Like a Virus In a Good Way

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I read the lead story in today’s Winston-Salem Journal with great interest.  You see it’s about the folks at King Moravian Church putting together a "Mission Blitz" and what’s really cool is that the idea came from their youth group.  From the article:

King Moravian had its first mission blitz last year. Volunteers from
the church worked on 10 homes around the county that needed everything
from new roofs to wheelchair ramps.

The Rev. Jim Newsom, the church’s pastor, said that young people in
the church gave older church members the idea for the program after
they had undertaken home-improvement projects in Ashe and Alleghany
counties through Laurel Ridge, a Moravian Church camp in Laurel Springs.

"(Our) church said, ‘What if we did a Stokes County mission camp?’" Newsom said.

Word of last year’s effort spread, and this year eight other local
churches signed on to help, including Methodists, Baptists and
Episcopalians.

My kids have done the mission camp at Laurel Ridge with their youth group for the last few years and every year they come back with great stories and a better sense of the world around them.  They also see how rewarding it is to do things that aren’t totally self-centered.

There’s a little family pride involved here since my Dad’s sister Debbie helped start the mission camp program at Laurel Ridge and ran it until last year.  I’m sure she’ll be thrilled to see that the Mission Camp concept has been taken home by some of the participants and is spreading like a virus, in a good way.

If you’re interested in the Laurel Ridge Mission Camps here’s the website.

Pricing Your Medical Care

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Due to changes in our health care system a growing number of us will be responsible for paying our medical bills directly.  Whether it’s because you don’t have insurance, or you have a high-deductible plan like my family has, you will be paying the doctors, hospitals and labs directly for their services.  Thus it stands to reason that you’ll want to know how much something costs and if it can be had cheaper somewhere else.  Well, good luck finding the information you want.

Yesterday I posted about my wife’s $1,900 MRI scan which was done on her shoulder in August.  I’ve gotten a couple of comments on that post plus some email sent to me directly that provide a few anecdotes from people who have dealt with similar situations.  The most interesting comment came from Mona Lori who dealt with a very similar situation to ours and decided to do some research into the cost of an MRI. She shares the results of her research in this report and what she found was a HUGE disparity between different providers for the same procedure, an MRI scan of a knee.  She found that one provider in Milwaukee would do the scan for $600 while another in New Hampshire charged $3,500.  At that discrepancy it would make sense to fly to Milwaukee to have the scan done because even with the cost of the airfare and cab ride you’d be saving a couple of thousand dollars.

Mona decided to do something about this and started a web service called OutOfPocket.com where people can share what they paid for services at various providers.  Of course that means you can also search to see what people paid for procedures at different places as well.  If enough people share their data there will soon be a rich database of prices for procedures which should lead to more informed shopping and hopefully lower prices as providers begin to lose their monopoly over the health service pricing information. Let’s put it this way, if I know that an MRI will cost $1,900 at one facility and $1,000 at another which do you think I’m going to use?  If those numbers become public and easily accessible how long do you think it will take the vast majority of people to shift their business from the more expensive facility to the less expensive one, and then how long would it take the more expensive facility to lower its prices?

A point I’d like to make is that most people think the cost of health care is equivalent to the cost of seeing their doctors.  Honestly the doctor’s costs is less than the x-rays, MRIs, lab tests or drugs.  In other words the parts often cost more than the labor, so if you want to reduce your health care costs you might want to start with the parts.  After all, whether or not a doctor is good is a highly subjective measure.  A doctor might be brilliant, but a real jerk that makes you feel horrible.  Is he still a good doctor, and is he worth paying three times more than the guy who didn’t graduate from Harvard Medical School but is still really good at what he does and also happens to be a really nice person who makes you feel good about yourself?  On the other hand an MRI, is an MRI, is an MRI.  Why pay triple for the exact same thing?

If you have information to share please use OutOfPocket.com or any other health pricing service you know of to share it.  Until the providers are forced to offer pricing up front in an easily accessible manner it’s the best way for us to control our health care expenses.

What’s in Your PageRank?

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Anyone who’s worked on websites spends at least a little bit of time wondering how they got earned their Google PageRank.  In fact Steve Rubel thinks that PageRank is uber-important:

There are three reasons why Google Page Rank rules.

1) Page Rank is something you earn by producing high quality content that people link to – or what John Bell describes as socially connected

2) It enables you to influence people on the Internet’s biggest
stage – Google – and just as people are searching for the topics you
are knowledgeable about. This means it amplifies your influence because
the press start at search engines when researching stories

3) Finally, Page Rank is channel agnostic and takes the entire
online ecosystem into account. It judges you based on links from all
kinds of sources, not just people who live in the same fish tank. In
other words, it goes beyond people who hang out on Twitter who love
people who Tweet or bloggers who link to other bloggers, etc. It
eschews the echo chamber

PageRank takes time to earn. There are no shortcuts. Google is
democratic and rewards professionals and amateurs equally if they do
their job well. Create high quality content that earns links from other
quality sources and, over time, your Google Page Rank grows as does
your influence and responsibility.

Here’s the thing, though.  I actually have two PageRanks for this blog’s home "page".  You see I host this blog on a service called Typepad and there are two addresses you could type into your browser and reach my blog: http://www.jonlowder.com and http://practicalinc.typepad.com/jon.  If you type in the first version my PageRank shows up as a "2 of 10" but if you type in the second one I’m a "5 of 10."  Exact same content, just different URL.  Essentially when someone types http://www.jonlowder.com they get forwarded to the second address, so really you end up in the same place (I think) but it’s interesting to me that they would have different PageRanks.  If some smart person could explain the difference I’d sure appreciate it.

An MRI from Wake Forest? $1,900

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I’m going to give you fair warning that the language of this post might get a little strong.  I can’t promise that I’ll control my fingers because I’m just a little pissed.  Here’s the story.

In August Celeste hurt her shoulder.  It got to the point that she couldn’t raise her arm past shoulder level without experiencing severe pain, and she couldn’t sleep comfortably because whenever she moved she experienced sharp pain radiating from the shoulder.  Eventually she scheduled and appointment to see a doctor for an examination.  He checked her out and thought maybe she’d torn her rotator cuff, but since he couldn’t be sure he ordered an MRI, which she had done late in the evening on August 25th.  The MRI came back negative so the doctor suspects that the rotator cuff is strained and that the because the shoulder is a complex joint that depends on all the non-bone stuff (my technical term) to keep the bones in place.  His thinking is that the strain has caused the ball to be pulled back into the socket and it is "catching" when she tries to raise her arm.  The prescription?  Physical therapy.  So Celeste and I went to Comp Rehab for one session where we were taught all the exercises, and she’s been doing all the exercises at home and making pretty good progress.

Here’s where it gets good.  Our insurance company informed us that the MRI wasn’t medically necessary.  That means that we’re paying it 100% out of pocket, which we would anyway since we have a high deductible policy tied to a Health Savings Account (HSA), but now it won’t count towards our annual deductible.  Then we get the notice from Wake Forest University Baptist Medical Center that our bill for the 1/2 hour MRI is $1,900.  What the hell?!

So here’s what kills me about this.  First, the medical necessity thing.  If Celeste hadn’t had the MRI the doctor would probably have ended up doing surgery.  At a minimum she would have had to have seen the doctor several more times in order to gauge what was going on with the shoulder, figure out a course of treatment, etc.  Even then he would not have been sure of his diagnosis and if she didn’t recover rapidly she’d end up under the knife.  As it is the rehab is taking time and without knowing for sure what’s going on with the shoulder Celeste and the doctor probably would have looked at alternatives by this point.  In other words it would have been much less efficient and much more costly to treat than the MRI was.  We’re going to appeal the BCBS decision, but I don’t think it will do us any good.

Second, no one ever told us what the MRI would cost.  The doctor ordered it and we went. Now, part of the theory behind HSAs is that since we are responsible for paying the bills directly we’ll help keep costs low because if something is too expensive we’ll squawk or go to a competitor.  Well, it’s kind of hard to do when no one tells you what it will cost.  There’s no price transparency!  Also, no one told us what our options were, if any, for alternative places to have the MRI done.  I’m willing to take some responsibility here.  We probably should have asked ahead of time if there were other places to do the MRI, what the MRI would cost, etc.  Unfortunately we’re still conditioned by our lifetime of working within a health care system that traditionally kept the decisions in the hands of the doctors and insurers.

Still, even with me acknowledging that maybe we should have been more diligent consumers I want to know what other business out there provides a service without telling you the price up front?  I guess there’s auto repair shops, but often they don’t know what the problem with the car is until they look at it and then they usually call you to tell you what the financial damage will be before they start to work.  With an MRI they know up front what it costs them to administer the test so why not publish their pricing?  Could it be that they have different rates for different people?  If you’re uninsured it’s one rate, but if you’re insured it’s another?  Could it be that maybe there’d be a mass revolt if everyone knew that an MRI process that takes 1/2 hour costs more than most peoples’ monthly rent?

Compare this to our experience at the dentist.  They always check with us before doing a procedure, and the pricing is readily available.  They understand that we may not deem teeth whitening to be worth $75, so they make their recommendation, tell us the price and then let us decide.  In the end they may not sell that one procedure, but they keep us happy and thus keep all five of us in their chairs.

I can tell you right now that if there’s another instance where one of us needs something done medically we will be much more active shoppers.  I’m not saying we’ll necessarily move away from Wake Forest, but if there’s a better alternative out there we’re going to take it.  Of course pricing isn’t the only consideration, but it is one of them.  Trust is another, and if they can’t provide pricing up front then they’ll probably lose us because I can’t trust someone who won’t level with me about the terms of our relationship. 

To reiterate, I don’t know if Wake Forest provides pricing up front or not because we didn’t ask, but the fact that we do have to ask in the first place tells me that the health industry isn’t yet ready for the "free market" that is represented by health plans like our HSA.

Last point: is there any question that our health care system needs fixing when you consider that one simple MRI costs $1,900?  Yes it’s an expensive machine and yes you have to pay a technician to operate it and maintain it, but if you do the math you realize that this is way out of whack.  If they charge that rate to everyone, average two scans an hour for twelve hours a day and work 365 days a year they are grossing over $16.5 million per year for that machine’s use.  Even if you cut that back to one scan per hour that’s $8.3 million per year.  Let’s say a new machine costs $2 million and lasts 10 years, that means that the machine averages $200,000/year for acquisition.  Then let’s assume that it costs $2 million a year to maintain and operate it, a number I think is high, then you have $2.2 million annual cost.  That means that the profit on the operation of the machine can be comfortably guesstimated at a minimum of 300-400%.  Feel free to correct me if I’m wrong, but my gut says this is highway robbery.

Oh, and Wake Forest University Baptist Medical Center is a "nonprofit."

Money Pit Strikes Again

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As I’ve documented extensively here our house is an absolute money pit.  I must have written over 20 times about the travails of owning this heap, but it seems that it’s the gift that keeps on giving.

My most recent post was about our bathroom reclamation projects.  Well, Celeste and I decided that we could handle putting the new linoleum in the kids bathroom as well as replacing the sink and cabinets.  On Sunday we went to Lowes and picked up the necessary materials and on Monday we tore out the old cabinets, sink and toilet.  We got busy with normal work/family stuff and put things on hold, and then Tuesday night I drove to Charleston, SC for business.  I drove home last night through four hours of rain, surviving the maniacal drivers on I-77 near Charlotte, and walked into what can best be described as a crap-storm.

Celeste had been working to tear up the luan and was visibly upset.  It had become apparent to her that there were problems with the sub-floor that were probably going to be beyond our means and she wasn’t happy.  I helped her tear up the remainder of the luan and I quickly came to agree with her assessment.  She had called Greg Hester, the miracle worker who’s saved our house on numerous occasions, and luckily he called her back just as things seemed darkest.  He was already planning to send one of his guys out to do the finish work around the bathroom and when he heard Celeste’s voice he simply said his guy would do whatever needed to be done to get us set up.

This morning Jeff, who’s been here enough this year that we’re thinking of adopting him as an honorary Lowder, showed up and looked at the floor, particularly where the toilet had been.  He went down to the basement to look at it from underneath and when he poked the floor from below with his screwdriver it went straight through the inch of wood.  Just a little water damage!

I started thinking about the scene in Money Pit that Keith pointed to in the comments on my last post and now pasted below, and then imagined someone taking a squat on our toilet and finding themselves sprawled in the basement wondering what they’d eaten that day that would cause a toilet to explode through the floor.  I’ve used that facility on a number of occasions and now consider myself very lucky not to have plummeted 10 feet to an unceremonious landing and porcelain embedded in my hind end.  I’m very, very close to breaking into the uncontrolled, hysterical, laughter exhibited by Tom Hanks in the movie.

FYI, if you ever have a home improvement project that needs doing just contact Greg Hester.  The work is excellent, he and his guys are reliable, and they come through in a pinch.  If you want his number just give me a shout.

Things Grandma Didn’t Have to Fret

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I’m thinking of starting a new category on this blog called "Things Grandma Didn’t Have to Fret" that will feature news items that, quite simply, couldn’t exist two generations ago.  Case in point, one man impregnating 30 lesbians in Australia without ever meeting them, which in turn is leading to concerns over inadvertent incest.  FoxNews explains:

One of South Australia’s
foremost experts in reproductive technology – Andrew Dutney – said that
in one reported case, about 30 lesbians were impregnated by sperm from
one man, the Advertiser reported.

The
mothers then organised picnics with all the children, raising the fear
they might socialise with their half-siblings without realising they
were related.

In another case, a man’s sperm was used to produce 29 children, most of whom were living in Adelaide.

They
did not know who their half-siblings are, raising concerns that in a
"big country town" like Adelaide, they could accidentally commit incest.

Eek.

Imagine if time travel was possible and someone who lived in the first half of the 20th century were to land on this day and read that story.

Silver Lining

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Just got my quarterly IRA statement. Gak! I’ve been reading that I’m a sucker because I bought and am now holding.  Well, I guess I’m just not a financial playa’.  The flip side of all this financial turmoil is that I now understand much more about the financial system than I ever did before.  Impending doom does do wonders for one’s focus after all.

I was talking to someone close to me, who shall remain nameless to protect his or her privacy, and I was telling him/her that I remembered a few years back when he/she got a LIBOR+margin, interest only loan for his/her house and at the time I had no idea what he/she was talking about.  I misheard "lie-bore" as "lay-bore" and so was befuddled at how my corporate-honcho acquaintance had finagled a loan out of the hated unions.  Well, now I know what the LIBOR is and how cool a loan that really was at the time.  I also mistakenly thought my acquaintance had refinanced with a more traditional loan since then, but was quickly set straight during our chat.  It seems that the loan is very much in place and resets every six months, and in fact just reset on September 30.  The conversation included a "funny if it isn’t your money" story about my acquaintance eating soup at a business lunch a couple of weeks back when someone checked their Blackberry and said, "Holy sh– the LIBOR just went up 7 points" at which point the soup was almost jettisoned.  Luckily the LIBOR dipped again before the reset on September 30 so the rate is at a respectably dismal level until at least April.  Still, the monthly payments on that loan have more than tripled since it was taken out.  At least it’s still affordable for him/her, which some people can’t say.

So I guess you could say that the silver lining of this whole meltdown is that I now know what mortgage backed securities are, what hedge funds are (kind of), what credit default swaps do and, yes, what LIBOR stands for.  Of course that’s kind of like knowing the number of the train that’s about to run you over.

Voter Info from Google

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Want to know if you’re registered to vote?  Want to know what Congressional district you’re in?  Google has mashed up voter data with Google Maps so that all you have to do is enter your address and it will provide you with links to sites that can provide you with all the info you need.  Here’s the Google Maps site.  I plugged in my address and here’s what came back:

Registration Info
State: North Carolina
Days left to register by mail: 5
Registration must be postmarked by:
Friday, October 10
Get information about voting in your state:
North Carolina voter hotline: 1-866-522-4723
Coming
soon! Voting location information will be available by mid-October.
Until then, please check with your state or local election officials to
verify your voting location.

Pretty cool.

WTF Wall Street?

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Those who have been skeptical of the big bailout, or The Splurge as some call it, had more reasons to be skeptical than they thought.  Congress puts us on the hook for a bazillion bucks and the schmucks on Wall Street may say, "Thanks, but no thanks."  From The Guardian:

Last Monday, after the bill was thrown out by the House of
Representatives, more than $1 trillion was wiped off the value of US
stocks as the market was gripped by panic. The bill was passed on
Friday afternoon, however, after the inclusion of $149bn of tax breaks
and strict rules for participating banks.

But Wall Street analysts, believe the addition of so many terms to the bill might deter potential participants.

One
of the least attractive elements is a section designed to curb
executive pay at banks that participate in the bail-out package. These
include limiting stock-related pay and banning ‘golden parachutes’ for
executives.

‘I think this hodge-podge of regulations and rules
will be enough to put many [chief executives] off participating,’
Caldwell said.

Sources close to Goldman Sachs and Merrill Lynch
indicated the banks might choose not to participate in the bail-out as
there is a growing view on Wall Street that the market may be bottoming
out.

Analysts also believe that the mere presence of the government as buyer
of last resort will be enough to get credit markets moving again, and
that a large number of banks would not need to take part for the
legislation to succeed.

In other words there’s the possibility that the pinstripe and wing tip set might find their balls and actually figure out a solution to the "impending financial doom" if their gilded lifestyle is seriously threatened.  Am I the only one who fantasizes about seeing these goobers seated around Al Capone’s conference table like in The Untouchables?  Forget taking away golden parachutes, let’s start playing baseball with these jerks.

Ringing off the Hook

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The robo-calls hit a fever pitch this weekend.  At last count we’d received six calls on Saturday, but I might have missed some since we have standing orders with the kids to erase all political messages before the message is done playing.  We heard from Republicans and Democrats, but unfortunately we didn’t hear from the candidates themselves.  The Republicans had a sultry sounding woman call us, but since she didn’t end her sentences with the "ya" sound I’m assuming it wasn’t Sarah Palin.  We had two chances to try and figure it out, though, because we heard from the Republicans in both North Carolina and Virginia.  It was awful nice of the Virginia Republicans to call us, but as residents of North Carolina I’m not sure what we can do for them in their "crucial battleground state." 

We also heard from T. Boone Pickens.  Something about his energy doo-dad, but he lost us after his first sentence and he was promptly deleted.  Maybe he’ll call back.  Actually I’m pretty sure he will since we’re one of the seven households in Forsyth County that still has a land line.  If this keeps up we might finally have our impetus to finally dump the wire.

November can’t come soon enough.