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My Struggle with Insurance Companies and Healthcare that is Broken

This may sound like a sour grapes post on my blog, but I must vent about how frustrated I am with insurance.

It is easy when one is not sick to use insurance in everyday life. Broken bones, and basic care is great. Having ALS means that much of my needed care is very expensive and not covered by insurance.  This is a common theme in the news when people confront a catastrophic illness, insurance companies want to drive care decisions to reduce exposure and cost.

In my case Humana has decided a few things for me that I'm not happy with.

• They will not pay for more than 12 visits of a home health nurse in order to keep me out of the hospital.  Staying out of the hospital should reduce cost to Humana but they don't care.
• I was prescribed an antibiotic recently. They paid a portion of my antibiotic, my portion was $500.00
• They would not pay for my ALS drug, which cost me $500.00/month (this is now generic which is affordable now) for over a year.
• They will not pay for an oxygen portable compressor so I can leave my house with a vent to visit a doctors office, they call this a luxury. $3000.00.
• They refuse to pay for technology to help me speak and use my computer, $750.00/month.

In fairness Humana has paid for a lot, but tell me in the list of items above could you afford these? Which would you do without?

I would give anything not to need insurance, I wish Humana could make a boatload of cash.  I did not do anything to get ALS.  I did not drink or smoke.  I exercised regularly and tried to eat right. Here I am  and others struggling to pay for these things while Humana pays big money to executives.

In 2011 Bruce Broussard the CEO of Humana, made 10.5 million in compensation.  That is 122 times my salary at my previous employer. Add in other executives and Humana is not a bad place to work.


I'm not saying I'm anti capitalistic, but when I see that kind of compensation and know that there are others like me trying to survive and have needs, I find it overwhelmingly backwards.  

I want insurance that tries to pay claims, not avoid them. Insurance companies are not the only root of the problem, hospitals are guilty of over pricing care, pharmaceuticals jack prices, and doctors run too many tests(over simplification ).

There is wide support for market based healthcare, but how are market forces helping me?

The Heritage foundation put out a report on repealing the Affordable Care Act. Below is the opening paragraph.

For a better life, Americans need a health care system that they, not the government, control. Consumers should have the ability to choose how to meet their health insurance needs in a free market for insurance. Taxpayers should benefit from a more efficient and affordable system for helping those who need health care but cannot afford it. Above all, patients, with their doctors, should make their own health care decisions free from government interference.

The important first step is to repeal the Obamacare statute that puts the government in charge of health care. The second step is to let the country move to a patient-centered, market-based system that focuses on citizens and not on the government. 

This report does not match up with the many struggling including me. 

To be clear, I don't want government healthcare either, but I just don't believe that for profit insurance is going to pay more claims over time.  I think its only going to get worse. Can insurance be market based? Paul Krugman makes a good point in his article that it can't be.

There are two strongly distinctive aspects of health care. One is that you don’t know when or whether you’ll need care — but if you do, the care can be extremely expensive.The big bucks are in triple coronary bypass surgery, not routine visits to the doctor’s office; and very, very few people can afford to pay major medical costs out of pocket.

This tells you right away that health care can’t be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you can’t just trust insurance companies either — they’re not in business for their health, or yours.

I'm not sure what the best answer is but I know my struggle is real and the pundits and policy makers can continue to debate healthcare. I hope we can solve these issues so folks can get what they need in trying times.

Home

Hello friends,

I want to take some time to tell you about my last few months.

The week before Thanksgiving, we had a normal weekend, but overnight I went into respiratory arrest. The Georgetown Fire fighters and EMS saved my life.  It turns out that I had pneumonia and did not know.  I have been on a ventilator since that night. 

My goal has been to return home and get our family back together. My wife Kim has been at my side 24 hours a day at the hospital to help me.  You see with a tracheotomy I cant speak, and the ALS prevents me from mobility of even lifting my hand.  She has become my communicater. I'm inspired by her will and dedication to me.

My two girls have had the support of my fantastic family and friends. They however have had to endure the ups and downs of my life in the hospital and no parent with them. I'm very proud that they have tried to work hard in school and get through these trying times.

With the generosity and support of family and friends, financially and spiritually supporting us and with  God’s will I can report I am home.  Unfortunately I have been home twice and had to return to the hospital because of pneumonia.  I'm hoping I'm over that and can get stronger so I can do some work from home, and return a little normalcy to my life and family.

This has been maybe the most trying time of my life, but being home makes it worth it.  God left me here for a reason so I have more work to do.  My road is still difficult and I may call on you for help.

Are You A Scooper Or A Stabber

Since living with ALS I have very low upper body strength. Because of this, I must have assistance with eating my food.

There is an interesting phenomenon that happens with this dilemma. When someone helps you put food on an eating utensil and give it to you, you start to notice the traits of how they pick up their food with their tool of choice and deliver it to their mouth. 

 You also start to notice how someone eats a sandwich, or more precisely a hamburger. You will start to see a pattern of approaches. Some folks go around the parameter of the hamburger and eat it. Some eat across left to right like reading a book, as they go through the burger.

I never noticed this phenomenon until now. Ever since this I've been watching how people eat food. I've come to the conclusion that there are two types of fork eaters. You are either a scooper or a stabber. Obviously you must have a fork in order to be a stabber, spoons can only scoop to my knowledge.

I will illustrate the differences. In the images you'll notice my wonderful looking Szechuan chicken. It has chicken, vegetables and rice on the bottom. In the bottom there is a delicious Szechuan sauce. 

A stab gets mainly the bulky parts of the dish. But a scoop gets savory juices and rice as well as other delectables. Therefore I believe a scoop is a better approach to eating most dishes with a fork.

A Stab, Very little goodies

I can think of all kinds of examples of how scooping is much better. When eating biscuits and gravy, you must scoop the biscuit  out of the gravy  giving you a delicious moist biscuit. Stabbing just gives you dry biscuit.

My wife is a stabber and since I'm a scooper we have an interesting and engaging conflict. I know in general with a dish like Szechuan chicken one must do some scooping and stabbing. However, I would argue that the majority of the time (85%) should be scooping.

A Scoop Mmm good!

I wonder if this is hereditary or learned? With my wife being a stabber and my two twins are split, one is a stabber and the other is a scooper. My mom is scooper I'm thinking my father was too.

What are you, a scooper or a stabber?

Economics of Fire Protection

There is a set of interesting articles in the Louisville Courier-Journal regarding suburban fire protection districts. There is great debate in Jefferson County Kentucky regarding merging fire districts together forming one big department or a few small ones. The debate goes on with regard to this merger.

I tend to look at the fiscal part of the fire services on a macro level or a per capita basis of providing protection. While this is not an exact science and there should be a greater matrix on looking at the quality of a particular department as well as the costs that it takes to run it, the per capita cost can give one a guide to the cost of fire protection. Services vary for example, some departments provided EMS to its residents, while others are combination departments having both career and volunteers provide services. Then there are all volunteer departments as well as all paid departments having all career firefighters. When looking at the per capita spending it is important to understand exactly the services that are being offered for the money.

Per capita spending on public safety and specifically in fire protection varies widely across the country states and counties. For example in my community we are providing fire protection services for $143 per capita per year. In the next community near my house (1/4 mile) they are spending $25 per capita on fire protection, and in the city nearby they spend $250 per capita on fire protection.  In Jefferson County Kentucky the proposal is that for $125 million, fire protection can be provided to the entire community. That would be 17 departments merging into one. The per capita cost of that in Jefferson County would be $167.

The services provided in each of the communities mentioned above do vary.  My community has a part career and volunteer force.  The community next to me is an all volunteer force.  As you can see the funding of an organization by examining per capita spending at a macro level is one metric that should not be ignored in public safety.  It will be difficult to balance the services in the mergers between an organization spending $25 per capita and another spending $250 per capita as there would be some extensive service balancing.

In general if efficiencies can be increased and levels of service increased while maintaining steady per capita spending over time merger should happen. The fire service is here to help people and render care. We should all do this to the highest level that we can. If we analyze the financial impact of providing services, increasing resources where they are needed and decreasing in other areas that are over funded, we can provide a better net product.

It seems that the fire service, police and EMS are not immune to budget constraints in every community across the country. I do feel in Indiana we are in better shape than in other states around us. Fire departments and fire administrators must be cognizant of the financial implications of providing public safety. We must remain diligent in looking at data and providing the highest level of service that we can afford for the taxpaying public. If merger is in the cards, and it provides a better service to the public, then it should happen and as public officials we should not be in the way.

Public safety is near and dear to my heart. I serve on the Board of Trustees for the Georgetown Township Fire Protection District  I'm an alumnus of the National Fire Academy and served as a volunteer firefighter for 13 years.

Rocket Equations

This summer I decided that I would spend some time with my 13-year-old daughters building model rockets. The process of doing this would teach them how to measure and build as well as engineer something that actually did something cool such as fly.  Building rockets is a good way to study a wide range of physics, engineering, math and science. I built rockets when I was a kid and it was such great fun I thought I would do it again.

I brushed up on my rocket skills and read the official NAR handbook. In the book they described rocket equations to estimate the height and velocity that a rocket will go theoretically ignoring aerodynamic drag. As I started looking at the equations I was slightly confused as to how they were derived. I looked around on the Internet and did not see a clear  representation of the math in one place that my kids would understand. My daughters have had basic algebra but most of the derivations on the net leave a lot of the steps out. I decided to derive these equations by brushing off my college physics book and going through it in a very verbose way. I’m writing about this because along with my daughters I thought it would help others who are teaching younger students on the basics of the equations of motion. 


Between reading the NAR handbook and this you will have a good understanding of the forces on a rocket.  The equations of motion are well documented in general. I’m going to glue together the basics of finding out how fast a model rocket will go and how high theoretically it will go. We will calculate the velocity of the rocket after its initial burn and then after the coasting of the rocket in the air. Remember this only works ignoring aerodynamic drag which is a very big piece of how a rocket flies.  Later I may address the more complex math but for now we’ll start with the easy stuff.

By definition these equations work with constant acceleration. We use Newton’s laws of motion.  All of Newton’s laws work on a rocket and affect how it flies. Remember this is ideal.  For much better real world models use RockSim or OpenRocket.  

Given the graph below with a line in a coordinate plane where Y is equal to velocity and X is equal to time. In this basic graph of velocity versus time I have defined acceleration as the change in velocity over the change in time. If we add up the area under the line this would be the area of a rectangle plus the area of the triangle. This area is called the displacement. For our equations this will be the altitude of a rocket.

Again looking at the graph of the line of acceleration as:

Remember that acceleration is the slope of the graph.  Rearranging gives us:

This final equation looks a lot like the basic equation for a straight line that everyone is used to.

We want to find the area under the line which is our displacement. In order to do this accurately we will use calculus and integrate velocity with respect to time.

Plugging in equation 1 to the integration and solving gives us:

By integrating we add up all the area under the line, that’s all integration really is. “s” is the disposition.  Physicist use s for some reason (note s = d in our graph).  This equation, we will call equation 2, has acceleration in it. In order for us to use it for our rocket equation we need to get acceleration out by substituting our definition of acceleration. We’re going to do some substitution and simplify.

The next equation we will take equation 3 and eliminate time.  The algebra on this is a little messy but I have all the steps and I’m using the binomial theorem.  Substitute t in equation 3 and simplify.

After all that work equation 3 is our altitude at burnout and equation 4 is our coasting altitude.

In order to get the altitude at burn out we will need the velocity at the time our motor runs out of burn. In order to get this we will use Newton’s Second Law F=ma:

T = thrust or force to put the rocket in the air 

t = motor burn time

g = acceleration due to gravity. 9.8m/s^2

wavg = average weight of rocket

vm =   maximum velocity during motor burn

In order to use this law we need to include gravity with mass to figure the force on our rocket and that is the gravity for acceleration. Given our equation above for velocity we will substitute.

Finally we can calculate some ideal values for our rocket. Given the picture of our rocket below lets figure out our altitude at burnout and our maximum altitude theoretically.

Using my kids Alpha rocket with an A8-3 motor in it weighs 38.8 grams at lift off. The weight of the propellant is 3.12 grams giving an average weight of 37.2 grams during the thrust of the flight. The motor thrusts for .32 seconds and has an impulse of 2.50 Newton seconds. In our equations you will want to convert grams to kilograms as the standard unit of measurement.

The maximum velocity of our rocket ideally will be 64.03 m/s or 143 mph.  Now let’s figure our altitude after the rocket motor burns.

Using equation 3:

Our rocket altitude at motor burnout is 10.24 meters or 32 feet above the ground theoretically.

Using equation 4 we can find out the total altitude theoretically that our rocket will go.

Our rocket theoretically will go 219.22 m or 719 feet in the air ignoring aerodynamic drag with constant acceleration.

A few notes on this last equation to solve for the coasting altitude. Many of the units I’ve used here are called vectors. They have a magnitude and direction. Gravity has a  downward direction. This is why the 9.8 is in the negative direction. It works out because negative divided by a negative is a positive and altitude needs to be positive. I didn’t mention vectors throughout because it may have been more confusing. Be aware however that a rocket doesn’t go just straight up it has an X, Y and Z coordinate.  We know when we shoot off a rocket it tends to point into the wind which would decrease its overall altitude. 

Living With ALS

Living With ALS

This is my first blog post. I have been wanting to do a blog for a very long time and for some reason I procrastinated. I guess I feel that I would be writing and no one would be reading. But maybe that's not the point in that I just want to express myself in a way that may resonate with a few or maybe I'll just blow off some steam.

In this first post I want to get something out the way and it's related to my health. I was diagnosed with ALS or Lou Gehrig's disease in 2009. Since this diagnosis many people ask about how I'm doing. Maybe this blog will be a place that I can give some updates periodically, however; I can assure you that I will not talk about it much. In fact this may be my last post ever about it, but I think it's worthwhile in saying something about it at least one time.

As you can imagine with a diagnosis like this it's a horrible feeling. As of today July 4, 2012, it is very difficult to walk (I use a walker), it is getting harder to talk, and my upper body strength is essentially gone. I use dictation software for writing however my hands still do work a little, but I don't type 90 words per minute anymore.

The physical toll that this disease takes is devastating. I cannot ride a bike, or throw a softball, frisbee or anything with my kids. I can't take them fishing or golfing or anything that is physical.  With this illness it is very hard to travel. It's embarrassing when I go to a restaurant and I have to have help eating because my upper body strength is weak. The total dependency on others especially those closest to me is the hardest part to take with the disease.

There is a financial toll. I have to invest significantly in assistance devices at home to help me. I have a lift chair for our stairs. I have rebuilt our stairs into the house so that the steps are smaller. I am in the process of buying a new handicap van and I will have to be doing more as time goes on in the house. Insurance does not pay for these things and our insurance continues to rise and there is less coverage for many things that are needed.

I'm not here to write and have a pity party. In general I want everyone to know how extremely difficult it is to deal with the illness. It is certainly not fun.

The good news is I have a wonderful job and a very understanding boss Chris McCarty with Cheap Cycle Parts. I love my job and my team and they have been very supportive of me and all of my professional and personal endeavors. I go to work every day and I'm very demanding professionally of those around me. I don't expect to be treated any differently than anyone else. I am very lucky and blessed that I have a good job so that I can provide for my family and have the ability to manage my illness.

I strive with the will to live. I am living with the disease and my plan is to be around for a very long time. I pray every night for a miracle and pray for a cure. Every wish I make is the same. I know now that there is more progress in ALS research than ever before. All we need now to solve this is funding, it can be cured and it will be cured.

To all those that want to help, all I asked for are prayers, love and friendship. On occasion I may ask for a little help pushing in my chair, straightening my tie or handing me something.

I have many dreams just like everyone. One in particular is to buy an RV that is equipped with everything I need to travel across the country with the family. This is something I really want to do and I'm trying to figure out how I can do that.

This blog will not be about ALS. I hope you find the things I write about in issues of public policy, public safety, science and business to be interesting. These are the things that interest me most other than my wonderful wife and children who support me every day.

As a footnote, If you want to donate to the ALS Association you can go to the site and donate anything that you can.