Drainage systems and health care

This will be a short entry as I’ve just finished my summer course on consumerism, and will continue to work on the drainage project at the house.   This project was supposed to be a two day effort starting on Monday.    We ordered 60 cubic yards of sand and 36 cubic yards of small stones.   We got 500 feet of pipe (perforated) and fabric.   It seemed like a straight forward project.  Rent a digger for the day and dig the trench (as well as pull out some stumps from the land we cleared out back).  Then on day two lay the pipe, cover it, and the job will be done (renting a different truck to haul and sand and rocks back and forth).

But as we got into it we found first of all that the job took more time than anticipated.   Since I’m teaching I can only work in the morning, or after I bring the kids home at about 5:00.   My wife works too, so her brother and his son do most of the work (and her brother designed the project).    Then there were other things that needed to be done, the job expanded so that most of our yard is being covered with sand (meaning we’ll have to get soil to put on top and reseed).   We missed a dinner with friends we’d planned for Tuesday,  we had to pay a babysitter to watch the kids so we could all work without interruption.

I pick up the boys in about twenty minutes.   Then they’ll play in their sandbox as we continue to work.   There is a heavy drenching rain in the forecast, which means we need to get this done tonight.

So what does this have to do with health care?   Though I believe we need major health care reform and hope Congress passes something soon, it’s a cautionary tale.   A project appears tractible at first.   For us, two days, and a certain amount of money (I’m not being secretive — I just haven’t calculated the amount).   Everyone involved has done things relating to every aspect of this project before, but none of us have actually done the work of building a drainage system around a house.

We get into it, and problems arise, the job expands, some things are harder than expected, and the costs rise.   Not only in time, but more on truck rental fees, more sand, more rocks, babysitter fees, etc.   Health care reform will be very difficult, it won’t be a panacea where suddenly things will get better and costs will go down.  The Republicans warning about hidden costs and unknown side effects should be taken seriously, those things are legitimate and real concerns.

Yet, that doesn’t mean we shouldn’t do it.   Though our basement has stayed dry, our house in the woods not far from a little river has had water problems in the yard since we bought it.   It’s been not only an inconvenience, but sometimes water from the leach field of the spectic system got pushed up to the surface with normal water drainage.  When this is done, we should have a dry yard that will be safe and can be shaped to our design.  This plus the clearing we made in the woods (whose cost and work also have been expanding — though put on hold for “drainage week”) will make our home a fundamentally better place to live.

And I’m convinced that getting the health care system in order will ultimately make our country a better place, especially as our population ages and retires.   I don’t pretend to know how best to do it, or if the House bill is the best idea — though the AMA is supporting it as are many health care professionals, people who were against it before, so that’s a good sign.

But be expected to have things change along the way, with a need to improvise, spend more money and address unexpected complications.   That’s a reality in almost every worthwhile task, from drainage systems to health care systems!

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  1. #1 by henitsirk on July 24, 2009 - 01:46

    I haven’t read up on exactly what is being proposed, but I did hear the beginning of an interesting interview on NPR the other day with an executive from Kaiser. I had forgotten all about Kaiser’s nonprofit model.

    I can say as a former Kaiser member that it worked quite well. It was very convenient to have our physicians, specialists, and the pharmacy in the same building. They were ahead of the game in using electronic medical records, which added to the efficiency and coordination of care. I recall one time my son had an abdominal x-ray taken, and 5 minutes later we were looking at it on a computer screen in the doctor’s office!

    Traditional fee-for-service insurance encourages doctors to bill for more money and yet take less time with each patient, and encourages insurance companies (who are, after all, corporations that have to value profits over all else) to reduce outgoing payments. And the patient, of course, is trapped in the middle of that dynamic. Nonprofit status removes all that, because the doctors are salaried instead of fee-for-service.

  2. #2 by Mike Lovell on July 24, 2009 - 16:44

    Henitsirk-

    Could I hear a little more on Kaiser, specifically the non-profit sector of it all? I’m unfamiliar that they even operated this side of business. As a former California resident, and still have much family there, Kaiser has always been a subject of the gripe speech and alleged criminality over many a cup of coffee. As far as corporations go, only PG&E could even consider rivaling them.

    • #3 by henitsirk on July 24, 2009 - 17:33

      Well, my understanding is that they are a nonprofit, so any excess funds left after their expenses are reinvested. So they aren’t a corporation, nor do they have stockholders to whom they are beholden. They run hospitals, pharmacies, doctor’s offices, etc. as well as being an insurance plan.

      All of the physicians employed by Kaiser are salaried, so there is no incentive to be either too stingy with services or overuse services. The theory is that this allows physicians to focus on medicine, instead of money. With the for-profit fee-for-service model, the insurance company wants to reduce expenses by reducing benefits and claim payments in order to maximize profits, while the providers want to bill as much as possible. HMO physicians who are paid a flat fee per month per patient have to minimize the time spent per patient visit so that they can have as many patients assigned to them as possible, in order to maximize their monthly income.

      Naturally, just as with any business, money is still a concern for Kaiser. But Kaiser is able to be more efficient, and they don’t have the complexity of administration that fee-for-service insurance companies do: contracting with all the ancillary providers (hospitals, pharmacies, physicians, etc.), paying claims, etc.

      I recall there being plenty of people who had bad experiences with Kaiser. I guess one drawback is that they are so large, and therefore there is a certain level of bureaucracy that goes along with that. I can only speak of my own experience, which was entirely positive. I’d have to hear specifics to respond to any gripes!

      I worked for two other health insurance companies for a total of 9 years, both of which were for-profit corporations. It’s not a very healthy nor efficient business model. Insurance companies no longer provide value to their customers, the employers/members, by simply reducing costs and providing care management as they once did. They have created a layer of bureaucracy and profiteering that has to change. But I can’t really blame them — they’re simply successful at doing what capitalist corporations are supposed to do, which is maximize shareholder profit.

  3. #4 by henitsirk on July 25, 2009 - 22:40

    More on the salary model in today’s NY Times: http://tinyurl.com/ndzc6t.

  4. #5 by notesalongthepath on July 26, 2009 - 04:21

    Hi Scott,
    I could picture you and your family trying to get your work done. How fun that you share that, too, with everyone. And you’re right about health care–it is going to happen that way–like birthing a baby–painful, hard work, but more than worth it in the end. And my niece doesn’t have many good things to say about Kaiser. Does anyone know how the House plan compare with Canada’s health care system?

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