It's off topic for my blog, but we just had insulation installed in our attic, and I wanted to record the experience before I forget. I chose to have our attic insulated to a total value of R-50 not only because that's the number that the Public Service Company recommends (see page 13), but also because I can see what is happening to the price of energy. My wife and I are at the point where our other conservation efforts have reached a plateau, so it is time to raise the bar a bit. Our last effort was in February when we killed all of the vampires that we had plugged in.
WHAT WE ALREADY HAD
Our house was built in 1925, and it already had four or five inches of vermiculite as insulation. So, since vermiculite is rated R-2.1 per inch, I had at least (2.1 * 4) = R-8.4 already in place. Since it is VERY old, I used R-6 for my calculations. Thus, I needed (50 - 6) = R-44 added to what was already in our attic. When the installer came to put the new insulation in, he looked at what was already in place and said it was probably more like R-11.
MATERIAL
I wanted cellulose insulation rather than fiberglass for two reasons: Cellulose is basically recycled newspaper treated for fire and insect resistance, and is thus "greener" (ick, I'm getting to dislike the way that word is being used); and also, I hate those little glass pieces that float around and make you itch when you deal with fiberglass. The more I read, I believe that for our climate here in Denver, Colorado, cellulose was the very best choice for the attic of our house.
I also like its fire rating. Indeed, I took a handful of the cellulose that was installed from my attic and tried to light it with a butane lighter; even when I held the flame in one place for 15 or 20 seconds, it just turned black where the flame was held, and then as soon as the flame was removed, it stopped turning black and could be immediately touched and picked up. Quite amazing, and it put me totally at ease about fire caused by cellulose insulation.
A PROBLEM
Official websites like Greenprint Denver are consistent in saying Cellulose is R-3.1 per inch. This makes it REALLY easy for the consumer; if I want R-44, I simply divide 44 by 3.1 and know that 14.2 inches of cellulose are needed. BUT, the insulation industry charges by the R-value per square foot, so guess what? They don't talk the same language, theirs is MUCH more difficult to deal with, AND they pretend to not understand the Greenprint Denver method even though they are listed as being a part of the Greenprint insulation retro-fit program.
I pressed them, and they fussed and fumed and looked at one of the little paper rulers that they use, and they FINALLY said that they would be installing 12 inches of cellulose. I wanted the full 14.2 inches, and when I grumped with the salesperson, he pleaded total ignorance, and said that he was just "going by the chart."
THE CALCULATION
So, you have to do your own arithmetic, and then translate it into THEIR language. When you really boil it down, they just need to know the number of bags of cellulose that they have to install. So, I know that our house is 1100 square feet, and I found that each 28 pound bag of cellulose will cover 0.00123 square feet per R-value. Thus, I need (0.00123 * 1100 * 44) = 59 twenty-eight pound bags of cellulose installed in order to add an additional R-44 rating for all 1100 square feet of our house.
Cellulose settles over time, and the settling reduces the R-value, so I added ten percent and came up with (59 * 1.1) = 64 bags. (They still charge by the R-value per square foot, but we agreed that 64 bags would be installed in our house.)
THERE'S ALWAYS SOMETHING ELSE
There are other costs involved: Air sealing and recessed lighting fixture encapsulation both add to the project cost.
A VERY knowledgeable fellow who REALLY believes in insulation and in the homeowner knowing what is going on, came out to look the job over the day before the insulation was to be installed. He was also going to do the air sealing and recessed lighting fixture encapsulation. The cost was going to be between $400 and $600 for the air sealing, and $40 for each of the eight recessed lights that we have in our kitchen, thus an ADDITIONAL $720 to $920 ABOVE the cost of the cellulose insulation. However, as I talked to him, he explained exactly how it is done, and I decided that I could do my own sealing and encapsulation, so he inspected the job and left without charging anything.
SEALING AND RECESSED LIGHT ENCAPSULATION
I went to Home Depot, and bought twelve cans of foam insulation called "Great Stuff, " for $5.75 each, along with metal buckets for $7.99 each that are large enough to easily cover each recessed light with room to spare - the buckets were three or four gallon size. Total cost: $130.00.
I then went crazy in my attic putting a bunch of foam around EVERY electrical box that penetrated the ceiling for things like ceiling light fixtures, foam around EVERY electrical pipe or wire where it penetrated the ceiling, foam around EVERY plumbing vent pipe, and foam along EVERY break along the inside bearing walls of the house.
My furnace vent pipe does NOT go through the attic; I would have had the insulation contractor deal with the furnace vent if I had one however, since the Great Stuff foam is only rated to 240 degrees Fahrenheit.
NOTE: Wear gloves; I didn't, and Great Stuff has to WEAR off your hands; it doesn't wash off and doesn't come off with mineral spirits or gasoline at all.
I even foamed knot holes, and a few little seams that I found here and there. I'll bet I got more air leaks than the company would have done, since I REALLY dug around. I was AMAZED at how many paths for air leakage I found.
Finally, I gently placed one of the buckets over each of the eight recessed light fixtures. They were just the right size, they didn't touch the recessed light fixture "can" or electrical connection box at all, and had two or three inches to spare inside all the way around and at the top. Because of the wiring, the buckets were not down tight; depending on how the wiring was installed, one edge of each bucket kind of tilted up a few inches. Then I used foam to actually create the seal all around the edge of the bucket. Where the bucket tipped up, I just used foam to fill in the gap. I was VERY careful to kind of shoot the foam down the outside edge of the bucket and NOT UNDER the bucket; I didn't want the foam to get too near the recessed light fixture itself. But, when I was all done, I had a large foam barrier around the bottom of the bucket that covered each light, but NO foam on the bucket itself except for a few inches around the bottom.
IMPORTANT NOTE: My recessed lighting fixtures are all "IC" rated. The IC means "Insulation Contact," which basically means that actually the extra metal buckets are not needed at all, it is safe for insulation to touch the lighting fixture. HOWEVER, the fellow that came to my house said that he always liked to do the bucket, because it makes a really tight seal, and it is extra safe (and it is an extra $40 each for the insulation company). If my recessed lights had NOT been IC rated, I would have had him do the recessed light encapsulation; I am very "fire conscious" and don't want to take ANY chances.
COST
In the end, they charged us $0.88 per square foot to add an additional R-44 rating to what we already had, which came out to (0.88 * 1100) = $968.00. We were able to take advantage of the Greenprint Denver rebate program, so we get a twenty percent rebate back on what the contractor charged (there is NO rebate on the costs for things that I did) so when the rebate check comes (in six to eight weeks) the job will have cost us (130.00 + (968.00 * ((100-20)/100))) = $904.40.
I should note that if I had purchased bats of insulation from Home Depot and installed them myself, we would have paid MORE and, because blown-in insulation is the best for retro-fitting attics, because of the gaps between the long edges of the bats, we would have gotten a MUCH worse R-rating had we used bats.
SUGGESTION
When they came to do the installation, I told them that I wanted all of the empty insulation bags. Before I paid them, my sweet wife counted them just to make sure that we were getting the correct amount of insulation.
CONCLUSION
I have always thought that we needed more insulation in this house. I am very happy that we did this; I got my quotes on a Tuesday, and because it's summer and things are slow, the insulation was installed three days later, on Friday. I also believe that with out of control inflation right now and energy costs going up a bunch this fall, demand for new insulation will be very high later in the year, and prices will be going up.
Also, because our roof slopes; the existing vermiculite is deeper than I used for my calculations; I added an extra ten percent to my calculations for how much new insulation is needed; the 1100 square foot number that I used was an EXTERNAL number and our walls are actually three layers of brick so the internal square footage is less; and because I was so fussy with the insulation installation company, we ended up with a higher R-value.
I measured in seven places throughout the attic, and we actually ended up with 16 inches of additional installation being added which, when added to the already existing vermiculite might be giving us an R-value of as much as ((16 * 3.1) + 11) = R-60.6.
WHO WE USED
In order to get the rebate, you have to use one of the Greenprint Denver-approved insulation installers. We used Bestway Insulation (303-469-0808). Their price was competitive (actually the same as or very close to the same as) the others I checked, and they seemed to be small, friendly, willing to let me fuss, and had a slot available to do the installation on Friday.
Our only complaint with Bestway was that the person that calls to tell you what is going on is not very good; we had to call several times because we would be told "they will be there at 9:00." Then 10:00 would come and we would call and she would say "they are just finishing another job, they will be there in a few minutes." Then at 1:00 they showed up and she hadn't called us at all. However, I still believe that we chose the right vendor; the installers really knew their job, and when I looked at it, they did GREAT; it was level and even, the edges had a bit more piled up, it was neat, and they cleaned up and vacuumed when they were done.
Saturday, June 28, 2008
Thursday, May 8, 2008
This Would Be The Perfect Medical Product, If Only You Had the Disease; But Buy It Anyway
A MOST DISTURBING VISIT TO A DOCTOR
My dentist has done something that made me feel unsettled. I went in for my twice-a-year cleaning and checkup, and just when the hygienist finished my cleaning, she launched in to what kind of sounded like a commercial about a method of detecting Oral Cancer, called ViziLite Plus. She added that it cost $65.00, and that my dental insurance wouldn't pay for it.
Then the dentist came in and while he was washing his hands before he looked at my mouth, he launched in to a pitch for good-ol' ViziLite Plus; he mentioned that it costs $65.00, and that my dental insurance wouldn't pay for it.
I said that he hadn't even looked at my mouth to see if there were any problems yet. He then proceeded to look in my mouth and under my tongue (much more thoroughly than anyone had EVER looked before) and said that he didn't see any problems.
I then said that I do not have dental insurance, but anyway I did not want ViziLite Plus. He then told the hygienist that I needed to "sign the form."
She took me out to the waiting area and handed me a six paragraph form, pointed at the bottom and said "Sign there where it says "No" to the VisiLite treatment." I was actually feeling kind of pressured about this whole thing, didn't take time to read its six paragraphs, and I stupidly signed and didn't even demand a copy of what I was signing. Sigh.
I began to feel more and more uncomfortable about this, and a few days later I called back and asked that they send me a copy of the form I had signed, which they did.
THE PROBLEM
I have been trying to analyze just why I feel distressed about this event, and here is what I have come up with:
1) The doctor and the hygienist were NOT saying that I SHOULD have this test for Oral Cancer, they were ASKING me if I wanted it. I considered the issue as charitably as possible, and thought "Well, they were just telling me about a new product and giving me a choice; choices are good, aren't they?" But, as I thought further about it, I am paying what for me is quite a lot of money for the DOCTOR to tell ME what should be done. I had absolutely no idea of whether or not I should have an expensive Oral Cancer screening. There are quite a few optional medical tests that I would like to have done (a full-body MRI for example), but that I can't really justify unless there is actually a medical reason.
2) For cancer screenings there are three criteria that should be used to decide whether or not a test should be done:
3) Why on earth would they coerce me into signing a document stating that I do NOT want this test? There are tens of thousands of medical tests; are we going to be asked to sign a piece of paper that we don't want each and every one? Can you get Carpel Tunnel Syndrome from signing ten thousand pieces of paper?
4) What if I actually get Oral Cancer? Years later would my health insurer use that piece of paper against me to refuse treatment? They certainly use every other excuse that they can come up with. How scary is that thought?
Anyway, I did what anyone does when they are stressing about something these days, I researched the matter on Google. I can now see EXACTLY WHY dental insurance does NOT pay for ViziLite Plus tests.
WHAT I LEARNED
The form that the doctor made me sign said right near the top in BOLD letters, "One American dies every hour from oral cancer." WOW, that sounds bad, doesn't it? This is terrible!! I want the ViziLite Plus test right now, no matter what it costs, don't I? Well, don't I???!!!
Hmmmm...One American dies every hour. That would be (24*365) = 8760 deaths per year from Oral Cancer.
This does not agree with the National Cancer Institute which says "Estimated new cases and deaths from oral cancer in the United States in 2008: New cases: 22,900. Deaths: 5,390."
Americans are notoriously bad at arithmetic, so let's see if we should tremble with fear about Oral Cancer:
The National Cancer Institute does not list Oral Cancer as one of the "Common Cancers." They say, "To qualify as a common cancer, the estimated annual incidence for 2008 had to be 35,000 cases or more."
The population of the United States is about 302 million, so there is a ((5390/302,000,000)*100) = 0.00178 percent chance of anyone in the US dying from Oral Cancer. To put it another way, the chance of dying from Oral Cancer in the US is 1 in 56,029.
However, that's not all. The National Cancer Institute goes on to say, "Tobacco use (cigarettes, pipes, cigars, and smokeless tobacco) is responsible for most cases of oral cancer. Alcohol, particularly beer and hard liquor, are associated with an increased risk of developing oral cancer."
I neither smoke nor drink. The National Cancer Institute does NOT define what "most" means, but ViziLite's web site states that "27% of oral cancer victims do not use tobacco or alcohol and have no other lifestyle risk factors." Thus, (5390 * 0.27) = 1455 deaths from Oral Cancer in non-smoker/drinkers each year. This changes my probability of death to be ((1455/302000000)*100) = 0.0004818 percent, or 1 in 207,560 each year.
The form also says "This enhanced examination is recognized by the American Dental Association code revision committee as CDT-2007/08 procedure D0431..." Well, it has a code, but I'll bet that the doctor picking his nose and charging you five dollars for it has a code; I've seen hospital bills and their millions of codes, so I don't know why having a code helps me make a decision. I looked up code D0431, and it is a very generic category into which VisiLite thinks that they fit: "D0431 - Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignant and maliganant lesions..." ViziLite Plus by itself is not in any way "recognized by the ADA code revision committee."
Dental Blogs.com reports that Vizilite has been denied the ADA seal of approval.
In an article in the Los Angeles Times, Dr. Valerie Ulene, a board-certified specialist in preventive medicine practicing in Los Angeles stated "The American Dental Assn. doesn't endorse ViziLite as a screening test for oral cancer."
ViziLite Plus seems to be quite profitable for the dentist. ViziLite's web site reports that "...The MSRP of one ViziLite examination ranges from $19.95/unit to $29.95/unit depending upon the volume purchased..." So, at the worst, the profit is ($65.00-$29.95) = $35.05 for each test. I estimate that the two hygienists that work at my dentist's office deal with a total of at least six patients each per day, so that means (2*6*5) = 60 patients per week, for 50 weeks per year which would be (50*60) = 3000 patients per year. My dentist wants to give the ViziLite Plus test to each patient once each year, and I will assume that the 3000 patients come in twice per year, so the potential PROFIT would be at least ((3000/2) * $35.05) = $52,575.00; all for a test that takes less than four minutes!
ViziLite's web site also reports that ViziLite "may etch" hybrid acrylics. "Make certain that any acrylic-based prosthetic is removed. If it is 'fixed', as in the case of an implant- borne denture, have the patient rinse for a maximum of 30 seconds." EEEK!!! It etches my brand new hugely expensive implant! Why would they give me something that does that if I don't REALLY REALLY need it!!!!
PERSPECTIVE
I then looked for some context to put Oral Cancer risk into perspective. The National Safety Council states the odds of dying EACH YEAR:
For me, sixty five dollars is a lot, and there are many many kinds of cancer; I certainly can't afford that much to test for each and every one.
Indeed, my chances are reduced even more because many many people with bad health habits don't go to the dentist EVERY six months, WITHOUT FAIL EVER, for fifty some odd years as I have done. And yet, this dentist is risking losing a visit for cleaning and check-up from me and my wife every six months each and every year (that would be a total of four visits per year at $125.00 * 4 = $500 total per year), not to mention the occasional crown or cavity repair, all for an unnecessary $65.00 scam - now I would call THAT high risk behavior indeed.
WHAT I WANT
I want to be able to trust my doctor and dentist COMPLETELY. I want them to prescribe tests or treatments only when they are MEDICALLY indicated. I do not want to feel like I have to be suspicious or wonder about the motives of ANYTHING that they tell me. I don't want them to ASK ME if I need a test. I want them to realize that medical care is extremely expensive, and I do not EVER want to feel cheated by a doctor or dentist. I want to not be sad about learning bad facts about the way my doctor or dentist do business.
CONCLUSION
This is NOT a common cancer, and I do not do the activities that "most" of the people that get it do. The probability of me getting Oral Cancer is EXTREMELY small. It would have been nice for the dentist to mention this.
The medical business in the United States appears to me to want us to live our entire lives in constant fear, and they do not provide information in any kind of context that allows us to make informed, rational decisions. They seem to be starting to use their medical knowledge and the huge power of advertising AGAINST us.
We are BOMBARDED with constant advertising of drugs and other medical products in the media, and now they are apparently extending their reach even into the offices of pliable or unethical doctors. This just totally destroys my trust in doctors, and I have always wanted to be very trusting of doctors, since I know nothing about medicine.
I believe that the medical business RELIES on the fact that Americans are bad at arithmetic, and either won't analyze their fear mongering, or won't understand it if someone else analyzes it.
It is my opinion that the marketing of ViziLite Plus to me this way is wrong. Tests like these are being used to line the pockets of doctors and medical companies and relieve suckers of what little money they have left after the health insurance shakedowns. The test would cost me $65.00 and there is NO demonstrated need for me or indeed EVERY patient to get. Perhaps if one has lots of money, and if someone is a high risk - smoke, drink, have a family history of Oral Cancer, or whatever, there might be some justification, but in my judgment, the number of lives saved by this product will be very very tiny.
ACTION ITEM
A new dentist for my wife and I. Again. Sigh.
FINAL THOUGHTS
Trust in government - gone; hiding behind a bush.
Trust in telecommunication companies - gone with the slammers in the 1990's.
Trust in banks - gone, way too many fee and fine stings.
Trust in insurance companies - Long gone.
Trust in doctors and dentists - Very very sadly, gone.
The movie Vacation with Chevy Chase had a scene where he had wrecked his car out in the boonies, and he had it fixed by a shifty mechanic:
Clark: How much do I owe you?
Mechanic: How much you got?
Clark: No, I'm asking how much the repairs are.
Mechanic: I'm asking how much you got!
Clark: You're out of your mind. Look, I don't have time to fool around so how much is it?
Mechanic: All of it, boy!
That's the medical insurance and doctor industry in a nutshell in the United States today; they want "All of it, boy!", and they mean it.
The United States needs to re-think its approach to medicine; what is happening now stinks.
My dentist has done something that made me feel unsettled. I went in for my twice-a-year cleaning and checkup, and just when the hygienist finished my cleaning, she launched in to what kind of sounded like a commercial about a method of detecting Oral Cancer, called ViziLite Plus. She added that it cost $65.00, and that my dental insurance wouldn't pay for it.
Then the dentist came in and while he was washing his hands before he looked at my mouth, he launched in to a pitch for good-ol' ViziLite Plus; he mentioned that it costs $65.00, and that my dental insurance wouldn't pay for it.
I said that he hadn't even looked at my mouth to see if there were any problems yet. He then proceeded to look in my mouth and under my tongue (much more thoroughly than anyone had EVER looked before) and said that he didn't see any problems.
I then said that I do not have dental insurance, but anyway I did not want ViziLite Plus. He then told the hygienist that I needed to "sign the form."
She took me out to the waiting area and handed me a six paragraph form, pointed at the bottom and said "Sign there where it says "No" to the VisiLite treatment." I was actually feeling kind of pressured about this whole thing, didn't take time to read its six paragraphs, and I stupidly signed and didn't even demand a copy of what I was signing. Sigh.
I began to feel more and more uncomfortable about this, and a few days later I called back and asked that they send me a copy of the form I had signed, which they did.
THE PROBLEM
I have been trying to analyze just why I feel distressed about this event, and here is what I have come up with:
1) The doctor and the hygienist were NOT saying that I SHOULD have this test for Oral Cancer, they were ASKING me if I wanted it. I considered the issue as charitably as possible, and thought "Well, they were just telling me about a new product and giving me a choice; choices are good, aren't they?" But, as I thought further about it, I am paying what for me is quite a lot of money for the DOCTOR to tell ME what should be done. I had absolutely no idea of whether or not I should have an expensive Oral Cancer screening. There are quite a few optional medical tests that I would like to have done (a full-body MRI for example), but that I can't really justify unless there is actually a medical reason.
2) For cancer screenings there are three criteria that should be used to decide whether or not a test should be done:
- First is like a colonoscopy where they say "Since this type of cancer is quite common, past the age of 50 you should have one of these tests every five years,"or whatever.
- Second is where the doctor says "I see something not right, we should do this test to see if this is something that needs treatment."
- Third is if your parent had something, your grandparent had something, and there is a high probability that you could have it as well.
3) Why on earth would they coerce me into signing a document stating that I do NOT want this test? There are tens of thousands of medical tests; are we going to be asked to sign a piece of paper that we don't want each and every one? Can you get Carpel Tunnel Syndrome from signing ten thousand pieces of paper?
4) What if I actually get Oral Cancer? Years later would my health insurer use that piece of paper against me to refuse treatment? They certainly use every other excuse that they can come up with. How scary is that thought?
Anyway, I did what anyone does when they are stressing about something these days, I researched the matter on Google. I can now see EXACTLY WHY dental insurance does NOT pay for ViziLite Plus tests.
WHAT I LEARNED
The form that the doctor made me sign said right near the top in BOLD letters, "One American dies every hour from oral cancer." WOW, that sounds bad, doesn't it? This is terrible!! I want the ViziLite Plus test right now, no matter what it costs, don't I? Well, don't I???!!!
Hmmmm...One American dies every hour. That would be (24*365) = 8760 deaths per year from Oral Cancer.
This does not agree with the National Cancer Institute which says "Estimated new cases and deaths from oral cancer in the United States in 2008: New cases: 22,900. Deaths: 5,390."
Americans are notoriously bad at arithmetic, so let's see if we should tremble with fear about Oral Cancer:
The National Cancer Institute does not list Oral Cancer as one of the "Common Cancers." They say, "To qualify as a common cancer, the estimated annual incidence for 2008 had to be 35,000 cases or more."
The population of the United States is about 302 million, so there is a ((5390/302,000,000)*100) = 0.00178 percent chance of anyone in the US dying from Oral Cancer. To put it another way, the chance of dying from Oral Cancer in the US is 1 in 56,029.
However, that's not all. The National Cancer Institute goes on to say, "Tobacco use (cigarettes, pipes, cigars, and smokeless tobacco) is responsible for most cases of oral cancer. Alcohol, particularly beer and hard liquor, are associated with an increased risk of developing oral cancer."
I neither smoke nor drink. The National Cancer Institute does NOT define what "most" means, but ViziLite's web site states that "27% of oral cancer victims do not use tobacco or alcohol and have no other lifestyle risk factors." Thus, (5390 * 0.27) = 1455 deaths from Oral Cancer in non-smoker/drinkers each year. This changes my probability of death to be ((1455/302000000)*100) = 0.0004818 percent, or 1 in 207,560 each year.
The form also says "This enhanced examination is recognized by the American Dental Association code revision committee as CDT-2007/08 procedure D0431..." Well, it has a code, but I'll bet that the doctor picking his nose and charging you five dollars for it has a code; I've seen hospital bills and their millions of codes, so I don't know why having a code helps me make a decision. I looked up code D0431, and it is a very generic category into which VisiLite thinks that they fit: "D0431 - Adjunctive pre-diagnostic test that aids in detection of mucosal abnormalities including premalignant and maliganant lesions..." ViziLite Plus by itself is not in any way "recognized by the ADA code revision committee."
Dental Blogs.com reports that Vizilite has been denied the ADA seal of approval.
In an article in the Los Angeles Times, Dr. Valerie Ulene, a board-certified specialist in preventive medicine practicing in Los Angeles stated "The American Dental Assn. doesn't endorse ViziLite as a screening test for oral cancer."
ViziLite Plus seems to be quite profitable for the dentist. ViziLite's web site reports that "...The MSRP of one ViziLite examination ranges from $19.95/unit to $29.95/unit depending upon the volume purchased..." So, at the worst, the profit is ($65.00-$29.95) = $35.05 for each test. I estimate that the two hygienists that work at my dentist's office deal with a total of at least six patients each per day, so that means (2*6*5) = 60 patients per week, for 50 weeks per year which would be (50*60) = 3000 patients per year. My dentist wants to give the ViziLite Plus test to each patient once each year, and I will assume that the 3000 patients come in twice per year, so the potential PROFIT would be at least ((3000/2) * $35.05) = $52,575.00; all for a test that takes less than four minutes!
ViziLite's web site also reports that ViziLite "may etch" hybrid acrylics. "Make certain that any acrylic-based prosthetic is removed. If it is 'fixed', as in the case of an implant- borne denture, have the patient rinse for a maximum of 30 seconds." EEEK!!! It etches my brand new hugely expensive implant! Why would they give me something that does that if I don't REALLY REALLY need it!!!!
PERSPECTIVE
I then looked for some context to put Oral Cancer risk into perspective. The National Safety Council states the odds of dying EACH YEAR:
- Pedestrian - 1 in 49,139 (And yet I walk a lot - outside!!!)
- Fall on and from stairs and steps - 1 in 179,278 (I go up and down stairs often!)
- Car Occupant - 1 in 19,216 (Gasp, and I drive quite a bit as well!)
- Bitten by a Dog - 1 in 139,617 (I'm safe, we have a cat.)
- Complications of medical and surgical care - 1 in 101,858
- Odds of being considered possessed by Satan - 1 in 7,000 (OK, I got this statistic from http://www.med-help.net/real-mrsa-odds.html, but still...)
For me, sixty five dollars is a lot, and there are many many kinds of cancer; I certainly can't afford that much to test for each and every one.
Indeed, my chances are reduced even more because many many people with bad health habits don't go to the dentist EVERY six months, WITHOUT FAIL EVER, for fifty some odd years as I have done. And yet, this dentist is risking losing a visit for cleaning and check-up from me and my wife every six months each and every year (that would be a total of four visits per year at $125.00 * 4 = $500 total per year), not to mention the occasional crown or cavity repair, all for an unnecessary $65.00 scam - now I would call THAT high risk behavior indeed.
WHAT I WANT
I want to be able to trust my doctor and dentist COMPLETELY. I want them to prescribe tests or treatments only when they are MEDICALLY indicated. I do not want to feel like I have to be suspicious or wonder about the motives of ANYTHING that they tell me. I don't want them to ASK ME if I need a test. I want them to realize that medical care is extremely expensive, and I do not EVER want to feel cheated by a doctor or dentist. I want to not be sad about learning bad facts about the way my doctor or dentist do business.
CONCLUSION
This is NOT a common cancer, and I do not do the activities that "most" of the people that get it do. The probability of me getting Oral Cancer is EXTREMELY small. It would have been nice for the dentist to mention this.
The medical business in the United States appears to me to want us to live our entire lives in constant fear, and they do not provide information in any kind of context that allows us to make informed, rational decisions. They seem to be starting to use their medical knowledge and the huge power of advertising AGAINST us.
We are BOMBARDED with constant advertising of drugs and other medical products in the media, and now they are apparently extending their reach even into the offices of pliable or unethical doctors. This just totally destroys my trust in doctors, and I have always wanted to be very trusting of doctors, since I know nothing about medicine.
I believe that the medical business RELIES on the fact that Americans are bad at arithmetic, and either won't analyze their fear mongering, or won't understand it if someone else analyzes it.
It is my opinion that the marketing of ViziLite Plus to me this way is wrong. Tests like these are being used to line the pockets of doctors and medical companies and relieve suckers of what little money they have left after the health insurance shakedowns. The test would cost me $65.00 and there is NO demonstrated need for me or indeed EVERY patient to get. Perhaps if one has lots of money, and if someone is a high risk - smoke, drink, have a family history of Oral Cancer, or whatever, there might be some justification, but in my judgment, the number of lives saved by this product will be very very tiny.
ACTION ITEM
A new dentist for my wife and I. Again. Sigh.
FINAL THOUGHTS
Trust in government - gone; hiding behind a bush.
Trust in telecommunication companies - gone with the slammers in the 1990's.
Trust in banks - gone, way too many fee and fine stings.
Trust in insurance companies - Long gone.
Trust in doctors and dentists - Very very sadly, gone.
The movie Vacation with Chevy Chase had a scene where he had wrecked his car out in the boonies, and he had it fixed by a shifty mechanic:
Clark: How much do I owe you?
Mechanic: How much you got?
Clark: No, I'm asking how much the repairs are.
Mechanic: I'm asking how much you got!
Clark: You're out of your mind. Look, I don't have time to fool around so how much is it?
Mechanic: All of it, boy!
That's the medical insurance and doctor industry in a nutshell in the United States today; they want "All of it, boy!", and they mean it.
The United States needs to re-think its approach to medicine; what is happening now stinks.
Friday, April 4, 2008
The Tag Team
I call my most recent medical sting The Tag Team. One of my crowns broke off and I went in to my dentist. He said that, although he could fix it, it probably would not last very long, and for the best results, I should have the stub to which the crown is glued extended. He said that he could not do this, and that I would need to go to a periodontist. He said that after the periodontist did his work, I would come back in to get the crown done. I have had several crowns done and at least one that needed to be fixed, and they seem to cost a bit more than $700 dollars each.
I made a rational, informed decision that I wanted the more permanent fix, and I went in to see the periodontist. He said that he could do the stub extension, but that I might want to consider an implant, which is basically a screw that goes into the bone with a post that eventually supports the crown. He told me EXACTLY what this would cost. He said that after the implant was all healed, I would go back to my own dentist for the crown.
I made a rational, informed decision to have the implant. It was quite expensive, but I decided it would be worth it for me, and at least I knew EXACTLY what it would cost me. So far, so good. I believed that I was making the choice that I wanted for my own care. What he quoted me was indeed EXACTLY what he charged me.
At some point during this whole implant procedure (it takes around six months), I even went in to my dentist for a cleaning, and we discussed how the implant process was going, and that I would make an appointment for the new crown as soon as the periodontist said it was time.
When the implant healed, I went back in to my dentist, and he took impressions for the crown and when it came in, he installed it. I like the result.
THE STING: I got a bit of a sticker shock when the bill for the crown came a few days after it was installed. It was almost $1000 MORE than the usual price that I have paid for a crown or a crown repair. The reason? Well, I'm not sure. What I am sure of is that I was NEVER told that the price of gluing a piece of porcelain on to a metal post is $1000 more than gluing the same piece of porcelain on to the stub of a tooth. Surprise!
And consider, how would I have resolved this? It turns out that the cost of the crown is dependent on what kind of implant the periodontist uses; my dentist had never done one of the brand that the periodontist used, so he probably didn't even know himself. Indeed, when I went in to get measured for the new crown, there were two marketing-types hovering around my dentist showing him how to take the impression. I just didn't know enough to realize that there are crowns and crowns, and they are not the same. They preyed on my ignorance.
I made a rational, informed decision that I wanted the more permanent fix, and I went in to see the periodontist. He said that he could do the stub extension, but that I might want to consider an implant, which is basically a screw that goes into the bone with a post that eventually supports the crown. He told me EXACTLY what this would cost. He said that after the implant was all healed, I would go back to my own dentist for the crown.
I made a rational, informed decision to have the implant. It was quite expensive, but I decided it would be worth it for me, and at least I knew EXACTLY what it would cost me. So far, so good. I believed that I was making the choice that I wanted for my own care. What he quoted me was indeed EXACTLY what he charged me.
At some point during this whole implant procedure (it takes around six months), I even went in to my dentist for a cleaning, and we discussed how the implant process was going, and that I would make an appointment for the new crown as soon as the periodontist said it was time.
When the implant healed, I went back in to my dentist, and he took impressions for the crown and when it came in, he installed it. I like the result.
THE STING: I got a bit of a sticker shock when the bill for the crown came a few days after it was installed. It was almost $1000 MORE than the usual price that I have paid for a crown or a crown repair. The reason? Well, I'm not sure. What I am sure of is that I was NEVER told that the price of gluing a piece of porcelain on to a metal post is $1000 more than gluing the same piece of porcelain on to the stub of a tooth. Surprise!
And consider, how would I have resolved this? It turns out that the cost of the crown is dependent on what kind of implant the periodontist uses; my dentist had never done one of the brand that the periodontist used, so he probably didn't even know himself. Indeed, when I went in to get measured for the new crown, there were two marketing-types hovering around my dentist showing him how to take the impression. I just didn't know enough to realize that there are crowns and crowns, and they are not the same. They preyed on my ignorance.
The Way of the Capitalist
When someone offers a product I want or need at a price that I am willing to pay, that is called capitalism. That is, the seller makes a decision on what product he wants to sell and at what price, and I make an informed, rational decision to purchase that product. If I don't like the price or the policies of the seller, then I can simply walk away and attempt to find a product elsewhere.
For quite a number of years, I have observed that a great deal of effort in the medical industry is going toward destroying the ability for consumers to spend their money in an informed and rational way.
Let me make a couple of definitions of things that are not illegal, but that are being used to extract money from people wanting to purchase medical items or care without their informed consent:
I think that a good example of a sting is my Qwest telephone bill. In their ads and when I call to ask the price, my telephone line costs $14.88 per month. But, when the bill comes, the price is $26.15 per month, an $11.27 difference. The taxes are $2.89 of this difference, and the rest are stings like: "City Occupation" fee, "facility relocation cost recovery" fee, "federal access" charge, etc.
I believe that Comcast Cable TV is another sting, and indeed, it borders on a scam. They advertise a $33 per month price that sounds pretty good. But, unless you absolutely know what questions to ask, when the bill comes you are charged a monthly fee extra for a digital converter, a monthly fee extra for a remote control, etc. In addition, the $33 per month is a short-term come-on price, and very soon, the real price kicks in; however, in their ads, even the real price WITHOUT the converter, remote, and other extras is mentioned in the middle of a very large paragraph of type printed over a multi-color background in a type size that my old eyes just can't read. For my part, if I could make a rational, informed decision, I might decide that Comcast's product is worth it and subscribe, but the way they do it, I am completely unable to get a straight answer from them as to just exactly what the full monthly cost of their product will be, so I forget it.
For quite a number of years, I have observed that a great deal of effort in the medical industry is going toward destroying the ability for consumers to spend their money in an informed and rational way.
Let me make a couple of definitions of things that are not illegal, but that are being used to extract money from people wanting to purchase medical items or care without their informed consent:
- SCAM - A scam is where you make someone believe that they are getting something that they are not. In my opinion, an example of a scam is Proactiv, a widely advertised range of quite expensive skin care products. These are advertised quite expertly as though they have some sort of magical powers of skin care. When I researched the active ingredients, I found that they indeed use chemicals that are commonly found to be effective. However, products with exactly the same ingredients are cheaply available from Rite-Aid and Walgreens. Indeed, Rite-Aid offers their own brand of products with a HIGHER percentage of the active ingredients (10% vs 2%) at about one fifth of the price. To further the scam, if you order from their 1-800 number using a credit card, WITHOUT TELLING YOU they automatically send you more product each month and, of course, bill your credit card each month. They make it REALLY hard to stop this automatic monthly subscription.
- STING - A sting is where you offer a product at one price, but when the bill actually comes, you are charged a slightly higher price. The difference is usually not enough for you to make a big stink about, but when you think about the total amount extra that is being extracted from hundreds, thousands, or perhaps even millions of consumers, it is not a good thing. I'm not talking about taxes here, but "other" charges.
I think that a good example of a sting is my Qwest telephone bill. In their ads and when I call to ask the price, my telephone line costs $14.88 per month. But, when the bill comes, the price is $26.15 per month, an $11.27 difference. The taxes are $2.89 of this difference, and the rest are stings like: "City Occupation" fee, "facility relocation cost recovery" fee, "federal access" charge, etc.
I believe that Comcast Cable TV is another sting, and indeed, it borders on a scam. They advertise a $33 per month price that sounds pretty good. But, unless you absolutely know what questions to ask, when the bill comes you are charged a monthly fee extra for a digital converter, a monthly fee extra for a remote control, etc. In addition, the $33 per month is a short-term come-on price, and very soon, the real price kicks in; however, in their ads, even the real price WITHOUT the converter, remote, and other extras is mentioned in the middle of a very large paragraph of type printed over a multi-color background in a type size that my old eyes just can't read. For my part, if I could make a rational, informed decision, I might decide that Comcast's product is worth it and subscribe, but the way they do it, I am completely unable to get a straight answer from them as to just exactly what the full monthly cost of their product will be, so I forget it.
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