The Ridiculousness and Real Cost of Heath Care in America

After some 30+ years of living in this country (the US being "this country" and Denmark being "where I came from") I have come to the conclusion that one of the things that annoy me the most about living here is insurance.

Or rather... the cost of insurance-- and especially the cost of health insurance.

People talk a lot about the "standard of living" in the US, but how do you really measure the standard of "living?" Sure if you look at the median income, it's a pretty nice number, compared to a lot of places in the world. You can also look things like Gross National Product per capita, and things still look pretty nice. The problem with those metrics is that they are "just numbers" but don't really look at "where" people truly are.

Here's the thing... when you look at "what can you actually DO with your life once you've paid for the basic expenses of living" things kinda suck. And that's the fundamental truth of living in 21st century America-- we may look like we have a lot of money... but we also have to pay a monumental pile of expenses... and when you consider the equation from the angle of "how many units of basic lifestyle can I buy with an hour of averagely compensated work" things are not so good.

And then... things are complicated further by the fact that we have utterly unrealistic expectations about what we "should be able to get" with the money we do have... there's this odd sense of "entitlement" that we "should" be able to buy boats, McMansions, trips to Europe, $300 sneakers, flat screen TVs and redecorate our house every three years with the relatively tiny pile of actual disposable income we have left over, at the end of the day, after basic expenses. And that really doesn't work, in a functional sense... the only thing it "works" towards is creating a bunch of underlying anger and frustration about how we "never have enough."

But I am digressing.

Insurance.

It's "a job" around here to pay the bills... And I keep looking at just how many of these bills are about insurance. Health insurance, auto insurance, homeowners insurance, title insurance, life insurance... insurance, insurance, insurance.... we're up to our eyebrows in insurance because we all seem to be hanging by such a fragile string that unless we're "insuring" ourselves to the hilt, everything we have and believe in could all "go away" if the slightest mishap comes our way.

Top of my "annoyance" list is health insurance. Now, granted, I grew up in a part of the world that has socialized medicine... so perhaps my perspective is skewed. In this household, we have been paying $611.00 per month in health insurance premiums... all for the privilege of being "insured" but still having a... get ready for it... $6,000.00 deductible.

"On paper," what that adds up to is that no matter what, our "healthcare" costs us over $7,300.00 per year (the premiums)... before we even grab the first Kleenex to blow our noses. Now if we do need the services of a doctor or "something medical" (as most of us do, as we move into our 40's, 50's and beyond) we're still out-of-pocket for the next $6,000... meaning that our health, allowing for occasional mishaps and visits to the doctor + medications means we've spent $13,300 per year before we've derived any damn "benefit" from "being insured."

Of course, just because we "hit that mark" doesn't suddenly mean that "it's paid for." Now we get into all the technicalities of "co-payments" and "disallowed" items and so forth.

Now, a $6,000.00 deductible may sound like a HUGE amount... but it's really less than you think. Why? Because we live in this society where it's (a) assumed that "it'll be covered by insurance" and (b) everyone is incredibly litigious, which drives up the cost of malpractice insurance, which drives up medical costs... you can use that up that deductible in a hurry. For example, Sarah went to the doctor this spring ($180.00) which required some bloodwork and labs costing $1,270.00, of which the insurance company covered no more than an "administrative adjustment" of $127.00. That's pretty normal, in the real world.

But getting back to that out-of-pocket annual amount of $13,300.00 for our health... that amounts to $1,108.00 a month just for "breathing air" without being seriously sick. That's more than most people's rent. Or mortgage payment. Or all utilities and food, combined. And we haven't even covered the "other" kinds of insurance we're having to pay for... auto, home, life, etc.

Now, you might think we have a really crappy insurance plan... but based on a lot of research, along with the insistence from other people (medical and private) that "it's actually a really good plan," this seems to be pretty much "what to expect" in 21st century America... unless you're working for some large employer of the government and get medical as part of the package.

OK, so let me back up. I said "America." I don't mean "America." The United States. Our neighbors to the north in Canada don't really have these kinds of issues (at least not to such an extent) because they have a form of national health care. Although healthcare in Mexico is not fully nationalized, it is effectively of a quality and cost low enough that many US based health insurance providers actually require their customers living within reasonable distance of the Mexican border to go to Mexican hospitals for many procedures.

In the US, we're very proud of our national self-reliance... but that may also be our Achilles heel when it comes to public health. The entire nation was founded on a mistrust of government, so it is not surprising that the idea of socialized medicine is a "hot potato" in the US. And I harbor no delusions that this attitude will ever substantially change. And then there's the age-old argument "yeah, but you would have to pay it in taxes, anyway!"

We'll get back to that one...

For me, such a central part of where the healthcare debate in the US completely misses the mark is in the way the vast majority of dialogue is centered on the practical aspects of public health. From where I am sitting, the vast part of it actually looks more like a social and societal issue that gets swept under the rug most of the time.

In the US, we're very attached to the whole "equal rights" thing, and how everyone should have "equal access" and all that good stuff, and yet... when you have a "for profit" type of healthcare system (or, for that matter, any type of for profit system) you automatically create a sort of "meritocracy" in which service is more readily available to those of means and is dished out according to financial ability, rather than actual need. Bottom line-- which we really don't like to look at, as a free enterprise culture-- in a for-profit system there is really no (or little) money to be made from peddling services to poor people.

The other-- and subtler, but potentially more pervasive-- issue involves the subtext and implications that go with living in a culture that has no "safety net."

We may not think of this on a conscious level, but for many people in the US, "getting seriously ill" basically means "losing everything you have" or going into bankruptcy... same end effect, either way. That knowledge "lives" as a constant undercurrent in our society. Probably two-thirds of the population-- if faced with some kind of major medical event-- would find themselves "on the rocks."

"True," you might say, "but so what?"

Well, if your life is subtly but constantly influenced by an underlying fear that you're "not going to have enough" it is also going to fuel a constant drive to try to get "more" to compensate for this fear. That's simply human nature-- psychology 101. Of course, fear of "lack" drives the quest for "more," and the quest for "more" ultimately drives "greed" (subtle, or not so subtle)... and the failure to get "more" leads to an undercurrent of frustration and anger. And where does living in a perpetual state of subtle anger and frustration lead? On the "soft" end, to ulcers and anxiety (requiring healthcare!) and on the "hard" end to marginally abusive and violent tendencies.

No, I'm not talking about actual physical violence, I'm talking about about the violence and abuses inherent in extremely competitive workplaces where the actual "contest" for "more" and "overcoming our fears of not having enough" play out.

Now, let's get back to those taxes... and how "we'd have to pay for it, anyway." To some degree, true. Of course there would be taxes. But it would be less than we pay out of pocket, right now... because the cost of the "profit motive" would go away. Healthcare would be a "basic service" like police and fire.

Funny, how that works. We're "OK" with having firefighters be a "public service," but not our health.

Ever considered a conversation that goes "Well, Martha, the house is on fire but we couldn't afford the fire service insurance this month, so it'll have to burn down because we can't afford to pay the fire fighters to come out." Probably not. Yet... that's what we do with our health.

"Yeah, but the really GOOD people would no longer become doctors in a non-profit system... "

Mmm... really? I have some major philosophical issues with that line of thinking.

Maybe I'm being overly naive or idealistic here, but the fundamental fallacy behind that argument is that it assumes "doctors are only in it for the money." This assumes that people go to medical school not because they are actually interested in medicine and healing people... but only because they can "make $400,000 a year."

Two (major) things to consider:

One, if "the lure of big bucks" was actually a bit less, wouldn't we actually end up with more doctors who were genuinely interesting in healing people, rather than those mostly looking for wealth? In a sense, wouldn't the system be self-adjusting towards creating a pool of doctors who care more, rather than care less?

Two, if you were a physician who was part of a structured not-for-profit system... where-- for example--your malpractice insurance premiums would all but vanish, and the need to constantly market yourself and "run a business" largely dropped away... wouldn't you not only be able to focus more on "practicing medicine" and still actually be "relatively" well off since your drop in gross income is partially offset by a drop in operating expenses?

Meanwhile... on a more personal level... if I there was some kind of safety net between me and the potential for destitution, I wouldn't have this eternal knot of worry in my stomach. And if I wasn't out this monthly $1,108.00 I might not feel quite so much like no matter what we do, it never seems to be "enough."

What do YOU think? I know it's a complex debate-- but everyone seems to have an opinion. And if you live outside the USA... what's your take on "healthcare in America?"
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Beginnings, Developments, Declines and Resurrections-- the Dubious Joy of Living with ADD

Every now and then, I think about "resurrecting" this blog, even though I can't exactly say that I have ever officially "abandoned" it.

The combination of being "a writer" and "living with ADD" is a strange place, sometimes most of the time. I have never been one of those writers who sits there, staring at a blank screen or page, lamenting their "Writer's Block." Mostly... I lament that I can't keep all my ideas organized enough to remember what I've already thought about, and written about.

The challenge is trying to stay focused on one idea long enough... and being able to tune out (or at least "postpone") the 47 that come up while I am working on the first one.

When I started blogging... sometime before blogs had actually been invented... my writing was most centered around "Generalized Daily Emotional Vomit." Not particularly attractive, entertaining or fun... but it did help me work through some "stuff." Eventually, I gave up on "general" blogging and instead pursued an increasing number of "micro-niche blogs" each of which was related to a specific interest (or work aspect) of mine. I still do that, quite a bit 99% of the time.

As the years have rolled by, more and more of my writing has been developed into a free-standing "article format" rather a blog format. The thing with blogs (at least the more interesting ones, in my opinion) is that they tend to be a conglomeration of "serialized thoughts." I have seldom felt very compelled to keep up with blogs that are about "shaving monkeys" one day, "changing an oil filter" the next, and "recipes for peach pie" the subsequent one. I see that approach and I'm like "Pick a lane, ANY lane, and stay in it."

And yet?

In SPITE of the fact that I was taught-- in college, and while working in the IT industry-- that the true sign of a good organization system was "never needing a MISC folder" I have to confess that I often end up with those dreaded "MISC" ideas. Even though I have a veritable smörgåsbord of venues to which I can share ideas.

Maybe one of the true banes of the ADD mind is that it's all but impossible to simply "discard and forget" something you've thought up. Makes me think people with ADD are the "psychological hoarders" of the world... we hoard "ideas," rather than "stuff."

The irony of my sitting here, writing these words, is that I was actually working on a different post/article... which was (IMNSHO) really quite good and insightful, and yet I couldn't think of a "place" to put it. It didn't really "fit" with any of the other things I normally write about. And it annoyed me... because it seemed idiotic to "waste a perfectly good idea." And so, I got sidetracked into "cleaning up" this old general writing venue... which involved giving it a quick "face lift" and updated appearance....

... of course, in the meantime, I thought up a way to "slant" my earlier post so that it would fit into one of my established "specialty venues," thereby making my efforts here "a waste of time," which-- in turn-- also annoyed me, so I decided to sit here and write for a bit, anyway.

Not sure why, though...

Maybe just as an illustration (and warning!) of the convoluted bullshit the ADD mind goes through. And it's not even NOON, yet!

At the Intersection of Idealism and Realism

When you've been online for many years and have been actively involved with a wide range of forums you get a LOT of fairly random email... including email asking for various forms of help. Getting help to get projects going has gotten easier than ever, thanks to online services like "Kickstarter," "GoFundMe" and several others that allow people to fund their dreams with peer support, rather than depending on bank loans or "rich uncle" funding.

However, it saddens me that so many amazing projects driven by beautiful ideas (and ideals) are created and doomed to fail... only because of piss-poor planning and unrealistic expectations.

Not thinking of anything or anyone in particular... because I see this ALL the time.

"Wow... you invented a new biofuel based on water, which will cut the cost of running your car by 90%, and the manufacturing bi-products happens a cure for cancer? And now you want to bring it to market yourself instead of letting some big corporation bury it somewhere? That's the most amazing and beautiful thing I have very heard! Go YOU!"

Long pause...

"Wait..... what? You want everyone to know about it and have the whole thing funded and developed in the next 30 DAYS? And you only have $43 to make this a reality? On WHAT planet is that possible?"

There's this surrounding illusion that "people" will want to get involved because there's this great idea. Unfortunately, these mystical "people" tend to get sent 300 "amazing ideas" every week... and they won't know you even exist... unless Warren Buffett happens to be a close personal friend. The dream that your idea will "go viral" and half a million people hand over $20 each to fund your Kickstarter campaign is pretty much just that... a dream.

The reality of life is that 99.9% of people have to be pounded in the head 600 times with a 20lb sledgehammer before they recognize-- let alone start MOVING towards... then accept and embrace-- a new idea, or a new product, or whatever... so unless you have that rich uncle you didn't tell me about and 20 of your closest friends happen to be movers and shakers with 5 million followers on twitter, you'd better re-think your approach.

Am I jaded and cynical? Do I not believe in realizing dreams? No, not exactly. I've dealt with the marketing of non-mainstream ideas and products for over 25 years... and my experience (even when you have most amazing and worthwhile thing) has been that to make your DREAMS become a REALITY... you have to step outside "dreamland" and "get REAL" with your dreams. Otherwise they shall remain... sadly... "dreams."

Not long ago, I watched the brother of a prominent writer wanting to create a documentary about his now deceased brother's life and times. Indeed, a very interesting project with a fairly broad appeal. Even with all the web tools we now have, it took him 90 days of persistent marketing and awareness generation to barely raise the needed funds. And this was someone with a fair amount of resources and an extensive contact list.

Certainly not writing these words to discourage people from pursuing their dreams. Merely pointing out that the whole notion of "making our dreams a reality" revolves around the word "REALITY." Which means the success of bringing your dream to market means you have to DEAL with reality... and plan around reality. Whereas it does happen-- once in a blue moon-- the "And Then A Miracle Happened" method of dream development is notoriously unreliable....

THINKING... and the Joys and Pitfalls of the Internet

The Internet is a lovely invention. Never before have we had access to such an extensive source of information and such an instant source of "the latest." Just SECONDS after Michael Jackson, Dennis Hopper or anyone else dies, there's a Wikipedia entry about their death.

Everybody becomes a news reporter, an expert, a commentator and a front row spectator to everything that ever happens, out there.

It's kinda stunning, don't you think? I mean, just sit back and ponder that, for a moment... just 100 years ago, it might be several days before you even knew the President had been shot...

I grew up in a dysfunctional household; dysfunctional parents... blah, blah, blah. Whatever other faults and problems the 'rents may have passed onto me... one thing they did give me was the ability to "think for myself." It's something I am incredibly grateful for, even though I have often been taken to task for my unwillingness to be part of "popular" culture, group-think and "normal," if and when it just "doesn't feel right" to me.

There's a saying "Great minds think alike!"

I was raised with "Great minds think for THEMSELVES."

But let's go back to that marvel we call The Internet.

Recently I was looking at a YouTube clip someone had sent me a link to, and it really struck home how the web is this place where you can find supporting "evidence" for almost ANY belief you might hold.

You believe that beef fat is going to kill you? Five minutes with Google, and you can find scientific evidence that your belief is true. You believe that beef fat is actually good for you? Five minutes with Google, and you can find scientific evidence that your belief is true. In a more recent historical context, you could concurrently find "overwhelming evidence" that the oil spill in the Gulf would cause the end of all life on the planet AND that BP had it under control.

My point being that I sometimes feel alarmed by the degree to which people mindlessly allow what they find online to become "an extension and reinforcement" of their beliefs... without pausing to QUESTION what they read!

This is particularly true of so-called "conspiracy theorists."

I keep thinking about "scientific methodology" and the various perils of research, as they were explained to me when I was in college. And the danger of being "attached to a theory," and then going off in search of "evidence" to support your theory, rather than merely observing FACTS and then forming a theory around patterns that appear to be true.

Odds are that the white cable company van across the street, and the cable guy pulling new wires into your neighbor's house is not "them" watching you, just a cable guy. Seriously? Wake up and smell your reality, friends!

The truth is that "they" don't give a shit about you, unless you're actively about to unveil something that will massively and effectively undermine and change the current dominant paradigm. You have a formula for an additive you put in water, and it becomes a fuel that can be used with existing internal combustion engines and the exhaust is only water vapor? Thereby rendering all oil production irrelevant? Yeah, "they" might be watching you. You're talking about UFOs with your online buddies? Newsflash... "they" don't give a shit, unless what you're talking about is video you shot inside the kill zone at Area 51. To think that you-- the individual-- matters to "them" is little more than a pathologically narcissistic inflation of your own self-importance. And I'm sure you now think "they" told me to say that!

So how did I end up here? Well, in recent years I've been trying to eat more consciously, and not put so much garbage into my body... not just for me, but also for the sake of my honey... we'd like to have a long and healthy life together. And so, where did I turn for information? The Internet. Where I found little more than a cloud of unsubstantiated opinions about what "healthy eating" actually looks like... from rabid vegans to equally rabid meat-eaters, to doctors, to nutritionists, to other experts...

... and it struck me that these people were all less about "providing basic facts," than about having a platform for their personal agendas. Like "The Undiluted And Straightforward Truth" is the last thing anyone wants to talk about... be they conservative or liberal; rabid or passive.

In the end, my "quest for food information" ended with a deeply non-electronic observation. I looked at my own relatives, many of whom lived past 90, none of whom had access to the Internet and few of whom even read a book about diet or nutrition... and realized how much the modern age seems obsessed with overcomplicating the very simple business of living. These people-- who were much healthier than average-- lived by very simple rules: Prepare everything from original ingredients, stay physically active, and eat/do everything in balanced moderation.

Of course, the cynic in me realizes that if it "was just THAT simple" there wouldn't be a multi-billion dollar health and food industry. There wouldn't be lots of "right" and "wrong" things for us to consume... to support the Capitalist Machine. But that's for a whole other discussion.

Bank of America and the Failing Economy

The whole Bank of America charging for using debit cards thing bugs me.

It bugs me not so much because it's another $5-a-month-nickel-and-dime-fee, but because of what it ultimately represents: a repetition of the very cycle of greed that ultimately underlies why banks-- and much of the greater corporate world-- fell on its butt, a couple of years back.

Have they learned NOTHING?

Folks, if you have an account with BofA, it's time to close it... and it doesn't matter whether you have deposits above the threshold where you are exempt from the fee.... and here's why: You are being charged for the "Fundamental Cost of Doing Business."

Let me offer some analogies: BofA's debit card fee is like the grocery store charging you 20 cents for running the register, or a house painter charging you $5 because he/she has to use a paint brush, or the utility company charging you $3 a month to read the meter. You wouldn't pout up with that, right?

BofA is a bank. Part of the core of being A Bank includes actions like counting money and having the basic functionality that goes with... well... being a bank.

It reminds me of the 90's when my business bank (BankOne, now Chase) decided it would charge my business (a retail store) $1.50 per $1000 to count cash included in deposits. I closed and moved my accounts (which often had $20,000-$50,000 balances) the next day... even though I was technically above a limit where the fee wouldn't apply to me.

The point being... it wasn't the $1.50 (just like it isn't the debit card fee, itself), but the fact that I was being charged for a bank to perform the core actions of a bank's business.

I'm sorry, if a business-- any business-- is not capable of functioning without charging for its fundamental actions that make that business possible, then it has NO BUSINESS being in business.

To wit, BankOne ceased to exist not long after it started in on a cycle of "fees for everything." By its actions, it would seem BofA is heading into a cycle of its own that may signal the beginning of its end.

The most powerful thing we can do is "vote with our dollars." I have voted with mine: I bank with a regional bank that has been in business-- under the same fundamental ownership-- for 104 years. It doesn't charge me fees, and it even continued to make a profit while all the "Big Corporate" banks were crashing.

Imagine THAT!?!?!

Of course, this bank is very "Un-American" because its management is satisfied with "making a profit" every year, and isn't caught up in the compulsive obsession with "we MUST make more and more profit every year" that drives most of corporate America and the machine of capitalism.

I hope you read this, and agree that this action by BofA (sure to be followed by other large national banks) is simply wrong.

I hope you act, and move your BofA accounts to a local Credit Union (usually fee free) or a regional/local bank that's not "part of the problem" that messed up our financial lives, in the first place. BofA has already been given a second chance, in the form of a bailout with your tax dollars. They (and others) do not deserve a third chance.

But it's not enough to just THINK and SAY "I'm mad as hell, and I'm not gonna take it anymore!" You have to ACT on it. Don't be complacent. Don't leave it up to "others" to make a change. Be the change, as Gandhi once said.

At the very least, if you agree with this, share it on your own pages, tweet it, link to it and spread the word...

You suck at Craigslist?

No, I'm not talking about the web site by that name.

Although there is one. It's pretty funny, as well: http://www.yousuckatcraigslist.com/

But that's not what I am writing about. I am thinking more about people on Craigslist who suck... aka, the latest scam going around.

Because we will be moving soon, we have some things listed for sale/free, on Craigslist.

In due course, a perfectly legitimate-- albeit slightly weird-- response to a listing shows up in my email box. In this case, the inquiry is: "This item-- it has been involved in any accidents?"

???

This, of course, is designed to elicit a response. As in "I'm sorry, I have no idea what you're talking about." But it's a response. Now the sender has my email address.

Next day, there is a very legitimate looking email... ostensibly from Craigslist-- citing bits and pieces about Terms Of Service (TOS) and listing items for sale, and "to please verify your Craigslist account, or your listings will be removed." Unlike many such scams, this one did NOT have typos and spelling errors. It also was more subtle than most, asking the reader "please go to the craiglist web site and log into your account to verify it (scam emails RARELY suggest this), or click on this link to do so."

This, of course is a "phish." But if you're not paying attention, you won't notice that the original sender isn't "craigslist.org," but "craigslists.org." Or something very close like that.

Anyway, you have to be really careful with craigslist... this was just a reminder. Overall, though, I love the site... and have both bought and sold many things there.

July 4th Musings on Potato Salad

It's the 4th of July, and I made potato salad.

I will be the first to admit-- and openly declare-- that I loathe most potato salads. Especially the "bland white" kind found at so many BBQs and picnics... which-- to my way of thinking-- amounts to little more than tasteless, mayo-infused mashed potatoes with a hint of pickle-juice flavoring.

No disrespect to anyone who likes the stuff. I just don't.

In my world, potato salad is supposed to taste of something.

It is supposed to be able to stand alone, and hold its own against spicy, tangy, heavy and deliciously flavorful BBQ.

Don't get me started on flavorless BBQ, either...

I grew up with potato salad in Denmark. My mom's was bland as F%$#!* and I didn't like it. However, my Aunt Ulla's was stellar, robustly flavored and based on a substance known in the family as "Dad's Lobster Sauce."

"Dad," in this case was my grandfather; my aunt's father.

I'm not sure there was ever an official recipe for "Dad's Lobster Sauce;" my impression has always been that it was created through some delicate blend of genetic inheritance and alchemy... my aunt would make fairly large batches of it, bottle it and distribute bottles of it to family members who seemed worthy of possessing the sacred drops. The rest she kept and used for flavoring in a wide range of hot and cold dishes, dressings, sauces and other things.

Oddly enough, my own father didn't much like it. "Tastes too Danish," he'd say, and turn his nose up.

But I digress.

The point is that "Dad's Lobster Sauce" packed an explosion of intense flavor, and I loathe bland potato salad.

Absent "Dad's Lobster Sauce," I spent some 8-10 years coming up with a potato salad that was some reasonable facsimile of what I grew up with. Much of this experimentation took place after I'd left Denmark; at least half of it after I'd moved to Texas.

In spite of occasionally battling performance anxiety, I have made my potato salad in front of dozens of people, for dozens of festive occasions. Dozens of same people have been outraged and baffled by the ingredients I use... and have let me known in no uncertain terms:

"Potato salad isn't supposed to be pink!"

"Where is the celery? Where are the mustard seeds?"

"Eeewww! You can't put YOGURT in potato salad!"

"OMG! You're putting cocktail sauce in it? Curry?"

The exclamations have been many and varied... as have the facial expressions and wrinkling of noses. As a concession to popular demand, I eventually agreed to add eggs... even though there were never eggs in potato salad, when I grew up. Eggs were for egg salad. But I kinda like them in there...

Of course, the point of this story is that 90% of the skeptics have been very surprised, once they tasted the finished product... often inspiring statements such as "Wow... I'm surprised-- this actually tasted REALLY good" and even "Will you make a huge batch of this for my next BBQ party?"

I once made a batch for 150+ people. I thought I'd made a lot. There was not even a tiny scrap left over.

I suppose the bottom line here-- which I also take to heart, myself-- is that just because something is nothing like what you're familiar with doesn't mean you won't like it.

Happy Birthday, America!