Healthcare Costs Out of Control — My Simple Solution

Back at the beginning of February, my son sliced his finger with a linoleum carving tool in Art. Here’s a sketch he did of it later:

Alex Cut Sketch

I picked him up and took him to the ER at a local hospital. The cut required four stitches. I was reviewing the claims for this on line and noticed that the hospital tried to charge my insurance company $362 for “Misc Services” and the doctor staffing the ER charged $898 for “Op Services” and “Surgery.” I’m supposed to pay a $150 deductible for ER visits. My insurance company reduced the hospital charge to $139 and had me pay it as my deductible. They paid the $898 charge to the doctor without reduction.

The primary motivation of my call was to determine why I had to pay the $139 (which turned out to be the lesser of the allowable charge and $150 deductible). I was also amazed that getting four stitches costs $900. That’s outrageous. That’s $225 per stitch! So the total cost associated with taking my son to ER to get 4 stitches in his finger was $1037!!!

Granted, I only paid $139 but I realize there’s no free lunch. All I have to do is look at what we’re paying through my wife’s employer for health insurance — $421/month to cover a family of four. I know from my former employer that the total cost of my health insurance was over $1300 a month to cover a family of four. These costs are out of control and unjustified. There have to be other factors at work here.

One that I can easily point to is ER treatment of illegal aliens for non-emergency care. Unfortunately, I’ve been to the ER three times in the past 18 months. Every time, a majority of the people waiting were spanish-only speaking brown skinned people with sick babies. I didn’t ask for papers, but it’s not a huge leap to infer that the majority of them were, in fact, illegal. Illegal aliens don’t pay payroll taxes (they present an strong argument for consumption based taxes, actually). In fact, I see the whole illegal immigration issue as a ridiculous subsidy for certain industries. They get cheap, exploitable labor at very low cost while all the rest of us foot the bill for social services that the employer should be paying for. I’ve always been puzzled by “liberals” that support illegal immigration. They are on the wrong side of this from the “I-hate-the-evil-corporations” standpoint. In fact, they really like cheap landscaping services, maid, and nanny services.

Another problem I can easily identify is other people (legal aliens, and citizens) opting out of paying for the health care system while at the same time relying on it via ER care. If you don’t have access to health care via an employer, it’s very expensive. So people who are on the edge (and even some rich, greedy folks), so to speak, just decide not to pay for health insurance, even though they will have access to it via emergency care. This should be addressed with a catastrophic health care payroll tax. Illegal immigrants and people who voluntarily or involuntarily “opt-out” of paying for their healthcare should not be allowed to be free-loaders (in the classical enconomic) sense any more. This is a clear tradgedy of the commons situation and needs to be addressed with federal intervention.

Another major problem is the whole “employer-provided” health care concept. People don’t see how much they are actually paying for health insurance. People also don’t see how much health care providers charge for services. Sure, you get explanation of benefits, but who really reads those? I know I don’t most of the time. People with health insurance just don’t have an incentive to keep costs down because they are shielded from those costs. The other big problem with this system is that insurance providers just have to sell corporate execs, they don’t have to provide good service. If you want health insurance, it’s almost always cheapest to get it through your employer — especially since it’s not tax deductible if you buy it yourself. So if you don’t like the service you get, it’s tough shit for you and the insurance companies know it.

My solution to these problems is very simple and requires only three things.

The first is the simplest. Make all healthcare expenses tax deductible for everyone, not just corporations. Why we put a 7.5% AGI minimum on deductible health care expenses is a mystery to me. There are Flexible Spending Accounts, but these are really just a bone thrown to plan administrators (insurance companies). Why do I need to commit a certain amount of dollars up front? Why should I have to try and guess what my medical expenses for the year will be and why shouldn’t the money roll over if I don’t spend it all? FSAs as currently structured are a joke. Just make all healthcare expenses tax deductible. Simple and effective with no corporate welfare thrown in.

Second, a new federal payroll tax that would fund catastrophic health care policies for all. If you have a job, you will pay this tax. You will pay it no matter how much you make and it will be the same rate for all people. I’m a firm believer in everyone paying some taxes no matter how little they make. Everyone that earns income (no matter how small) should have a stake in how the government spends tax money. The government will set minimum policy requirements and allow private insurers to offer policies. Each taxpayer will be able to select their policy of choice each year.

Third, lock-down the border and implement a real guest worker/immigration program. By lock down the border, I mean do whatever it takes to shut it down. If they have to build a fence and man it with machine gun-toting guards, fine. I’m tired of hearing how this is impossible and will cost too much. It’s quite possible and wouldn’t cost much at all. Do the math yourself and then compare your computed costs to the national budget. Now compare them to the cost of social services, education, and health care for those workers. Yes, you see it really is possible and not that expensive.

Now, by real guest work/immigration program I mean allow millions of people to work/immigrate/apply for citizenship a year. If there’s demand for 10 million cheap laborers, then do the paperwork and get 10 million cheap laborers here legally. I’m even for a path to citizenship. See, I’m not a racist. So don’t pull that tired argument out. I’m for law and order. I’m for screening out people with criminal backgrounds or contagious diseases. I’m for creating a non-exploitive environment for “undocumented workers” that isn’t a huge corporate subsidy. And notice that I’m not even mentioning terrorism here. This is a simple dollars and sense issue with the bonus of creating a less exploitive environment for manual laborers.

The sad thing is, I know I’m not the smartest person in the world. Not even close. In fact, I’m sure many of the people running for various offices, including the presidency could think of all this themselves. I’m sure they have. You could tweak the details of my plan to make it look more “liberal” or “conservative.” But the fundamentals are sound and plainly visible to anyone that looks at this problem with some care. We are paralyzed on this issue because of the special interests that would be hurt by this plan, namely health insurance companies, health care providers, corporations exploiting cheap labor, and hypoctritical, racist latino groups that promote illegal immigration to grow their power base.

What’s That Funny Smell — Helper and Util?!?

I’ve been coding a long time and something I’ve come to realize over the last several years is that if you can’t come up with a good name for the class you’re working on, you probably have an outstanding design issue that you aren’t aware of yet. If your class includes the phrase “helper” or “util” then you need to come up with a better name. If you can’t, you’ve got a problem or you’re not really doing OOD. I’ve encountered a lot of designs filled with “Helpers” and “Utils.” I’m even guilty of writing a few in the past. But I urge you, for the sake of fellow coders everywhere, to come up with a better name and/or better design. “Helper” and “Util” don’t really tell me anything about your class other than it’s very likely to exhibit low cohesion.

If you’re writing Helpers and Utils, I bet they’re filled with static methods too. ARG!! Static methods can’t be part of interfaces which means you’ve tightly coupled yourself to a specific class, not an interface. As a result, you can’t easily write unit tests nor can you substitute a differnet implementation without renaming classes. All ugly, very ugly!!! I implore you to stop writing static methods. Object creation is highly optimized nowadays. New X().Method() is likely to be almost as (if not as) fast as X.Method(). Not that you’d really want to use that, but I’m just trying to ease you away from the static members. You will want to inject an instance of X somewhere in your run-time object hierarchy.

Google Disappoints Again

I’ve written on this topic before — Google’s first link continually disappoints me. I predict that they will either buy another company that has better search technology than they do or they will lose the lead in search in the next 5 years. I hope Wikia can do for search what they did for encyclopedias.

Today, because I was getting bad results searching on standard poodle grooming I thought I would look for a search engine that actually allowed users to rate the results. You can imagine my disappointment when I got as the top result for the phrase “search engine rates links.” I’m happy that gays and lesbians have a wonderful site like this. However, I am quite perplexed as to how its the top result for the phrase “search engine rates links.”

I am planning on writing an article on my recent purchase and use of Verizon’s kickass wireless broadband service so I typed in “wireless broadband” and the first link is Welcome to Google TiSP. Google, you are really trying my patience here!!! WTF is that?

Every time I write about this, I become more inclined to think that Google has “jumped the shark” so to speak. C’mon Google, focus on your core business, search. You really do need to make search better or someone else is going to unseat you just as quickly as you became the king of search yourself.

I do have to admit that it is somewhat ironic and hypocritical that I tried using Google to search for a better search engine.

P.S. 02/20/2008: I’m not the only one that thinks Google is losing it.

P.S.S. 03/26/2008: Well, I guess someone at Google is reading my blog. :) If you follow the links above to Google, you’ll find that the Gay Website is no longer the top link. In fact, it’s no longer on the first page. And Verizon is now the first link returned instead of Google’s TiSP (whatever that is).

Wireless Hell

I’m sure being a doctor is even more annoying, but as the tech geek, I am always being called to solve all my friend’s and family’s techical problems. A buddy of mine recently changed jobs and had a new laptop. He’d had wireless working flawlessly at his house with the old laptop (with my help, of course) for the past year or so. Now, he has a new laptop and he expected to be able to just type in the passkey and things would work. No such luck.

Why does every wireless hardware vendor think the world wants to use thier, custom, oh-so-much-better wireless management module (or whatever the hell it is). Even if theirs worked perfectly (which was not the case), is it really any better than the one that comes with Windows? Even if it was better, I don’t want to learn the ideosyncrancies of their implementation. If things are working, the user hopefully will never see that piece of software again. So when they do, why the hell should it look and feel completely different for every damned wireless vendor? Wirelss isn’t new anymore! I didn’t have to use a different, vendor specific window (at least not for the last 10 years) to set up my wired lan cards. Why the hell do these vendors think I want to for my wireless card?

Resharper 3.x is Buggy as Hell

I was a huge resharper fan…until I installed 3.x. I have experienced nothing but bugs. The little bug/feedback box pops up 5 times a day on average. I have to delete all the resharper files to get the arrow keys working in one of my projects. I’ve submitted numerous bug reports and even gone to the trouble of providing screenshots and bug-demoing projects. None of them have been addressed yet.

I have read a lot of positive posts about 3.x but I really find it hard to believe that I’m the only one out there having these problems. So, as unpopular is it may make me, I’m making this post giving Resharper 3.x a big thumbs down.

P.S. I recently installed 3.0.3 build 3.0.520.30 and things are working much better.

Why Are Code Snippets XML?

Today I was going to write my first code snippet. I was tired of writing out the null argument check code in constructors. I figured it would be as easy as just taking some working code, replacing the variable name with a variable, and saving this somewhere. When I open the help….which takes forever and defaults to going on-line which makes me wish I had just googled what I was interested in except that the first link would probably have been a site wanting me to register before showing me the answer…I see that code snippets are effing XML. WHYYYYYY????? If there was ever a case of the misuse of XML to overcomplicate and obfuscate something simple. So my simple little code snippet which should have been something like:

if ($variableName == null)
throw new ArgumentNullException(“$variableName”);

Is this ridiculous XML monstrosity which I won’t even bother to list. It has the big long namespace and the oh-so-familiar overly verbose XML layout that completely sucks for authoring a code snippet. The XML is such a tedious pain in the ass I’m not even going to bother to create the snippet. Instead I spent the time posting this rant. :)

Why is Google’s Stock Price So High?

I am continually amazed at how bad the first link returned by Google is. It seems like it’s getting worse by the day. I searched on this phrase: “selectively copying table data using ssis.” The best Google could do is return a link showing a discussion group post where someone asked how to transfer data WITHOUT using SSIS. Thanks Google. Share price currently $510 and you return the opposite of what I ask for as the top link. You might want to put some of those talented people you keep hiring back on search.

P.S. (10/31/2007): Now at $700.