Hidden Costs

Leave a reply

One of the interesting changes we're seeing in the US is the different behavior of health care consumers when they are actually allowed to act like consumers. From the Wall Street Journal:

Last fall, two big employers embarked on a radical new approach to employee health benefits, offering workers a sum of money and allowing them to choose their health plans on an online marketplace. Now, the first results are in: Many workers were willing to choose lower-priced plans that required them to pay more out of their pockets for health care.

The new online marketplace, operated by consulting firm Aon AON -0.29% Hewitt, a unit of Aon PLC, was used by more than 100,000 employees of  SearsHoldings Corp.  SHLD -0.86%  and Darden Restaurants Inc.,  DRI +0.43% as well as Aon itself, to pick plans for 2013. The employers gave workers a set contribution to use toward health benefits, and they could opt to pay more each month to get richer plans, or choose cheaper ones that might have bigger out-of-pocket fees, such as higher deductibles.

"When people are spending their own money, they tend to be more consumeristic," said Ken Sperling, Aon Hewitt's national health exchange strategy leader.

Go figure. When people are given pricing options and asked to consciously weigh costs/benefits and risks/rewards they make "consumeristic" decisions. Forget for a moment all the details about "Obamacare" and your feelings towards it, and instead ask yourself these questions: Can any health care reform program succeed if it doesn't allow people to behave like a logical consumer? How can a logical consumer exist in a market where pricing is obscured? To that end, the next time you go to the doctor's office try this exercise: ask them what your appointment is going to cost before they do anything. They likely won't be able to tell you because they simply don't know – the cost depends on what kind of insurance you have and the rates your insurer has negotiated with the doctor's network. Craziness, huh?

Changing gears, but sticking to the hidden costs theme, have you ever wondered why we it's been so difficult for people to grasp the true costs of the wars in Afghanistan and Iraq? It's because the bill has shown up in the form of an exploding deficit and not a "War Tax." Deficits are like credit card debt: you know they're bad and that they can be a drag on your financial well being, they are hard to get overly excited about because your daily life doesn't change much until you run out of credit and the bills come due. On the other hand if you're paying cash – or a War Tax – the cost of your action is immediately clear and you're far less likely to be so sanguine about whatever you're doing. 

So here's a rule of thumb we need to teach our children: if the cost of something is hidden, or if you aren't asked to pay for it up front, it is likely much higher than you think so you should really think hard before making that purchase decision. There should also be a corollary: if it's a politician doing the selling then you should probably just walk away or be ready to spend 100x whatever you think the cost is (see War, Iraq).

Health Care Frustration

Leave a reply

The video below was emailed to me by my mother. It offers up a vision of the health care industry being revolutionized by information technology. Hopefully that vision will be realized, but pardon me if I'm skeptical. As I told my mom in reply to her email, I can remember being a member of the Kaiser Permanente HMO in the DC area twenty years ago. They had an integrated computer network that allowed me or any member of my family to walk into any one of their centers and have our records accessed immediately by a doctor or nurse. No carting charts from one doctor to another! This, I thought, was the very near future of medicine. Twenty years later it still hasn't happened for the most part and I remain skeptical that the vested interests in health care will allow the changes needed to improve health care delivery in this country.

After watching this piece I truly hope I'm being overly pessimistic:

Blogageddon

Leave a reply

In the span of 18 hours I learned that my RSS manager of choice, Google Reader, is going dark as of July 1, 2013 and that the Godfather of Blogging in the Triad is shutting down his blog for a while.  I understand Ed's motivation – I long ago morphed into a leisurely poster here because I just didn't have the time or energy to manage an ongoing dialogue like he has for 12 years – but I'm still really bummed to see him pull the plug. It will be interesting to see if anything fills the online void in Greensboro.

A serious hat tip to Ed for providing a valuable online forum for the Greensboro community. I hope he enjoys the peace and quiet.

International Bank of Bob

1 Reply

If you want to buy me a book I'd like to recommend it be this one:

Hired by ForbesTraveler.com to review some of the most luxurious accommodations on Earth, and then inspired by a chance encounter in Dubai with the impoverished workers whose backbreaking jobs create such opulence, Bob Harris had an epiphany: He would turn his own good fortune into an effort to make lives like theirs better. Bob found his way to Kiva.org, the leading portal through which individuals make microloans all over the world: for as little as $25-50, businesses are financed and people are uplifted. Astonishingly, the repayment rate was nearly 99%, so he re-loaned the money to others over and over again. After making hundreds of microloans online, Bob wanted to see the results first-hand, and in The International Bank of Bob he travels from Peru and Bosnia to Rwanda and Cambodia, introducing us to some of the most inspiring and enterprising people we've ever met, while illuminating day-to-day life-political and emotional-in much of the world that Americans never see. Told with humor and compassion, The International Bank of Bob brings the world to our doorstep, and makes clear that each of us can, actually, make it better.

You can read an excerpt at Boing Boing.

I’ll See Your Bible and Raise You a Torah

Leave a reply

There's a proposed bill in the NC senate (SB 138) that would allow local school boards to offer elective courses in Bible study at their high schools.  This would probably cause some consternation with folks who see this kind of thing as violating the separation of church and state, but quite honestly if it's an elective that seems to be a bit of a stretch. On the other hand it does seem to put the state in the position of favoring one religion over others since it doesn't include other religious texts like the Torah or the Koran.

If the intent of the course is not to indoctrinate students but to study how the the Bible has influenced society then it could be seen as a legitimate educational effort rather than an effort to indoctrinate non-religious or non-Christian students.  And if that's the case then why not write the bill so that school's could offer similar courses to study the Torah, the Koran or other religious texts that have obviously had a tremendous impact on our world? 

Perhaps it would be helpful to look at the text of the bill to see if we can discern the intent. Here it is:

A BILL TO BE ENTITLED
2 AN ACT TO PROVIDE FOR LOCAL BOARDS OF EDUCATION TO OFFER TO 
3 STUDENTS IN GRADES NINE THROUGH TWELVE AN ELECTIVE COURSE IN
4 BIBLE STUDY.
5 The General Assembly of North Carolina enacts:
6 SECTION 1. G.S. 115C-81 is amended by adding a new subsection to read:
7 "(g4) Bible Study Elective. – Local boards of education may offer to students in grades 
8 nine through 12 elective courses for credit on the Hebrew scriptures (Old Testament), the New 
9 Testament, or a combination of the two subject matters. A student shall not be required to use a 
10 specific translation as the sole text of the Hebrew scriptures or New Testament and may use as 
11 the basic textbook a different translation of the Hebrew scriptures or New Testament approved 
12 by the local board of education or the principal of the student's school. A course offered by a 
13 local board of education in accordance with this subsection shall (i) follow federal and State 
14 law in maintaining religious neutrality and accommodating the diverse religious views, 
15 traditions, and perspectives of the students of the local school administrative unit and (ii) not 
16 endorse, favor or promote, or disfavor or show hostility toward any particular religion, 
17 nonreligious faith, or religious perspective. Courses may include the following instruction:
18 (1) Knowledge of biblical content, characters, poetry, and narratives that are 
19 prerequisites to understanding contemporary society and culture, including 
20 literature, art, music, mores, oratories, and public policies.
21 (2) Familiarity with the contents, history, style, structure, and societal influence 
22 of the Hebrew scriptures or the New Testament."
23 SECTION 2. This act is effective when it becomes law and applies beginning with 
24 the 2013-2014 school year.

At first blush it seems innocuous enough, but you still have to ask why other prominent religious texts aren't included.  By not including them it's easy to see how people would assume the underlying intent is to introduce Christianity to the public schools, and as mentioned before it definitely seems to put the state in the position of favoring one religion over another.

Let's end with a fun scenario game:

  1. Bill becomes law.
  2. School district decides to offer Bible elective at its high schools.
  3. Two-thirds of the way through the course a teacher, who's a Baptist, goes out on maternity leave and the replacement teacher is a Mormon.
  4. Parents of several students demand either a different teacher be assigned to the course or that their children be allowed to transfer out of the class without penalty. Their argument is that they don't want their children being fed "lies" by that "cultist."

Wouldn't it be fun to be a fly on the wall of the principal's office that day.
Related articles

Bill would create Bible study elective for high schools