hid a kill list of mainly catholic priests. The system had to butcher post revolution thousands to millions for the hidden evil spirits of the super rich to feed of human energy to the serpent gods of capitalism one sign is Einsoft the occult jewish God of Talmud and Kabbalah and true ethics of press owners and academia which is to cover up realities of 300 years of wars, junk science deaths in health care and its violence in pushing…

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The Fraud of the Anti Racists. Racism is a Word the Communist Mass Murderers Use For Dark Occult Evil.

@worldtdolphins

The super class teach their kids from Kabbalah, to Talmud to Zohar the catholics and protestants are a for 300 years declining minority of the very rich. Canada has the rare catholic Christian and catholic billionaire Frank Stronach of magna auto parts also into electric car technology and at over 75 into new mini innovative electric cars. While others internet truthers say the super rich are all bad perhaps Frank represents Lot in Sodom a world where only money counts > The neo lib world values obedient to banks jews “ City of London “& Israelis and rich and powerful gentiles or psychopathic war criminal rich & the war crimes include austerity or increased Canadian poverty is a capital offence due to billionaires or jewish banking cartel role in pay cuts and scams like just in time labour or contract labour or Walmart having workers put in 2 hours of…

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