I’ll have the, ummm, health care please.

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.

Zain Naboulsi just topped by biggest BS- …

Zain Naboulsi may have just topped by biggest BS-ers list (an unofficial, unpublished list to be sure). As if all the virtual world evangelists aren’t bad enough, now Zain from Microsoft claims to be “the creator of Virtual Worlds Evangelism.” I pray he meant some organization and not the otherwise inferred noun.  There were people evangelizing virtual worlds while his av was still in diapers.

Come on guys. Do something. Use the stuff. Stop inventing titles, blog bickering, and comparing the size of your tribe.

Twitter does beat Second Life for the ap …

Twitter does beat Second Life for the application they are talking about. Who needs a bloated 3D viewer and immerse experience to build community, network, marketing and friendships–especially with those whom you would like to meet. Such business use was never the primary intent of Second Life (and OpenSim for that matter) and thankfully people are coming to that realization. Still, many do find these business uses happening organically in the Second Life and OpenSim communities where Twitter and OpenSim are working together for such business collaboration. The ThinkBalm community is one that I am aware of that is emerging here.

It has been said a thousand times but no harm saying it again. Use tech that fits a need, not tech for tech’s sake. In the case of economizing on travel, not to mention a dozen other business applications, virtual worlds make business sense.

I am sick of reading “this tech beats that tech.” Hype really is damaging. Comparative hype is an even more potent subspecies. It makes people jump on things for no reason other than hype and others abandon good tech for the proper application.

One of the greatest things to come from the slow decline of sponsored journalism is reality replacing hype. I would rather read the novice opinions of a dozen bloggers and tweeters over a few highly visible, highly sponsored news channels, magazines, commentators, book authors, and self-proclaimed industry leaders and innovators. Vive the meritocracy.

If you can’t make it work for you. Fine …

If you can’t make it work for you. Fine. Don’t use it and go away. That is my reaction to Sean Carton’s recent Is Twitter the Next Second Life? flame bait. People dismissed the web, email, and instant messaging as time-wasting, over-hyped technology and now what. Business efficiency would not exist today without them.

Frankly I grow tired of the insinuation that leveraging new technology is proof that you have too much time on your hands. People tend to measure efficiency by their own abilities. This speaks volumes about their own efficiency, but is irrelevant and unfair when applied to others’ use of that same technology. Following twitter feeds, Facebook, blogs, and even using the archaic ‘VI’ text editor are actually all time savers if you know what you are doing. This simple blog has helped me prioritize work and organize thoughts that would otherwise be lost. Video and other tutorials are as much to capture information I will need again later and have difficulty recalling as they are about sharing that information.

Oh, and here’s a thought. Maybe some of us are so efficient at our day jobs that we can quite easily accomplish all the is required of that job and more in less than your less-efficient expectation.

Efficiency aside, these technologies enable things impossible before now. Meeting someone in a virtual world is the next best thing to being there and often being there just isn’t realistic. Besides, where in the real world would I even have had the opportunity to meet such great friends like professional New York musicians?

I don’t know why I waste time even responding to that blog, but then again, I suppose responding perfectly supports your point. I would not have even read about it were it not for a tweet about it.

Had to install Perl to get Java Certific …

Had to install Perl to get Java Certification. I laughed sadly for five minutes after learning that to get our application officially Java Certified we have to download, install and configure Perl on all operating systems that our product will run on. The deep irony is that this entire release, a six month plus process, has been focused on shoehorning another monolithic product, with it’s Java requirement and client JRE into the client, into a light, grassroots application that has been working well for four years now in compiled Perl and Winbatch, so much so that it was consumed by monster (like so many monster’s do to ‘aquire’ innovation instead of coming up with it). So much for any hope of ever being Agile again.

I am all about the right technology for the right application, even if that tech is unsexy or unpopular or I can’t program in it. If it gets the job done well and can be maintained it just should not be touched.

The people making these architecture decisions are so far removed from the actual users who are responsible for system compliance and administration that they have not sufficiently listened to them, other than token User Acceptance Testing mostly done by people not actually using it. The real users, that we also support at L3, continue to use and want improvements to the existing working system, a system largely built by such users to begin with. People who do not use the system are making decisions about what will be used and ultimately sold.

I have barked about this point and been beaten down like a dog so much that my tail is now comfortably between my legs. Clearly portions of this company are not always interested in innovating and meeting customer needs, there is always more to the story than that. So I will continue to attend rah-rah pat-ourselves-on-the-back-with-whatever-stats-we-can-find all hands meetings while the people using the stuff, the masses, quietly comply with what some senior manager has purchased and another has decided is what he should purchase.

Combine this with very likely being forced to move OFF of Subversion and Trac and onto other archaic time-wasting tools and I find myself dealing with a level of repressed anger for this disconnected, anti-innovation that reaches levels almost beyond my capacity to withstand. [Yeah, I know, "Tell us how you _really_ feel."]

Thank God for leadership from at the most senior level with continued emphasis, and my manager’s support, for “connectedness” and allowing us to innovate in spite of this company sometimes. I do not know what I would do without the ‘volunteer’ work I do for OpenSim, the VUC, and virtual worlds community in general. These occupations fill my time after ‘priorities’ are complete with true passion and the freedom to innovate. There is always hope and, at least currently, the people that matter most understand.