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.

Health Care

So health care costs in US grow faster than Income and Economy.   It surely can be partially blamed to how inefficient and high overhead the system is but I think fundomental reason is different.   Medicine has to offer a lot to people these days  – I did the MRI another day and was surprised to see how many artificial things people can have in their body.    The more advanced medicine is just more expensive –  in terms of development, training, care.

The cost of what medicine could provide for individual is so high everyone can’t possibly get the health care at the maximum extent possible.   This is scary – the life is sacred and we want to believe everything possible would be made to save our life but this is just not possible.  Furthermore with continuing development the gap between average health care society can afford and what medicine can provide will widen.

What does universal health care do ? It fixes the costs which in the end means it limits amount of health care one can get.  In my life I lived in 3 countries with universal health care – Russia, UK and Sweden and there is a lot in common.  You would have the long lines for certain specialists and procedures or the doctor will plainly refuse to send you to specialist for the same condition as you would have no problem going advanced diagnostics in US.

Just in the last month I had a routine MRI check.  I could schedule it the next day.  My mother in UK also needs one…  she is still to get back the letter when her appointment to be scheduled and expects it to be at least 6 months away.

True, the state run health insurance usually treats life threatening conditions seriously and you can get diagnostics you need, but because of economy on screening and diagnostics or outdated equipment you have less chance to be diagnosed in time.

Available drugs is also the question.  During my time in UK there was a big scandal with national health care not covering expensive last stage cancer  drug.  It extended people life few years but it was considered too expensive  still    – the same money could save more lifes being invested in something else.

As I mentioned the numbers of course matter. Litigations as well as salaries play its role.  Russia for example can afford much more doctors because they are paid much less.   The doctors in state run hospitals could be earning as little as $200 a month.  Doctors in UK and Sweden of course earn much more than that but still no match for their US collegues.

Insurance companies (at least some) also place the limit on the medical expenses.  I think my insurance covers expenses up to $2M  in a life time.

There is no free cheese and if  health care is provided to everyone there is going to be caps on the services provided.     The only question for me if this is going to be honest and clear what services are available or would it be making services available in theory but impossible to get in reality.

On Being independent and Bias free

One of the core values I had for Percona is providing indepentent/bias free services for the customers focusing on just their needs and benefits and avoiding the things which would stop this from happening.  As I was thinking about this matter over the years I see there are number of things which forms the bias or breaks tru independense and some are harder to deal with than overs.

Product Sales – if you own the product you’re doing consulting around it is very hard to be independent. It would take a lot of guts for consultant to go out there and say the competitor product would work better for the customer and it takes a lot of leadership to ensure  such opinions can be exposed without putting the job at risk.  At Percona we’re in good position about this one because we made a choice not to sell any products – all software we develop is freely available and we do not have any direct insensitive to push our software to be deployed.  True we think it does provide value and improves effectiveness in many cases but it is not the same thing.

Partnership Commissions –  Another insensitive company may have is to push product or services by the partners earning comission on the deal.   In this case it is similar to Product Sales issue  as there is a motivation to recommend partners which pay highest commission  and avoid solutions which do not pay any.     This is harder one to solve.     If we simply to refer the customer  to someone we do not want any comission on this. If someone would like to give a token of appreciation to Percona we would rather see in form of  discount to our customer.  We’re paid for bias free recomendation of best solution for the client and this is what we do.     If however customer wants to work with Partner through Percona we have to charge certain fair margin to keep operations running.  If we subcontract we’re exposed to legal risks,  financial risks of failing to get the payment from the customer and quality risk, potentially being forced to seek solutions at our cost for mediocree work partner has done.      We try to structure our deals in this case to ensure we fairly share revenue with partner and so we have limited insensitive choosing one partner over another.   Of course relationships does matter in this case  – if some partner does a great job performing some task he naturaly becomes preferrable.

Personal Preferences – Here is another hard one.  Personal preferences.  There are people who love Linux others love FreeBSD – they know one better and would be naturally biased towards that.  Everyone has their individual experience which leans us way or another.  The only solution I see here is education for consultants to be factual and really evaluate situation based on facts rather their  personal preferences as well as disclosure of customer experience in regards to matter.   For example if you’re compating AIX to Linux   and never had experience with AIX  you only can say that, as well as state the fact  there are much fewer people running MySQL on AIX than Linux so risk  of platform specific issues is higher and there is less “community” experience.

Resource Availability –   As a company we have experience with some technologies and less or no experience with others.  This of course means we’re not as confident recommending technology we do not know – for example comparing MySQL to CouchDB it would be hard to be objective for us because we know much more about first than the second one.  Though full disclosure helps in this case to make sure advice is interpreted correctly.  The other  issue is – if customer decides on CouchDB he will likely hire another company to work with, while if it is MySQL – business stays home.   This really requires consultant integrity and this is important personal skill for Percona hires.  Another way is to ensure we as the company have experience for relevant technologies.  If CouchDB is better than MySQL for large class of application this means we better to get experience on CouchDB either inhouse or via partner.

Any other problems you see or solutions for stated ones ?

Donations instead of charges

The Parcell Tax initiative has failed  here in Pleasanton which means a lot of staff and program cuts from the Schools, which is something this area is proud of.

To partially offset the problem there is a fund drive.    For example you can donate to PSEE to save music classes.

Now I can understand why parcell tax measure failed – there are a lot of old people in Pleasanton having kids out of School.   I however do not understand why not to make these extra activities, which have no money for them in budget to come at added cost ?    There are some paid additional classes at the school already such as computer typing classes and I do not understand why this makes the difference.

I did donation more than to cover my fair share but I think this is a bad way to collect money for such an activities.  If you look at my  (or other individual) choices –  I can skip donating and potentially enjoy free ride because somebody else paid my share or well it may be it would not be enough to support the program.  If I do donate I have to donate more than my fair share to keep program in place because there will be people who will not donate.   This is screwed as it provides and extra excurses and motivation for people who can pay their share but choose not to do that.

Of course there are children which parents can’t afford to pay, though I think they are a small minority in this pretty expensive town.  I would much rather see they applying for scolarship or something like it to enroll into the classes and I even do not mind donating some money for it.  Such approach would ensure you’re not the most rewarded for the absolutely passive approach of sitting there and doing nothing as donation based funding rewards.

Co-Installations are new kind of Spam

What is getting annoying during last few years is the Co-Installations a lot of (typically free) software uses.    I’m am in particulary annoyed when it is opt-out instllation so if you just click through in default install you get software installed and if software which is installed has little to do with software being installed.

It is my expectation as a “user” the vendor has picked the default installation options to really provide configuration what most user wants and getting in some junk in there hurts my trust to the vendor.

One very annoying example I have to deal with comes from Sun Java.   If you install Java it will trypically check for updates automatically and suggest you to install them.  When you install updates it will try to sneek in Yahoo Toolbar  Each time ! With updates every couple of months it is only matter of time when somebody like me forgets to uncheck the checkbox and get the unwanted crap installed.  I surely did it more than once and had to clean it up with uninstall.

This stratregy probably works well recruiting Yahoo Toolbar users and may pay off in terms of number of users to Yahoo and Sun.    Many computer users probably would not notice and would not mind – and I guess this is what the marketing in this case count for.   Some other people (like me) get annoyed and loose their trust to Yahoo for getting in such spammy software distribution tactics and Sun for making it possible.

Expenses and Cash Flow

Back in Russia we saw little difference in the expenses and spending the  cash in personal finance.  Life was simple you buy something and you have expense – same thing.   It was very interesting for me to learn in my life in the states this is not the same thing.   It is very easy here to get an expense such as buying the car spending very little cash but  having liabilities instead.   If you count  car as an asset you would see after your initial purchase only interest payments and depreciation are “expenses” while you may have a lot of cash flowing out paying principle.

With Credit cards another interesting thing happens – because you get about 1 month of interest free credit (if you pay your ballance in full) you have about 1 month lag between expenses and cash flow.   If you spend a lot on a credit card one month it will affect your cash flow on the next month.

With income things may not be as straight as well.   There is something called “Flexible Benefits” which can be used for child care or medical expenses which  is seen as an income but does not directly become available cash in your bank account – you have to incurr expenses and apply for reimbursement to get true cash out of that.

These things get personal expenses much more complicated (though on the positive side they teach you bunch of concept you would need for business finance anyway).   Because of these things I have been left more than once I felt somethat confused about financials – the change in the bank account for the month may not really match the expenses you had during it.