Wednesday, November 11, 2015

Larkin Arts Deck Show

I have this habit of being cajoled into doing art projects. Mostly this is because I just plain love my Harrisonburg Art people. In December I've submitted a piece into a really cool art show... The Larkin Arts Deck Show Invitational Here's some progress. Come to the opening on 12/4 to see the final results:

Monday, May 19, 2014

Something that bugs me about net neutrality

(If you don't know anything about Net Neutrality (NN) find yourself a good primer on Net Neutrality.  The Wikipedia article is pretty decent as is this Medium article.)

If you read anything about net neutrality you will undoubtedly include references to "fast lanes" or how Netflix will have to pay more to get good service for video or other tiered service concerns.  Tiering is NOT the problem...  No one would complain about a tiered service model that drives prices down like the tiered/bulk pricing models for online services like AWSMailChimp, Dropbox, or myriad others.

The problem is that there isn't enough competition among internet service providers and in the absence of more competition and/or regulatory power the consumer (innovative start-up OR end user) will lose.

Monday, February 24, 2014

My name is Andy. I'm an an ACA policy-holder.

There is a vocal contingent of people that sees the Affordable Care Act as a train wreck and people like me as dependent on a government hand-out.  So I wanted to air some facts.
  1. If you can I cannot agree on the high-level goals of the first 17 pages (the table of contents) of the Affordable Care Act then we should probably just part ways now.  The goals, to me, seem like things that we should all be able to agree on.  If you agree on the goals but have a better solution then talk about *that*.
  2. My family selected Optima's Vantage Foursight 3500/80% silver level plan. Here are the important terms:
    • $1,140/mo. premium (we'll talk subsidies below)
    • $3,500 deductible per person, $7000 for the family
    • $6,250 maximum out of pocket per person, $12500 for the family
    • $25 co-pay on 4 doctor visits per person per year and 20% co-pay there after
    • $150 drug deductible
    • Tiered drug co-insurance... $15 co-pay/generics and the greater of $30 co-pay/40% co-insurance OR $50/50% depending on the "tier")
    • 20% co-insurance on almost anything else
  3. We forecasted income at $56,000 (as an entrepreneur starting something new and with only intermittent income it may be lower but we wanted to avoid dealing with another set of rules and regulations that we would've qualified for under Medicaid as a family of 5 with 3 kids).  This qualified us for $633/mo. of premium subsidies.
  4. In the worst case (multiple big expenses and non-generic drugs charged at 50% co-pay for multiple family members) assuming we qualify for the subsidy for the whole year (i.e. we don't make more than $56k for the year) we would pay: $18,584 total for the year.
  5. If we ceased to qualify for the subsidy that total increases to $26,180
Undoubtedly you will look at those numbers and think "$%@*% that is really expensive!  The median US income in 2013 was $51,000.  How is nearly 50% of your income AFFORDABLE health care?"  consider few more things:
  1. This is the worst case.  Best case where we had no medical expenses at all would be $6,084/$13,680 (with and without subsidy)
  2. There are actually two types of subsidies/tax credits; premium subsidies and cost-sharing subsidies.  I have not investigated the cost-sharing subsidies which could limit my out of pocket expenses beyond premiums.
  3. Take a minute and review my pre-ACA analysis of Anthem Health Insurance plans.  The best and worst case of the common "Anthem Premiere" plan is within 10-15% of the ACA plan above.  So it's not as if the existing options for my family were hands down better before the ACA.
  4. The point of insurance is to hedge against costs that are financially ruining.  The worst case under this policy would not be financially ruining to almost anyone.  On the other hand the cost of even "routine" hospital visits can quickly rack-up bills that are ruinous much less things that are not "routine."
  5. ACA-compliant policies have broader coverage, no pre-existing condition exclusions, and no lifetime limits.
Yeah, but is it really worth it?  Let me leave you with a few more facts.
  • We use a couple of drugs that don't have effect generic equivalents that cost almost $500/mo each.  That alone could add up to near $12,000 (you don't get a "cash" discount from pharmacies and even Canadian online pharmacies were only 10-20% cheaper).
  • We had several "routine" procedures that used hospital or other special facilities, anesthesia, etc.  The total of those was around $20,000.
You do the math.

Wednesday, January 8, 2014

Let go of who you think you should be to be who you are

It's an odd thing that we single out "mid-life crises" and talk about them as a moment; an event suspended in time.

Nothing happens in a moment as if it were plucked out of nowhere and dropped onto the timeline of your life.  And everyone, not just those who are middle-aged, experiences profound changes throughout their life; vocationally, spiritually, personally.  Perhaps most of us just develop the capacity for, or appreciation of, self-reflection during middle-age.  And upon honest reflection of vocation, family, spirituality, possessions, etc. an impulse to change is not a surprising result.

My "mid-life crisis" began in 2010.  That year for my annual performance evaluation, after pouring myself into my team and project and working 80-100 hours per week for almost an entire year, I was given a rating of "developing" (only one step above "needs improvement").  Starting in 2011 my spiritual community split over issues of human sexuality, attempted transformation among those remaining, lost our vicar, and ultimately closed.  In the fall of 2012, at work I got a new boss.  He presided over intense and dramatic changes.  In March of 2013 I had the crushing responsibility of laying off 10 people (from a 20+ person team).  In June I found myself and rest of the team in the same cross-hairs of a layoff.  It may have been luck, intuition, or God but my angst at work had me exploring start-up ideas in April and May.  So when I heard the words "your position is no longer needed" at least I had something to pour myself into while I sought to make sense of "what I want to be when I grow up."

One summer when we lived in Seattle a family friend and sea plane pilot invited us to "get a slice of pizza in Poulsbo."  Poulsbo, is at least an hour and a half driving distance and involves a ferry so when I said "a slice of pizza?"our friend responded without skipping a beat "yeah, we'll be flying."  We boarded the plane, took in beautiful sights, did a loop around the Space Needle, landed in the middle of a carnival, had a slice of pizza, and returned home.  Back on the dock at home I stumbled to express my gratitude saying, "George.  You have ruined me for fun.  I may never enjoy myself again."

The past three years have "ruined" me for many things.  I'm ruined for "church"; at least the church that primarily concerns itself with buildings and "services" and bulletins, Sunday school, potluck dinners, small groups, and undemanding relationships.  I'm ruined for "jobs"; at least the sort of jobs where shareholder value is primary and it's people are secondary.  I'm ruined for "capitalism"; at least the capitalism that isn't deeply troubled by the impact of widening economic inequality and environmental degradation.  I'm ruined for "politics"; at least the politics that finds no compromise, even on goals, if not means, and is corrupted by money and powerful interests.

I recently re-watched a TED talk by Brene Brown about vulnerability.  She describes a group of people from her research whom she calls the "whole-hearted." They are people who have embraced vulnerability.  They have the courage to be imperfect, compassion towards themselves and others, and have relationships based on authenticity.  Brown says they have:
"let go of who they think they should be in order to be who they are."
 I may be "ruined" for church, jobs, or politics.  But I am NOT ruined in faith, enterprising ideas, or political convictions.  Quite the opposite...  I find myself pondering who I thought I should be, who I really am, and whether I've been fooled.  I haven't found the answers yet but I'm certain I intend to live "whole-heartedly."

Monday, November 4, 2013

And then there was that issue of pre-existing conditions...

I should've known better than to have believe that I'd finally gotten to the end when I wrote my last Critical Information about Health Plans post.

Friday, just in the nick of time I sat down with the insurance broker and hastily filled out the application (again.  I'd already done it online but repeated the process again so that she'd get the credit) to get it submitted in time to get coverage effective 11/1.  Everything went swimmingly until we got to the final section where you had to list "other doctors" in which case I brought up the doctor my wife has seen for a pre-existing condition...  That condition was not called out at all in any of the prior questions except possibly as one of the "any other conditions" general catch-alls.  When I mentioned it the broker's face dropped and she said... "I need to be honest.  She will be declined, or HIPPA rated meaning she will get the highest rate."

Needless to say I was caught off-guard.  When the broker ran the quote for my wife ALONE at the highest rate the premium was double the rate that I had previously seen for my ENTIRE family.  Furthermore, while I don't have the final underwriting details yet it would appear that the new premium (for the entire family) will be a. nearly as expensive as COBRA (which I'm currently on) and b. as expensive as unsubsidized silver-level plans under the ACA.

It would seem that the ACA-compatible health exchange policies are:

  1. Necessary - because we now have a pre-existing condition that, remarkably and unbelievably, puts us in the same category as something really serious like having cancer
  2. More affordable premium - even if we don't get subsidies and definitely if we do (which would apply up until about $100k salary)
  3. More affordable deductibles and out of pocket limits.
  4. Subjectively more trustable - had I not discovered the significance of reporting the condition above I might have switched to the policy at the cheaper quoted rate only to discover that the policy (at least for my wife) was voided because I failed to report a pre-existing condition.  That won't happen with ACA-compatible plans.
Apparently this story is still not over yet as I haven't finalized a new policy so stay tuned.

Wednesday, October 30, 2013

Critical Information About Health Plans

This is to follow-up on my original "Analyzing Health Plans" post.

First a recap of some key details

  • Our family is currently insured through Aetna on a COBRA policy that we went on when I was laid off from Rosetta Stone.
  • COBRA premiums are about $1400/mo
  • When you leave a group plan (even under COBRA) to join an individual plan even for the same company you get no special treatment (i.e. you have to go through the same underwriting/quoting/etc.)
  • I've spent most of my time researching Anthem because, a. we had it in the past and b. I had a contact who pointed me there to get started.
Prior to the launch of I was 95% convinced that our best approach was to sign up for the Lumenos HSA Plus plan with a $10k deductible.  It offered a nicely bounded worst case scenario (about $25k ... premiums + in-network and out-of-network OOP maximums) and a very favorable best case scenario (~$450/mo premiums or $5400 annually).  However, when launched and with the prospect of a subsidy (since I'm starting a company and our only income currently is Shiree's) it seemed like a good idea to explore our options in the new plans.

Like everyone else did not work for me.  I was able to complete an application but could not view eligibility results, shop for or enroll in plans.  Knowing that is just acting as a broker for plans offered by private companies with constraints (like covering certain things, no pre-existing conditions, etc.) I figured I try to find the ACA plans on Anthem.  It wasn't hard.  In getting a quote you simply indicate that you want the plan to be effective in Jan. 2014.

The quoting process for ACA-approved Anthem plans takes you through a Kaiser Family Foundation subsidy calculator and then you end up with 11 possible HealthKeeper plans from Anthem summarized in this PDF.  Given our current income it appeared as if the coverage we could get under ANY of the plans was great and the subsidies made the premiums REALLY affordable.  So, I started to reconsider my Lumenos strategy.  I, instead decided to look into a 90-day short-term policy with Anthem that would cover us until January when we could sign up for plans under the ACA.

However, sensing the likelihood that a misunderstanding of the fine print (despite spending HOURS reading and analyzing it) might result in a giant mess I reached out to the local company LD&B.  My 10 minute phone call with Michelle Wodey was by far the most useful 10 minutes I've spent on any of this.

Without further ado, I give you a few more lessons...
  1. When short-term policies say they don't cover pre-existing conditions they mean it.  You find IDENTICAL language in long-term policies, but so long as you've been covered by insurance within the past 62 days it doesn't apply for long-term policies. NOT SO for short-term ones.
  2. Short-term policies have the same underwriting/qualifications process.  So you can be denied them just as easily as anything else.
  3. ACA subsidies are paid monthly but qualified for annually and you have to repay subsidies if you are no longer qualified at the end of the year.  For example... In January I qualify for 94% subsidy on my premium given income and that amounts to $800.  The rest of the year I no longer qualify (because I started making money).  In taxes for the year I have to repay the $800 subsidy I received in January.
  4. If you qualify for a long-term plan you lock it in for a year but aren't obligated to keep it that long.  So, as the kinks in the the ACA get ironed out and as it's clearer what our income for 2014 will look like we could cancel our policy and enroll early in 2014 (I think there is another open enrollment until March)
Given those additional tidbits I'm now 99% sure that the Lumenos strategy is the right one for our family.  It's not possible to be 100% certain when profit-seeking entities are involved; their interests and mine aren't really aligned.

Wednesday, October 9, 2013

Public debt and private wealth

One of my biggest complaints about typical conservative dialog in America is that it is, generally, argued by wealthy people and it, generally, understates the role that the government played in the accumulation of their wealth.  Try asking a conservative this question:
What percentage of your wealth is due to government spending, support, or intervention?
A totally reasonable response would be "how on earth could I possibly know that?"  However the response tends to gravitate towards "What do you mean 'I didn't build that!?'" to borrow a line from the rhetoric in the 2012 election.

Similarly, conservatives are very concerned about the national debt (to the point that we're legitimately risking a default on our debt obligation).  If you tweak the question and instead ask:
What percentage of the national debt should you be responsible for?
The response does not tend to take personal responsibility but instead blames "government bureaucrats", "entitlements," etc.

All of that got me wondering about the relationship between the public debt of America and the private wealth of America.  Consider two graphs:

This one pulled from the wikipedia article on the US national debt.

The second from the wikipedia article on wealth in the United States:

This is obviously an unscientific comparison, and the scales differ by multiple orders of magnitude but it doesn't take a scientist to suggest that the shape of the curves are nearly identical.   I contend that there is a strong hypothesis that there is a correlation between the dramatic increase in private wealth over the past forty years AND the dramatic increase in public debt over the same interval.

That is NOT to say that this trajectory is sustainable, even the most liberal voices on public debt (Paul Krugman ?) agree that we have a problem to address eventually (but now is the wrong time).  It does however give credibility to the question above ("what percentage of the national debt are you responsible for?") and arguably takes it further suggesting that the wealthy should be responsible for more of the debt since they have gained more wealth.

It has always been true that there is no such thing as a unique idea (I'm always stunned how most Nobel prizes are awarded to multiple people who discover amazingly complicated things "at the same time") and in the Information Age it's typically easy to confirm that...

A paper entitled "Public Debt and Private Wealth" by a Candian academic makes this exact argument.  He starts the paper...
The purpose of the present study is to show that, contrary to common belief, prosperity and “democratic wealth” in a capitalist economy depend in a crucial way on a greater government intervention.
and later concludes that
[T]he creation of private wealth and its equal distribution in capitalist societies depend in a crucial way on the implementation of a democratic public policy. In particular, it was shown that public deficits are an important source of wealth for the private sector, which also benefits from the positive effects of low interest rates (with the exception of the rentiers) and a more generous public spending on social programs. 
To be fair the paper feels a little flimsy and some of the macro-economic explanations and formulas are likely open to withering critique (having never formally studied economics myself) but nonetheless I believe it asks the right question.

What portion of your wealth are you willing to contribute to solve our national debt/spending problem?