Sunday, February 19, 2012

The Sneaky Opt-In Culture of the Web

"Why do we need your email?" So I clicked to find out. "The Clymb is a private member network. Pricing arrangements with our partner brands require that our low prices are only available to members of The Clymb. We need this information to establish your membership, but your information is kept strictly private. We do not share, rent, or sell our members' personal information."

This outfit may be totally legitimate, but I'm not buying. It reminds me of being a member of Price Club or any of the big box stores, where "membership" to a retailer is merely a function of paying an annual up-front fee. This is where companies earn their profits and sell you bulk items at low margins and steep discounts. It also reminds me of the brick-and-mortar merchant that asks you for your email address or phone number when you charge an item (for "security purposes"). I used to just say no rather than complain to the poor teenaged clerk. Now I give them a wrong number. I confess I'm trying to throw wrenches into this continual process of data mining for commercial purposes.

My point is this: Most of us have become accustomed to getting angry at the concept of having to "opt out" rather than "opt in." So the marketeers are now using stealth methods to get you to opt in. As soon as I see a bunch of blank fields with little red asterisks, unless I absolutely crave the product or need the service, I am clicking as far away from the site as I possibly can.

E-commerce has a lot of good qualities and an attraction that I need not recap here. But beyond the incredible amount of spam that even the best screening programs can't keep up with, it has become a merchant mart where sellers are using surreptitious techniques to get your email address (and usually a lot more personal information).

Then it's incumbent on the user to opt out. Even opting out is not always that easy. The more unscrupulous ones make you jump through hoops to do so, and then probably sell your email address anyway (or keep you on the list for other related companies). Why do companies even bother asking you to check a box about why you're leaving? Especially the ones that offer the choice "because I didn't sign up in the first place." The ones that really are annoying finally tell you that you've successfully opted out, but it will take up to "10 business days" to get you off the their email list. Oh. Really. It takes 8 seconds to get on the list and 10 days to get off it? The honest purveyors at least auto-unsubscribe customers right away.

Wednesday, February 1, 2012

One reason why healthcare is so expensive....

Answer to the riddle? (Question on the Facebook teaser: What's the difference between a popsicle stick and a tongue depressor?) About $6.

There are a dozen good explanations for why our healthcare system has spiraled into the depths of hell -- and I'm sure there's some measure of validity to all of them -- but I'd like to recount one from the trenches that you might find useful and informative.

Some time ago, I woke up with my elbow swollen and tender. Though I wasn't in any pain, my wife convinced me that it looked weird and deformed so I should probably get it examined. I had banged into a wall the previous day playing squash and thought I could have injured it in some way. I trekked to the ER at Roosevelt Hospital (closest one to my apartment), and was lucky that it was a weekday during lunch hour. No line at all and I was taken immediately. The doctor on duty X-rayed it and found "nothing to worry about." He suggested icing it to reduce the swelling and then following up with my regular internist. Co-pay: $50. Time spent: 45 minutes.

Icing it did not reduce the swelling, so after a few days, I went to see my regular doctor. He looked at it and said, "Oh, you have a bursa." According to one definition, "A bursa (pl. bursae) is a small fluid filled sac that decreases the friction between two tissues. Bursae also protect bony structures." The swelling was due to excess blood in the joint, and it needed to be drained. But, of course, he didn't do any draining himself. He mainly listens to complaints and types into his computer. He recommended a "specialist." Co-pay: $15. Time spent: 15 minutes.

I got an appointment with the referral, a Russian doctor, a woman in her 50s or 60s. She looked at it, and said, yes, a bursa, and it had to be drained. Before the simple procedure she spent a long time asking me about my medical history, and she took copious notes. Then she used three or four needles to extract the blood. I was impressed with her thoroughness. She recommended taking vitamin D supplements because I was getting up there with age and deficiencies came with the territory. Co-pay $15. Time spent: 1 hour.

This took two weeks and cost $80 out of pocket, and a lot more to the healthcare insurer. (Meaning all of us.) Oh, and when I received the financial statements from my HMO, it had knocked down the Russian lady doctor's reimbursement to about $65 (from about $250 claimed). She had done the most labor to treat my injury, and she received the least amount of compensation. What's wrong with this picture, folks?

After I was cured, I ran into one of my softball buddies, Dr. Mark Melrose, a terrific physician who had just opened an Urgent Care Clinic in my neighborhood. As soon as I began telling him my story -- literally, a minute into it -- he guessed, "Oh, a bursa."

Thirty or forty years ago, I would have gone to my family doctor and it would have been taken care of in one visit -- not three, and probably not a hospital visit -- and it would have cost a lot less, even in adjusted dollars.

Of course, the hospital ER doctor misdiagnosed my injury. He could have figured out what was wrong by just Googling "swollen elbow." But he was covering his ass by simply doing an X-ray, which didn't reveal a fracture.

What does this story tell us?

The system is designed for referrals. It's designed for specialties. It's designed for fear in taking responsibility for treatment. It's designed for inefficiency. And it's designed to cost us far more money than is necessary. And this is one reason it is bankrupting the country.