The Affordable Care Act…included provisions that tried to keep insurance companies' profit margins in check. The "medical loss ratio" said insurers had to spend at least 80 percent of what they took in from premiums on medical care. That sounds like a good idea, because it limits ridiculous administrative costs and profit margins. But it also contributes to rising health care costs. Insurance companies like to say their profit margins are small, and that may be the case. But their duty and obligation are to make the company money, not save yours. So let’s say they just give themselves 3 percent profit. In that case, the company increases its revenue by spending more.
Tilting At Quixotic Mailboxes
2021-10-05 22:16
Biking to the skating rink today was actually the first time in a few weeks (since 2021-09-15) that I’ve biked or skated at all. This is because of a nasty incident I had jousting (without a lance) against a mailbox which was stupidly placed between the road and the bike path I was cycling on. Cycling at full speed. While I was extremely lucky to survive and even ride away from this event (barely), this collision required some astonishingly bad luck.
There is an image of the enemy mailbox. The green line represents the path of the rider who had passed me — not a common occurrence, so he was going pretty fast. I wasn’t right on his wheel but I picked up my pace to match his and rode several bike lengths behind him for a pretty long stretch. I know this route well enough to know that my turn off up ahead is inaccessible from the bike path when it once again separates from the road. Here where it is joined is where I must cross the street. I looked back to check for traffic — all good. I looked forward, started my move, and… mailbox. What. The. Fuck. A mailbox?! The guy ahead of me — riding sensibly — had just perfectly eclipsed the mailbox with his body and the post with his bike. I had a driveway’s width at 20+mph to do some self-preservation. I did manage to save my bike but I couldn’t shift my own mass to the right fast enough.
I’m pretty lucky to have survived and without a trip to the ER. But you don’t rip the door off a metal mailbox with your pelvis without some damage. It was my wrists that were most seriously injured; I think I led with my right palm and back of my left forearm.
While skating and biking are not a problem, even a light fall could be catastrophic for my wrist. So I dare not (until today). Very frustrating. Not exactly an ideal time to be trying new exotic skates, but I couldn’t resist. I actually wore all my ice padding today and was actually just taking it very easy.
But I mention this incident because it was an extreme example of how shit happens. I wouldn’t trade mailbox dodging skills with anyone and yet here we are. That mailbox was very badly placed and I think it was a real long shot that I got caught by a perfect storm of compounding issues (another one would be riding at night - I don’t even want to think about that). This may be the most extreme weird freakish bad luck event that has happened to me on a bike. Let’s hope this is a less than once in a lifetime kind of thing.
New Ice Skates
2021-10-05 16:52
I told you about discovering the very nice ice skating facilities within convenient biking range of my house. And then having the place immediately close because of The Plague. And then returning to it this year when it reopened and really enjoying it. Then I started looking into ice skates that were not so hockey-specific which got me mixed up with impressive speed skating people.
It turns out that you don’t just pop down to Walmart for fancy speed skates. Even the hockey shops here (yes, that’s a thing) are clueless about the entire sport. After months of research and struggle in pursuit of better skates, I have finally achieved success. I now have proper skates that are right for my skating.
The Bont carbon fiber boots are super cool. And, importantly, they fit. (For future reference, I wear 8|41|272mm in this brand’s weird sizing.) So I’m pretty happy. The boots are Dutch orange, but the frighteningly sharp 16.5" blades are actually made in Holland from Sandvik 12C27 knife steel. These skates are awesome and I’m delighted with them.
One slight annoyance is actually quite interesting and, fortunately, quite fixable: the blades are bent. This is deliberate so they more easily make severe left turns. Serious speed skaters only can skate in counter-clockwise circles. The concept of skating clockwise to them is strange — no competitions are like that, so why would you ever want to do it? Well, I’m not racing anybody and my skeleton is telling me that overcooking one side of my body is probably not the smartest thing I could do. The whole idea of an old man skating at all is sketchy enough. I come to this with a lot of in-line speed skating experience so my ability to turn right is probably my strongest skill for someone who owns ice skates like these. It turns out there are special bending jigs that can straighten them back out (or bend them more).
Here is a video of me trying them out today for the first time.
It was a good day to play with them since I had the whole rink to myself. A great day!
Computer Graphics Contest Tips
2021-09-15 10:18
As yesterday’s post explains, I have just spent way too much time studying the 1900 videos submitted to the Dynamic Machines Computer Animation contest. All of this has given me some ideas about strategic approaches which I will share here.
Specific To The Dynamic Machines Event
I’m going to start with some tips specific to this recent contest. Although this advice is too late to be helpful here, it may translate to other projects and may be worth noting.
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Do not hide the ball! If the main character goes into hiding it is hard to follow along.
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Do not teleport the ball. If you absolutely must, give very obvious cues where to look. Seriously, giant glowing arrows would not be overdoing it.
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Do not have a mismatched environmental HDRI (high dynamic range image) reflection on the ball. There were so many indoor and underground scenes with reflections of a bright sunny desert or something equally absurd.
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Even worse, the reflection should not roll with the ball. This actually takes extra work, but it happened.
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Lens flare might be a bad idea. If the camera is being controlled by the organizers, it’s risky to meddle with it too much. Similarly depth of field adjustments are possibly effective, but must be used carefully for a project like this.
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If you are an organizer, don’t make the video hard to find by calling it, and I quote, "Jaw-Dropping Collaborative 3D Marble Machine!" We were given a chromium ball, not a marble!
Any Computer Graphics Event
Ok, that event is in the past. Moving on. These tips apply to any computer animation project.
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If you can competently throw in some live action video somewhere, it does usually produce good effects. Green screen work, inset screens, anything. (e.g. 1:50:18=waterfall)
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Do not use gears! As an engineer and good friend of a gearbox designer, this was painful. I know a lot of people think everyone loves the steampunk look, but consider how the originality will suffer. And unless you know what a contact line and a trochoid are, avoid gears specifically.
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Anything with the Blender grease pencil will be extremely unique. If you’re good at it it might even be easy and extremely effective.
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If you’re going to randomly download an asset jumble make sure scales and poly densities match. Ask not what your random collection of assets can do for you; ask what you can do for your random collection of assets.
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A well thought out water, smoke, particle effect is good. Gratuitous use is not so good. A random collection of your software’s physics effects is like a jumble of random assets; maybe if you had an "effects shop" theme it could work, but you need some very good pretext to do that.
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Make sure the scales of everything make sense. This includes textures and models. For example, don’t have woodgrain rings that are bigger than another entire wooden artifact.
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If you make a wooden board, the endgrain must at least be different from the face. If you’ve never used any kind of saw to cut wood in your life, best to stay away from wood textures completely. And don’t just wrap a random scene in "wood" texture and expect that to be sane.
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In general, be careful texturing implausible shapes implausibly. Think about the necessary thickness of whatever makes that texture. In the last contest I saw things like impossibly thin wood ramps, and curved bricks curving down the exit hole.
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Try to use Eevee (a Blender rendering engine) if you can. If you must use Cycles (the other Blender rendering engine), make damn sure you don’t have what I call "Cyclesburn". If you can’t tame the noise issues, best to just plan your whole project around an engine that is orders of magnitude faster, and use that speed to iterate to success.
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Bright scenes render better (e.g. less Cyclesburn) than dark ones all things being equal. They are easier to see in various compromised conditions (scaled down, on a phone in sunlight, skipping frames, poorly adjusted monitors, etc.).
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Subtle changes to HDRI environment textures are surprisingly important and must not be neglected. Compositing can also do amazing things and should be explored.
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Avoid obscure references. We referenced classical art which one might assume would be a "classic", but no. Universal themes work best independent of any other zeitgeist, locale, aesthetic, brand, IP, etc.
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Are you recreating a video game or an animated movie? Make sure your scene is much more interesting than simply playing the original.
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CGI is vector based and can scale infinitely. This makes it tempting to create a grand scene that realistically doesn’t fit and then try to cram it all in. Make sure your scene fits your ultimate resolution comfortably. You should imagine that people will be viewing the work on much worse resolution screens (phones, small browser windows, thumbnails, etc.) Test this.
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Make sure your action fits into the frames you have. If your plot is too complicated, it will move so fast people will not be able to follow.
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Surrealism today takes more than it did in the past. When Dali painted a jumble of assets together on a canvas, it was amazing; when you do it in Blender, it is tedious.
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Don’t just put one tiny surreal detail into an otherwise prosaic scene. That’s not surrealism, that’s a mistake.
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"Sign" your work somehow because the organizer may do a shit job of labeling it and letting others find your portfolio if you and they are interested. QR codes can be ok. If you don’t want the internet actively finding you, consider leaving evidence that you specifically created the work and not someone who stole it and claims you stole it. In ours, for example, the two broken wheels at the bottom of the frame make the letters "e e".
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When you can subtly put a Blender logo or Suzanne head or computer screen with Blender or QR code to blender.org or donut (see 10503_stewart_n), it is good PR. Remember we are Blender’s PR department. Help out where you can.
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If there is a theme or point to your work, don’t hide it in the periphery. Make sure it’s obvious. Make sure it’s obvious to people who aren’t knowledgeable about your theme. "Insider jokes" are probably not worth the effort.
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If you stumble upon a very cool effect that you want to base your whole scene on, come up with a new concept that makes it work; don’t just show the random thing randomly because you can. For example, you should refrain from including a random cloth wall hanging that you got from the most basic cloth tutorial. That kind of thing just draws attention to the fact that elements in the scene are not well integrated.
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Avoid animating by hand anything a professional studio would insist on mocap for - it will be very hard and it will probably not look great. If you can get high-quality custom mocap animations, that can be quite powerful and distinctive. Most modern professional computer graphics animations are still done with actors. Because of the Laundry Problem animating a robotic version of anything will be more effective than a natural creature.
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If you’re nabbing random image texture assets make darn sure they have the resolution to support your scene without dropping into a pixelated mess. And I pray that the person who left the stock-photo watermark on their project, did so ironically.
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Don’t listen to me! Study the thousands of entries to previous contests and come up with your own set of rules that you yourself discover are important.
Dynamic Machines CGI Contest - Opinions Of Random People
2021-09-14 22:50
As you might recall, back in July EE and I worked very hard to create a unique and high quality submission to the Dynamic Machines computer graphics animation contest. Our web site for that is here.
After several weeks, the "results" were finally released. They were kind of disappointing as we knew they must be. The problem is that instead of being judged by a panel of computer graphics experts, it was judged by one guy whose opinions mostly do not match mine. I’d say that to reliably make a random judge’s top 100 list you really need to be in the top 20 overall as judged by a group of experts. In other words, to ensure getting picked, you must have a project so outstanding that nearly everyone considers it universally brilliant.
There were definitely twenty projects much better than ours! As you might expect, I thought that our project was pretty good, but of course one never knows how some random guy will feel about it. And we still don’t really know; we just know it didn’t make his official "top" 100. Putting our project aside (maybe it was #101 or actually terrible, doesn’t matter really) what I was really disappointed with was how many amazing and deserving projects were overlooked and basically thrown in the trash heap. This did not seem cool to me.
To honor and learn from all the amazing artists who participated, I set out to properly look at all of the entries and make my own decisions about them. With 1900 submissions, this was a much bigger undertaking than I had imagined. And in the end we just have another random guy’s stupid opinions. If you participated but I didn’t highlight your entry, don’t feel bad — these were all of such quality that I’m sure you’re on someone’s list of favorites.
As much as I really enjoyed working on our original submission and seeing all the entries, there was a ton of room for improvement in the contest format. Such collaborative events are really cool and have so much potential but I was very annoyed by many details.
First, there should be better exposure for some of these really great projects. I don’t know exactly what the answer is. Maybe some kind of subcategory awards. Maybe by country or state specifically. Maybe give some attention to the top 200 or top 500. Obviously some kind of community voting mechanism would be ideal — maybe give each person who submits a valid entry 10 votes. And for all 1900, it would be polite if the artist’s contact information (generally a link to their portfolio) was conveyed just as they are for the chosen 100. There are some entries that I’d love to contact the artist and congratulate them on an amazing entry and ask how they did it, maybe see their other work and help out their stats.
The obvious improvement is to have a panel of judges. To have one colorblind (not even kidding) guy with three whole years of experience saying what’s good as the voice of the whole CG community is probably not ideal. And this is a big deal. I noticed that this "top" 100 video was being recommended in all kinds of diverse places. It currently has over a half million views and will probably just keep accumulating hits for years to come.
Speaking of YouTube, that platform is not necessarily ideal. I ended up downloading the entire video (hint: youtube-dl is great). That allowed me to get full exact native resolution and consistent full frame rates — that makes a huge difference! These scenes are packed with underappreciated details that YouTube’s rough handling can obscure, especially if you’re watching it scaled down.
The soundtrack of the compilation videos was a crime. We mourned the life-hours lost by so many artists who lovingly enhanced their projects with a soundscape only to have it obliterated by the abject stupidity of the organizer. This is inexcusable and I’m not happy about it. I suspected when I worked on my sound design that this would happen and it’s not so important for our project, but there’s a whole category of musical scenes and the music has been replaced with something completely wrong and awful. WTF was he thinking? Note that the same organizer who ruined these entries was the same guy who said, (and I am quoting verbatim) "Sound design is highly encouraged." Why do that? Super uncool. I had to mute the whole obnoxious thing it was so terrible (the hot key is "m" in a Youtube player if you need it).
In my opinion, the whole concept of a ball rolling through a Rube Goldberg contraption was set up to be somewhat boring. Ten scenes of that might be cool. Twenty tolerable. But we’re talking about 1900 here, 3.5 hours! Thankfully the massive creativity of the community mostly rescued it. I wasn’t the only one to feel this way. There were about three entries that we very much liked that went through the whole Rube-Goldberg trope very classically staged, but then subverted expectations by having the contraption break and fail comically, illustrating how that was actually much more satisfying. (e.g. tom_d 0:29:06).
Beyond the obvious and somewhat reasonable cliche that the organizer envisioned, I was surprised by how many weird tropes emerged. If your entry included one of these, it could have been brilliant in every way except for one: originality.
The first weird tropes were from video games. In our project planning, I personally thought of Donkey Kong but quickly dismissed it as too obvious — it turns out, correctly. Minecraft will always have a mob of enthusiasts (I’m one) who will craft something in that theme. But the one I found really weird was Portal. Portal is a fine game, but somehow it caught the imagination of many artists who thought this project’s concept reminded them of Portal. I found those entries to be generally confusing to watch. If you’re going to use a video game (including Legos) theme, you need to make sure it is more interesting than just playing the game! It does not seem wise to compete with the likes of Legos and Disney.
Here are some other tropes that emerged that I noticed: bathrooms, showers specifically, kitchens, fridges specifically, pinball, claw machines, ferris wheels, rope bridges, balls fired from canons, lab experiments gone wrong (e.g. 0:45:18 john_w), alimentary tracts, basketball hoops, ball heating to glowing red or melting, ball inspection, desk tableaux (especially a character interrupted at their desk), parking garages, the internal components of desktop computers, and ants.
Some of these were just fine. The ball inspection scenes for example, were almost all extremely well done. Some common themes surprised me, for example ants, because I would have thought that was a safely original theme. However, even we considered it.
I’m sure the people who stuck an eyeball on the wall thought that was very quirky and unusual. I actually liked the effect (as when I first saw it in the early 1990s with unix’s xeyes) and most of those entries were high quality, but, uh, nope, not as unique and creative as you might think. That was done quite a bit including by the entry that won the over all grand prize! (Ahem.) Can you identify it?
Many projects featured random assets downloaded from somewhere and some started to become familiar. One that stood out to me is the nixie tube; I may be the only person involved who has actually used old equipment with this numerical display technology.
Speaking of antiquated people and technology — the gears!
I counted 126 projects using dysfunctional or mostly pointless gear trains. There were some decent ones though, for example: 0:37:25 sajith_a and 2:28:55 jose_a.
There were also rendering style cliches. Neon was the big one - it is simply so damned effective that it is massively overdone. Brass and gold metal were everywhere reminding me of the materials available to rendering engines of the mid 1990s. The same with marble and granite.
Legos were also a very common trope both as a theme and, I think when properly considered, as simply a rendering style. Many of the Legos projects had nothing to do with Legos the toy. They just were random scenes rendered in Legos style.
My least favorite common theme was personally pandering to the judge. I
understand that maybe he has a legitimate fanbase who are excited to
promote his brand and the contest itself — just as I was happy to see
entries that gave a deserved hat tip to
Blender. However, I can’t help but feel that
by putting his image and branding in their projects it seems like an
effort to curry favor, which seems a bit cheaty. (An egregious example
at 00:33:33.) Also bewildering and disturbing were the ones featuring
outright product placement. What’s the deal with the advert for a
telephone brand at 0:37:24? Then there were ones that might have been
just favorite brands of the artists so I’ll just try to ignore them
(1:44:11, 1:19:10, 3:11:33). Seriously, using youtube-dl and
skipping ad interruptions kept me sane.
One trope that I expected turned out to be completely missing: the Loc-nar! It is incomprehensible that a huge cult movie (that inspired the recent Emmy-award-winning brilliant Netflix computer animation showcase, Love, Death & Robots) got not a single reference as far as I could tell. That film from 1981 (the same year as the highly represented Donkey Kong) was Heavy Metal. In that movie, the binding theme was the antagonist, the Loc-nar, who literally is a sphere which passes through disparate animated scenes. I thought it would be done to death! (No pun intended there.) Not even a Heavy Metal pinball machine! Well, one project at least gave the ball the Loc-nar’s character!
Well, that’s about all I have to say/rant about the contest such as it was. Instead of immediately sending you off to the official videos I wanted to do something hopefully helpful and interesting. I went through the full set and highlighted entries I personally found interesting and worthy of attention. I then wrote a program to allow me to extract its middle frame. I then spent way more hassle than I’d planned and created a web site to show them off.
Given the tricky portrait orientation, it’s hard to figure out how to best display these, but my goal was to let you see the full resolution. If you’re using a monitor that is less than 1920 pixels tall, you may want to open this in a new window and resize it to be tall and narrow until it fits on your screen. If you have a big (4k+) monitor, it should be fine. Note that there are previous and next buttons below the image. I put them there to keep them out of the way in case the image was just barely fitting.
These are in order of how they were presented in the main full video. After rewatchting the 100 video, I found some more that I did think were deserving of the attention they’re going to get — they are at the end.
Anyway, I found it very useful to study these still shots from the scenes. If any are intriguing you can open the main video cued to that entry with the linked timestamp in the upper left.
Open a new tab and check out my web page highlighting and annotating my favorite entries.
Note that I really do think all entries were fantastic. The amount of talent on display here is astonishing. I had some heuristics that I judged from (e.g. the somewhat objective property of being unique) but that’s just my opinion. Your opinion might be quite different from the organizer or mine. After looking through my still collection, I encourage you to watch the whole thing. I would strongly advise starting in the middle, not the beginning. This will let you skip over dozens of repetitive video game recreations and get to some more diverse stuff. The 2 hour mark is a good place to start. If you manage to make it to the end, start at the beginning and watch the rest.
Here is the main URL for the official video of all contest entries: All 1900 entries 3.5 hours!
If you finish watching all of that and are really curious which ones the organizer picked, you can find out The 100: here.
I spent a lot of time working on our entry and also studying the other entries. So much time that it is a bit unnerving. However, I must say that I have learned an incredible amount from this experience. Scrutinizing hundreds of very high quality scenes has been very educational. I don’t delude myself about my chances of ever putting this knowledge to professional use, but I enjoy this kind of artwork so much that it has been totally worth it just to improve my skills recreationally.
I remember when I was in high school, I went down to the local university’s art school to see a screening of a short collection of a handful of computer generated animation videos — maybe it was a SIGGRAPH thing. It was definitely mind blowing state of the art. We got to see maybe 15 minutes of computer animation at a time when having any kind of image on your computer meant painting it yourself by hand. I was absolutely blown away and I remember thinking that was the kind of future I wanted to be a part of. Now I am!
Review: Never Pay The First Bill
2021-09-09 15:36
I do not understand horror movies or novels; they make no sense to me. I enjoy fiction because my time spent with it is enjoyable. If the horror genre and being horrified is somehow enjoyable to people, why mess around with fiction? Real life far exceeds the imaginations of fiction (like this example and another). Well, this book by Marshall Allen about the unsexy topic of medical billing is firmly in the "true horror" genre.
Some might wonder why would I read this kind of book? I am not paying any medical bills at the moment and historically never have. (I actually want to get this back to the library ASAP so it can resume helping its real target audience.) For someone not staring down horror genre medical bills this would seem kind of off topic. But just as the safety of nuclear warheads is not off topic for any human, medical billing is a grave topic that all Americans need to be facing squarely and taking very seriously. Sorry, it’s simply not optional. I spent months in college learning how to solve differential equations (without a computer!) and no one would think of calling that use of my time frivolous — taking a few hours to learn what I can about medical billing is by far a much better educational investment.
I’ve traditionally operated under the belief that medical billing is really quite simple. I have traditionally believed all medical bills were essentially identical. They ask you to pay a certain amount of money and my assumption was that the amount never changed. Whether you were getting a simple checkup or a heart transplant, the cost was the same: infinity dollars.
It turns out that simplification may have been a slight exaggeration. I was amazed and delighted to see actual finite numbers emerging from the medical industry’s RNG. I found encouraging stories like the one on page 192 about an incident that the author wrote about on Propublica.org — the title of the article says it all: A Doctor Went to His Own Employer for a COVID-19 Antibody Test. It Cost $10,984. Note that the materials cost $8. Frankly I’m simply relieved to see finite numbers such as 10984 and 8 involved in US medical billing. My mind is much more at ease.
(Actually there is one other kind of bill, for a procedure that my personal billing system codes as "The Washington". For that the patient pays zero dollars.)
Before scoffing at my conception of US health care, ask yourself what is the practical difference between a price of infinity dollars, and a price far in excess of all the money you will ever acquire in your life? None. My simplification is much closer to reality than it might at first seem. For example, one of the topics that is not discussed is a problem I typically find with "health" "insurance": the maximum coverage payout amount. I can’t remember the exact details but I remember it typically being in the $100k range which left me pretty nervous. My health care needs tend to run either $0 per year or $50 million for rebuilding all of my internal organs after getting smashed by a hit and run driver. One of the lessons of the book is that if you’re in the latter situation, you probably will want to be paying bankruptcy lawyers instead of your doctors. Sorry doctors, but you yourselves are ultimately responsible for this whole mess.
US "healthcare" is famously a big mess. Why we suffer this is somewhat mysterious. Yes, the US is backwards compared to otherwise comparable countries, but why? No one really knows. I personally believe that the 55% of the population having employer sponsored "health" "insurance" introduce a subtle well-meaning yet catastrophic bug into the entire system. If employer "health" "insurance" "benefits" were simply prohibited, health care would quickly become much saner.
People think there are two major groups in the US with respect to health care: people with insurance through their employer and those who don’t have that. But there are really at least four groups: people with employer supported "coverage", people paying for their own private plans, people who use the US’s perfectly ordinary socialized medicine (i.e. old people, veterans 34%), and the uninsured (8%). That fact that children do not have a basic human right to medical care is one of the most damning and embarrassing aspects of the USA.
Employers acting in good faith are in fact badly obfuscating any potentially sensible free market mechanism. The book hints at this (p133) as it highlights the counter-intuitive notion that your "health" "insurer" is actually not interested in making the system not terrible.
Gosh, that’s hardly ideal. No matter. Fortunately/unfortunately, this is moot in a rich country. If someone tries to sell you a used piece of chewing gum, how much is that worth to you? Before you answer, imagine the someone — they’re chewing the gum, oh, and pointing a gun at your head. Ok, comrade capitalist, how much? I’m pretty sure the latest thinking in academic free market economic theory is still "your entire wallet, promptly".
Well, the medical business is nothing like that, right? No. It’s more like you’re trapped down a mineshaft with some poison gas seeping through a crack that you might be able to plug up with some used chewing gum. If negotiations with the gum chewer at the top of the mineshaft fail, it’s not like they murdered you. But do note that the price is likely the same: your entire wallet. Praying to the gods of free market capitalism will do you no good when one party has no freedom. This is a bigger problem philosophically than any simplistic quick fix or blame game can address.
So that mostly covers my personal misgivings about the medical profession’s serious structural defects when it comes to solving coordination and resource allocation problems. Moving on.
What can be done? What actionable advice can help limit the losses of these daylight robberies?
Right away the title provocatively suggests: never pay the fist bill. I didn’t get a strong sense that this involved some kind of law of nature or immutable code in some billing software. I think the idea is that if you get a shocking medical bill, question it, look into it. Don’t trust the medical profession to be looking out for you at all once you leave their presence. (Makes you kind of wonder about them the rest of the time, doesn’t it?)
So you’ve been hit by that car and are bleeding to death in the ER — one interesting tip is to amend the forms that establish your financial agreements. The book recommends to add the following text:
I consent to appropriate treatment and (including applicable insurance payments) to be responsible for reasonable charges up to two times the Medicare rate.
If you’re still lucid enough to get all that right, having done that can be a very helpful move in the case of disagreements later. And what are the hospital staff going to say? "Oh I’m sorry sir, could you go bleed in the parking lot until you’ve agreed to let us charge infinity dollars for your treatment"? Actually, don’t answer that.
Another good tip is to be super vigilant and diligent about getting all billing codes. You know how some people check their receipt as they walk out of the grocery store? You need to do that live while you’re conscious constantly in medical situations. These "billing codes" refer to CPT codes or Current Procedural Terminology. Some specific resources mentioned were FairHealthConsumer.org and HealthcareBluebook.com to get an idea of what health plans are paying for various services. Also, don’t assume an "insurance" plan covers the thing you need!
Another tip is to avoid hospitals. Obviously you’re doing your best to not need any medical care ever, but hospitals in particular are apparently especially expensive. This applies to labs and facilities associated with them.
Oh, and if that car has smashed your collarbone, do not get into an ambulance; get back on your bike and ride to the nearest medical facility that is not a hospital. (Actually with a collarbone fracture that’s still somewhat intact, you might want to follow my example and just ride back home — there was nothing the medical profession could have done for it besides torture me with forms, waiting rooms, nosocomial infections, and bills.) The book affirms the dystopian situation with ambulances that John Oliver covers better here. Not assuring care for sick children is a hallmark of an evil population; not making ambulances a free public service is the sign of a stupid one.
If you must be at a hospital, check to see if they are complying with federal regulations to post their prices. Apparently many flout this legal requirement — which is frightening. What other public safety requirements do they also feel are beneath them?
The next messy topic relates to your "health" "insurance" if you’ve got it. Much of the book is really just making the case that in many situations "it’s actually more expensive to have insurance than it is to not have insurance." (p144) An example case is explored on p145 where a woman cut herself in her kitchen and went for three stitches at the ER. The "insurance" rate was listed as $5805 which is what the woman and her "insurance" company had to pay. The cash price on that exact same thing was listed at $257.
What’s going on with that? Well, that’s related to the insurers making more money when they process bigger bills. This is why dentistry, cosmetic surgery, and veterinary medicine are so reasonable by comparison. Not only that, but there is plenty of billing fraud. The title on p203 sufficiently describes a fact that is later more carefully detailed: "It’s just not worth it for your insurer to ferret out fraud". Again, they don’t want costs and transactions going down, not from a rational profitability perspective.
Always ask what the cash price would be for the service, even if you have "insurance". It is often a much better deal. If you’re not going to come anywhere near your deductible (which are often very high these days) it is often best to pay cash, even if you are "insured".
For drugs, GoodRX and Good Shepherd Pharmacy are specifically mentioned as some kind of drug dealers who are not quite part of The System. It’s confusing, and I avoid magic beans so I’m no expert, but if you think you need some and your "insurance" seems way out of whack, these specifically mentioned resources may be worth a look.
There is a whole section in the book designed to help small employers navigate the funhouse mirror version of distorted capitalism that is "health" "insurance" brokers. Seems these brokers have a big misplaced incentives issue. Shocker! I didn’t pay super close attention, but it’s there if you need it.
What’s crazy is that I read this entire book on the topic of not doubling your medical calamity with the iatrogenic costs, and yet I get the feeling I just scratched the surface. Still, my chance of barely surviving a serious car wreck is far greater than encountering a pressing calculus problem which I have, in theory, spent years preparing for. So reading this book was probably time reasonably well spent. Let’s hope I’m never forced to learn more while down a mineshaft, at gunpoint.
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