Transparent pricing is literally the least we can do to improve US health care

There are very few actions or aims of the current administration of the United States Executive Branch with which I agree, but one such rare alignment won a legal victory this week when Judge Carl J. Nichols ruled against the insurance-dominated medical establishment in favor of American patients.

The U.S. District Court ruling agrees with the White House that it is reasonable to force medical service providers to publish a full accounting of negotiated prices for their services. Disclosing the price a patient would pay if s/he elects to pay cash will also be required.

Insurers say their negotiated prices are their own secret treasures to share with providers, and that we—the consumers, the patients, the worried loved ones—don’t deserve to know what they are. I say that insurers offer so little value relative to the enormous fees paid to them that their wishes are irrelevant and a distraction from the goal of almost all Americans to have better health care with fewer going bankrupt to pay for it.

I believe that the administration of the U.S. medical care system could be improved in almost every way. That said, cost transparency requires no bipartisan agreements on contentious issues such as rationing of care or how much in dollars a government owes each citizen in the provision of health care.

Price transparency will cost almost nothing save a few hours of administrative work by hospital staff. Typing up and publishing these lists will take a minuscule fraction of the labor hours currently spent on insurance billing. In exchange, and, for the first time in decades, cost-conscious consumers of health care—the ill, the injured, the infirm—will have at least a passing chance to vote with the pocketbook by taking business to more efficient providers. Continue reading

Evangelical Christians trample my religious freedom by applying their convictions to all in the abortion debate

The abortion debate in America is a contentious one that I have no interest in rehashing here. While I have many thoughts and opinions on the issue, most of them fall outside of the kind of rational discussion I prefer to instigate on my little site dedicated to the wonderful as opposed to the profane.

Something I cannot ignore of late are the actions of multiple states—tellingly, states which tend to be poorer than the U.S. average with a markedly less educated populace—as they defy the moderate will of the majority of American citizens and the affirmed constitutional right of individual Americans to follow their own faiths and consciences with regard to abortion procedures.

Activists at the extreme of both sides pervert this complex and morally fraught issue by ignoring subtleties and braying out absolutes and ultimatums. I reject those dangerous simplifications from both the right and left. Most Americans believe that some abortions should be safe and legal. Less than half of Americans support either a total ban or the complete freedom to terminate any pregnancy.

In particular, as a Jewish woman, I find it offensive that conservative Christians are promoting their religious beliefs in the political arena with a total disregard for the separation of church and state.

This separation, of course, is another freedom guaranteed to each of us by the Constitution.

The actors on these Supreme Court defying laws like to portray themselves as sole legitimate arbiters of God’s will. Upon signing the most restrictive anti-abortion bill in America, Governor Kay Ivey of Alabama issued a statement that she did so because “every life is a sacred gift from God.” Of course, with no exceptions in the Alabama bill for survivors of horrific crimes against girls no matter how young or women whether competent to consent or not who become pregnant, it’s obvious that Governor Ivey feels some lives are more sacred than others, and that it is her place to judge such matters.

Jewish law argues that a mother’s life must be saved at the expense of a fetus if the parent is in danger and the process of childbirth has not yet begun. “[T]he life of those already living comes before the life of those yet to be born.”Jewish law also recognizes the mental health of the mother as a vital factor in making the decision to terminate a pregnancy. Other faiths advise their adherents differently.

It is evangelizing pure and simple for this kind of dictatorial Christian to attempt to subvert my religion with her own when it comes to my family’s medical decision making.

There are suppositions about the moment that “life” begins, but no definitive answers from science yet to trump matters of faith and belief. We may someday know when the spark of animation—or the soul—enters the bundle of cells that grow into living flesh. We do not know now beyond a general range of viability dates for human babies.

From my perspective, it would be wise for people who value unborn lives above those of living women to invest heavily in the technological leap of gestating fetuses outside the womb. If it were possible to “harvest” unwanted pregnancies and nurture them elsewhere, some of the moral quandaries would change if not diminish. Certainly at that point those with the most extreme viewpoints on the subject of abortion could offer to save every unwanted child and assume the costs—financial, social, and emotional—thereof.

https://theawarenesscenter.blogspot.com/2011/02/incest-pregnancy-abortion-and-halacha.html

College cheats: getting in is nothing; learning is everything

The most obvious truth revealed by the recent college admissions cheating scandal that has ensnared Hollywood celebrities and other rich fools nationwide is that typical Americans have completely lost sight of the purpose or value of education.

Paying bribes to be admitted to university is frankly moronic for most of us. All of the real value of the college experience comes as a direct result of studying—and learningtherein.

Graduation cap and degree captioned University of DeceitRich kids will continue to stumble into lucrative careers because they have the right connections. Average kids, and the less well prepared, will take on massive debt for less and less substantive rewards when we devalue our universities by sending kids with no direction or purpose simply to fill seats.

Naturally, those who steal and cheat to get into college go on to cheat while attending college. I wouldn’t want to work with or hire that kid!

Businesses already decry the lack of qualified applicants for job vacancies though the percentage of Americans attending college has been increasing for decades. Being admitted to college confers zero qualifications. Learning—at a university or anywhere else—actually builds skills.

So, too, does honoring oneself and one’s community by behaving with honesty and dignity.

True scholarship also enhances one’s life in less quantifiable ways. The cheaters are too cowardly to risk realizing this fact for themselves.

Pile of moneyEarning a college degree has held, thus far, as a predictor of higher pay, but for how long? When students are enrolled only because “college is the next step after high school” vs. following an interest in deeper, more focused study of something specific, the automatic pay bump for a bachelor’s degree will disappear.

We ought not mold our colleges and universities into the image of our less and less functional compulsory K-12 system. Academia is not the right fit for everyone. All students are not the same. Disparate careers benefit from differing methods of preparation for new workers. Human beings have different learning styles.

Jobs go to people who can do the tasks required. College, in and of itself, teaches no specific skill save mastering the “admissions game.” That’s defined as test taking and/or bribery and fraud, apparently.

Children should be encouraged to do their best academically, but honor their unique selves by accepting both their strengths and weaknesses. Don’t let them fall victim to the patently false modern myth that admission to “the right college” is a golden ticket to happiness, prosperity, or success.

Consider trade schools, sampling classes at a local community college, internships, or self-directed online study if there is no perfect path to a four year degree right after high school.

Life is so rarely perfect! Why would one person’s education be?

One of the most compelling stories by an alumna of the small women’s liberal arts college I personally attended came from someone who went on to attain an MBA from an elite American business school. This woman was committed to attending that particular institution for her advanced degree, but had to apply three times before she was finally accepted. They were eventually persuaded by her passion and dedication.

Her message to us: persevere when you know what you want. This particular woman of color had reached her own definition of personal success by working hard and refusing to take no for an answer. She was a CFO at a startup at that time.

Education is not a zero sum game, though seats at a particular university may be. Focus on attaining the skills required by a career suited to your personality and strengths, and do realize that “where you went to college” becomes irrelevant very quickly after graduation for the vast majority of people.

“Steal,” yes, because cheaters have taken, through fraud, a slot at an institution where another scholar might benefit and contribute honestly to the campus experience for the entire community.

3 reasons I book domestic airline tickets in one way increments, not round trip

I keep being surprised by how many of my friends and family members still book domestic airline trips as round trips. Today, it is often smarter to book two separate tickets, one for your outbound journey, and another for the return.

Why?

Airfares within the USA* are no longer discounted for a round trip as opposed to one way. Your two one way tickets to and from wherever you’re headed will add up to exactly the same price as the round trip fare if you book the same segments.

If price is a draw, why book two separate tickets then?

1) If you need to adjust one segment of your journey, odds are your ticket these days is non refundable and costs over $100 to change. A domestic one way fare could cost less than the change fee. I’ve booked domestic legs from BOS-SEA, cross-country, for $119 in recent memory. On my favorite airline, Alaska, change fees are typically $125. Always double check fares for a new flight before paying an exorbitant change fee.

2) If there are changes to the outbound leg of your journey, your return segment won’t get screwed up when it is a separate ticket. Most leisure travelers avoid changing their airline itineraries because the costs are so high, but my husband travels for work. Due to his demanding schedule, it’s not uncommon for him to reschedule part of a trip. Changes to the outbound leg seem to have correlated with annoying, unexpected adjustments to his return flights. Usually, his seat reservation is changed. Occasionally, the entire reservation has disappeared from the system. Admittedly, DH has the worst travel luck of anyone I know, and a slew of amusing party anecdotes to show for it, but this is less likely to happen when two flights are booked as one way journeys.

3) You can book the best flight for your needs there and back, regardless of airline partnerships. This may be saving the best for last, but I suppose it needs to be stated for those who’ve never considering breaking up their domestic flights into two pieces: you aren’t beholden to one airline with this strategy. Book the combination of time, date, and airport that works best for you. This can be enormously more convenient for those who live near busy airports served by many airlines; it will matter less to those whose airport is part of a modern monopoly.

When is this strategy not a good idea?

Booking two one-way flights is good domestic strategy, but less often applicable to international flights from the USA with the big airlines, often referred to as “legacy carriers.”

The alternative, “discount carriers,” are more likely to offer one way bookings, even internationally.

NZ passport documents - 1If you are being reimbursed and your company accountants can’t accept two separate receipts for one trip, you’ll want to do what it takes to get your money back from the corporate overlord.

Some fare sales apply to “round trip fares.” You’ll need to meet whatever the stated conditions are to get the very best special fares, and that might include a round trip purchase.

Similarly, JetBlue’s frequent flyer program has gameified the mileage accrual process. There are bonuses to be earned, and a number of them depend upon “round trip” travel activity. If you are a points or miles collector, you’ll have to figure out whether one way flights will help or hurt your bottom line.

*Internationally, it’s usually old school all the way. Go compare fares for round trip as opposed to one way to Europe, and you’ll see prices thousands of dollars higher for the single leg.

That being said, you may save hundreds of dollars by booking a flight FROM Europe to the USA and back if you are considering spending cash for Business Class. You will still need to get to Europe to begin your trip, however.

This works if you have multiple trips coming up, allowing you to book your initial outbound flight TO EUROPE as a separate round trip coupled with with your ultimate return flight FROM EUROPE, leaving the Europe TO USA and FROM USA in the middle for a second ticket. It also works if you book your initial flight out using miles or points from a frequent flier program. Perhaps you’re taking a cruise, arriving in Europe by ship. Check one way and round trip fares back from Europe to the USA if you’re willing to walk away from an unused return and want the lowest possible fare, though choosing to ditch an unwanted return can have repercussions with the airline if you do it often because it is technically a violation of your contract with the airline created by buying the ticket.

Business Premier eases chronic pain on 13 hour Air New Zealand long haul flight: Part 1 (OneUp upgrade bid win)

On the economics of getting into business class for members of the 99% with chronic pain: how I did it for 37% of the paid fare with an upgrade bid, and why every penny was totally worth it.

I didn’t know until I arrived at LAX for my 13 hour flight from the USA to Auckland that my bid for upgrade to business class had been accepted. Air New Zealand might surprise you with such information at the very last minute. Luckily, this is the best kind of surprise.

I am a frequent flier in US domestic economy who occasionally splurges or upgrades with miles/status to first class. I also live with an autoimmune disease and chronic pain.

In spite of this, I continue to indulge my love of travel as often as I can. Now, however, I must sometimes make adjustments to accommodate my body’s varying demands.

What follows is my assessment of a very long haul flight in the Business Premier cabin. I’ll try to specifically address the experience of a traveler with chronic pain.

While I’ve found a plethora of reviews sharing the opinions of healthy business and luxury flyers, my own sometimes odd and very specific wonderings are rarely addressed.

Air NZ awards upgrade bids up to the last minute

Last year’s Swiss International Airlines (SWISS) upgrade from economy to SWISS Business was awarded several days before my flight. SWISS may even have provided a full week’s notice.

This time, I received a “too bad, you lost” email from Air New Zealand in the days before my trip. I took off from an intermediate stop at PDX with no knowledge of the highly beneficial change of plans.

Try to imagine my delight upon receiving a text message of congratulations for having my OneUp Business Premier upgrade bid accepted by Air New Zealand at the last minute. I learned of it as my Alaska flight touched down in Los Angeles and I resumed cellular connection to the world.

Having chatted with my nearest seatmate about our respective travels during lunch on Alaska 568, I couldn’t help but turn to her to share news of my good fortune:

“I just got the upgrade from Premium Economy to Business Premier for the long flight to New Zealand!” I crowed

“That’s great!” She replied. “Now your husband won’t have to feel guilty or to share his better seat.”

Air NZ Business Premier pix - airport espresso

It was reason for both DH and myself to celebrate, indeed. He is a gentleman, and he worries about me.

Of course, a man who will wait in line to buy an espresso for his tired wife in a busy airport even though he thinks caffeine is a pernicious addiction like heroin that shouldn’t be catered to or socially acceptable will always give his seat up to a lady.

To be crystal clear, however, on our return, when we were seated in different classes of service, I never did ask him to shove over or swap with me. I spent 13 hours in Premium Economy flying AKL-LAX towards home. I’ll add a link here to my post on the subject once I’ve finished writing it.

Continue reading