Editor's Note -
The following clipping makes the case for some of the advantages of a publicly owned and managed health care system vs. our current privately owned, for-profit system in dealing with an emerging public health threat.
-SPC
Opinion | Monkeypox Could Exploit a Big Weakness in Sexual Health Care
Monkeypox infections are spreading rapidly in many countries, and the United States has, yet again, been caught flat-footed when confronted with another virus. Many problems with the Covid-19 response by the United States are being repeated: limited access to testing, contact tracing, vaccination and isolation support, and scant data from public health officials about how and where people are being infected. With infections currently concentrated among men who have sex with men, monkeypox has also exposed another critical vulnerability in the U.S. public health system: limited sexual health services in many parts of the country. That will make it more difficult to know how many monkeypox cases there are and to stop the virus from spreading.
The general public needs to demand that elected officials recognize the urgency of having a strong national strategy and budget focused on sexual health. By making sexual health a routine part of wellness and by funding it sufficiently, we can lower the barrier to essential services and protect everyone from emerging health threats, such as monkeypox.
Monkeypox is caused by a virus similar to smallpox, and many outbreaks were thought to begin with human contact with infected animals in central and western African countries. The virus often causes several days of flulike symptoms, followed by a skin rash.
Since May 2022, monkeypox cases have been reported in many states in the United States and in Europe, primarily associated with men who have sex with men. Public health investigations strongly suggest that infections are spreading during sexual contact, likely from an uninfected person’s skin touching an infected person’s skin in the genital or anal areas. While there is some debate among epidemiologists about whether to call monkeypox “sexually transmitted” versus “sexually transmissible,” it is reasonable to consider that sex is one activity that transmits infection, similar to other infections that are transmitted by skin-to-skin contact during sex, like herpes, syphilis and the human papillomavirus. While no deaths have been reported in the United States, more widespread infections will result in some people experiencing severe complications, such as damage to the brain, eyes and lungs. Infections may also be more severe in people with H.I.V., which is more common in men who have sex with men in the United States.
Many cases of monkeypox during the recent outbreak in Europe and the United States have been detected at clinics dedicated to treatment of sexually transmitted infections. But there are reasons to believe the United States is missing many more cases than have been reported. The Centers for Disease Control and Prevention has said that it does not know how some U.S. patients acquired the virus, suggesting that there are likely people spreading infection not yet diagnosed. The C.D.C. has also reported at least two different variants of monkeypox in the United States, suggesting more than one outbreak at the same time. And my personal experience has shown that young men who have sex with men are likely being misdiagnosed when they go to emergency departments.
Why are cases being missed? One reason is that the United States lacks a sufficient number of clinics that specialize in sexual health, including family planning, sexual dysfunction, gender-affirming services, and S.T.I.s. Historically, most of these clinics have been affiliated with local health departments with public funding.
The clinics have several advantages over primary care or urgent care centers. Patients often perceive them as more welcoming, because they can ensure anonymity, have staff members well versed in gay men’s health, often charge no or minimal out-of-pocket fees and may provide rapid screening options and vaccines particularly important to sexually-active teens and adults. They also have clinicians who have expertise in accurately differentiating one S.T.I. infection from another and providing treatment to patients and their exposed sex partners. Widespread availability of sexual health clinics lowers the barrier for people to get screened, seek care for any symptoms and get vaccines when available.
Controlling epidemics of S.T.I.s depends on prompt diagnosis and effective treatment of infected people and their contacts. Yet government funding for diagnosis, treatment and contact tracing has been declining. In the 2010s, many health departments reduced hours at sexual health clinics, and prevention programs were further disrupted starting in 2020 because of Covid-19. In part because of these reduced health services, S.T.I.s have been rising for years, and the C.D.C. estimated that, on any given day in 2018, one in five Americans had one of these infections. Rates are particularly high in people 15 to 24 years old and men who have sex with men.
Other experts and I fear that monkeypox will exploit this vulnerability and become a permanently entrenched S.T.I. in the United States, as has happened with syphilis and H.I.V. Initial skin changes in this outbreak often appear innocuous and can occur in locations that are easy to miss, such as inside the anus. Nevertheless, these lesions are highly contagious and can even contaminate surfaces or materials such as towels, which can spread infection to other people. The skin changes can also mimic those of other infections, such as herpes, molluscum or syphilis, so monkeypox can be easily misdiagnosed by someone not expert in evaluating S.T.I.s.
As we know from other S.T.I.s, patients who have genital or anal symptoms that they believe are associated with sex may be reluctant to see a primary care physician in part out of fear that their diagnosis will be documented in their medical record and jeopardize their health insurance (if they have insurance). The current absence of easily accessible clinics that offer monkeypox testing will make it more likely that infections will go undiagnosed early and continue to spread. And the dynamics of some sexual networks among men who have sex with men — in which men with multiple sexual partners have sex with men who also have multiple partners — are likely to contribute to ongoing monkeypox transmission in this population.
Federal and state governments should immediately begin large-scale campaigns to educate health care providers of all types about monkeypox. Public health officials cannot assume that doctors will simply know when to test for it and how to navigate the process of swabbing a skin lesion and getting it to a specialized lab.
Public health agencies need to dramatically increase collaborations with community groups and hookup apps, party promoters and travel companies that specialize in gay, bisexual and other men who have sex with men to promote self-screening for skin changes. Some gay men are quite comfortable taking and sharing photos of their penis and anus while flirting; encourage them to do it for their health as well. The federal government also should authorize state health departments to use unspent Covid-19 funds to support S.T.I. supplies, equipment and staff for expanded hours and outreach at sexual health clinics, as well as contact tracing and support for isolating infected persons.
Monkeypox is unlikely to affect as many Americans as Covid-19. Nevertheless, an important lesson of the past decade of Covid-19, Ebola and Zika epidemics is that unchecked transmission means a virus will not stay limited to any one subset of the population and will lead to unpredictable health complications. Strengthening sexual health services now can serve the dual purpose of stemming the monkeypox outbreak and the ongoing one of S.T.I.s.Jay Varma is a professor at Weill Cornell Medical School. He is an epidemiologist focused on large-scale responses to infectious diseases.
https://www.nytimes.com/2022/06/27/opinion/health/monkeypox-sexual-health.html
America the Merciless
As the Fourth of July looms with its flags and its barbecues and its full-throated patriotism, I find myself mulling over the idea of American exceptionalism. What, if anything, makes this country different from other countries, or from the rest of the developed world, in terms of morals or ideals? In what ways do our distinct values inform how America treats its own citizens?
I land on a distinct absence of mercy.
Witness the ruthless evisceration of Roe v. Wade and the expansion of the right to carry guns in public in the wake of two horrific mass shootings. Both courtesy of a Supreme Court that is supposedly the institution vested with carrying out the highest standard of justice for its citizens and yet is wholly indifferent to the lives of America’s women, children and families. Witness the horrors of Jan. 6 or our mismanagement of the pandemic. Witness a health care system that continues to see human beings as walking P&Ls rather than as people deserving of compassion and care.
I can’t help but see a particular American bent toward cruelty. Especially when it comes to life-or-death matters, with a merciless streak that dictates not only how we live, but also the laws around who dies.
Three books I read over the pandemic brought these issues to the fore for me, offering broader and deeper context. Two of the books are explicit about the question of mercy in their titles, both published in 2014: Bryan Stevenson’s “Just Mercy: A Story of Justice and Redemption” and Anand Giridharadas’s “The True American: Murder and Mercy in Texas,” each highlighting this country’s penchant for condemning to death those who might wish to live. The third, published this year, is Amy Bloom’s “In Love: A Memoir of Love and Loss,” which looks at the flip side of that equation: our heartlessness when someone close to death wishes to die.
When it comes to someone fighting for his life on death row or someone longing for the right to die at life’s end, America generally goes with the least empathetic option.
The laws on both capital punishment and physician-assisted suicide are clear. Our enthusiasm for the death penalty puts us in the same camp as China, Iran and 16 other countries that killed its citizens in 2020; as of early June, America had put seven people to death. As for end-of-life laws, euthanasia — which permits a doctor to administer, for example, a lethal dose of morphine to a suffering patient — is illegal across the United States. Only 10 states and the District of Columbia allow for physician-assisted suicide, which generally enables a terminally ill person strictly within six months of dying to administer the means of his or her own death.
Stevenson’s “Just Mercy,” which has spent 281 weeks on the New York Times best-seller list, is probably the best known of the three books. A forceful and persuasive indictment of our criminal justice system, “Just Mercy” makes alarmingly clear how stacked it is against those least equipped to push back. It’s a system that has all but abandoned efforts toward rehabilitation and instead continues to punish former felons long after they leave prison. A system, increasingly privatized, that is more concerned with maximizing profits than with improving lives. A system that leaves little room for compassion or redemption.
Among the lines from the book that stay with me: “Fear and anger can make us vindictive and abusive, unjust and unfair, until we all suffer from the absence of mercy and we condemn ourselves as much as we victimize others.”
The second book, Giridharadas’s “The True American,” tells the story of Raisuddin Bhuiyan, a Bangladeshi immigrant who in September 2001 was shot in the face by a white supremacist, Mark Stroman, and then unsuccessfully urged clemency for his would-be assassin. Through the story of these two men and the skewed morality of the justice system that failed them, we see how the country squandered its brief moment of post-9/11 cohesion. A sense of cohesion gave way to “us vs. them,” abetted by easy access to firearms and hate-mongering.
Among the lines that stay with me: Quoting from Stroman’s legal team, “‘There is nothing illogical about a system where society does not always fulfill the victim’s desire for revenge, but always respects the victim’s desire for mercy.’”
Bloom’s memoir may seem to have little in common with the other two. But America’s indifference toward those suffering at the end of their lives offers a startling contrast to those waiting out their attenuated lives on death row.
In January 2020, Bloom accompanied her 66-year-old husband, Brian, recently diagnosed with Alzheimer’s, to Zurich, the only place in the world where Americans can travel for a “painless, peaceful and legal suicide.” The few places in the United States where assisted suicide is allowed impose restrictions so exacting they are difficult for people in state, and often nearly impossible for anyone out of state, to meet. Brian’s death comes at his own wish and by his own hand, and while marked by grief, there’s nothing unwanted about it. This, I thought while reading, is how it’s done — and yet we cannot do it this way, here in America.
Among the lines that stay with me: Quoting a doctor, “‘When any kind of right-to-die legislation is proposed — the opposition shows up with 10 million dollars as soon as it’s about your right to choose.’”
At our worst, we ourselves display an undeniable strain of mercilessness, in ways that have come to pervade our culture. Minor mistakes are taken as capital offenses. Apologies are often forced and true forgiveness, rare. In the push to identify and condemn an enemy, we fail to allow for people to make amends. The drive toward justice and accountability too often veers toward blame, retribution and abnegation.
Well, then I won’t end here with more blame. It would be inaccurate, in any case, to pin these policies entirely on the American people when polls suggest that most wouldn’t choose these arrangements. A majority of Americans, 72 percent as of 2018, support euthanasia, and 65 percent as of 2018 support physician-assisted suicide. Around six in 10 Americans believe abortion should be legal in all or most cases. A minority — about 39 percent — but still a sizable number of Americans, oppose the death penalty. Yet majorities concede that innocent people might be killed and that in practice, the current system is racist.
It’s worth asking ourselves, as a nation, what it is about our political and legal systems that leads to so many policies that we Americans — even at our worst — don’t necessarily support.
How do we ask young people just starting out, or older people who have seen so much progress reversed, to care about a country that seems so determined to care so little for them? How do we celebrate on the Fourth of July a country whose laws and institutions so often fail to bring out the best in us?
I am seeing here only the worst side of what feels right now like a broken country. Perhaps it is wise to bear in mind these words from Stevenson’s book: “Each of us is more than the worst thing we’ve ever done.” I’d like to believe this holds true not only for us individually, but also collectively. Perhaps even as a nation.
https://www.nytimes.com/2022/06/26/opinion/america-the-merciless.html
Editor's Note -
Read the following clipping on "Surprise Medical Bills", then read the comments (!!) by clicking on the following url:
https://www.nytimes.com/2022/06/30/well/live/surprise-medical-bills.html.
How to Dispute Surprise Medical Bills
After receiving a $21,500 doctor’s bill for a mere 10 stitches, I researched bad medical billing. Here’s how to fight it.
In October, I received a doctor’s bill for $21,500 for treatment my daughter received in the emergency room of a local hospital after suffering a one-inch cut on her forehead. I remember opening the bill while walking down my driveway and nearly having a heart attack: How could 10 measly stitches possibly cost more than 20 grand? And why were we being billed for services we’d received at a hospital that was in our insurance company’s network?
I’m one of many Americans who have had experiences like this. A 2020 report from the Kaiser Family Foundation, a nonprofit organization that focuses on national health issues, found that nearly one in five emergency room visits and up to one in six in-network hospital stays prompted an unexpected out-of-network medical bill.
These bills arise because even if you visit an in-network provider, you can still be treated by an out-of-network physician who works there, said Karen Pollitz, the co-director of the Kaiser Family Foundation’s Program on Patient and Consumer Protections. “The doctors who work in hospitals generally don’t work for the hospitals,” she said. “They bill independently, and they can decide which networks they participate in.”
In January, a new federal law called the No Surprises Act went into effect, aiming to prevent health care providers from sending surprise bills to people with private insurance. (Protections like this were already in place for people with Medicare, Medicaid and Tricare.) But “the hospitals don’t always comply,” said Marshall Allen, the founder of Allen Health Academy, a health literacy organization, and the author of “Never Pay the First Bill.” So surprise bills are still a problem. And bills for medical care provided before 2022 — like my daughter’s stitches — aren’t covered by the law, either.
The good news is that with this new law in place, many unexpected medical bills can more easily be fought or lowered to a reasonable amount. Here’s how.
Determine whether your bill is covered by the No Surprises Act, and dispute it if so.
If you receive a surprise medical bill, first figure out whether that bill is illegal under the new federal law. The law, which went into effect on Jan. 1, covers people who receive insurance through their employers or a health insurance marketplace or who have individual plans they purchased directly from an insurance company. It says that insurance companies have to cover, as if they were in-network, any out-of-network services incurred after receiving emergency or routine medical care at in-network medical facilities, as well as all air ambulance services, Pollitz said. Essentially, this means you can’t be billed for more than what you’re used to being charged for in-network services — and bills that ask for more are illegal.
If you receive a bill that you think violates the new law, you can challenge it in a handful of ways. The Centers for Medicare & Medicaid Services has a new help desk and hotline that anyone can use to ask questions and file complaints, so that’s a good place to start, Pollitz said. (If a medical provider does send an illegal, surprise medical bill, it can be fined up to $10,000.) Your state may also have a consumer assistance program you can contact, Pollitz added. These programs are typically staffed by lawyers who can help with medical bill disputes and answer insurance-related questions.
You might be able to make the bill go away without a formal complaint, Allen said. He recently advised a woman who had received an illegal, surprise medical bill to contact the hospital’s billing department in writing. She told the department that the bill was in violation of the No Surprises Act and said it needed to contact her insurance company to resolve the charges. “Within 24 hours, she had a call and many, many apologies from the head of the billing department,” he said.
Even if a bill is legitimate, you can still fight it.
Some surprise medical bills aren’t covered by the No Surprises Act. These include bills for ground ambulance services, bills for medical care provided by out-of-network urgent care centers that are not licensed to provide emergency services and bills for some tests processed by out-of-network labs. And consumers are still required to pay for non-emergency care provided by out-of-network hospitals.
But you can still contest these bills or, in many cases, at least reduce what you owe, Allen said. First, ask the medical provider for an itemized bill that includes billing codes describing the care you received. If the provider is hesitant to give it to you, he said, explain that the Health Insurance Portability and Accountability Act, known as HIPAA, requires medical providers to share this information with patients.
Once you have the itemized bill, check whether the billing codes the provider used, which are usually strings of numbers, accurately describe the care you received. (You can learn about the codes by Googling the code numbers along with the phrase “medical billing code.”) Often, medical providers bill for services they didn’t actually provide, or they bill for care that is more complex than what was delivered, Allen said. If that’s the case, he said, contest those charges and ask for a corrected bill by contacting the medical provider or the physician’s office directly.
You can also compare the amount of money the medical provider charged for each billing code with what insurance companies say is a reasonable amount to charge by looking up the codes on hospital websites or on the website of the nonprofit organization Fair Health Consumer. When I did this, I saw that although my daughter’s E.R. doctor charged $17,000 for the stitches he had sewed (and another $4,500 for the E.R. visit itself), the average out-of-network cost for these kinds of stitches where she was treated is $2,983. In other words, he charged me more than five times the average out-of-network price. In this type of situation, you can contest the charges as being unfair and even take the provider to small-claims court.
Another smart thing to do is to track down your insurance company’s explanation of benefits — the statement that summarizes the medical services billed to the company — because your medical provider should have tried billing your insurance company before billing you. You can call your insurance company to get your statement, or you may be able to access it online on the company’s website. If your medical provider didn’t bill your insurance company first — meaning there’s no explanation of benefits at all — don’t pay the bill you received, said Nicole Broadhurst, a patient advocate and the founder of Tennessee Health Advocates. Instead, call and ask the provider to bill your insurance.
Don’t give up the fight.
It’s unfair, of course, that these burdens are placed on the consumer, especially when so many billing issues reflect mistakes made by medical providers or insurance companies. “It does take a certain amount of time, and it can take some hassle,” Allen said. “And you have to be persistent.” But for people who have the time and resources, he added, it’s important to fight unfair medical bills. In doing so, we not only help ourselves, but we also send a message to the broader health care industry. “We all need to stand up and say, ‘Hey, what’s been happening is not right, and we’re not going to let you do this anymore,’” he said.
Tracking down my company’s explanation of benefits helped me understand my daughter’s ridiculous E.R. bill. When I studied the statement, I saw that the doctor who sewed my daughter’s stitches had tried billing my insurance but with the wrong billing codes, so my insurance company rejected the claim. The doctor should have resubmitted the claim to my insurance company with the corrected codes, but instead he billed me directly.
Fortunately, that sky-high bill has gone away, at least for now, because the doctor’s billing department agreed to resubmit a claim to my insurance company. If the department does settle the bill with my insurance company, as it should, I’ll consider that a win — but will ask for a different doctor the next time we go to the E.R.
https://www.nytimes.com/2022/06/30/well/live/surprise-medical-bills.html
His-and-Hers Cataract Surgeries, But His Bill Was 20 Times as Much
by Angela Hart - Kaiser Health News - June 27, 2022
Danilo Manimtim’s vision was cloudy and blurred — and it was growing worse.
The 73-year-old retired orthopedic surgeon in Fresno, California, knew it was time for cataract surgery. “It’s like car tires wearing out because you drive on them so much,” he said.
In December 2021, he went to the outpatient department of the local hospital to undergo the common procedure that usually replaces the natural eye lens with an artificial one and is designed to restore vision. The outpatient procedure went smoothly, and Manimtim healed over the next few weeks.
Manimtim, who since retiring took a job evaluating disability claims for the state of California, knows the health care system and keeps tabs on his health benefits. He knew he already had met his health insurance deductible for the year, so he expected a manageable out-of-pocket expense for the surgery. He calculated his coinsurance would be about $750.
Then the bills came.
Patient: Danilo Manimtim, 73, of Fresno, California. He is insured through his employer by Anthem Blue Cross of California for outpatient care and is covered by Medicare for hospitalization.
Total Bill: Overall, the charges were $9,084 for surgery, anesthesia, medical supplies, pharmacy, and clinical laboratory services. Anthem paid $5,027 and initially billed Manimtim $4,057.
Service Providers: Saint Agnes Medical Center. It is part of Trinity Health, a nonprofit hospital system headquartered in Michigan with 88 hospitals and 125 urgent care centers across the country. The hospital system brought in nearly $20.2 billion in revenue for the most recent fiscal year.
Medical Service: Cataract surgery as an outpatient, involving anesthesia.
What Gives: Manimtim’s big bill stems from a simple decision that turned out to be a pitfall in the nation’s complicated health care system: He scheduled his surgery at a nearby hospital — a hospital that happened to charge about $7,000 more for the procedure than his insurer would pay.
Manimtim has proof that it could have been different right under his own roof: Four months later, his wife, Marilou Manimtim, 66, got the exact same procedure at an outpatient eye care surgical center in Fresno called EYE-Q. It is a half-mile from Saint Agnes Medical Center but is not affiliated with the hospital.
Both patients have the same insurance coverage through Anthem Blue Cross of California; they had identical cataract surgeries; and both providers were in Anthem’s coverage network. Marilou owed $204, while Danilo was on the hook for a staggering $4,057.
“This is ridiculous, and it feels very unfair,” Danilo Manimtim said. “How can it be so much more expensive than the surgical center? It’s walking distance away, and if I would have gone there, I would have saved myself a lot of money.”
Manimtim’s insurance plan, via his employer, the California Public Employees’ Retirement System, caps payment for outpatient cataract surgery at $2,000, according to Anthem. CalPERS instituted a “reference pricing” system in recent years, in which it determines a reasonable price for a high-quality procedure of that type in California. It then reimburses only up to that amount, encouraging patients to shop for treatment priced under the bar. For the cataract surgery itself, patients in Manimtim’s plan are on the hook for any charges above $2,000.
Even for hospital-based care, Saint Agnes’ overall charges are high for cataract surgery, said Dr. Ira Weintraub, chief medical officer for WellRithms, which analyzes health care prices for employers. “The hospital charged three to four times the amount of what this surgery typically costs, which is around $3,000.”
“Nobody gets $9,000 for cataract surgery,” he added.
If Manimtim had opted for Medicare Part B, the part of the Medicare program that covers outpatient care, he likely would have been on the hook for only about $565, a Medicare cost comparison tool shows. Medicare pays a set amount for procedures regardless of where they are performed.
But like many older Americans who are still working, Manimtim chose not to sign up for that coverage, instead opting for his employer’s plan because his monthly premium would be significantly cheaper.
Health care prices often have very little to do with the actual costs of providing the care and its quality — and patients often face the “double whammy” of high prices and complex benefits, said Anthony Wright, executive director of Health Access California, a nonprofit advocacy group. Too often, patients are on their own to figure out high prices and complex benefits, he said.
“You wonder what is the rationale for any of the prices in our health care system,” Wright said.
Resolution: After inquiries by KHN, Anthem contacted the hospital, Saint Agnes, seeking help for Manimtim. Although the doctor is responsible for requesting an exemption from CalPERS’ $2,000 limit on payments for cataract surgery under Manimtim’s plan, that didn’t happen before his surgery. Anthem asked the hospital and doctor to consider the request post-surgery, said Anthem spokesperson Michael Bowman.
Saint Agnes spokesperson Kelley Sanchez told KHN that the hospital and provider later requested the exemption that would allow the insurer to pay more than the $2,000 limit and that it was ultimately approved by Anthem. That is expected to leave Manimtim with a much smaller coinsurance bill, around $750 — and get him off the hook for being taken to collections by the hospital. The hospital will receive a higher payment from Anthem, which will cover a large portion of the remaining $4,057 bill.
And that high payment, like all high payments, contributes to rising health insurance payments for all.
Sanchez said the hospital isn’t in the price-gouging business but noted that hospitals generally have higher costs and tend to charge more than outpatient facilities.
“We never want to cause harm or create hardship for our patients, and that extends to our billing practices,” Sanchez said in a prepared statement.
She noted that Saint Agnes has financial assistance programs available and encourages patients to ask questions and understand potential costs before seeking care. “Every patient’s insurance plan is unique so it is their responsibility to understand their plan benefits,” she wrote. “It’s still complicated and we recognize that, and will continue to work toward greater price transparency.”
The Takeaway: The bottom line for patients, experts say, is to be sure to read the fine print of insurance coverage plans to understand all out-of-pocket responsibilities, including premiums, deductibles, copays, and coinsurance. Also, a small number of large employers that self-insure are using reference pricing, putting caps on what they’ll pay for common procedures. Shop around, and ask about prices on the front end if possible.
“People often focus on premiums because they are easy to compare, but premiums don’t tell the full story, and this example illustrates the trade-offs,” said Tricia Neuman, a Medicare expert at KFF.
Anthem spokesperson Bowman urged patients to use the online Anthem “care finder” to compare patient costs and find a cheaper option if one is available. Had Manimtim done that, he might have seen that getting his cataract surgery at an outpatient surgical center would have been much cheaper. But the details of provider cost and insurance coverage can be idiosyncratic and are often not displayed in a patient-friendly manner. Manimtim did try to explore his benefits before the procedure, he said, but did not get a clear answer from the insurer or hospital.
Manimtim also had advice for consumers: If you receive a medical bill and don’t understand the charges, don’t pay right away. Instead, call your provider and insurer to ask about the charges and whether there are ways to lower your bill.
“People need to be more informed by the insurance companies and hospitals about what options they have, to prevent overbilling,” Manimtim said. “A lot of people don’t know this could happen to them.”
https://khn.org/news/article/his-and-hers-cataract-surgeries-but-his-bill-was-20-times-as-much/
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by James Kahn - Health Justice Monitor - June 16, 2022
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