Wednesday, July 8, 2015

Healthcare in the USA

This is a collection of links around the 'net about problems with healthcare in the US.

The problems are best articulated by some of the posts by Karl Denninger.  He points out several examples where services in the US cost between 5 and 10 times what they cost in other developed countries.  Given that the patient typically has a copay for that amount, it means that if the services were being billed appropriately, one would not need insurance.  Sadly, this same model is being exported to all countries where healthcare is not socialized.

In addition to a complete lack of transparency; i.e. not knowing how much a service will cost until after the fact, there are often billing errors resulting in overcharging due to mistakes by both providers and insurance companies.  This speaks to the complexities of the whole system.  Most doctors' offices need dedicated staff to handle billing.

Sadly, despite the costs, misdiagnosis and incorrect treatments are very common.  Here's what this article says:
A follow-up study published in 2013 argued that the IOM numbers were a vast underestimate, and that medical errors contribute to the deaths of between 210,000 and 440,000 patients. At the lower bound, that's the equivalent of nearly 10 jumbo jets crashing every week — or the entire population of Birmingham, Alabama dying every year.
An interesting documentary about healthcare is Sicko by Michael Moore.  Things have only gotten worse since this documentary from 2007.  In fact, medical bills are the biggest cause of bankruptcies in the US.   Health, literally, is wealth--it is one's biggest asset, and lack of it could potentially be one's biggest liability.

Increasingly, because of the complexity of dealing with insurance companies, primary care doctors are converting to concierge services where they charge an upfront fee for all services during the year and provide a higher and easier level of access to healthcare.

Personal anecdote about cost of services

This is an excerpt of a bill I received for recent blood tests.  The total charge by the company providing services is $983.78.  This is what someone without insurance would have paid.  With insurance, the negotiated rate is discounted by $892.00.  That is a 90% discount off the list price!  Why are medical providers allowed to gouge people without insurance?  This is pretty typical of almost all services I receive whether it is doctors office visits or surgery.  It pretty much means that these prices are never actually paid because those without insurance most likely will not be able to afford to pay for these services anyway.  These are oppressive business practices and I am surprised and disillusioned to see that they are allowed to affect something as necessary as healthcare services in a country as progressive as the USA.

This also points to the shape of things to come in developing countries as insurance companies take a stronger foothold.

Billing errors

Over the last few years, I have personally witnessed a significant increase in billing errors both by doctors offices and insurance companies.  First off, the bills are extremely cryptic and it takes tremendous effort and focus to cross check between the explanation of benefits, the bills from the service provider, and reimbursements from the flexible savings account.  I have spent hours on the phone sorting out billing issues.  This is like rubbing salt on a wound -- the services are already too expensive for what is received, the insurance deductibles and co-pays are way high, and to top it off we now have to deal with billing issues going back and forth between the insurance company and the provider and undoing incorrect, automatic reimbursements from the flexible savings account.

The phone systems are typically quite bad and disconnections are very common.  Each time you dial in, you have to go through the sequence of prompts and re-verify yourself with the agent (name, SSN, address, etc.) and re-explain the whole problem from the start.

If we make any mistakes (like forgetting to pay), these corporations will come after us by sending the payments to collection and creating all kinds of legal hassles for us.  But we must simply put up with their poor service because we only have a very limited choice of providers through our employer.

If you are not already sick, you will be sick by the time you're done dealing with this!

Over marketed

Another problem with healthcare in the US is that it is over marketed.  Everything from the quality of care to the outcomes of treatment are over-exaggerated by commercials.  Many doctors choose less treatment over more when it comes time to make a choice for their own treatment because they understand the nature of over marketing.

Cost of snake bite treatment

Here's a classic case.
When dad got the bill he almost needed to go to the hospital because it was over $1 million. The exact amount $1.188 Million Dollars! 
Additional reading

Sunday, July 5, 2015

What I learned appliance shopping - Washers & Dryers


There are basically 3 types of washers.
  • Top loader: These are traditional washers with an agitator.  These are slowly being phased out in favor of high efficiency models.  They tend to use more water and they are harsh on clothes; e.g. you won't find one of these with a gentle "hand wash" setting.  (Edit: This is not true per one of the commenters below.)  On the flip side, these tend to be workhorses and some brands like SpeedQueen are known to last very long.  These usually range about 3-4 cu ft in size.
  • High efficiency top loader: These ones usually don't have an agitator.  They typically have a load sensor to determine the amount of water to be used.  The drum bobs up and down and this is how it tends to wash.  Because there's very limited movement and no agitator, many users report that they do not clean as well as traditional top loaders.  They are also very susceptible to loads making the drum go unbalanced.  When unbalanced it gets noisy.  Some machines try to "auto balance" the load which involves adding water and trying to move things around.  In this case, part of the efficiency is given up as more water is utilized in trying to rebalance, sometimes without success and requiring manual intervention.  These can go as high as 5+ cu ft in size, but users report it's hard to balance the load when the machine is filled and so it can't really be filled to capacity.
  • Front loaders:  As the name suggests, these washers have the opening on the front.  Once closed, the unit is sealed shut.  One typically cannot add clothes mid cycle.  They offer the best cleaning performance as the drum rotates using gravity to move clothes around.  While it is possible to get an unbalanced drum with this, they are relatively rare compared to HE top loaders.  Many of these come with a gentle "hand wash" setting.  The main downside with front loaders is that water can become trapped in the seals and can eventually cause mold.  Suggestions to prevent mold include leaving the door open after a wash so that it has time to dry out and using a cleaning cycle with bleach.  Additionally, some newer machines have a drum that is tilted forward (and thus water is less susceptible to stagnating) and some have a fan to blow air to speed the drying process.  Still, despite all of this some users report problems with mold.  (Mold is never an issue with top loaders.)  Additionally, since the opening for loading the machine is in the front, these machines are amenable to stacking.  Even when not stacked, their tops can be used as counter space.  These can range in size from compact (~ 2 cu ft) to full sized 5+ cu ft.  The general rule with front loaders is that you can load them up as much as possible as long as one is able to shut the door.
One of the key specifications to look for is size of the drum.  I have seen sizes from < 2 cu ft to > 5 cu ft for most home machines.  Even for size, there are 2 ratings -- there's the IEC rating and the DoE rating.  The DoE rating is typically smaller and corresponds to the actual usable size.

Sizing works different for top load machines vs front load machines.  Front load machines typically hold more laundry than a top load machine of the same size.  For example, on a recent visit to a laundromat, I found that while the top load machines were rated for a single load, their smallest front load machine was rated at 3 loads.

Sometimes washers are rated in lb.  For example, a 20 lb washer is capable of holding a load equivalent to that of two standard top loading machines with an agitator.  The 2.83 cu ft (DoE) Asko washer is advertised as handling up to 24 lb, while the smaller 2.12 cu ft (DoE) Asko washer is advertised as handling up to 18 lb.

The size of the drum does not tell the entire story.  Depending on how the machine is designed, it may or may not perform well when heavily loaded.

Features to look for when buying a washer:
  • The size of the drum.
  • The location of door hinge and if it's reversible.
  • Water and energy consumption.
  • Internal water heater.
    • When equipped with an internal water heater, washing machines can wash with significantly higher temperatures than what is possible from the home's heater, which is usually set to a lower temperature to reduce the risk of scalding.
  • Wash programs and especially programs such as hand wash.
  • Warranty.
  • For front loaders, the design of the door seal and whether it is prone to mold.
  • Whether the washer can be interrupted to add clothes after a cycle has been started.
  • Material used for construction of the drums (inner and outer) and the guides/impeller in the drum.
  • Delayed start.
    • Useful when you want a program to start running just before you get home.
  • How the unit is powered.
    • 110v, 240v, must plug into matching dryer, etc.

Dryers are a lot simpler than washers.  There are 3 basic types of dryers.
  • Vented dryer: This is the most common type and is what one would expect to find in the average US home.  As the name suggests, the dryer has to be hooked up to a vent.  Hot air is sent to the vent.
  • Condensation dryer: These units are made specifically for homes and apartments that do not have a vent.  With machines of this type, hot air is released into the room after the moisture has been removed from it.  Condensation dryers typically take a lot longer to dry the clothes, and some folks find the release of hot air into the room annoying.
  • Heat pump dryer: This is the latest technology for condensation dryers.  With dryers of this type, instead of the hot air being released into the room, the hot air recirculated back helping lower the energy consumption.
Many dryers offer the option of running on gas or electricity.  The ones that run on gas typically cost about $100 more.  But because they run on gas, and gas is typically cheaper, they can help lower the utility bills.  However, some utility companies have cheaper electricity and some homes are equipped with solar panels, so the economics starts to dull.

Perhaps the most interesting feature in a dryer is a moisture sensor.  This allows the dryer to sense the remaining moisture in the clothes and either extend or shorten the drying time.  Without a sensor, one would have to manually check if the clothes are dry, or risk "cooking" the clothes.

The matching dryer for any given washer is typically a little larger because dried clothes take up more space than wet ones.

Features to look for when buying a dryer:
  • Size of the drum.
  • Whether it has a moisture sensor.
  • The type of dryer.
  • How the dryer is powered -- gas or electric, if electric whether it is 110v or 240v.

As with refrigerators, there are the usual brands.  Most of the European brands only make compacts.
  • Asko: A Swedish brand now owned by a Slovene company called Gorenje and manufactured in Slovenia.  A cool innovation with their washers is they have figured how to build a front loader with no rubber seal in the door opening (instead there is just a small rubber seal on the door itself), making it less susceptible mold.  These are less pricey than the Miele, but more expensive than the other brands.
  • Blomberg: A German brand that is owned by Arcelik, a Turkish company, and the units are now manufactured in Turkey.  Also only make compacts.  Their prices are much lower than Miele and even Asko.
  • Bosch: A German brand, but they only make compacts.
  • Electrolux.
  • GE.
  • LG.
  • Miele: A German brand, and they only make compacts.  You buy these from a dealer, but they are delivered and installed by Miele.  The build quality is great, but they are expensive (about twice the price for half the washer).  This was Steve Jobs' preferred brand for a washer (see the discussion at the very bottom of the page).  Most people that have these like them, but at 2 cu ft, they fall in the compact category.
  • Samsung.
  • Speed Queen: These are made in US, and seem to have good reliability based on reviews.
  • Whirlpool family: These include Whirlpool, Amana, Maytag.  These are "assembled" in the US, meaning that final assembly is done in the US, but many parts are imported.

Thursday, July 2, 2015

Self help courses

In addition to things like meditation and life coaches (there seem to be an enormous number of these nowadays), I have come across several organizations that claim to be able to help one get over all sorts of problems in their life and lead more fulfilling lives.  I haven't tried any of them yet, but I'll use this post to list some of them and discuss my opinion on them.

I have only tried meditation and after a little over a decade of regular practice, I still struggle with the same issues that brought me to it--anxiety attacks and various, most likely stress-related, health issues.  Has it helped at all?  At the time I started, I was quite hopeless.  It gave me a lot of hope for a while, but the last few years have been particularly challenging and have made me question its efficacy.  I also know a number of meditators who face similar challenges and who give up meditating altogether.  But given that I was in that situation even before I started meditating, I know for sure that meditation by itself hasn't caused it or made it worse.

Back to the topic of this post, here's the list of several courses I have become aware of over the years.  My main concern with these, based on limited research on the 'net and from talking to a few folks that have participated in them, is that they tend to be cultish and often involve a lot of money and/or ongoing commitment to the program.  For these reasons, I have chosen not to participate in them.
Then there's also techniques such as the Law of Attraction popularized by the book and movie The Secret, and Abraham Hicks, and also teachers like Teal Swan.  A lot of information about these is available for free.

Decoding the VIN of a BMW

The BMW VIN Decoder page provides the list of features and options for a BMW car given its VIN.  It also provides details like the colors, where it was built, and the production date.  It goes all the way back to 1928 and includes BMW cars, BMW motorcyles, Mini, and Rolls Royce.

The Wikipedia article on VIN has information for how to quickly decode the VIN for any car, but does not provide anywhere near the detailed information that the VIN decoder above provides.