Gas station without pumps

2019 April 17

Running hiatus

Filed under: Uncategorized — gasstationwithoutpumps @ 10:48
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I am going to stop running for a few weeks and reassess my goals.  What triggered this change was my annual physical, where I got some of my various aches diagnosed.  There were three main outcomes:

  • It is worth trying ezetimibe in addition to my current rosuvastatin to see if that controls my cholesterol better—it is probably less of a risk than increasing the statin dose.  Interestingly, my insurance requires prior authorization for ezetimibe (a $9/month generic), which makes no sense at all.  I’ll probably be paying for the prescription without insurance, since the full price will be less than the insurance co-pay would be.  (They don’t pay for the $6/month rosuvastatin either.)
  • My elbow injury is probably tennis elbow (lateral epicondylitis), for which I’ve been prescribed stretching and strengthening exercises.  I’ll also start wearing one of the tennis-elbow braces that wraps around the forearm.  I’ve had elbow inflammation before (due mainly to bad keyboarding posture), so I know more or less what to do about it.
  • The ache in my hip that I’ve had since last August is osteoarthritis, as I suspected (confirmed by X-ray). This is bad luck, but not unusually bad luck—the incidence of hip arthritis among men my age is about 12%, if I’m reading the literature correctly.  Experts seem to disagree about whether running is safe for people with hip arthritis, but even those who recommend running agree that one needs to change to low-impact running styles and do other exercises to stretch and strengthen muscles to avoid further injury to the joint.  Almost all recommend working with a sports medicine specialist and physical therapist trained in running and arthritis to determine exactly what is reasonable.  I’ll probably be doing that when I have some spare time (this summer?).

I was just feeling good about having done a 5km run last weekend, albeit at a slow pace (8:35 mile pace), and now it looks like I won’t be increasing my distance to 15km this summer as I had planned.  I may never run a marathon—I should have tried 20 years ago, when my body was better able to tolerate abuse and recover from it.

2018 March 2

Long-term care insurance

Filed under: Uncategorized — gasstationwithoutpumps @ 20:59
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Every year, I get a letter from the State of California’s Department of Health Care Services urging me to get long-term care insurance, but the reasoning in the letter never makes sense to me.  They say

Most of us have fire insurance on our homes, even though only 1 out of 1,000 home owners will ever have a serious fire. Consider that 700 out of 1,000 of us over the age of 65 will need some type of long-term care.

OK, I’ve considered it, and their argument makes no sense at all. Insurance is a trade-off—you pay somewhat more than the expected cost of something, in order to reduce the variance.  So for fire insurance, if you have a 1/1000 chance in 40 years of a $1 million loss, then the expected cost per year is about $250, but people are willing to pay about $1000 a year to reduce that loss to a few thousand if it does occur.  The variance is now quite small (almost constant cost whether or not there is a fire), rather than high probability of no cost with a low probability of enormous cost.

But it long-term care is almost always needed, then insurance is not the right vehicle for dealing with it—savings is.  The cost of the insurance would be more than you would need to save (otherwise the insurance company would make no profit), and if you turn out not to need the long-term care, you would still have the savings, but insurance premiums would be gone.

The only justifications I could see for long-term care insurance are

  • if there is a very small probability of needing very expensive care, so the insurance reduces the probability of a disastrous outcome, or
  • as a forced savings plan, because people can’t be trusted not to spend the money that they have set aside for the possibility of long-term care.

Whole-life insurance used to be used as a form of forced savings, which turned out to be very profitable for insurance companies, but very bad deals for consumers. (Separate term insurance and other forms of savings were much better financially.)  So I don’t trust insurance companies to devise good forced-savings plans.

That only leaves the very small probability of needing very expensive care as a possible justification, and the letter sent out each year implies just the opposite—that there is a very high probability of needing long-term care.  I wish that they provided real information—like the probability distribution of cost of long-term care for the population, so that I could figure out how much risk was really being covered by the insurance.

2018 January 24

Good news in the mail today

Filed under: Uncategorized — gasstationwithoutpumps @ 20:32
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I got two pieces of mail that were pleasant to get:

  • From the IRS: “Thank you for your response to the notice we sent to you about your 2015 (Form 1040) taxes. We’re pleased to tell you that the information you provided resolved the tax issue in question and that out inquiry is now closed.”  Previously, they had wanted a few thousand more in taxes from me, because they missed where I had reported income and because they wanted to tax the withdrawals from the 529 account that is paying for my son’s education at UCSB.
  • From Anthem Blue Cross: “Amount charged by your provider $50, Anthem Blue Cross paid $50, You pay $0.”  This was for my wife’s flu shot.  My flu shot was on last year’s insurance plan, where no paperwork to us was generated, as the flu shot was obviously covered, and there was no deductible to worry about.  This year I went with a much cheaper insurance plan that has a high deductible and less coverage.  I think that the maximum out-of-pocket cost is still less than the premiums on the more expensive plan, as long as only one of us gets seriously ill.  The rather expensive plan is about the equivalent of the free plan I got when I was first hired at UCSC—benefits have steadily been eroding.

2011 April 3

Possibly bogus prediction contest

Filed under: Uncategorized — gasstationwithoutpumps @ 19:44
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The Heritage Provider Network (whoever they are) has announced a $3 million prize “to develop a breakthrough algorithm that uses available patient data, including health records and claims data, to predict and prevent unnecessary hospitalizations.”  They claim that they want this to benefit individual patients, but it seems to me that the most obvious use is to deny insurance or charge very high prices to those most at risk of hospitalization.

I don’t believe that data are really available to allow high enough accuracy in prediction to benefit any individual (what do you do if your risk of hospitalization is twice normal?), but there is plenty of data to assess higher insurance rates or deny insurance to people because they have a somewhat higher chance of filing claims.

Quite frankly, I’m convinced that this is a morally bankrupt contest, and I want no part of it. If we had a system of health care that was not dominated by for-profit insurance companies, I would have fewer concerns about the ethics of this prize competition.

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