Healthcare: insurance should not be needed

Posted by & filed under Misc, Politics.

It’s Sunday, which probably means that by the end of the day US will have “health care reform”. Political reasons aside, it’s still puzzling to me why politicians do not want to fix the actual cause of the situation.
Scratch that, considering the amount of money involved in politics, I understand that.

I am, like any other guy, fond of the word “comprehensive”. I do think that US has a huge problem with medical industry, being interested in profit and current “status quo” (“quack” for patients, money for doctors). But I don’t think the current form of “solution” proposed in a shape of 2000 pages long bill is the right way.

I wish there were series of smaller, short bills, that deal with specific problems and add clear regulations. Written in plain English, instead of legalize, so you can read them. It’s like with the spring cleaning — the goal of “clean the house” never get anything done. A series of “clean big room, wash floors, dust ceiling fan” etc seem to do the job, and if not the 100%, at least 80% of things get done. Better than none.

So, here are my main rant points:

I don’t think it’s right to force people into relationships with private companies (especially when a few large ones exist in environment of monopoly/duopoly). Yes, I mean the mandate. Insurance should return back to state of helping in a case of a major and unpredictable (more or less) event. Because the regular price of the medicine/procedures should go down.

I wish reform would disallow multiple price points for medical stuff. Nobody can convince me that if hospital allows patients with BCBS pay $12 for blood panel, patient without insurance should pay “regular” price of $320, and if you have another insurance you pay $27. “Contractual concession” should come only in one case – when patient brought her/his own materials to work with. Whatever the lowest price point is, everyone pays.

Please do not allow consumer-facing ads. Psychology aside, marketing should not be making medical decisions. Do not allow bonuses/vacations/free trinkets from pharma companies to be sprinkled onto medical workers or hospitals. If pharma company wants to donate money – let them sponsor a hospital, but make it general sponsorship, like a stadium. Medicine news, along with peer reviews, belong to medical journals.

Do not allow pay-offs of generics manufacturers. If patent is off, paying someone “not to make generic version of medication available right away” is a collusion. Antitrust law, fine up the wazoo, a bit of a mandatory jailtime for involved personnel.

Remove requirement for hospitals/ER to “treat everyone no matter the cost/reason”. Current situation where you have to wait 4 hours for treatment is not sustainable and makes ER a joke. ER should only deal with life-threatening situations. For that, offer people basic low-level emergency insurance. Make that insurance a single non-profit organization, covering emergency services only. I bet this could be done under $5 a month (heck, if it really covers everyone, could be even less).

For hospitals that want to provide social treatment programs, offer tax write-offs. There are poor people out there, and even with prices going down, some probably wouldn’t be able to afford doctors, for those there will be these extra cheap/free clinics. This is where people have to go when they cut a finger or sniffles, not ER. You try to go to ER with that, you get your ass kicked out.

Offer to all doctors/medical personnel centralized non-profit malpractice insurance, with reviews and certifications. Bad doctors get banned. Doctors with good track record and happy patients get lower premiums.

For common maintenance-dependent conditions offer non-profit country-wide coverage for medicine/procedures. Single purchaser is certainly a powerful tool.

For all “basic”/federal programs offer encouragement of early enrollment. While nobody would be turned down for “Federal Diabetes Program” that purchases for you insulin and testing supplies, if you enroll early, before you get diabetes, you get lower premiums

All prices for hospital services should be readily available. Patient should be able to tell that hip replacement in hospital A costs $X and B – $Y, decide which one she/he wants, and go there. Publish ratings of hospitals and comprehensive list of what is included. Disallow little asterisks and fees/taxes.

Do allow private insurance to help people. But make them consumer-facing institutions. They deal with patient only and simply reimburse the client after the fact. They don’t “negotiate” with hospitals and have no say where or which procedure you get (they may not cover some procedures, but there should be no scenario of “Well in this case we won’t cover NNN” – list of procedures and max coverage should be available upfront, no wiggle room). They are a financial service, that kicks in when medical event happened (this is how many European insurances work – they give insurability guarantee, premiums vary only due to age/sex, etc). Allow them to provide patient with a credit card, for those cases where procedure is costly (but will be covered by them at least partially anyways). Tax break for preventative measures, or extra expansion of covered stuff.

I think this should be it. Unfortunately this won’t happen any time soon. Though it would be interesting to watch how public goes from hate to love to hate of the new bill when it passes.

Did I goof off significantly somewhere above? Let me know.

Census: form in hand, questions in mind

Posted by & filed under Politics.

On slashdot.org there’s a recurring joke — in Soviet Russia [any noun] [any verb] you! In this case it would be “in Soviet Russia, census participates in you!” (yes, grammatically incorrect, but you get the picture).

But to my surprise, US census form seems to be asking for more personal information, than Russian one. There was a country-wide census in Russia in 2002, and if you look at the actual census form (sorry, only in Russian), you would notice a peculiar fact — there are no fields for name, or phone number, though form also asks if people that live with you are your relatives.

So, of course I don’t understand why the census form asks for name or phone number. A note on official site says “so you wouldn’t forget to count everyone” and “so we can call if we have questions”. That’s an odd excuse. If someone forgets about another person who lives with them, they wouldn’t write name nor include her/him in the total count. In fact, I don’t think people actually count by listing full names in their minds. When someone asks you “how many people live with you” you do a quick mental inventory (“parents — that’s two, plus wife, and my boy, the answer is four”) instead of listing actual names and counting them.
Also, who would answer a phone these days if it’s a call from an unknown number? Heck, given the identity theft epidemics and scammers, I wouldn’t agree to tell a stranger my birthday.

So, I think the form should simply say “we’d like to have a full name and phone number for everyone who lives in America”. Super-mega-white pages with data available only to the government agencies and scientists.

Given the number of commercial databases that happily sell any information to anyone for a few bucks, would people really be more upset than left thinking “why do they want my name? why won’t they allow me to list my country of origin if I’m not Hispanic?”
But I guess it’s bureaucracy awkwardly trying to pretend being human again, so I filled all fields out. Yet another listing in government database won’t make any difference.

Oh, and while on the subject of weird questions — way to go on question number 10. That’s a nifty way to pack a number of unrelated questions into a single one. Let’s see:

Does the person 1 sometimes live or stays somewhere else?
◻ No ◻ Yes – mark all that apply:
– in college housing
– in the military
– at a seasonal or second residence
– for child custody
– in jail or prison
– in a nursing home
– for another reason

Now, if this is not a vague question, I don’t know what is.
In “Start Here” section instructions clearly say: “Do not count anyone living away either at college, or in the Armed Forces. Do not count anyone in a nursing home, jail, prison, detention facility, etc, on April 1 2010. Leave these people off your form, even if they will return to live here after they leave college, the nursing home, the military, jail, etc. Otherwise, they may be counted twice”.

Therefore, if you actually follow instructions, your answer to question 10 is most likely to be “No”.
Because otherwise you wouldn’t be counted, right?
So, why ask about living somewhere else? Probably because it’s an easy way to compress the following questions in one:

“in college housing” — are you a student?
“in the military” — enrolled in the military?
“at a seasonal or second residence” — do you have a second home/time share?
“for child custody” — are you divorced with partial custody, and your child lives with an ex-spouse?
“in jail or prison” — obvious answer here
“in a nursing home” — do you live in assisted living facility?
“for another reason” — suddenly instead of place, it asks for the reason of living somewhere else. I’m at loss here…

Again, all of that information is available from commercial databases, so there’s really no need to ask for it. Or there could be a disconnect between one department, that writes general instructions for filling out the form, and another department that actually makes up questions, lists answers and decides on how to solve the problem of entering data into computer systems.

I wish the census would be done online. It’d be so much faster and easier, to just allow people to enter that unique code from the form into web field, and then mark all the answers on the spot (those who have no access to the internet would fill out the form and mail it back as before). No need for months of processing, lots of money saved on mailing and handling, more accurate results (if you write chicken-scratch like me, due to massive amount of keyboard use, I pity the optical scanner)…

Oh well. Hopefully in another 10 or 20 years…

This language, such a silky song of bureaucratic thinking

Posted by & filed under Misc, Oddities.

Everyday I run into oddities of the language. I suppose I pay attention because English is not my frist language. Technically speaking it’s not even my second, though leftovers of my German are barely enough to say Wienerschnitzel (I have to remember to write an ode to the wonders of childish stubbornness towards anything knowledge, multiplied by the soviet foreign language schooling, resulting in such pitiful outcome).
So, when I read, say, a bill from the city, I try to understand, how exactly people come up with this stuff. What do they mean? What was the reason write explanations of charges in this way, instead of the human way?

Here’s an excerpt from the City of Austin bill:

“Solid Waste Service”
I don’t want waste to be serviced. Can I have “trash removal” instead? No, of course I can’t.
Anti-Litter Residential ($5.00)
These people have something against cat litter? Or is this an advance fine for littering on the street? Maybe littering inside the house (residential, after all), or do they mean guests of the city litter for free. So not fair!

Res. – Base Customer Charge ($8.75)
Spelling out “residential” twice is hard, so let’s shorten it. But then, why not just call it base service charge? It doesn’t matter how many people live at the address anyways.

Res 60 Gallon Cart@ $10.00 each ($10.00)
Third time “residential” is mentioned, so the dot evaporated too. Plus, if it’s a solid waste, why is this cart measured in gallons, like milk? I understand that my metric brain can’t really comprehend the volume of 60 gallons, hopefully locals can (by the way, that would be the output of an “average” holstein cow over a period of 10 days).

Sales Tax
Hey, I am not selling the garbage! Nor buying it. Nevertheless, it is charged here ($1.56). But not on water service. Hm…

Drainage/Street Service
They charge it no matter what time of year it is. Even when there’s drought.

Comprehensive Drainage Fee ($7.75)
Um… is there a shortened or small drainage fee? Apparently not. Calling it “street cleaning” would be too human, I suppose.

Transportation User Fee ($6.63)
This one has a small note, saying that if you’re over 65 or don’t drive/own a car, then you can get an exemption. First I thought that this is a “bus” fee — I mean there is a public transportation system in Austin, however unusable in suburbs. But apparently it’s just a charge for driving on the roads. I wouldn’t have guessed otherwise.

Another small weirdness hides behind water/wastewater service. Water service section has “customer charge” and “consumption charge”, while wastewater has “customer charge” and “flow charge”. Why one is consumption (I can’t consume 400 gallons of water, though I can use as much) and the other is flow? Mystery…

Bonus note. Billing rates for water and wastewater are listed as:
$1.0000000 and $3.4300000 per 1,000 gallons
1.2345678
Now, let’s see how much water (and sewer service) can one consume before the last digit becomes relevant. Presuming rounding is important, 10,000,000 gallons (which would result in $10,000 bill, if scale was linear, which it is not). That would be a 267 feet long x 50 feet wide x 10 feet deep pool filled 10 times over. I’m not quite sure that would qualify as “residential”, especially within city limits…

All this out of a single bill… phew… better go pay it now, or no matter what language they use, the outcome will be regretful.

Post-apocalyptic metal world at Wildflower Center

Posted by & filed under Oddities.

Every once in a while I go to the Lady Bird Johnson Wildflower Center. And while the flowers themselves are pretty much the same year after year, each time I see some new sculpture there. Frankly, I am not a big fan of “modern” art, and constructions out of old toilets or rusty buckets usually give me fits of giggles. But then, for classical art people go to the museum downtown. Flowers are not very picky, they can survive being pretty much near any art.
So, here we go…

What can be more appropriate than sculpture of Fire Ants in Texas. Little vermin causes so much grief, but there’s always someone who wants to take it to a whole new level. The Post Apocalyptic Mutant Metal Fire Ants. Shudder and weep!

From WildflowerCenterMar132010

Chewed up lady torso completes the landscape:

Completing the entrance group is something that looks like “Catching of a Lab Assistant, who dropped beryllium sphere”

Frog-spider hybrid is way smaller than ants. Not much less creepier.

Bevo head is also made out of parts.

Monster bunny is made out of a pile of… pile of…. well… it just looks like that, in reality it’s also some sort of metal. But I ain’t touching that thing.

For the rest of the art and flowers see the full Wildflower Center album (March 2010).

I wonder if someone will buy the sculptures afterwards, or they will be dismantled, or hid in a warehouse somewhere, to scare future generations of children…

I’m not really an arts person, you can probably tell already.

Horseback riding, and why Santa got it all wrong

Posted by & filed under Misc.

When I moved to Texas, I had a general idea of the whole “cowboys” thing that had very little in common with reality. And it’s fine. You can’t really expect movies and TV to provide you with any accurate information about any profession. Programmers cringe at pretty-looking meaningless interfaces, doctors find tons of errors in House episodes, and so on and so forth (if you’re not one of the before-mentioned, just try to find a tv show that has anything related to your profession, I am sure you will agree). So, cowboys were supposed to ride fast, do good deeds, control their horses by doing that “Hiiiyah!” ninja-like scream.
Well, wrong. When I saw cowboy competitions onTV after the move, I was impressed. I also marked on my to-do list “find a place to learn how to ride a horse”.
It took me several years to actually get to that to-do item — a friend of mine told me he was taking riding lessons, and wondered if I wanted to tag along. I did.

First surprise was the command to force horse to stop. “Ho!” does the trick. Which means that Santa and his jolly “Ho-ho-ho” would result in abrupt stoppage of carrier (presuming reindeer do follow standard western controls) and, given absence of the safety belts, Santa’s head would end up in one of those reindeer’s behind. Not pretty.

The other surprise was pretty much a joystick on the saddle. Resemblance was uncanny. Alas, pulling on it doesn’t control the horse in any meaningful way (pity, really, wouldn’t you love a joystic-controlled live horse?). It’s used to tie up the rope when dealing with cattle, plus to annoy unexperienced riders, like me, because I can’t lean forward that much without it jabbing me in stomach.

Third surprise was that leaning forward is a command “go faster”. So, when someone in panic tries to grab onto the horse’s neck and clings forward, that’s pretty much “go-go-go!”, instead of “oh cr*p! Stop!”. That would be leaning backwards in saddle. It goes against all instincts and is difficult to learn, but work pretty well with cowboy-trained horses.

Now, most of the described surprises come from “cowboy” or “western” trained horses. Saddles for English riding are different, commands are different, it’s a whole new world. But this is Texas. So, I continue to ride periodically, and dream of the time when I will finally be able to do something useful, like herd cows, and not just dedicate 100% of my computational resources on figuring out how to make horse go where I want it to go, and at the speed I want it to do.

P.s. can you imagine what a surprise was when I learned about vaulting… Jumping and doing all sorts of other tricks on the horse’s back while horse is running (in a circle, but still). See my gallery of vaulting pics