The GirlAlive Blog

About My Book

Okay, so I’ve referenced the book that I’m working on a few times here now, and now that I have nearly 20,000 words on the page I’m willing to go public with what I’m writing about.

Actually, I’m working on 3 different books, but the one I’m furthest along on, and the one I’m enjoying the most is a book written for Americans to explain the things they will find in Great Britain that will annoy, confuse or surprise them. I’m covering basic things like words that are different (like pavement instead of sidewalk), to how the government is structured, to which celebrities the British talk about that the Americans have never heard of. I’m trying to make most of it funny and light, a bit like my British Food web site.

I’m also planning to intersperse my text with famous quotes about Britain, and maybe some original illustrations. I don’t have a publisher. If there are any interested, let me know. If need be, I will self-publish. (The actual publication could still be a few years off, realistically.)

Also, I don’t have a title. If you come up with a title for me and I use it, I’ll make sure you get a free copy and a mention in the “thank you” section. If you can think of anything about the British that annoyed, surprised, delighted, or confused you, feel free to post it in the comments, or hit me up on Twitter or Tumblr. I’ve already done about 160 topics, but there’s always a chance I’ve missed something.

So that’s what I’ve been working on that has kept me from posting here and on my book review tumblr as much as I should. With the help of a netbook I can use while I’m still in bed, and my patron saint of writing, Neil Gaiman, I’m actually properly determined to finish this book and see it in print.

Why Health Care in America is So Expensive

To start with, let me give you an idea of my credientials in this area. I worked for a PPO network in the state of Washington for about three years. Then I spent a year working for a midwestern health insurance company. Then I moved to Scotland and worked for the NHS for a few years. I have gathered enough information at these jobs to understand why an aspirin from the drug store costs about 3 cents, while the same aspirin in a hospital costs $35.

When a doctor opens a general medicine practice, they go around to all of the major health insurance companies and apply to be a Preferred Provider. In some cases, if they’re part of a big clinic, that clinic makes them automatically signed on as a Preferred Provider. The Preferred Provider agreement that they sign with the health insurance company means that they promise to be generally a pretty good doctor, and in exchange, the health insurance company guarantees to pay them for their services according to a set fee schedule.

Let’s make up a doctor. Dr. Smith just joined up with SuperClinic, and so he is on a bunch of Preferred Provider lists. This means that he gets a ton of new patients and he is guaranteed to get paid by all of them. He decides that he wants to charge $50 for every 15 minute consultation. The fee schedule from the health insurance company will only allow him to be paid $40 per appointment, but that’s ok. He just writes off that extra $10 as a business loss, because as part of the Preferred Provider network, he can’t bill the patient for it. If a patient comes in without insurance, he charges them the full $50 and gets it.

A year goes by and the health insurance company revises their fee schedule. The fee schedule is set based on the average that doctors are billing and the health insurance company finds that doctors are charging more than $40, so they raise their rate for a consultation to $50.

Now Dr. Smith is getting a full $50 for every insured patient and $50 for every uninsured patient. He decides that’s great, but he could be making more. If he raises his prices, he gets to write off some loss from the insured patients, and get more cash from the uninsured. So he starts charging $60 per appointment. If you are his patient, and you have insurance, you never even notice that he raised his prices because your insurance company handles all that.

This occurs every year. Health insurance companies do not pay doctors based on the actual cost of providing services, but based on the average that doctors decide to charge. Doctors have figured this out, so most of them continually charge just slightly higher than the insurance company will pay, in order to ensure that they get themselves a raise every so often.

This same thing happens with hospital services. They started out billing insurance for the actual cost of an aspirin, but then found that they could get more just by telling the insurance company that it cost more, even if it didn’t. Whether they charge $0.30 or $30, the health insurance company pays it.

Because the health insurance company is throwing money around to doctors and hospitals, they have to charge their customers more. And refuse coverage to anyone who is likely to need to go to one of these expensive doctors or hospitals. It is a free market, so the doctors have the right to charge whatever they want, and the health insurance companies are powerless to say, “That aspirin didn’t really cost that much.”

This growing number of people who can’t get insurance end up having to pay the full price for a doctor (which is more than the doctor makes from his insured patients). Those people end up bankrupt from major medical expenses, or they end up chronically ill because they can’t afford a doctor. People who are sick can’t work. So those people end up on welfare rather than just getting the health treatment that they need in order to get healthy and get back to work. This effects the entire economy of the US. Fixing healthcare in America is part of fixing the economy in America.

In a government-managed health care system like in the UK or Canada, everything is cheaper. The doctors are paid a generous yearly salary, based on experience and education. The government pays all of the expenses based on the actual cost of care rather than based on what the doctor feels like charging. So it costs a fraction of what it costs in a free market system for medical care, and it is available to everyone, regardless of pre-existing health conditions.

The American health care system also has higher base costs due to the fact that in order to deal with all of the health insurance companies, clinics have to hire billing specialists, who are trained in filling out insurance forms in order to get maximum money. There is no need for a billing specialist or any kind of insurance specialist in a government-run system. It all runs together as one large government-funded corporation.

I’m not saying that government health care is perfect. No system is perfect. But government-run healthcare can provide decent health services to the most people for the lowest price.

UPDATE:
In light of the Occupy movements, there have been a lot of articles analysing who is in the top 1% of incomes in the US. People in the medical field make up about 15% of the “one percenters”. Not only are regular people being denied healthcare, but it is primarily because a portion of medical practitioners are grossly overpaid. So again, the answer to wealth inequality and the poor economy in America should start with complete reform of the health care system.

I think I just caught tuberculosis on the bus.

Okay, so it has always been my understanding that when you get on a crowded bus and you have to sit on an aisle seat next to a stranger, the polite thing to do is to move to a free seat when the bus empties a bit. The guy next to me on the bus today apparently did not get that memo.

He got on early in my ride (I think near the center of Edinburgh). The bus was empty to the point where I could see empty seats in front of me by the time we got to Cameron Toll. And still the guy sat there next to me. Coughing and hacking like he might have tuberculosis. Coughing into his hand, and then resting it on the back of the seat in front of him. By Straiton, my back was starting to seize up from being stuck in the same position for, by then, about an hour. I was actually tempted to turn to the guy and tell him that there are plenty of free seats for him to spread his diseases to. But I’m way too introverted to do that. Instead, I’ll just whine on the internet about how rude and disgusting he was. He didn’t get off until a few stops before me. I dread to think what kind of foul diseases he has generously shared with me.

And yes, I washed my hands a lot when I got home. A lot.

Plans and the absence thereof.

I haven’t been posting here. That is pretty obvious. I’ve been spending a lot of time reblogging stuff on Tumblr and sending out half-assed tweets, but I’ve mostly been laying low.

There are a number of reasons for this. First of all, I just don’t feel very witty or entertaining lately. I feel like anything I write here is going to be a disappointment after spending so long not writing here. And then it compounds the longer I fail to write.

I’m going to be flat-out honest about another reason I’m not posting here. Back in 2008 I left my job with the NHS under not very good circumstances. I had said some things about my job here that offended people. I also said things here that were in no way related to my job — in some cases written as much as 4 or 5 years before I even worked for the NHS — that was used against me in a complaint from my (now former) co-workers. So I am understandably wary about being honest on the internet. But enough time has passed now that I can be honest and mention that when I left that job, the boss basically threatened me and said that if I ever wrote anything negative about anyone working at the NHS again, she’d make sure I never got hired by anyone ever again.

So what has happened here lately? I got hired by a non-profit organization back in January, for a 6 month contract working in clinical trials. I worked those 6 months, and now I’m unemployed again, though I am working a few days this week at my old office as a consultant, to help them with a bit of a backlog.

During my time working there, we lost two of our guinea pigs. Elvis died from unknown causes. He lost weight and then eventually died. After he died, Fudge was distraught. He stopped eating and wasted away, dying about a month after Elvis. Apparently, Fudge didn’t know that it was time to eat if Elvis wasn’t there squeaking about it.

We are down to two pets. Spike is getting old. He’s nearly 6 years old, which is pretty ancient for a guinea pig. He never squeaks at dinner time. He hardly squeaks at all, so it’s been very quiet here. He’s developed an impacted anal gland, so husband has the unenviable job of cleaning out a smelly guinea pig ass every so often.

We still have our hamster Luna. She’s a terrible hamster. She bites and tries to escape and seems to be furious most of the time. I’ve never seen so much hate packed into such a tiny fluffy package. We can’t take her out and play with her because she has a taste for flesh. She doesn’t just bite because she is trying to figure out what your finger is. She bites because she knows it is your finger, and she hates you. We can’t even put her in a rolly ball thing because she can escape from them. Before we had Luna, I didn’t know that hamsters could hiss and growl.

At the moment, I’ve been working on writing more. Not here, obviously. But I’ve been working on a few fiction and non-fiction books that I’d like to write. So I’ve been writing about 1000 words a day, you just don’t get to read it. So far, we’ve been okay financially because I knew my last job was temporary, so I saved up a lot.

The plan is to move to the US sometime next year. Here’s the problem: I’m used to having a lot of paid vacation time, and basically unlimited sick leave, and free healthcare and a pretty good retirement plan. I’ve gotten spoiled living in Europe. I’ve gotten used to being treated like a human being, which is not really encouraged by American corporations. So I’ve looked around at jobs in America that have benefits comparable to those in Europe. So far the only job I’ve found is in Congress. So I might have to run for office when I go back to the US, because politicians are the only people in America who get the same benefits as average people in Europe.

Ambivalent

Most people think that “Ambivalent” means that you don’t care. What it actually means is that you have very strong opinions pulling you in opposite directions.

My plan right now is that my husband and I will move back to the US next spring. But I don’t want to. But I desperately want to.

American politics terrify me. American health care is appalling. But all of my family and friends live there.

I thought maybe if we just got a better house in Edinburgh. I looked at house listings. And I cried. The houses here are just so tiny and crowded and ugly.

If I stay in the UK I can’t have kids. I don’t have any working ovaries, so we have to either adopt or find a surrogate. I have no friends or family in the UK, so I can’t really get a surrogate here. And if I adopt a kid in the UK, there’s no guarantee I’d ever be able to move back to the US because that kid might not be eligible for a greencard in the US. Plus, I may not be eligible to adopt here because I’m fat.

So I don’t like the political system in the US. I don’t like the health care system in the US. I hate the weather in all the regions where my family lives. But if I want a house I don’t hate and if I ever want kids, I have to move there.

I wish I could just move to Canada. But we can barely afford immigration costs for my husband to move to the US. We really can’t afford for both of us to be immigrants.

So I’m torn, I’m confused, and I have no easy answers.

The 50 Things to Eat Before You Die

The British version of the food network made a special about the 50 top things to eat before you die. It was based on polls of the British public, and then there was commentary from British tv chefs. I learned one main thing from this special. The British don’t know squat about American food.

One of the chosen foods was “Barbeque”. I have to believe that that was voted in there by Americans living in Britain and British people who have been to America and who know what that word means. The “chef” commentators sadly had no clue what they were talking about. They went on and on about how they hate barbeque because it’s just good food burned outdoors. And every piece of food they showed was not barbequed, it was grilled. It was all charred over high heat. Which is not barbeque.

I’m not from the south. I’m from Minnesota, which is not a state with a long barbeque history. And even I know that real barbeque is cooked at a low temperature for a long time, more like hot smoking than grilling. If you don’t know what barbeque is, you have no right to say that you don’t want to eat it.

This isn’t the first time the British have shown that they have no clue about American food. I’ve seen countless tv chefs here making hamburgers that they describe as “American” burgers, and then filling them with breadcrumbs and eggs and all manner of crap and fillers. That’s not a real American hamburger. That’s a meatloaf. The only British cookbook I’ve ever seen that had a proper and authentic American hamburger recipe was a book by Delia Smith. In an American hamburger, the only ingredients should be beef, salt and pepper.

So I get hate mail from the British because I have come to the UK and tried the food and genuinely not enjoyed some of it. And these same people will criticize American food based on third-hand accounts of what American food is like, based on tv chefs who don’t know what they’re talking about. I’m very disappointed in the tv chefs of the UK. And I’m so glad they’ve started showing American food shows here. Maybe some of those chefs will watch a few and learn something before they start talking about American food.