Profit at the Expense of the Consumer, Part 2: Talking to India

We've all experienced poor customer service. Getting a customer service representative on the phone in the first place can be difficult and time consuming. Large companies like Chase and Citibank force customers to fight their way through computerized menus before we can talk to a human being. Some companies do not even publish their customer service phone numbers.

And, when you finally get someone on the line, they are likely to be uneducated, untrained and underpaid. Often times, they are located in India or El Salvador and might not even speak English well enough to get the job done. Hotels.com comes to mind as a company with laughably bad phone service. Their employees only speak enough English to handle two or three specific tasks. Beyond that, you'll need to speak Tagalog or Spanish, depending on which call center you get.

Part of the reason for poor customer service is a simple desire to save money. It costs a lot of money to staff a customer service line, and it is cheaper to hire someone in India whose English is less than perfect.

But there is another, and I believe more important, reason why some companies make it difficult to communicate: they want customers to just give up. Most of the time when you call your bank, for example, it is because you were charged a $7 fee you should not have been charged, and you want it removed (how many times have you called a company complaining that you were undercharged?). Many companies, United Airlines being a prime example, have an active strategy of making it difficult to communicate in order to be able to get away with overcharging or otherwise not providing what they promised.

Another way in which big American companies try to bamboozle consumers is with incomprehensible bills. If you cannot understand your bill in the first place, it is hard to know if you are being cheated, let alone convince the company to refund the $18.47 they overcharged you this month. For example, my Sprint contract is quite simple. I pay a fixed amount of money for a fixed amount of "anytime" minutes each month. Everything is supposed to be included in one price. Or at least that is how they sold me the contract. But, my current Sprint invoice has no less than 42 entries, not including the various taxes. They charge me odd amounts for various items, then credit me back for other items. None of it has anything to do with our actual agreement, and none of it makes any sense. AT&T and DirecTV both do the same thing. Their bills are actively designed to be difficult to understand so that we will not question them. It would be easy to make the bills easy to understand, but that is not what AT&T wants.

These incomprehensible bills nearly always contain mistakes, and the mistakes are nearly always in favor of Sprint, AT&T and DirecTV. I know that from experience, and if you look closely at your own bills, I am certain you will find the same thing. But, finding the mistakes, getting through to customer service and trying to get them to refund the excess charges is rarely worth the time and effort. And DirecTV is smart about the way it overbills its customers. The amounts are generally small, on the order of $10 to $30 each month. That way, some consumers will not realize that they are being cheated, especially given the complexity of the bill. Others may realize that they are being overcharged but are unwilling or unable either to figure exactly where on their complex bill the overcharge appears, or to fight through the customer service jungle to get back $18.47.

It seems that the majority of large American companies have adopted the same cynical policy of abusing their customers in order to squeeze out a few extra dollars each month. True, it is not all of them. Apple, for example, has a policy of providing excellent customer service, often giving their customers more than they agreed to provide, e.g., serving a product a month after the warranty expired. The business practices of the majority of the companies, however, are just the opposite, and the cost to society are high. The uncivilized and dishonest practices of Sprint, AT&T, United Airlines and DirecTV may net them a few extra dollars in the short run, but they make life unpleasant in small but persistent ways. These companies teach people to have low expectations, and to cheat whenever you can get away with it. And, in the long run, these companies destroy their own reputations, at their own peril.

Profit at the Expense of the Consumer, Part I: Gift Cards

Gift cards have become increasingly popular with consumers in recent years, and for good reason. Say you are looking for a gift for a friend. You know she loves music, and you know what kind of music she likes, but if she really likes an artist she may have already bought most of his albums for herself. That makes it hard to select the right gift. If you buy her a gift card, she can choose for herself, and she always gets the right gift. In a culture such as ours that frowns upon giving cash, gift cards are a good option, both for the giver and the recipient.

Gift cards are popular with merchants for an entirely different reason: about 10% them are never redeemed. Best Buy sells a $100 gift card for $100. Seemingly, there is not profit on that transaction, just a small cost in creating and handling the card. But on average, $10 of that card will never be redeemed. That money does not get forfeited to the State, nor donated to charity. Rather, it is nearly pure profit for Best Buy; a plastic card sold for $10. The business of selling gift cards is less risky and more profitable than selling televisions, computers and cell phones.

Gift cards are only profitable because consumers make mistakes. Consumers buy cards that they do not need, they lose the card or just put it in a drawer and forget about it. If everyone cashed in their gift cards, the business model would not work. It is a business designed to take advantage of people's mistakes; no mistakes, no profit.

Compare that with the ordinary business of Best Buy, which involves selling consumer electronics. Certainly, Best Buy could increase its profits by selling shoddy or overpriced goods, or by misleading or otherwise cheating customers. But none of those things are necessary in order to make money as an electronics goods store. On the contrary, at its core, the business of selling electronic goods is based on the principle of selling consumers what they want and making a profit at the same time: a win-win business model.

No, I do not think gift cards are the devil, or that they should be banned. But, consumers should be aware of what is going on. And, when you buy a gift card, you are buying a very high profit item and you should expect to get a little something in return. For example, Peet's Coffee gives a dollar off for every $20 added to a Peet's card. That makes sense; the consumers share in the windfall profits generated by the gift card business.

Medical Hell, Part III: 7.5 Minutes

Most doctors schedule four to eight appointments every hour. Eight appointments an hour, which seems to be the norm for orthopedic surgeons, means an average of less than 7.5 minutes per patient, given that the doctor must spend some time walking from room to room, etc. We're probably lucky to get five to fifteen minutes of our doctors' attention in the average appointment. Next time you visit your doctor, look at the sign-in sheet and figure out how little time the doctor has allotted for your consultation or examination.

In these short appointments, we are expected to make important decisions about our health: whether to take a medication, to undergo a procedure, or to just let things be. It is simply impossible to make a good decision in such a limited amount of time, and I can think of no other profession that gives such short shrift to its clients. Yet there is no profession more important than medicine.

I am confident of the problem, but I am less sure of the cause(s) and solution(s). Nevertheless, in the spirit of the internet (speaking out when you are not really sure if you know what you are talking about), here goes:

The underlying problem is that we simply do not have enough doctors to go around. There are two reasons for this. First and foremost, we do not have enough medical schools. There are only about 125 medical schools in the entire United States, about 1 for every 2,500,000 people. As a result, there are many capable students who would be more than happy to pursue a career in medicine, but who are not able to qualify. We would do well to close a few law schools and open a few medical schools.

Second, medical training is unnecessarily long. Many doctors --dermatologists, for example -- do not use even a fraction of what they learn in medical school. These specialists should be given separate degrees, with training focused on what they will need in their practice. Think of dentists, for example. Reducing the length of training means that each medical school can produce more doctors.

Clearly, there is a need for some doctors who know all fields well, and there is a need for all medical practitioners to have a certain minimum understanding of how the human body works. But, in a world of limited resources, it makes sense to allocate education more carefully.

Airport Security Has Become a Fraud

I fly frequently, and I care very much about my safety and the safety of my fellow passengers. Some airport security is necessary for that safety. But that being said, airport security in this country has become a very expensive farce.

All activities entail risk. Driving to the airport to catch a flight entails the risk of dying in a car crash. That risk is -- and always has been -- far higher than the risk of dying on the flight from all causes combined. Staying home is risky, too. There may be an earthquake or a hurricane. And, no matter what you do, you might die of cancer or some other horrible disease. Each of these different deaths is, in an important sense, the same. The victim is dead. To put it another way, I do not care if I die from cancer or in a terrorist attack -- I just want to put it off as long as possible!

But of course there are limits to what we can do. Even if we drive 10 miles per hour and wear helmets at all times, there is still a risk of dying in a car accident. Even if we go to the doctor every day, and have every possible test, there is still a risk that some disease will go undetected. We have to make choices about what steps we take to improve our safety.

So, we must apply some common sense. The amount of time, money and energy we invest attempting to mitigate any particular risk should be based on a simple cost-benefit analysis. How much risk can be reduced at what cost? People -- especially Americans -- like to put their heads in the sand and claim that there can never be a compromise when it comes to safety. But there always is such a compromise, whether we like it or not. Best to acknowledge that fact and make the smartest compromises. Refusing to acknowledge that we are making compromises prevents us from making good decisions and ultimately makes us less safe, not more.

The risk of dying in a terrorist attack is, in the scheme of things, trivial. No one has been killed by a terrorist in the United States in over eight years. Not one person. In the meantime, millions of people have died from cancer, heart disease and accidents of all kinds. A few unlucky folks have even died of being hit by lightning and as a result of shark attacks. Certainly, there is a risk of terrorism on airplanes. There always will be such a risk and, like most risks, it cannot be entirely eliminated. But that risk is already very, very low on the list in terms of actual size.

Moreover, there is very little we can do to reduce the risk further. We already spend millions of dollars, and spend millions of hours of people's time, trying to further reduce a risk that is already very small. As with any endeavor, there is a law of diminishing returns. The cost of improving something starts low and gets increasingly higher, while at the same time the benefits become smaller and smaller. At some point, there is nothing more that we can reasonably do. Airport security passed that point long ago.

Furthermore, even if we could make air travel "completely" safe from terrorism, it is unclear if that would make us any safer. Presumably, terrorists would learn that it is impossible to destroy an aircraft, and they would therefore turn their attention to other targets -- boats, bridges, stadiums and the like. Terrorists are going to hit the weakest point, so making one particular facet of our lives "terror-proof" would be of little benefit, even if it were possible.

The irony of all this is that the press and the government are playing directly into the hands of the terrorists by creating unjustified fear. The idea of terrorism is to scare people and to make them stop living their lives normally. The terrorist cannot hope to kill enough people to bring down his victim; terrorism is not war. Terror works through fear, not bombs. A "war on terror" should focus on stopping fear. But we seem to be doing the exact opposite.

The failed attack on December 25, 2009, provides a perfect example. All of our elaborate airport security was unable to prevent the would-be terrorist from getting his "bomb" onto the airplane. The attacker apparently was not particularly skilled nor persistent -- he simply stuffed a small bag into his underwear. Short of a real (or virtual) strip search, the next attacker can do the exact same thing and be all but certain to get his "bomb" onto the plane.

The attacker failed to blow up the airplane, but not because of anything the TSA did to stop him. He failed for two simple reasons. First, he was not very bright. Second, the passengers intervened (this is at least the third time that has happened -- the final plane on 9/11 and the "shoe bomber" being the other two examples of passengers intervening). Experience suggests we can count on both of these factors in the future. Competent terrorists are, fortunately, rather unusual. Brave passengers are not (and it only takes a few brave passengers on a plane to stop a given attack).

Ironically, however, the attack of December 25, 2009, did succeed in an important respect, but only because of the government and media reaction. The US government reacted by imposing more airport security measures. While those measures would not stop a similar attack tomorrow, they do impose a huge cost on travelers, airlines and ultimately the world economy. The stocks of airlines, for example, fell substantially. The attacker may have failed to take down that airplane, but he caused hundreds of millions of dollars of damage, based on the airline stocks alone. And he did not even have to blow himself up to do it!

The media did its part, too. Scaring the public is always a good way to improve ratings, and almost all major media outlets could not resist. No one said, "Here is just the second attack in eight years, and again it failed without the need for any security. This is proof that we are safe." Instead, the media ran the story so as to scare the daylights out of anyone who was planning to fly.

Terrorist attacks, like shark attacks, cause visceral reaction in most people. Mature, educated people can acknowledge that fear, but at the same time apply their reason and make decisions accordingly. Please, do not play into the fear game. Do not be afraid to fly. Even when there is another crash -- and sadly, there will always be another one -- use your common sense. Flying is, always has been and always will be, a very safe way to travel. If you want to fight terrorism, do it by not being afraid.

Should You Trust Yelp?

The review website Yelp provides a useful service. On the most basic level, Yelp is a good place to go if you want to get a list of businesses in any given city, whether it be restaurants, dry cleaners, dog kennels or whatever. Yelp seems to have reached critical mass, in that most businesses seem to listed. Going to Seattle, and want to find a good Thai restaurant? They are probably all listed by Yelp. Need the address of a specific restaurant? Again, it is probably provided on Yelp.

Yelp's reviews, however, are of dubious value. No review, reviewer or review website can ever be perfect, but Yelp could do a whole lot better. Most importantly, the reviews on Yelp tend to be overly positive. Remember, Yelp takes advertisements from the same businesses it reviews. No business would buy an ad of any kind on Yelp if their own review is negative. Because every business that is reviewed on Yelp is also a potential advertiser, it suits Yelp's on financial interest to keep as many reviews as possible positive.

Yelp does a number of different things to keep the reviews positive. Most obviously, Yelp allows a business owner to pay to have a preferred review at the top. And, at the top of each review is a purported "average" star rating. I did the math on Yelp's own reviews of itself, however, the average is just wrong. Guess which way!

Yelp also displays reviews -- and even deletes reviews -- in a manner that is far from transparent. Yelp will not release the algorithm it uses, but they do say popularity of the reviewer counts. Positive reviews are popular, so this pushes positive reviews to the top and keeps them listed. Yelp also fails to tell people when their reviews have been removed. I see no valid reason to remove a review simply because the reviewer is not popular. Let the consumer sort by popularity if he wants, but do not just take reviews down. And, when the reviewer logs in, he actually sees his own review, as if it is were published.

There have also been allegations that Yelp engages in practices that are little short of extortion, such as offering to move good reviews to the top for money, then doing just the opposite when the business owner refuses to pay. I have no personal knowledge of any such incidents, so I will simply provide a link to an article that contains more detailed allegations.

http://www.eastbayexpress.com/eastbay/yelp-and-the-business-of-extortion-20/Content?oid=1176635

Finally, I recently had Yelp remove one of my reviews, with notice to me, for an alleged violation of their rules. I was looking for a painter, and found one on Yelp. He had one five star review. But, when I called him, it became clear that he had written his own review on Yelp; foolishly, he did not even bother to use a pseudonym. The name on his answering machine matched the review. So, I never spoke to the guy and never used him, but I did post a review on Yelp calling him out for cheating. Yelp pulled my review, saying I had no personal experience with the business. I think they should have thanked me!

All that being said, Yelp is still useful. You can find a business, its address, phone number and website in a flash. Even the reviews are of some value, just so long as you know what it is you are getting.

Down with the Dow!

The American news media are addicted to the Dow Jones Industrial Average. Radio and television stations seems to believe that reporting the Dow (and, often, the NASDAQ) is an essential part of any news cast. Even NRP includes a mention of the intra-day progress of the Dow repeatedly throughout the day. CNN is the worst. It displays the Dow constantly in a corner of the screen. Watch CNN, and you will see ever little movement, refreshed every few seconds. What a waste of electrons!

These constant updates on the stock market are worse than useless. The fact that the market is up 0.4% on a given day is utterly meaningless to the vast majority of people. The stock market's daily, and even weekly, drift is no indication of the direction of the market, let alone of the economy. Even a relatively large move in the market, say a rise or fall of 3% in one day, is not meaningful. There is nothing that any intelligent person can or should do in response to it, nor does it change anyone's life.

Reporting the Dow is, at best, a colossal waste of time. At worst, such reports create paranoia and fuel speculation. People who listen to the news, with its moment-by-moment reporting on stock values, could reasonably infer that these reports mean something. The Dow is down -- the economy must be in trouble! The Dow is up -- things must be improving! But that is not true. The Dow is up 0.4% today as a result of random drift, not because "bargain hunters are snapping up shares," as ABC reported.

Worst of all, the reporting of the market's small random drifts encourages people to speculate. The true value of stocks, over the long term, is based on the value of the businesses. More specifically, the value of stocks is based on the dividends that they will pay. Therefore, the value of a stock does not go up or down on an hourly basis, absent some important event, e.g., Merck's latest drug obtaining FDA approval. In any market, however, there will always be an element of speculation as well, people who buy solely for the purpose of finding a greater fool who will pay more. They do not care what the stock is worth, only what others think it is worth. Focusing on ultra-short term fluctuations in the market encourages people to focus on what the market will bear, not on the value of what is being traded.

Finally, although this is really beside the point, the Dow is a poor measure of the value of stocks, as it takes into account just 30 large companies. If you need to measure the value of the stock market, look to the S&P 500 or the Wilshire 5000, which take into account the broader market.

Phasing Out Pharmacies

There was a time, or so I was told, when pharmacies and pharmacists played an important role in our health care system. If those days existed at all, they are now long gone. It is high time that we begin to phase out the pharmacy. We should do so by progressively making more and more medications available without a prescription. At the same time, we should ban advertisements for any medication.

Pharmacies add a significant layer of expense to our health care system. While I can buy aspirin or ibuprofen at the 7-11 store, I can only get meloxicam (an anti-inflammatory that serves the same purpose as ibuprofen and is no more dangerous) at a pharmacy. That creates two different kinds of expense. First, it adds to the cost of the medication. A pharmacy must have a highly trained -- and highly paid -- pharmacist on duty at all times. In addition to the pharmacist, there is almost always a second employee who hands out the prescription medications and often rings them up on a separate cash register. Furthermore, the pharmacy incurs expenses in complying with various regulations. Compare that to the cost of selling aspirin. A store simply stocks the shelves with bottles, and the customers help themselves.

The pharmacy also imposes a non-monetary cost, one which I find particularly vexing. I can get an aspirin at the 7-11 or Trader Joes at any hour, without a prescription and without an appointment. Getting propanolol (a common beta blocker) requires a prescription, which must be presented at a licensed pharmacy. I must then wait until the pharmacist fills the prescription, and stand in a special line to receive that one item. That process is a waste of time, in addition to a waste of money.

I suspect that the prescription system imposes yet another cost, which may be even more important than the two costs described above. The prescription system discourages patients from being good consumers and paying attention to the choices they are making. Prescription drugs are treated as holy: only the doctor decides which ones we take, when and in what doses. The insurance companies have their secret formularies, which try to impose on the doctor's choice. Then, only the pharmacist can actually deliver the goods. Even a patient who wants to get involved in choosing a medication will have a hard time doing so in the face of those three forces.

Compare the purchase of pain killers, where the patient can select from a variety of over-the-counter medications, in various doses, brand name and generic. These medications quickly lose their magic aura, and patients learn to make intelligent choices. Consumers feel free to think for themselves and experiment appropriately with the available products. They learn to avoid overpriced brand names, and they learn which medications work best for them. I suspect that eliminating the prescription requirement on a medication would quickly create more savy consumers and thus reduce the price the market would bear in many instances. I bet the big pharmaceutical companies would hate the idea of phasing out the pharmacy.

We do not get anything worthwhile from pharmacies. Few, if any, patients actually seek the advice of the pharmacist. If a few patients want to pay for such advice, they should of course be free to do so, but there is no reason to require everyone to pay for advice which very few of us want or even receive. Pharmacists do not tell us how and when to take medication; doctors do that. The pharmacist simply copies what the doctor wrote down and, in my case, often makes mistakes in doing so. Theoretically, a pharmacist could alert a patient to conflicts between medicines. That only works, however, if the patient always uses the same pharmacy. The only time I have been alerted to a conflict was by my doctor, and one of the conflicting medications was non-prescription, so a pharmacy could not catch it, even if it knew all of the prescription drugs I was taking.

The prescription system most certainly does not protect those who would abuse drugs from getting what they want. Even making a drug completely illegal does not prevent determined buyers from getting ahold of it. The prescription system provides even less protection than an outright ban. One who is determined to get his hands on a prescription drug can always find a crooked doctor, forge a prescription, fake a symptom and/or send the same prescription to ten different online pharmacies. Pharmacies are not in the business of preventing the improper sale of medications.

Far more importantly, only a small minority of prescription medications are drugs of abuse, i.e., fun. No one is going to pop Lipitor at a party. Sudafed, on the other hand, can be turned into a drug of abuse.

Most prescription medications are no more dangerous than over the counter medications. It is easy enough to kill oneself with all sorts of household items, beginning with alcohol. I doubt that taking an entire bottle of Crestor is any worse than taking an entire bottle of ibuprofen.

In the end, pharmacies are just another entrenched special interest. We take it for granted that they are necessary, but they are not. It is time to start phasing them out.

eBay "Giving Works" and MissionFish are a Scam

eBay now allows sellers to auction an item for charity. Sellers can agree, in advance, to donate anywhere from 10% to 100% of the proceeds to the charity of the seller's choice, so long as that charity is on eBay's approved list. The listing shows a cute little ribbon, telling the bidder that the auction is for the benefit of charity, as well as a short paragraph extolling the benefits of the particular charity that will benefit. What's more, eBay discounts its fees in connection with charity auctions. The discount is proportional to the percentage donated to charity; eBay gives up almost all its fees if the auction is 100% for charity. Sounds great, but sadly it is a scam.

In the fine print, it turns out that all donations must be made through "MissionFish." What's more, MissionFish takes a fee for its service. There is a small notice on each charity listing stating that a "small deduction may apply." Those words are in faint print and small type. There is no "may" about it, and the deduction certainly is not "small." In fact, MissionFish charges far more than eBay. That's right, you would be better off ignoring eBay's offer to waive part of its fees. Simply sell the item, pay the fees and donate the balance to charity. Far more will go to charity that way than if you take eBay up on its supposedly charitable offer.

MissionFish charges:

20% of the first $50

15% of the next $150

10% of the next $800 and

5% of the amount above $1,000

So, for an item that sells for $500, MissionFish will charge $72.50. That's right, MissionFish takes $72.50 from the charity for the "service" of delivering your $500. By way of comparison, on the same $500 item, eBay would charge a $4 insertion fee (at most), plus a $19.69 final value fee, for a total of $23.69. So, eBay does not waive its fee. Quite to the contrary, the fee nearly triples! And, what is worse, you do not even see it unless you look very carefully.

Here is how MissionFish and eBay hide the fact that they are stealing from charities. Again, say you auction an item for $500 to benefit charity. The buyer sends the money to you. You then take the $500 and give it MissionFish, which tells you that you made a donation of $500. You never find out that about 15% of your money went to MissionFish.

Finally, eBay (which owns paypal) gets a fee when the money is sent to you by the buyer. So, you end up with less than $500 because paypal/Ebay takes a bite up front, but then you have to give MissionFish the full $500 so that MissionFish/paypal can take their next bite. And, if you forget to feed MissionFish the full $500, they will bill your credit card. Want to take your credit card off their account? No problem, just enter a new card and click that you authorize them to charge that. The website does not allow you to simply remove your credit card.

Do not be fooled! If you want sell something for charity, by all means do it, but do not tell eBay. Just sell the item and donate the proceeds yourself.

United Airlines' Charity Policy

I had a few extra United Airlines upgrades in my account recently, and realized that I would not be able to use them before they expire. I know that United does not allow the sale of upgrades or miles, but they do allow members to donate miles. I therefore decided to donate my upgrades by holding a 100% charity auction on Ebay, with all the proceeds going to Kiva.org and Much Love Animal Rescue. In the listings, I expressly stated that the auctions were subject to United's rules, and that if United objected, I would remove the listings.

United waited until the listings were over, then told me I had violated their rules. Even though 100% of the proceeds went to charity, United still views what I did as a "sale." Moreover, United penalized me by taking away two systemwide upgrades which, based on the Ebay auctions, were worth $500 each. Even worse, United took away the upgrades from the Ebay bidders. So, they did not get what they bargained for. The charities already have the money, so I cannot get it back to return it! I protested with United, but got nowhere.

I am done with United Airlines. Hello American!

Medical Hell, Part II: I Wish I Were a Dog

Our medical system is so badly broken, we would all be better off if we were all dogs or cats. I do not say that sarcastically; I believe my pets have received far superior medical care to what I have received, and at a far lower cost. We would do better to simply scrap our entire system, and replace it with what we give our pets.

My dog can get an appointment for a check-up within a day or two. I have to wait several months. My dog can see a specialist within a few days. Again, I wait for months. His wait at the emergency room is a fraction of mine. Moreover, his vet spends time with him and with me, explaining the situation, offering various options and even sympathizing when times are hard. Our vet returns phone calls. He even gave us his cell phone number, without me asking. Our vet also hands me all the medications my dog needs, without having to go to a pharmacy. Most importantly, our vet seems at least as knowledgable as any doctor I have met. The nurses I encountered while in the hospital were so bad I would have been better off without them. Doctors often seem to know their stuff, but spend so little time with each patient that it hardly matters. In every respect, our pets get far better medical care than we do.

The cost of this service is far lower than what we pay. My dog was hospitalized for five days, and the total cost was $1,900. I was in the hospital for 12 hours, and the co-pay to the hospital was over $3,000. The doctor charged me separately. Moreover, those are the amounts that I paid personally, with insurance. The insurance company paid more, and I paid the insurance company premiums every month for the privilege of paying those prices.

I am not sure why our medical system is so badly broken. Some might point to the high cost of medical malpractice insurance. While the cost is indeed high, it is not nearly high enough to play a material role in causing the problems we face. Perhaps different kinds of people become veterinarians rather than doctors. Maybe it is the absurd bureaucracy created by the insurance companies that has broken our medical system. It could be that the massive amount we spend on the last six months of life bogs the system down, whereas our pets euthenized when that is the merciful thing to do. I certainly am not qualified so say what is causing the problem, but I can say this: nex time I need medical care, I will be wishing I were a dog.

Medical Hell, Part I: Sign Your Life Away

I'm planning on posting a short series of comments on the failings of our medical system, based on my experiences. In each case, my point is not to whine that I have been treated poorly. Quite the opposite, I believe that the treatment I received is typical or even "good" by our incredibly low standards. It is the medical system that I wish to criticize, not my particular health care providers. Here's the first installment:

A couple of months ago, I decided to undergo a relatively low risk heart procedure. The first available appointment was about six weeks in the future when I made the decision. During that six week period I visited the doctor once, received various papers in the mail with instructions on where to show up and when, as well as several phone calls asking to confirm the appointment and for information designed to make sure that the hospital can get paid for its services.

It was not until the just before the procedure, however, when the IV was already in my arm, that the hospital gave me detailed legal waivers to sign. Then, the nurse came in and told me she wanted to discuss the various risks of the procedure so that I could give my "informed consent." All this while I am already lying in a hospital gown with a rubber pipe sticking out of my arm. One other minor point: before all this happened, I had already passed out once when the nurse tried to get the IV into the back of my hand and, after several minutes of trying, failed and had to pull it out. My blood pressure dropped to 72/42: the perfect time to sign legal documents and make important decisions about one's health care.

I know I don't really need to say more, but I cannot resist. Just imagine me saying, "wait, nurse, I need to review the fine print in this release before I sign it." Or how about, "nurse, I'd like to negotiate here in paragraph 24.2(a)(2), where the arbitrator is JAMS. How about the AAA instead?" Or how about this one: "What? There is a risk of stroke in this procedure? Well, in that case, I changed my mind. Take this IV out of my arm, I'm going home!" Sadly, I was in no condition to be a smart-ass. What actually happened is that I signed the releases without reading them and told the nurse not to go over the risks with me, lest I pass out a second time. She beat a hasty retreat. (Yes, I knew the risks. I did my own research).

This "sneak attack" is standard operating procedure in our hospitals and doctors' offices. After the patient has bought the health insurance showing the doctor as a preferred provider, and after the patient has arrived for his appointment, the doctor presents forms waiving many important rights. Sign it or you get no treatment. Hospitals routinely wait until the patient is checked in before demanding that the patient sign their forms. Sign it or check back out.

I used to trust doctors and hospitals, but no more. This outrageous conduct is only one of the many reasons.

Corruption at the United States Passport Office

My recent experience with the passport office raises two concerns about our government.

The passport office website informed me that it would take approximately 6 to 8 weeks to renew my passport. The actual work in issuing a new passport is minimal, and probably takes less than an hour. There is no reason why the entire process should ever take more than a couple of days, even at busy times. A typical private company would accomplish a similar administrative task in one day, or else be forced out of business by other companies that did. Denial (or delay) of a passport is a serious matter, preventing one from leaving the country. I am troubled that our government is unable to (or does not care to) perform a simple but important task in a timely fashion. But it gets worse.

I discovered that a "private" agency can get a passport in a day -- for a fee. That is corruption, pure and simple. The private agency does not know the secret way to fill out a form, nor does it have people standing in line holding a place just for its next customer. Quite to the contrary, the private agency has a connection (what kind, it is impossible to tell) which allows it to get a passport as fast as you happen to need it, for a sliding scale of fees. I paid to get my new passport back in a week, and that is when it was returned to me, but I noticed that it was actually issued the day after I left my old passport at the agency. Obviously, those with connections have no trouble getting a passport in the usual time.

Someone inside the government is selling the right to get a passport. It is no wonder that it takes six weeks to get a passport the "usual" way. If it took a day, no one would pay to get their passport faster!

Slowly but surely, the United States is becoming a corrupt third world country.