A Bureaucracy of One

Footage of Satellite being Shot Down

I thought about having some pithy title for this article, but really this is too cool to denigrate in such a coarse manner.  Footage of the interception occurs at the 1:00 mark.

I Think I Hate 75% of the U.S. Adult Population

My biggest problem with the latest idiocy from Boston?  The asshole-news agencies that are reporting Star Simpson as having a "fake bomb" strapped to her chest.  No, what she had was a harmless improvised electrical device attached to her hoodie that was mistaken for a bomb!  Notice the difference?  I go into it a bit more below. 

You know, I'd complain about news agencies being responsible for the dissemination of the facts, and whine about the "good 'ol days" of responsible journalism, but that was never true.  News outlets have always been about selling stories.

Now, my second biggest problem?  The charge of  "possession of a hoax device". 

Hoax:  n. 1.something intended to deceive or defraud

Yes, Ms. Simpson displayed a poor grasp of airport-appropriate clothing.  And I'm not making the argument that the police over-reacted in the initial incident. From the accounts I read, they responded appropriately to the apparent situation. 

No, what causes my current headache is that the Boston D.A. feels the need to throw a bogus hoax-device charge at Star Simpson.  At no point did Ms. Simpson try to get the people at the airport to believe that she possessed a bomb.  At no time did she actively engage in behavior meant engender fear and panic in the populace.  If she had, then the charge would make sense.  However, she did not engage in any such activities, and so should have simply been released with a warning.  At least the judge who set her bail seems to grasp the ridiculousness of the situation, unlike District Attorney Margolis who seems to believe Star Simpson is only one step removed from being Osama's protege.

That's it for now.  I really want to rant and rave about the stupidity of America, and its asinine preoccupation with a nearly non-existent threat, but I really don't feel like filling the WWW with even more acid-laced invective.  Instead, I'll leave you with a link to Bruce Shneier's "Refuse to be Terrorized".  He says all I want to say, but with calm intelligence that needs no gerunded four-letter words to emphasize his points.

Peace out, bitches
 

This Changes Nothing - In Fact, it has the Potential to Make it Worse

Karl Rove has resigned.  Whoopity-f***ing-doo.  As a friend of mine put it:

Imagine this.
Karl Rove with no oversight.
Now, try to sleep at night.

So pardon me for not celebrating.

The High Cost of Cholesterol - Fat People Part 2

This post may make more sense if you have read this one first.

Fat People Part 1 left off with Hippolyta "Hippo" Buffet-Wrecker dying eight years before her due, due to her horrendous diet, and the ignoring of her doctor's advice.  Yeah, tragic, real damned tragic.  I'd weep, but because of her, and the ever-increasing number of People of Monumental Mass like her, my insurance premiums have increased tenfold in the last fifteen years.

Why?  Because keeping fat people alive costs, and costs big.  Insurance companies have to absorb most of that cost, but still make a profit (they have share holders, you know).  To do this, they have to raise their premiums.  So then, let us take a simplified look at how an insurance company makes their money, by discussing Sid's Suds.*

Sid's Suds is a local bar, and Sid employs nine people, making Sid's Suds a member of the SGB, or Small Group Business, portion of Acme Insurance.  Of the nine people employed by Sid, five are full-time, three are part-time, and one is a bum that Sid pays to sweep off the deck at night.  Now, of the five full-time eligible employees, only four are actually enrolled in the Acme HMO that Sid offers; Sid himself, one of his bartenders, his head cook, and his head waitress.  The fifth employee, Sid's other bartender, is also his wife, so she is covered by Sid's insurance.

So, out of a potential pool of nine employees, Acme is only earning premium off of four of them.  This is why insurance companies do not use something called credibility when rating groups under fifty; if only one of Sid's employees gets a large claim, it blows the average of the whole group out of the water.  Instead, most insurance companies apply a general underwriting factor for experience (i.e. claims), which is capped by Small Group Reform laws to about a 10-15% increase year-over-year.

So, let's say that our friend Hippo was Sid's wife.  Poor Sid, now you know why the pretty red-headed waitress is considered "full-time", and the other two aren't.  Regardless, because of Hippo's insurance claims, Acme insurance is going to be slapping their max rate-up factor of 1.10 on Sid's Suds every time they renew.  This is because the first year of Hippo's large claims indicate to the insurance company that she is going to be costing them thousands of dollars in the near future.

Again, some numbers to illustrate:
Acme's annual premium from Sid's Suds - $12,500,
Hippo's Medical Costs, First Year: $5,000
Second Year: ~$150,000
Third year: $15-20,000
Etc.

While Hippo's first year claims can easily be absorbed by the group's premium the first year, they easily dwarf it the second year, and continue to out-strip it for years afterward.  This is because SGR laws prevent Acme from screwing Sid's Suds, and increasing their rates to where the premium matches the claims.  Now, ignoring all other factors (trend, demographics, area, group size), Acme can only increase Sid's rates by 10%.  So, for the next year when Hippo's costs are going to be around $150,000, Acme's premium from Sid is only going to be $13,750, and $15,125 the year after that.

If Sid's Suds were the only such small group with an unhealthy fat person, this wouldn't be a problem.  Eventually, Acme Insurance would be able to get Sid's premiums up to a point where Hippo is no longer costing the company money.  However, it isn't.  There are many such small groups, and many such Hippos, which means that Acme is not just losing money, it is starting to hemorrhage it.

So what is Acme to do?  Well, all Small group rates are based off what are called "book rates".  These are the base rates that Acme has filed with each state's Department of Insurance, and are calculated by each company's actuarial department.  One of the primary factors that is used in the development of these rates is something called Trend.

Now, Trend is a slippery beast, and it is constantly changing.  Primarily, Trend is based off the general increase in the cost of providing health care.  The factors that drive this factor are varied, but include new medical procedures, doctor's rates, hospital costs, drug costs, and cutting edge medical equipment.  Simply put, you could think of it as a form of medical insurance inflation.

See, every operation, every procedure, every hospital visit, and every drug, cost in time and resources.  As these resources get used more and more, the providers of those resources - the hospitals, the doctors, the drug companies - start charging more.  This, in turn, drives Acmes cost up.  To cover their rising costs (and keep their shareholders happy), Acme increases their Trend, which in turn increases their base rates, which raises the insurance rates of Sid's Suds and any other small company covered by Acme insurance.

All because Hippolyta and her ilk can't stop hitting the Little Debbie snack cakes.

Now, there are many other causes and components that contribute to the ever growing beanstalk of insurance rates.  There are the ridiculous prices charged by drug companies; irresponsibly high liability rates for doctors (due to our legal-happy culture); and the runaway technological developments in the fields of medicine (not convinced that's entirely a bad thing).  Fat people, however, are still a, ah, "hefty" burden society, and unlike most of the other factors, our weight is something we have some modicum of control over.

*disclaimer: this is all from my experience as a Small Group underwriter.  I will not, and cannot speak to the other segments as I have no experience there.

Like Pooh Stuck in the Window - Fat People Part 1

There is a scene in the wonderfully off-beat Triplets of Belleville  where Madam Souza makes it to America in search of her missing grandson.  As the camera pans out to show the harbor, we see a very stylized , and very fat, statue of Liberty analog holding a hamburger on a plate, and torch made up of a mounded ice cream cone.  The same goes for the other residents of Belleville, grotesque fat-asses the lot of 'em.

Sadly, this is not merely an idiosyncratic French vision of what the U.S. is like.  No, the truth is that we are a nation of fat-asses, and the problem is getting worse.  How bad?  Well, it seems that many people are too fat for x-rays and other advanced forms of medical imaging.  Due to either being too fat to fit into the MRI chamber, or having fatty deposits that are too dense for the x-rays and other assorted exotic particles to penetrate, means these people are at even higher risks of tumors, having heart disease, and driving up my insurance premiums.

People, obesity is much like smoking in that it is something that adversely affects everyone, even us non-fat people.  Ever had to sit next to a fat person on a long plane flight?  How about two fat people?  Huffing and puffing to get into and out of their narrow economy-class seats;  no matter where you sit in the row, you are screwed. 
Window seat?  Forget getting up to use the bathroom with Porkins McGastric-Bypass, and his blushing bride, Whaley von Heifer, taking up the center and aisle seats.  Center seat?  You'll look like a Burger King hamburger - a thin paste of meat caught between two enormous mounds of complex carbohydrates.  Aisle seat?  You may as well stand up the entire flight, because in the time it takes for the Rhino Twins two get settled, the flight will be well underway.  Then one will have to get up to use the bathroom, followed thereafter by the other one.

Okay, so it is not lung cancer, and perhaps I am being a tad mean-spirited.  Let's go back to my last point in the second paragraph - insurance premiums.  Think your sky-rocketing insurance costs are due to there being too many illegal immigrants mooching off the health care system?  Well, you are wrong.  The overuse of the hospital emergency room is not confined merely to those cannot afford regular medical care; it is a pattern that encompasses most all demographics.  However, that is rant for another time.  This time, it is about fat people, and how they are driving up the cost of insurance premiums.

Now, having until recently been employed by one of the oldest providers of health insurance in the country, I know a little something of what I speak - and that is this: fat people cost insurance companies a shit-load of money.  The why is very simple; the more overweight a person is, the higher their risk of diabetes, hypertension, heart attack, chronic kidney failure, atherosclerosis (hardening of the arteries), and chronic renal failure.  The kicker is that if an overweight person has any one of the above, they are very likely to have one or more of the others. 

So, let us look at what might be the claims that might be associated with an overweight person going in for a doctor's appointment.  We'll start small; Hippolyta "Hippo" Buffet-Wrecker goes to her doctor complaining of chest pains.  Not uncommon, and a general check-up reveals High Blood Pressure, and borderline Benign Hypertension.  Her doctor recommends a change of diet to reduce her blood pressure, and recommends she try to manage her stress better.  Cost to the insurance company, about $5,000*.

Hippo ignores her doctor's advice and keeps eating her regular diet of high-fat, high-cholesterol , high-sodium foods.  A year later, she goes in for another check-up which reveals she still has HBP, and now her Benign Hypertension is becoming not so benign.  She is also complaining of being tired all the time, and the doctor discovers that she is setting herself up for renal disease.  Her diet is basically overloading her kidneys, and they are starting to show signs of possible failure.  The doctor again counsels Hippo on a change of diet, this time restricting her even more, and admonishes her that if she doesn't get her weight under control, she is very likely to have a heart attack.  He also prescribes her two medications to try and get her blood pressure and rising cholesterol under control.  Cost to the insurance company, about $10,000*.

Well, not two months later, Hippo is rushed to the emergency room when she collapses after complaining about sharp chest pains.  Hippo has had a heart attack, and her doctor is surprised as the numbers on her blood work did not indicate that she was that far along.  What Hippo had failed to disclose to him during her first visit though, was that both her mother and her maternal grandfather had suffered heart attacks in their mid-forties.  Cost to the insurance company, about $25-30,000.

Now, armed with the knowledge that her family has a history of heart disease, her doctor starts grilling her on any other details she might have left out, or "forgotten".  As a matter of fact, yes, there are two minor ones; her mother had developed Type II Diabetes just prior to her heart attack, and Hippo's maternal grandfather had to have his right foot amputated when he was sixty, due to circulatory problems.  Hippo's doctor immediately re-structures her diet for a third time, and this time explains to her what Type II Diabetes is, what what it means if she is diagnosed with it.  the new diet will help minimize her risks, but she must stick to it.  Hippo laughs it off, and goes home to a bowl of cookie dough ice cream comfort.  Six months later, Hippo suffers a second heart attack, and has her first by-pass surgery.  She is only 47.  She is now on seven different meds, and is finally starting to follow her doctor's recommended diet.  Cost to the insurance company, about $100,000*.  Expected yearly cost to the insurance company simply for Hippo's meds, about $15,000*.

Ten years later, Hippo has her second, and final, bypass surgery where they also install a pacemaker.  Cost to the insurance company, about $250,000*.  Hippo, now following her diet religiously, and walking four miles every day, lives to be 72.  A good eight years short of the 80 year life expectancy for a female in the U.S.

Continued next Post

*numbers are rough approximations, but not far from claims I have seen.