Eventually the scenario will occur where most everyone is paying for the public option. Would the govt be able to sustain the low rates, go without the overhead and profit, with an entire country to cover? It sounds like a great plan and something that should work, but is it wise to change the entire system when it might not work. How can they undo this if the financials don't work out as planned, if it costs more for the govt to run the healthcare system than they thought it would.
Or what if some other govt agency takes the money earmarked for health care? It has been known to happen before. Roads in San Antonio received funding, but the money was taken to pay for other things; Children Health Insurance Plan was given funding in Texas from Tobacco lawsuits, but the money went elsewhere. Education funding was supposed to come from the new state Lottery... See a pattern? Is it possible that this happens in other states as well? Ask the people in Oklahoma and Illinois who are fixing to be asked by their state gov'ts to pay $9K and $32K respectively.
This entire issue all comes down to a person's fundamental belief in either competition among insurance companies and less federal regulation leading to better practices or the gov't taking over and coming up with their own best practices. My money is not on the federal gov't. Sorry.
There are many things wrong with this huge industry, and I think people would be glad to support some of these reform measures right now. This would give Washington more political capital to work out the larger problems without the rush we have experienced in the last six months.
One concern that so many people have with this particular version of reform is the fact that someone has gone on the record as saying they are going to pole vault over the People to get this done. Wow, that doesn't sound right! I think it makes people defensive and wonder why they would need to do that if it was the right action.
I'm still offended by Obama's comments at the State of the Union where he said that people against his health care reform are wondering what's in it for them. He needs to get a clue. Even if congress and the president are being 100% up front about everything, the people are pushing back hard because their ability to choose is being taken away from them.
If I thought that our gov't could do something efficiently and streamlined, I might agree with you. Our family has been on a govt insurance plan three times: SChips for my kids, medicaid for myself, and tricare. I love free or reduced cost health care and I think many people love the idea of not paying very much for health care. But if this became the norm, you would get what you paid for, in terms of updated equipment and meds and caliber of dr.
Another thought is that the health care providers in the military are great, but the military medicine system is so large that it is hard to change course, to update, to somehow make decisions based on a short-term and long-term basis. There tend to be access issues due to the sheer volume of patients.
On the other hand, China is a great country to look at as they try to combine socialism with capitalism. Because the Chinese govt does not worry about political games, they are free to consider the long term. China obviously has socialized medicine, but they are attempting to update that system and offer other options. Is it possible for the private system to run side by side with a public option? Watch China, but don't write anything bad about them on the internet.
My overarching concern with this bill is financial: most people who oppose this bill worry about the cost. Will it really be as inexpensive as they say it will, where will the money really come from? Would it be possible to set aside tax revenue and premium payments without other gov't agencies taking it? Also, people look at the Social Security program and even state pensions and wonder how we will fund healthcare if we can't fund these other programs.
The gov't just does not have a great track record as far as keeping costs low. Ask Hillary Clinton who recently authorized $5.4 million dollars in lead-free cyrstal for freaking entertaining at American embassies around the world. Really? My left-leaning friends wonder why I worry about health care costs staying affordable and this legislation staying under budget.
BTW, look for the picture of Obama on the Great Wall of China shaking hands with some diplomat. Read Obama's body language and tell me what you think he's saying. That's the next bump on the horizon.
Tuesday, March 16, 2010
Healthcare, Part II: Pre-existing conditions and the Self-Employed
Obama has politicized and dramatized the coverage extended for pre-existing conditions. His Organizing for America website asked people to submit videos of showing pictures of loved ones who suffered when their pre-existing conditions were not covered. I heard that it was quite the emotional outpouring.
My guess is that people do not usually have their pre-existing conditions covered for the first year at a new insurance company. Or else they are not covered at all. Either way, families are left to pay for COBRA. My dad, who has a job with the City of Houston, pays $600/month plus deductible and copay. I can only imagine what that would cost for a family. It is an unfortunate problem.
The risk of a person with pre-existing conditions needing money from the insurance pool is 100% , so their cost to the insurance company are going to be higher than the average Joe. Insurance companies' main concern is minimizing risk, and if the risk of a patient/consumer is 100%, they are at an impasse. If that person is indigent or over 65, they already have access Medicaid/Medicare. Otherwise, the cost to treat their illness is spread to the rest of the insurance pool, and rates go up for everyone.
My Facebook friend suggested this: when everyone who has a pre-existing condition gets into the gov't insurance pool, they will pay their premiums to the gov't, and the cost will spread and be equally carried by the patients themselves. They will leverage the size of their group and more people will be paying less. If that works, great.
Insurers will not cover people with pre-existing conditions because they cut into the company's profit margin by filing more claims and because the insurance company needs to consider their shareholders. This is the rationale for taking health care out of the for-profit sector. The assumption is that the govt would not be out to make a profit, so they can take all of these pre-existing condition patients, cover their health care needs because they would not have to jack up the rates to cover a profit margin. BlueCross/BlueShield of NC reportedly posted a 2% profit margin last year. I am not sure what their overhead was, but windfall profits these are not.
Could the govt plan keep their costs low enough to make it affordable or would they have to add those people to the dole?
Would it be possible to take a group of people who are not joined geographically or by a common business, and increase their leverage to that of a large company? There is a saying that goes something like this, "Where does the 700 pound Gorilla sit? Where ever it wants." This is how you work with insurance companies: a large group of people and large groups of doctors have more to leverage against the insurance company. But the need for this approach might become obsolete with this new bill.
I just do not understand why the gov't is the only solution that people can come up with for this problem? This is another opportunity for someone to earn a living, feed their family: come up with this kind of plan. Surely someone has already thought of this...
My guess is that people do not usually have their pre-existing conditions covered for the first year at a new insurance company. Or else they are not covered at all. Either way, families are left to pay for COBRA. My dad, who has a job with the City of Houston, pays $600/month plus deductible and copay. I can only imagine what that would cost for a family. It is an unfortunate problem.
The risk of a person with pre-existing conditions needing money from the insurance pool is 100% , so their cost to the insurance company are going to be higher than the average Joe. Insurance companies' main concern is minimizing risk, and if the risk of a patient/consumer is 100%, they are at an impasse. If that person is indigent or over 65, they already have access Medicaid/Medicare. Otherwise, the cost to treat their illness is spread to the rest of the insurance pool, and rates go up for everyone.
My Facebook friend suggested this: when everyone who has a pre-existing condition gets into the gov't insurance pool, they will pay their premiums to the gov't, and the cost will spread and be equally carried by the patients themselves. They will leverage the size of their group and more people will be paying less. If that works, great.
Insurers will not cover people with pre-existing conditions because they cut into the company's profit margin by filing more claims and because the insurance company needs to consider their shareholders. This is the rationale for taking health care out of the for-profit sector. The assumption is that the govt would not be out to make a profit, so they can take all of these pre-existing condition patients, cover their health care needs because they would not have to jack up the rates to cover a profit margin. BlueCross/BlueShield of NC reportedly posted a 2% profit margin last year. I am not sure what their overhead was, but windfall profits these are not.
Could the govt plan keep their costs low enough to make it affordable or would they have to add those people to the dole?
Would it be possible to take a group of people who are not joined geographically or by a common business, and increase their leverage to that of a large company? There is a saying that goes something like this, "Where does the 700 pound Gorilla sit? Where ever it wants." This is how you work with insurance companies: a large group of people and large groups of doctors have more to leverage against the insurance company. But the need for this approach might become obsolete with this new bill.
I just do not understand why the gov't is the only solution that people can come up with for this problem? This is another opportunity for someone to earn a living, feed their family: come up with this kind of plan. Surely someone has already thought of this...
Monday, March 15, 2010
Yard Fairies and a novel about Health Care
It has taken two guys, a sitting lawn mower, two blowers, a tarp and the bed of a pick up truck, working since 10AM. As of 4:30 Pm, they still were not done. This is probably the best money I have ever spent because it's now obvious to me that I could never have done this on my own. Money can't buy happiness, but I sure feel better knowing that my yard is not harboring snakes under all those leaves. Did I mention that I paid the guys at noon, and they continued to work hard all afternoon? That is integrity.
Here are my current thoughts on health care. I posted some of this on a friend's Facebook page.
Here are my current thoughts on health care. I posted some of this on a friend's Facebook page.
Thursday, March 11, 2010
Reading List
I have read some amazing books in the last month. Everyone should read these books!
1) Megatrends China: Written by a guy with the last name Nesbitt. He wrote the original Megatrends in the early 1980's. I read this book in 6th grade, and developed a city of the future as an enrichment project. I picked up Megatrends China at the library just because I recognized the title from back in the day. Megatrends China was written by an American and his European wife, but most of the research was done by Chinese business students. The facts were taken from a database that they compiled and translated into English. The database was taken from all mediums of news reports, print, television, and the internet. The data is a compilation of the way the Chinese view themselves. After reading this book, China is my new 2nd favorite country. My favorite idea was "Borrowing Arrows." I will come back to its relevance in modern business policies. "Borrowing Arrows" comes from a story about some Chinese dynasty's army that was stuck on one side of the river without any arrows left to fight the bad guys. So they tied a rope to a canoe, filled it with straw and it sent it out into the river. The morning was foggy, and, due to the low visibility, the bad guys assumed the canoe was filled with warriors. They shot arrows into the canoe. Once enough arrows filled the straw, the good guys pulled the canoe back to their side with enough arrows to finish off the bad guys. If you know anything about China's current events, you will see the application to their business sector.
2) The Aid Trap, written by Hubbard et al. This is my dream job described in a book. I even emailed one of the authors, and he thought I had good questions about the book. It has a concise history of economic systems as well as the international charitable giving paradigm. The essence of this book is that all of the money poured into developing countries since the 1970s has not served to raise the world's poor out of poverty. Even the UN's Millenium Plan to bring the world out of poverty by 2015 is not going to happen on time. Instead, the authors say that we should pattern aid after the Marshall Plan. I had heard of the plan, but had to Google it. Charitable organizations should stick with emergency aid, food, refugees, etc, but not development. The Marshall Plan lent money to businesses in Europe after WWII. Their plan calls for the same format. The businesses, in turn, would repay the loans to their respective governments. The federal governments have to agree to the rules in order to qualify for this investment. The money has to be spent on infrastructure or other programs that lead to stability and business development in their country. If we believe in Capitalism and pro-business measures in America, why do we thwart the business sector of the countries we want to help? Or if you are Bono, and do not believe in Capitalism, but still move your business to another country entirely when your hometown decides to start taxing you, this still applies to you. If a foreign charity comes into a poor country and builds a well, that's great. But then the well breaks, and they have to wait for another charity to come along and build a well. What if, instead, we give a loan for a well-building business, facilitate education and training through grants and American professional societies and universities, and allow the local guy to build the well and earn the money? Then he can feed his family, employ others, and pay taxes to his government. What a concept. The authors use China and India as examples in this book, and the references made more sense to me after reading Megatrends China.
If you read my blog on a regular basis, you already know what a dork I am. So it should come as no surprise to you that this idea practically brings me to tears. Working for the Auxiliary last year taught me that if I am going to spend all day going to meetings, answering emails, and putting out fires, it had better be for something worthwhile. Could rebuilding a country and lifting millions of people out of poverty be any more amazing? I am going back to school in Boston so that I can be ready when someone takes the concepts from this book and actually starts a business. Or, I would like to run a Food Bank. Yes, I aim high. I know.
3) Socialnomics. Author unknown at the moment. I'll have to get back to you, or you could Google it as I am currently sitting in on a conference call from San Antonio where my friends are planning the 10th Annual BAMC Auxiliary Charity Golf Tournament. (It was all great until I heard that the newest Marriot Golf Course and Convention Center is hosting a tournament and Gala at the end of March. The tickets are $800, including golf, the gala and a hotel room. This is all benefitting the CFI and the Ft Sam Hoston Fisher House. Why are my friends going through the trouble now? Maybe the Fisher House manager should have mentioned this other charity golf tournament back in September when my friends started meeting for our tournament.) Moving on, this book describes the effect of social media on economics. There is a paradigm shift in marketing, production, and revenue streams due to internet sites like Facebook, Twitter, Youtube. A key point of the book is that Barak Obama would not be the President if not for the masterful work of leveraging social media. The author cites the number of times Obama was mentioned on social networking sites the last month before the election. He dwarfed McCain on those sites. By a huge margin. Another point was that you either life your life more fully because it sounds cooler to post that you went snowboarding on Facebook instead of sitting around watching reality tv re-runs. Or you tamed your life down because you did not want your bad choices going viral on Youtube. People get fired over things like that.
Coincidentally, I just read a report by NY Times publisher that says their opinion is that we, the public, should not expect to view things online for free. (Did they forget that I already pay for the internet in my cable bill and on my phone? If they wanted to make money off the internet, then they are in the wrong industry. They deliver news, not the internet.) Nonetheless, they are going back to charging us to read news on their websites. How about this: NY Times charges you for the news while I study up real hard, find the news, write it on my blog where you can read it for free. And then I have so much traffic on my blog that I get someone who will pay to advertise on my blog. Which sounds more likely?
1) Megatrends China: Written by a guy with the last name Nesbitt. He wrote the original Megatrends in the early 1980's. I read this book in 6th grade, and developed a city of the future as an enrichment project. I picked up Megatrends China at the library just because I recognized the title from back in the day. Megatrends China was written by an American and his European wife, but most of the research was done by Chinese business students. The facts were taken from a database that they compiled and translated into English. The database was taken from all mediums of news reports, print, television, and the internet. The data is a compilation of the way the Chinese view themselves. After reading this book, China is my new 2nd favorite country. My favorite idea was "Borrowing Arrows." I will come back to its relevance in modern business policies. "Borrowing Arrows" comes from a story about some Chinese dynasty's army that was stuck on one side of the river without any arrows left to fight the bad guys. So they tied a rope to a canoe, filled it with straw and it sent it out into the river. The morning was foggy, and, due to the low visibility, the bad guys assumed the canoe was filled with warriors. They shot arrows into the canoe. Once enough arrows filled the straw, the good guys pulled the canoe back to their side with enough arrows to finish off the bad guys. If you know anything about China's current events, you will see the application to their business sector.
2) The Aid Trap, written by Hubbard et al. This is my dream job described in a book. I even emailed one of the authors, and he thought I had good questions about the book. It has a concise history of economic systems as well as the international charitable giving paradigm. The essence of this book is that all of the money poured into developing countries since the 1970s has not served to raise the world's poor out of poverty. Even the UN's Millenium Plan to bring the world out of poverty by 2015 is not going to happen on time. Instead, the authors say that we should pattern aid after the Marshall Plan. I had heard of the plan, but had to Google it. Charitable organizations should stick with emergency aid, food, refugees, etc, but not development. The Marshall Plan lent money to businesses in Europe after WWII. Their plan calls for the same format. The businesses, in turn, would repay the loans to their respective governments. The federal governments have to agree to the rules in order to qualify for this investment. The money has to be spent on infrastructure or other programs that lead to stability and business development in their country. If we believe in Capitalism and pro-business measures in America, why do we thwart the business sector of the countries we want to help? Or if you are Bono, and do not believe in Capitalism, but still move your business to another country entirely when your hometown decides to start taxing you, this still applies to you. If a foreign charity comes into a poor country and builds a well, that's great. But then the well breaks, and they have to wait for another charity to come along and build a well. What if, instead, we give a loan for a well-building business, facilitate education and training through grants and American professional societies and universities, and allow the local guy to build the well and earn the money? Then he can feed his family, employ others, and pay taxes to his government. What a concept. The authors use China and India as examples in this book, and the references made more sense to me after reading Megatrends China.
If you read my blog on a regular basis, you already know what a dork I am. So it should come as no surprise to you that this idea practically brings me to tears. Working for the Auxiliary last year taught me that if I am going to spend all day going to meetings, answering emails, and putting out fires, it had better be for something worthwhile. Could rebuilding a country and lifting millions of people out of poverty be any more amazing? I am going back to school in Boston so that I can be ready when someone takes the concepts from this book and actually starts a business. Or, I would like to run a Food Bank. Yes, I aim high. I know.
3) Socialnomics. Author unknown at the moment. I'll have to get back to you, or you could Google it as I am currently sitting in on a conference call from San Antonio where my friends are planning the 10th Annual BAMC Auxiliary Charity Golf Tournament. (It was all great until I heard that the newest Marriot Golf Course and Convention Center is hosting a tournament and Gala at the end of March. The tickets are $800, including golf, the gala and a hotel room. This is all benefitting the CFI and the Ft Sam Hoston Fisher House. Why are my friends going through the trouble now? Maybe the Fisher House manager should have mentioned this other charity golf tournament back in September when my friends started meeting for our tournament.) Moving on, this book describes the effect of social media on economics. There is a paradigm shift in marketing, production, and revenue streams due to internet sites like Facebook, Twitter, Youtube. A key point of the book is that Barak Obama would not be the President if not for the masterful work of leveraging social media. The author cites the number of times Obama was mentioned on social networking sites the last month before the election. He dwarfed McCain on those sites. By a huge margin. Another point was that you either life your life more fully because it sounds cooler to post that you went snowboarding on Facebook instead of sitting around watching reality tv re-runs. Or you tamed your life down because you did not want your bad choices going viral on Youtube. People get fired over things like that.
Coincidentally, I just read a report by NY Times publisher that says their opinion is that we, the public, should not expect to view things online for free. (Did they forget that I already pay for the internet in my cable bill and on my phone? If they wanted to make money off the internet, then they are in the wrong industry. They deliver news, not the internet.) Nonetheless, they are going back to charging us to read news on their websites. How about this: NY Times charges you for the news while I study up real hard, find the news, write it on my blog where you can read it for free. And then I have so much traffic on my blog that I get someone who will pay to advertise on my blog. Which sounds more likely?
Thursday, February 25, 2010
The Thrill-Seeking McMullin Gene, or Snowboarding in New Hampshire
Last week, Neil and I took a mini-vacation/house-hunting trip to Boston. We picked Ann up at the airport, said good bye to the kids, and waited for our plane to leave. We waited for another few hours until they cancelled our flight going in to Boston. Fortunately for us, there was a flight with space for us the next morning to Manchester, New Hampshire. Renting our car in New Hampshire saved us $100 in taxes and fees compared to what we would have paid in Boston. That paid for the hotel we stayed at in Raleigh when our flight was cancelled. While we waited in the airport and for the hotel taxi (they forgot to tell the driver to come get us), I was repeatedly reminded of how stressed I would have been during the wait if I had my four children with me.
We visited some homes in Belmont, MA once we got our rental car and then drove back to our B&B in Danbury, NH. My thought on the houses in Belmont is that if the house has a trash compactor in the kitchen, it's time to update the appliances. The Inn at Danbury is a quaint, family-owned place with authentic German food. I tried Wiener Schnitzel, which, due to a five-year old-esque aversion to the name, I never thought I would eat. Instead of the traditional veal, I substituted pork; I am not that adventurous. Who knew that this crazy sounding dish was actually breaded pork tenderloin. Yum.
I consider myself a fairly low-maintenance girl, but as we prepared for this trip, I was adamant that my snow clothes had to be cute and matching. This stubborn streak drives Neil insane; however, in my defense, I should be allowed one high-maintenance eccentricity. Waiting for cute clothes to go on sale rather than dropping money on clothes I will hate sounds reasonable to me. We had to drive to Raleigh to find snow boots for me. Neil could not understand that I wanted super cute pink and black fashionable snow boots instead of hiking boots. Unfortunately for me, REI does not carry such stylish boots. I ended up with brown and maroon hiking boots; I am pretty sure that Neil planned this all along. Neil's trip to the desert/mountains provided all the cold weather clothes he will ever need. My new Fayetteville friend, Adriana, and my mom loaned me clothes and mittens, and we were ready to go.
If you know me well, I would guess that you are already laughing at the prospect of me on a snowboard. If you have seen Neil's video of me snow boarding, you are still laughing. I have discovered that the "Thrill-Seeking McMullin Gene" is not inheritable through marriage.
Example 1: I never thought I was afraid of heights until I rode on the ski lift. All the way up to the bunny slope. I would have had an anxiety attack if Neil had not been there to remind me to breathe. It is true that I would have felt better with at least a bar keeping me from falling to my death, but I could not manage the bar with my snow board. Needless to say, I about had a heart attack watching some kids practically wrestling in the lift on the way to the top of the mountain.
My rental snow board stuck to the snow, which made my life difficult, but I had a great instructor and great, warm clothes. The sun was out and we were sweating as we rode down the mountain. I even had to put my hand warmers in my coat pocket because it was too warm for them. Snow boarding, even when you go slow like me, is exhilarating. It is also an incredible work out. At first, my legs were thanking me for all of the squats and lunges I did in January. By lunchtime, though, my legs were shaking.
Example 2: Once you fall backwards on a snowboard, there is only one way to get up. You cannot turn over and rest on your hands and knees. You just have to point yourself down the mountain to take advantage of the gravity, and stand up from a deep, deep squat. I did not think my knees would last. Another problem I had standing up was when I was pointed down the mountain and started sliding downhill before I had finished standing up. Going down the mountain while attempting to stand up was more than I could handle.
Example 3: One other thing I had not anticipated were all of the small children crossing my path. When those little kids on snow boards and skis lost control around me, I had to crash myself to avoid running them over. Other times it was humbling to watch them zoom past me. Those little kids on skis, especially, had no fear. They never fell. They just snowplowed down the mountain. The little kids on snow boards fell more often, but they never crashed and burned. It was more likely that they could not control where they were headed, so they just sat down. Sometimes they would stand up and then fall over forward. But none of them fell more than I did.
The first time I fell forward, I felt the jarring from my fingers to my shoulders and I was grateful for Kristen's suggestion to wear rollerblading wrist guards under our mittens. The time I fell back and landed only on my tailbone and head, I was grateful for my helmet. Apparently the snow in NH is less powdery and more icy than Colorado.
Example 4: I did not try snow boarding backwards down the mountain like our coach suggested. Big surprise there. Instead I just shifted which foot would lead down the mountain. That sounds like a much more sane idea.
Example 5: Did I mention that I fell every time I got off the lift? Yeah, you have to snowboard right off the lift down a 80% incline hill to get to a landing where you can actually strap your boots into the bindings. Needless to say, I usually just slid down the hill. Luckily, they never had to stop the lift for me. That would have been more than humiliating.
Notwithstanding all my crazy crash stories, learning to snow board was a blast. The first time I actually went down the hill and turned and kept going was cool. It is difficult to explain what it felt like. The morning was made even more amazing with the combination of snow and beautiful blue skies.
That evening, though, Sydney asked me on the phone if I had broken my leg yet. Apparently I had previously remarked that I was thought it might happen. I do not think I was such a fraidy cat when I was younger, but oh well. This is to be our family sport for the next three years. I have the pants, I have the hot pink coat. And Neil bought me some snow board boots on sale yesterday. They are hot pink and black and exactly why I would never settle for anything less than amazing. With my pink boots and some wax to keep my snow board moving, I am ready to try again. I am still looking for my pink snow boots, though.
In case you were wondering, Neil, of course, was great at snow boarding. He said something about skate boarding when he was a kid and all of the exercising he did in Afghanistan making it easier. That still doesn't explain the ten year-olds passing me on the mountain.
We visited some homes in Belmont, MA once we got our rental car and then drove back to our B&B in Danbury, NH. My thought on the houses in Belmont is that if the house has a trash compactor in the kitchen, it's time to update the appliances. The Inn at Danbury is a quaint, family-owned place with authentic German food. I tried Wiener Schnitzel, which, due to a five-year old-esque aversion to the name, I never thought I would eat. Instead of the traditional veal, I substituted pork; I am not that adventurous. Who knew that this crazy sounding dish was actually breaded pork tenderloin. Yum.
I consider myself a fairly low-maintenance girl, but as we prepared for this trip, I was adamant that my snow clothes had to be cute and matching. This stubborn streak drives Neil insane; however, in my defense, I should be allowed one high-maintenance eccentricity. Waiting for cute clothes to go on sale rather than dropping money on clothes I will hate sounds reasonable to me. We had to drive to Raleigh to find snow boots for me. Neil could not understand that I wanted super cute pink and black fashionable snow boots instead of hiking boots. Unfortunately for me, REI does not carry such stylish boots. I ended up with brown and maroon hiking boots; I am pretty sure that Neil planned this all along. Neil's trip to the desert/mountains provided all the cold weather clothes he will ever need. My new Fayetteville friend, Adriana, and my mom loaned me clothes and mittens, and we were ready to go.
If you know me well, I would guess that you are already laughing at the prospect of me on a snowboard. If you have seen Neil's video of me snow boarding, you are still laughing. I have discovered that the "Thrill-Seeking McMullin Gene" is not inheritable through marriage.
Example 1: I never thought I was afraid of heights until I rode on the ski lift. All the way up to the bunny slope. I would have had an anxiety attack if Neil had not been there to remind me to breathe. It is true that I would have felt better with at least a bar keeping me from falling to my death, but I could not manage the bar with my snow board. Needless to say, I about had a heart attack watching some kids practically wrestling in the lift on the way to the top of the mountain.
My rental snow board stuck to the snow, which made my life difficult, but I had a great instructor and great, warm clothes. The sun was out and we were sweating as we rode down the mountain. I even had to put my hand warmers in my coat pocket because it was too warm for them. Snow boarding, even when you go slow like me, is exhilarating. It is also an incredible work out. At first, my legs were thanking me for all of the squats and lunges I did in January. By lunchtime, though, my legs were shaking.
Example 2: Once you fall backwards on a snowboard, there is only one way to get up. You cannot turn over and rest on your hands and knees. You just have to point yourself down the mountain to take advantage of the gravity, and stand up from a deep, deep squat. I did not think my knees would last. Another problem I had standing up was when I was pointed down the mountain and started sliding downhill before I had finished standing up. Going down the mountain while attempting to stand up was more than I could handle.
Example 3: One other thing I had not anticipated were all of the small children crossing my path. When those little kids on snow boards and skis lost control around me, I had to crash myself to avoid running them over. Other times it was humbling to watch them zoom past me. Those little kids on skis, especially, had no fear. They never fell. They just snowplowed down the mountain. The little kids on snow boards fell more often, but they never crashed and burned. It was more likely that they could not control where they were headed, so they just sat down. Sometimes they would stand up and then fall over forward. But none of them fell more than I did.
The first time I fell forward, I felt the jarring from my fingers to my shoulders and I was grateful for Kristen's suggestion to wear rollerblading wrist guards under our mittens. The time I fell back and landed only on my tailbone and head, I was grateful for my helmet. Apparently the snow in NH is less powdery and more icy than Colorado.
Example 4: I did not try snow boarding backwards down the mountain like our coach suggested. Big surprise there. Instead I just shifted which foot would lead down the mountain. That sounds like a much more sane idea.
Example 5: Did I mention that I fell every time I got off the lift? Yeah, you have to snowboard right off the lift down a 80% incline hill to get to a landing where you can actually strap your boots into the bindings. Needless to say, I usually just slid down the hill. Luckily, they never had to stop the lift for me. That would have been more than humiliating.
Notwithstanding all my crazy crash stories, learning to snow board was a blast. The first time I actually went down the hill and turned and kept going was cool. It is difficult to explain what it felt like. The morning was made even more amazing with the combination of snow and beautiful blue skies.
That evening, though, Sydney asked me on the phone if I had broken my leg yet. Apparently I had previously remarked that I was thought it might happen. I do not think I was such a fraidy cat when I was younger, but oh well. This is to be our family sport for the next three years. I have the pants, I have the hot pink coat. And Neil bought me some snow board boots on sale yesterday. They are hot pink and black and exactly why I would never settle for anything less than amazing. With my pink boots and some wax to keep my snow board moving, I am ready to try again. I am still looking for my pink snow boots, though.
In case you were wondering, Neil, of course, was great at snow boarding. He said something about skate boarding when he was a kid and all of the exercising he did in Afghanistan making it easier. That still doesn't explain the ten year-olds passing me on the mountain.
Tuesday, February 23, 2010
Updates and Halo
Sadly, it has been weeks since I have written on my blog. There are many things that I would like to write about, ideas floating around in my head, but my schedule is different now that Neil is home. While I would not say that I actually have a life now, at least I have Neil around to run errands with me or watch my favorite tv shows at night. I easily spend an hour every time I write on my blog and typically find that uninterrupted time after the kids go to bed, so there are things I'd rather be doing now that Neil is home. In fact, Neil is at Sydney's basketball practice tonight and my dishes are already done. Not that I would put off writing to do the dishes.
Picking Neil up from the airport was amazing, but I did not think we would ever get there. We got lost following the google map directions on my iphone, we hit every red light and we got stuck behind every slow car and old truck. Finally we pulled up to the airport, and it was as if I was picking Neil up from the hospital after work. (We only had one car for most of med school, so I spent a few years picking him up at the end of the day.) It did not seem that he had been gone for six months.
The first few days after Neil got home were surreal. I would look over at him while he sat next to me on the couch and get confused. It felt normal to see him, but unnatural to have anyone actually sitting there. Unfortunately for Neil, he had to spend the first three days checking Army boxes on Post. While I understand the need for post-deployment Psyche evals, all of the appointments and waiting do not sound to me like a great way to encourage reintegration. Fortunately we have spent plenty of time together since then because Neil's department gave him a lot of leave. At this point, he has almost two weeks of leave left. I could get used to this.
Everyone I talked to was concerned about the reintegration process and how Neil would adjust to being home. Neil and I have spent time talking about his deployment and the things crossing his mind as he got used to being here. If I had to guess, Neil's occupation as a surgeon allowed him to form coping mechanisms in advance of deploying that allow him to deal with some issues regular Army guys experience upon returning from war. When we were in Boston, it seemed to blow his mind that he had been in the middle of war a short while ago.
BTW, currently Zach and I are sporting our wireless XBox headsets and are pretending to play Halo. Did you know that in our pretend world, that if you push the button on the left you get a bazooka? Syd and Neil just walked and Syd made 4 baskets! Off to have Girl Scout Cookies for dessert.
Snowboarding stories can wait for another day.
Monday, February 15, 2010
Snow Day Pictures
You can see our fun neighbor, Elise, who came out to play with everyone. Then Zach makes snow angels and gets caught in the act of pelting Ainsley with a snowball. Audrey poses right before eating that snowball. We have so many pictures of all of the kids eating snow that day.
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Obama's "Organizing for America" is a great website. You can find it at www.barakobama.com. I might not be in agreement with the content, but I am amazed at the how the website forwards his plans. Obama does new media very well. You should check it out, even if it is to see what you are up against. Many people could learn from how he allocates resources to interact with people via new media, for example, blogs and interactive websites, Youtube, Facebook and Twitter. Apparently he is the first President to keep his Blackberry and maintain his own email communication. From what I have read, his blackberry is James Bond-esque in it's security apps and his email address is known only to a select few.
I agree that there is a need for health care reform, but this version is not the best alternative. Health care reform is a huge problem with complicated solutions. I agree with Obama that the Reps had 8 yrs to do something, but they didn't. My guess is that they knew it was a complicated issue in ways that are technical, financial, and emotional. While I have not researched this, it is possible that political donations, lobbyists, and the overwhelming representation of lawyers in Congress have prevented them from tackling this issue before now. The more I research, the more I find that there is still to learn.
I read last night, and need to do more research to verify this, but the federal govt decided at some point in the past that if a doctor accepted cash, or what is called now "fee for service", they had to pay higher taxes on that amount than if an insurer paid a claim to them. It is my opinion that there are huge ramifications if that is the accurate; however, this story will probably never see the light of day again. For better or worse, doctor's needs are low on the priority list of health care reform.
My theory is that there are small parts of the puzzle that we could fix now. Here are a few:
1) Keeping costs low to the provider will translate to lower prices for the consumer:
Tort reform is a huge part of improving costs and access to health care. Look at the success Texas has had since they enacted Tort Reform laws. When you have a neurosurgeon who pays over $100K a year in medical malpractice, the money has to come from somewhere. And that "somewhere" is the patients.
Take the example of a surgeon who operates on an indigent patient. This could be someone who is not already covered by Medicaid, or an illegal immigrants, or it might be someone who has fallen through the cracks, homeless people, for example. The hospital receives money from the gov't, but the surgeon does not. Again, the money for the doctor has to come from somewhere. A certain percentage of pro bono cases is one thing, a large majority of a surgeon's work obviously cannot be done without compensation. This problem isn't likely to be fixed by the current reform. If people fall through the cracks, then mandating insurance for them won't help.
Another idea is to consider requiring that insurance companies, including Medicaid/Medicare, should be required to pay claims within 2 weeks, or a month at the latest. When a doctor has to wait a year to be paid, the money to pay for their overhead-the staff, rent, and equipment-has to come from somewhere (Read the patients).
Did you know that doctors do not have the right to collective bargaining? I thought that meant they do not have the right to unionize, but what Neil told me is that a medical practice negotiates for each of it's physicians a reimbursement deal from an insurance company. The doctor is not allowed to know what the other doctors in his practice get from the insurance company, nor are they allowed to know what a different practice is getting from the same insurance company. When you only have one or two large insurance companies to deal with, you have no option but to accept their insurance. I have heard that if the doctor finds out the rates for other physicians and act on that knowledge, the insurance company can sue that doctor. There are websites that allow users to compare salaries, so that potential employees can better negotiate and make better career choices. That option is not available to doctors.
2) Competition in the insurance industry. Is competing against the federal govt a good idea? Will it force the insurance companies to change or just put them out of business.
I am not a fan of insurance companies, but I am also not out to look for scapegoats. There are people that feel that a public option would force the insurance companies to compete, but I am not sure that competing against the govt is the best idea.
In every other communist/socialist country, where there is actual govt ownership of the means of production, the private sector always does better in comparison. When people are given the freedom to innovate and take ownership of their product, whether it is something tangible like a refrigerator or intangible like media, they come up with something better. They create a business or a system more efficient than the govt owned enterprise does. If you would like to open a private business in China, there are times that the govt forces the entrepreneur to take over two state-owned enterprises. One of them would be a company that already does what this new company wants to do. The second company would be a failing company, most likely in a different sector of the economy so that the new business owners will have to fix both companies. This is the only way to get access to the licensing rights and govt distribution channels that are necessary for business success in China.
If our country turns to the public option, would it be possible for these new govt employees to come up with ideas that increase efficiency? What if that means getting rid of a GS job (govt service job)? One thing is for certain, it is impossible to fire a bureacrat or GS employee. Neil tells stories all the time of how poorly performing employees are promoted to get them out of someone's hair. Surely a private insurance company can compete with that kind of inefficiency, but should they?
Apparently, there is an issue with insurance companies merging. As the options have disappeared, the competition in the insurance market decreased. As a result, the insurance companies can charge whatever they want and cover whatever they want, because who else is the patient, the consumer, going to turn to? For example, maternity benefits are not automatically covered.
US News and World Report says:
"The near total collapse of competitive and dynamic health insurance markets has not helped patients," AMA President Dr. J. James Rohack said in a new release. "As demonstrated by proposed rate hikes in California and other states, health insurers have not shown greater efficiency and lower health care costs. Instead, patient premiums, deductibles and co-payments have soared without an increase in benefits in these increasingly consolidated markets."
Rohack added that a lack of competition in the health insurance industry "is clearly not in the best economic interest of patients," and the AMA wants the U.S. Department of Justice and state agencies "to more aggressively enforce antitrust laws that prohibit harmful mergers."
End of part I.