Monthly Archives: September 2009

More on Health Insurance

I finaly have watched film Sicko by Michael Moore and  I honestly was very dissapointed seing things presented in such a way as everybody is suffering with medical help in USA and  in other countries survaved things are just great – you get the best medicine available with no wait and money to pay.  And… it also does not seems to cost anything in taxes.

I believe there are people happy with medical care in Europe or Canada same as there are in USA and there are ones which are NOT happy.  I do not know about ratios but it is surely far from black and white.

Personally as I lived 1.5 years in UK (one of featured countries)  the US health care (PPO) was something I missed a lot.    On the top of that I paid similar amount in Healthcare taxes to what was full cost of my health insurance in USA.   Of course my situation does not apply to everyone  and especially those who are with no health insurace or HMO would like UK medicine more but surely not me.    We had denied referrals to specialists multiple times.  There are also significant wait times for some operations or longer times between certain things you’re entitled to.   Under my US health insurace I’m entitled to once per year full medical exam which would be once per 5 years or something in UK.     There is an option to make a house call but once I tried to do it for my doughter  being 1yo at that time I was pushed to bring her in instead.

My mother visiting us here in US had an incident so she had to get to ER. She has gotten MRI and bunch of other exams immediately.  Now back in UK she is still waiting to be scheduled for followup MRI exam. She tells me they will likely write her back in 3 months and she may get appointment 6 months out or so.   Well  no surprise there is a special BUPA private insurance in UK which makes sure you get admitted to private exam if NHS does not schedule you within the defined wait period.

Of course you may say this is life threatening ER visit which can’t be compared to the followup visit (though if you had rushed to ER I’d expect it to be quite important to find out what was wrong with you)  So I can tell from the personal experience. Few years ago I had a brain surgery so I need MRI checkups which are far from urgent.  I was always able to schedule them basically the next day in US and my insurance have not have any problems.

Other thing which I remember which was covered by a lot of press was cancer drug which was rather expensive and generally prolonged life to the terminal cancer patients few months.  NHS decided it is not wise to spend limited money it has such a way and this drug was not covered.  I got impression this is not the first neither the last case.

Another thing which surprised me in the film  was showing Canadians worried to go to US without insurance because of medical costs. Well what would you expect, really ? The medical care has its costs and why tax payers of the other country should pay for someone outside ?  Unless there is no special treaty between the countries foreigners should be paying…  and yes getting travel insurance is a good way to do it.  This is for example what my mover wisely did for her trip to US.

What do I mean to say ?  Do not take it black and white.  People die. People die with public or private health care.   And as the saing goes the grass is always greener on other side of the fence.

Also  whenever your like it or not the health care will always be better for people more powerful and/or reach.  This is just fact of life –  there supply of brilliant doctors is limited same as certain equipment.  This is  very politically inconvenient and tough reality.   Expecting us all to get same quality of care is same as expecting everyone to drive in the same kind of cars or live in the same quality of hourses.  We can starve to provide some good base level to everyone but not even it out completely.

Imagine for example there is a magic cure which gives every person  10 more years to live.   It however required 20 years worth of “labor” looking at productivity of average person.    The basic math tells us it will not be possible to provide to everyone and well modern medicine is close to that.

If you look at medical research over years you can see (same as with other sciences) it becomes more niche and focuses.   Few hundred years ago doctors were often dealing with general “fever” or “infection” while it changed now to many thousands of different decieses with its own diagnostics and cures which all had to be researched.  If you see research happening now you would see focus sometimes being the special condicions for the special kind of cancer which  one out of 100.000 people or less may get.   If only 1000 people can be helped in a year by given research imagine what the cost would have to be to cover research costs.    In case of government doing funding similar things happen – budgets are limited so some projects are funded and others not.  Some people get cure found for their decieses others left to die.

If you’re Bill Gates, Warren Buffet  you can fund research of your conditions (or conditions you’re likely to get based on your DNA)  of not you’re left to count on someone targeting your “market” being it government or private group.

If you ask me what I think about health care in US I think it is too regulated (bringing hosts for basic care too high) and there are way too many litigations. Doctors make mistakes. People die.  There should be responsibility of course but to harsh concequences lead to fear and restrict innovation.

I think universal health care is good and practical but same as with Schools it should be up to the certain level.    The Emergency care is something which should surely be covered same as base prevention.  However you should be able to reach to private care if you need something special what  social medicine which only has so much per capita of spending in budget can’t allow you.   Government could be helping to ensure there is an insurance available for these low probability but high impact events.

How straight is your pricing model?

Some businesses have straight model, others advertise you extremely low prices which have nothing to do with what you will pay in the end because of various not so obvious items.  Sometimes it is related to specific industry and sometimes just to some players  tricking the customers with some of the prices.

In general I think US is more prone to this compared to Europe.  In Europe when you have the price it typically includes VAT and other prices so it is the price you’re going to pay.  Not so in US with Sales Tax ommited from the price.   I remember number of friends comming to visit falling for the trick surprised to learn $3 in cash do not buy $2.99 cup of coffe.   Also in many European countries the tip is indeed optional in US it is considered hiden part of the price –  you would not avoid pain it in the restaurant you go for lunch every day.  It can be even forcibly added to your bill for large parties in many restaurants.

For Percona Training we just have been deeling with a similar trap with a hotel.  What a time waster.  Some hotel would advertise very low room rates but if you learn about insignificant extras which you’re going to need they can cost 3x-5x of advertised room cost.   How would you like for example Wireless internet access for one day having same cost as the room or  permission to use your own projector being over half a room price.

What really annoys me with such industries it is probably very hard to do business if you price things straight playing fair.   If you advertise full prices which is structured in obvious and straight way you probably would not have people even call you so you could explain them how things work out.

This pricing scam actually goes more.  I constantly spam by mail to get something for free (just paying $15 of shipment and handling) .  This goes to continue to more fine sales tricks going back to fine print.  Some businesses like banks may bite you with fees which you never would know existed.

Another innovation (which smells more like as scam to me) which I see quite commonly used by banks having your credit cards offering you something for free – free gas free air ticket etc, just asking you to mark yes sign and mail back the card.  The fine print however would say you’re subscribing to some service by accepting this offer.

I’m very surprised and somethat dissapointed in US with so many litigations and crazy laws there are no laws in this area or they are not enforced well allowing all kind of consumer deception.  I can only speculate in consumer based economy goverment wants you to buy, so any business tricks which make you to buy more spend more borrow more would be supported and praised as innovations.

Happily with Percona we’re in the industry which allows to keep straight prices and we keep it this way.  This bites sometimes with people complaining rates are high (because we do not play any tricks with them) but we do not need any deception or obfuscation to be in business.

Power of Memory

The interesting thing about US in regards of current economic conditions is most people seems not to remember any big crisis.  So there is belief some events simply can’t happen.

I find being very grateful for my childhood memory in  Soviet Union and Russia which show some things you think could never change collapsing in a few short years.

My first memories go back to early 90s when I was a child myself.  I remember the empty shelfs and having hard time to buy anything changed with great selection at very unaffordable prices as the prices were let go.   Inflation made life savings of most of people worthless.  The only thing which remained for most of people was their flats.

What I find interesting is how this later was described by the government as necessary  (and I think they had the point) – There was imbalance between income and  production but as prices were fixed  you simply had very hard time getting anything at these prices.  Of course there was black market for many goods but most people just preferred to save money and wait their turn to purchase things at official prices.

As inflation happened not only savings but also state pensions were affected and a lot of  older people had to get back to work to make their living or relay on their children.   For years I would see typically older women  moping floors at school and other locations.

In Russia the elder generation gave up its rights.  Not prepared for battle with single party system they always fallen for the tricks and brought to the power the party which had had mainly youth interests in mind.

Visiting Sweden around 92  I remember I was shocked seeing people in their 70s just starting to live – visiting restaurants, traveling, being well dressed etc.  In Russia most of eldery people at that time would have very modest life style spending mainly on food and medications.

As I see in US the situation is different, probably because of Baby Boomers which are large in numbers as well as because of senior people experienced in politics.   The interest of eldery is maintained with Social Security and Medicare kept intact with little idea how it is paid in the future or notorious proposition 13 in California.

From my opinion situation is somewhat similar  between Russia of early 90s and USA.  In both cases there were significant  promises made to people – in terms of Savings in Russia and in terms of promises of Social Security, Medicare, 401K and other equity in USA,  while the production – the ability to deliver on these promises  is impaired.

In case of Russia this was long stagnation followed by large economic collapse in USA it is very marginal growth in the last 10 years and now aging population reducing amount of people who can produce.

Things are significantly different too. In Russia Government owned everything and there was very little of personal dept which allowed the clean start, on other hand transformation to previously non existing market economy was a very big change.

I’m not expecting developments in US to take the same development as In Russia I just remember the things which you think were impossible actually taking place.

On Books

Couple of days ago my son asked me why people would drink or smoke. I told him some of them do this so they can relax and forget about their problems. Well he answered why do not they just read a book ?

For me too books are great source of relaxation. I can relax while reading, looking at the undread books at the book shelf, shopping on Amazon or well best visiting local book store.    I like paper books as they seem real. I like good made hardcover books though a lot of technical books never come out as such.    I buy more books when I  have time to read.  I like to have a choice of books on the book shelf to pick up and browse through when I have a spare time.  I also never throw away books which just feels like a crime to me.

I have been growing up with a lot of books. My grand father has thousands of me with book cases and shelfs from floor to celling in virtually every room. I always threated him as a library when I lived in Russia – there was no book he would not have. Of course this is different now when my interest have shifted to a lot of advanced stuff.

Leaving Russia we took number of books with us and each time we go there we bring some.  We mainly bring old books as it is easy to buy new prints online.   Moving from US to UK and back probably half of our shipment was books. I think we shipped some 20 boxes of books from Seattle and around 30 or 40 back from UK.

Financial Organization Online Usability

I think financial organization web sites are often the most annoying on a web. They are often slow and have extremely poor usability.

One thing which amuses me a lot is the user name and password policies.    Some would allow basically any user name such as email – which is what I prefer to use as it is easy to remember and there is no chance of somebody using the same name, others would not allow to use any special symbols.    Wachovia  (Auto Loans Site) amuses me the most  – the login name has to be 7-9 digits  and contain at least one digit.   Exactly same rules apply to the password.

Both such small variance and digit requitement makes it tricky to pick the user name to remember which causes you to write it down/memorize in browser which only would reduce security as well as increase the load on the password recovery tool.     I would suggest allowing most of characters in the user name (enough for emails to work) and having low minimum character requirement and generous upper limit.  3-20 characters is a good limit.

For password you may want to have more restrictions requiring strong password but allow generous length too.  6-20 or 8-20 chars can be the good range.   In reality you can allow even higher variance – for secure systems you often would store hash of the password rather than the password itself, which means password of any length require same amount of storage.