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Discussion in 'Northeast' started by Toshi, Apr 20, 2002.
I'd refuse to ride with you if you had a 4ft stinger attached to your body or bike!
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Maybe a 4ft tether and a tiny gyrocopter holding the camera aloft.
Medical billing is a clusterfuck. The concept that HSAs lead to informed consumers that choose rationally based off of price (among other factors) is a farce.
Mariko had an outpatient surgery on Jan 5. The surgeon, hospital, and anesthesiologist should all have been in-network, as far as I can tell from having looked up them beforehand. The final price for the surgeon's and anesthesiologist's professional fees and the hospital technical fee for the OR and recovery time is completely unknown to me. Hell, the billing office at the hospital has no idea: they send the bill to Anthem and then Anthem tells them what they had previously (secretly) agreed was the price.
The most egregious thing about this current episode is that on Jan 4 the hospital billing people called my wife and told her that the hospital policy is to charge $1,699 up front–before the surgery, and again not knowing how much the cost/payment would ultimately be.
The explanation I got from the billers is that this crazy net-minus-1 "billing" practice is based off of their estimated charge (and for what–just the hospital technical fee?). If Anthem says the negotiated rate was 1 cent then they'd refund us $1,698.99 and if Anthem said the rate was $2,000 then we'd be billed after the fact for $301.
I can't understand how this is legal. They charged us in advance for a service they hadn't yet provided, and for which the cost was and remains entirely opaque. I can afford to float $1,699 (and will ultimately reimburse myself for whatever the ultimate net cost is from my family's HSA) but that's not the point. The point is that this system is bat-shit insane.
The whole system is bullshit. I walked into my hand surgery with a similar idea of what it was going to cost. Luckily it worked out but it was luck.
This year my employer offered a health plan linked with the UW hospital system. The idea being all my care would be within UW with some exceptions. No one could tell me what those exceptions were. As it takes two weeks even with a referral to even get the opportunity to make an appointment with a specialist at UW I chose the traditional plan and will be handing out an extra $30 a paycheck.
You should ask a doctor that is involved in the healthcare system. They would surely know how it works.
1) Amidst my EV-to-Vail adventure today I demoed Rossignol Experience 88 skis, in a generous 180 cm length. They were not as responsive as I'd hoped, and the extra kick wasn't outweighed by the Mantra's ability to smear turns on steep stuff to shed speed easily. These wanted to grab always.
2) For those not following along on the Facebook thread, today was my Vail experiment. It didn't work that well.
Between charging at Frisco on the way, at Vail, and in Golden on the way back I input 41.2 kWh from Chargepoint's level 2 EVSEs, so perhaps 38 kWh made it to the pack. (All of these electrons were free, which is nice, but not so nice when one considers that I spent an hour in Frisco, an extra hour in Vail as compared to when I was actually done with skiing, and 40 minutes in Golden just waiting on the car to charge.)
Morals of the vehicle part of the story:
- 41.8 kWh is not enough for a RAV4 EV-shaped vehicle to get from my house to Vail, and may have been barely enough on the way back had I not run into terrible road conditions and had I been patient enough to wait out completion of the extended charge (I left Vail with about 35 kWh in the pack)
- 6.6 kW public level 2 EVSE are effectively too slow for day trips even as destination chargers, and are super slow for topping off on the go
- if kid 3 happens then I'll need to replace the RAV4 EV, and it'll be replaced with a 75 kWh+ Tesla (such as the Model Y or perhaps a 3) or a PHEV like that super-ugly Honda a few posts up
3) Hidden in the Facebook comments is that I wasn't too impressed with Vail as a day-trip destination, either. As a multi-day place it'd be nice: nice lodges, nice restaurants, etc. As a day trip it's too far (even without EV issues) and going over 2 passes means dealing with that many more shitty drivers, possible terrible weather as today, etc.
Physically the layout wasn't great, either: garage looked and felt old and uninviting (and $30 parking for 4-12 hours!), schlepping one's ski gear across the village is a pain, and there's no non-commercial lodge type building at the base where one can stash one's gear for the day a la Winter Park by the rental shop.
On top of that I wasn't blown away by the runs. Seemed like every other resort. I admittedly didn't get into the back bowls since coverage everywhere was poor, so that could be a saving grace, but still that's a lot of driving for a day of skiing...
Dude. Vail sucks. Didn't anyone warn you before you went??
Warnings were proffered but not heeded, since I like to figure out things for myself, apparently.
Should I also avoid Keystone? A-Basin will probably be fine since I like the simpler, park-closer kind of places.
Jeezus. If there is one place that sucks worse than Vail, it's Keystone.
You have seen the "Hitler wants to ski Vail" sketch, right? Hilarious...
This one? Hadn't seen it. After today I get it, especially the winds up top--like Panoramic at Winter Park... (and yes, it's Panoramic, not Panorama. Gah. http://assets.winterparkresort.com/...7.1850216856.1515649263-1183170505.1515649263)
I was fairly amazed at how crowded the village and slopes were given that it's a random Wednesday. Foreign tourists? American randos who come for the week or month? Lift lines weren't bad at all, though. I did hang out the most on Avanti today, amusingly, mainly to avoid the godforsaken wind and the fog as highlighted in my 10 second Facebook video.
the best argument for universal health care i have heard, deals precisely with this.
if pre-paid health care exists, then a starting point for pricing exists; somewhat-rational comparisons and decisions can be made; and clusterfucks are mostly avoided.
The problem is that no one accounts for the true price of things. They just account for their out of pocket cost. Most universal plans that I have seen are low deductible types of things, and without true price transparency nothing would change for high deductible people.
I don't think that price transparency would necessarily follow from single payer, but even if it did I'm not sure it'd have the desired effect. Maybe everyone would choose to go to XYZ Cancer Center because they must be the best if they're the most expensive, right?
If only I could have ridden an avalanche down the east side of Vail Pass I could have made it home on one charge:
Looks like I’ll be getting $110.91 back. The gulf between what was charged (what an uninsured patient would be billed for if not negotiated beforehand) and what was allowed is immense. What a ridiculous system we have.
Even accounting for the flat reimbursement covering nursing, OR and recovery time, and the surgeon’s and anesthesiologist’s fees, $6,375 for a 30 minute outpatient surgery (albeit under general) seems quite fair.
Harkening back to my earlier common complaint with the Prius Prime and the Lexus LS 460: I belatedly realized that the Honda Clarity has absolutely no trailer hitch options, let alone the 2” that I desire (that’s what she said, eh?). This makes sense as it’s a unique platform and none of the variants are rated to tow bupkis.
So that’s a problem, as is my lack of enthusiasm for the Outlander PHEV, noting that assuming we figure out how babby is formed (sfw and “correct” spelling for the non-meme wary) my hand will be forced by next winter.
I then idly read posts on thetruthaboutcars.com as I am wont to do and found out that there exists a Kia Niro PHEV. I didn’t know of this. 8.8 kWh iirc, 25 miles electric, but significantly it has a 2” Curt hitch available for it!
But it’s bland, has a crappy interior like the Mitsubishi, and runs $35k pre-credits when nicely equipped. Not much more compelling than the Outlander PHEV after all. At this point I was even considering that I’d have to go with a non-PHEV option, to the horror of teh baby Jeebus...
Then I had the thought of checking out Torklift’s site. They make 2” receiver hitches for unlikely hitch candidates. I looked up the BMW i3 on their site on a whim, and sure enough a 2” hitch is available (and the Range Extender version would work for my uses assuming skinny 20” winter tires exist--not interested at $50k pre-credits, though). I also checked the Toyota page again—they didn’t have a Prius Prime hitch over the summer, during the time when I had the Prime on order from the uncommunicative Boulder dealer that may have not actually ordered one anyway. Lo and behold, they now have a 2” hitch option for the Prius Prime as well!
So now I have at least two options that meet my criteria (tax credit-eligible, appealing to me in some way, will be able to take me skiing and biking (thus the hitch) alike). The i3 would be a pain due to its doors but it’s quirky and has a very cool, airy interior. The Prime has the giant screen inside and would be the value proposition. The only thing holding me back at this point is that I’m underwater on the RAV4 EV and don’t want to take out money from my investments now, as I’m awaiting travel reimbursements and anticipating lots of tax money refunded. The (never ending) story may continue come summer.
healthcare has, pretty much, zero price elasticity.. specially the ER/life threatening kind.
zero price elasticity service + low supply (by CIA numbers, the US ranks low in MDs per capita for high-income countries) = current pricing clusterfuck being the most rational outcome.
the gap between "suggested price" and "actual price paid by insurance" reflects both and suggests a cartel-like situation, only a very incompetitive market could allow for such huge "discounts".
its not that any single one of these notions proofs anything; but it appears to me, they all converge to the same answer.
1) Surgeon’s professional fee was billed separately after all as per above. Note that this was about 8% of the total procedure cost! (So don’t cut my or my colleagues’ salaries, please!)
2) A-Basin today. Good snow quality but not much of it on the bumps. I liked the steep groomers, in particular Powerline right under the Lenawee Mountain lift. Altitude made me super tired. Parking in upper lot was a pain—got up there late. Slow lifts are super annoying and possibly enough to make me avoid the place for my mid week skiing: Lenawee Mountain is about a 10 minute ride. That run is about 3 minutes. QED.
3) Gave the Mantras a good workout today and enjoyed them. No complaints today other than banging tips together on flat sections due to their no camber, rockered nature. Maybe I’ll put that permanent base treatment on them after all.
And the answer is...? single payer?
I am tempted to disregard your advice and try Keystone. I like carving big turns on groomers, and I hear they have many. I like fast lifts.
On the other hand, I do not like carrying my shit on my shoulder through a faux European village in order to get to the first lift. Hmph.
i think so.
single payer systems appear to get the most for the money, as in life expectancy/child mortality rates plotted against USD per capita in healthcare.
I think the US spends about 50% more than the average of the next 5 single-payer western european contrues; with poorer health indicators; and it appears to me, the difference is mostly pricing/gross margins.
heck, its about twice the USD spent by japan, where the median age is about 10 years more; and the outcome is no better.
I don't know how much it costs to process medical billing. Without fail no matter my insurer or doctor If I am asked for a co-pay at the office, I get a refund a few weeks later. If I don't have to pay a co-pay, I get a bill a few weeks later. I then often get a refund on the bill I paid.
I am not sure how much those interactions cost insurers or doctors, but it is certainly adding no value to anyone, except possibly someone who gets an inflated cash balance for a short period of time.
The poorer health indicators thing is largely a function of uninsured patients, low SES patients (+/- overlap with group 1), and poor lifestyle choices. Those who are insured here and who live reasonably have good health outcomes, I’m reasonably sure.
Agreed that billing, etc. represent overhead that’s unnecessary and not contributing to anything productive.
Equally applicable to about 80% of HIPA.,..
I confirmed today that I will not be buying a Mitsubishi Outlander PHEV. It's a shame, because I'm probably the most credit-worthy person who walked through their doors this week. It's also a vehicle that on paper would have been good for me and my biking/skiing exploits (PHEV, AWD, SUV ground clearance, 2" hitch easily available)… but no, just no.
Like this but in red, and in Denver in the winter, not California in the summer perched jauntily on a rock. It did have those hideous PHEV optional logos, though.
Test driven: 2018 Mitsubishi Outlander PHEV, GT S-AWC spec.
- it's the only reasonably priced PHEV SUV, not to mention that the European models (e.g. X5) have laughably short EV-only ranges
- fair amount of pep while staying in electric-only operation (flooring it in any mode will add in the gas motor)
- quiet and smooth in electric-only mode, as one would expect
- CarPlay and Android Auto
- adaptive cruise control operation is absolutely awful–-I'll expand on this point below as I can't bullet point-describe it
- looks ugly outside even before the optional side skirts and PHEV logos
- huge sill to step over, like it's some fancy race car
- stupid dildo-looking shifter, where the Park button is obscured by the dildo-head (ahead of the shaft)
- pretty terrible dashboard layout, clearly constrained by the initial design year of the Outlander (old): distracting, small center LCD, nigh useless huge power meter on left, no option for a digital speedo readout instead of a huge D icon, blank plates all over the dash and wheel, controls all over the place (Eco on dash, AWD and power management buttons behind the dildo-shifter), etc.
- feels very big for a 2 row SUV, noting the gas version comes in a 2.75 row variant (3rd row explicitly only for < 5' 3" passengers )
- seems very overpriced compared to the wife's barely more expensive but much, much nicer feeling PacHy
So about that cruise control:
In a properly implemented full speed adaptive cruise control system like my wife's PacHy, if you're on cruise and traffic ahead of you comes to a stop then the vehicle comes to a stop as well, with a reasonable distance between you and the rear bumper of the next car in line. It then holds you in place while they're stopped. Once they move then you tap the gas accelerator pedal or hit the resume button, and it'll creep forward to follow them and then follow traffic smoothly once again.
Simple, enough, right? Well, Mitsubishi's implementation is all manner of wrong:
It follows traffic while moving well enough. It has 3 following distance options and the longest was comically long. Option 2 was decent while moving… but when it came to a stop it stopped uncomfortably close to the car ahead. That's not even it's big flaw, though: once stopped it locks the brakes and holds you in place… for about 3 seconds! It stops, flashes an "Apply Brakes!" warning in that ugly LCD center screen, beeps twice, then disengages the cruise control.
Did I mention that when it disengages the cruise control it starts to creep forward on its own? (It does this even if the Auto-Hold feature is on, which would have held the vehicle in place with no creeping if one had stopped in the usual manner, via your foot and the brake pedal.)
So it comes to a stop, beeps twice, and then dumps control on the driver by starting to creep towards the bumper of the car in front, which was already nearby due to its behavior in stopping in the first place. Not good. Then to re-engage it one must accelerate on one's own to ~10 mph and then hit resume. It won't follow back up to speed from a crawl.
This behavior makes it a feature of very limited utility, even dangerous if one's attention is diverted: beep, beep, crawl, …, bang?
Cliffs Notes: :nononocat.gif: It's unique in the marketplace but I have no desire for one at this point, post test drive.
Were you wearing a top hat and monocle?
I was wearing my embroidered Patagonia Better Sweater replete with the CU Radiology logo and my name. Ya gotta know my shit's fancy when I have my name on my jacket, worn over a tie dye Ben & Jerry's T-shirt, no less, which shows that Honey Badger does what Honey Badger wants to do.
Like this guy
That reminds me of a question on a "are you an urban elite?" quiz from a few years back, which was whether you have worn a non-scrubs uniform as part of any job you've held. I've never had such a job.
"Fall from couch" is perhaps the most American of imaging study indications conceivable
I have had three proffesional jobs that required some form of uniform.
One was a company branded mechanic shirt or jumpsuit.
Big pharma gig required a range of get-up from scrubs to sterile ass mother fucker
Current job requires various levels of get-up depending on location. occasionally a lab coat and booties for low grade clean room but generally a high visibility vest color coded (red) to identify my specific engineering role.
I don't think clean room wear should count, like scrubs. It's Jim-Bob mechanic (or infantry grunt) that they're getting at, I think.
Why you no like rock crawling?
Had to sit in a row like that before, I'm 5'9. Terrible experience.
I know you have to have your morning burritos and shit, but why you divert attention when operating a vehicle.
Sometimes you have to sneeze. Sometimes you look down to pick a different audio source. I don't text and drive or do anything like that, but it's impossible to not have tiny lapses.
A sane thought for once:
2018 Nissan Rogue with ProPILOT Assist.
2" hitch is cheap from Curt. Conventional gas, for better or worse, so no range issues. I could even get a second set of 17" steelies and keep the Nokians from the RAV4 EV as the tire size for 17"s is the same...
Hmm. I should drive this (as well as the Prius Prime +/- Clarity) and see what is inexcusable about its face behaviors. I can't see myself springing for an effectively $60k after credits midsize Volvo when credible options exist for much less.
You should totally get one with CVT.
What could go wrong?!
I rented a Rogue with CVT for my road trip in the Smokies. One of the worst drive trains I've ever ridden.
I’m going to test drive one Monday afternoon. I’m hoping to be impressed by ProPILOT.
2018 Toyota Prius Prime Advanced. Test driven at AutoNation in Centennial.
Looked a lot like this, only dirtier from being outside in the Colorado winter.
Interior looks like this, which is relevant.
- Fancy adaptive cruise works just like how it should: follows to a stop, holds the car there, follows from a crawl with the Resume button/cruise control wand gesture
- Heated steering wheels are always nice
- Great forward and side visibility
- Tons of headroom in the front row
- Dashboard layout is very distracting: in 2nd gen Prii the "eyebrow" gauge cluster with the speedo, etc. was simple and monochrome and thus not distracting. In this one it's multicolor and shit is always popping on and off the screen, like when the cruise control starts to slow down when following a car. Not cool.
- Rear visibility is similarly worse than in the 2nd gen Prius: both have a dividing bar in the way, but the Prime also has its space-helmet double bubble glass setup adding more distortion, and the beltline has risen over the years in the back of the car.
- Fancy center stack giant screen is largely wasted on the same kind of interface that other Entune-equipped Toyotas have on normal screens, just with giant navi
- Control layout is all over the place: toggle for the HUD down by the left knee, seat heaters by right shin under that shifter pod thing, steering wheel heat button on steering wheel itself
- Tall of torso/giant head gripe: In my normal seating position I actually couldn't see the HUD, which was distracting and tiny anyway, only duplicating the blaring blue speedo readout a few inches to the right. I had to recline more than usual to get in the angle range for it. :lol: I also hit the ceiling in the rear seat, not such a big deal if this were my car
Verdict: Yes, it's a Prius that plugs in and has fancy cruise control. Upon actually experiencing such a thing I found it underwhelming, with the dashboard distraction and poor visibility both more annoying than I'd like. That the dealer is way off the mark on price (MSRP + $1k + semi-low balling the RAV4 EV as trade) made this an easy deal to pass on.
Thus, an updated list of things I'm looking for:
- Fancy adaptive cruise with proper stop and go behavior
- Good visibility all around
- An interior layout that is pleasing aesthetically and functionally
- Smooth and quiet (but not necessarily PHEV or the like--I feel like I'm striking out in this realm save for that Volvo that's super pricey to start with)
- 2" hitch, with sedans ok as long as they meet this requirement via Torklift or the like
- 4 regularly hinged doors
- Feels special enough to make me take the financial hit to realize the depreciation on the RAV4 EV