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Antithesis of Capitalism: Healthcare in America

by skyrien

A recent post I read in the Wall Street Journal exposed what I consider near-criminal margins that are enjoyed by our healthcare system. TL:DR–a man with very limited health insurance came in for a necessary procedure, and was quoted the treatment at $23,000, insisting on $20,000 up front. When the man nearly backed out of the procedure due to cost, the hospital re-classified him as a self-pay patient, and re-quoted the procedure at just over $3,000. In other words, the procedure cost $17,000 less by not using insurance.

It’s worth noting that the $23,000 figure, nearly 7-times greater than the cost the hospital was willing to charge, is determined not by the cost of the procedure and free-market principles, but by backroom negotiations between insurers and healthcare providers. Most people never see these numbers, conveniently shielded from such information by their insurance plan and seemingly well-intended doctors who (perhaps honestly) have no idea of the actual cost of their recommendations. Ultimately, had the man had insurance, and/or had the money to pay, $23,000 would be the cost he or his policy would pay out.

I always knew that there was an obvious gap between the prices set by insurer-hospitals and the actual cost of care, but I had no idea that it was that substantial. That kind of markup for such a simple (yet life critical) procedure is just wrong. I’m refrain from saying that it should be illegal, but given how much of the economy healthcare represents (though, now it’s just looking hyper-inflated), we need better regulatory oversight and policies against this type of anti-market environment, in any industry.

I thought him calling out that we’re not really using health “insurance” anymore, rather, we have “health plans” is particularly interesting. The current system of hospitals-insurance company confidentially and arbitrarily setting prices is obviously disruptive to engaging market forces here.

Clearly, we need some changes to this system. The current issues surrounding patient cost and insurer reimbursement raised two concerns:

Patients are kept in the dark about the actual cost of their healthcare care.
The medical profession seems to have developed the idea that if a patient knows the costs of procedures, that such knowledge will interfere with decision making, and have become reluctant to openly discuss costs with patients.

EFFECT: Disruption of market economics in the cost of healthcare, leading to a increasing inefficiency. This much is obvious. And rising costs disproportionately fucks over those with less means.

ISSUE #2. We need better oversight into the actual cost of care vs. the billed cost, including making it more clear to the patient.
In Singer’s case, it’s obvious why a number like this $20,000/$3,000 would be hidden–because it is absolutely obscene to charge that much of a margin on any product, let alone a “routine procedure” that also happens to be life critical. For every Jeffrey Singer in this article, I imagine there is a horde of less fortunate patients that were affected by this withholding of information. But what about these preferred provider contracts that prohibit sharing of this knowledge?

EFFECT: Increasingly frequent ridiculous margins to which are out of proportion with anything that an efficient market would consider a valid price given the demand and the base cost of goods. The ensuing pain is broad: The tax paying public at large, and the nation a a whole is paying for.

These are such systemic issues that a broad rethinking involving all stakeholders in the healthcare system is required. As a patient interacting with healthcare providers, I find the opaque nature of healthcare and the deliberate withholding of information to laypersons to be outdated.

We need policies that allow engagement of the market to incentivize improvements in healthcare (cost, efficiency, effectiveness).
At the provider–costs need to be made more clear at the onset. That includes any checkups, preventive care, cost of tests, and doctor visit cost. Across the industry (and within each relevant subsection region or subsection of the market), costs for procedures, particularly “routine” procedures need to be made public, and easily accessible to patients.

We also need policies that disincentives care providers giving and billing wasteful procedures.
I’m sure there’s a liability factor here, where the risk of getting sued (substantial) for a missed diagnosis leads to doctors to over-provide services; particularly if the patient is the one pushing to get the procedure. I think this can be partially solved by solving Change #1–the rest we’ll need political solutions for, including the legal framework for measuring and rewarding efficiency.

One last thought–I don’t know why the author feels the ACA is going in the wrong direction. The ACA at least provides for an oversight board to call out and publish reasonable rates for procedures. Also, his suggestion that insurance should just be insurance is short-sighted; people want health plans, and with health plans, we can develop broader strategies to improve health, including better incorporating preventative care. Totally worth it to just NOT CODE THE BUG instead of spending 10x more to fix the issues that come up later.

Gaming Perf: Are we hitting a plateau?

by skyrien

Generational perf gains not coming like they used to be?

Historically, being a PC gamer meant that you had to invest in your hardware. In order to keep up with the kid next door, or even just to experience in full what the original Unreal had to offer, graphically. Spending thousands every couple years to refresh your gaming rig with the best graphics card/processor combo that any consumer would ever need, so brag your epeen about being able to play whatevertheheck game at ever increasing resolution with more shadows, more NPCs, and nifty little graphical quirks. I remember when playing Doom at 30 FPS was a feat, and that was at 320×240 back in 1994, or when Descent suddenly became a whole new game after I popped in 3dfx’s newest Voodoo2-chipset (does anyone remember the loop back cables that you used to need?). I remember it had a whopping 8 MB of RAM; ‘Who would ever need that much’, I thought. Mind you, this was on a Pentium 90 Mhz, with a massive 64 MBs of RAM, my second computer, which was a beast, when everyone around me had 386SX at best (this was in Korea).

Sometime in the last decade, the paradigm changed. I say this while typing from my home desktop computer, an 8-year old behemoth (Core 2 Quad, 2.66 GHz, 8 GB, Radeon 7850), that nonetheless happily chugs along the latest games that I’m interested in playing. A decade ago, I’d have been well into my second upgrade cycle, but I’m finding little want given it’s current performance, gaming or otherwise.

I’m not alone here.

This is also evidenced in the current “next gen” systems, the Xbox One and Playstation 4, both of which tend to fall behind even mid-range PCs of today. Given that these systems are expected to have 10+year functional lifespans, it seems that Microsoft and Sony are making the bet that pure number crunching power isn’t what will keep them on top.

Just some thoughts.

Thoughts on black-asian race relations coming from A Good Day to be Black and Sexy (2008)

by skyrien
A film by Dennis Dortch; A between-the-sheets peek at Black Love and Sexuality.
A film by Dennis Dortch; A between-the-sheets peek at Black Love and Sexuality.

I had a chance to watch A Good Day to be Black and Sexy (2008) earlier today; let me definitely say “Thank you Netflix!” If it wasn’t for you, I would never have the fortune to find completely random stuff like this that I would come to enjoy. I’ll admit, before I watched the film, I was expecting something along the likes of Soul Plane, a ‘unique’ (if not utterly ridiculous) film, exemplifying (and exploiting) the over-the-top hip-hop archetypes of material worship and what some would call misogyny. In stark contrast, Black and Sexy is a delicate film depicting six related vignettes to show an interesting cross section of indiviuals and relationships in different states of stress as they go about defining moments. I particularly enjoyed Tonight (Part II), and American Boyfriend, both of which I thought showed rarely depicted yet universally understood relationship interactions. The latter, which I’ll speak on here, deals with the only interracial couple throughout the film, with Jesse (Alphonso Johnson) being the illicit black boyfriend of Jasmine (Emily Liu), who is a second generation Chinese-American.

Contrary to many films dealing with an asian character in a supporting role, especially one in an “African-American romance” film, I felt that Jesse and Jasmine’s interactions, particularly the interracial quirks of a black-asian couple, surprisingly authentic. It’s beauty lies in the subtleties of the acting, and both performers play it well off each other (if not with each other). While the scene in the first half is ridden with mildly race-related undertones, it is done under the pretext of flirtatious banter and is certainly not an unnatural concept.

The interesting bit comes in the second half when her first-generation parents come home, and Jesse is hidden in Jasmine’s room. After failing to sneak Jesse out, she ends up going downstairs for dinner, leaving Jesse upstairs in her room to call a friend to discuss what he perceived as the ridiculousness of the situation. Meanwhile, Jasmine downstairs is confronted by her parents about her affair, and while she attempts to dodge most questions, finally concedes when asked “is he Chinese or American?” If it wasn’t understood already, Jasmine’s mother asks if he is a blue-eyed blond, making it clear that by “American”, Jasmine’s parents are clearly referring to “white”. Almost as if it was a cop-out, she says “American”, which is technically, if not semantically, true. While progressive minded second generation asians may cringe at the exploration of this theme, it is likely an experience that every asian raised in North America can relate to. “It” being the ever-present, either subtly or overly, racist undertones against those of African descent, ironic given the near universal recognition of Michael Jordan and Tiger Woods among sports-watching native asians.

So how did this come to be? It’s hard to say, given that at the turn of the last century, there was just as much dislike of those of European ancestry. Perhaps it had to do with the various military incidents of Okinawa, the tales of the Rodney King riots in LA, the transported stereotypes from their native lands as multi-culturalism takes root, or, perhaps more interestingly, transmuted stereotypes from American culture finding interpretation among Asia. Regardless, racism of various forms directed at blacks are a reality among many first and zero generation asian immigrants. Now, I’d like to make a clear distinction between racism of first and second (and beyond) generations. The vast majority of second generation asians know full well the history of race relations in America, and are more prone to play racist among decidedly American stereotypes, though, I’d have to say, at a less overt level than that among white or black Americans (when is the last time you saw a group of asian people yelling racist slurs at a passerby? Probably a lot longer, though the reasons are debatable).

In any case, the struggle that Jesse and Jasmine are facing will be distinctly familiar to those of either decent, and I remember actually watching American Boyfriend in great suspense as I wondered how this conflict would flare up. As Jasmine is becoming more at ease with her “American boyfriend” story, Jesse becomes increasingly agitated as the minutes wear by. He finally snaps, he starts dribbling his basketball in an overt rejection of his covert status, and Jasmine becomes increasingly flustered attempting to divert the discussion somewhere else. Finally, he marches downstairs in an overt disruptive show, stomps around the dinner table and makes a point to kiss Jasmine right in front of her shocked mother, before storming out with a grin.

I really enjoyed this scene for what it depicted, a smack in the face at traditional-minded racist views of an oppressor. Yes, part of me wasn’t entirely happy with Jesse’s rejection of the subtleties of asian-black race relations, but I’ll admit, he was right to. Much to the direector’s credit, the depiction of the stress in Jasmine and her family felt authentic, and the righteous exit of Jesse was well justified. It did make me wonder though, about why race relations between blacks and asians are so tense and undefined in an allegedly “post-racial” society.

Now, I’m not saying that there aren’t other sources of tension and mutual struggles for legitimacy in a society that is still very white-centric, but I need to ask: what factors contribute to the particular asian-black interaction? In particular, what is different that characterizes asian-black interaction versus asian-white or black-white race relations in America?