With the red tape of health insurance already causing frustration for millions of Americans, doctors are helping to shed light on a common industry practice: downcoding. Insurance companies change claims to save money, and according to experts, it’s yet another way that health insurance plays into a rigged system.

What’s downcoding?
When downcoding, insurance companies “automatically downgrade the claims a doctor sends them to a lower tier of reimbursement, without actually reviewing details about the visit itself,” said NBC News. For Dr. Terry Wagner, a family medicine doctor in Hudson, Ohio, this “means a ‘level four’ office visit that might yield $170 is being paid as if it’s a ‘level three’ for about $125.” 

It’s “blatantly disrespectful,” Wagner said to NBC. A “computer program is deciding what my level of care is. If they question my level of care, then ask for my notes.” Aetna and Cigna have both admitted to downcoding, and other insurers including “Anthem Blue Cross Blue Shield, Humana and Molina Healthcare have all acknowledged downcoding higher-level claims for certain office visits,” said NBC.

Why is it a problem in health care?
Insurance companies have defended the practice. Cigna says the “goal is to fight upcoding and billing abuse, arguing that some physicians bill for more complex visits than were actually provided,” said health care website Stat News. 

The “understanding of everyone who has been rallying the cry about this” is that the new policy “just says they are going to downcode everybody and it’s up to us to go back and fight and prove we are not doing it inappropriately,” Dr. Peter Hahn, a cardiologist in Uncasville, Connecticut, said to The Connecticut Mirror of Cigna’s downcoding plan.

This could result in doctors having to “make choices that are inherently bad for patients, like cramming more patient visits into a single day to make up for lost revenue, dropping patients on certain insurance plans, or selling their practices altogether,” said NBC. There’s a “break point, and it’s like you either see more” patients and “give them less time, or you just give up,” Wagner said. “It’s exhausting.”

Zohran Mamdani, the Democratic socialist candidate running for New York City mayor, has proposed free public buses as part of his campaign. It has become a major part of his platform, as he and his supporters argue that free buses could increase ridership and efficiency. But the suggestion also has its fair share of critics, who say it would reduce bus safety and increase taxes.

Get on board
Implementing free New York City buses could “increase ridership citywide by 23% — an additional 170 million trips in a year — and increase the average bus speed,” said The New York Times. Making buses faster also “incentivizes people to ride the bus who might otherwise now be taking an Uber” or a taxi, said economist Charles Komanoff to NPR. 

The proposal could also improve efficiency. While there will be a drop in revenue because of the lack of fares, the city would “benefit economically because of the time and money that riders would save,” said the Times.

Free buses are also “fiscally progressive, disproportionately benefiting the less wealthy,” said Slate. It “removes a major barrier to transit access for low-income individuals,” said Amitrajeet A. Batabya, an economics professor, at the Rochester Beacon. Fare elimination improves access to “nonwork activities, such as shopping, health care visits and social interactions, which may improve overall quality of life.” 

Missing the bus
There’s “no such thing as a free bus,” said The Washington Post editorial board. Removing fares would “cost more than $500 million annually,” said Vital City. The city’s bus system is “controlled by the state, meaning any changes would need buy-in” from Gov. Kathy Hochul (D), said the Post. She has “already ruled out raising taxes on high-income residents to pay” for Mamdani’s agenda.

Free buses can also lead to “major safety issues,” said Paul J. Gessing, the president of the Rio Grande Foundation, a New Mexico think tank, at the National Review. Especially in increasingly extreme weather, they might become “rolling homeless shelters.” While “wealthier residents would find another way to get around,” those who are poor and most dependent on the buses would “suffer the most.”

Mamdani “understands that transportation affects job prospects, influences public health and helps shape the cost of living,” said Slate. “Many of his proposals are creative and worthwhile. Nixing bus fares is an exception.”

Kenyan police struggle to control a crowd during a stampede at the entrance to Nyayo Stadium, where the body of opposition leader Raila Odinga lies in state. The former prime minister, who has died at the age of 80, was a giant of Kenyan politics for decades.
Luis Tato / AFP / Getty Images

“One Battle After Another” has scooped a 95% rating on Rotten Tomatoes and garnered plenty of Oscar buzz. If you have seen it, loved it and are wondering which of director Paul Thomas Anderson’s films to watch next, there’s plenty of quality work to choose from. 

‘Boogie Nights’(1997)
This comedy-drama stands out for the director’s obvious “affection for his characters,” said Slant magazine. The movie chronicles the rise of Dirk Diggler, played by Mark Wahlberg (pictured above with Julianne Moore), a nightclub dishwasher who becomes a porn actor under the tutelage of adult film director Jack Horner (Burt Reynolds). Diggler builds a supportive circle of friends and soon becomes a porn star, but his spiraling drug habit and growing ego threaten to bring his world crashing down. Anderson “tries to be a bad boy but settles, thank God, for being a humanist.” It’s an “amazing achievement.”

‘There Will Be Blood’ (2007)
Set in early-20th-century New Mexico, this epic drama follows the “ruthless quest for wealth by silver prospector turned oil baron Daniel Plainview,” played by Daniel Day-Lewis in an Oscar-winning performance, said Esquire. It captures the “pursuit of the American dream in all its nightmarish horror.”

‘The Master’ (2012)
There has “really never been a performance like the one Joaquin Phoenix gives as Freddie Quell,” a “shattered and strange” World War II veteran, said Vulture. Struggling to readjust to society and his old life, he falls under the spell of charismatic cult leader Lancaster Dodd, played by a “spectacularly preening” Philip Seymour Hoffman. Anderson’s filmography is “full of bangers,” but this movie is the “greatest of them all.”