Thursday, April 14, 2016

Shopping for Health Care Not Yet Perfect

(From the April 14, 2016 issue of the Grand Haven Tribune)

The letters started coming recently. When you deal with lots of doctors, medical bills, and insurance statements, you get a little worried about crisp looking letters from the insurance company.

These letters from Priority Health were not frightening or bearing bad news. But they were at least mildly upsetting. They pointed out a recent specific medical procedure my wife had and encouraged us to use their online price comparison tool to see if we couldn’t find a lower cost option in the future.

Now, this makes some sense at the outset. No one is unaware of the fact that our national health care system is in turmoil, and not least of its problems is the rising aggregate cost. Certainly if patients would start looking for and selecting lower price options for various medical procedures, then in large scale the system would save a lot of money. Free market theory would say that if patients paid more attention to price then prices may even come down.

The two-minute video on Priority Health’s web site makes this point. It reminds the viewer that they may spend months researching a vacation, and they would compare prices when buying a new home appliance. So then, the logic goes, we should pay attention to the varying rates for everything from arthroscopy to Zika virus remedies.

The video falls a little short in its argument, however. If we are going to make medical decisions an economic concern, then we should consider the economics more thoroughly. Economists talk about the assumption of perfect information. In other words, people make economic decisions, both rationally and emotionally, on more than one or two select facts. Perfect information means economic theory such as market price fluctuation and elasticity of demand depends on people having complete information, all the facts, multiple variables. Price is merely one consideration.

Take the vacation and home appliance examples. The considerations we certainly all do in such cases has more than price on our minds. Say you went on a trip to the mountains and got to your low price destination and a man named Clem greeted you toothlessly and offered to carry your bags to the barn, while his brother Earl rocked and played banjo while spitting tobacco and eyeballing your children. I’m going to suggest few if any of us would rejoice at our cost savings for this mountain getaway. Also, having shopped for appliances with a woman, I have empirical evidence that price is one of the last considerations after things like top vs. side load, size and location of freezer, color and materials and so forth.

In the same way, I hardly think we’ll see someone show the scar from a knee replacement and say they still can’t walk stairs without pain but grin and proudly announce they saved hundreds on the procedure. Nor would anyone say at Aunt Edna’s funeral that we’re sorry to see her go but we just couldn’t see paying 12 percent over market rate for that recommended life-saving surgery.

Well, I logged into my Priority Health page to test out this tool. I searched for a chest MRI with contrast, a procedure my wife has had in Grand Rapids, and the results came back that no nearby facilities did this. But a search on Chest CT gave lots of options, including those in Flint and other paces well across the state. When the tool does work, you can chose facilities and doctors and compare a price list, as well as distance in miles from the zip code you enter. There is also doctor information, including specialty, gender, board certification, language the doctor and staff speak, medical school and residency. This is somewhat helpful, but also irrelevant. By that I mean the real information patients want about doctors is their personality—are they compassionate, do they listen, do they think outside the box? They should make transparent in the search results the data from patient satisfaction surveys for both facility and doctor. That matters too.

The tool is a good start. We may consider using it in the future. But more complete information would be better. As a side note, it would be a nice move in the interest of transparency and medical ethics if Priority Health would disclose that Spectrum Health, one of the providers that comes up on price comparison lists, is in fact their own parent company.

If the goal is to save cost, Priority Health could ask Spectrum Health to lower costs. Or, instead of giving Visa gift cards of $50-200 to patients who select “rewardable” options for medical procedures Priority Health could lower premiums or deductibles on policies.

At the end of the day, Priority Health must know that for their patients and policy holders health is in fact the top priority.

Thursday, March 10, 2016

Communication Technology Can Aid or Invade the 'Good Life'

(From the March 10, 2016 Grand Haven Tribune)

I don’t often bring scholarly articles to the foreground in a family newspaper. But I read something recently in the Journal of Communication that I think will be of interest to almost everyone.

That’s because the subject is communication technology, which seems to be of interest to almost everyone.

The scholar, who teaches in both Germany and China, proposed that communication technology is so popular because it meets three basic human needs. For one, he said, technology gives us access to information of any kind, any time and anywhere. This is true, as you may have experienced yourself in everything from news and sports scores to restaurant reviews or finding the hours of a local mechanic.

A second need communication technology meets is a desire for stories and narratives. Here again, this could be the online stories provided by professional or “legacy” media, but they also come from friends, acquaintances and total strangers from across the globe via YouTube, Facebook, Vine, Snapchat and an array of other platforms. The stories range from the informative and moving to the entertaining and silly.

The third need that this author suggests technology meets is the need to be together, to not be alone, and to not be excluded. Certainly, he always on and mobile aspects of technology these days would seem to satisfy this.

In fact, the author says that the technology of today meets this needs exhaustively, so much so that one could think our technology infrastructure has offered a form of utopia or “the good life” in terms of meeting satisfying what humans innately desire. But the author gives caution also. The mediated world we live in brings us closer to a good life, he says, but in other ways technology leads us further from it.

He gives three examples of the negative aspects of communication technology. One is the anxiety that comes from the constant expectation of something big to happen, something that will distract us from our normal life, which used to be just fine but now has been rendered banal by comparison to the frantic news feeds on our phones.

Related to that is the problem of the desire for stories that has left us living in a fictional or fantasy world. We have been trained to construct alternate realities, in which we are popular, successful, humorous and smart all the time. We can’t allow ourselves to be ourselves in this hyper high-tech world.

Finally, the saturated aspect of never needing to being alone has rendered it impossible for some people to ever be alone. There are many benefits of solitude, and at the very least it is not a bad thing to be alone once in a while. But technology has not only aided us in this regard, it has invaded us.

Others have picked up on the cautionary tale with regard to communication technology. Other scholars have written books about the subject, including “Reclaiming Conversation” by MIT professor Sherry Turkle. There are also novels that tell a dystopian tale about the excess of technology, such as “The Circle” by David Eggers.

These negative consequences of communication technology are not a reason to abandon them altogether. Like almost anything else in life, we are responsible for exercising self-control, reason, and responsibility. Some joke that they are addicted to their phones or other technology. That may be literally or figuratively true. But it is also true that most people are capable, with conscious effort and discipline, to control the technology and not cede control to it.

As you read this column, I am doing that. I am in a place where I can not retrieve messages. Far from making me anxious, this gives me delight. I am be communicating using only my ears, eyes, and mouth. I am enjoying solitude with my wife.

That’s a good life too.

Thursday, February 11, 2016

Notions of Rights are All Wrong

(From the February 11, 2016 issue of the Grand Haven Tribune)

Bernie Sanders has become popular for making assertions about people’s “rights.” But he is so wrong.

He has been adamant on the campaign trail that health care is a “right.” But, while popular among throngs of mostly young people, this idea is pure folly when examined more closely.

First, he isn’t talking about health “care.” He’s talking about insurance. Insurance is a product of risk management—we buy it as a hedge against a future misfortune in which we need health care and then we’ll have the means to pay for it. But our society has corrupted this notion in two ways. First, we have equated health insurance and care as the same thing, such that we have insurance approve and pay for everything instead of the most expensive procedures and medicines. Second, we have equated health as entirely a right and removed any notion of the incumbent associated responsibility.

It would be helpful to look at a history of health insurance. Companies began offering health insurance as a benefit after World War Two as a benefit to attract employees when there was a labor shortage. But after decades of employee health insurance, people came to expect it. We went from understanding health insurance as a benefit to seeing it as an entitlement. And it was a short step from that to seeing our health not as our responsibility at least in part and seeing it as a right.

This leads to the most important and fundamental question: what is a “right”? To summarize a lot of political philosophy, a right is the sovereign ability to act without the permission of others, in particular the government. Each person may exercise their own rights up to the point where they infringe on the rights of others. A right is universal, and as such applies to all individuals, not just a few. A right must be exercised through one’s own effort and initiative. This means a right is not a claim on others. None of us has a right to anyone else’s time, life, money, or property.

In fact, the “Bill of Rights,” a set of amendments to the U.S. Constitution, was written by James Madison in response to several states that wanted more protection of individual liberty—in other words they wanted freedom FROM government and not more regulation by or dependence on it. This is how we got free exercise of religion, freedom of speech, protection against illegal search and seizure, a fair trial and other well known rights. Nowhere does this document grant us the right to have other people, through the government, pay for anything for us.

This is why Bernie Sanders, as well as Hillary Clinton and other candidates, are flat wrong when they talk about taking from some to provide for others as a form of guaranteeing “rights.” We may as a nation to decide to enact various social welfare policies, and we already have. But these are acts of corporate (in the sense of collective) compassion, not the fulfillment of rights.

The Sanders position that college should be free gets an F in policy based on the above. It’s not free. Someone is paying for it. And if students don’t pay for it, they will most likely have less appreciation for it. Also, what to say of students who can afford to pay for it? Our system is not perfect now, but a sizable number of students go to college on merit and need-based scholarships. College attendance should continue to be based on responsibility and social compassion—it is not a right.

All of this misguided talk of rights is offering candy to new voters. It is part of a leftist meme of hating all wealthy people indiscriminately and redistributing what is most often rightfully theirs. This avid socialism and over-generalized animosity towards successful people is dispiriting and shameful. Certainly, there is fraud on Wall Street, as Sanders says. But not all wealthy people are fraudsters. And not all fraudsters are wealthy. Not all rich people avoid taxes. The New York Times reported last fall that the top 1% pay one-third of their income in taxes, the next quartile—the top 2-5%--pay a quarter of their income in taxes. The bottom half of earners pay one-tenth of their income in taxes, if they pay any. The IRS reports that 40% of all tax revenue comes from the top 1% of earners. Taxing the rich more and giving to others regardless of their need and self-initiative is not correcting any kind of wrong nor is it a sustainable plan.

There is room for policy improvement in our country. But simple-minded, hate-the-rich anger and pandering to people with incorrect notions of their “rights” is not the kind of reasoned leadership we need.

When Barack Obama ran for president at first he chided his predecessor for his “failed policies of the past 8 years.” Yet Bernie Sanders proposes policies that have failed for the past 80 years in socialist regimes from Latin America to Eastern Europe. Even those who are far from rich see the folly of Sanders’ socialism. Margaret Thatcher, the daughter of a grocer who became Britain’s Prime Minister, noted that the “problem with socialism is that sooner or later you run out of other people’s money.” Star Parker, an African American former welfare recipient who is now a syndicated columnist, has noted that “the poor are not poor because the rich are rich.” 

And there’s me, the product of a plumber and an immigrant who sees Sanders not as a progressive but one whose plans are regressive, to the lack of liberty, responsibility and opportunity that denied us true rights before we declared independence.

Thursday, January 14, 2016

Hallmark Hits the Mark with Holiday Movies

(From the January 14 issue of the Grand Haven Tribune)

At least I know I’m not alone. The shopkeeper in Saugatuck said her husband is the same way. A few guys we know from church agreed. A few neighbor men went along with it too.

Men. Dudes. Watching Hallmark movies. And not just because they have to.

I got into Hallmark movies with my wife over the recent holiday season. Although we’re not done yet. She loaded up the DVR by recording almost every single Hallmark movie on the chart during the holiday season. We couldn’t watch them fast enough. No really—the DVR zapped a few “Hawaii 5-0” episodes we were storing up to watch during the snowy season. So for those we’ll have to surf over to the right web site on my laptop to watch them that way. Surfing for a show in Hawaii seems right.

But back to the Hallmark channel. As I noted at the outset, this is not some weakness or flaw in my masculinity. It’s not like going shoe shopping just to be a good husband. These movies are popular.

The cable network released two new movies every weekend in November and December, all with a holiday theme. And they were a hit, according to ratings data reported in the Wall Street Journal and several advertising trade publications. The Hallmark Channel has seen percentage increases in viewership each year since 2012, while many other networks endure double digit declines in audience.

So how to explain this success? The Wall Street Journal was on to it when it described the movies as “feel good.” Indeed they are. The themes all include romance, redemption and recovery of some sort.

The movies are so feel good that at times I took liberty with the ending, articulating an alternative conclusion more consistent with what might appear in theatres or on other networks. The handsome man would turn out to be an Albanian spy, or a con artist inserting himself into the lonely widow’s life just to get at her bank accounts. Or the newly married woman turns out to have an evil side and attacks her new family with an axe. I created these variant story lines—much to the chagrin of my wife---not because I am sinister, but just to demonstrate the contrasts.

Some would say the Hallmark movies are predictable plots, even formulaic. The sardonic might roll their eyes at the consistently syrupy endings, the implausibly neat sewing up of situations, all in two hours, minus commercials.

But therein lies the beauty. Simplicity is not always unsophisticated. Happy, predictable endings are not necessarily amateur. They satisfy the audience. Isn’t it a good thing that a good story with a happy ending is what people want in growing numbers?

I’ve written before about the folly of  “reality” television. I’ve complained about the mind-numbing conformity of network entertainment offerings that are endless variations on the predictable plot of big city detectives, with gratuitous violence and inevitable sexual situations. It may seem old fashioned to some, but the Hallmark movies—many of which come from short stories and novels—rely on human emotion and good storytelling. In that respect they are less predictable than the staged “reality” or pandering to depraved interests that is available on other television entertainment fare.

The Hallmark movies often start with a story of someone who has suffered a loss. There has been a relationship break-up, a death, or a realization that career pursuit left something lacking. Then there’s a plot twist, a change in direction, a new character emerges. Sure, it is easy to see the plot coming, the conflict and resolution. But the thing is, it is a joy to see.  People gawk at car accidents on the highway, but it’s far more compelling and delightful to watch a wedding on the beach.

Some may secretly mock people who watch these Hallmark movies for an indulgence into something sappy. Many others find the channel a welcome respite. We have ISIS cutting off heads, drug lords on the loose, mass shootings, and another long season of politicians slinging mud across the airwaves.

Hallmark is on to something. We’re all still children, at least a little bit. We want to close the curtains on the world out there. We want to be distracted from the potential of monsters lurking. We say, tell us a story.

Thursday, December 10, 2015

It's Time to Move Past 'Millennials'

(from the December 10, 2015 issue of the Grand Haven Tribune)

Let me say at the outset that I work with the age group of human beings who are called “millennials.” I put that in quotes to show that it is a coined label and not necessarily a real word.

The term comes from the word for a period of 1,000 years because this group of people is the generation that would be the first to grow into adulthood in the new millennium, the 2000s. The term was invented by “demographers.” I put that term in quotes because they annoy me.

Demographers annoy me because putting a label on a group of people simply because they coincidentally came into the world at the same time is one thing. But the tendency to describe this group and ascribe characterizations to all of them seems like a colossal over-generalization. Millennials, for example, have been called lazy, entitled, self-absorbed and other things that they would not want on a resume.

As a college professor, I have seen these negative attributes among some of my students. But I have also seen these attributes among people decades older. I often tell my students I defend them as a group, because I have seen work ethic, integrity, creativity, civility, and humility among them that is not only encouraging, but inspiring.

So, I’m against these generational labels. As for myself, I was born in the year on the cusp of two generational labels. I am neither a “boomer” nor a “buster.” I am just some guy, a man who defies definition.

It seems like the rest of the world is moving beyond such age group labels too. If they are not moving beyond labeling, they are moving beyond a fascination with millennials that has led to both fawning and fretting over young people. Much space in advertising trade publications is devoted to how to reach this age group with messages. A lot of the entertainment programming is geared to appeal to them. Employers have assembled into special task forces to find ways to attract and retain young “talent,” the common term for a class of skilled workers in demand.

Perhaps all this fawning makes it easy to understand a recent malevolence towards millennials. Several ads by major national brands, and a skit on “Saturday Night Live,” have dared to mock this age group for being so na├»ve and self-absorbed. There was a meme going around on Facebook—which I could not resist sharing in spite of the millennials on my friends list—that pointed out that in 1945 18-22-year-olds stormed beaches and dropped behind enemy lines as part of a global war offense, whereas today’s 18-22-year-olds storm into their professors’ offices or drop on their parents’ couch to complain about how they suffered an offense at something someone said.

This is more than idle chatter by critics who are merely older and finally resentful of the millennials. Just last month the Wall Street Journal had a large feature called “Closed Minds on Campus,” all about the recent spate of protests on college campuses. The author pointed out that today’s student protests are not about war and major global and social issues, but inane and even imagined injustices suffered by individuals. The irony is that the university as an institution and college students as a generation are supposed to be defined by open-mindedness, cognitive exploration, challenging assumptions, and developing character. Instead, some of today’s students narrow the dialogue by creating a chilling effect on expression of a variety of ideas with hyper-sensitivity.

Of course, some of this has been enabled by colleges themselves by the culture they have created. That culture has done damage to strength of thought and consideration with its own diversity training that informs young people about “micro aggressions”—little, well-intended comments that may nevertheless be offensive. Professors in some schools are encouraged to utter “trigger warnings”—an alert that subjects to be discussed in the class about to start might be upsetting.

There is a push back, some of it from the millennials who redeem themselves from the culture that makes almost everything potentially offensive. Students at Princeton formed an Open Campus Coalition and let their president know they would not be intimidated from free speech because what they wanted to say didn’t meet the foregone determination of what is an acceptable point of view to express. Good for them. They provide proof that attitudes and behaviors vary within generations and among generations.

Family background has more to do with a person’s character than a certain age of a person. My parents had a better way of handling things that upset me. My dad, I am pretty sure, coined the phrase “Be quiet or I’ll give you something to really whine about.” My mom, on the other hand, met my complaints about some one else’s comments by saying “just don’t let it bother you” without even putting down her knitting. I remember it well for it’s lasting effect on helping me grow up; I was 5.

Is it any wonder that in this environment there is space, even a perceived need, for a blog and a resulting book called “Adulting—How to Become a Grown-Up in 468 Easy(ish) Steps.” This used to be something we all did, as the millennials might say, organically.

I would hope that the parents of the younger siblings of millennials are taking note. We can’t have kindergarteners coming home upset about Winny the Pooh for not wearing pants, or for being named for what used to fill their diapers. What then? Tigger warnings?