Snipping Costs

I got snipped today. I was also a minor contributor to high healthcare costs due to insurance benefit design.

Vasectomies are very straightforward, generic procedures with few complications. It is a fairly low skill operation. It could be done almost anywhere. However I elected to have it done at a regional academic medical center.

This choice structure was partially influenced by my benefit design.  I am insured through work, and I have a deductible with no co-insurance plan. Let’s see where the high cost choices came into play.

I had $173 of deductible left to fill for the year before everything gets covered at 100%. :

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Obama in South Africa

Here’s President Obama speaking earlier today at Nelson Mandela’s memorial service:

A beautiful, powerful speech, in my ever-humble opinion.  It was fully fitting too, I think, for Obama to make a veiled, but perfectly intelligible political demand late in the speech.  As he said, Mandela was no marble bust; rather, he was a powerful, tough, smart leader of a struggle,”the last great liberator of the 20th century.”  And, again, as Obama said, that struggle has achieved great triumphs — but yet has a long road to go.

One more thing.  Unsurprisingly, Ta-Nehisi Coates nails it on the need to pierce the glow of fond Mandela remembrances to recall those who did all they could during Mandela’s life  to ensure that his struggle would fail. TNC also reminds us that such foul behavior was not inevitable, and not the inevitable choice for American conservatives back in the day.  Which is to say that those, like William Buckley (and many others) who came down on the side of white supremacy could have acted otherwise and didn’t, to theirs and their heirs lasting shame.

Open Thread: Happy Diwali / Deepavali !


MOAR LIGHTS, more fireworks, more sugar — perfect holiday. Please forgive me if I’m jumping the starters’ pistol here…

(CNN) — Fireworks boom, bulbs flash, and flames flicker as tens of millions of people across the globe celebrate the beginning of the Festival of Lights.

Diwali — from the word Deepavali, meaning “row of lights” — is observed by Hindu, Sikh and Jain communities, who celebrate for five days in autumn to mark the victory of light over darkness.

This year, the festival begins on November 3, with splashes of color, lighting displays and blaring parties set to greet Diwali’s arrival.

Celebrated for centuries across much of the Indian subcontinent, Diwali is now exploding: spreading the promise of wealth, knowledge and happiness to new communities across the world…

Fireworks are said to drive away evil spirits and, at this time of year, many Hindus will also clean the house and light small oil-burning lanterns to attract Lakshmi, the goddess of wealth into the home.

But the celebration is anticipated with excitement by many across India — as well as neighboring Sri Lanka and Nepal — regardless of religious beliefs…

diwali in boston facebook page

From the ‘Dewali in Boston‘ Facebook page

Depends on where you’re standing

This is from commenter Phoenix Rising :

My wife had cancer in 1994. The small business where she worked at the time lost their insurance over it. She hasn’t been insured for 19 years. The only bright spot: the indications that your leukemia is back include full-body bruising and blood coming out your ears when you floss. At least we haven’t spent the decades wondering if something was lurking that regular followups might have found.
In January 2005 her mammogram showed a mass. We knew that we were going to lose everything, as the best-case outcome. My wife went outside after listening to the voicemail (left at 4:55pm on a Friday asking her to come back in Monday morning but not saying why…) and smoked her last cigarette.
By Monday we’d found the baseline film, by Wed. the radiologist that Planned Parenthood referred her to (paid by the YWCA program for uninsured women) had matched them up. The lump was scar tissue from a bee sting in childhood. She still hasn’t smoked again, but that was the longest weekend of my life.
This is what it means to be uninsured: the news that your 5 year old may lose a parent in elementary school takes a backseat to ‘we’re going to lose the house…unless my wife dies quickly’.
I have melanoma, the cancer that lurks. I’m now on a followup schedule that continues until I die of something else, or the lurking semi-solid cells that are statistically likely to be somewhere in my body hit a switch and start to multiply again.
Our business has never been big enough to offer insurance. We knew from 1994 that plans to cover fewer than 50 people wouldn’t pay out or would take the premiums and run if we ever made a claim, so we didn’t bother to offer the option to make Blue Cross richer in order to feel insured. Obviously this has affected recruiting at our company.
Two critical points:
-In the past 4 weeks, I have received 5 resumes from exactly the kind of people we would like to hire more of. All say they’ll be available around the 1st of the year. Demographically they’re very different from the resumes I’ve seen over 15 years in this business. They’re younger and looking for fewer hours doing something they already know is hard in ways they enjoy. They can afford to leave Big Ugly Death Star Corp. because they can buy health insurance.
-I was diagnosed in Sept. 2011. Because my state had already implemented the part of the ACA that requires insurance companies to continue policies at similar rates EVEN IF the individuals on them make claims–not something we expected, after our earlier experience–I’m still insured.
We’re going to buy an exchange plan that puts our family on one deductible and OOP max, for the first time ever, next week.
The technical issue we discovered with the web site was after applying: whoever coded the ‘citizenship for adopted people’ section of the eligibility database chose the wrong field type for the only way our government has to verify my kid lives here legally. So we have to talk to a manager with superpowers before we can choose among the 57 (!) options to get our family covered.
We can afford any of these plans. Fifty-seven choices. Sure, some of them aren’t appropriate for our family’s health profile (rare cancer=must have some out of network coverage; hearing aids for kid must be covered, etc.). Some of them cost more than I’d prefer to spend, once we add up the premium and deductible–which we anticipate meeting sometime in Feb. 2014, with the backlog of preventive and screening that Mrs Phoenix hasn’t had access to since before PET scans were invented.
But we get to buy insurance, in a market that has to take our money and has to pay for the health care we may need.
As a parent, a spouse and a small business owner, I would carry the Congresscritters and President who got us these solutions across a river of acid on my back to keep them.

I feel like this about community health centers, because I relied on one once for pregnancy care so I get Phoenix Rising’s devotion.

Speaking of community health centers, oh look! Here’s a GOP supporter of community health center funding under Obamacare, but only when he’s in Kansas, not when he’s in DC:


(Moran breaking ground at an Obamacare-funded clinic in Kansas. Photo credit: Moran’s Facebook page)

BJ Pet Calendar 2014: First Call for Photos

twinkles pack Pups_Wallpaper_Size2

On the “news that doesn’t suck” front, I am very pleased to announce that Beth S. has once again graciously volunteered to assemble this year’s Balloon Juice Pet Calendar. These were her specifications last year:

I’m looking for the highest resolution images possible. The photos themselves won’t be that large, but the largest and highest resolution images people can send the better. I have photoshop and can do some remediation on images as necessary.

Until Beth has a chance to set up a dedicated account, you can send your pics to me at (or click on my name under ‘Contact’ in the right-hand column). Don’t be shy, you know we don’t measure love by the ‘professionalism’ of your pics, or the ‘show quality’ of your companion animals!

Questions, comments, suggestions — leave a comment below.

Photo at the top by commentor Tony S.; link here for Twinkles’ story, if you missed it over the weekend.