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Garage sale Tuesday, September 29, 2009

We couldn't get our stuff together in time to have a garage sale before we moved, so we brought all of it to our new place, added a whole bunch more from another friend, and had a garage sale at our new place. Of course it helped that, unlike our old apartments, we actually have a garage here!

The sale date was picked about a month in advance, and sure enough, we picked the only rainy day in a two-week period. I think the drizzle kept a lot of potential customers away, but we got rid of a bunch of stuff.

The highlight was the pirates who plundered our booty and bought out our supply of decorative skulls and skeletons. "Lickety Split" and "Ugly" were in the neighbourhood from Seattle for the annual Pirate Festival.

Summer Cotillion (and pie fight) Monday, September 28, 2009

OK, so I've been a really bad blogger lately. I'll try to catch up a bit this week, starting with an event that Perrie and I attended almost a month ago. But first the back story...

When Perrie and I got the keys to our new house we had about 24 hours to do some cleaning before all of our stuff got in the way. Washing windows and cleaning toilets isn't exactly a rock'n'roll way to spend a Friday night, but it was urgent and desperately needed.

About 8 that night we heard a knock at our door. The visitor introduced herself as Marilyn, our neighbour behind our backyard, and gave us a flier and tickets to an event they were hosting in a couple of weeks: the "2nd Annual Summer Cotillion (and pie fight)." Naturally we were curious so we looked up cotillion and marked the date on our calendar.

On the appointed day, we arrived fashionably late to find the party in full swing. Judging for the pie decorating contest was under way (right), followed by a live demonstration on how to properly throw a pie (your choice of cream—shaving or whipped). Then the real fun began as kids (young and not-so-young) had the opportunity to throw their creations at one another.

The event was a benefit for the Nomadic Theatre Co., who practice in the old church behind our house. Here are a few more pictures from the pie fight (and aftermath).

[left] Dressed in an outfit made of garbage bags, Sarah Liane Foster braces for the impact of Michael O'Neill's pie Aug. 29 at the 2nd Annual Summer Cotillion in Portland. The two members of the Nomadic Theatre Co. were demonstrating the correct way to throw (and receive) a pie. [below] Nomadic Theatre Co.'s Heather Pearl revels in the aftermath of an intense pie battle.

American beauty Saturday, September 12, 2009

With all of the amazing scenery, not to mention the creative talent in this country, why does so much of it look like this?

Greeting from beautiful Burlington, Wash.

Orchid Highway interview Thursday, September 10, 2009

My interview with The Orchid Highway was published on Northwest CanCon today. It took a while to edit—we talked for nearly an hour, and I edited it down to about 15 minutes. Check it out here. There's also a slide show from their performance, here.

These photos are a couple of out-takes from the concert and portrait session. Below, from left: Scott Perry, Jamie MacDonald, Rory MacDonald, Adrian Buckley, Derek MacDonald.

Health Insurance Costs Wednesday, September 02, 2009

The mailbox was full when I stuck my head outside the door just after lunch today: a magazine, a Visa bill, two movies from Netflix, and a large package from my health insurance provider.

"Dear Health Net Plan Member, Thank you for your continued membership ..." As a self-employed individual, I bear the full cost of my health insurance. Starting in October, that will be $254 per month—more than $3000 per year.

"The primary reason for the rate increase this year is the continuing upward trend in medical costs. In particular, hospitals continue to drive much of our costs, and this trend is not expected to change significantly anytime soon," the letter explains, adding that their hospital costs have risen 128% and utilization of hospital services is up 28% since 2001. It's hard to know whether "utilization" is on a per-member or absolute basis, measured in dollars, days or number of procedures, but the 128% price increase alone is astounding since inflation over the same period has been approximately nil. "Other reasons for rising medical costs include prescription drug costs, expensive medical technology and benefit and administrative mandates passed by the legislature."

[right] My personal health insurance premiums (yellow) and percent increases (green) over the past four years for the same coverage. Note that it does not include dental or vision care, and there is a $1000 per year deductible for most services. After that I'm still responsible for 20% of most care. (Click the picture for a larger view.)

So what can you infer from that? Either the member population is getting sicker and needing more care, they are getting more/more expensive treatments (necessary or not), or they are being charged more for the care they receive. Or a combination of all of these.

Personally, my insurance premiums have gone up by 65% in less than four years (a compounded average of 13.3% per year). And I haven't changed age brackets in that time. The scariest point, though, is that the year-over-year rate of increase is going up exponentially: in 2006 my premiums went up by 8.4%. The increase was 9.0% in 2007; 13.7% in 2008; and 22.7% this year. Next year I move to the next age bracket. That alone will increase my premiums by 6% or so.

[left] Paramedics wheel an injured volleyball player off the court at the state championships in Forest Grove, Ore.

So where is all this extra money going? In 2003, about 6.2-million health care workers earned $342-billion in wages*. In 2008, 7.1-million workers earned $480-billion in wages*. Between people and wages, that's a rather modest 7% increase per year. Over the same period, the total payroll for health care support workers increased by about 6.4% per year*. So I think it's safe to say that neither the number nor the remuneration of doctors, nurses, and therapists are to blame.

So that leaves their service providers. I don't have numbers to back me up, but I doubt that hospital costs are up so much because the price of food, cleaning and waste disposal services have outstripped inflation, nor because electricity, water and gas rates are going off the charts.

What about malpractice costs? I can't speak to the costs of malpractice insurance, but the total settlement costs were actually down 14% between 2001 and 2006*. That may be due to increased spending on defense attorneys.

The cost of treating the uninsured is another big weight on the system, but most sources suggest that it has been fairly consistent around 8% of the cost of insurance, which makes sense when the percentage of uninsured people holds steady. But with the rapid escalation in health care costs in recent years combined with loss of benefits and jobs in the current recession, the proportion of uninsured residents is sure to go up.

Marketing significantly outpaced the general rate of medical inflation, increasing by an average of 15.7% between 2001 and 2005*, but it is a relatively small percentage of a hospital's budget.

So what's left? What happens with the extra $100 per month I'm spending for the same coverage I had three years ago?

I can only conclude that the majority of the price increases we've seen in recent years is ending up in the pockets of the corporations that run the system: insurance companies, hospital corporations, drug companies and medical equipment manufacturers.

It's hard to blame them. In a pure capitalist system, companies are supposed to maximize their profits without regard to the effect that has on others. Take, for example, a diabetic who wants to buy individual insurance. The insurance company knows that customer will cost at minimum a couple hundred dollars per month for insulin and supplies alone. Why would a private insurance company ever take them on for less? Why should they?

And because the barrier to entry into the market (money) is so high, the few companies have an effective and sustainable oligopoly. Obviously, it's in the interest of the health care industry to maintain the status quo.

[right] A medical researcher treats samples at Portland's Oregon Health and Science University.

There is plenty of demand for health care because everybody needs it. Perhaps it is a reflection of the optimism inherent in the American dream: people will pay anything for a marginal improvement in their well-being. After all, without your health you have nothing.

Therein lies the problem: As certain as taxes is death, and almost as certain is a stage of declining health before the curtains are closed. At that point, the health care industry has you right where they want you. They can offer you the cure, or at least a stay of execution ... for a price. They could name just about any price, and you'll pay. I mean, what else are you going to do? You could be dead tomorrow.

And yet, therein is also a solution: as certain as death are taxes. I find it highly ironic that otherwise sane Americans who couldn't care less if insurance premiums skyrocket (i.e. the well-to-do and those with employer-provided health insurance), are so fearful of a government-run insurance program that might increase their taxes. A side-effect of the inherent distrust Americans have for their government (warranted or not), they fear that any government-run program will be innately counterproductive—even if the existing systems were still in place. They fear it will be inefficient, wasteful, and they don't know what they would get if they tried to use the program.

Well, fortunately I've never been in a situation where my medical insurance really started to kick in. And I hope that they would cover me if I were—after all, that's what I'm paying them for. But have you ever tried to read one of those contracts? Even in "plain English" the list of coverages and exceptions is extensive, changes every year, and the terms are detailed. If the insurance company ever decided that my claim was too expensive, I'd be in a worse position than David against Goliath if I tried to challenge it.

Fair or unfair, the federal government is about the only institution large enough and willing (maybe) to challenge the oligopoly that is today's U.S. health care system. Is it a perfect solution? Probably not. Is it a radical change? Yes. But you can't cross a chasm with small steps.

The health care system in this country is not healthy. It's time for a real change.