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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.,..