Monday, August 24, 2009

My story of medial rationing

Something that can't be said often enough or loudly enough during the ongoing heath-care reform debate: Most of the dire things protestors and reform critics are most anxious about are happening now.

Want to see a real death panel? Go before an organ transplant board. Scared of waiting two months for an appointment with your family doctor? In Boston, the average wait time is currently 63 days. Worried that scarce and expensive health care will be rationed? It already is. The only difference is that the decision-makers about who gets care and who doesn't are insurance companies, not government-backed organizations.

Three years ago, we had a health care scare in my family. David and I are among the medically lucky: We've always had plans provided by large, multinational employers with relatively deep pockets. An ambulance ride, a night in the ER, a week in the hospital, and prescription drug costs of around $120 a month were covered with fairly little fuss. Of the roughly $20,000 that emergency week cost, we paid only around $1,500 out of pocket.

But this health scare necessitated weekly follow-up visits, initially with more than one specialist. It happened literally in the very first week of the year -- after I'd made my health care elections and locked in my FSA contributions (then at $0, because we'd never before used much medical care). In the 52 weeks that followed, about 60 follow-up appointments were required.

These weren't optional. I had letters from three different doctors attesting to the extremity of the situation and the fact that, in their opinion, this was a potentially life-and-death situation.

But our medical plan capped outpatient visits at 30 a year. Somewhere in my filing cabinet I have a letter where the company explains that in this case, the medical necessity of the appointments was irrelevant. Having letters from doctors saying "left unsupervised, this could result in death" didn't matter at all. What mattered was that the fine print of my insurance plan said that beyond 30 visits a year, the company would not pay a penny, no matter what.

So we had a choice: Come up with $125 a week for these appointments, or take our chances without.

We're lucky. We were able to scrounge up the almost $4,000 a year that cost (on top of the $1,500 in out-of-pocket costs for Emergency Week, the $3,000 a year we already paid toward our work health-insurance plans, and the $500 we spent that year on prescription co-pays).

But if we hadn't been able to pay? No health care. If the result of that had been death, the insurance company would have had no liability, because in this case, it was completely within the terms of its agreement to entirely disregard the medical needs of its clients.

So when people drag out scare quotes about government health care rationing, I get extremely cranky. Doctors, drugs, hospital beds and the money to fund all of the above are limited. There is a reasonable debate to be had about how those resources should be allocated.

But let's not go into it pretending that we're not already making some brutal decisions about who gets care and who doesn't.

And if you're one of those who, like me, has a nice cushy corporate insurance plan, don't think you can't land in a situation where you're left without essential medical care.

Tuesday, August 18, 2009

Financial shocks

Today's fun money stat: Your ATM is a drug dealer.

From the AP:

Chances are there's cocaine in your wallet. Researchers looked at 234 bank notes from 17 cities in the U.S. and found that 90 percent had small traces of the illegal drug.

Bills from larger cities, such as Baltimore, Boston and Detroit, were among those with the highest average cocaine levels. Salt Lake City had the lowest.

Not surprising on either the high- or low-end front -- glad to see my semi-hometown, Balmer, is representin'.

Also not surprising: The notice I got in the mail today from American Express today about their terms crackdown. In the face of growing defaults and next year's looming credit card reform laws, Amex, like most other credit-card companies, is looking to pry higher profits out of its remaining customer base. My APR is about to jump from about 11.5% (8.24% plus the prime rate) to 17.24%. If I'm late on a payment, it vaults to 27.24%.

I've never been late on this Amex, but I did go late on a Providian card payment about three years ago when I was traveling and lost track of dates. I'm usually careful, but I can't swear I will never for the rest of my life miss a deadline.

Should I do that, I'll also be whacked with a $39 late payment fee.

Meanwhile, Chase-- the bank with which I have a backup card that thankfully has no balance -- has yoinked minimum payments up sharply, in some cases more than doubling what people owe. Three guesses what happens when someone owes a larger monthly payment than they can afford to pay? Oh look, late fees and higher APRs!

I realize credit card debt is a problem people opt into, and bear responsibility for. But also -- arugh. This is gonna be ugly.

Tuesday, August 11, 2009

My next career move: Professional gambler

Back in 1969(ish), my mom decided to invest in real estate.

Her much-older sister, who was of a generation that strongly believed in investing in Tangible Things, bought a summer house upstate. It was once part of a batch of cottages owned by a local hotel, which got sold off piecemeal as the 20th century progressed. Soon after her sister bought her house, the one ten feet away came up for sale. Family lore (I haven't cross-checked against property deeds or anything) has it that my mom bought the house for $6,000, and its furnishings for another $3,000. Thus did my family acquire a 700-square-foot house named Covehurst, more popularly known as "the decrepit shack in the Adirondacks."

(That sounds unfairly derogatory except to those who have actually seen the place. It was built around 100 years ago and, until recently, left untouched. Functional plumbing was an exciting and rare occurrence.)

Since we had a "summer house," my family trekked up to Brant Lake every summer. And promptly began casting about for entertainments. Our 30-year-old vintage Monopoly set, Lake George tourist traps, and outlet shopping will only take you so far on a family vacation. You eventually need new distractions.

Like gambling.

At some point, my family realized that Saratoga Springs was less than an hour away. My mom and dad had always enjoyed horse racing -- my dad has stories of the Triple Crown race he watched Secretariat run live, and win by 31 lengths. So we began making annual day trips to the Saratoga races. I'm pretty sure my sister and I started betting on horses before either of us had our first beer, which has to be a fairly novel and backward way of doing things these days.

This weekend, my family converged upstate, and I spent Friday watching the last seven races of the day at this year's Saratoga meet. I don't know enough about horses to handicap with any kind of "effective" gambling system, and I suspect that if I did, I wouldn't be successful any more often than I am now. If gambling were a science, lots more people would be rich. So I look over the stats, but I'm still susceptible to a catchy name.

Like "Economic Tsunami."

In the middle of an epic recession, is there any way I'm not betting on the horse named Economic Tsunami?

I picked another horse that looked good and laid down an exacta box and an across-the-board bet on Economic Tsunami.

Who came second! I can't recall exactly what I was holding, but I hit the exacta and a few other bets, and my $10 wager paid me back around $100.

That was the first of three exactas I hit, my new daily record. Since I only place $2 bets, I'll never win crazy money, but I walked in with a stake of $120 and left with $296.40 (advantage of a statistician spouse: you always end up knowing exactly what you won or lost), which was definitely my best day at the track to date.

And I owe it all to Economic Tsunami.