Amazon’s $15 Minimum Wage Won’t Change How Americans See Work – Bloomberg

n 2017, the real median household income in the U.S. was $61,372, which is roughly what two earners with full-time jobs making $15 an hour would make.

I remain totally confused about class as a term to classify people in America. This article is a prime example. While overall this is good news, if $15-per hour helps the middle class, how little do you have to earn to be working class? And why is that term never used?

As far as I’m aware the amazon deal doesn’t include health insurance, which effectively means before taxes, you’ll have to work for nearly 1-week in 4 just to pay for an individual plan, for a family plan, you’ll be working for just over two weeks every month just to pay your health insurance premiums. Then there’s food, rent, transportation etc. and so who knows where you are going to find the average $4,533 deductibles if you do get sick. Rather than working class, you are the working poor.

If two people have to work for a couple to survive they are working class. Telling them they are “Middle class” if they earn more than $22 is just a great example of gaslighting. To be middle class,  surely it means when one of you can chose not to work.

Source: Amazon’s $15 Minimum Wage Will Won’t Change How Americans See Work – Bloomberg

Data Interchange and Interoperability in Healthcare

I recently had to go for x-rays on my hip. The imaging company called saying they’d received the “order” from my chiropractor for a knee arthrogram without contrast.

Apparently, this was both wrong and confusing. It’s wrong, because the “order” said hip, but they couldn’t read it; also it’s confusing because, well something to do with x-ray and contrast.

After a short discussion, it turned out the imaging company received the order by fax. Yes, real actual paper fax. The US medical profession still seems to run on faxes. My prior cardiology hospital sent my medical records to my new cardiology Dr via, yes, paper fax. Hospital-1 printed the records to a fax based printer driver, which sent them uing a fax protocol to Hospital-2. Apparently Hospital-2 receives as images in a variation of the TIFF file format.

In the case of my PT, no such luck. Handwritten, manually faxed, received by paper. Even if there had been no problem this created a HIPPA privacy and security cost. In this instance, the cost to clear up the confusion likely cost almost as much as the actual hip x-ray, as that was all that was needed.

While I know there are data interchange standards in the USA for medical records, or as they are called PHRs, it seems there still nothing that is universally adopted. When I contacted my new cardiology hospital and offered my PHR in (Epic Systems) Lucy format, they declined and asked for them to be faxed.

There are a growing number of apps for both ios and android that support EHRs (electronic health records) however, for the most part these are tied to a specific hospital and/or medical group. A good example is the Epic Systems MyChart app. It can read the data from my former cardiology provider, including details of my ER/and cardio surgery and the prescriptions I was given. I can export the data using the Hospital groups website, and that’s it.

Unless you choose your medical providers not on their medical excellence, but their ability to import your lucy records, this is no use at all.

The Big Boys are doing data interchange

My interest was sparked by the recent announcement from Google, Microsoft, Twitter and Facebook introducing the open-source Data Transfer Project (DTP). For the more technically interested, you can read the DTP Overview here.

Ultimately it doesn’t look that different from the Enterprise Service Bus implementations we were working on 15-18 years ago. Same core concept, n-n interchange and interoperability. Same basic extensability through adapters and shared protocols.

I have to say, the use cases given for DTP are pretty weak. Conceptually, though there is much potential for this architected “Share…” facility. One of the key failings of DTP is that there is no ability to delete data, sure you can share your data to more sites/services but the DTP as specified doesn’t allow you to leave.

However, the most disappointing thing about this announcement is it’s aimed at allowing you to move your videos/photo’s, social media posts, and hopefully subscription platforms among the services supported.

To become a supported platform there are a few fairly simple architecture docs and then you have to build plugins or adapters to interface to the service to be able to send/receive data.

Ho hum. Boring. There is definitely space for big tech co’s to innovate around data interchange, but who cares about social media. I want to be able to pay for a PHR service, where I can store and control my medical record. Where I can grant access rights and authorise medical providers to retrieve my data, where I can see my medical records from across the providers etc.

I’m hoping that someone will point out this already exists, or that Nigel or Tom, who both now work in Helathcare will tell me why this isn’t a good idea. The USA is in desperate need for data interchange but it isn’t for social media.

FURTHER READING:

  1. Paper on moving from paper to electronic records and the associated problems.
  2. Review of numerous leading healthcare records mobile apps.

 

Maternity medical crisis

As we approach this year’s open enrollment period for health insurance, I continue to be shocked and disappointed about almost everything I learn about the US Healthcare system. Before I return to notes about my own experiences and my own health, maternity care is another healthcare topic that doesn’t often get discussed, as the average American prepares to pay more than $10,348, per person, per year on healthcare.

While many argue about the definition of single payer, and if it would lead to socialism (and what that is?), the inefficiency, mistakes, cost and just outright expense of what should be routine treatment, continues to make me despair.

America has healthcare snobs, millions of them, they just don’t realize that while they might have great access to medical facilities and Doctors, that doesn’t mean it’s always good, or that the system acts in their best interest. However, any suggested change is met with claims of death panels, socialism and more. Oft heard is also they ‘don’t want the Government in the healthcare.’

Even I was left speechless as I watched a recent CBS Sunday Morning segment on maternal healthcare. Among the points made were:

  • U.S. “most dangerous” place to give birth in developed world
  • The United States is ranked 46th when it comes to maternal mortality. That’s behind countries like Saudi Arabia and Kazakhstan.
  • “Sixty percent of the deaths in the United States are preventable,”
  • At least two women are dying every day

And it’s not about access to healthcare; it’s not about the poor without insurance; yes, there is a racial element, but it’s not what you’d think. Here is the entire segment, well worth watching before you enroll this year.

| Edit: The embedded video doesn’t apparently load in some browsers, so here is a direct link to the CBS This Morning web page. https://www.cbsnews.com/news/maternal-mortality-an-american-crisis/

Can it be true that women giving birth in America are more at risk than women in dozens of other countries?

“Profiteering” in prescription drugs

The New York Times has an interesting piece on the price of drugs, of which Pharmacy Benefit Managers are only part of the story. Add to this the general secrecracy over prices and Pharmacy benefits and drug list (aka the formulary) which are their negotiated discount drugs, brand or generic.

This has been my experience, even without insurance, it’s almost impossible to find out how much specific drugs are going to cost in advance; if there are cheaper generics; and if there is a better price.

Glass full, not half empty!
Drugs R-US

I took an alternative route and did a deal with the devil for my most expensive drug. Despite having supplied the drug manufacturer with more financial information than I did to get a mortgage, they still declined to help financially, unless and until I applied for AND was declined for Medicaid.

I most probably would be eligible for (full scope) Medicaid, since I’ve already surpassed the 5-years/40-quarters requirement. That said, I’m really not comfortable in applying for any government assistance(despite assertions like this unofficial website) until I become a full US Citizen.

Faced with a circa $300 per month drug cost, I took an alternative route and was able to secure the best part of a years’ supply. Also, to get to this point, I’d spent probably 50+ hours trying to find alternative prices and supplies.

Like many other things, this is another example of the disgraceful profiteering in the US Medical for-profit business.

On the remainder of my medical billing, I’m about to give-up, the system has worn me to down, I just can’t waste any time or energy on it. In my last communication, I laid out specifically, in detail where the billing didn’t agree with what they’d told me the cost would be. Their answer:

Our financial aid has been applied and your balance is correct. If you have any other questions, feel free to contact our customer service team.

Which takes between 30-60 minutes per call since you have to go through multiple layers of call center and no one has any real authority to change anything which means they have to appeal to a “supervisor” and they never return calls. It’s time to pay them all off before they go into collection and hurt my credit rating.

Medical Billing update

After spending another hour yesterday making calls to try to come to a conclusion over the 2x appointments and treatment I had for my leg wound back in August and early September. I’ve been applying the lessons learned, experience I’ve had resolving my billing for my heart attack, which i close to, but not yet finally resolved. Here are some tweets I sent after getting off the phone yesterday.

The Real Reason Hospitals Are So Expensive

So much about this rings true, especially this segment. In essence I said I had no insurance and would pay cash. Most, but not all of my bill was instantly discounted by 60%.

I’m at about $38,500 now including follow-up, by minus drugs. I still have to work out how to pay that.

@potus isn’t the only one projecting

I’ve always understood the term “projecting” but it has been fascinating to see the press and media trying to make sense of the Presidents sometimes incoherent and unrelated public tweets and statements.

The best explanation is he is “Projecting”. That is he’s told something, or concerned about something and immediately make some form of statement about it. In many cases these things become apparent days, weeks or months later. There are write-ups on this here, here, and here.

I got a surprise on July 30th, I had a heart attack. My left anterior descending artery was completely blocked. I’ll deal with what happened and how and some of the sports related stuff over on my triman livejournal blog.

I thought it was worth stating this here, because I’ve been writing and even boasting somewhat about my lack of healthcare insurance, because I’ve been otherwise super fit and healthy. Turns out it would be fair to say, just like the President, to some extent I’ve been “projecting“.

See my posts here, here and here. And this with some irony now I’m unemployed and have no health insurance.

In a number of following posts, I’ll trace my efforts and my frustrations with what is already a $78,400 list of charges. The hospital has already been great, but there are already a number of important lessons learned, thos are what I’ll try to cover. I’ll be linking the posts with the tag https://markcathcart.com/category/uninsured/

Way to go Texas

I’ve been quiet recently for no other reason than I’m mid-move from Austin Texas to Louisville Colorado. I don’t think Texas will miss me, or care if I’m gone, but I can’t help but be glad to turn my back on the what must be some of the most vindictive, small minded, and regressive politicians I’ve ever come across.

11380987_867608403331615_1505800615_n[1]It kind of doesn’t matter where you stand on the abortion issue, I’m pro-choice. However, when you look at the time, effort, money and all the laws, regulations that Texas has pursued in their attempt to de-fund Planned Parenthood, it is nothing less than a scandal. Worse though are the indirect consequences, the way womens health has just become an acceptable casualty in the battle, little more than mere shrapnel.

While the Texas politico’s have gone after Planned Parenthood, what they’ve actually achieved is the large scale closing of family planning clinics around the state. Of the 82 clinics that have closed, only a third were Planned Parenthood. Those clinics didn’t perform abortions, they were not there just to encourage women to have sex outside of marriage, they provided obstetrical care, gynecological care, and Pap smears.

For those that remain open, there are often massive distances to travel, and long waits, less than a quarter of those that should be seen, are being seen for subsidized preventive health care treatment. That would barely meet the World Health Organization requirements for a third-world country. Welcome to Texas.

Wade Goodwyn has a good report on NPR on the state of affairs in Texas, from George W. Bush childhood home of Midland, far west Texas. The most depressing thing Goodwyn says in his report is:

Texas is becoming the model for other conservative states that would like to defund all family planning clinics associated with abortion providers.

http://www.npr.org/player/embed/464728393/464744500

Out of control drugs

For-profit hospitals appear to be better players in this price-gouging game,” says Bai, an assistant professor of accounting at Washington & Lee University. “They represent only 30 percent of hospitals in the U.S., but account for 98 percent of the 50 hospitals with highest markups.

Of the many things wrong with the US Medical system, and there are a great many, not least it is the most expensive in the world, are the prices of ancillary parts of the healthcare system.

I’ve just been catching up on my bills, one of which was a visit to a chiropracter. A single visit, with a company provided insurance, my out of pocket cost was $485. Yes, it’s complicated, it involves deductibles, co-pays etc. and of course since it’s my only healthcare visit so far this year, I got essentially nothing from insurance. You then start to question what you got for $485. 10-mins with the specialist; 15-mins electrical stimulation; and about the same ultrasound. Sigh.

I have a mild form of psoriasis which randomly appears(stress?) on my right elbow, left thumb and a couple of other areas. It’s really no big deal, I use maybe two or three small tubes of Fluocinonide per year; in a couple of days and it’s gone. I went to get a replacement tube of cream from CVS recently. It’s a prescription cream, which comes with its own problems. The pharmacist gave me the cream and announced they’d changed providers and the price was now $8. No big deal to me, I can afford it. I paid and left.

Out in the car, I stopped and thought about it. I’d just been stung with 62.5% price hike. Seriously same active ingredient, same size tube; different generic brand. And there you have it, you have no control, no choice, no free market, it’s effectively too difficult to shop around because it’s prescription only. Yet, strangely you can buy it online for pets, it’s about the same price, meaning again, my drug insurance is effectively worthless.

The problem in America is that there is no effective control for the price of drugs. This report by Johns Hopkins Bloomberg School of Public Health report, highlights how this is commonly exploited, let alone specific deliberate abuse.

The 50 hospitals, they found, charged an average of more than 10 times the Medicare-allowed costs. They also found that the typical United States hospital charges were on average 3.4 times the Medicare-allowable cost in 2012. In other words, when the hospital incurs $100 of Medicare-allowable costs, the hospital charges $340. In one of the top 50 hospitals, that means a $1,000 charge.

Of the 50 hospitals with the highest price markups, 49 are for-profit hospitals and 46 are owned by for-profit health systems. One for-profit health system, Community Health Systems Inc., operates 25 of the 50 hospitals. Hospital Corp. of America operates more than one-quarter of them. While they are located in many states, 20 of the hospitals are in Florida.

For-profit hospitals appear to be better players in this price-gouging game,” says Bai, an assistant professor of accounting at Washington & Lee University. “They represent only 30 percent of hospitals in the U.S., but account for 98 percent of the 50 hospitals with highest markups.

We all pay the price for this abuse. It’s nonsense to think that a single payer, public healthcare system would cost anymore. If we had it, there would be drug price control. Those against price control often argue that would stifle innovation and invention of new drugs, they role out the enormous cost of bringing out new drugs and using the profit of successful drugs to underwrite research, and failures during the process.

This is simply invalid. Anyone who thinks that humans won’t become involved because they are prepared to standby and watch their fellow citizens die, is just plain wrong. While medical innovations have progressed dramatically over the previous century, the last 20 years specifically have resulted in monumental advancements that substantially increased medical care standards and improved overall global health, but most of those advances didn’t actually come from the actual drugs(*), but from a better understand about the human body, how diseases spread and much about healthcare. The real ripoff in drug use is both at source, manufacturers, and those that sell the drugs.

Lets hope the next President take drug pricing as a priority.

* Not withstanding massive public health crisis drugs, like HIV, Ebola et al. These serve as exactly as an example of the invention that will still come.

Healthcare – Points mean Prizes!

Back on April 6th I wrote a blog called “Healthcare Stupidity“. In a work email today it contained the following:

It may surprise you, but prices for medical services can differ depending on where you go. For example, identical cholesterol tests can run between $10 and $270 and an MRI can range from $300 to $3,000. Need a minor outpatient procedure? Searching in Castlight could save you hundreds. With Castlight, you can compare costs for doctors and medical services before you make an appointment.

Earn more points! Sign up, perform a search and review your medical plan in Castlight by June 30 for a chance to win 10,000 WOWPoints on e-Deals (valued at $100)*! For rules and more details please visit Castlight Rewards Sweepstakes.

Speechless, you can’t make this stuff up. As Bruce Forsyth used to say, Points mean prizes, play your card right!

Watch the video, If you are one of my US Friends… It will dispel any notion you have of the British being intelligent and articulate, much like the US Healthcare system it seems.