A Life in a Day...

Sunday, December 10, 2017

"May Your Days Be Merry and White..."

Texas State Capitol Ornament 2017

George and I have collected Texas State Capitol ornaments for nearly 20 years. It's our Texas Christmas tradition after all.

However, it's so easy to blindly follow a tradition for sentimental value without realizing it sometimes perpetuates institutionalized racism.

As beautiful as this year's ornament might be, it's not truly representative of the diversity of American culture--much less Texas where people of color are the majority.

"The Christmas Song,"

Nat King Cole

Saturday, December 9, 2017

It's retail , baby! (Explanation of Benefits Part Deux)

Even when you do have EXCELLENT insurance, price gouging is the norm--or why else could a person "negotiate" down what the insurance doesn't cover 20-30% of that charge and/or have it written off altogether.

It's retail baby! I worked in retail for a very long time. I can't remember the exact formula, but we'd mark up the price from buyers at least 50%. So when we had a sale, we'd still be making a profit. I also worked selling furs in my youth when I didn't know any better. The mark up was tremendous.

Same thing with purchasing a car even with no interest, banking... everything retail. The goal is making a profit, and health care is no different even under a "not-for-profit" tax shelter.

Oh... a word about employee discounts--depending upon the percentage of the discount and the items eligible, a worker is basically using his/her paycheck to earn profit for the company. It would have to be a discount on a significant mark-down to be a real deal for employees.

Otherwise the company is essential hoarding your earnings to make a profit while at the same time pretending that the "discount" is part of your paycheck. So you're basically volunteering as free labor for a business the more you use an employee discount. It's all legal, but is it ethical to set-up a situation to further benefit a company by which employees shoot themselves in the foot to save money--allegedly? Why not just increase pay?

Same with a company that pressures employees to apply for its credit card. The company is getting a kick-back, and you're paying interest--or that's the plan and hope, particularly if you can only receive employee discounts by having the credit card.

So retail whether for-profit or even non-profit to some degree can be a shady place, including but not limited to the health care industry:

We cannot reform health care intelligently unless we understand the medical marketplace well. Debates about reform have scrutinized the health-insurance market, but they have neglected a crucially defective feature of the medical marketplace — the way doctors and hospitals charge patients when prices are not set by regulation or by negotiation with insurers.

The Problem

When patients are not protected by large private or public insurers, doctors and hospitals charge them astonishingly more than patients with Medicare or managed-care insurance. Some price difference would make sense, because insurers offer providers large volume and economies of scale.

But we are not talking about discounts of 10, or 20, or even 30 percent. Providers routinely double, triple, or even quadruple prices for unprotected patients. Such huge mark-ups can only be regarded as price-gouging — exploiting market power to charge prices virtually unrelated to actual cost or market value.

A comprehensive analysis of data hospitals report to Medicare shows that, on average, hospitals charge uninsured patients two-and-a-half times more than they charge insured patients and three times more than their actual costs. In some states mark-ups average four-fold.

Data for physicians’ prices are less comprehensive, but information from office management systems is disturbing. Across a range of diagnostic and invasive specialty services (echocardiography, coronary catheterization, liver biopsy, upper GI endoscopy, circumcision, flexible sigmoidoscopies, hysterectomy, appendectomy, gall bladder removal, and arthroscopic knee surgery), many physicians in 2003 charged uninsured patients roughly two to two-and-a-half times what insurers paid.

Only primary care physicians appear to be staying within plausible bounds. They typically charge uninsured patients only one-third to one-half more for basic office or hospital visits than they received from insurers..., "Price Gouging By Doctors and Hospitals,"July 19, 2009; Mark A. Hall, Professor of Law Public Health, Wake Forest University, and Carl E. Schneider, Professor of Law and Internal Medicine, University of Michigan,

Friday, December 8, 2017

Explanation of Benefits

“In this world, you get what you pay for,” Cat's Cradle, Kurt Vonnegut.

Well...not necessarily. When it comes to health care, we pay huge premiums every month for a service only to "haggle" for discounts and write-offs as well as financial assistance when a loved-one is seriously, chronically and/or terminally ill.

Are you freakin' kidding me?

No wonder we need 'billing advocates" to protect us while the system profits from our misery. Consumers are thrown into the middle of a power struggle between medical professionals and insurance companies for ultimate control of our destinies just due to getting sick--and old if we are lucky enough to live that long.

Oh and don't even get me started on EOB's. Without recourse, patients and/or their caretakers are compelled to check pages of "Explanations of Benefits" for mistakes by insurance companies, hospitals, or doctors, having zero accountability.

Considering the high cost of monthly premiums, THERE SHOULDN'T BE ANY MISTAKES. Sadly, public and private sectors, individuals and families, all are required by law and/or circumstance to invest a significant chunk of change to sustain the sub-par status quo of insurance companies and health care "professionals."

Forever abdicating control, most Americans excuse this insanity because that's the way it's always been. When are we are going to say, "Enough already"? We seem to be very quick to judge social service programs and "the government" while giving a pass to the private sector as if it were any better, including but not limited to the big business of health care.

Why don't we hold the private sector--specifically the health care industry to the same standard? It's as if most Americans blindly trust the juggernaut of capitalism seeing ourselves as players, not victims. It's about survival of the fittest, after all.

Unwittingly, we set ourselves up for failure through nothing more than bad luck--medical expense bankruptcy looking more like a viable option albeit viewed as as a sign of weakness for everyone except the upper 1%. In spite of doing everything right, we have failed somehow if we struggle to navigate and/or worse afford " the system"?

Yet it is "they" who have failed us. Why do we keep feeding the beast to sustain itself only to drown us in debt? Even after investing thousands perhaps millions of dollars over a life time, it's simply not enough to defray the outrageous cost of getting sick and staying alive. Nothing like a catastrophic illness to check us back into that grim reality.

Traditionally, Americans believe money equates power. The truth is that very few of us have that kind of financial freedom and stability. So we become victims of an anachronism, caught in a twilight zone through no fault of our own. Sooner or later, we will all have to play the game with the house set-up to win nearly every time.

Are we so entrenched in politics that we can't see what is happening until it happens to us? And rest assured, it will happen to every single one of us eventually.