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

Children, First Class, disability & who “deserves” to sit where in an airplane

Because I at least try to be a considerate and thoughtful traveler, I regularly look up phrases to suggest “the best way” of doing things. One such example? Parents traveling in First Class whilst their children trail along in steerage a lesser service category.

What I find most fascinating about the search results is the concurrent expression of two opinions that lead inexorably to parent shaming without a solution:

  1. Children don’t belong in First Class unilaterally!, while
  2. Parents who “abandon” their kids in Economy while riding up front themselves are monstrous jerks who should be drawn and quartered (or at least shot.)

Essentially, the sum of those two arguments leads to the conclusion that parents ought never travel in First Class while their children are under age.

Here’s where I’ll swing back around to a point I’ve stressed on this blog before: I often purchase tickets in premium cabins because of my health. Chronic autoimmune illness makes that option more comfortable—but also safer and healthier—for me.

I live with chronic pain.

Every day, I probably ache in at least a few joints. Travel—otherwise one of my great joys—can make my symptoms worse. A larger, more adaptable seat does help. More room, easier access to a lavatory, and the simple comfort of a foot rest or extensible leg support makes the difference between a successful trip and a multi-hour torture chamber.

Note that the acquisition of a more comfortable seat is something I do in addition to taking the most powerful opioid painkillers I’ve got. In transit, I will still suffer more pain than my daily average with these interventions. I choose the world-expanding possibilities of travel in spite of the cost, but the calculus for any given trip can be complex.

If there were legal protections on a minimum amount of space per passenger on a plane, the actionable facts in this argument could be different. If I were guaranteed a seat in Coach that provided enough room to shift position and freedom from being kicked and elbowed by even a plus-sized seat mate, I’d be open to debating the courtesies of keeping younger travelers out of the pointy end of the plane.

Since that is a pipe dream, however, the traveling public is going to have to tolerate my presence in Premium Economy and better, when I can afford it. And, where I go, there also will travel my children when I deem it desirable that they join me.

Given these facts, which option is preferable to the segment of society that objects to children in First Class and kids seated away from their folks?

My own choice is usually dictated by my finances.

When I score an awesome cheap fare up front, I typically book my little guy (middle school aged, so not so terribly tiny) in the seat next to me. He is delighted by the idea of a luxury trip, though modern domestic First Class is a far cry from gold-plated splendor. I prefer having his company to sitting alone.

Then again, I do actively discourage any sense of entitlement to this, my more peer-influenceable child. He has also known the joys of sleeping in a cramped Economy seat on a too-long/too-short transatlantic flight, and he knows full well how to wait his turn in the interminable queue to board, settle quickly into his seat and stow his own carry on, and then keep himself to himself en route to make the uncomfortable as tolerable as possible for everyone else aboard the jet.

The older teen would rather sit on his own regardless because he’s way too cool to be seen with me, so he’s stowed in steerage unless a really high Coach fare is actually a poor value compared with the mileage earning and family togetherness opportunities of a bargain up front.

Don’t gasp–it does happen! Leisure travelers who covet rock bottom fares and business travelers whose companies pay top dollar tend to prefer flights on different days and times.

Always check fares in all classes before booking! You may find First Class for less than Coach. It’s rare, but I have seen it* myself.

This summer, I’m accompanying my husband to a conference in the UK and we’re bringing the little guy along. On the way out, his ticket, purchased with frequent flier miles, is in Comfort+ (i.e., Premium Economy) while his father will be four rows ahead but behind the magic curtain in Delta One.

My own flight, also bought with miles, will be on a different date, itinerary, and airline entirely. We don’t have that many miles on any given airline at one time. Also, I often depart ahead of time to allow a day (or more) of recovery before entering full “tourist mode” and because I enjoy travel so much more than DH does. He rarely takes even a single day off concurrent with his business trips.

It’s a transatlantic redeye, so the kid is expected to sit, settle, and sleep. His “solo” presence is unlikely be a bother to anyone at all under these circumstances, even offering his adjacent seatmate a bit more space due to his small stature. Purchasing the equivalent to his dad’s company-paid Business Class seat was simply out of our reach.

To be clear: I, personally, am not talking about abandoning a toddler 40 rows back from his responsible adult companion. Perhaps non-parents need to be told, too, that there is no single age when every child will be ready to sit alone. As with staying home alone without direct supervision, I’d judge the right age to be over six years at a minimum and by the age of 13 for almost everyone.

Our return to the US presents a completely different set of circumstances. The lo-o-o-ong nonstop flight from Ireland to the Pacific Northwest should see the boy wide awake and therefore more likely to want or need something from a parent, if only to ask if my usual strict limit of one sweet drink per flight could be adjusted, “just this once.” I also found a relatively low fare in a premium cabin whereas Economy on the direct flight I wanted was rather high. In this scenario, I’m opting to pay to seat my child up front next to me.

It’s been argued that children don’t appreciate the “best parts” of the premium cabin experience. For many travelers, that appears to be getting drunk! True, my son won’t be sipping champagne, and he isn’t overly inconvenienced by the cramped conditions in the cheapest seats so the extra room is “wasted” on him.

Both of us will enjoy easier access to the lavatory, however, and the better service offered by less harried flight attendants. My younger son is outgoing and friendly; he will appreciate plenty about traveling with a more gracious level of service. The fact that different elements of Business Class will tickle his pre-teen fancy doesn’t make his experience count for less.

Where will my teen be during this jaunt? Well, he would rather fly alone to visit his grandparents sooner and leave the UK to the rest of us. Somehow, I’ve produced offspring that aren’t as interested in foreign travel as I am. After a bit of practice sitting in Coach 20 rows behind me, he graduated to a solo flight with Unaccompanied Minor service around age 12. Now, though still in high school and underage, he’s old enough to manage his own passage through the security gauntlet and onto a direct flight without paying for the airline’s hand-holding.

My solo teen might also annoy those who like to complain, but he’s not an intrusive passenger with his slim build and quiet habits. On his last trip to visit Grandma, he texted me joyfully upon landing from his ultra cheap middle seat that the guy by the window didn’t need to pee even once. Never having to get up once makes a great flight by his metrics.

Glasses of wine and water on airplane tray tableFeel free to compare that behavior to the tipsy adult who spills his third drink all over you and your laptop. The guy may offer to pay for your dry cleaning, but you’ll be wearing stained and sticky pants for the next half a day regardless.

*This actually seems to be most likely around holidays when families travel to be together. What a great way to treat yourself if clan gatherings are a source of great stress as well as joy for you.

If there were a way to get him booked into a hotel without an adult in the event of delays or flight cancellations, I would trust him to make connections, too. The boy is downright competent!

10 hour airport layover teaches me: airport showers are awesome & often accessible

If you’ve never stepped foot in an airline lounge, you might not know that some of them have shower facilities. That isn’t very important for most of us who take the occasional domestic flight, but it can be a real game changer after a red eye or when laying over before an international long haul.

img_7364You don’t need a First Class ticket to use an airport shower facility, though you’re more likely to gain access for “free” if you spent a lot more for your ticket. At DFW, for example, the Minute Suites Terminal D location–a nap cubicle “hotel” past security in the airportalso sells shower passes with no private suite rental required.

Expect to pay around $30 to buy access to a fee-based airport shower facility, or around $50 per traveler if you’re purchasing access to an airline lounge like the American Airlines Admiral’s Club I used at DFW.

I probably wouldn’t have paid for a shower during my ten hour layover in July, but, having taken one in part to kill time after I’d visited every terminal and viewed all of the public art in DFW’s brochure, I would consider paying for a shower the next time I’m spending more than a few hours cooling my heels en route.

For me–an introvert with arthritis–I got about equal pleasure from two separate aspects of this experience. First, being totally alone in a room after hours of being in public. Second, the nice, warm shower itself, which always does some good at easing my joint pain.

DFW Terminal A Admiral’s Club shower

img_7366img_7367Can you ever feel really, REALLY unhappy when looking at a pile of fluffy white towels someone else has placed for your comfort and convenience? I can’t!

Everything you need comes with the key to the private shower room at the Admiral’s Club-DFW Terminal A location. Ask at the front desk to get access.

Shampoo, shower gel, Q-tips, and cotton balls are in place in the room, ready for your use. I used my own, of course, since sensitive skin is another fact of my life, but the products offered weren’t overly perfumed. This is a reasonably safe space/experience for those of us who get headaches from strong fragrances.

DFW Admiral Lounge AA shower - 1There were more towels than I needed, enough that I might ask, next time, for just what I would plan to use to save the water/energy of washing untouched linens. The space was quite scrupulously clean. There’s also a luggage rack to keep your suitcase above* the damp, and a hairdryer if you want it.

Since I was feeling quite well, I forgot to ask if there were accessible showers, but either they all are in this Admiral’s Lounge, or I just happened to get one that was. It had a fold down bench in the shower enclosure and an adjustable height hand shower wand in addition to the rain shower head. You won’t lose out on luxury if you just need grab bars sometimes, like me.

If you can’t stand at all, you might need to ask the staff to lower the hand shower to an appropriate height on your behalf. Mine was set way up at the top of its range when I walked in.

London Heathrow AA Arrivals Lounge shower

In addition to the Admiral’s Club shower at DFW, I took advantage of the same perks included with my First/Business ticket, purchased with Alaska Airlines frequent flier miles on AA, and visited the American Airlines Arrivals Lounge after retrieving my checked bag at London-Heathrow (LHR).

LHR Arrivals Lounge AA shower - 2LHR Arrivals Lounge AA shower - 3

LHR Arrivals Lounge AA shower toiletries - 1Though without a doubt the more hygienically important shower I enjoyed during the trip, the Heathrow shower room was smaller, less well appointed with little extras, and decidedly not accessible. (Again, I failed to ask specifically for a stall equipped for mobility impairments, so this is what you get without asking for special treatment.)

LHR Arrivals Lounge AA shower - 1There was no luggage rack in the compact LHR Arrivals Lounge shower room, leaving me to wedge my full size carry on next to the sink on the lavatory counter itself. I had checked a mid-size rolling suitcase, which you can see standing on the floor beneath the counter and blocking the exit door in my photo.

Perhaps there was luggage storage somewhere else for those who pack heavily, because there certainly wasn’t space in the shower room for large checked bags!

It was as clean as you would expect, however, and made the transition from night flight to the Tube less stressful than it might have been in spite of temps in the 90’s on London’s non-air-conditioned subway cars.

 

Dublin, Ireland 51st & Green Lounge shower

Upon my return from the United Kingdom to the USA, laying over at Dublin (DUB) airport, the 51st & Green Lounge, post security, was free for USA-bound Business and First Class customers, but accessible to anyone willing to pay the €39 entrance fee.

DUB departure Lounge 51st and Green shower - 1Shower use is included in the price, but there is just one accessible stall available, and it is combined with the only wheelchair accessible toilet in the space.

img_7478 This accessible bathroom/shower—also serving as the sole baby changing space— is in a different area than the main restrooms, also off the main entrance hallway but a bit further along from the front door. Thankfully, this made it a bit closer to the lounge’s seating areas. The primary restrooms felt like a real trek as my arthritis acted up during my wait.DUB departure Lounge 51st and Green showers - 1

Knowing that no other handicapped toilets were available if I opted to use the shower made someone with generally good mobility like me hesitate to even consider taking one, though I was having noticeable symptoms even before my nine hour flight home and the hot water might have felt good. There was another passenger in the lounge who appeared to be confined to a wheelchair when I was there, reinforcing my feeling that taking an unnecessary shower would be a bit selfish.

The standard shower room looked reasonably spacious for my purposes, but it didn’t have a safety hand rail. With a knee acting up that day, it didn’t seem worth taking a risk.

Fortunately, it was neither a blazing heat wave such as I suffered in London, nor a double digit hours layover like my time in Dallas, so foregoing a test of the 51st & Green shower facilities an hour after I’d left my Irish hotel was no real sacrifice, except to my ability to share the experience with readers here. There are few reviews of this particular shower, but most USA bound flights from Ireland leave in the morning, so perhaps the demand is simply low, and a single stall is adequate.

The 51st & Green Lounge was lovely, very new, and everything else was to a high standard, though, leading me to expect the showers would measure up.

*Though the shower drained properly and no water spilled out of the enclosure or anywhere near my luggage, I would advise travelers to always assume the worst with unknown plumbing and place all belongings somewhere high and dry, just in case.

I thought I was going to see a man laden with bags die in front of me on the London Underground. Ugh!