San Francisco, here I come!

March 16, 2012:  I don't remember much from this phone call other than that it likely included something along the lines of "I got matched in San Francisco".  Regardless, of what was said exactly, it was who said them and how they were said that immediately changed my life.  As someone that generally doesn't take many risks, 2012 had already included me leaving a job I'd been at since my Junior year of college and subsequently traveling to a third world country by myself.  Yes, January was pretty exciting.  But as I tried to process those words as they were tearfully repeated to me over the phone, I knew that the excitement of 2012 was just beginning.  I knew immediately that judging from my girlfriend's tears and my immediate emotional response, our relationship had progressed way past our joking 2 months earlier that it was "nice getting to know you" if she didn't match to a medical residency program in Boston.

And so here I go on what will quite possibly be the most scary, stressful, and downright exciting three months of my life.  I will be renting out my condo (anybody interested in renting out a really nice place from me?), packing my bags, saying goodbye to the city I was born in and have grown to love, and then driving my car west to San Francisco at the end of August.  I will be following in my parent's footsteps (when they were my age) and staying out there for at least the next three years before likely returning back to Boston.  For such a big decision, it strangely has been incredibly easy to make despite the bottomless pit of questions (What will you do for a job?  How will you make friends?  Do you really want to leave all of your family and friends behind?). Perhaps it's because I will be embarking on this wild ride with such an amazing girl (who will be about the only consistent thing in my life in 2012).

Unfortunately, this also means that for the second time in a year, I am starting a job search as I will likely not be staying at my new employer past the end of this year.  Thankfully I work in IT and am going to be living in the greatest city in the world for technology companies.

Check your calendars, who's coming out to visit me and the California sunshine?  3 hours from Yosemite and skiing Tahoe, minutes from the Pacific, and a brand new city to explore, I CAN'T WAIT!

How about some incentives to reduce the $2.6 trillion spent each year in health care?

At the heart of every Economics 101 course is the idea of the incentive:  essentially giving carefully crafted incentives can lead to a happier world for all to enjoy.  I've been thinking a lot about this lately for a few reasons, but mostly because of my seemingly never ending battle to stop my sciatica pain.  It's now been about 10 months, $3,000+, 2 chiropractors, 3 doctors, 2 physical therapists, and one MRI later and all I know is I supposedly have piriformis syndrome and that I should avoid sitting (go ahead and try to do that for a day or two, I dare you). My most recent trips to a new pain management specialist gave me some first hand examples of where some economic incentives could drastically reduce spending on health care and most likely have zero impact on quality of care.  Most importantly, this could be done through the regular HMO or PPO health care plans that most Americans use today (High Deductible plans are another way to provide a similar incentive, but I realize those are not for everyone).  In my case, in my first visit the specialist billed me $532 for my initial hour long diagnostic appointment.  That's pretty steep, but she did a detailed exam, spent a lot of 1:1 time with me, and my insurance company had a contracted rate to only pay $280.  The treatment we agreed to was to try "trigger point injection" shots where the sun don't shine to try to loosen up my muscle.  This consisted of another 4 identical visits to the specialist which each lasted less than 10 minutes.  The key word here is identical, because when you look at what I was billed you'll see some big differences in what was actually billed to my insurance company.

claims

Notice how my first two injection appointments (3/5 and 3/13) include an "ancillary" facility charge from the hospital of $400 plus a "surgery" charge of $283 (a whopping $683 for 10 minutes of a doctor's time and a clean needle - I'm almost positive the needle was empty).  But after my first two visits I'm suddenly only charged $124 for "surgery" with no facility charge(3/19 and 4/2).  That's a pretty significant difference that has been billed for identical appointments.

So how does this tie into incentives you ask?  Well, since my health insurance plan has a $500 deductible which I've already met this year, I have zero motivation to pickup the phone and try to fix this.  As a result, my plan will have paid more money to Spaulding Hospital (the winner here), my employer and I will pay a marginally higher premium next year, my doctor likely won't see a dollar extra, and the US economy is spending more than it should.  I also don't have any incentive to try to find a lower cost doctor, or at least a lower cost facility that my doctor practices out of (she rotates through other hospitals).

So, here are two incentives that could have changed this situation and had a dramatic impact if replicated across the millions of Americans each year in similar situations.

Incentive #1:  Encourage the patient (that's me!) to review the bills (even if they aren't responsible for them) to try to find errors.  If the patient works to correct an otherwise approved bill that ultimately results in the health care plan spending less money, give them 10% (or some other %) of the savings in reduced premiums or co-pays.  In this instance, there is potentially $1000 in charged amounts that I could likely recover on behalf of my plan.  A $100 incentive would likely motivate me to take on that burden and it would still save my plan $900

Incentive #2:  Encourage, but don't force, patients to use lower cost providers.  If a patient uses a provider that is lower cost than the average in-network provider in that area, give them 10% of the savings.  My MRI last year cost my insurance company almost $1600, which I found out later could have been $800 had I gone to a different place down the street.  $80 in my pocket would motivate me to shop around a bit (especially for labs and images) and would have still saved my plan $720.

By the way, a few of the other reasons I've been thinking so much about this are that:

• I work in the healthcare IT industry now and I'm slowly starting to learn some of the fundamental challenges and problems (or to put it bluntly, just how fu$&*d up it is)
• This New York Times article highlighted the huge variance in hospital bills between medical providers and sometimes even in the same hospital:

Fees for a routine appendectomy in California can range from $1,500 to — in one extreme case — $182,955. Researchers found wide variations in charges even among appendectomy patients treated at the same hospital.

• The publicity of "Obamacare" and the pending Supreme Court decision has led to a number of interesting stories highlighting just how out of whack US healthcare spending is.  For example, also according to the NY Times (article here):

In 2010, the United States spent $2.6 trillion on health care, over $8,000 per American.....So the United States, with a population a quarter of the size of China’s, spends just on health care slightly less than half of what China spends on everything.

• Despite the incredible amount of money we spend, our care isn't really that good.  The non-profit Commonwealth Fund published this study showing the US pretty much ranks at the bottom compared to other countries.

Commonwealth fund infographic

Amazing cover song of "Creep" by Radiohead

This is hands down one of the best covers my ears have heard in quite a while (it also happens to be quite easy on the eyes). It is performed by Carrie Manolakos at Le Poisson Rouge in Greenwich Village. Check it out here, and make sure you stay until at least 2:25 if you start to get bored:

http://www.youtube.com/watch?feature=player_embedded&v=aZ5ZclZTeTU

Things I just don't understand

You've all seen them and likely didn't give them a second's thought.  But seeing a "This Car Climbed Mt. Washington" bumper sticker recently got me thinking, there are just some things that no matter how hard you try I would just not understand.  Interestingly, as much as I don't understand it now, that doesn't necessarily mean that my opinions can't change.  Case in point:  I've been training for my first marathon the past 3 months and that would have been on my list 5 years ago, but at this point in my life running has become a big part of who I am. Here's the rest of the list I could brainstorm (in no particular order).  What would you add or remove from this?

• Automatic transmissions in sports cars (even if transmissions are technically faster these days, the point of having a sports car is to have fun, and having fun requires a clutch and a shifter)
• Rick Santorum - Need I say more?
• Anybody still using a blackberry by choice over an iPhone, Droid, or Windows phone
• Pennies - At this point you can't buy anything for less than a nickel, so why bother?
• Drinking crap beer when much better stuff is available for essentially the same price (I'm looking at you Mr. Bud Light drinker)
• The Washington Post social reader app on Facebook - requiring users to use/install your app seems rather unsocial, no?
• Eating beef well done - I can understand and appreciate those who are vegetarian, but if you choose to eat beef and purposely overcook it that is just a shame
• Why NPR has yet to figure out some kind of subscription model so that those who donate (like myself) don't have to listen to the unbelievably annoying pledge weeks
• WWF Wrestling
• Nascar