A story in which a health insurer is not the bad guy.

Well, I survived my major medical procedure and apparently don't have stomach cancer or any other life-threatening condition. Julia had a delightful time because she got to narc on me when the nurse asked how often I took THC gummies. (Imagine the most incredulous voice you've ever heard choking back laughter and saying, "'Once in a while'???") I had a delightful time because she took me to Whole Foods afterward and I got a top-shelf roast beef sandwich. I also had a whole conversation with the doctor that I don't even remember, because they put so much fentanyl in me. (I'm told that I asked him thoughtful questions like "Should I change my eating habits?" and "Should I exercise?")

On a coincidentally superficially related note, here's an interesting story that may inform how you look at the news. There's a twist, so don't stop reading early:

The American Society of Anesthesiologists put out a press release last month attacking a health insurer (Anthem Blue Cross Blue Shield) for saying its plans in some states would "no longer pay for anesthesia care if the surgery or procedure goes beyond an arbitrary time limit, regardless of how long the surgical procedure takes." The subhead of the press release reads: "Another example of insurers putting profits over patients."

Sounds bad, right? A health insurer is saying it won't cover anesthesia costs if a surgery takes longer than the insurer believes it should. And of course, anesthesia bills are enormous, and patients—especially patients who are under anesthesia—have no control over how long a procedure takes. You don't want your surgeon to rush things, but you also don't want to wake up and find out you owe $78,000 because she took five extra minutes. (Yes, the surgeon is a woman. In fact, she is a Latina trans woman. This is a very woke newsletter.)

Anyway, it's very easy to believe that a health insurer like Anthem BCBS would do something like this, because so many Americans have dealt with or heard about an insurer doing everything possible to deny coverage for medical treatments. People hate health insurers. And that hate is about as justified as hate can be, because health insurers make money by finding reasons to refuse coverage, and do not even have to report how many claims they deny. Accounts like left-wing nonprofit news organization More Perfect Union shared the press release with tens of thousands of surely outraged followers on Twitter and Bluesky.

But. (This is the twist.)

A guy from Minneapolis on Bluesky, who has about 15 years of experience as a health actuary, looked into it more deeply. And here is what is actually happening:

Starting in February, Anthem BCBS is going to start using standards set by the Centers for Medicare & Medicaid Services to evaluate anesthesia bills. As Aaron Blackshear, the guy in question, explains: "What this policy change is doing is saying there is a cap on how long you can bill for based on the type of surgery, just like there is when it's someone on Medicare. The days of padding those bills for commercially insured people is over."

So Anthem is not going to deny coverage of anesthesia care if a procedure takes too long. It's just not going to pay anesthesiologists more if they bill above a set number of hours for a particular procedure, the same number used by Medicare and Medicaid. (And the specific, not at all arbitrary number of hours is established by surveying the doctors themselves.)

This sounds much more reasonable. Anesthesiologists and other doctors shouldn't be able to pad their hours and overbill insurers. Of course, many anesthesiologists feel differently, which is why the American Society of Anesthesiologists—which is a lobbying organization, not just a group for anesthesiologists who want to talk shop and blow off steam—put out the press release in the first place. It wants to get Anthem BCBS to revert to its old standards, which were more profitable for its members.

I'm sharing this because it's a good example of how deep we often need to go to understand this kind of story. We can talk about "big business" or "corporate America" trying to screw over the little people, and we're not wrong when we do; but we're not quite right, either, if we don't understand that big business and corporate America are made up of smaller blocs and organizations that are trying to screw over each other, as well as the little people. You have to envision these forces with their own overlapping interests and conflicts, rather than always thinking simply in terms of good guys and bad guys.

The Fun Part

And this previously unreleased track from the new 20th anniversary edition of How to Dismantle an Atomic Bomb is so good if you love weird little U2 songs, like I do. I posted it on Bluesky the other day, and a stranger said, "I am soundly 'meh' on U2 in general but I like this song instantly," which is more or less the only thing I have ever wanted anyone who wasn't MacKenzie Bezos to tell me.

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