I’ll have the, ummm, health care please.
May 29, 2009
I am in no way a health care consultant or professional, just a father trying to game the system as much as anyone.
Recently I went to New York with my wife. We enjoyed eating out. But there was one restaurant that just didn’t get it.
A meal to remember, and forget
We arrived at our reservation time but were told we needed to wait, but not for how long. “We’ll call you,” said maitre d’. We waited another 15 minutes before they sat us at a nice table next to some colorful New Yorkers celebrating a birthday party. I was sure I had seen two of them on T.V. before. We enjoyed people watching while waiting for our waitress.
“Are you two actors?” she asked.
We were new to that type of cuisine and seriously needed some expertise, so we asked the waitress for her recommendation. We figured the lack of prices on the menu just meant that it was a fancy restaurant and gave it no mind. We were confident we could pay. She was happy to give her recommendation and insisted it was the best for us. We took her advice.
We enjoyed our meal and paid with credit card. The waitress brought back the bill to sign for payment. It just had a spot for a signature, nothing more, no listing of items purchased, nor even a price. We signed trusting the price to be around $100 and left a $20 tip since the waitress was helpful.
We went to the theater and returned home. Days later we received several strange bills in the mail in separate envelopes from different people apparently:
- $5 for the waitress, noting the cost of recommendations, paid by card
- $10 for the bus boy, paid by card
- $10 for the maitre d’, paid by card
- $5 from some NY City restaurant association, unpaid, pending payment
- $500 meal for two from the cook, unpaid, first installment due
In all, $550 for restaurant services including the $20 waitress tip. The bill from the cook included 0% financing terms and a due date for our first $50 payment.
We were shocked. What kind of restaurant is this? How do they stay in business?
None of our frustrations or confusion did anything about the ridiculous bill. We had to deal with it or face collection agencies, or worse, a ding on our credit. We could pay but we were not going to just pay for this without understand first. We obviously wouldn’t have paid had we known the price in advance, even though we were very hungry and had made reservations. Then again we did eat and we did sign for payment. Something just wasn’t right, but who’s fault was it?
We decided to call the restaurant having already long returned home. After several calls back I was able to get the waitress on the phone, who normally never takes calls. After several attempts to explain the problem, it became apparent she did not see how this involved her since she was completely paid up.
“Sounds like you have an issue with the cook,” she said trying to be polite. She didn’t realize how ridiculous that sounded. She really did not understand that we should have had one bill, in advance, with everything listed before we agreed to dine. How could this not be obvious to her? It seemed as if this had been ingrained in her from years of doing it that way.
I tried to explain. “But don’t you see, we took your recommendation. Had we known your recommendation was going to cost almost $600 we would have considered something else, maybe even a different restaurant.”
“Well there’s no way I could have known it would cost that much. We generally don’t consider price in our recommendations. I’m sure you understand. At our restaurant thinking about price too much would affect the quality of our service and affect our ability to give customers what they really need. I’m sure you will agree often the customer does not know what they really need–especially when fine cuisine is involved.”
Her words infuriated me. Yes these elitists knew more about fine cuisine than me, but the decision was still mine. It was my money after all. I resented being made to feel a lesser person for bringing up cost, but $550? I don’t care how fine the cuisine or how hungry we were or how special an occasion, it was not worth $550 and Alicia and I did not want to pay it.
So I got the cook on the phone, spending most of a remaining vacation day doing so.
“What on Earth was in this meal to cost $500?” I asked.
“For that I can mail you an itemization of your dinner, would you like that? If so let me transfer you to …”
“NO!” I cut in, “Just tell me what was in the dinner that cost that much? You made it. Tell me. I don’t need another letter in the mail–especially since the first payment is apparently due in four days.”
“There is no need to raise your voice, sir. I see the problem, your waitress insisted on saffron and other expensive spices, quite tasty and, might I add, a great choice. Clearly the best.” His voice sounded like his head had taken a ponderous turn while he reflected on the recipe, ignoring me.
I broke in again. “Just curious, sounds like there’s a way to make that recipe without those fancy extras. Would that be correct?”
“Oh yes, yes, I make this at home all the time and have a wonderful substitute for those spices. Every bit as good but only the most discerning palette would know the difference.”
“Why didn’t you give us that version then?” I asked naively.
“Well, your waitress shows you insisted on the best.”
“WE DIDN’T! We didn’t, ” getting myself together. “We would like to have known about that option.”
“Well why didn’t you SAY you wanted the ‘budget’ option? We have customers all the time that tell us that. After all, we are a restaurant of fine-cuisine with a reputation to maintain, but we understand those on budgets. Indeed, without those on budgets eating here with the others we could not afford to keep the doors open and no one would enjoy our services.”
“So you are saying this is my fault because I didn’t ask for the ‘budget’ option? I didn’t know such a thing existed.”
“Well, you didn’t ask if it did or didn’t exist. You could have at least mentioned you were ‘on a budget’ to the waitress. She regularly responds to those words and adjusts her recommendations, even has a different menu. Also, I see you paid with credit card, which we assume means you have the money and are not ‘on a budget’. We usually ask people who pay cash if they would like the ‘budget’ version of the meal.”
“How does paying with credit imply I don’t want the budget option? Just because I have it doesn’t mean I want to use it to pay more.”
Feeling frustration and some self-critical depression settling in. I closed the call giving in to the fact that no amount of calling and ranting would fix all the misunderstanding, bad assumptions, and confusion that led to this ridiculously high bill and horribly bad memory. One thing is for sure, I will never eat at that restaurant again. And no matter what, I won’t eat or do anything until I have in writing how much it is going to cost me. I could care less what people think now.
So it wasn’t a restaurant, but why couldn’t it have been?
You may have figured out that not all of this really happened, not in a restaurant anyway. In fact I had a great time in New York, it was coming back to a $896 ‘lab work’ bill, and the real events following, that pushed this post out of me. Long before our vacation she went in feeling flu symptoms that persisted (like any box in the medicine cabinet suggests one should see a doctor about). The doctor visit cost $100. The lab work to “make sure something else isn’t going on” cost $1000 and we didn’t know that until the bill came. Calls to the doctors office and the hospital that did the lab work went just like the dialog of that bad restaurant story. It got us no where.
Restaurants really do understand service, customer, and reputation. Those that survive anyway. Why? Because they are one of the most direct examples of free trade and market economy. Only one person sits between the consumer and the producer. In stark contrast, centuries of bureaucracy, litigation, fear and politics have built one of the world’s most advanced, bloated and absurdly inefficient Health Care systems in the world. There are so many layers between producer and consumer, even though they often are in direct contact with one another, that the health care market is completely out of whack.
Beat the system, drop your health insurance
Recently a friend shared a story that provides an interesting insight into how to beat this incredibly screwed up health care system of ours. It boils down to one thing: drop your health insurance, completely. That’s right, don’t hang onto that glimmer of false security a high-deductible HSA seems to offer. Drop it all. Here’s why.
Insured and Uninsured
Of all those boxes and blanks on that form you dutifully fill out at the doctor’s office are mostly to answer, “Can you pay for this?” You might think this question is the same as “Are you insured or uninsured?” Guess what, it’s not, at least not as much anymore. A recent experience from a temporarily uninsured friend demonstrates this.
“Uninsured, O.K. I’ll drop bill 60%”
My middle-class, intelligent, married friend with three kids recently passed through a short stint of unemployment and found that by telling people he was uninsured that they surprisingly did not deny him or his family treatment, but instead knocked %60 off the bill and did everything directly, even providing 0% financing. It seems the not-so-secret secret is that the people doing the work, many of the individual doctors, optometrists, pharmacists, and some of the hospitals are already quite adept handling the non-insured, even catering to them as a growing part of their customer base. There are simply too many uninsured out there–many with plenty of money–that health types cannot simply turn them away because it would affect their bottom line.
By the way, we found out you can’t hold onto any insurance at all for this to work. We thought we’d try the middle of the road with a high-deductible HSA which worse. It prevents you from invoking whatever systems your health care people have set for helping the uninsured and also does next to nothing, in effect, to help you.
You are not a dead-beat for not having insurance
The waves of uninsured blowing in from all directions are breaking down the reef of a long-held stigma about them. Not having insurance does not mean ‘you suck’ (as in you suck everything you can from any welfare and government subsidies you can find). In fact, choosing to not have insurance can demonstrate your intelligence and responsibility, not unlike savvy investors make conscious decisions to go with companies that have proven market value and attention to what the consumer wants. No one wants to spend money on a bad product, which is what health insurance has really become, like savings and loan investments and variable-rate mortgages.
You think health insurance has some value still?
Combine the ridiculous cost of even a high-deductible, company-subsidized HSA, with the general sleaze, unresponsiveness, and all-around foo-bared state of large, bureaucratic insurance companies and you start to see what a bad product health insurance is, despite the flood of advertising they spew to the contrary. Health insurance has no future.
The biggest health insurance clients, big companies, like IBM, are increasingly unable to make insurance workable for their employees as insurance companies struggle to contain the unchecked inflation for medical goods and services driven by the disconnection of such goods from the consumer. It is just a matter of time before corporate health care, like so many other company benefits (pensions, training, etc.) gets dropped as an employee entitlement and with it insurance company revenue–unless they figure out a way to sell directly to consumers instead of by way of their company.
More and more ‘free agents’ (see Pink’s, Free Agent Nation) are taking their chances on their own, 25% of all workers, going it without insurance and, according to Pink’s stats and conclusions, no visibility into the system designed from its roots to function in conjunction with employers under failing Organizational Man models.
Unless health insurance companies radically change they will fail as big and noisily as did Fanny Mae, GM, and the savings and loans long before them. Insurance companies seem to define the very oh-that-will-never-happen ideas and decisions behind such things as the credit default swaps, which tanked some of the biggest financial institutions in the world, and some might say governments. Yet their resources are being hurt by a failing economy while the number of claims increase as the fattest country in the world ages into needing that insurance.
Then there are the healthy people who are catching on to this mess and just taking their money and playing elsewhere. They save on their own, stay healthy, and thumb their nose at insurance companies. Ironically, these healthy people are the life blood of insurance companies, which suck that blood from them to pay for claims from the sick who too often got that way from years of irresponsible living. That blood is drying up.
Be prepared. Save it.
Get out now. Use that money for life and saving it someplace as safe as you can rather than throwing it away to insurance companies. That is the only way the market will respond enough, as it has already started to (see my friend’s case) to meet the needs of individuals.
Before you go lumping me with Michael Moore or any FUD-throwing doomsday prophet. Consider the very real circumstances of those around you, virtually and physically. Two of my friends come to mind, one was completely dropped from insurance after they discovered he had cancer, preferring to let him fight it out in court rather than pay for services he had been paying for. What did faithful insurance payment get him? Another dear friend, eventually lost his wife after of years battling insurance companies and hospitals and pharmacies for condition she faced which eventually bankrupted them and robbed that family of wife and mother. He has a remarkably positive outlook on life despite that painful experience. He did his best to make ends meet and played the insurance game. He maintains it did help, but I can’t help wondering what he could have done differently. Like the insurance companies infer in their advertising, this is the last thing you want, “we’ll be there” blah, blah. I say, show them the money. Insurance IS fraud.
Here’s the horrible reality, if something big happens to you, you are likely going to go bankrupt anyway. No modern insurance company is going to cover you enough, because they themselves are failing. Don’t let that scare you. Take control, get fit, prepare, and promote the doctor-patient economy we need to get people well. The sooner you start building your own personal health savings, the more prepared you will be if and when something big hits. We don’t need no stinking insurance companies.
The Benefits of Distraction and Overstim …
May 19, 2009
The Benefits of Distraction and Overstimulation:
The brains of Buddhist monks asked to meditate on “unconditional loving-kindness and compassion” show instant and remarkable changes: Their left prefrontal cortices (responsible for positive emotions) go into overdrive, they produce gamma waves 30 times more powerful than novice meditators, and their wave activity is coordinated in a way often seen in patients under anesthesia.
Ooo, here’s another good one:
This sort of free-associative wandering is essential to the creative process; one moment of judicious unmindfulness can inspire thousands of hours of mindfulness.
Which just goes to show that Daniel H. Pink might be on to something in his book A Whole New Mind, Why Right-Brainers Will Rule the Future, which I find interesting being overly left-brained but constantly working on developing the other part.
