Wordless Wednesday
Monthly Archives: February 2016
Sale! Sale! Sale!
Americans lurve sales. We shop the grocery fliers. We bargain for our cars. We go to garage sales.
I bought milk on sale Saturday because it was “on sale” but it would be “regular price” today when I actually run out. I have to buy milk every few days, sale or not, but I try to time it to match the store cycles.
On the other hand, I’m in the market for a new-to-me pickup truck and a camera lens. I don’t need either of those today so I’ve been more picky waiting for the price I’m willing to pay.
Willing to pay is the key.
Ever tried to figure out what that new car actually cost the dealer? How about what the dealer paid for that “certified pre-owned”?
I found a car on sale recently. A dealer bought the car for $9,500 and spent about $400 for repairs and reconditioning. The car went on the lot for $13,990. That’s more than a 40% markup for some “floor” space on a gravel lot.
The eventual buyer “negotiated” the price down to $12,450 for that $9,500 car.
We trust used car dealers, don’t we?
The Interwebs have exploded with people discussing Mr. Sanders and his plans to tax the rich to fund free universal health care, free college, free birth control, free housing for the poor, and more. One poster wrote:
“Obamacare is a giant bloated horrible mess. Medicare is much the same. We can’t simply toss them in the trash, though, and tell everyone, ok now, go out there and shop for insurance same as you do shoes, good luck! Because unlike the kabillion shoe-sellers competing with each other for our business, there are only a couple health insurance companies colluding to eff us all up the ass. No matter what happens, they are guaranteed to raise their rates and make more money. Nothing and no one stops them, the way things are currently structured. Obamacare never even pretended to fix this.”
Mr. Obama lied.
The NYTimes reported that, Back when he was pushing the Unaffordable Care Act, President Obama lauded Grand Junction as a model of better, cheaper health care. “You’re getting better results while wasting less money,” he told the residents.
It turned out that Grand Junction’s Medicare billings were lower than average with no impact on health outcomes. “All we have to do,” he implied “is get the rest of the country acting more like Grand Junction, to get U.S. medical costs to drop.”
Grand Junction is one of the most expensive health care markets in the country for anyone on ObamaDon’tCare or any other private insurance despite its unusually low spending on Medicare. It turns out that Grand Junction has a small enough, healthy enough Medicare population that providers can cost shift to the private plans. Grand Junction has a big enough population with little enough competition that they can charge mostly what they want.
That works because a house call used to cost one chicken but today we have no idea how much your physician will charge for the half-dozen “procedures” that go on the bill for a simple checkup.
Have you ever asked your doc what an office visit costs?
And no one every notices that Emperor Obama’s plan has no clothes.
We need a sale!
Oh. Wait. Here’s a more personal example of costs and transparency.
SWMBO had a “screening mammogram” last fall. The bills included the actual boob crushing/digital picture taking, computer analysis, more computer analysis, and an assessment. The hospital billed $402. The physician who read the “film” charged $151. Medicare paid the hospital $104 and the doc $38, about a third of the billed cost.
No one at the hospital knew how much it would cost. No one could even tell us who would “read the film” so we could ask that price.
A south Florida provider advertises “cheap” mammograms for $799. The commercial doesn’t tell us if that includes just imaging, imaging and computer assessment, imaging and computer assessment and assessment, or something else.
We had no idea how much SWMBO’s procedure cost until Medicare sent us the make good on how much they paid. It’s intriguing that the total charge (not what we paid but the total charge) was less than the “cheap” one in Florida.
Medicare is like getting medicine on sale, right?
I’ve written about cost shifting before.
ObamaDon’tCare is like getting medicine on sale, right?
Rather than reducing costs, the Unaffordable Care Act has raised the annual cost of health care from $8,299 to $9,146 last year to a looming $10,000 per person this year. That makes it a $3.2 Trillion budget item. That’s THREE POINT TWO TRILLION DOLLARS.
Mr. Sanders’ failed-plan to expand health care coverage is pretty simple arithmetic. He wants to expand health care coverage by adding or increasing specific taxes (a 6.2% income-based health care tax plus a 2.2% income-based tax, plus new progressive income tax rates, plus capital gains and dividends taxes, plus estate tax). Total government spending is about $3.8 Trillion for the Feds and $6.2 Trillion for all U.S. Federal, state, and local governments. Mr. Sanders will double the Federal budget and push government spending overall to about $10 Trillion. That’s TEN TRILLION DOLLARS.
Mr. Sanders’ “let’s pretend we can do it by soaking the rich corporations” approach takes away the retirement of seniors and guarantees poverty for everyone else working for for a living.
We need a sale!
Many pundits believe all we need is some transparency. They’re wrong, too. Just knowing how much an office visit costs is only part of the solution.
The real answer is simpler. There isn’t enough money in the U.S. economy to pay for the current model of U.S. health care whether it is nationalized a la Mr. Sanders or market-based a la the national association of used car dealers.
Back in 2009, my treatise on fixing the U.S. health care system started from a simple premise: Health care in America is fundamentally broken. The numbers in that piece are still dead bang on. In 2018, I wrote then, “health care will cost $13,000/year for every man, woman, and child in America.” It’s 2016 now and we’re at $10 grand already.
The fix is a two-part piece, starting here.
This directory lists some of the earlier No Puffin Perspective™ articles about the Patient Protection and Unaffordable Care Act signed into law by President Obama in 2010.
Wordless Wednesday
Mail Order
Both North and South Puffin are somewhere beyond the end of the rainbow so instant gratification is more than a little difficult here. When I was a child, my family would literally mail an order form to a company like Sears and they would send a box of goodies by parcel post the day after the order reached them.
Mail call was always like Christmas around the Harper household and planning was important because it generally took a few days for the (first class) letter to get to the vendor and more than a week for the package to get back.
Today, we click a button on a website and a fulfillment house somewhere generates a label for same day or next day delivery but the principle is the same.
And some of us still call it mail-order. Heck, I usually counsel clients to ship via the US Post Office. It’s easy, it’s cheap, and it gets there on time, I tell them. In fact, I shipped a box by parcel post to a business up north on Friday. It was in their PO Box this morning.
Confession: I take drugs.
These days, of course, most people my age do. We take anti-cholesterol meds and anti-arthritis meds and blood pressure meds and anti-anxiety meds and anti-dizziness meds and anti-gout meds and antihistamines. We take drugs to combat osteoporosis and respiratory difficulty and heart attacks and sudden bladder symptoms. Then we take diuretics to help us pee. After all that, we really do need the antidepressants.
Anyway, our insurance companies train us all to buy by mail order to save us money and time.
I do.
I ordered my usual 90-day refill from the Humana Pharmacy in Phoenix on December 4, 2015.
12/7 email
Your Humana Pharmacy Order Has Shipped!
Order Number 120128889
Estimated Shipping Time: 3-5 days
Click on “Tracking id” under your order information.
Humana sends its mail order drugs by US Mail. They drop the bottle(s) in a thin, gray plastic pouch and send it off into the night from the Phoenix PO.
I clicked the tracking link.
Humana sent the “preshipment info” to the US Postal Service the same time they sent me the email notification. The next thing I know, the package is in Essex, Vermont, just three days later. Nobody, least of all USPS, knows how it got there from Arizona.
Pretty good, eh?
Except it was supposed to be shipped to South Puffin, not North Puffin.
12/11 Tracking Page
Available for Pickup, North Puffin VT12/11 Tracking Page
Forwarded, North Puffin VT12/18 Tracking Page
Arrived at USPS Facility, Brockton MA12/18 email
Your Humana Pharmacy order is on hold.
Our pharmacy team has contacted your doctor to get the information that we need.
Order Number 120128889
Order Status On Hold
From Massachusetts, the package went to Jacksonville and back to Springfield, MA.
12/27 Tracking Page
Departed USPS Destination Facility, Springfield MA12/27 email
Your Humana Pharmacy order is on hold.
Our pharmacy team has contacted your doctor to get the information that we need.
Order Number 120128889
Order Status On Hold
Destination Facility? It was on its way back to North Puffin.
12/28 Tracking Page
Forwarded, North Puffin VT12/29 email
Your Humana Pharmacy order is on hold.
Our pharmacy team has contacted your doctor to get the information that we need.
Order Number 120128889
Order Status On Hold
That was the last email from Humana which still may think they haven’t heard from my doc. It was also the last we heard from USPS for a while.
They did turn up ten days later. The USPS tracking page reported they “arrived at our USPS facility in JERSEY CITY, NJ 07097 on January 7, 2016 at 8:54 am. The item is currently in transit to the destination.”
Unbelievable. Jersey City is *never* in the routing from North Puffin to Springfield MA to Jax to here. Humana shipped December 7. Humana, btw, keeps emailing “Your Humana Pharmacy order is on hold.”
My drugs went to Phoenix.
Phoenix?
Really? Phoenix?
When they arrived at the “facility” in Phoenix, I called my friend Liz Arden who lives out there somewhere. She promised to look for them. No joy. Meanwhile, I used the “Contact us” link on the tracking page to send them this nastygram:
“USPS has forwarded this package
everywhere except to me. The
package contains prescription
medication that is now almost
a month overdue.
USPS needs to find it and get it
here by January 15, 2016 even
if you have to send it by FedEx.”
On January 16, my drugs were in California and I had not heard from USPS.
I hope they really are the drugs I ordered.
Philadelphia on January 18! It will be interesting to see if the drugs turn north or south; odds on they’re headed for North Puffin again. On the other hand, the postmaster in Marathon called and left a message. She had gotten my nastygram from the website. She didn’t leave a phone number, though. I tried to call back at the phone number given on USPS.com (and at 1-800-Ask-USPS) but the number has been disconnected. Except when it’s busy.
The tracking page said my drugs were still in Philly on January 20 but I did finally reach the Marathon Post Office. A nice rep there said she would send a slip to a supervisor. She also suggested I call USPS customer service.
After 33 minutes on hold at the 1-800-CallUSPS number, the lovely Sammy came on the line. Sammy sounded Chinese which made me wonder. We do know USPS outsources a lot of functions, particularly truck transportation of mail, so I figured it’s possible. I found lots of tin hat sites saying that USPS outsources their call center but no real evidence. One fellow posted this:
“So here’s the deal – I called the USPS to get information on a lost package I had shipped. After 20 minutes of miscommunication, on both ends, I asked, ‘Are you working in India?’
“Response – ‘Yes.'”
“For shits and giggles, I called 1-800-ASK-USPS a few hours later. Had a brief conversation about the tracking of the same package. The accent prompted me to ask, in a pleasant voice… ‘What country are you working out of today?’
“Response – ‘China’.”
Anywho, Sammy promised to have a supervisor find my package, take it out of the forwarding system, and manually send it to me. Yeah, you’re right. That didn’t happen either.
The post office (eCustomerCare National @ usps.gov) emailed me January 23 and apologized for “the inconvenience that you have experienced in regards to the delivery of your package.” The tracking page had had no updates since the drugs arrived in Philly. eCustomerCare National suggested I ask Humana to send a replacement order.
1/28 Tracking Page
Arrived at Post Office, North Puffin VT1/28 Tracking Page
Forwarded, North Puffin VT
The North Puffin Post Office received the drugs and forwarded them before I knew they had left Philly.
<SMH>
Still, when I called, the clerk there said she’d find them on the truck. She called the Swanton PO to divert them, tracked them down on the truck, had the driver hand the package to a clerk in the Swanton PO. The Swanton clerk had prepared a Priority Mail box so she dropped the bag of drugs in the new box and sent it. They departed the Swanton Post Office at 3:18 pm. The North Puffin clerk called me back with the tracking number. Expected Delivery Day is Monday, February 1, 2016.
January 28. The cool news of the day is that, 52 days after Humana shipped them, a human bean found my drugs put them in a new box, and sent them by airplane.
January 29. According to USPS.com, my drugs arrived in Nashua this morning … and stayed there. USPS.com isn’t very good at updates.
“USPS is definitely not good at updates and communication,” Miz Arden said. “I rarely get information about USPS-based shipments, except those via Amazon or similar company that will themselves track the package and provide the updates. Sometimes USPS provides an update (I suspect the company who shipped with them worked that out with them), but it’s usually the day they ship, and then the day after the carrier placed it in your parcel box.”
They seem willing to tell us when things arrive at (some) entry points but seem to have no idea of departures and waypoints.
This package started in Phoenix, AZ. It went to North Puffin three times, to Florida twice, back to Phoenix, and surfed in California once before winding up in South Puffin after 54 days. You should see all its passport stamps!
January 30. My drugs arrived! A day ahead of schedule and 54 days after they shipped. And all it took was a real person who put her hands on the package to rip it out of the forwarding system. The thin, gray plastic pouch inside the Priority Mail box looked like it had been ravaged by wolves. And I have no idea what Humana was talking to my doctor about.
At least we now know how to get a package from Phoenix to South Puffin, now. It has to go by way of the Ozarks.