Big Scary Health Insurance Pitfall

Friend-of-the-Slog Paul Trapani points out a little-known health insurance pitfall contradicting my assurance in yesterday's posting that a plan's maximum out-of-pocket "is the point where your insurer shuts up and pays. Forget coinsurance, copays, deductibles, etc.; the health care system opens up and saves your ass from potentially infinite expense."

First, one note: not one of the Affordable Care Act plans in NY state include any provision for out-of-network treatment.

There’s a potential gotcha with “out of network”. I don’t think the maximum out-of-pocket applies there. You can obviously choose in-network when it comes to your personal physician and specialists, etc., but you may find yourself at an in-network hospital, being operated on by an in-network doctor and they call in an out-of-network anesthesiologist or other out-of-network-specialist. People have been hit with high bills because of it.

This can be extremely expensive, because out-of-network doctors never agreed to your insurance company's negotiated rates and can charge whatever they want.

In the event this happens to you, you have two plays:

1. Apparently insurance companies sometimes relent and pay.

2. You can negotiate a payment plan with the out-of-network provider, even if it’s a minimal figure like $20/month. They are willing to work with you out of fear that you'll declare bankruptcy, leaving them completely unpaid. Not ideal of course, but it’s something....

Psyching Out Health Insurance

After staring at Affordable Care Act plan choices for hours, and taking lots of time to parse wording and seek foothold on the actual decision points, I believe I've found the gist and uncovered the game.

This is deliberately confusing. It buries the actual decision point. Consider:

Deductible is 5500, and max out-of-pocket is 6550. This means "50% coinsurance after deductible" (e.g. emergency and hospital services) only applies between 5500 and 6550 in expenses. Up until 5500, you're paying in full. Past 6550, you don't pay a cent. So virtually all terms of the plan apply to the very narrow terrain between those points. So it's all misdirection.

Upshot: you'll pay some, one way or another, for all your standard health care stuff like doctor visits and prescription costs. You can't get around this. You might find a hugely expensive plan taking care of most of that stuff (there are no such plans in NY state under Obamacare), but premiums would be so high that you'll still lose in the end. It's like Vegas: you will absolutely lose in the end, so strategy, insofar as it exists, is entirely about setting hard limits.

Fortunately, Obamacare makes this aspect super clear, via "maximum out-of-pocket". That's the point where your insurer shuts up and pays. Forget coinsurance, copays, deductibles, etc.; the health care system opens up and saves your ass from potentially infinite expense. [UPDATE: Hmmm...maybe not. Definitely read this.)

And god bless Obama for making it so they can't cut you off for previous conditions or if your totals do get scary high. That's not a scenario most of us will experience, but it's extraordinarily relieving not to have to worry about it. Also: the exchanges are highly regulated, so the cheapest plan will keep you just as alive as the most expensive one. That's not clear at first glance, either. A lot of the goodness is baked in and not explicitly touted.

So...

Typical doctor visits and prescription charges are more or less set costs (a tad higher or lower from plan to plan, though you will never ever find one mis-priced to give you a break). Above/beyond that overhead you'll be highly vulnerable (in case of health surprises) up to the max out-of-pocket. All variability between ACA plans occurs in the subtle shadings within that vulnerability window. Which is to say, they don't really matter! What matters is your maximum out-of-pocket. So keep your eye squarely on that number. I did, and chose a cheap bronze plan from Oscar.

I'm shaving complexity here, but by no means implying that you shouldn't still study and compare coverage. For example, one important variable for me is the "gatekeeper" requirement. Oscar doesn't make you go to your primary care physician for specialist referrals (a huge pain).

Video Driving Games and Trump Scandal Hobbyism

When I was first learning to drive, I was also playing driving video arcade games. And one day while doing the latter, I realized something that made me gulp: since I was crashing frequently in the game, doesn't that mean driving's super dangerous?

The next time I got behind the wheel of a car, I shifted my frame of perspective, and imagined myself inserted into a driving video game. And I instantly realized: real world driving is really, really, really slow. Crazy slow! That's why people only rarely crash.

Driving normally doesn't seem slow. After all, it's ten times the speed of walking, and there are tens of thousands of annual fatalities. But cars aren't poised to kill you at every given moment, and that's because they're really, really, really slow...at least compared to driving games.

I've been flashing to this memory throughout the progression of the Mueller investigation. It's seemed like a relentlessly intense roil of activity; so many revelations, so many puzzle pieces endlessly being filled in. The Friday night news dumps. The indictments. The talking heads and their hot takes. I know people who've hardly taken their eyes off their iphones and TVs. They feel exhausted and aged by the speed of it all.

But it's an illusion. It's all been happening really, really, really slowly. All the fantastic reporting from WaPo, NYT and Daily Beast has been so minutely incremental that one has scarcely needed to read beyond the headline. A vanishing drizzle felt like a hurricane. You could spend all day watching cable news or digesting newspapers without aggregating much more useful new data than you could via a fast rake through a few smart Twitter feeds. The daily movement of the progress thermometer could easily be encapsulated within a few 140-character Tweets.

Take a James Fallows article that came out this morning: "Serving Trump Revealed Who John Kelly Always Was". I haven't selected some turkey to shoot at; it's a good article, well-conceived and well-written. But there's no new news, no fresh theory, and nothing not entirely understood by virtually everyone. The article could be boiled down to a single hashtag: "ETTD", the signature acronym of Rick Wilson, author of the bestselling "Everything Trump Touches Dies", from whence the acronym draws.

We've become so meme oriented that we endlessly re-wield the same bag of memes and feel expressive...and we endlessly re-consume those same memes and feel full. We keep sweeping the same pile around the floor. Very little's actually happening but we're plumb exhausted not by the speed or the complexity but from the sheer density of our own collective repetition. We're perpetually crashing from memey sugar highs augmented by the starchy ingestion of mountains of padding. It feels like the bracing rush of a car race though the car's actually been just barely inching along.

Some try to rectify the contradictory sensations by diving into minutiae. I know people who can name all the relevant Russian oligarchs; who've mapped the corporate spider web of Cambridge Analytica and mastered the time line of the Trump Tower meeting and its foreshadowings and after-tremors. These Trump Scandal hobbyists are even more frazzled - and hardly more clued-in, generally - than the rest of us.

The solution, I think, is to do precisely what weighty folks rails against: skate. Grab the minuscule daily bait in the form of headlines or tweets, swallow quickly, and move on to other life stuff. In so doing, you'll know 95% as much as the hobbyists, and what's missed can easily be filled in later when our First (Crime) Family is in orange jumpsuits and the networks produce slick retrospective overviews (which will have the added benefit of being accurate and thorough).


I made some of these same points 1-1/2 years ago, including links to the Twitter Feeds I find helpful.

Ricky Jay

I've been thinking a lot about Ricky Jay, who died last month. If you don't know about Jay, you absolutely need to. Start with the documentary about him, "Deceptive Practices" (free on Amazon Prime), move on to the New Yorker profile, and from there you have a world of books, films and videos to explore (as well as Jay's own web site).

You don't need my two cents about Ricky Jay. It would be ridiculous to try to sketch - to capture and circumscribe - a man who'd made an exquisite art form out of startled surprise. Lightning resists bottling. However, I will relate the most Ricky Jay-ish experience of my life. If I'd ever met Jay - alas, I did not - I'd have told him this story, and I'm certain he'd have loved it.


There was a "bookstore" in the East Village in the 80s called Harris Books. I use quotation marks because it was not, in fact, a bookstore. It was just this dude's apartment. His name was Harris, and he lived a couple floors above Kiev Restaurant on Second Avenue with his hippy British girlfriend and an autistic (or maybe I should say 'especially autistic') cat. If you rang the "Harris Books" buzzer, and he was at home, you could come up and hang out, and perhaps buy a book or two from his large-ish collection.

Harris looked a bit like Zonker, the character from the Doonesbury cartoon strip, and he was a real character. Once, I mentioned that I'd been hunting for a certain extremely obscure book. I was mostly just making conversation. The title was much too arcane to be found even in a gigantic bookstore. But as soon as its name left my mouth, he broke in and said "Look straight down." I did, and there it was. The very book.

I tallied the miracles. First, that he had the book. Second, that I was standing right in front of it. Third, that he knew that I was standing in front of it. And fourth (and perhaps most unsettlingly), while there were hundreds of volumes within my line of sight peering downward, something about his unequivocal command to "look down" made my eye lock straight onto that specific book.

Next visit, I mentioned another obscure book (different topic), whose title I'd forgotten. He asked me to describe it, I offered a vague few words, and damned if he didn't pull it straight off a shelf and hand it to me.

On the following visit, I'd planned to ask about yet another book in yet another topic, but when I arrived the title once again escaped me. "What's it about?" Harris asked. That, too, had suddenly slipped my mind. As I stood, sheepishly mute and struggling to recall, Harris walked to a shelf, pulled out a volume, and it was, somehow, that very book.


This was one of only a precious few times I've experienced a sense of heart-stopping wonder akin to the Max Malini ice block trick.

"Cornered Rat" Report #29

It's been a while since the last "Cornered Rat" report, back in October, when the phrase "cornered rat" found 123,000 Google search results.

It's now up to 144,000, a gain of 17%.

All "Cornered Rat" postings in reverse chronological order

Bagel Postscript

If you've heard the term "hand-rolled bagel" and wondered what that meant, the bottom photo on my previous posting is a great example. You can clearly see where the ends were joined together. A machine-punched bagel has no end (trippy....but also less delicious).

What the hell; I'll re-publish the photo for your convenience:

A Toasted Bagel Tutorial and Manifesto

This starts off about bagels, then blears without warning into something more broadly about toast. I was going to re-jigger it for consistency, but I really want to say both things, and it's my party, so I'll blear if I want to.

Much like my overwrought ravings about perceptual framing and karma yoga, it's just another poorly organized missive from an eccentric, enfeebled former writer, the poor dear!

Ok, cue the curmudgeonly, condescending food snob voice, and....go!


TOASTING
Every toaster has a hotter side, and the brown part of the bagel must face that side. You want the brown side thoroughly caramelized, its blisters well-crisped. The cut side is a more delicate matter. There is an extremely brief window where a wide diversity of toasty coloration and texture can exist. The outer rim has just begun to display a dark golden brown hue while virginal white wheaten patches still punctuate a fast-widening golden landscape. Wait another five seconds, and the entire surface will be browned, dry, monotonous. Pull five seconds too early, and there'll be little crunch or resistance (#resistance).

To zero in on that vanishing moment requires high-level attention-paying. As I wrote last year:

I've made toasting a spiritual practice, honing my tolerances to milliseconds, aiming to extract the bread at its peak. That's working out quite well, but it's just a matter of vigilance and commitment - of wanting it (watching me peer expectantly into my toaster oven, you'd think I was slicing atoms).

BUTTERING
You must commence buttering immediately, and work swiftly. You can't pause for an instant, because the surface is rapidly cooling and drying - i.e. becoming less absorbent. Soon, your buttering knife will kick up micro-powder from the desiccated surface (if you hear that awful scraping sound, you're too late), and the powder will settle back down and absorb the butter. Greasy grit. Awful.

You must strive for very thin yet very thorough coverage. Know that there's a theoretical limit to buttering thoroughness. One can never completely cover the surface without using huge quantities of butter. So one must triage. Darker ridges are the highest priority. Being more caramelized, they're more flavorful, so non-butteriness will stick out more than with butterless gaps in milder, breadier portions.

There must be no pooling of butter. I understand the French aesthetic of bread-and-butter (i.e. tons of the latter), but a bagel - a homely, sturdy carb bomb - is no sophisticated Frenchie delight. A bagel is earthy, and whether you're a Hispanic Indian pounding out tortillas or a Japanese crunching through the rooty delights of kinpira, earthiness is something to connect with directly, and not to defile with reckless gussying-up.

Also: this is toast. Fresh bread can receive infinite butter while remaining bread, but toast absorbs, and no one wants to suck saturated pockets of liquid butter from their toast. Yuck.

This is more or less where it becomes about toast, generally. Hey, happy holidays, everyone! Be careful out there, and don't forget to tip your waiters! Ok, I'll let you get back to it...

The butter's nothing more than a necessary compromise to mitigate what would otherwise be unendurable blandness. So paint with your knife, rather than smear. Butter quickly, yet thinly, yet thoroughly, a devilishly tricky goal. In my fifth decade of effort, it still doesn't come easily. It requires inhuman commitment.


TIMING
If your first bite comes more than 10 seconds post-buttering, you've committed an atrocity. That hard-won diversified landscape of toasty texture is quickly stiffening into the inevitable end state of hard, dry unity; what industry types call "bagel rigor mortis". The clock's ticking, so you'd best be chewing.

If your ideal breakfast is to leisurely work on a crossword puzzle with periodic interruptions for a bite of toast and a slurp of coffee, for god's sake, find some other bready vehicle. Toast must be eaten not calmly, like a croissant, but eagerly, like xiaolongbao.


YOU'RE NOT RIGHT
I realize much of this contradicts widespread beloved life habits. But people acclimatize themselves to hideous culinary results all the time. The average American is perfectly fine with roaringly rancid nuts (e.g. 75% of the nuts in packaged foods like breakfast cereal or granola), and see no problem at all with "skunked" beer, where light's interacted with the hops through clear or green glass bottles to conjure up horribleness. We accept awful tastes out of habit, and toast is among the most grievous victims.

If you enjoy crap like Taco Bell, bless your heart. It won't taste any better if you're diligent, so scarf freely. Botched toast, however, is a crime, and a waste, because toast can be great.


SACRAMENTAL RELICS
Ok, cue the singing angels (and click, please, for full porn):

...and no, you can not have my bagel plates when I die. They will be shattered and buried, because I have looked long and hard but found no one worthy of the mantle.

Being Bob Hope

Whatever you do (assuming you think you're pretty good at it): if a total stranger stumbled across your most recent three efforts, would he find them impressive?

If not, regardless of your excuse (e.g. if they were just dumb jobs you essentially phoned in, knowing that'd suffice; or if it was a bad day; or if the asshole who hired you didn't want quality; or if you had life issues distracting you from doing your best work) then you might want to reexamine your self-image as someone-good-at-what-you-do. You have very likely fallen victim to a widespread virus that makes people forget that they need to actually be good to assume they are good. Not just once, at a fondly-recalled peak, but all the time...including right now.

I saw Bob Hope sporadically on TV for thirty years - from the early 1970's until his death in 2003 - without once so much as cracking a smile at a word he ever said. I sat through accolades and standing ovations, preenings and posings, and he was never, ever funny. It's not that he was in a decline - i.e. trying his best but simply out-of-date. He made no apparent effort at being funny, nor did he seem to care in the least that he wasn't.

He didn't need to be. He'd grown beyond it. He was Bob frickin' Hope. And that, alarmingly, appeared to be sufficient. A reputation for quality paradoxically supplants any obligation for quality. So if you want to be That Guy Who's Good more than you want to actually be good, there's no reason not to stop cold at that finish line and gloat amid the perqs.

Most singers become singers because they want to be singers, not because they want to sing.

When I finally saw some of Hope's old movies, they, unsurprisingly, weren't funny, either.

Pro-Bono Dignity vs the Condescension of Compensation

I had two friends over my house, served them delicious drinks, and drove them to a great obscure place for dinner and back. When the check arrived for our meal, and we all pulled bills from our wallets, one refused the $10 change he had coming to him. "Keep it!" he told me. " All the driving and hosting...!"

I, alas, couldn't conceal my indignant reaction (which he absolutely did not deserve; one of my several character flaws is a complete lack of 'game face'). "Ten bucks doesn't cover all that, dude!" I replied. To his credit, he thought about it, nodded slightly, grabbed the ten, and stuffed it in his wallet.

A lot of my seeming "generosity" stems from the disgustingly conceited conviction that my effort is priceless. 'For free' makes it a gift, and there's dignity in that. Turn it into a job, and odds are that I'll recoil from the inevitable condescension.

I remarked to a friend during my Chowhound slog that if I were being paid to run the site, and it was anything less than an absolutely obscene wage, I'd have dropped the whole thing in a hot second. Stressful 15hr/day/7day/week unpaid work amid abject poverty was preferable to the prospect of condescension.

I've been condescended to a lot in my life, and have become over-sensitized. I used to consider this evidence of my own roaring ego, but eventually discovered that I don't enjoy deferential respect much, either.

Working for free is always the next best option.


At age 21, I was the world's angriest street busker. When someone threw a quarter into my trombone case, I wanted to throw it right back at them. It's not that I expected them all to toss fifty dollar bills. I didn't know what I'd expected! I just sure as hell valued myself at more than a lousy quarter. And, to this day, I still can't unravel the knot. I see how my perspective is justified and right, and also how it's awful and wrong, but can produce no higher-level Slog-ish insights beyond reporting a deep, deep impulse to simply play, period, and let it be a gift. To let it all be a gift. It sounds kookily quasi-messianic, I suppose, though - at least when I think about it - it feels like defeatism.

It Will Be Totally Rod Blagojevich

I have a prediction on the Trump/Russia thing. I already essentially put this on record back in February:

...but let me solidify it.

The president has no strategy post-Mueller. His lawyers might have concocted a strategy, but they knew their client would just blow it up with some stupid tweet, so they've simply kept him out of Mueller's hot seat and gathered intel on the investigation via slimeballs like Manafort. And his aides haven't the slightest idea what he actually did, so they have no way of anticipating any end game. After towing the brainless, loud-mouthed "No Collusion!!!" line for months, that's all they've got. It's the facade, the building, and foundation. There's no other structure.

So just as dear, dear Rod Blagojevich indignantly and furiously insisted on his innocence of blatantly obvious crimes right up until his fate was sealed and there was nothing else to say, we'll see that Trump’s got nothing (or, as Giuliani might put it, "bupkis"). We'll hear incredible tales backed up with incontrovertible evidence from Mueller (or whoever winds up sharing/leaking Mueller's report despite Trump's inevitable effort to muzzle it), and there will no rebuttal.

Needless to say, there will be fire and brimstone, rage tweeting, random incriminations and deflections, and there might even be a tail-wagging war with Iran to try to change the subject. His base will stand with him, and as long as they do, so will the Senate. Impeachment is inevitable, but conviction is a very tough hill to climb. So I'm not saying the story will be over.

But mark my words: it will be utter anticlimax. He'll be even guiltier of worse deeds than we imagined, and that...will be that.