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

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.

Considering antidepressant medication? Try vitamin B-12 first.

This isn’t medical advice. I’m not qualified* to offer that.

Vitamin bottle B12 - 1I am simply a self-educated consumer who lives with a chronic health condition. I’ve drawn my own conclusions from research done as an intelligent lay person, tempering it with common sense. I invite you to do the same.

Many of us diagnosed with autoimmune conditions, degenerative neurological diseases, and chronic pain will be prescribed antidepressants. There are fine reasons for this.

Some chronic pain responds positively to antidepressant medications. Given in lower doses than those prescribed for psychological reasons, side effects are often less as well.

Here’s a link to a (long, almost 2 hrs!) YouTube presentation by Dr. Dan Clauw, M.D. that offers a great explanation for the current understanding of why these drugs may help certain types of pain.

Depression is also a normal human response to learning you can expect to spend the rest of your life with constant pain or in a rapidly degenerating physical condition.

That is a depressing situation for any rational person to contemplate. Treating mental health problems is important, and I do not sit in judgement of anyone who takes pharmacological steps toward better self care.

If you are a danger to yourself, please seek immediate, aggressive care. Do whatever it takes to get well. Your life matters.

That said, I’ve recently learned that the major physical symptoms of depression mirror almost exactly those of a vitamin B-12 deficiency. Hmm…

Even patients with valid diagnoses of other conditions—here’s a study about multiple sclerosis, for example—often have other stuff going on in the body that can make symptoms worse. Large numbers of hospitalized, depressed patients have measurable Vitamin B-12 deficiencies.

It isn’t known yet whether B vitamin deficiencies help create conditions that allow us to develop disease, result from lifestyle responses to living with chronic illness, or are direct side effects/symptoms of disease processes.

I’d argue that the underlying mechanism doesn’t matter so much when we’re talking about supplementing with vitamin B-12.

Why? There is no known upper tolerable limit for safety for supplemental B-12. Say that in plain English? No one ever “overdosed” on this vitamin.

Here’s a link to a more reputable (than me) resource, a state university, for detailed mainstream medical information on the subject of Vitamin B-12. And another to a US government fact sheet on the vitamin for American consumers.

B-12 is water soluble. If you take too much to be used by your body, it will leave your system naturally via your urine. You might “waste” the vitamins you’ve bought and paid for, but odds are tiny** that they will hurt you in any appreciable way.

If someone is ready to prescribe antidepressants to a patient, that patient must have at least one medical doctor who could also be consulted about taking vitamin supplements. Ask your doctor before starting a new treatment, including Vitamin B-12, but, odds are, you will be told this is safe to try.

You may also hear that vitamin B-12 won’t help you. But, then again, antidepressants aren’t a guarantee either. They include a long list of side effects, some of which are very unpleasant. Those prescription pills can also be expensive.

Also, it’s just as unscientific to assume the vitamins won’t help you as to assume that they will.

I’ve come to realize that no one cares as much about my health outcomes as I myself do. With good insurance and caring doctors, I’m still left with unanswered questions and a merely tentative diagnosis for what causes my chronic pain and fatigue. Where stakes are low and scientific certainty is lacking, I choose to perform nutritional experiments upon myself.

If it is highly unlikely to hurt you, and it could help you, why not take some extra vitamins for a while and see if you feel better, too?

Assuming your doctor said such a trial is safe, the only possible barrier is cost.

I picked up a bottle of store brand vitamin B-12 at wholesale giant Costco with 300 pills for $19. Each offered thousands of percent (20,833%) of the RDA***, making a bottle good for the better part of a year taking one per day.

That works out to $23.12 annually. Costco typically offers very good value.

At an expensive local vitamin specialty retailer, a three month supply (of 16,667% RDA pills) cost $16, coming out to about $64 per year. I suspect it would be hard to spend much more than this for these vitamins.

vitamin-bottle-b12-2.jpgThere are several forms of B-12 available, and both of these offerings are for the most expensive type, Methylcobalamin.

Some users have reported that the most common, cheaper form, Cyanocobalamin, doesn’t resolve their symptoms, but the Methylcobalamin form does. At less than $20 per bottle, it seems within financial reach of most Americans to do this self experiment with the potentially most effective version of the supplement.

My two sample bottles also both contain dissolving lozenges to be held under the tongue rather than swallowed and processed through the digestive system. Again, some argue that a sublingual or injected B-12 is more effective than a swallowed dose. I went out of my way to test this type of supplement, just in case, though science tends to think it is irrelevant for most.

In all of this, note that my primary interest is in clinical results, i.e., how I feel. It will be great if research comes to understand why and how B-12 or any other supplement improves patient outcomes. But I am not a working scientist.

The bottom line for how I make a decision about self-treatment comes down to whether or not I feel better, and at what risk.

The “clinically small” improvement of a group of MS study participants quoted above may be of only slight statistical significance, but when your function or your sense of well being has descended to, say, 25% of your old normal, well, then, 27% or 30% represents a win.

I don’t know what you should do to help yourself live a healthier life. I do have some opinions about which alternative health practices represent good risks worth a try for a person in pain. Perhaps this little experiment can ease some of yours, too.

Your body; your choices. Make them in good health.

*My education in both Biology and Chemistry ended in high school as my college science classes were limited to Physics courses. My major was Mathematical & Physical Sciences with a concentration in Computer Science.

Make no mistake that the side effects can be significant, however. They are also likely to affect your offspring, not just yourself. There are studies showing this in very obvious and less direct ways.

Powerful drugs are appropriate to treat significant illness, but I’d argue that they should be employed after milder alternatives have been tried and found insufficient.

Other sources, regarding. depression.and .neurological and psychiatric disorders

**There are some instances of allergic reactions to vitamin B-12, but I only read of such response to injections (shots), not over the counter vitamin pills. Reports of acne or skin rash in response to large dose vitamin pills do occur with some regularity.

You decide whether temporary skin issues are something that would stop you trying a larger dose of this vitamin for yourself.

***In most cases, we do NOT know the “optimal” level of vitamin intake. Vitamin B-12 reference ranges vary from 180-914 ng/L in the USA, 135-650 pmol/L (183-881 pg/mL) in Australia, and 500 – 1300 pg/mL. (ng/L=pg/mL, so no conversion necessary there.)

If you think this is an important thing for people to know, write to your government representatives and tell them you support basic nutrition research. Private companies have very little motivation to pay for this kind of work; there’s no resulting drug patent to fund the endeavor.

There’s a reason some public services, like infrastructure and basic research, are paid for by taxation. Otherwise, they simply aren’t available to all of us.

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.

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Angelrox “The Loop” scarf vs. the Shawl: sustainable fashion well suited for travel

If you’re anything like me, you’ve browsed the Angelrox online store and yearned for one of each garment in all your favorite colors.

I love this women’s clothing brand from designer Roxi Suger for reasons I’ve gone on about before. A quick recap, Angelrox offers:

  • Made in the USA
  • Woman owned business
  • Small New England (Maine) company
  • Celebrates bodies of all sizes in its imagery
  • Beautiful colors in figure flattering silhouettes
  • Comfortable, sustainable knit fabrics including organic cotton
  • Great customer service

Most of these factors also make Angelrox garments moderately expensive. The prices are fair, but you’re not going to hit a big closeout sale and overhaul your entire wardrobe at a bargain price like you might at a retail giant importing its goods from low wage nations.

Angelrox is not fast fashion. Consider a purchase from them a way to shop your values and invest in a sustainable wardrobe.

You might like Angelrox if you also wear Eileen Fisher.

The Loop and the Shawl by Angelrox

Here’s a preview of the two specific pieces I’m comparing today, The Loop $38 (infinity scarf) and the Shawl $78 (wrap)

I make repeat buys of the silhouettes that I know and love. Between the Goddess dress $158, Glow gown $188, and Doublet $78, I’m dressed in Angelrox several times each week.

With most orders, I also splurge on at least one new accessory. I’m curious about many styles, and there’s always another color I’d like to see in person. You can only judge hue so well using pictures on the internet.

Accessories are the most affordable way to get my hands on the whole rainbow of Angelrox options. The least expensive choice, The Band $10, doesn’t suit my positively Medieval forehead, but I wear their fingerless gloves (Sleeves, Aria $22 or Opera $28) almost daily as a balm to my arthritic small joints.

Recently, I’ve added The Loop and the Shawl to my Angelrox collection. I ordered both in Violet, a bold magenta.Angelrox Loop Shawl comare table

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