Every year, I get a physical exam. Nothing invasive, just a quick set of questions about my health and how I'm doing. Usually, it comes with a request to get some lab tests done, which until recently hasn't been a problem; the umbrella organisation of which my doctor is a part ran its own labs, they had reasonably convenient locations, and it was all nicely joined up. Now, though; oy. Sometime last year, the organisation closed its labs. They now have a contract with a nationwide lab firm, and it's very difficult to determine whether my health insurance covers getting lab work done by these people, and with other changes that have been made, it's very difficult to determine if all their locations are what's known as in-network or not.
What this means is that I am now dealing with lots of new worries about my healthcare provision, none of which should be happening at all. The only thing I should have to worry about with respect to my healthcare is "Am I sick?". Any other question should be unnecessary.
Odds are good at this point that I simply won't get the lab work done because I don't have the spare time to call my insurance company and figure out if they'll pay for it. It is frankly ridiculous that this is the case, and yet another perverse healthcare incentive; it's in the insurance company's interests to make determining this sort of thing as opaque as possible, because then IF it even gets done (not a certainty; and if it's not done, no payout) then it's going to be a non-zero probability of getting it done at an out-of-network provider by mistake, which lets them get away with paying less. Once again, the quality of my care is distorted and lessened by the profit motive.
I keep hammering on this point, and it bears repeating again and again: healthcare is a public good and should not be subjected to the profit motive. Pay the providers fairly, but cut the insurance companies out of the loop. They yammer on about "freedom of choice" and arbitrarily restrict our choices to confuse us.
Thursday, March 20, 2014
Saturday, March 15, 2014
What I should have been doing...
The LA and No. 1 Daughter have been out socialising for much of the day, while I've been at home. I was supposed to have been writing, since I'm currently working on a piece which has a chance of earning actual money, but I've not had enough uninterrupted time all day, because I've been working through a backlog of laundry. Burp cloths and towels, adult clothes, baby clothes, and now sheets. It seems like every time I've sat down, a laundry machine has beeped at me again.
In other news, I've been feeling distinctly cold of neck recently, since I decided that the baby's habit of firmly grasping a lock of my hair and wrenching my head around was beginning to do nasty things to my neck. So the LA and I repaired to a haircut place, and as it turned out I had just enough hair and in good enough condition that it could be donated to an organisation which makes wigs for children suffering hair loss. Once that was done, some cleanup was in order, and my hair is now shorter than it's been since sometime in 2002. In the years of being long, it's apparently been trained towards the back, and so the short top sort of fluffs upwards away from my forehead - thus avoiding one of the things I disliked about my short hair in years past. My hair becomes greasy fast, and it would fall onto my forehead, clogging pores and resulting in volcanic acne. The cut I have now is very much a low-maintenance affair; every couple of months, I'll need to go back and have it cut again, but other than that I just need to shower regularly and it's good. I can even choose whether or not I want to comb it; it's too short to tangle. So my daughter has accomplished what her great-grandmother never could; she's persuaded me to get my hair cut.
In other news, I've been feeling distinctly cold of neck recently, since I decided that the baby's habit of firmly grasping a lock of my hair and wrenching my head around was beginning to do nasty things to my neck. So the LA and I repaired to a haircut place, and as it turned out I had just enough hair and in good enough condition that it could be donated to an organisation which makes wigs for children suffering hair loss. Once that was done, some cleanup was in order, and my hair is now shorter than it's been since sometime in 2002. In the years of being long, it's apparently been trained towards the back, and so the short top sort of fluffs upwards away from my forehead - thus avoiding one of the things I disliked about my short hair in years past. My hair becomes greasy fast, and it would fall onto my forehead, clogging pores and resulting in volcanic acne. The cut I have now is very much a low-maintenance affair; every couple of months, I'll need to go back and have it cut again, but other than that I just need to shower regularly and it's good. I can even choose whether or not I want to comb it; it's too short to tangle. So my daughter has accomplished what her great-grandmother never could; she's persuaded me to get my hair cut.
Friday, March 7, 2014
A perverse incentive, illustrated.
Back in November, I suffered a mental health crisis, and wound up in my local county hospital's psychiatric emergency room. I'm still dealing with the paperwork and financial fallout from that, which is a distinctly suboptimal state of affairs, but I've just realised that there is in fact a perverse incentive operating here; it's in the hospital's interests to suck at accounting.
Now I should mention that part of the delay was due to their billing the wrong insurance provider (in most US states, Blue Cross and Blue Shield are in fact one and the same, while in California they are NOT the same; I have Blue Shield insurance, they initially attempted to bill Blue Cross, and naturally got an answer of "Who's he? Never heard of him." when they provided my name. The fact that they somehow managed to overbill by two orders of magnitude, leading me to suspect a failure to hit the button that puts in a decimal point, is a mere bagatelle) but still, one might expect things to be done promptly.
Not so, unfortunately; it's more in their interests to drag things out so that the patient wants this to just be over, and stops scrutinising the bills they receive. It's also in their interest to be distinctly less than wonderful at actually connecting payments to services.
You see, once they finally managed to bill the correct insurance company, they were paid promptly. Unfortunately, their accounting system is apparently a mess; the payment for $x-100 (since for this service, I have a $100 co-pay) didn't actually get applied to the account for my services, so when they generated a bill for me it was for $x, not the $100 it should have been for. Had I not been a good boy and kept my insurers' notifications of payments made, this might have slipped by me; they'd have ended up with $2x-100, instead of $x. When x is the thick end of a grand, it becomes clear that it's very much in the hospital's interests to suck at matching up payments with accounts.
I don't have a plan to fix the broken healthcare "system" in the USA, but I very much feel that perverse incentives like that are a big part of the problem.
Now I should mention that part of the delay was due to their billing the wrong insurance provider (in most US states, Blue Cross and Blue Shield are in fact one and the same, while in California they are NOT the same; I have Blue Shield insurance, they initially attempted to bill Blue Cross, and naturally got an answer of "Who's he? Never heard of him." when they provided my name. The fact that they somehow managed to overbill by two orders of magnitude, leading me to suspect a failure to hit the button that puts in a decimal point, is a mere bagatelle) but still, one might expect things to be done promptly.
Not so, unfortunately; it's more in their interests to drag things out so that the patient wants this to just be over, and stops scrutinising the bills they receive. It's also in their interest to be distinctly less than wonderful at actually connecting payments to services.
You see, once they finally managed to bill the correct insurance company, they were paid promptly. Unfortunately, their accounting system is apparently a mess; the payment for $x-100 (since for this service, I have a $100 co-pay) didn't actually get applied to the account for my services, so when they generated a bill for me it was for $x, not the $100 it should have been for. Had I not been a good boy and kept my insurers' notifications of payments made, this might have slipped by me; they'd have ended up with $2x-100, instead of $x. When x is the thick end of a grand, it becomes clear that it's very much in the hospital's interests to suck at matching up payments with accounts.
I don't have a plan to fix the broken healthcare "system" in the USA, but I very much feel that perverse incentives like that are a big part of the problem.
Monday, February 17, 2014
I don't want sympathy, just help.
As most of you will know by now, I have some health issues. Well, a lot of health issues; at 33, my daily prescribed pill count (when things are going as they ought, which at the moment is not entirely the case) is 9 pills. Five to adjust my brain in various ways, and 4 to allow my body to avoid tearing itself apart.
And for all the pill-popping, sometimes I go out and have to deal with being visibly disabled. It's mild, but it's there; I sometimes have to use a cane to help me walk. Normally, I present as a relatively healthy youngish man, and so people see me using the cane and assume it's a transitory thing. I'm frequently asked if I've suffered a sports injury.
And that's where the trouble starts, because I'm now forced into discussing my medical history with strangers. I can be churlish and impolite, refusing to discuss why I need a cane; but this upsets people. I can fake it, pretending it's a sports injury; but I dislike lying. I can be honest, and say that I have arthritis; and that's the option I take most often, despite my distaste for the inevitable result.
Every single time, when someone finds out I have arthritis, the response is along the lines of "but you're so young!" Yes, I am aware that osteoarthritis at age 33 is uncommon, but that doesn't change the fact that I have it. All you're doing by saying that is making me feel ashamed of something I cannot control. I wouldn't have chosen arthritis; no sane person would choose a life of impaired mobility and constant pain.
I have similar issues if I have to go out while suffering effects of migraine, or side-effects of the medication I take to defuse them. I'm invariably looking unwell in those circumstances, and people will insist on trying to be sympathetic, usually by rattling off a huge list of helpful suggestions, of which I've invariably tried all the sensible ones and the nonsense ones are so incredibly off the wall that I can't imagine why people would bother.
I am, in fact, fed up to the back teeth with people offering sympathy. I have health issues; they suck; if you're willing, I'd accept your help in dealing with the consequences of said issues. Such as, if you're limber, fetching me up a jar of pickled jalapenos from the bottom shelf, because bending down is going to be excruciating for me. Or turning the music down so I'm not having to strain to hear while my brain is full of rotted wood. Words may cost nothing to you, but that means they're no fit substitute for deeds. If you must talk about my medical status in public, keep it to a "how can I help?"
And for all the pill-popping, sometimes I go out and have to deal with being visibly disabled. It's mild, but it's there; I sometimes have to use a cane to help me walk. Normally, I present as a relatively healthy youngish man, and so people see me using the cane and assume it's a transitory thing. I'm frequently asked if I've suffered a sports injury.
And that's where the trouble starts, because I'm now forced into discussing my medical history with strangers. I can be churlish and impolite, refusing to discuss why I need a cane; but this upsets people. I can fake it, pretending it's a sports injury; but I dislike lying. I can be honest, and say that I have arthritis; and that's the option I take most often, despite my distaste for the inevitable result.
Every single time, when someone finds out I have arthritis, the response is along the lines of "but you're so young!" Yes, I am aware that osteoarthritis at age 33 is uncommon, but that doesn't change the fact that I have it. All you're doing by saying that is making me feel ashamed of something I cannot control. I wouldn't have chosen arthritis; no sane person would choose a life of impaired mobility and constant pain.
I have similar issues if I have to go out while suffering effects of migraine, or side-effects of the medication I take to defuse them. I'm invariably looking unwell in those circumstances, and people will insist on trying to be sympathetic, usually by rattling off a huge list of helpful suggestions, of which I've invariably tried all the sensible ones and the nonsense ones are so incredibly off the wall that I can't imagine why people would bother.
I am, in fact, fed up to the back teeth with people offering sympathy. I have health issues; they suck; if you're willing, I'd accept your help in dealing with the consequences of said issues. Such as, if you're limber, fetching me up a jar of pickled jalapenos from the bottom shelf, because bending down is going to be excruciating for me. Or turning the music down so I'm not having to strain to hear while my brain is full of rotted wood. Words may cost nothing to you, but that means they're no fit substitute for deeds. If you must talk about my medical status in public, keep it to a "how can I help?"
Friday, February 7, 2014
What is Rogue like?
Recently, a friend gave me a gift copy of a Humble Bundle, described as "Roguelike games". Roguelike is a surprisingly widely-used adjective for games, and to listen to many people, often misused. I'll admit, I'm one of those who thinks it's often used incorrectly, but I really need to justify that. Let's get on with it.
I can speak with a certain amount of authority on what Rogue itself is like; it was, twenty-mumble years ago, the first computer game I ever played. I never did win it, but I played it a lot. It had a lot of things going into its makeup. I've also played a lot of games considered lineal descendants of Rogue: NetHack, with forays into SLASH'EM; ADOM; several variants of Angband; and many other roguelikes, most of which I can't even remember the titles of. Everything from a futuristic one set after the end to an educational one meant to teach the country top-level domains. Frankly, for as much as I love other games, roguelikes are the defining games of my life.
But which elements of Rogue make it distinctive? Here's where opinions diverge; the best I can do is give my opinion, and ask that you use your own judgement.
I can speak with a certain amount of authority on what Rogue itself is like; it was, twenty-mumble years ago, the first computer game I ever played. I never did win it, but I played it a lot. It had a lot of things going into its makeup. I've also played a lot of games considered lineal descendants of Rogue: NetHack, with forays into SLASH'EM; ADOM; several variants of Angband; and many other roguelikes, most of which I can't even remember the titles of. Everything from a futuristic one set after the end to an educational one meant to teach the country top-level domains. Frankly, for as much as I love other games, roguelikes are the defining games of my life.
But which elements of Rogue make it distinctive? Here's where opinions diverge; the best I can do is give my opinion, and ask that you use your own judgement.
Monday, January 20, 2014
The lesser of evils
This morning, I was linked to an article (actually, a transcript; NPR is marvelous in providing transcripts of its radio pieces) regarding a campaign in California to increase the minimum wage. That article may be found here.
The campaigner is an unlikely one: a multimillionaire, generally held to be very right-wing (in America, remember; our "left-wing" candidates are, by European standards, a long way to the right of Michael Portillo), but he seems to have understood the fundamental issue at hand.
His point is that with the minimum wage not being a living wage, some means to support those relying on it is necessary. Minimum wage jobs are generally not exportable; that status only applies to middle tiers of jobs, leading to a large gap between minimum wage and executive-level jobs, but I digress. Minimum wage earners will be located in the US, and it is in the national interest for them not to starve, hence food stamps. However, what Mr. Unz has worked out is that food stamps are an unnecessary complication; the lesser evil, the lesser government intervention, is to require that employers pay a living wage. Regulations are cheaper than interventions.
Now, ideally, companies would be able to figure out what Henry Ford worked out over a century ago, and the CEO of Costco continues to espouse: that paying their employees enough to live well on results in more demand for their products, and thus more success for the company overall. Ideally, regulations to require a living wage wouldn't be necessary. Unfortunately, America's particular outlook on economics doesn't seem to look beyond the next set of quarterly results, or the share price (which is almost entirely divorced from any actual metric of results).
The campaigner is an unlikely one: a multimillionaire, generally held to be very right-wing (in America, remember; our "left-wing" candidates are, by European standards, a long way to the right of Michael Portillo), but he seems to have understood the fundamental issue at hand.
His point is that with the minimum wage not being a living wage, some means to support those relying on it is necessary. Minimum wage jobs are generally not exportable; that status only applies to middle tiers of jobs, leading to a large gap between minimum wage and executive-level jobs, but I digress. Minimum wage earners will be located in the US, and it is in the national interest for them not to starve, hence food stamps. However, what Mr. Unz has worked out is that food stamps are an unnecessary complication; the lesser evil, the lesser government intervention, is to require that employers pay a living wage. Regulations are cheaper than interventions.
Now, ideally, companies would be able to figure out what Henry Ford worked out over a century ago, and the CEO of Costco continues to espouse: that paying their employees enough to live well on results in more demand for their products, and thus more success for the company overall. Ideally, regulations to require a living wage wouldn't be necessary. Unfortunately, America's particular outlook on economics doesn't seem to look beyond the next set of quarterly results, or the share price (which is almost entirely divorced from any actual metric of results).
Friday, January 17, 2014
Three months
It's been a busy quarter of a year. Started with a lot of stress, then I had to take an enforced vacation in a psychiatric ward, and since then I've been rebuilding myself (with help, this time; I've suffered breakdowns before, and I strongly discommend attempting to rebuild oneself solo) and trying to make sure I properly bond with my little girl.
I think I've managed to.
I think I've managed to.
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