Mar 18
Andrew CrazePolitics Healthcare, Politics
A friend recently forwarded this e-mail to me that’s apparently been making the rounds. (My response below.)
Dear Mr. President:
During my shift in the Emergency Room last night, I had the pleasure of evaluating a patient whose smile revealed an expensive shiny gold tooth, whose body was adorned with a wide assortment of elaborate and costly tattoos, who wore a very expensive brand of tennis shoes and who chatted on a new cellular telephone equipped with a popular R&B ringtone.
While glancing over her patient chart, I happened to notice that her payer status was listed as “Medicaid”! During my examination of her, the patient informed me that she smokes more than one costly pack of cigarettes every day and somehow still has money to buy pretzels and beer.
And, you and our Congress expect me to pay for this woman’s health care?
I contend that our nation’s “health care crisis” is not the result of a shortage of quality hospitals, doctors or nurses. Rather, it is the result of a “crisis of culture”, a culture in which it is perfectly acceptable to spend money on luxuries and vices while refusing to take care of one’s self or, heaven forbid, purchase health insurance. It is a culture based in the irresponsible credo that “I can do whatever I want to because someone else will always take care of me”.
Once you fix this “culture crisis” that rewards irresponsibility and dependency, you’ll be amazed at how quickly our nation’s health care difficulties will disappear.
Respectfully,
STARNER JONES, MD
Jackson, MS
The letter appears to be legitimate. Snopes.com describes it as “Correctly Attributed”. My buddy asked me what I thought, so I hereby respond with this open letter:
Dear Dr. Jones:
Every day in the US a criminal in involved in a high-speed pursuit — frequently police or other innocents are killed. Should taxpayers stop paying for roads?
Every day in the US someone sets their house or apartment on fire because they’ve overloaded electrical outlets, or fell asleep smoking in bed, or screwed up cooking crystal meth. Should taxpayers stop paying for fire departments?
Every day in the US criminals use the telephone to plan murders and kidnappings, to bilk the elderly out of their savings, to sell drugs and to book prostitutes. Should taxpayers stop paying for phone service for those who can’t afford it?
Every day in the US people are shot and maimed or killed. Should we repeal the second amendment?
Bernie Madoff conned people out of tens of billions of dollars. Should we close the stock markets?
The fact of the matter is, there will always be a small percentage of the populace that abuse any system. This doesn’t mean that that system isn’t worthwhile. Anecdotes are not data.
Yes Dr. Jones, I do expect you (and all taxpayers) to pay for this woman’s (and every US citizen’s) health care. She’s an unfortunate case, but let’s not throw out the baby with the bathwater. Lack of personal responsibility is not an issue that’s confined to health. Why should we sacrifice everyone else’s health to punish those few?
And finally, for the record: this woman came to the Emergency Room and is on Medicare. We’re already paying for her health care. Let’s try to get more value for the rest of us.
With equal respect,
Andrew Craze
Cleveland, Ohio
Those of you that read my earlier post know that we spend much more than any other nation on healthcare and get nowhere near the quality of their outcomes. Health insurance reform is about getting better value for all of us — even the irresponsible.
Jul 28
Andrew CrazeCode Coding, GiveCamp, LinkedIn
Ann Arbor GiveCamp participants
A week and a half ago, I spent the weekend in Ann Arbor Michigan, at GiveCamp. This is a (now annual) event where teams of volunteer programmers are assigned to work for nonprofit organizations for the weekend. It’s an all-out coding marathon, sleep is optional, and I must say, it’s a helluva lot of fun.
This was my first experience with GiveCamp, having heard about it from a couple local developers here in Cleveland. My understanding is that the first give camp was in Ann Arbor two years ago. Since then several additional locations have had GiveCamps, including Columbus and Knoxville, both on the same weekend. In addition to volunteering my time, I had an ulterior motive -there’s some talk about doing a GiveCamp here in Cleveland in the coming year, so I hoped to find out more about it and “learn the ropes,” so to speak.
I arrived about 5:00 on Friday, in the opening ceremonies started at 6:00. There was an initial presentation about how it works and some of the projects from prior years. There were about 50 or 60 developers there and 18 nonprofits. The organizers had already assigned developers into groups and routes to each of the nonprofits based on proposals the nonprofits had submitted. They ran down the group assignments and each group and went off to dinner with their non-profit. Domino’s pizza was one of the event sponsors, so we got to know each other and begin discussing the projects over pizza. (We got to try Domino’s new regional pizzas.) My team was three developers: John, Farrukh, and myself; and we were assigned to the Southeast Michigan Regional Energy Office. They had two representatives there: Sarah and Mozhgon . They explained the purpose and history of the organization, and outlined what they needed from their new site. Sarah also stayed with us for the weekend answering questions and helping test and add content.
The Southeast Michigan Regional Energy Office is an offshoot of the Michigan Suburbs Alliance, that has local communities in SE Michigan as its members. They needed a site that would provide news and information to the general public, as well as having a password-protected section for city managers to be able to discuss, exchange ideas and war stories, etc. Because they had an existing web host which dictated we use the LAMP stack, we set about coming up to speed on tools. (I have done some PHP work on FreeBSD Unix, but it’s been years. John was in a similar boat – he’s an ASP.net guru. Only Farrukh had some applicable experience.) Several other teams had decided to go with Joomla! for web projects that weekend, so we followed suit. Learning to use an unfamiliar tool while trying to produce useful work while sleep-deprived and under a tight deadline was stressful, but deeply exhilarating at the same time. By noon on Saturday, I think we were all convinced we wouldn’t make it, but that’s also just about the time we really started to hit our stride. By 5PM we were pretty sure we would succeed.
One of the things that really made it possible was the shared-goal approach the organizers impressed on everyone. Josh Holmes hosted regular stand-up status meetings, and if anyone was stuck, he would connect them with someone who had expertise right on the spot. “Trouble upgrading Joomla!? Who’s good at that? There. See that guy after the meeting.” It was clear that this team (Michael Eaton was the head organizer this year) had done this before. To my mind everything went extremely smoothly, and everyone was well taken care of. I never expected that I would gain weight on a weekend-long coding marathon!
The closing ceremonies got underway at 4PM on Sunday. I expected to be impressed, yet was still amazed how much had been accomplished. Each team did a brief presentation of their project, and there was a video round-up of the weekend, as well as an announcement that the venue and weekend are already locked up for next year, and the goal is to help 50 charities!
Plans are underway for a number of GiveCamps around the country, and of course I’ll keep you posted here on plans for Cleveland. If you’re a coder, graphic designer, database guru, or just want to help with event coordination, I encourage you to get involved. It’s a great experience and time well spent.
Photo credit: David Girard
Search Twitter for Ann Arbor Give Camp (#aagivecamp)
Other blog posts on the AA GiveCamp:
Jul 15
Andrew CrazePolitics Healthcare, Politics
This last week I attended an event promoting the so-called “public option” for the impending health-insurance reform with which the president and congress are currently wrestling. A good and smart friend asked me to convince him why, and I must admit I did a rather poor job. So I did some more looking and thinking to expand and clarify my position and this post is the result.
To start from first principles, insurance is an aggregation of financial risk. If some catastrophe, such as a fire or car accident, occurs, it could have huge financial costs for the individuals involved. But these things don’t happen to everyone, so insurance gathers a large group of people together to share that risk. For example, if we say that on average 1 person in 1000 will have a fire this year, and that fire will cost $50,000 we divide that cost by 1,000 and everyone in the group pays $50 so there’s enough to cover that loss. (The actuality is a little more complex, because the insurance company skims some money off the top to cover their cost of doing business, and they must also hold some money in reserve, since not all years are “average” years. But the basic principal stands.) Since the money goes in first, the insurer uses past history to estimate what the likelihood of the catastrophes are, and what they’re likely to cost. What makes insurance work is that the catastrophe could happen to anyone in the group, but the group is statistically large, so the risk is spread widely. This is how the vast majority of insurance works today.
Unfortunately, despite the name, health insurance in the US does not exactly follow this model. As James Kwak points out in his excellent piece in the Washington Post for most types of insurance, the consumers have a great deal of control over their risk. For example, drivers might drive fewer miles or get a safer or less expensive car. Health care consumers, while able to exert some influence (quitting smoking or starting exercising) much of the risk remains uncontrollable (genetic predispositions or getting older.) But I think Mr. Kwak misses a more significant point, which is that health insurance is allowed to subdivide their pools to a much finer grain. The vast majority of us in the U.S. get our insurance through our employers. More than half of the US workforce works for small businesses, and since each business has an individual rating on which rates are based, they are in effect each small insurance pools. The problem is, small businesses are much too small for the statistical model described above to be meaningful.
OK, so what? It’s a capitalist free-market system. If people aren’t happy with the risk/reward equation, they can just pay-as-they-go for health care. No one is making them pay for insurance. The problem with this is that almost no individual can afford the cost of even relatively minor medical disasters. An estimated 62% of the personal bankruptcies filed in the U.S. in 2007 were a direct result of medical bills. (See the study from the American Journal of Medicine here.) This is where it crosses over into the area of public policy. In addition, the disproportionate share of per-capita cost borne by small business is a public policy concern as well.
As many articles have pointed out, (this one from the Maine Department of Labor is a good summary) the U.S. spends the most of any nation on healthcare per capita, yet the World Health Organization ranks us 24th in life expectancy, last in infant mortality and 37th in overall outcomes of industrialized nations. So why are we so inefficient? Why do we get such a lousy bang for our medical dollar?
This is hard to say, and of course is where the real fighting begins. However, I and others think there’s a compelling case to be made for a lack of preventative care. Any doctor will tell you that catching problems early or preventing them before they happen is a much more effective and cost-efficient way to address medical problems. If the patient waits until they’re bleeding out of both ears and shows up in the emergency room, that’s the worst case scenario. Those patients are the most expensive to treat, and the least likely to survive.
And this brings us back around to health insurance. If health insurance is not available to any given consumer, either because they’re deemed too high of an individual risk, or because their group’s risk rating makes it unaffordable, then preventative care becomes unavailable to them. The fact that medical providers charge the uninsured significantly more than the insured for the same services exacerbates this problem. (As a personal example I recently had an emergency room visit that was billed at well over $11,000. The hospital accepted $3,000 from my insurer as full payment.) Ensuring that affordable insurance be available to all that want it is the only solution to this problem.
The “public option” for health insurance is intended to do exactly that. Since health insurance companies have shown that they’re unwilling or unable to guarantee affordable coverage, it becomes incumbent on the government at some level to take up the slack, not as a way to interfere with the market, but as a matter of good public policy. Because the public option is likely to draw a higher proportion of high-risk individuals (essentially the cast-offs from the existing private insurers) the system must have as wide a pool as possible to ensure that the risk is sufficiently spread and rates are affordable. This makes the federal government the proper place for such a program.
Make no mistake: I don’t think this is the best possible plan, only the best available in the current political and economic world. Obama opened the conversation by saying “Everything is on the table.” Sen. Max Baucus, (D. Montana) who has taken so much money from the health insurance companies he’s going to have to name his kids “Aetna”, “Cigna”, and “United Healthcare”, and who is the Senate Finance Committee Chair, immediately countered with “Single-payer is off the table.” So that isn’t even being discussed.
Wendell Potter, the former chief spokesman of Cigna, admits that insurer’s negative portrayals of single-payer systems in Canada and England are largely untrue. His insider’s testimony as to how the industry operates is a good read in itself.
So, “public option” is the option that’s possible this time around.
Other interesting, related links:
May 12
Andrew CrazeCode Codeswell, Entrepreneurship, Healthcare, LinkedIn, Software Business
I’m sorry I haven’t been blogging lately. From what I’ve read from folks who have been doing this much longer than me, there’s a common pitfall to blogging where if you go too long without posting anything, you wind up putting pressure on yourself to post something more weighty and relevant, which further discourages catching up. I fear I have succumbed to this, but hopefully, this entry will clear the logjam. I only wish it were more weighty and relevant. (Ha, ha.)
Until a couple months ago, I was earning a living as a software “hired gun”, coding under contract through a friend’s consulting company. This was a good and reasonably lucrative job, but I’ve been itching to go back to work for myself for about a year, and finally decided that if that’s what I wanted to do, there was no point in waiting longer, so when my current project ended, I set up my own company and hung out my shingle.
The new company is called Codeswell, and my plan is to write software products, and self-fund the startup by continuing to do consulting and contract development work. Over the ensuing time, I’ve done a couple smaller projects, and generally kept busy enough that I haven’t spent much time on the Codeswell’s own site, so I apologize for the lack of flash (with a lowercase F) and sex appeal. I’ll get to it. Really.
Also in the meantime, I spoke to a number of business and technical advisors (all friends) about a great idea for my first project. I started to design and build a business case for some software that would allow medical patients and caregivers to track and manage the financial part of health care. Sort of a Quicken for health care. (Yes, Intuit released a product like that several years ago, but to be honest, it wasn’t that good, and there were no signs they planned to improve it.) The more people I spoke to about the problems I wanted to solve, the more I found there was and is a real need, and thus a market. The fact of the matter is: the way we pay for health care in this nation is one of the most complicated and unfair systems I’ve ever seen. And patients and caregivers are almost universally confused and frustrated by it. (Doctors are increasingly ticked off too. In fact the only folks who seem to be happy are the insurance companies, but that’s a subject for another post.)
So, I started to do the technical work: I drew up proposed UIs, started to create a feature set, researched encryption methods for databases and HIPPA requirements, etc. I also started to ask business people I know questions about how to get started, if I should raise money, how to establish partnerships when I’m the little guy and the partners were giant institutions like major medical centers and health insurers.
Then, in late April, Intuit sent out a press release indicating that they hadn’t abandoned that market – they had just released a whizzy new web-based product and were already aligned with a number of major insurers. Their new product solves most of the problems I planned to solve, and is free, since the insurers are providing it through their sites and picking up the tab.
It remains to be seen how successful they’ll be. I hope the best for them – I like Intuit as a company, and have been reasonably happy with the products of theirs that I use – Quicken and QuickBooks. The thing that worries me is that the patients’ and insurers’ interests are often not aligned, so it will be interesting to see how those conflicts will play out. Unfortunately for Codeswell, it’s back to the drawing board. Since then I’ve been continuing to do contract projects. (Shameless plug: I’m looking for a few more, so if you need that kind of work, or know someone who does, drop me a line.) And, of course, I’ve got a couple other product ideas I’m exploring…
Mar 09
Andrew CrazePolitics Politics, The Economy
I haven’t written anything lately — busy with getting the new business going. I promise I’ll write about that soon.
In the meantime, I read a neat piece on The Paragraph over the weekend. Enjoy.
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