Ones and Zeros

Recently I needed an MRI for a sprained ankle to see if I’d torn a ligament or not.  I decided to use this as a project to figure out how much an MRI costs.  (I was inspired by the excellent podcast episode of Planet Money: ”Shopping For An MRI“.)

I had a choice of two MRI facilities, one was the local hospital and the other was an independent MRI/x-ray/sonogram company.  When I called the hospital it was clear that cost wasn’t a common question.  After twenty minutes on the phone talking to several people and being on hold I found I needed a diagnostic code to find the cost.  But it wasn’t clear where to get that code.So I called the independent place instead, they were more helpful.  They had two offices locally about five miles apart and the cost at one was $1200 and at the other was $500.  That’s $700 difference for similar equipment and the same staff.  After some discussion I found the real difference was some competition near the cheaper one.But wait!  This wasn’t the cost that I faced.  I have insurance and these costs are the “self-pay” costs for those without insurance.  However, no one really pays these self-pay costs.  If you pay up front they discount it 40%, if you pay in installments they discount it 25% I’m told.

Also the insurance companies contracting with the facility to pay a certain rate for each service.  Different insurance companies may pay different amounts if their contracts are different.  Without a long and tedious discussion with the billing department I wouldn’t be able to find out what my insurance company paid or what my co-pay amount was.

The usual rules of the free market fail here miserably.  To recap those rules: We have to have roughly equal sized sellers and buyers so that no one unduly controls the market.  Second, the prices and services in that market have to be known and similar.  Here the medical and insurance companies in this market are much larger than I - I have no ability to negotiate on anything like equal terms.  The insurance company is supposed to do that for me, but I’m locked into one particular insurance company at work and can’t easily change so there’s no real competition there either.  And, as we see, price information is essentially unavailable.  I also have a limited ability to compare the quality of the service since I’m not a medical expert.

The optimizing abilities of a free market don’t apply here since it’s not a free market in the economic sense of the words.  Besides, do you really want to price-shop for the cheapest doctor?  Yeah, me neither.  In the absence of market competition there’s no price control.  Some sort of regulation is necessary as the usual mechanisms don’t work.  That, I hope, was the original point behind the health care bill.  We’ll see how well it works out now that it’s passed through the partisan meat-grinder of Washington DC politics.

And that ligament?  Yup, it’s torn.  I’ve got a “boot” on to prevent me from moving that ankle, and there’s to be no running or hiking this fall for me.

This blog will continue to be an occasional thing.  I’ll continue to post things I’d like to comment on or adventures of flying and other activities.  Between the demands of my personal life and of my work life, I’ve been pretty occupied lately.  If life is the business of opposing entropy, well, I’ve had a lot of entropy to oppose lately.

So this is just a quick post to let anyone interested know that 1) I’m still around and online, 2) I’ll still be posting.If you have comments or questions, feel free to email or post them.  I’d like hearing from you.  Just - no spam. I’m really tired of deleting Ambien and Xanax ads from comments!

The “don’t ask don’t tell” (DADT) policy was struck down by a California court this last week, a clear and legal process outlined in the Constitution.  Yet the Obama is directing the Justice Dept to appeal this ruling saying.

 “This is not a situation in which, with a stroke of a pen, I can simply end the policy. It has to be done in a way that is orderly, because we are involved in a war right now. This policy will end, and it will end on my watch. But I do have an obligation to make sure that I’m following some of the rules,” he said. “I can’t simply ignore laws that are out there. I’ve got to work to make sure that they are changed.”more by Barack Obama - Oct 14, 2010

He’s also said that he wishes to overturn DADT, but needs to “let the process work”.  Well, as detailed in the Constitution, there are several processes.  Since Congress passed a law creating DADT, they can pass another law overturning it too.  Alternately, a court can overturn the law.  Both processes are part of our Constitution and history.

Looks like the process has already worked.

I tried the iPad with the ForeFlight app for charts, plates, and airport information on a recent IFR flight.  ForeFlight is an app that for $75/year subscription will supply you with all the charts, plates, and airport information cached on your iPad.  This post is a review of a flight I did with the iPad/ForeFlight combination for charts and plates.

I took an IFR flight that happened to be to CHO from JYO, the return was via OHM.  I was either in the clouds or on top of them for the majority of the flight.  I did my pre-flight brief and filed my flight plan with FF (the iPad/ForeFlight combo).

The brief worked well, the usual DUATS information was broken into separate sections in a table view.  I needed to tap on a section to read it, then tap the back button, and tap the next section I wanted to see.  I would have liked a “next” button to tap on, it would have been smoother.  Not a major issue though, but a “nice to see”.

The flight plan was there in ATC when I called in - so that worked.  I set FF to show my flight plan (that I’d entered in earlier in planning) on the low-enroute chart.  I could have selected high-enroute or a sectional/TAC.  When the iPad has cell reception, I can get radar, satellite, current conditions, etc.

I have the Apple iPad case which has a kind of microfiber coating, it doesn’t want to slide off my knee and stays more stable than my paper charts did.  FF tracked my position, heading, and altitude and showed me a moving map of where I was on the chart and with respect to my flight plan.  The icon that FF used for my plane looks like a larger plane - might be cool thing to be able to change that.

Coming out of JYO the first waypoint is STILL, but ATC turns you before that which I appreciated.  I ended up on radar vectors to CSN, my next waypoint.  I found that the usual buttonology management of the panel GPS was doubled as I had to mess with FF as well.

After CSN instead of going to WITTO, I was redirected to KENNI for the ILS.  More buttonology.  I kept wanting to tap on the airport on the map screen to bring up the airport information.  The approach plates are listed with the airport information in FF.  To get from the chart to the airport the easier way is to 1) make sure the flight plan is showing (tap the flight plan button on the chart screen if not), 2) scroll if necessary to show the airport on the flight plan, 3) tap the airport code on the flight plan.

I’d prefer to just tap the airport on the chart screen.  I can do that for VORs, NDBs, airports, fixes and arbitrary locations to add to my route.  But I can’t get to the airport screen that way.  This was the worst issue I had with FF.

When I broke out at the top of the clouds on the way down to CHO, and even in the clouds, I had a big glare problem with the iPad screen.  I prefer to buy matte screens, but the iPad doesn’t come with one.  While a glossy screen is brighter, it also reflects much more easily creating glare problems.  And with my sunglasses (yes, I had to wear sunglasses in a cloud, it was that bright) the screen wasn’t visible at all.

I found out later that my polarized sunglasses lined up with the iPad polarization in the vertical position to block the screen view.  That’s my problem, but in any case the glare is an issue.  I’m going to look into a covering for the screen to reduce glare.

 The battery life was great.  After my leisurely flight planning and preflight brief, a return flight planning and brief, and a 2.7 hour flight, I’d used just half the battery capacity.  More than enough for my purposes, especially since charging is fast.  You can also get a car charger cable for in-flight use too.

I found the iPad/FF combination was, aside from the issues above, very usable.  I need to practice the buttonology, and I hope ForeFlight adds a direct way from the chart to the airport screen.  But there are some things I liked better: Everything was there and available.  The iPad stayed put more easily that paper charts and plates.  And it’s cheaper than paper charts.  I didn’t have the heat shutdown problem that some have reported, and I don’t fly high enough to cause problems with the GPS.