Choosing Hospitals

Choosing hospitals, like choosing insurance, seems like a super daunting task. Sure you can look at the newsmagazine "Best of..." lists but they are at best quasi-scientific and probably have little to do with the experience that one individual will actually have. You can also visit the Medicare Hospital Compare website but again it is a bunch of statistics that may or may not be relevant. A couple questions come to mind as I look at the stats on their site:
- Since these stats/surveys are about/from Medicare patients, who are generally older, sicker, and less well educated than I am how do I translate them for my own use?
- When I am wading through the stats how do I know what is a significant difference. Look at this graph about how well nurses communicated with patients. Does a 5% difference really mean that one is better than another? I assume that the sample size is large enough that these numbers are meaningful but they could be skewed by the department that most of the patients were in.

Ok so I haven't solved anything but at least I made a note that there is a place where you can get survey results that provide statistics about hospitals and that you can use these in an attempt to compare one hospital to another.

Legislative language

In musing about how Congress should stay on topic I found govtrack.us (which seems to be a very useful site). (No comments on how my first sentence is not related to the rest of my post).

As a result of finding govtrack and the full text of the bill I skimmed through the Credit CARD Act of 2009 and read the section allowing guns in National Parks and National Wildlife Refuges. The thing that struck me was the language used. I did student congress in high school and I know that the law has its own language. But some parts of this section read more like PowerPoint slides than legal language. The sentence that really got me:

Congress needs to weigh in on the new regulations to ensure that unelected bureaucrats and judges cannot again override the Second Amendment rights of law-abiding citizens on 83,600,000 acres of National Park System land and 90,790,000 acres of land under the jurisdiction of the United States Fish and Wildlife Service.

Weigh in? Next thing you know Congress is going to leverage the synergy of the new process to produce outstanding results in all that they do.

Why doesn't congress stay on topic?

I've been thinking about this for a long time but the recent passage of the Credit CARD Act of 2009 prompted me to write it down. Would our government be better or worse if members of Congress were compelled to deal with issues one at a time? Or maybe not even that--members of Congress do need to multi-task and deal with many issues in a day. Would public policy/legislation be better if it were always limited to a single topic? We would end up with more bills certainly but would they be better?

Regardless of how one feels about credit card regulation or carrying guns in National Parks these topics are not in any way related. I know that there is a good deal of horse trading that goes on to get legislation passed. And I have heard the old saw about laws being like sausage. But even if the deal making includes unrelated topics it seems like the legislation itself should be on a single or closely related set of topics. Maybe there are big advantages to doing it this way that I just don't see but it seems ludicrous that such muddled thinking and writing are the norm and that everyone accepts it.

HealthCare could be better...

As a Kaiser patient ordering from their mail order pharmacy involved logging in to the website and entering some information about the prescription I wanted filled and my credit card number. Since their docs enter the prescriptions in their system the pharmacy fills it and sends it to me.

Now that I have Aetna I have to go to my doctor, give them a form, which they fax to Aetna, and then I send Aetna a payment, and then Aetna sends me the medicine. The Chipotle add that says "1984 called and they want their fax machine back" comes to mind.

Thankfully our health care system gives me "choices" and since my employer dropped Kaiser I got to choose Aetna. I think Aetna is typical and Kaiser is the exception with regards to computerized records and I find this amazing (in a bad way).

audi a4 dome light rattle

As it turns out it isn't the dome light that rattles so bad--it is the piece of plastic right behind it that covers the built in microphones (for the bluetooth that I don't have).
It's not actually that hard to take the whole thing apart but the steps at audiworld helped. I took the whole assembly apart which made it easy to snap the rattling mic cover off. I then stuck some double-sided tape (the puffy stuff for mounting pictures to frames) on the inside and re-assembled. Hopefully this fix will last longer than the dealer's did.

competition for government contracts

Competition for services is different that competition for goods
After hearing about that no government contract should be awarded sole source and that no contract should be cost-plus I have been thinking about what that might look like. The problem is competition for government contracts is not like competition in a normal marketplace. Most contracts aren't for widgets that are being built and the government is trying to buy a few--it is for a service. So it should be thought of more like hiring a home contractor or a doctor. Have you ever tried to get a fixed price contract with your doctor? Do you shop for a different doctor every time you feel sick?

I am not saying that all contracts should be sole source or that fixed price contracts are bad. I do find the lack of depth in the public conversation to be frustrating.

My wife is way smart (programmable thermostats)

A while back my wife and I were discussing how a programmable thermostat can save energy (money). I fell into the trap of thinking that it took just as much energy to heat back up as was saved while the house was cooling. She pointed out that savings is not while cooling down or heating up but while the house is sitting at the cooler temperature. In almost exactly the same words the Department of Energy says the same thing. She claims she's not a physicist--just that she studied physics--but I don't think I believe her, she thinks like a scientist, a super smart one.

I love you T.

Times Reader

I downloaded the Times Reader (Beta) for Mac a few months ago, when it was first announced. I played with it a few days and then deleted it finding that I preferred reading the email headlines and then surfing around NYTimes.com. But after a recent plane flight when I couldn't get to the website I decided to give Times Reader another look. Here are my thoughts:
- I wish that it scaled better. At the middle-sized font (they let you choose from 3) most articles are divided across 2 pages. But the Reader window is limited to a small portion of my screen. I am sure this is for some reasonable technical reason but it feels clunky almost to the point of annoying.
- Partly because articles are divided a lot of navigation is required -- the keyboard shortcuts help out a lot.
- It doesn't keep track of what has been read and they don't keep stories to a certain date. So I skimmed through the whole paper yesterday and today it is showing me a bunch of the same stories. Maybe I don't really understand how it works. On the 28th I went back to the 26th and found an article whose byline was the 27th??? Anyhow it doesn't give me a feeling that I am in control of my reading experience and that was one of the things that I really hoped to get from this application that NYTimes.com doesn't offer.
- The Most Emailed section is way better than the NYTimes.com version. It includes pictures and short summaries of the article whereas NYTimes.com just shows the headline.
- I don't know if it is Times Reader itself or Silverlight but the application seems to spend a bunch of time with the spinning beach ball. (I guess this might be a function of the app being in beta...)

I'll keep playing with it but as of now I am not sold

Money Management Software

It turns out that I am pretty tired of Quicken. It seems to be a bit buggy and the amount of advertising in it is really annoying. Plus I have been using the Windows version and hear that the Mac version stinks. Even if I wanted to switch there is no good way to convert from Windows to Mac (Intuit provides a tool but basically says "Use at your own risk -- we didn't design these to convert back and forth."). So I am stuck with Quicken for Windows in a Parallels session (which is nice and all but it's slow and clunky).

As a result every few months I think I'll try Wesabe, or Mint, or Yodlee, or Morningstar. But I always back down and then forget most of what I have learned in doing the research. Keep in mind I haven't used any of these sites--this isn't a review--just some notes to myself about what I have learned about each site. So here goes:

Wesabe:

Tim O'Reilly is an investor and backer which makes me like it from the get go. They are crazy about security and data rights -- their philosophy is that you own your own data. They don't take account numbers or user names or anything. Instead of automatic updates of account information it is semi-automatic. They provide uploader tools so that you can download info from your bank to your own computer and then upload it to Wesabe. This means that all they have is a pile of data -- no way to access your accounts.

The focus of the site seems to be on managing spending and saving -- tracking cash flow. They claim to have nifty reports and so forth and let you compare your habits to other people. They can help you by providing a community to work on spending goals (or savings goals).

The big downside is they do nothing to track investments, zip, zilch, nada so they don't really meet my needs.

Mint:

They claim to do both cash flow and investment analysis. You provide account login information when you sign up and then they automatically retrieve transactions from your financial insitutions. The rub here is that they claim they don't store any of this stuff (username, passwords, etc). Which, I guess, is, technically speaking, true because they use yodlee for this (see entry below). But it means that all of your passwords and login info is stored in a single place on the web. They also claim that Mint is "read-only" so nobody could mess with your accounts even if they broke into your mint account. I guess this is also true. But the credintials that are stored by yodlee are the same ones that you use to log in to the banks' websites so again all of your info is out there in one place as best I can figure.

Seems like it might be worth trying if I wasn't paranoid about having all of my username/passwords in the hands of a single website.

Yodlee:
Based on the look of their website they got their start as a financial aggregator not a consumer website. They offer a personal money management page but it does not appear to be their primary business.

You provide yodlee with all of your usernames and passwords and they periodically log in to your financial institutions and get updated account information. They also make some mention of managing money all in one spot so it may be that they can initiate transactions from their website.

Like Mint they claim to show you investment accounts too.

Morningstar:
Focused entirely on investments. They provide no cash flow or budgeting tools. They also provide no tools for automatically updating accounts -- you have to enter all transactions by hand and there doesn't seem to be an uploader. Finally there is a monthly cost to use the service. On the other hand they are the industry leader in providing investment information and the tools do seem to be pretty useful (I signed up for one of their free 14 day trials and put in some fake data to try things out.)

That's all I can think of for the moment. See you in a month when you get sick of Quicken (again).