By Dan Pool, editor
Sitting here with an $800 brace on my leg following knee surgery two months ago, I can offer firsthand perspective to a recent piece in the New York Times detailing the high cost of medical treatment in America.
The article, which mainly focused on colonoscopies, pointed out standard medical procedure in America is to go with the best option first and almost exclusively. When it comes to medical care a good-enough approach is rarely mentioned.
But, as America grapples with how intertwined health spending is with the overall economic output, valid questions arise of whether cheaper alternatives might suffice in routine procedures.
Consider some of the findings in the Times’ The $2.7 Trillion Medical Bill - Colonoscopies Explain Why U.S. Leads the World in Health Expenditures:
• International Federation of Health Plans, a global network of health insurers, found that the United States came out the most costly in all categories they monitor— and often by a huge margin.
• Healthcare is a $2.7 trillion annual industry in this country.
• A hospital stay in this country is roughly three-times as expensive as those in other developed nations (for the same length of time/same general services)
• Americans spend an amount equal to 18 percent of our gross domestic product on healthcare.
On a personal level, many of the factors cited in The Times described well my experience. For my knee injury, no consideration of price was ever given by the patient (me). As The Times found, with insurance, patients assume the costs will be covered by someone else so there is rarely any discussion of price or cheaper options.
Healthcare is the only industry where customers don’t universally consider cost at the time of purchase. In fact they don’t even see the bills directly if they have insurance, so they are in limbo as a disinterested third party while the insurer and the medical providers hash out the payments.
This was absolutely true in my case. In the first round, it’s up to the Progress insurance plan and Piedmont to sort through the numerous bills.
A point often raised in the healthcare debate is if patients were informed that their insurance may not cover some of their treatment or they were told cheaper alternatives were possible,would it affect their choices?
In my case, probably not. The orthopedic surgeon was confident in his diagnosis with the basic emergency room x-ray and didn’t order any additional tests/scans. However, had he felt an MRI was needed, as a patient, it would be hard to question a guy about to slice your leg open.
There didn’t appear any extra perks during the surgery day. Piedmont Mountainside seemed to process me through and get me out as efficiently as possible. Maybe a real miser might have cut out some of the precautionary work but for me there was no overnight stay, nor barrage of tests (other than a chest x-ray which was said to be standard for anyone having surgery).
Without lengthy discussion and education there was nothing I (as a basic patient) would ever think to question on price or options?
So we’re back to my $800 brace. The price of this was never discussed or mentioned until the bill arrived. I can think of no other incident in my life where I walked (hobbled) out of a place with an $800 product without knowing the price. Nor are there any other industries that will let a guy leave with $800 in merchandise without a serious payment discussion.
The brace might have been the one place, where I could say, “isn’t there something more economical?” If I were really hard up, I could have foregone the brace entirely in favor of two yardsticks and some duct tape I suppose.
For myself (and most people I suspect) even if the cheaper/lesser option is available, you really don’t want to scrimp on what will lessen your pain and support your healing most effectively.
There is no doubt a nationwide economic problem with healthcare costs exists, but from a patient’s perspective, cost cutting at the doctor may be as needed as a knee surgery but it’s likely to be just as uncomfortable.
Remember decades ago when teenagers used to sit on home telephones for hours each night talking to their friends? Then along came the internet and with it an explosion of ways to share your life without actually speaking to anyone.
First it was MySpace, then came Facebook and now there are scores of life-sharing apps available to our teenagers, who have become the most electronically connected generation of all time.
Today, Facetime, texting, and online photos are the way teens prefer to keep in touch. And there are some seriously cool tools to help them. A recent study found that 13 to 17-year-old boys and girls in the United States spend an average of two hours and 20 minutes a day online and 80 percent of that time is spent on social networking sites. According to the Pew Research Center, 86 percent of 15 to 17-year-old girls; 69 percent of 15 to 17-year-old boys and 38 percent of 12 to 14-year-olds have some type of online social media profile.
Regardless of whether we, as parents, like our kids being on sites like Facebook and YouTube as much as they are, it seems the trend is here to stay, replacing trips to the mall to hang out in person. There are advantages to online friends because teens can build social relationships and connect with people of shared interests, regardless of their geography.
Facebook has been the big dog on the street for years but for teens there’s a new crop of free social networking applications that can foster their creativity - whether showing off their newest “selfie,” musical or artistic projects, or their most recent vacation shots to friends.
With over 100 million users, Instagram is the most predominant teen app out there now. It touts itself as a fun, free, and simple way to make and share photos. Instagram, which launched in 2010, touts their app with its filtered effects and cropping tools as a way to “transform everyday moments into works of art.”
Like its owner, Facebook, Instagram’s live updates keep teens in the know on what their buddies are doing. However, unlike Facebook or Twitter, Instagram is a photo-only app that banks on creativity.
For teens who want to send their friends gifts, GifBoom is a moving version of Instagram that makes it easy to create animated photographs. Although some users say this app isn’t very user-friendly at first, moving Instagram-esque photos is pretty cool and worth figuring out.
For teens or adults who enjoy Facebook’s timeline, Path allows you to share almost anything - from your location to what you’re watching or listening to at any given moment. Path users can private message and chat instantly. Friends and family can “comment, smile, laugh, gasp, frown, or love your photos, videos, places, music, movies, books, workouts and more.”
Path, with its live updating, offers users a minute-by-minute timeline of someone’s day (for those who might be interested). The cool thing about Path is you only have 150 friends, creating a more close-knit feeling for many users.
Want to send a selfie that doesn’t stay in the cyber-world forever? Check out Snapchat with its real-time picture chatting whose messages disappear in 1-10 seconds after being opened.
Snapchat lets you take a photo or short video, add text or a doodle and send it to your friends to view for a set amount of time (1-10 seconds, your choice).
Once someone opens the pic, they have to press down on their phone screen to view the photo. After the timer is up, the photo or video disappears forever.
Snapchat creators say all the messages are deleted from their servers and the only way they can be captured is if the recipient takes a screenshot or uses an image capture device.
Regardless of which apps teens choose to communicate and keep in touch, there are lots of options out there.
There are good and bad effects for teens from social media but many psychologists who study these effects believe the positive benefits outweigh the negative ones, but parents should make an effort to ensure that the positives win out by monitoring your teens and their online activity.
Last Thursday the percentage of carbon dioxide in the atmosphere surpassed 400 parts per million (ppm) for a daily average at the National Oceanic and Atmospheric Administration station at Mauna Loa in Hawaii.
This is the first time that CO2, the most important heat-trapping gas, has gone over the 400 ppm level for a 24-hour period average since scientists began keeping records 50 years ago. CO2 levels have previously hit peaks exceeding that amount at the Hawaiian observatory and that level is reached in the Arctic, but this is the first time the daily average has exceeded that threshold, according to news reports of the event.
It’s important to keep in mind that the 400 ppm reading is just a number. It doesn’t directly mean anything in regard to climate change or possible climate change – if you are one of the people who worries about such stuff. Polar bears aren’t going to start drowning as the arctic ice melts and oceans won’t rise just because the number is now over a level that scientists have longed pegged as a limit we didn’t want cross.
Carbon dioxide levels are numbers just like blood pressure is a number or your weight is a number or the amount of cholesterol in your body can be measured and recorded.
You won’t automatically have a heart attack when you top out at 280 pounds on a scale? Nor are you guaranteed a stroke when your blood pressure hits 175/105.
Along these lines, cars don’t automatically fall apart at 300,000 miles; nor is coffee at $3 a cup a crime against humanity.
But numbers have meanings as measurements and the vast majority of scientists are concerned by the amount of carbon dioxide in our atmosphere.
If blood pressure/weight numbers are being read to you by a doctor who is also shaking his head and offering advice, are you going ignore it? Or would you scoff as it’s possible the science behind blood pressure and heart disease may contain errors?
Carbon dioxide levels may continue to rise and no dire effects occur, just like many people live long years wearing XXXL.
But the general consensus among scientists is that rising levels of carbon dioxide are directly tied to warmer global temperatures which will lead to increasingly unstable weather – such as the January tornado North Georgia had this year, plus longterm effects such as drought. This is not to say that global warming produced the winter tornado, but increasingly unpredictable weather is a consequence often tied to climate change.
Another sour note regarding crossing the 400 ppm threshold is it clearly shows previous efforts to reduce carbon emissions have failed. Everything from proposed government programs to letting industry take care of the problems has not produced any good news.
Like a dieter seeing the scale still going up after a month on a new regime, it’s time to take a completely different approach with reducing human-produced carbon dioxide emissions.
Throw the old cap and trade, new technology playbook out and start at ground zero -- find an approach that is tolerable to the public and to business.
Or then again, maybe it’s not necessary.
Maybe the 400 ppm level doesn’t mean anything at all. Maybe the conservative politicians are right and the scientists are wrong. We can always wait and see what happens. Of course by the time you are in the emergency room, it’s a little late to start eating lettuce.
Over the past two weeks, evidence has surfaced confirming what most Americans already know; the IRS is a great big mess.
Testimony on Capitol Hill as to why certain groups were targeted over their tax exempt status revealed not so much partisan leanings as a massive dysfunctional bureaucracy run amok.
While the Tea Party was prominent on the list of groups targeted, testimony and news reports revealed that the IRS had incompetently handled tax status applications for more than 400 groups, and that doesn’t include stacks of files that never got handled at all.
Unfortunately, the one agency every American deals with on a yearly basis is the Internal Revenue Service with their arcane forms, confusing directions, and incomprehensible communications all bound by a yearly deadline.
The problems behind the IRS are so vast and intricate, it’s hard to know what the overseers should do to clean up the mess.
But it is crucial that something be done to fix or replace this system.
Since the federal income tax came into being in February of 1913 with the ratification of the Sixteenth Amendment, the IRS has grown to collect over $2.4 trillion annually from approximately 234 million tax returns.
The rules governing how, when and in what amounts we pay taxes have grown consistently more complex and worse year after year, now amassed in a tax code of 4 million words.
It is exactly this byzantine system that led to the latest problem – not political ideology among tax collectors.
The latest federal snafu began with the Supreme Court ruling in a case now referred to as 2010 Citizens United, which allowed corporations and groups to spend money on political campaigns.
The ruling created a landscape where more money was pumped into politics, and it in turn created mass confusion for the division of the IRS that handles tax exempt status. This division had 200 employees but handled 70,0000 applications in the last year.
Former employees of that office who have spoken in the press have made two points: first, their division was considered a low rung on the IRS ladder and, second, many employees didn’t understand the new rulings and were not given guidance on how to handle applications. Allegedly they were supposed to wait on word from higher up tax attorneys, but that communication rarely occurred.
A story by NPR.org explained the determinations these employees were asked to make: “ In brief, there are three big categories of tax-exempt groups. Those under section 501(c)(3) are charities engaged in charitable work. They're allowed to do only minimal political activity. At the other end of the spectrum are Section 527 organizations. These are purely political and are required to disclose their donors. In between are 501(c)(4)s. They can do issue advertising and some campaign politics, but not too much.”
The categories, like the whole code, are too vague – requiring exactly the type of judgments we don’t want to see bureaucrats making. Tea Parties, for example, typically fall into the “social welfare” non-profit who can spend 49 percent of their revenue for politics. But the definition of politics is so nebulous that it requires a judgment call – thus requiring more information, thus allowing/requiring government employees to ask political groups to explain what they mean by “education on the Constitution.”
According to IRS employees’ testimony before congress, they weren’t interested in groups’ ideology when they sought additional information, but were trying to figure out which category they belonged in and if donations to them should be taxed. This is big business. In the last election cycle at least half a billion dollars was spent by these groups.
What needs to happen is, first, to clean up the mess in the short-term (get control over the agency and see that it’s fair and efficient). But more importantly is that our leaders finally listen to the calls for a completely new and simple tax system.
A tax system that the average American can understand and an average tax collector can process quickly is paramount of the needs of this country.
This week the U.S. Senate is expected to approve the Marketplace Fairness Act, which will force online retailers to charge state sales taxes.
While the most un-compromising, no-new tax advocates, including North Georgia Congressman Tom Graves, are opposed to this, conservatives with common sense are supportive, realizing this is about leveling the playing field between online retailers and Main Street businesses.
Graves released a statement saying that “States that want their businesses to be more competitive in the marketplace should engage in a race to the lowest tax rate rather than seek to level the playing field by imposing higher taxes and new burdens on competitors and consumers.”
In theory, Mr. Graves’ sentiment is great, reduce taxes. But in practice we’d ask how are states supposed to fund schools, roads and prisons? One day we might be able to do away with our own state sales tax, but until then, we advocate for seeing that Main Street businesses are treated fairly.
From our position at the Progress on Jasper's Main Street we can't see any reason that Amazon.com with its billions in revenue shouldn't pay the same taxes as Jasper Drug Store or Coco's Cottage.
Originally internet retailers were let out of collecting sales taxes in states where they didn't have a building by a 1992 Supreme Court ruling. The sentiment at the time was this perk to online businesses would foster growth in e-commerce (obviously this worked) and also that internet retailers wouldn’t have to pony up to maintain schools and roadways in places where they don't have any physical presence.
But a lot has changed since then. Now, it's the businesses with brick and mortar that need a boost. For higher-ticket retail items people are aware you can go to a store, test a $500 item, get advice from a salesman face-to-face, then go home and order it online to save 4 percent by not paying (Georgia) sales tax. It really isn't fair.
A lot of online businesses offer extremely low prices. In addition to not charging sales tax, they cut costs by not employing our neighbors here in Pickens County, nor do they support social groups, church choir trips, youth sports or give out candy to kids at Halloween. They do lobby in Washington, however, which may explain the warmer feelings regarding them by lawmakers.
Not only do we encourage our congressional members to support making these online companies pay the sales tax, we also encourage our readers supporting local businesses directly, by considering all the advantages they offer us in Pickens County, Georgia -- even if a cheaper price can be found online.
Requiring these online businesses to pay sales tax would have an immediate positive impact.
State funds coming to local school systems and for local paving have dried up. Seeing that the dot-coms pay their share of the sales tax provides a new source of state revenue, which might save a teacher's job and help keep our county property taxes down.
Differing estimates say that the internet sales tax could generate between $11 billion to $23 billion a year –divided among the states based on their residents’ purchases and tax rate.
Three arguments are generally lobbed against requiring online businesses to pay:
• First it's a new tax and people don't want any new tax -- Not true. The sales tax already exists. This just makes sure everyone pays their share.
• It will be too hard for online businesses to figure out how to charge it. Again, not true. First, businesses that generate less than $1 million a year in online sales are exempt. So it will have no effect on anyone selling a bass boat on Craigslist.
And if a company can figure out how to sell more than $1 million a year online, it can figure this out.
• Finally, it's not going to be popular with the people – likely true among online shoppers. But this is a case of supporting communities and fairness.