In Memoriam

Drones Above

No, not the Hellfire Predator unmanned aerial vehicle used last week to reduce Islamic Fundamentalist Mullah Akhtar Mansour to ashes while being driven in a Toyota Corolla in rural Pakistan, but the increasingly everyday kind of drone that suddenly shows up over your head.

My first close encounter came last summer at the West Tisbury Farmers Market. There it was, about 20 feet high, buzzing about, doing what I'm not sure. But it was intrusive, unsettling and unwelcome. Everyone pointed, shook their heads, and then happily paid exorbitant prices for heirloom tomatoes and other island farm-to-table fare.

The Wall Street Journal recently used its WSJ Twitter page to poll followers on their thoughts. Altitude seems to be the most concerning variable. Its demographic probably skews right and the results aren't scientific, but put me with the majority here.

The Doctor Bill

vox.com published a story last Friday, The Case of the $629 Band-Aid - and what it reveals about American healthcare. The story recounts a young couples' visit to the ER after their one-year-old daughter's fingertip got cut while trimming her nails, and the more complicated odyssey to understand their bill. The story rang true with my experience, and I'll guess most people in the U.S. would agree.

My first experience involved a 20-minute ER visit for a convulsive cough where they sent me home with cough medicine with codeine. The bill? $4,800, negotiated down by our insurance company to $3,200, with a patient responsibility of $1,200. More recently, my wife had her gall bladder removed in a non-emergency, 101-minute procedure. The bill? More than $20,000, negotiated down to $14,000 with a patient responsibility of $4,000. And this is after paying close to $8,000 in premiums annually, with ever-higher and restrictive deductibles.

In both cases I wrote letters to the hospitals requesting more explanation. The ER visit justification was remarkably transparent, though entirely unpersuasive. I was told the hospital serves many people who don't have insurance and can't afford to pay anything so they bill people with "insurance like yours" more to make up the difference. I mailed them a check for half the patient responsibility. They cashed it. The gall bladder operation was trickier because it involved the use of something new, a surgical robot called a Da Vinci Arm, which the hospital billed by the minute. Based on my own ER experience, I visited the hospital in advance of my wife's surgery and asked for an estimate for the facility, anaesthesia, surgeon, Da Vinci Arm, etc. The hospital rep chuckled and said, "We can't do that, there are too many unknowns." I replied that certainly there are some knowns or ranges? The rep shrugged his shoulders.

Again, I mailed a check, paying half the patient responsibility. I also enclosed an article that had run in The Wall Street Journal about doctors and hospitals in other countries who publish the prices of procedures and related services online, enabling people to comparison shop, if not negotiate. The hospital called me and threatened to "ruin your credit rating." I said, "Do what you have to do." They sent bills for a year, and then sicked a collections agency on us. I patiently replied to every bill, letter and phone call with the same sane reasoning and copies of all prior correspondence. The collections agent said, "You're right." The bills and calls stopped.

A couple of months ago, The Wall Street Journal published another article about the clout of cash. It turns out doctors and hospitals don't like the medical insurance companies any more than you do. The article reported that people in need of specialists and hospital care should negotiate with cash at the outset for the best deal. Sounds more and more like the car dealer where only the naive don't haggle, paying the "manufacturer's suggested retail price" instead.

All Over the Map

A.D. 1498 - The Discovery of America

I grew up reading National Geographic. We saved every issue, in order, on several shelves in a glass-doored bookcase. The subscription started long before I came along so there were a few decades of issues, and maps, to catch up on. I always loved unfolding and studying the maps that came each month. When we bought our first home, we papered the TV room wall with National Geographic's "World Classic Wall Map." Despite Google and other online resources, the wall map continues to be a frequent destination to understand where in the world things are happening.

Betsy Mason and Greg Miller, the map bloggers at WIRED, have digitally moved to National Geographic and their new All Over the Map blog. Of course, they're also @mapdragons on Twitter and mapdragons at Instagram. Their latest tweet is about recruiting cartographers to map the surface of the planet Mars.

Canada's Electoral College Problem

Yep.

The New Yorker ~ Kim Warp