Ryan, Debi, and Toren Cragun's Blog

Not sure if anyone will be interested in this, but I occasionally talk about this issue in my classes and finally found a document to illustrate my point.

Our health care system in the US makes little to no sense, in large part due to health insurance companies.  From what I understand, health insurance companies negotiate prices with health insurance providers for pretty much every service they cover (when they cover services).  Thus, the health care provider (your doctor) charges some price for a service but the insurance company pays a different price.

So, an example:  Let’s say you go to a doctor for a visit.  The doctor charges you $100 for the visit.  The bill goes to your insurance provider, who has negotiated ahead of time to only pay $50 for a doctor’s visit.  So, your insurance company pays it’s percent of the negotiated amount – 80% or $40 -  and you pay your percent – 20% or $10.

Here’s the kicker: If you don’t have health insurance, you still get charged the full amount by your doctor – $100, no discount applied (some times they do, but often they don’t).  Now, this may not be a big deal if you’re only talking about a doctor’s visit for $100.  But what if it’s a $1000 charge, or $10,000?  Now it’s an issue of really screwing over the uninsured.

Additionally, insurance companies increasingly want all expenses to go through them – you don’t even pay co-pays anymore.  This makes it so individuals have no idea how much their health care actually costs.  I don’t remember the last time I went to a doctor’s office and the doctor actually told me the up front cost of a procedure or visit.  This way, the insurance companies are like a big black box – health care providers submit charges, the insurance companies pay whatever they pay, and they pass on a certain percent to the consumer.  This puts the insurance companies in almost complete control of health care in the US.  Consider what life would be like if all of your purchases worked this way:

You walk into Best Buy to buy a TV.  When you walk in, you have to sit down and fill out a form that asks about your purchasing history to make sure you will have no complications purchasing anything at Best Buy.  There are no prices on any TVs, but you talk to someone in the store who tells you that you “need” the 46 inch flat panel TV.  You agree and tell him you’ll take it.  You pull out your “merchandise insurance card” and hand it over.  He photocopies it, tells you to sign a piece of paper, then sets up a follow up visit to consider universal remotes.  They load the TV into your vehicle and you drive it home.  Several weeks later your “merchandise insurance company” sends you a bill.  Best Buy charged them $10,000 for the TV, but they have a discount negotiated with them of $8,000, so the TV is only $2,000.  You pay 20%, so you owe $400.  Of course, to use this “merchandise insurance company” you also pay them about $500 per month for a family plan and your employer pays an additional $1,000 per month.  So, your insurance company makes $1,500 per month and doesn’t pay full price for services.  If you don’t have “merchandise insurance,” you pay the full price at Best Buy.  Who would buy anything this way if you have no idea how much it will eventually cost you?

So, I was getting rid of 2007′s financial records when I came across a bunch of notices from our old health insurance company.  The one I scanned is great.  I won’t say what it is for, but the charge from the health care service provider was $965.  The discount for the insurance provider: $885.  That’s a 92% discount.  That leaves $80 to be paid.  Our co-pay at the time was $15.  Which means the health insurance company paid $65 out of $965 charged to it, or 7% of what it was charged.

How many times have you heard someone say, “Thank god we have insurance”?  Are we really lucky to have health insurance? Health insurance seems like a good idea when it is used to spread out the cost of major healthcare expenses.  But today it is generally used just to enrich people: catostrophic health care is passed on to the government because the health care companies either drop them or won’t take them for pre-existing conditions.  They also try to find as many things as possible to not cover.  That leaves health insurance companies providing insurance just for the healthy, who have lower costs.  Then they get discounts and pass some of the cost on to you.  You pay for the privilege to not know how much you have to pay.  It’s time for a new system…

A friend gave us a gift card to Carrabba’s Italian Grill a little while back.  We used it on November 10th (it took me almost a month to remember to get the picture off my phone).  We had never been to Carrabba’s, so we were excited to try it out.  But, we’re also cheap.  So, we tried to make sure we could cover our entire meal with the gift card (that’s how we roll!).  Also, we know servings at most restaurants are big enough for the two of us, so we usually split one, especially when we are on vacation.

With all this in mind, we decided on the following: I would order an entree we would both like – the Manicotti.  Debi would order a bowl of soup.  The entree came with a cup of soup or salad.  We’d split the entree; I’d get the cup of soup, and Debi would get the bowl of soup and we would be good to go.  The soup of the day was an awesome tomato soup.  We thought this would fill us up, so we went ahead and ordered it, oblivious to what we had just done…

A few minutes later out comes the waitress carrying these:

I actually said as she delivered these “bowls” to our table, “You have to be kidding.  That’s not a bowl, it’s a pot of soup!”  The waitress seemed surprised by our surprise.

I know the picture isn’t great quality (taken with my phone), but hopefully you get the point.  The small bowl fathest away from Debi was the “cup” of soup.  That “cup” is as big as the bowls we have at home.  It was easily a bowl of soup.  The enormous vat closest to Debi is what qualifies as a bowl at Carrabba’s.  I know it’s a little difficult to get a good reference to illustrate the size of this bowl, but think about it this way: Debi is 5’4″.  While her waist is quite narrow and she’s very thin, the “bowl” of soup was actually larger than her waist.  There was enough soup in the “bowl” to feed a family of 4.

They served both the “cup” and the “bowl” with a side of bread.  They also brought us half a loaf of bread with olive oil and pesto dipping sauce.

I ate my bowl and bread and was pretty full.  Debi ate about half her bowl and her bread and was stuffed.  I finished off her bowl and was ready to pop.  When the waitress brought out the entree we just laughed.  We told her to just put it into a to-go box. I skipped breakfast the next morning – too full from the night before.

Certainly you don’t have to eat what they bring you at Carrabba’s.  And, just so I’m clear, I thought the soup was great.  But I don’t really wonder why 34% of Americans are obese… If people don’t bat an eye at a vat of soup that is called a “bowl,” people have a serious issue understanding portion sizes.  We estimated that we were served somewhere between 14 and 16 servings of food (1 cup of soup is usually a serving).  We were easily served 8 servings of soup alone.  Add the half loaf of bread, the other bread, and the entree, and we were served enough calories for three people for one day (about 6,000).  I’m sure Carrabba’s is just catering to customer wants, but when will the over-sizing end?

…before a Wal-Mart Employee was trampled to death in the mad rush of consumerism on Black Friday.  When shopping deals are based on a first-come, first-served basis, you can only expect people to trample each other.  The structure of the situation facilitates misbehavior.  It could be solved with a lottery system.

This doesn’t absolve the people, of course.  How despicable do you have to be to be willing to sacrifice the safety and even lives of others in the interest of saving a couple hundred dollars?  The worst part about this is that the people felt no remorse even after they found out an employee had been killed.

Happy holidays… :(

I’ve been wanting to write this for a while but am just now getting around to it. When we moved to Cincinnati we bought a very modest condo in a working class condominium complex. We liked the area and even though we didn’t know most of our neighbors, we were mostly content. At least, that was true initially. Over time little things about the complex started to add up and turn into big things. One of the things that really got on our nerves over time was the fact that there was a manager of the complex who made a lot of money for basically doing nothing. I wouldn’t go so far as to describe my graduate school work experience as slave labor (20 to 25 hours per week at roughly $10k per year – though that doesn’t factor in my tuition), but I know I worked a lot more hours per week than the manager of our complex did and she made $18,000 per year. Here’s a scan of the yearly budget as evidence:

In addition to the purely gratuitous wages of the complex manager, there were a lot of other things that eventually really upset us. For instance, on the rare occasion that it snowed enough to be an issue with driving, the complex would plow the main parking areas, but not the back lots, which is where our assigned parking was. I shoveled most of our back lot twice while we lived there – spending almost the entire day each time. The complex also had the power to levy sudden, emergency fees whenever it felt like it and you had to pay them or else. This happened about three times while we were there, and we can only imagine the hardship it must have caused to some people in the complex who lived on fixed incomes. Finally, the complex had a pool and club house. The pool was a decent size, but a bit old and regularly needed repairs. Additionally, it was seldom used during the summer but cost thousands of dollars in upkeep. Given all of the financial problems of the complex, Debi suggested that they not open the pool one year to save money. This was met with a stunned silence and then an outcry, “How dare you suggest…” As for the club house, while it was supposed to be a common area, it was basically treated as an addition to the club manager’s condo. This was most evident in the fact that it was not smoke free (the complex manager smoked) and always smelled heavily of stale tobacco. To hold an event there you had to pay a fee, even if you lived in the complex. I never really understood that either.

Never having owned a condo before (nor really knowing many people who do), we were really disappointed with the whole experience. Maybe others have had better experiences living in condos, and I certainly hope that is true, but our experience soured us to owning a condo ever again… (Of course, with the housing market currently tanking, we’re beginning to wonder if we wouldn’t just be better off renting the rest of our lives.)

On a brighter note, we are now officially Floridians (okay, that’s probably only true in the technical sense – not sure when we’ll start feeling like we are “from” Florida): we have Florida Driver’s Licenses. We had to get them in order to get the strange “Homeowner’s Exemption” here in Florida (which is a tax break for people who actually live here year round). I was a little sad to see this beauty go:

Also, we received a copy of a photo taken at our University’s holiday party. One of the perks, I guess, of working at a smaller university (that probably also has a little more free cash than most public universities) is that there is a yearly holiday party. It’s a rather posh affair with chocolate fountains, decadent food, live music, and even an open bar (which we will, unfortunately, never really take advantage of). Anyway, we liked our picture from the event:

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Now playing: Dave Matthews Band – Jimi Thing
via FoxyTunes

In a new twist, a post by budding skeptic, Debi:

Ryan kept insisting that the little store around the corner from our house (it’s called “Nutrition Works” and is owned by Raj Patel) had a flashing sign saying DNA Testing. Being curious I finally told him I had to go check it out. The store sold “organic”, “health” stuff. Ryan urged me to go talk to the owner who had said hi when we walked in. He seemed nice, and I didn’t want to cause him stress or make him feel stupid. Anyway I did ask what the DNA testing was and he informed me that they could send off for any type of testing. When pressed he provided examples such as paternity or ethnicity testing. He reiterated at least two or three times that they could do DNA tests for medical conditions, but later couched this by indicating that would require interpretation by a doctor. He clearly didn’t understand what I meant when I said I didn’t think the company did that type of testing or looked at any of the pieces of DNA necessary for that type of testing. Had I not been so nice I am sure I could have made him look more like an idiot. He asked me if I had ever done genetic testing at which point I disclosed that I trained as a genetic counselor and at that point he didn’t have much to say. Looking back I should have gone in and asked him if he could do BRCA1 testing for breast cancer, my fear is that he would have said yes. Paternity and ethnicity testing cost between $250 and $500, which is about the same as what the company charges if you do it directly through them.

This is a good illustration of companies jumping on trends to make money regardless of any evidence supporting what they are claiming. We got a card from Mr. Patel and it says, “We offers (sic) DRUG TESTING, DNA TESTING, PATERNITY TESTING, STEROID TESTING.” I don’t really want to be mean, but this is remarkably misleading.

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Now playing: Eileen Ivers – The Rights Of Man
via FoxyTunes