The Oath

The new semester is off and rolling and this time around, I have a job on campus! One of my professors hired me to help with some research, mainly doing some statistical analysis on some data that another university is collecting related to something in the power system. I don't know much about it right now as things are just getting started. Stay tuned.

As part of getting this (paying) job I had to fill out paperwork to get hired on as a student at Wichita State. This was a mostly harmless but very repetitious process as I wrote down the same information on multiple applications: federal documents, state documents, university documents, background check authorization, etc. I'm sure I went through the name/address/birthday routine at least six times. It is in moments like this that the engineer in me kicks in and wishes for some kind of centralized database where all of this can be stored and easily accessed. It is then that the libertarian in me kicks in and points out what a dangerous idea this is. Oh well.

The most unusual part of the application was a simple one-paragraph section of the state paperwork which I will reproduce here in full:

STATE OF KANSAS EMPLOYEE’S OATH

K.S.A. 75-4308 et seq requires that the following oath from K.S.A. 54-106, be signed by new employees before entering the duties of employment and before funds for services may be disbursed:

I do solemnly swear (or affirm) that I will support the constitution of the United States and the constitution of the State of Kansas, and faithfully discharge the duties of my office or employment. So help me God.

___________________________________ Employee’s Signature

Not making this up at all. Coming across this stopped me in a bemused pause. I guess I was effectively going to be a state employee so I guess that means I have to take an oath of office. Sadly, I don't have a working knowledge of either the US Constitution or the Constitution of the State of Kansas and I hope that whatever knowledge I do have combined with my ability to "discharge the duties of my office or employment" will be good enough.

Hollywood and the Feel-Good Story

Katie and I went to go see "The Blind Side" yesterday afternoon and both of us enjoyed the movie. It was a well-crafted, feel-good, inspirational story that was at least loosely based in reality. For those of you who haven't seen it, the plot focusses on an older teenager, lost in the foster care system, who is taken in by a family and through a lot of effort, is able to succeed in school and football in a way he never was before. The plot is not horribly creative (hard to do in a feel-good movie) but still entertaining nonetheless and, using the Creshell Pennington criteria, "its a good movie because it makes your cry."

I have no problem with stories like this making it to the big screen. Like many movies, there is some degree of "escaping from reality" that many people desire to see and following a story full of winners makes everybody happy when they leave the theater. There is a place in the spectrum of films for stories like this; dozens more have been made and will be made where the down and out are helped to success by caring outsiders. School teachers tend to be featured in such films.

All that said, I do have a nit to pick with this movie because it implies that the problem that many of the "under-privileged" have is a lack of opportunity, that nobody seems to care enough to give them a shot. These films tend to portray a situation where the key to changing lives is that loving mentors give these children the opportunity to succeed and they will. In this film, the family that takes on the down-and-out youth does invest quite a bit; they provide him a home, clothes, food, a tutor, and genuinely make him a part of the family. Based on my relatively limited experience with working with at-risk kids, I'd have to say that the story ordinarily isn't as simple as that. Often, even when given opportunities, kids in the these situations do not respond well and often end up making choices that are self-defeating. More simply put, coming from a broken home can't be fixed by a change in circumstances, at least for most people.

Most kids who have difficult home lives have more than problems than the externalities of these situations; its more than not having, say, a reliable source of food, money for school supplies, a quiet place to do homework, parents to offer support and encouragement, etc. These are all real barriers and some of them can be overcome simply; the federal school lunch program is an example of such an attempt. More fundamentally, though, these students have a problem with developing good decision-making skills and behavior patterns that will allow them to grow into healthy, mature adults. You might call this "having character", in a non-moral sense of the word.

The cause for this lack of character development is usually straight-forward: the naturally influential adult figures in their lives (mostly parents) often have not been good role models and have failed to instill these good habits to their children, usually because they don't have the habits themselves. The damage done to these students has been deeper than a school-lunch program or after-school tutoring can fix. It requires digging in and making a significant investment of time and energy. It requires a great inconvenience on the part of those seeking to help and, in my experience, will be more frustrating than rewarding for a very long time.

The church I attend is partnered with an organization called Youth Horizons that seeks to provide mentors/role-models for kids who are in these kinds of difficult situations. I have many friends who are mentors and know a few of the stuff there decently well. For all of them, it is a labor of love. There is no high-altitude "love-bombing", this is "in the trenches" kind of work that isn't done in a casual way. The only reason they stick with it is that it can sincerely believe that this kind of work can actually change lives and have meaningful impact down the road.

I had a friend from my time in Boise that, in his thirties, finally was reaping the benefits of investment that others made in his teenage years. Fifteen years after his time in a church youth group where he had many loving adults pouring into his life, he realized that his life back then was better than it was now and that he needed help like that to get his life in order now. He moved back Boise, where his old youth pastor was working, still in ministry, and asked for help.

I ended up connected with him and saw a humble man who had realized that many of his choices in life had not played out the way he hoped and that he needed a fresh start under the influence of people who cared about him. There were some externalities that needed fixing: he needed a cheap place to stay, he needed a job, he needed help getting his finances in order. More importantly, though, he realized that he needed a new character. He needed to learn how to make good decisions for himself, he needed to learn how to make short-term sacrifices for long-term gain, he needed to learn how to follow-through on commitments he made. He was extremely teachable and a joy to walk along side as he tried to re-build his life and it was all because of the investment made when he was a young adult.

Clearly, children who don't develop character in their youth grow up into adults that also lack this kind of character. Being ten or twenty years older than a teenager does not guarantee character; an individual has to choose to learn and grow from experiences in life to gain that character. Without that character, they lack the ability to raise their kids in a more successful way than they know. You can't instill a value in your children that you yourself don't have. When people talk about the problems coming from broken families, in my mind, this is the fundamental issue, this cycle where a lack of character continues to perpetuate itself from one generation to the next. We all "inherit" the failings of our parents; they are the most influential models we have and whether we like it or not, we bear their fingerprints on our lives.

I hope that movies like "The Blind Side" inspire people to be more involved in their communities, helping students who have rough backgrounds to grow into men and women of character. Steel yourself, though, because it probably won't be as easy as what you see in the movies. Count the cost and make the investment.

Merry Academic Christmas

Well, its been a week since my third semester at Wichita State ended; just one more to go until I'm done with my Master's. I took all my tests two weeks ago (the week before finals) and had a final presentation the last day of finals week. Unlike last semester, our presentation went nearly exactly as planned and the presentations by my classmates were also much better than in previous semesters.

My final semester will be different than the past three. I'm only taking one class and the other six hours will be thesis. I've already unofficially started on it this past fall and have made a good start, getting a lot of the time-eating logistics and co-ordination with other people worked through. Now I just have to, you know, do my part. Developing some software, doing some experiments, lots of writing, that kind of thing.

In addition to my official school-work this spring semester I also got a job with my thesis advisor as a research assistant. We haven't nailed down what specific project I'll be working on but it'll be 20 hours a week and it looks like it will continue into the summer as well. This is essentially the work/school balance I had when employed at Cessna, just without the commute time. I'm excited about getting a chance to see what the research world is like and hopefully get some ideas for further research I could be involved with.

So, yeah, after talking with my wife we've decided I should go on to do my PhD and unless something crazy happens it will be at Wichita State. I've done a lot of reading over the Christmas break from other graduate students who have written about their experiences on the Web and it is echoing what I hear from grad students I know personally: having a good advisor is gold and I have a fantastic advisor. I know the department well, am interested in what my advisor is working on and have enjoyed my classes so far.

One of the best articles I've read recently had some very good advice: write down and define very specifically what you will and won't do for a PhD. Katie read the article too and she is a big fan of this idea, defining a line that will set expectations for the next several years of school. I'll have to think through this before I put pen to paper but the exercise will be invaluable. Part of the appeal of Wichita State is that, given our state in life and circumstances, it is a program that I can manage. If I was ten years younger, without family, and able to move anywhere in the world, the situation might be different. That's not where I am now, though, and so single-minded devotion to a PhD is not an option; I know that I'm not willing to give all my life now for the degree.

There are many great things about this Christmas but having a path for the next few years nailed down (Lord willing) is the best Christmas gift.

Two Wheels Through Winter

I rode my motorcycle to class today. The high for today in Wichita was 24 'F and I've ridden both my bicycle and motorcycle in colder weather. When I lived in Boise, I would routinely ride by bicycle all the way through the winter. Boise is pretty dry so I rarely had to worry about snow and ice and since I was moving the whole time, only my fingers and toes would get cold. I would often end up riding with my jacket unzipped due to all the heat I was generating.

Now that I don't have a commuter-worth bicycle, I'm on my motorcycle all the time. Many people think that riding in the winter is crazy, it being so cold outside. It helps that my commute is only five miles or so and I don't ride with snow or ice on the ground. When the temperature doesn't rise above freezing, I would be hard-pressed to say I enjoy the ride or find it comfortable. Its over soon enough, though, and I can manage.

I was reminded a week or two ago why I do ride motorcycles when we spent over $1000 on car repairs: its cheap. $5 for fuel every two weeks, insurance is $100 a year, I can do most of the repairs myself and though parts aren't "cheap" they tend to be cheaper than a comparable part for cars. After paying $350 dollars to have the power window mechanism replaced, I get almost giddy when I think that this is a repair I'll never have to make on the motorcycle. No air-conditioning, no heater, one cylinder, four valves (which I just adjusted last weekend), one carburetor, two wheels. There's something to be said for simplicity.

Electric Cars

I just got back from a presentation by one of my class-mates who was giving his PhD dissertation proposal. His topic was the performance of the future "smart grid" and one of the major factors was the impact that electric cars will have. He said, and I'm assuming he did the research and isn't making this up (a bad thing to do if you're trying to get your PhD), that the Chevy Volt is estimated to use in two months of operation the same amount of energy an average household would in one year.

Think about that. It may be cheaper per mile to operate an electric vehicle but that may only be true if you're the only one that has one. Utilities will have to build more power plants, the distribution grid will all have to be massively upgraded for all the additional energy it will have to provide, rates may go up. Buying a Chevy Volt and parking it in your garage will, to the power company, look like you just built six more homes to live in and are powering them all from the same wires that are running to your house right now.

This seems like big deal to me. I'm glad people like my friend are doing the research on how to make this work now before it becomes a huge issue.

Admitted

I just got a letter from WSU stating that I have been admitted to their PhD program for the fall 2010. This is not really a surprise considering that they admitted me to their Master's program and I've done quite well in it. Its still good to see it in black and white, though.

So if I decide to go the PhD route in the fall, I've got at least one place to call home. I plan on applying to at least one other school and am debating/agonizing about whether I want to go through all the effort of applying to one of the Big Name schools. I would probably have to retake the GRE test because my score is very mediocre (when compared with those who are admitted to such institutions). More effort, more studying, more tests....

This PhD decision is not easy for me. Though Wichita State is far from prestigious I have found a great professor here who would serve as my advisor and he is well-respected in the field. The quality of the eduction here is pretty good, though not as rigorous as I was hoping. (On the other hand, I don't know if my life supports a rigorous program at this point.)

The big problem with Wichita State is the name recognition. If I get a PhD from Wichita State, nobody is ever going to look at my resume and think big things of me. In general, I don't care much about this but there are a very small group of people I do need to be impressed with me: those that might want to hire me. In this single regard, Wichita State fails me. In fact, this is my only serious reservation about working on a PhD here; will I be able to have a career in academia after getting done?

I guess we'll just have to wait and see.

New bathroom floor

The last home improvement project for the season (if you consider October part of the spring/summer season) was replacing the floor in the front bathroom with, you guessed it, tile. In the process, I managed to break the old toilet and thus turn a $200 project into a $450 project. As you might guess, breaking the toilet was not a high point of the project for me.

Just like tiling the kitchen and dining room, under the carpet I found vinyl on particle-board subfloor. All of it had to come out....

and be replaced with plywood.

Once the new plywood was in, the Ditra was laid on top (shown here prior to mortaring onto the subfloor).

I spent several hours cutting all the tile first which is a bit risky as it is hard to keep the tiles from shifting and the cuts consistent. Once all the tiles were cut, they got mortared in and let set for a day or two.

Grouted.

The new toilet gets installed and everything gets caulked and prettied up.

New Backsplash

Fulfilling a promise to my wife when we redid our kitchen floor, we finally got around to doing the kitchen backsplash. Mainly due to size, the backsplash went a lot faster than the floor. We tore the old tiles out in a few hours (a few weeks before), set the new tiles in four or five hours one day, and grouted in a few hours a week later. Though she had trepidation about her choice of tiles, Katie is very happy with them now that they are installed.

Original, boring small white square tiles:

Fancy new brick tiles, prior to putting in the grout:

Backsplash after grouting:

Completely cleaned up and finished.

Bye-Bye Bicycle

Last Thursday my bicycle was stolen on-campus at Wichita State University. I'm normally very diligent about locking it up but forgot to when I made a quick run into the athletic center to get something out of my locker there. I was away from the bike for 30 seconds and when I came back it was gone. Shame on me for not locking up. Shame on the thief for taking something he/she did not own. I'm hoping that another student on campus took it and I'll spot it again soon but more than likely it is a lost cause. For now that means I'm riding my motorcycle to school and maybe someday I'll get another bike. Maybe.

Its a shame it was lost, though, because I actually used it quite a bit. It didn't have that many miles on it either, probably about 10,000 or so.

Phone Number Mix-Up

I just got a call from a person unknown to me who has a phone number very close to mine. He sounded like an older gentleman and was having a problem with people calling him on his cell phone when they were trying to reach me. He was hoping that I could help him do something about this.

I was a bit perplexed. I know my phone number pretty well and may occasionally give out an incorrect variation of it but I assume I get it write most of the time. Clearly, I don't give out the wrong number with the intent of preventing communication between them and me. Similarly, I have not been not instigating some kind of prank on him by passing around a bogus phone number. From what he said, there have been quite a number of people calling him instead of me, ranging from the unemployment office to the insurance company to my friends.

I told him I didn't see what I could really do to help the situation; if I've handed out a bad phone number there's not much I can do at this point to keep people from using it. It seems more likely to me that people were mis-dialing my number than have it written down incorrectly but he didn't seem convinced of this; hence his call. He suggested that whenever I meet up with my friends or go to a place of business that has my number I double-check and make sure that their records are correct. This seemed like a reasonable suggestion but unless I make a campaign out of it and call all the appropriate people myself, it will probably take a while. The hardest part will be remembering to make a point of asking.

Oddly, there is another older couple in my life that has endured a similar mix-up. The couple the lives two doors down from us has a similar looking house (shape, color, yard) and when we first moved in, they got a lot of people knocking on their door looking for us. They seemed more amused by it than anything; we still have a good, neighborly relationship with them

Obama's Healthcare Speech

Katie and I didn't have a chance to catch this evenings speach live so we read it together before going to be last night. This is the only reading we've done so far on Obama's proposals and what you're about to read is based entirely on that speech. You can be sure that I'll be doing more reading, both from those who are support and oppose this bill but for now, I'm mulling over what was said during the speech. And, as always, the devil is in the details. We've all seen good ideas get ground into worthless laws by the legislative process. The specifics of the bill (which I haven't seen yet) could make the intentions expressed by the President into a unhelpful legal mess.

Using lists as a crutch, here are my thoughts:

• Federal Cost Controls I think that our national deficit is a very significant problem that seems to be commonly overlooked when it comes to legislation. I'm a member of the generation that, unless something is done, will literally be paying the consequences of our governments overspending and want something done to address the deficit sooner rather than later. I am glad that the President wants to include provisions in the bill to require the program not add to our federal deficit and if the savings the bill is intended to produce don't arrive, then it would require cuts in the budget to keep the plan budget-neutral. Not knowing any details, I'm skeptical of the level of efficiencies to be gained through the other aspects of his proposal but I am quite glad to hear that there are concrete and realistic measures being taken to keep this program from growing out of control.
• Patient Cost Controls I was most surprised to hear the President propose a requirement for annual out-of-pocket maximums and removal of lifetime maximums from insurance policies. As a patient this is good news but it is not clear to me what the long-term consequences of this will be. Insurance companies have used things like a lifetime maximum to prevent a few patients from costing the company an extra-ordinary amount of money due to having to cover expensive treatments. This is another piece of the puzzle that prevents insurance companies from only insuring the healthy (see below) and because of that, I'm generally in favor of it. There's no such thing as a free lunch, though, and I wonder how this will play out over time.
• Required Coverage I like both sides of this coin, both requiring nearly everybody to buy health insurance and requiring insurance companies to ignore "pre-existing conditions" when writing policies. These two items go together, hand-and-glove. As the President said, many insurance companies have (logically) sought to reduce their liability by trying to only insure the healthiest individuals. By removing the ability to deny coverage to anybody based on pre-existing conditions (that is, things the insurance companies know will cost them money) this bill would force the insurance industry to treat all of us like potential customers. By requiring everybody to have insurance, we make nearly our entire country the customer-base for these companies which should be something they like. They just can't pick and choose anymore and have to treat us all the same. This is a big first step in divorcing health insurance from our employers which should give us, the workers, more security by making it easier to switch employers.
• Market Forces and Public Option The key to making me happy with a public option is that it is expected to operate more like a non-profit rather than a corporation subsidized by tax-payer dollars. This seems like a great idea to me; fighting the profit-driven insurance companies with a non-profit, patient-oriented entity. If a for-profit company can offer policies that are competitive with the public non-profit policies, then they deserve the money they earn. If they value they add is not enough to justify the price of their policies or if they become solely profit-oriented at the cost of making policy-holders satisfied, then they'll lose business. More generally, I see no problem in having for-profit businesses compete with non-profits even if in this case the non-profit is a government entity. The playing field is level as long as this government non-profit must be self-sufficient. I'm not totally clear on this but Obama said in his speech "Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it...." If my employer offers health insurance but I find that the public option is better for me, can I choose it? I think I need to be able to do that for there to be a true marketplace where choices force competition. In short, it seems like the public option might be a good way of introducing more market forces.
• Waste and Increased Efficiencies The $900 billion price tag (over ten years) for this reform is intended to be paid for by reducing waste and inefficiencies in the current system. Specifically, this alleged waste resides in the way Medicare/Medicaid is handled by the insurance companies in their attempt to increase profits. I'm skeptical of the amount of waste alleged in the President's speech but I'm not in a good position to know one way or the other. I hope the President has good data in this regard because the ability for this reform to work well for all relies on these savings. As the President said, if these savings don't materialize, expenses have to get slashed and the reform gets gutted.
• Subsidies From what I've read, if don't get insurance through your workplace and the open-market (with both the traditional for-profit insurance companies and the public non-profit company) can't offer an affordable policy, then a tax credit will be given to you which I assume is intended to make the policies affordable for low income earners. There is also a "hardship waiver" for individuals. I'm confused by this. Does this mean that as we move down the income scale the tax credit increases but insurance is still required until a given (very low) income level where the requirement to carry insurance is removed? If this is the case, I hope that the tax credits stop at that level as well.
• Uninsured There will still be uninsured living in the US. The President made a point of saying that the insurance reform will not help illegal immigrants and he also said that there will be a "hardship waiver" for those who just can't afford health insurance. There is nothing in the speech about hospitals being allowed to turn away uninsured so I'm assuming that those that are insured will be indirectly subsidizing those that aren't insured when they go to the hospital. (Hospitals make up the money they lose on non-paying patients by raising the prices over-all for paying patients. Its the same way stores make up money lost to theft; they raise the prices on the paying customers to cover the loss). The percentage of uninsured needs to be very low for this to work.

Katie and I came up with a few items of note that this bill didn't seem to address:

• Health Insurance Complexity As you've heard me rant about before, right now our health insurance system is quite complex. There is very little transparency in pricing, it is hard to shop around, billing overhead is significant for most providers, and the whole in-network/out-of-network stuff can drive you crazy. I heard nothing in the President's proposal to make any of this simpler. Whether you have a private or public insurance plan it sounds like you'll still be jumping through the same hoops. Providers will still have a mountain of paperwork to deal with, patients will still have to try to wade through bureaucracies to figure out how much a given procedure will end up cost them. I haven't had any personal experience with Medicare/Medicaid so I don't know if having the government as the insurer makes the process easier but I doubt it.
• Healthy Living There didn't seem to be any effort to include in the bill some kind of provision to encourage us as citizens to live healthier lifestyles. Legislation like this is not easy to write but I can't recall anything the President said that would encourage people to make better lifestyle choices. There was some talk about encouraging marketplace competition so maybe insurers will come up with a way to encourage us to reduce their costs by going through some kind of wellness program. Stealing from Michael Pollan, I would love to see our government overhaul the Farm Bill in such a way that it was not so cattle/grain/pig-centric. Are their good reasons for not subsidizing fruits and vegetables instead of corn which often gets made into either cattle-feed or corn syrup?

The big take-away: health insurance will be required by law just like auto insurance is. For those who already have insurance, the cost of complying with this law should not increase and may decrease (depending on how effective this new insurance market works and other devilish details). For those currently without insurance, this will be an increased cost that there won't be any legal way around. I don't know if, on average, the dollars spent on health-care per person will increase or decrease. The hope is that by growing the market and forcing it to run more efficiently (by introducing a public non-profit into the competition) that the average will stay roughly the same while providing insurance to many more people. In short, economies of scale might just make this a win-win.

The Great Car Exchange

This past Labor Day weekend I helped do a favor for my uncle living in Oregon by driving the car his son has in Kansas City half-way to Oregon and there, meeting with another party, switching cars and driving the replacement back to Kansas City. Actually, its a bit more complicated than that but that's the gist of it. My cousin had a rear-wheel drive Volvo and the weather in Kansas City can be such that rear-wheel drive is a bit dangerous. My uncle had a front-wheel drive Volvo he wanted to get to his son and recruited Katie and I to help make the car exchange happen. As it turns out, my uncle also recruited his brother (my father) to do the western leg of the drive so I also got to spend half a day with my parents in Evanston, Wyoming where we made the switch. Two thousand miles of driving, three days, several bottles of root beer. Good times.

One of the great things about the drive was getting to see a bunch of wind farms near the interstate. I'll put a few pictures up here but there are more on my Flickr stream. (I must admit, though, that once you've seen one wind turbine you've kind of seen them all. At least when you're driving by at 75 mph. Up close its a different story.)

Passing through Concordia, KS we saw this carved mural on the side of the tourist information/museum. I don't know how it was done or have ever seen anything like it.


Last but not least, in honor of a dear little girl I know who loves a DVD titled "I Dig Dirt", we saw one of the machines featured in said DVD. The photo is not near as impressive as seeing it action, even if just while driving by.

Return Paranoia

One of our rear turn signals burnt out yesterday and so before heading out on a road trip this weekend, I went to AutoZone to get a replacement. I used the convenient part selection book to find the correct lamp and purchased it. Upon heading home and removing the headlight cover I found that I had purchased the wrong lamp. Pulling out the broken lamp as a reference I went back to AutoZone, found the lamp I needed, and went to the counter to make the return and purchase.

The clerk started on the return first and instead of just scanning the item and asking if I wanted it back on my credit card she asked for my name, phone number and address. I told here I didn't want to provide that information and she said for returns it was required. Not believing this, I clarified that even with a receipt and even having just purchased the item five minutes ago (literally, I live no more than five blocks from the store) they needed all this information. She said yes, the computer would not allow a return without this information. After thinking this over a few seconds I decided that it wasn't worth getting my name in their database for who knows what reason and told her I'd keep the wrong lamps and go buy the correct lamps at another store. Fortunately for me, one of their competitors is five or six blocks the other direction from where I live.

I'm not normally a big privacy advocate but am tired of getting junk mail and phone calls from corporations (despite being on the "Do Not Call" list) and usually decline to provide this information to businesses. Until now, none of them have refused to do business with me because I won't give them a name, phone number, or address. This was a first and its a bit scam-y that you probably don't know they'll want this information until they have your money and you'd like to make a return. All the more reason to make sure you buy the right item the first time.

Which, by the way, it turns out I did. I was looking in the wrong spot for the burnt-out turn signal and once I figured this out, realized I had purchased the correct part. In this one special case, I was able to stand on principle AND not be inconvenienced. I still don't plan on shopping at AutoZone any more, though.

School is my life

As I suspected, with school now back in full swing I am once again fully busy. I've turned in my first two homework assignments and have started doing some background reading for my thesis. Due to a retirement and my lay-off, I've switched topics for the thesis and have to start over pretty much. Fortunately, I wasn't too far along in the process before all these changes hit. Even though we haven't decided that I'm doing a PhD, it is enough of a potential that I've got a handful of applications I'll have to do this semester as well.

So, consider this a pre-warning that my posting will probably get sporadic, just like they've always been.

(Oh, and we've finally got all the equipment we need to replace the backsplash in the kitchen and the front bathroom floor. That will also be sucking my time. Did I mention we're driving most of the Labor Day weekend to help move a car from Eugene, OR to Kansas City, MO? Fun times.)

Camping and Botanica

More photos are now up on my Flickr stream from a camping trip in Colorado with Katie's parents and a trip I made to Wichita's Botanica Garden. Enjoy!

Health Insurance Reform (part 2)

(Part 1 here.)

One of the podcasts I listen to (Planet Money) has lately been exploring the health insurance reform from an economics angle. They had a guest on this last Friday (Aug. 21st 2009) who made an excellent point that further illuminates to me that something is fundamentally wrong in the way health care works in the US.

DNA testing is slowing and surely growing in common practice. We aren't even close to something on par with the ultra-fast and comprehensive testing portrayed in Gattaca but were clearly headed in that general direction. There are tests now that can identify genetic markers that have been correlated to many types of cancers and other common genetically-induced maladies. All other things being equal, these tests are valuable for patients because they allow us and our doctors a more insightful view of our health. With more information we can make better decisions and, depending on a situation, may have incentive to make lifestyle changes to counter-act some of our genetic pre-dispositions. Using a very broad brush, I would say genetic tests are good for patients health...

... except if that information is by some means conveyed to a health insurance company and they use it to deny coverage. If I know that I have a genetic marker for a certain disease and don't disclose this to the insurance company when I try to buy a policy on the open market (that is, not through work or some other group plan), the insurance company has the ability to cancel my policy if or when they find out (called a rescission) . There was a recent hearing in Congress where health insurance executives were called to account for abusing this area of the law; it was not pretty. I am better off not having this information if I am trying to buy an individual policy because it isn't lying if you don't know the truth. Ignorance of my medical condition works to my advantage...

... except that this is my health we're talking about. I don't want to avoid information that could help improve my health so that I'm eligible for health insurance to treat the life-threatening disease I am genetically pre-disposed to. You see the problem? The incentives in our current system are all wrong. The health insurance companies don't want to have to cover people who are more likely to develop serious medical problems due to genetic pre-dispositions and patients want health insurance but shouldn't have to remain ignorant of any the results of any genetic testing for fear that they won't be able to get coverage.

The problem, once again, is revealed in the semantics: health insurance isn't really thought of as insurance any more, at least not by patients. We all get sick, we all need to go to the doctor, we all will have medical bills to pay. It isn't a matter of "if" but "when" and "how much". For the health insurance companies, I think "insurance" is the right word. They are thinking entirely in terms of liability and risk. We are insuring 500,000 right now: How many are going to get cancer? How many will be in a car accident? What is the average cost per patient? What can we do to improve our odds of having to make a big pay-out? Its all a numbers game and they are in it for a profit.

The fact that health insurance companies would like to have as much genetic testing information as possible so that they can remove as much risk from their pool of customers shows that something is wrong: who is going to cover all of us with genetic propensities that are completely out of our control? The insurance companies want to make as large a profit as possible and, to the extent the law allows, are going to do what they can to maximize that profit. That corporations are interested in profits should not surprise anybody. They have a strong incentive to reduce and eliminate costs by being as selective as they can with who they cover.

Our system is broken when information that is good for our health turns out to also be too expensive to know for our own good.

First day of class

I had my first class of the semester this morning at 8am. The experience was completely unlike a year ago when I started my graduate work. Then I spent fifteen minutes wandering around campus trying to figure out which poorly labeled building I needed to go to. When I finally found the lecture hall, I entered to see a sea of students from south Asia; I was probably one of ten US citizens in that class of over 100. I knew nobody in there.

Today, I walked into the much smaller room to see eight other students (the other five showed up after me). I recognized all of them and knew seven of them by name. I was good friends with two or three of them. Today was much better.

Day before school

Since today is my last day of my summer break before classes start again and I've finally got all the computer stuff here at working the way it should be, I'm finally going to put some of the pictures we took in Hawai'i up. I'll just be putting a few here but you can see a good deal more on my Flickr stream. (One of these days I'm going to get much better at keeping it up to date.)

We spent a good deal of time snorkeling, a new adventure for both of us. Snorkeling is super easy and in waters like we experienced with lots of wildlife, it was fun, fun, fun.

During one of our boat tours we saw both a monk seal and a sea turtle. It was humbling and awe-inspiring to see them both move through the water so easily and unencumbered.

There is a great deal of elevation change on the island that afforded some fantastic views

And of course, sunsets over the ocean are always great.

Like I said, there's more to see on my Flickr stream. Vicariously enjoy as the school year starts up again.

Health Insurance Reform

I don't know much about the specifics of the current discussions and debate regarding health insurance reform. Since Congress has not finalized a bill in both houses prior to their August recess, I believe a lot of the details are still up for debate. What I do know about is my experience with health care and health insurance when I injured my back a few years ago. Based on that experience, I have some thoughts and opinions on how this system should work. More specifically, my thoughts are more along the lines of identification of problems I experienced. Its much easier to point out flaws than develop solutions and after thinking over this stuff for a few years, good solutions still allude me.

The trend in health-insurance I've noted is the move to HDHP (high-deductible health plans) and HSA (health savings accounts) and which usually are presented right along with the buzzword-BINGO term of "consumer-driven health care". The idea behind consumer driven health care is to bring a market-based approach to making health care better and more affordable.

The first part in this plan is the HDHP. Deductibles are raised to several thousand dollars in an effort to make the health-care recipient have "skin in the game". The "consumer" (more on the use of that term later) aka "patient" is responsible for paying all of that deductible and so has an incentive to shop around and find the most economically efficient way to get the services he/she needs. Its the consumer's money paying for the service and just like consumers have for ages, they will force the market (health care system) to provide quality products/services at competitive prices.

The trick to making HDHPs work is the second prong of this new idea, the HSA. The HSA is a tax-advantages account that holds funds used to cover costs of health care for the account owner. Money from these accounts can only be used for approved health-care services (physicals are OK, going to the witch-doctor is not) and all contributions are tax deductible. Also, this account is independent of the employer; when I lost my job at Cessna I kept my HSA and can continue to use that money for any health expenses I may have in the future.

The first real catch in consumer-driven health care shows up when the question of who is mainly responsible for funding the HSA arises. At Cessna, the employee is. The company contributes about 20% of the annual maximum contribution and the employee can choose to contribute more (tax-deductible) money or not. In my case, as a Cessna employee, the result of this was a significant increase in the cost of health care by me, the employee. I was responsible for 80% of the annual deductible whereas before this change, it was more like %40. I know of two other companies that have HDHP/HSAs and the employer provides the majority of the funds. In these cases, the employee bears roughly the same cost burden as they might under a more traditional plan but now has an incentive and discretion to use those funds more wisely.

The HSA funds aside, though, "consumer-driven health care" has a fatal flaw that will somehow need to be addressed if it is ever to take hold. The root of the problem is actually revealed in the syntax: "consumer". Consumers are people who shop around, look for good deals, make informed purchasing decisions, do their research, drive markets to better value and better products. Very few of these apply in a health-care setting.

Firstly, patients have a SEVERE knowledge gap regarding what kind of treatment and care they need. This will always be true and this is why we go to doctors. Granted, if an individual has a long-term specific condition, he/she can actively educate him/herself and ask intelligent questions of the doctors. Cancer patients tend to become more educated over time because they have an incentive and the time to become more educated. But nobody, when presenting with a severe pain in the stomach for example, will wait to hear the doctor's diagnosis, go home and read up on it, and decide whether he/she agrees with the doctor. As patients, we must place or trust in the our doctors and do the best we can to be informed as we go through treatment. In this regard, we are never informed consumers in the health-care market.

Secondly, as things stand right now, patients/consumers have a very hard time determining the price for a given procedure. Have you ever tried to shop around for routine treatment, trying to get the best price? I dare you to try. I started and gave up quickly. The structure of the health insurance system right now is not designed to easily define the price of a given procedure; there is no price tag for a colonoscopy (as was my case).

I know I won't get this exactly right but here is how the billing system worked when I was under the health insurance at Cessna. The health care provider has a number that most closely approximates the sticker price for a given procedure. If you were independently wealthy but had no insurance and walked in and asked for that procedure, that's how much you'd pay. If you do have health insurance, though, your insurance company has signed up with one or more "networks". I don't know all that goes into being part of a network but I do know part of it: price control. My health insurance, by being part of a given network, had gotten the health care providers to agree to charge a certain amount for a given procedure. By being in that network, the health care provider has a greater likelihood of seeing more patients because the health insurance company provides financial incentives to the patients/consumers to use in-network providers. So, if I go to in-network providers, rather than charging me the sticker price for the procedure, they charge me the lower network price and the provider sees more people like me who are trying to control their own health-care cost. You still with me?

Now, with the reduced price, the health care provider sends the bill off to the insurance company (as a courtesy to the patients, rather than making them deal with this mess). The insurance company takes that bill and looks at the specific agreement they have with me, the consumer/patient to determine what, if any part of this they will pay. Have I met my annual deductible? Am I in the cost-sharing payment zone? Is this preventative care that the insurance company pays for entirely? Is treatment even covered? (Have I gone to the witch-doctor who is then trying to get paid by the insurance company?) The health insurance company runs the claim through their computers and comes up with the amount they will pay the health-care provider. A payment for that amount is made.

The ball is back in the hands of the health-care provider. Odds are, the amount that the insurance company paid is not sufficient to cover the bill they sent. The provider then has a choice; do they bill the patient for the remainder or do they just absorb the loss. Most of the time, I'm guessing they bill the patient. To me, the end consumer/patient, this is my actual out-of-pocket cost.

Do you see all the machinations that number went through before I eventually got the bill? Trying to predict this number can be very difficult. The health-care provider should be able to quote the in-network cost they will bill the insurance company and it should be possible to call the insurance company and, if given the right information, they should be able to have a very good estimate on how much they will pay the health care provider but I'll let you guess how easy and how many phone calls it would take to figure out the final cost to the consumer/patient. If it was two phone calls totaling less than 30 minutes, I would be thrilled. In my experience, it was nowhere near that simple.

(As a side note, this billing shenanigans is entirely avoided for organizations like Kasier Permenante, a health care provider that is also an insurance company. There is no external billing, no passing-the-buck. All of these costs are monitored and set in-house and because there is no distinction between insurer and provider, the final cost is much more easy to determine up-front. Also, the patient never has to wonder if a given procedure is covered by insurance; if the doctor's prescribe it, the procedure is covered.)

In my case, it gets worse. As an example, my doctor recently suggested I have a colonoscopy done and I started trying to look into how much this would cost. It turns out that there are several parties involved in a colonoscopy. There's the facility (provides the location for the procedure), the doctor (the one actually doing the procedure), an anesthesiologist (keeping the patient safely unaware during the unpleasantness) and if a biopsy of something in the colon needs to be done, a pathologist of some sort. In the case of my health care provider, my doctor would perform the operation and the clinic I went to had a colonoscopy suite. When I called asking about prices, my clinic was able to quote to price they would bill the insurance company with a high degree of certainty for those two parts of the bill. The anesthesiologist, though, was brought in from out-of-house and any one of several may be used during that procedure. Each anesthesiologist has a different cost, I had no control over which one was used the day of The complications for the pathologist was similar.

So what I am supposed to do as an empowered consumer in this consumer-driven health care? How am I supposed to compare prices when there is literally no define-able price tag? Do I go look for a larger clinic here in town that also has a colonoscopy suite and also staffs an anesthesiologist and a pathologist so that all costs could be known ahead of time? That wouldn't even solve the problem because then I would only have a price for that clinic and not knowing what I was getting for that price doesn't really help me. How can I compare prices when I can only get one place in town to even get me a quote, anyway?

My point, if it is not utterly obvious, is that consumer-driven health care is dead in the water until a price tag for procedures is readily available. There is no way it can work until I can call five colonoscopy providers in Wichita and get five prices. Even then, I face the difficulty of not knowing what I'm getting for my money? Do I go with the cheapest provider? Do I go with the provider I know best? How do I learn about each of these providers? Online reviews for doctors? Ask around?

You see, we aren't consumers when it comes to health care; we're patients. There may be some areas of health care that could eventually fit a market-based model. Colonoscopies are routine; it may be possible to create a health-care system where a consumer can effectively shop around for a colonoscopy using a traditional consumer mind-set. Maybe there will be online reviews for colonoscopy providers. Maybe a clinic in town will specialize in colonoscopies and find a way to provide a cheap and effective way of doing the procedure and they end up doing most of the colonoscopies in town. It could happen and I don't necessarily think it would be a bad thing. I also agree that one way to control health-care costs is to provide incentives for patients to get the least expensive, best treatment they need. Having skin in the game is not a bad thing at all.

But we're patients, not consumers. We're not customers and clinics are not merchants selling wares. At some point, health care is a highly personal and personalized/customized system. Whatever the reform brings, if it forgets this point we all loose. There is no other way to keep people healthy than by treating, handling, and caring for them on an individual basis, case-by-case. This is why we go to see doctors in person, often ending up waiting longer than we'd like in some lobby. We need that individualized care and market-based models, if permitted to control the entire system, do not afford the individual.

Scooter is sold!

Today I finally realized one goal I had for this summer: the sale of my scooter. In late March I replaced my scooter with a more traditional motorcycle but due to a lot of factors wasn't able to sell it until later in the summer, after we got back from Hawai'i. I put it up on Craigslist a while back and have had a fair number of inquiries, a few offering to buy at half the offering price, one or two that came by to looker, but no serious offers. Until today.

I was able to sell it for about what I hoped and I'll be able to get a refund on registration which is only a month or two old. As a bonus, we now have more space in our garage and my wife is very happy to be done with it.

Now that I'm done with it, I'm still can't say that I think it was the best choice for a first bike, especially given the fact that I was able to buy my current bike for less and I suspect it will last longer. The scooter did fill its role in providing cheap transportation for three years, though and in that regard, I can be satisfied. The funny thing is that now that I'm won't have to be commuting to Cessna this school year, I may not end up riding the motorcycle much since I'll be on bicycle much of the time. When that time comes, though, I suspect that I'll have an easier time selling the motorcycle than this scooter.