The Health Savings Account preventive visit scam

I got stung this time. I was a mark.

Darn it.

My excuse is that this scam was a subtle one. I'd classify it as an occult emergent fraud. It's the third one I've met from Anthem Blue Cross/Blue Shield; health insurance is a breeding ground for these things.

The trick starts with making a "preventive care" or "routine physical" visit a "free" part of a health savings account insurance plan. These are commonly included in HSA plans ...

... A recent industry survey found that in July 2007 over 80% of HSA plans provided first-dollar coverage for preventive care. This was true of virtually all HSA plans offered by large employers and over 95% of the plans offered by small employers. It was also true of over half (59%) of the plans which were purchased by individuals. All of the plans offered first-dollar preventive care benefits included annual physicals, immunizations, well-baby and well-child care, mammograms and Pap tests; 90% included prostate cancer screenings and 80% included colon cancer screenings ...

At first, and even second, glance this looks like a nice benefit. After all, HSAs are all about having individuals feel the true cost of care, so we will inevitably reduce our use of preventive services. Making those "free" seems to make a care plan less harmful.

The catch is, as I recently discovered, is that it can be quite tricky for an adult to get this benefit. The responsible physician has to choose to bill a care episode as "preventive". These visits, however, pay poorly -- they're only cost effective if they can be done very quickly. A physician, meanwhile, is legally and ethically responsible for overall patient health. Any adult over thirty, and many younger, has health problems that can, at the least, be reviewed to confirm all is well enough.

So the physician is biased to doing at least a moderate amount of work, which makes the preventive care payment uneconomical. So these visits will usually be charged as something other than preventive care, which means they come from the general HSA pool -- not the free preventive care visit. (Immunizations and such will be covered, but not the physician fee.)

This should be possible to study. What percentage of adult males, we could ask, actually manage to get their visits billed as preventive care services?

In my particular case I was steamed about being charged a Level III fee when I had worked quite hard to get my "free" preventive care visit -- including confirming with Anthem that it would be covered. I even complained about it to the physician's billing office. It was only when I worked out the angles that I realized I'd been stung, and that I just needed to shut up and pay up. It wasn't my physicians fault, or the fault of their billing office. It was just the way the system works.

I doubt anyone planned this out. It's just a happy coincidence that an expensive (to Anthem) benefit ends up not being used. The emergent fraud aspect is that once an unintended scam like this emerges, nobody will work very hard to fix it.

See also:

• Verizon scam: Emergent fraud earns a fine
• Emergence: how entropy and incentives create scams
• Emergent fraud: Anthem and automatic payment denials
• Memphis mortgages, complexity attacks and long term consequences
• Anthem - Putting the Hell in Health Insurance
• Causes of the crash of '08 - how much fraud?

Update 11/7/10: The "13 month preventive medicine" visit is a variant of this scam. Marketing and legislative presentations will claim a yearly physical is part of a plan. This does not, however, mean that one can schedule a covered preventive medicine visit on Nov 1 and March 3rd. In practice a "year" means "no less than 365 days apart". Many people fall prey to this trick.

Midterms 2010

So far I've found three things that seem novel about the American 2010 midterm elections.

The first is that the federal results were unsurprising. In the blog age any interested person has access to the analytic work once limited to a few newspapers or to major political campaigns. We knew what would happen, and it happened. This is different.

The second is that the results, at first glance, seem to be very much to the taste of the Corporate Entity (CE). I have more to say about this. The CE should not be confused with shareholders, the board, or the CEO. The CE interacts with our material universe, but it's not made of atoms.

The third is that candidates identified as crazy by the national media lost. That's interesting.

Looking for glimmers

About as bad as expected nationally, worse than expected in my home state of Minnesota.

Two glimmers of hope:

1. The average voter has a 3 month memory. In 2012 there is now a chance that they'll remember the GOP.
2. In Minnesota the GOP will have to balance the state budget. This will be a disaster for special needs education, but they'll have to make some very hard choices that they would prefer to avoid.

Any other glimmers?

A NYT job interview and capitalism 2010

Emily told me of a lightweight NYT piece on job searching describing the clever and industrious things a young man did to land a job in a competitive marketplace. She was appalled by the implications -- the job market for bright young men is lousy.

Emily missed the darker subtext though.

The job is in search engine optimization (SEO).

Few non-geeks know what SEO is. SEO is about fighting a war with Google. Google wants to give us answers to our questions, SEO wants us to read marketing material. SEO geeks make their living exploiting flaws in Google's search algorithms.

SEO is about making my life worse. It's not unique. A vast amount of American intellect, from Wall Street to SEO, is not delivering value. It is engaged in making all of our lives worse.

We are pouring our water into the sand.

Apple's share price, market movers, and the latest market bubble

Two fragments that I like to consider together. One is an anonymous comment on an Irish Economy blog called out by Paul Krugman ...

What markets want ...

... The markets want money for cocaine and prostitutes. I am deadly serious.

Most people don’t realize that “the markets” are in reality 22-27 year old business school graduates, furiously concocting chaotic trading strategies on excel sheets and reporting to bosses perhaps 5 years senior to them. In addition, they generally possess the mentality and probably intelligence of junior cycle secondary school students. Without knowledge of these basic facts, nothing about the markets makes any sense—and with knowledge, everything does.

What the markets, bond and speculators, etc, want right now is for Ireland to give them a feel good feeling, nothing more. A single sharp, sweeping budget would do that; a four year budget plan will not. Remember that most of these guys won’t actually still be trading in four years. They’ll either have retired or will have been promoted to a position where they don’t care about Ireland anymore. Anyone that does will be a major speculator looking to short the country for massive profit.

In lieu of a proper budget, what the country can do—and what will work—is bribe senior ratings agencies owners and officials to give the country a better rating. Even a few millions spent on bumping up Ireland’s rating would save millions and possibly save the country.

Bread and circuses for the masses; cocaine and prostitutes for the markets. This can be looked on a unethical obviously, but since the entire system is unethical, unprincipled and chaotic anyway, why not just exploit that fact to do some good for the nation instead of bankrupting it in an effort to buy new BMWs for unmarried 25 year olds...

The second fragment comes from an analyst ...

asymco | Apple trading even with the S&P 500

if you had invested $100 in the S&P 500 in September 2005, you would have $103 now. If you invested $100 in Apple in September 2005, you would have $529 now....

... Although Apple received a premium valuation to the S&P prior to October 2008, it has traded at a discount or in-line with the S&P since then...

Another way of putting it is that the P/E ratio for large companies has returned to pre-recession levels. The P/E ratio for Apple has not...

However, in terms of reward for earnings ... For much of 2009 and early 2010, Apple was considered to have a far less promising future than the average large American company...

Asymco makes a persuasive case. Apple is valued as though it were a quite mediocre company.

Now consider this.

No publicly traded company in history is as studied and dissected as Apple. It is analyzed from a thousand directions. The "market", in the case of Apple, is not made up of "junior cycle secondary school students".

On the other hand, the share price of most companies, as best I can see, bear little resemblance to value delivered. I can believe those prices are largely determined by the hormones of young traders.

So perhaps it is misleading to say that Apple is undervalued compared to the average publicly traded company. It may be more enlightening to say that the average publicly traded company is now grossly overvalued. Apple is fairly priced.

Bubble.

Greg Bear: City at the End of Time - A review

I gave Greg Bear's City at the End of Time three stars; five for ambition, two for execution...

Amazon.com: John Faughnan "John G...'s review of City at the End of Time

Bear aimed high with this one. Very high.

It's something between science fiction, magical realism, and hard fantasy. I think it's primarily science fiction; an abstract description of a reality and technology vastly beyond human compression.

It's dark, like much of modern science fiction it shows the influence of horror and zombie. It's densely written, with eloquent phrases and language that sometimes works and other times struggles.

I was never captivated by any of the characters. It was a relatively easy book to put down, but I pushed through to the end out of admiration for Bear's ambition. If you want to stretch a bit, and need a dense book you can put down when its time for sleep, this one has a heart.

I do respect the ambition. Death, creation, murderous struggle, the root of all evil and the wellspring of young love and the nature of reality transposed to a human perspective -- that's extreme ambition! The execution could have done with fewer zombies.

It's not just Bear. There are far too many zombies in the science fiction of the past five years. Give it up guys, it's time to move on.

Words we need to add to English

In a list of novel words from around the world, I found six we should add to English, and three in bold I have added to a list of words I practice ...

Language Log » Translating the untranslatable

• tartle (Scots): hestitate while introducing someone because you forgot their name
• Torschlusspanik (German): gate-closing panic as age begins to close off opportunities
• wabi-sabi (Japanese): way of living that peacefully accepts the natural cycle of growth and decay
• dépaysement (French): the feeling of not being in one's own country
• tingo (Pascuense): obtain desired objects from a friend by borrowing them one by one
• l'appel du vide (French): that "call of the void" that makes you feel you want to jump when you look down from somewhere up high

Is Quebec why Minnesotans drive on the right side of the road?

It finally occurred to me to wonder why Americans, and especially Canadians, drive on the Continental (right) side of the road instead of the UK/Commonwealth standard. I believe the UK practice was well established in the 18th century, so the US should have followed that convention. Canada was an English possession until 1867, so the Canadian deviance is even more puzzling. (When Newfoundland left the UK for Canada in 1945 they had to change driving habits.)

This article came up early, but is a bit vague ..

Drivers.com: Driving on the wrong side

Today, most of the countries that adhere to left side driving are those that came under the influence of British rule during the 19th Century. It would seem likely then that the USA, having been once a British colony, would have retained the driving on the left rule. However, in his book The Rule of the Road: An International Guide to History and Practice (now out of print), author Peter Kincaid states that he could find no evidence that left side driving was ever widespread in the USA. He attributes this to the influence of European settlers used to driving on the right, and also the fact that vehicles such as carts and the postillion-controlled Conestoga Wagons were popular in the colony and favored right-side driving. However, there may have been some parts of the country that did adhere to left side rules for a time.

In Canada, the evidence is that Ontario and Quebec, which started out under French influence, always had right side driving. Other areas such as British Columbia and the Atlantic provinces, remained staunchly English in their influence and drove on the left. They switched to the right in the 1920s to conform with the rest of Canada and the USA."

There's a bit more here ...

Why do some countries drive on the right and others on the left ?

... In addition, the French Revolution of 1789 gave a huge impetus to right-hand travel in Europe. The fact is, before the Revolution, the aristocracy travelled on the left of the road, forcing the peasantry over to the right, but after the storming of the Bastille and the subsequent events, aristocrats preferred to keep a low profile and joined the peasants on the right. An official keep-right rule was introduced in Paris in 1794, more or less parallel to Denmark, where driving on the right had been made compulsory in 1793.

Later, Napoleon's conquests spread the new rightism to the Low Countries (Belgium, the Netherlands and Luxembourg), Switzerland, Germany, Poland, Russia and many parts of Spain and Italy. The states that had resisted Napoleon kept left – Britain, the Austro-Hungarian Empire and Portugal. ...

... In the early years of English colonisation of North America, English driving customs were followed and the colonies drove on the left. After gaining independence from England, however, they were anxious to cast off all remaining links with their British colonial past and gradually changed to right-hand driving. (Incidentally, the influence of other European countries’ nationals should not be underestimated.) The first law requiring drivers to keep right was passed in Pennsylvania in 1792, and similar laws were passed in New York in 1804 and New Jersey in 1813.

Despite the developments in the US, some parts of Canada continued to drive on the left until shortly after the Second World War. The territory controlled by the French (from Quebec to Louisiana) drove on the right, but the territory occupied by the English (British Columbia, New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland) kept left. British Columbia and the Atlantic provinces switched to the right in the 1920s in order to conform with the rest of Canada and the USA. Newfoundland drove on the left until 1947, and joined Canada in 1949.

I wonder if this understates the influence of Quebec and Louisiana on the adaptation of right hand driving in North America. Quebec was very dominant along the river routes of (future) American and the northeast region through the 17th and early 18th centuries, and Louisiana would have had a similar influence from the south.

Any Quebecois historians out there?

Lessons from the Cloud: Nobody loves your data like you do

There's a lesson here worth sharing  in this personal story (revised from original post to correct and clarify) ...

I now have about 5000 posts without paragraphs - Blogger Help

... I have about 8,000 posts in 2-3 "blogger" managed blogs going back to 2001.

As of today thousands of them no longer have paragraphs. Google did something that changed the way their software recognizes paragraphs. Perhaps it was a side-effect of using one of Google's newer templates. (For example.)

These posts are rather difficult to read. There are far too many for me to repair.

This is the most impressive episode of content destruction I have ever encountered. I've lost many hard drives over the years, but I was always able to restore from backup.

I can't fix this...

Coincidentally, Apple did something similar to their loyal customers this week. An update to iPhoto destroyed many customers entire photo libraries.

Although Apple's sin is even greater than Google's, there's an important difference that we all need to remember.

I can manage Apple. I don't use their software until months after a release; Apple uses early adopters as beta testers. I also use a very robust (but still imperfect) backup strategy. If Apple trashes my data I can restore it.

I can't manage Google. I don't have control over my Cloud data.

Sure, there's probably somebody at the increasingly troubled land of Google who feels badly about trashing my posts. I can guarantee though, that they don't feel as badly about as I do.

That's the problem with Cloud data, and it was a problem with the "ASP" market too (application service provider, which is what we used to call "Cloud services" before that market went pear shaped).

Nobody cares about my data as much as I do.

The problem with the Cloud isn't a technical problem, it's a social problem. If Google had to pay a billion dollars every time they mangled data, they'd really care. As it is now, they only sort of care.

My blogs are the my only serious investment in the "Cloud" data -- and that investment has gone sour.

Don't trust your data to people who don't care for it the way you do.

Rally for Sanity - and The Enemy Within

The Rally to Restore Sanity was today. It went well. Emily and I would love to have attended, but most sane people our age are pretty rooted. It's no accident many of the "6 billion" attendees were around retirement age.

The theme of the Rally reminded me of one of Shatner/Kirk's better Star Trek moments -- as the divided Kirk of The Enemy Within in the fifth episode of the first(!) season. The ever unreliable transporter splits the Captain into a sane Kirk, and a sociopath Kirk.

The sane Kirk is clearly the better half, but he's not an effective leader. Like any modern CEO, he needs his inner sociopathy. When the two Kirks are reunited the Captain returns.

America needs all of its components, including some version of the GOP.

My life with Amazon

Amazon's Improve Your Recommendations list is a chronological record of purchases. The oldest item on my list of about 560 items is a book on Java and Corba (!) published in 1997 [1].

Amazon went only in 1995 and I believe I bought some books from them in 1995 or early 1996 -- so the list isn't complete. It's close though.

When I started the list we had 1 dog and no children; I worked in the early days of a startup company (Abaton.com - the domain has lapsed). Today we have 3 children, 1 (different) dog, and a fish. I work in a large publicly traded company.

Browsing the list is a strange window into the past 13 years. There were some surprises -- I bought too many (non-fiction) books I never read. I'm better about that now.

What's your list like?

[1] Oddly, there are three prior items listed that I'm reasonably sure we didn't order. You can skip the end of your list by editing the URL.

Can Apple be sued for false advertising?

On the Aperture site Apple claims that the move from iPhoto to Aperture is "designed to be seamless".

That's certainly untrue. Aperture has nowhere to store Album or Event comments for example.

So can Apple be sued for false advertising? Any desperate lawyers out there? (Note since I've not been injured I can't be a litigant, but I'm sure one could be found.)

Lessons in Software: Aperture 3 and iPhoto 11

The state of OS X photo management is mixed.

It’s not so bad for customers who aren’t invested in iPhoto. Much of Adobe’s OS X software is lousy, but Adobe Lightroom is a singular exception. It still, for example, uses Apple’s installer instead of Adobe’s malware installer. It’s a professional level product with a learning curve, and it shares Adobe’s uncertain future, but it’s the best choice for a new user.

Apple’s professional product, Aperture, used to compete with Lightroom, but it lost that battle. Aperture has been unreliable, slow, and buggy – which professionals and prosumers can’t tolerate. Aperture’s only future is to be an upgrade path for iPhoto. That’s where things start to get grim. Apple claims there’s a smooth migration path from iPhoto to Aperture, but Apple lies (yes, they do). Aperture has nowhere to store much of iPhoto’s event and album annotations

So what about iPhoto? Ahh, that’s where the really bad news starts. The latest release, iPhoto 11, has a “bug” – it can delete images. Tens of thousands of images. This would be bad even if everyone had backups – but backup is an unsolved technical and social problem. It’s likely that iPhoto 11 also deletes images in a less obvious fashion, which, if you think about it, is worse than deleting all images all at once.

Image deletion is a bit of a nasty bug, but it doesn’t affect me personally. I know Apple. I never use their software until the beta testers early adopters are done. I am, however, impacted by Apple’s product direction. They are making iPhoto more of a true consumer product, removing functionality and foreclosing features I want (like detached library management).

iPhoto power users are on a sinking ship, and the Aperture life raft comes with mandatory limb removal. We’re left in the sad situation of hoping Adobe will bail us out with a Lightroom migration path, but I suspect they no longer have the resources to build one.

Yech. This sort of thing happens much too often these days. I’m in a similar situation with my Google hosted blogs. So, what can I (we?) learn from this? Here are my take home lessons:

1. It’s very hard to live between markets. This is true across many domains, from power tools to software. There’s a stable market for costly professional products, and a market for lowest denominator consumers. The in-between “prosumer” market is unstable.
2. The “consumer” market isn’t a good place to be. Consumers have short memories – they upgrade to Apple’s new products despite a long history of major data destroying bugs. Consumers, by and large, don’t care enough about their data.
3. Apple doesn’t have a culture of quality because their customers don’t demand quality. They do have a culture of design. If you’re like me, and you love both design and quality, you’re in trouble. There’s no easy answer, but don’t forget the tradeoff.
4. There’s no fundamental reason Aperture couldn’t be changed to support more of iPhoto’s metadata…

The last one, to me, is the most interesting question.

Why doesn’t Aperture support more iPhoto metadata? It’s in Apple’s business interest to migrate iPhoto users to Aperture, why not make that work properly?

I don’t know, but I think this is one aspect of a general problem with software. There are a million good paths to take in software development, but you can really only take one. If you take ‘em all, you get a symphony composed by committee. Software development requires a tyrant, but it takes a long time to do good software. It takes about 5-10 years.

Ten years is a career. It’s too long a tenure for modern business structures; it doesn’t match career or business models. Tyrants can’t last in large businesses – unless the tyrant owns the show (Jobs). It costs too much to devote very talented tyrants to maintaining and building something like Aperture when iOS development returns far more value.

I’m hopeful we’ll eventually figure out a solution for problem 4. I’m hopeful that the OS X App Store and its FairPlay DRM will make small company software more viable. If that happens Apple could sell Aperture to a company that could make a good profit migrating iPhoto customers – and Apple would still earn 1/3 of the revenue from App Store sales. That could be a win-win for everyone.

In the meantime, OS X iPhoto users need to stay with iPhoto 9 and wait for a solution.

Google's computational thinking curricula for grades 6 and up

A new way to torture your grade 6-12 child ...

Google: Exploring Computational Thinking

... Use a CT approach to develop an algorithm for calculating percentages using mental math. This example is based on released questions from the California Standards Test, 6th Grade...

I looked over the examples, but they they felt strained. The curriculum is based on teaching Python in 6th grade.

Why we can't raise the retirement age to 70

We live longer, work is less physical, and so we can raise the retirement age. That's the usual argument.

Then there's this. Gassee is quoting from a May 2007 USA Today story ...

Google’s Self-Driving Car | Monday Note

“Fatality rates for drivers begin to climb after age 65, according to a recent study by Carnegie Mellon University in Pittsburgh and the AAA Foundation for Traffic Safety, based on data from 1999-2004. From ages 75 to 84, the rate of about three deaths per 100 million miles driven is equal to the death rate of teenage drivers. For drivers 85 and older, the fatality rate skyrockets to nearly four times higher than that for teens.”

Driving a car is cognitively demanding. Performance drops off for most people at age 65 -- traditional retirement age.

We're not going to be able to extend the knowledge worker's employment life until we can slow the decline of the human brain.

Of course this is before we factor in the effects of epidemic Diabetes.