Sunday, December 31, 2017

Health Care vs Health Insurance

There is much talk about health insurance and even drug costs but so little about health care - quality or costs.

I have had individual health insurance for the last 17 years and for a few other scattered years before that. Most years I have been the insurance company dream client paying more in premiums than they paid out in coverage. One year I had a sports injury (sprain) with an ER visit. One year I had knee surgery and met my deductible but not the maximum out of pocket for the year.  This year was a bit more traumatic for me and more costly for the insurance company but because of insurance, it was limited in out of pocket expenses.

It also provided some data in terms of care and cost with and without insurance. I know that health insurance currently provides me with several things.
  • Coverage for certain preventive screenings and care as required by law.
  • A maximum out of pocket per year amount for health care costs. (and no annual or lifetime limits)
  • A reduced rate for the health care I need (and pay for myself) from in-network arrangements.
  • And as long as I keep insurance, coverage for "pre-existing" conditions requiring on going treatment (ie asthma).
Most (the exception being the variety of choice for and in the in-network provider list) of these benefits are better than the plans I had before ACA and just now (5 years later) becoming more expensive than what I had before ACA. I have said before, the ACA is not perfect. It was too complicated a project to get everything right the first time through. It needs some tweaking. But the past year's attempts to repeal and replace, along with all the calls from constituents demanding components stay around, confirm my opinion that there is more good in there than bad.

I think one topic being left out of the discussion is the cost of health care. It impacts those without insurance and it impacts the insurance companies. Even the not for profit insurance companies just trying to break even.

Many people recognize the maximum out of pocket limits. Many complain that even those limits are out of their reach especially on top of the premium costs. I wonder though, how many realize how much they save by being "in the club".  Take my annual checkup with lab work and stuff.  Most was covered by the plan. The insurance breakdown was
  • Billed: $498
  • Allowed: $255.69
  • Covered: $155.83
  • My costs: $99.86 (I had some additional "optional" labs).
Note that the original billed costs was almost twice the  "in-network" cost negotiated by the insurance company.

My ultrasound (not including the doctor review) was:
Billed: $755.00
Allowed: 275.90

This should be comparable to any xray or scan of a sports injury by an otherwise healthy person who thinks they do not need health insurance.  Without the insurance they would be paying 3x as much plus the costs of the ER visit and a Doctor review and exam. I just gained back a month (or more) of my premiums with the savings negotiated for that procedure.

Then there is the hospital bill for my surgery (not including the surgeon or the anesthesiologist)
Billed: $22,814.89
Allowed: $7,469.49

So really, the hospital can do the surgery for 1/3 the price? Does this qualify as price gauging the uninsured?Or is it a "discount everyone gets" so even a government employee is allowed to be billed the lower amount?

Government talks about drug costs being out of control but they rarely talk about hospital costs and equipment costs. A lot of the equipment costs, like drug costs, are related to FDA regulation, certification, and testing. I suspect there is room for improvement in the efficiency of those procedures. Meanwhile, the costs are set mostly by for-profit companies. Who can retain the best doctors? Can you pay the registered nurses enough to make the doctors look even better? How do we meet the requirements for sterile environments or obtain the most accurate diagnostic equipment? And for the hospitals, who covers the cost of the uninsured who default on payments? Rural areas may have only one hospital and no competition (which can both help and hurt).

Remember when buying a car was about who could haggle the best? There is a suggested retail price and a dealer price (which varied by dealer) and the consumer had to figure out how to find the best deal somewhere in between but few had the "dealer price" available when negotiating. Now it is pretty easy to find out the what others are paying and the negotiation window is smaller. In health care costs, the consumer does not even get to option to negotiate a price between the "billed" and "allowed" that I see on my insurance statements. We have to pick an insurance company (if we get a choice) and hope they are negotiating well with the pool of money they collect from premiums.

With so many private businesses and so little transparency, how can anyone find out these costs before a treatment? How can they shop around for the best combination of care and cost? It is only with the statements from my insurance company that I see these numbers and the huge difference in costs for the uninsured vs those privileged to have insurance. So people look at what they can see. The cost of the premiums and the amount they need to find if they have to pay up to the deductible or maximum out of pocket.

I'm not sold on single payer but I do wonder if letting private industry set the prices is still the best thing. If there were more companies (both providers and insurance companies) competing maybe it would still work. Medicare has some history of red tape, abuse of entitlements, and wasteful spending but overall and recently it is one of the best run insurance companies out there.  Unless government gets involved in more than just the insurance aspect, there is still a battle between the private business elements of health care (providers and equipment companies) and making sure essential needs are available for all humans (especially the children). Is there another option that hasn't been found yet? Will a better understanding (by consumer, business, and government) of the health care costs help find those options?
I have more questions than answers.
I will not, however, be taking advantage of the dropped "mandate penalty".
I will keep health insurance. It is worth the premiums to avoid the financial risk while stressed about ones own health.


Saturday, December 30, 2017

How was 2017? (my personal view)

As the year winds down there is a flurry of "how was your year" posts. Some point to a blog post. Some ramble in the new expanded twitter. Some are probably on Facebook and I'll never know (I am not!). There are all types: the average, the "hated it" but hope for a better next year, the "wow I did that!", and everything in between.

My favorite has been a very upbeat twitter thread:

I stayed out of that thread. The work related accomplishments were good but business as usual and for the personal side I fall more in the started ugly but got better as the year went on category. My personal year in review also makes a solid case for having health insurance and access to great health care (and those are two different things despite what DC and the news might make one think!)

Sidebar: I am a fan of women's basketball and have been since growing up in eastern TN. I was a band geek supporting players who went on (eventually) to the WNBA. While working on my master's degree I found a new team to love. I even had the opportunity to represent SILS as an honorary coach for a game and am now a dedicated season ticket holder. I spent a year taking photos and maintaining the web page and weekly newsletter of the fan club, Team Tempo. I ended up the 2010 volunteer of the year for that fun.

I finished last year reading Coach Hatchell's book Fight! Fight!: Discovering Your Inner Strength When Blindsided by Life. about her winning fight against cancer.  It was inspiring and my health struggles are (still) nothing in comparison. They center mostly around not enough exercise and too much stress eating and social drinking. I had just buried one feline companion and was nursing the other through old age ailments but I still had that Jan motivation to do better this year.

And then...

Feb: (at Dr annual visit...) "it is probably nothing... lets get an ultrasound"
Mar: "Its still probably nothing. 90% are benign but lets get a biopsy"
Apr: (while at the vet) "Suspicious" "surgeon" "Cancer Center" "appointment" blah blah blur.

Somewhere between scheduling the biopsy and the results I was at the Hatchell Radio Show and had her sign my copy of her book. I couldn't help wondering how she really felt hearing those words. I was still at the probably nothing stage and my head was buzzing.

The other really interesting thing that I did not completely realize until after the surgery... for the last couple of months, my cat had been annoying me with her paw pressing on my throat. It was uncomfortable. I would move her, she would return to that spot. She stopped the day I had the biopsy. And after the surgery (and enough healing) when I realized swallowing was easier, I also realized that the paw there had hurt because of the nodule.  She knew? I believe.

In May things got MUCH better.
The surgery went well from the surgeon's view. Everything was benign. I still have the other half of my thyroid. So far it is working well enough I don't even need any drugs to help it work right.

It took me a while to get over the anesthesia (I don't react well to chemicals) and for my body to adjust to half a thyroid. At least it was summer so I was able to stay warm. I slept through a lot of it.

I own the company I work for, so of course my company was supportive. But so were my clients. The part time gig I was working on just got stretched out a bit more. Shorter weeks and more of them but less gaps away teaching. I had to cancel one teaching week and hold off scheduling some others but once I knew I was good, we worked out the scheduling. The year ended up being one of the best for my company.

The year also ends upbeat for a friend of the family also being declared cancer free (after chemo and surgery). She must have told Mom around the time I was having the biopsy. Mom didn't tell me until after the surgery.

So my accomplishments?
- surviving (medically)
- surviving (financially)
- remembering what is important: in life, in work, in friends, in family, in faith.

Overall, and despite the empty house and current pain from cold induced asthma, I am ending the year more calm than I ever remember. And more content with myself and my life.

-SML (Go Heels!)

Tuesday, December 26, 2017

Holiday week

This is a holiday week. Most of my clients are shutdown for the whole week. Even the local library has a few extra days closed.  It means it should also be a week of personal time for me. Of course, as a small business owner who runs the company on a calendar year cash basis, it is the week I make sure all the paperwork is in order for end of year accounting and taxes. It is also a week where I can use self paced and online learning to catch up on some work related but non-billable professional development. 

While this blog was created to share the more personal and fun side of my professional life shared, it was still intended to stay professional. Sometimes the two mix and this week I am going to try to keep my writings less technical and more personal.

I will start with reading lists. All the year end best reads are out and I am looking for something fun.

NPR has 374 to choose from in their Book Concierge app.

TechGirlz suggested A Mighty Girl list. has 10 must-read DevOps resources (see I can't stay away from work related topics completely)

I also need to get a copy of Despite the Height (and see if I can get it signed at a game this season).


Friday, December 22, 2017

Year in Review - reconnecting with Cloudera Training

I already wrote about Red Hat adventures of the past year but that is not the only part of my (professional) world. I also do some work with Apache Hadoop, mostly in partnership with Cloudera, Inc. I did not make any of the big data conferences this year but I did reconnect with Cloudera Training and Certification.

Apache Hadoop just had a release update but I am not sure when enough changes will trigger a major update to the downstream enterprise products.

The big news of the year for Cloudera as a company was the IPO (unfortunately they did not have a friends offering but hey, it isn't the big boom days either).

Over the past couple of years Cloudera has been moving their certifications to hands-on. This is a "good thing".

The big new class of the year is the Big Data Architecture Workshop which I have not yet had the chance to attend but am very interested (anyone care to sponsor me?). I do need to learn a bit more of the data science developer side first.

This year I had a chance to see some of the Cloudera Training OnDemand training (which they launched in 2016) and continue to contribute to some of their course materials.

A couple of related topics that I would like to explore in the coming months.
  • Integrating Cloudera Manager and FreeIPA. CM recognizes AD and direct admin connections to an MIT KDC but for FreeIPA it needs a custom script. 
  • Expore how the open Ambari manager works with securing hadoop clusters when using FreeIPA for the KDC. It appears to have been available as experimental since Ambari 2.4 according to this article.
  • Investigate Hadoop ecosystem and similar products  with Containers. Such as Machine Learning on OpenShift and Kubernetes and Big Data and Apache Spark on OpenShift Pt. I (2016)

It can be interesting to see the different and similar ways that companies manage curriculum development. Some day maybe I will see if I can get the permissions needed to share my amusements. Of course I have an opinion on which ways are better - just let me check on who is paying my fees for this week....  😇

I'll end with a plug for the Cloudera Training 2018 schedule since I hope that they sell enough seats to need me to teach! :)

Thursday, December 21, 2017

Year in Review - Red Hat training activity

I have been a certified instructor since the beginning of the program in 1999. I have contracts with delivery partners and am required to keep up on my skills and other information around the program.  This a roundup of information from 2017 which is relevant to this part of my world.

Wednesday, December 20, 2017

Themes and Layouts

The layout of this blog was past getting on my nerves. It was an old theme, probably now a "classic" theme, from when I started the blog many (many, many, get off my lawn) years ago.

Blogger got acquired, options got updated, and the look of the theme I had got narrow.  I tried just adjusting the widths. That was "not available for this theme".  So I clicked around a bit and picked something else not too objectionable. 

I did edit and repost the last entry I made. I wanted the pictures to be placed better. But perfection was not to be. At least not tonight. 

I skimmed some other old posts - only a couple of pages worth - and most do not look to bad with the change.

The edit mode is still narrow and not anywhere near wysiwyg. This makes it hard to place pictures and text together nicely.  I may have to try some more options soon.  I may need to find a better host. Change is hard though.


RIP little Toni

Toni: July 14, 1998 - Apr 3, 2017

Toni stayed with me for just over three months after Cleo left us. It just took me a lot longer to pull together the memories and pictures.

She was the inquisitive one but very shy at first. When I met them, Cleo was playing but Toni was content to sleep on the bed in the other room.  She was quiet, small, and shy. When I got them home I found out who was boss!  (hint: it was not the bluebird at the window!).

Cleo would get "caught" on the counters or into something but I soon discovered that Cleo only checked things out after Toni. Toni would hear me coming and get away from the trouble (and look at me innocently) as I chased Cleo away. Other times Cleo sat patiently waiting her turn, such as when Toni took over ALL the new catnip toys.

Toni rarely curled up with her sister and until the old age caused too much pain from the cold, she rarely cuddled with me either. She just was not a lap cat or big on being held.

That is, other than at night in bed - where she also hating sharing. She would glare until her sister left and try to take her half out of the middle even with me before settling in on top of the covers and between my ankles.

She was pretty good at staring me awake in the mornings too. When that didn't work, she would bat at my face.

During the day, she was an expert at following the sun.

The last few months though, in her search for warmth and comfort, she was determined to make it hard for me to type by draping herself across my arm.  These were, of course, work from home, bad hair day, haven't taken a shower yet, productive days.

She also started sleeping under the covers but by then was also so skinny that sometimes I had to lift the covers to actually find her.


Sunday, December 17, 2017

Triangle InfoSeCon - a (late) summary

Just a few thoughts on Triangle InfoSeCon 2017:
(and a record of sessions attended for CISSP continuing education credits).

A collection of available slides is at:

For the most part I got into my first choice of talks each session. At least one was full before I decided. While this conference has less tracks than All Things Open (at the same venue) it has only a few less attendees. The people to seat ratios mean that some sessions are very full.

Low Hanging Fruit – Protecting Yourself from Ransomware by Being Brilliant at the Basics (Slides)
An entertaining speaker with good information but the all too common "too much info for the allocated time". I look forward to hearing from him again in the future.

The 3 Reasons Why Small Businesses Don't Have Better IT Security And Where to Start

The Machine Fights Back: AI and the Future of Cyber Defense (Afternoon Keynote) by Nicole Eagan - CEO at DARKTRACE
Fascinating implementation of learning patterns for each deployment instead of always comparing to a common and usually too generalized baseline. 

Basic Web Threat Hunting
You cannot go wrong with a reference to regex golf!

Recent Developments in the Law of Cybersecurity
I think this is was an update of last year. Not as much has changed but I do hope this type of talk continues to get offered.

Trends in Healthcare Information Security and Privacy - Panel Discussion
This ended up being more about Security IT in hospitals and such. Very informative on how recent FDA instructions impact the fight to get vendors to allow OS updates on equipment. However, I was hoping for some information about how trends are impacting the individuals and doctor-patient relationships. Topics such as the privacy of data collected on wearable devices and the risks of attack through pacemakers and insulin pumps.

I also stayed for the After Dark session to race a drone and do a little electrical work.

Or rather try to race a drone. I did get it to take off and cross the first low wire. I also managed to crash it once and flip it once.

The electronics session was hosted by Kramden Institute. They were testing a new class for summer camp. 

Save the date: Oct 26, 2018


ATO2017 - A (late) summary

Just a few thoughts on All Things Open 2017:
(and a record of sessions attended for CISSP continuing education credits).

This event - which happened way back in October - just keeps growing. It is already almost too big!

Sunday: I made it to the early checkin and social in the evening. The location for the social is a cute place. It hosts local art and for the October dates, some spooky themes. Many thanks to Red Hat - specifically the Red Hat Open Source Stories team - for the sponsorship. I am not sure how many people realized that their videos (which are amazing!) were running on the TVs around the space.

Monday: After scoring a pair of socks from, I focused on the Security track with the following sessions:





I also attended one security related talk from the DevOps track:


Chatter on twitter was coming mostly from the the community track which was nice since those talks always have some good stuff in them but I would have liked to hear a bit more about the other technical talks I was skipping. That is the problem with SO MANY tracks. It can be hard to choose where to invest your time.

Tuesday: I attended a couple talks in the Education track and explored the hallway a bit. Unfortunately one of the talks I had to leave due to asthma triggered by (chemical) cologne worn by another attendee. I never really got to feeling all that great the rest of day and headed out early to go home.



I was also asked about the Fedora branded long sleeve white button up shirt I was wearing.  Info is here:

Some slides from the conference are posted at:

A comment on the focus and participation.
I overhead a conversation at lunch one of the two days that despite the name of "ALL" things open, this conference was very developer focused. I think that is and always has been  the intent of this conference. The person who was a bit disappointed is more of an admin and ops person.  I do remember having a few more interesting admin and community options in previous years but that may have more to do with what I was looking for those years. Also this year was in competition with a big conference in Europe that altered the attendance some. This is not necessarily a bad thing. Seeing the same people at all the conferences can result in really good talks by experienced presenters but it can also mean that there is not enough growth and encouragement for new talent in the industry.

As long as this a local, low cost, and fits my schedule, I will continue to attend and offer to speak. Even if it is more developer focused than my usual activities.

Save the dates:  Oct 21-23, 2018.